Eastern Health Annual Report 2009–2010
Eastern Health Annual Report 2009-10 1 Contents
4 Chair’s report 5 Chief Executive’s report 6 About us 10 Our executive team 12 Our people 20 Our community 26 Our programs and services 48 Our sites 56 Our corporate performance 70 Our governance 78 Financial statements and notes 120 Glossary
Cover photo: The annual Maroondah Hospital Fun Run held on 25 October 2009
2 Eastern Health Annual Report 2009-10 Highlights
Victorian government We provided announced more than $407.5m 134,000 funding to redevelop episodes of acute box hill hospital inpatient care
a total of a total of 4513 13,668 babies were delivered at patients were admitted Eastern health hospitals for elective surgery
reduced our waste Fundraising efforts sent to landfill by generated more than 29% $2m
A survey showed most reduction in the staff would recommend number of patients who eastern health as a waited more than 24 hours good place to work in emergency by 75% 90%
Developed our strategic plan for 2010–15
Eastern Health Annual Report 2009-10 3 Chair’s report
There has been much exciting practitioner and primary healthcare services; service to the community and reflect on how development> and change at Eastern Health implementation of new access targets for times have changed in healthcare. this past year. Perhaps the most exciting emergency and elective surgery patients; It has been particularly pleasing to work with has been the Victorian Government’s increased capacity for sub-acute beds and my Board colleagues on the development announcement of $407.5m funding to strengthening of the healthcare workforce – of Eastern Health in partnership with staff redevelop Box Hill Hospital. are certain to have direct impacts on Eastern and consumers. Key forums and committees Health. While some of these changes will Due for completion in 2015, the Box Hill such as our Board Forum for Medical Leaders, challenge our thinking and our practice, they Hospital redevelopment is the largest single Community Advisory Committee and Primary will provide opportunities to strengthen our suburban health infrastructure project in Care & Population Health Advisory Committee, organisation as a key health service provider. Victoria and will support Eastern Health in bring a range of expertise and views to bear, providing great health and wellbeing for Eastern Health people are anchored by helping us to genuinely understand the health people and communities in the east. The our values and a strategic plan that clearly issues affecting our communities and design redevelopment of emergency, surgery and states our mission: to provide positive health strategic responses. Our partnership with the critical care services will enhance inpatient experiences for people and communities community has been expressed in financial and ambulatory services and provide greater in the east. Our plan outlines five strategic terms too: in 2009-10, over $2 million was capacity to meet the community’s needs. It directions – essentially, we aim to be a generated through fundraising where patients will be supported by training, research and provider of great healthcare, provide a and their families have ‘given back’ in gratitude state-of-the-art diagnostic services, which will great patient experience, be a great place for care they received. We look forward to make Eastern Health a great destination to to learn and work, be a great partner continuing to engage with our communities learn, work and receive care. Preparations for with our communities and a great and to strengthen our fundraising with the the demolition of the Clive Ward Building are achiever in sustainability. For direction, establishment of an Eastern Health Foundation underway and a team is being mobilised to we have four specific goals against which in 2010-11. manage this exciting project. our performance will be comprehensively My first year as Chair of the Eastern Health measured and reported. Recently the Victorian Government also Board of Directors has been exciting and very announced a $3 million capital upgrade Together with our Statement of Priorities satisfying. I wish to acknowledge and thank of the Healesville and District Hospital and agreed with the Minister for Health, Eastern my colleagues on the Board, our executive Yarra Valley Community Health Service, Health’s new strategic plan will guide our management team, staff and volunteers for which is a wonderful development for our overall activity, operational and improvement their excellent contributions throughout staff and communities in the Yarra Ranges. plans and individuals’ work plans through to 2009-10. I would especially like to commend Another highlight this year is that we can now 2015. It was developed through extensive our Chief Executive, Alan Lilly, who has led the treat patients who need general medicine consultation with our staff, volunteers, organisation with tremendous enthusiasm, and geriatric evaluation/management stakeholders and members of the community. energy and commitment. as inpatients at our Healesville site. The To understand more about the Eastern Health opportunity to offer other services at the Strategic Plan 2010-15, please turn to the What Eastern Health people do is important. site is also being considered in light of the inside cover of this report or contact Eastern Eastern Health provides an extensive range capital upgrade and in consultation with the Health to request a copy of the brochure: of services to people of all ages in a wide Victorian Department of Health and the [email protected] or ph 03 9895 3243. range of settings in Melbourne’s east. It is a local community. vital part of Victoria’s health system. In spite Just as we look forward to the developments of significant change and continual growth Change and the challenges it brings are set to ahead in our health service, it’s also rewarding in demand for services, Eastern Health has continue with the developments in national to look back – the 70th anniversary of Angliss performed strongly over the past year and is health and hospital reform. Although yet to Hospital, the first anniversary of Yarra Ranges set for a great year ahead. be realised, the reform’s proposals – such Health and the forthcoming 25th anniversary as the implementation of local hospital of Peter James Centre – have given us the Dr Joanna Flynn, Chair, networks; Commonwealth auspice of general opportunity to celebrate milestones in Eastern Health Board of Directors
4 Eastern Health Annual Report 2009-10 Chief executive’s report
Expanding our capacity to provide development and encouragement of open Our commitment to research has been the> care that our communities need and communication have been, and continue underscored by the establishment of the improving our efficiency in how we deliver to be, key priorities and pivotal to our Eastern Health Office of Research, which will services are central to our mission of success. An independent survey of 100 be led by our newly appointed Director of providing positive health experiences for senior managers throughout Eastern Health Research; the establishment of the Eastern people and communities in the east. has provided valuable understanding and Health University Academic Council, and These goals are aligned with our values, insights. Importantly, most respondents (75 capital redevelopment of education precincts particularly ‘excellence’ and ‘accountability’, as per cent) would recommend Eastern Health at Angliss and Maroondah hospitals. well as our strategic directions, as a provider to family or friends as a good place to work. We achieved a key milestone in the of great healthcare and a great patient This indicates that our staff is willing to align implementation of HealthSMART Clinicals experience. their personal brand with ours. Also positive is system, with the initial release occurring that most believe Eastern Health lives up to its With this in mind, I am pleased to report a at Box Hill Hospital in November 2009 and values, particularly compassion and integrity, range of key operational improvements in a further release to follow in August 2010. and most believe Eastern Health has a sense 2009-10, particularly in increased accessibility Ultimately, the system will support clinicians of community responsibility as part of its to our services. This has been supported in providing safer, better patient care. normal activities. by the establishment of the Eastern Health In the process of developing the Eastern Access Taskforce, which includes clinical Healthcare is a costly business and our Health Strategic Plan 2010-15, we refreshed representation from across our health service. community and stakeholders, rightly, expect the way we expressed our values. Excellence, The taskforce oversees improvement initiatives us to live within our means. Therefore, we accountability, compassion, teamwork, designed to ensure that patients receive timely have worked to enhance the financial integrity, respect and collaboration – these care. We achieved numerous improvements sustainability of our health service by qualities are what we value and how we in both elective and emergency care. Some implementing an innovative range of work. In the demonstration of these values by of these outcomes are the best in the past strategies designed to achieve millions Eastern Health staff, we want to ensure that five years. The appointment of the inaugural of dollars in financial improvement. Our people and communities in the east will have Director of Inpatient Access will increase access achievements include reduced use of nurse positive health experiences with us. further in the following year, and while we are agency staff, improved management of staff My first full year as chief executive has been driven to achieve the Victorian Government’s leave and greater utilisation of private health challenging, rewarding and highly enjoyable. targets for elective and emergency care, our insurance among admitted patients. improvements are already providing better I wish to thank the Eastern Health Board care for our patients and their families. That is During 2009-10, there have been some of Directors for its support during the past what we are here for and deeply committed exciting strategic developments in our year, particularly our chair Dr Joanna Flynn, to doing. mental health services. We amalgamated with whose wisdom and leadership are greatly Turning Point Alcohol and Drug Centre and appreciated. Also, I would especially like to Whole-of-organisation approaches such together with Monash University, appointed thank the executive team for their hard work as this allow us to harness the energy and a Professor of Addiction Studies and Services and support throughout the year and for their creativity of staff across our health service and Clinical Director of Turning Point. We commitment to positive change. and ensure the best possible services for our opened up our three acute adult mental communities. To this end, we have adopted I have had the pleasure of meeting many of health inpatient units, whereby the doors are the strategic intent of: Eastern Health in name, our staff and volunteers who are grounded unlocked most of the time, which supports in thinking and in service delivery. In February in our local communities and clear about provision of care in the least restrictive 2010, we introduced a new organisational their roles – to make people feel better. Each manner. Also, a new area designated for structure designed to optimise organisational and every one of us has an important role in women only has been established at and service performance and promote providing positive health experiences for our Maroondah Hospital’s mental health units. Eastern Health’s identity to patients, clients communities and I look forward to continuing Recently we completed a comprehensive and our local communities. this work in the year ahead. service redesign to create a new Child Youth Engagement of our staff in the design and and Family Mental Health Service for people Alan Lilly, delivery of our healthcare services, leadership up to 25 years and their families. Chief Executive
Eastern Health Annual Report 2009-10 5 6 6 Eastern Eastern Health Health Annual Annual Report Report 2009-10 2009-10 About us Great health and wellbeing
Highlights
largest geographical area of any metropolitan health service in Victoria
More than 800,000 episodes of patient care every year
Active education and research focus
we employ more than 8000 staff and volunteers
we operate from more than 25 different locations
we aspire to be great in everything we do
Eastern Eastern Health Health Annual Annual Report Report 2009-10 2009-10 7 7 About us
Eastern Health provides a comprehensive Our strategic directions range of high quality acute, sub-acute, We have five key strategic directions, which palliative care, mental health, drug and will help us to achieve our mission: alcohol, residential care and community • A provider of great healthcare health services to people and communities • A great patient experience that are diverse in culture, age, socio- • A great place to learn and work economic status, population and • A great partner with our communities healthcare needs. • A great achiever in sustainability We deliver clinical services to more than 700,000 people through seven clinical Our values programs from more than 25 different locations. Our services are located across Our values guide how we work and support 2800 square kilometres in the east – the us toward achieving our mission and goals. Manner of establishment largest geographical catchment area of any They are: metropolitan health service in Victoria. We As a public health service established under • Excellence employ more than 8000 people, deliver more section 181 of the Victorian Health Services • Accountability than 800,000 episodes of patient care each Act 1988, Eastern Health is accountable to • Compassion year and manage a budget approaching $700 the Victorian Health Minister, the Honourable • Teamwork million per year. Daniel Andrews MP. The functions of a • Integrity public health service Board of Directors are • Respect We aspire to be GREAT in everything that we outlined in the Act and include establishing, • Collaboration do. We focus extensively on continuously maintaining and monitoring the performance building a high quality healthcare system for of systems to ensure the health service meets Our sites the people we serve and through which we community needs. can also attract and retain the best staff. We operate from 25 different locations and our largest sites include: We have an active education and research Our role • Angliss Hospital focus and strong affiliations with some of • Box Hill Hospital Australia’s top universities and educational Since forming in 2000, we have played a key • Healesville and District Hospital institutions. As a progressive, responsive and role in the provision of public health services • Maroondah Hospital innovative health service, we demonstrate our in Melbourne’s eastern suburbs. • Peter James Centre commitment to excellence through external We work together with community healthcare • Turning Point Alcohol and Drug Centre accreditation with the Australian Council on providers such as general practitioners, • Wantirna Health Healthcare Standards. The standards comprise community health services and affiliated • Yarra Ranges Health customer focus, strong leadership, a culture healthcare agencies. In partnership with the • Yarra Valley Community Health of improvement, evidence of outcomes and wider community, we work with, listen to and striving for best practice. act to provide services that respond to the Our services We encourage and support consumer community’s needs. engagement and community participation Geographically we cover the municipalities of Eastern Health provides a wide range of in the provision of our healthcare services Boroondara, Knox, Manningham, Maroondah, healthcare services for the communities and work closely with our Board of Directors, Whitehorse and Yarra Ranges. of Melbourne’s east and outer-east. community advisory committee, volunteers, Our clinical services are organised in seven auxiliaries, primary care partners and clinical programs. Our mission consumer advocates to achieve this. Our mission is to provide positive health experiences for people and communities in the east.
8 Eastern Health Annual Report 2009-10 about us
Directorate Clinical Program Clinical Service Emergency and General medicine Intensive care General Medicine Emergency services Gynaecology Paediatric services (including Women & Children’s neonatology) Maternity services Cardiology (including interventional Infectious diseases cardiology) Dermatology Neurology Endocrinology Oncology, chemotherapy and Specialist Medicine radiotherapy Endoscopy services Renal medicine and dialysis Acute Health Acute Gastroenterology Respiratory medicine Haematology Rheumatology Breast surgery Plastic surgery Colorectal surgery Thoracic surgery Ear, nose & throat surgery Upper gastro-intestinal surgery Surgery General surgery Urology Ophthalmology Vascular surgery Orthopaedic surgery Adult mental health Child & adolescent mental health Mental Health, Turning Point**, Aged persons’ mental health Spectrum* Alcohol & Drugs Turning Point**, alcohol and other drugs Acute aged-care services Palliative care Acute care of the elderly Post-acute care
Aged care assessment Rehabilitation Community rehabilitation Residential aged care Complex care Specialist clinics including continence, Continuing Care cognitive dementia and memory, falls and balance, movement disorders, rapid outreach and response and Mental Health Geriatric evaluation, management Sub-acute ambulatory care
Continuing Care, Community Community Care, Continuing and rehabilitation Hospital admission-risk program Transition care Home-based rehabilitation Allied health Aboriginal health Community Health Community support Primary care Health promotion
*statewide **statewide and national
Eastern Health Annual Report 2009-10 9 > Our executive team
Alan Lilly Janet Compton Dr Colin Feekery Neth Hinton Peter Hutchinson Chief Executive Executive Director, Executive Director Executive Director Executive Director April 2009 – current Acute health – Medical Services – Continuing Care, – Finance, & Research Community & Procurement & Mental Health Information Services Chief Medical Officer Previously Alan held Janet Compton, who Chief Allied Chief Finance Officer executive and senior began with Eastern Health Officer management positions Health in 2006, was In July 2008, Dr Colin at both Alfred Health previously General Feekery was appointed Peter has held a variety Neth joined Eastern and Southern Health. He Manager of Peter James Chief Medical Officer. of roles in the public Health in February has extensive experience Centre and Wantirna Previously he held health system over 2010 and has wide in the management Health. Previously she senior medical and 20 years. Since 2000, experience in managing and development of was CEO at Calvary management positions he has been Eastern sub-acute inpatient acute, sub-acute, mental Health Care Bethlehem at the Royal Children’s Health’s Chief Finance services, transition health, residential and at Nepean Hospital (Melbourne) Officer and oversees a care, residential care, care, community Rehabilitation Hospital. and Western Health. number of corporate community-based health and ambulatory She has also held senior He has also worked and information services and aged services. Alan holds management roles at in paediatric private service areas. Prior persons’ mental health. undergraduate Western Health and practice. He holds to Eastern Health, Neth holds both qualifications in Alfred Health. She has a a Master of Health he worked at Austin bachelor and master mental health and Master of Public Policy, Administration and is a Health in management degrees in social work. general nursing, as as well as qualifications member of the Tweddle accounting. Previously, well as postgraduate in administration, Child and Family Centre’s he was involved with qualifications in physiotherapy and Board of Management. auditing at one of health service science. Her professional the larger chartered management and health affiliations include the accountant firms. He administration. Alan Australian Institute of holds a Bachelor of is a surveyor with the Company Directors, Commerce (Accounting, Australian Council on Institute of Public Economics) and is a Healthcare Standards Administration Australia Fellow of the Australian and a Fellow of the and Leadership Victoria. Health Services Australian Institute Financial Management of Management. Association.
10 Eastern Health Annual Report 2009-10 Zoltan Kokai David Plunkett Gayle Smith Cheryl Woollard Executive Director Executive Director Executive Director Executive Director – Corporate Projects – Nursing, – Quality, Planning – Human Resources, and Sustainability Access & Patient & Innovation Fundraising & Support Services Communication Chief Nursing & Zoltan Kokai joined midwifery Officer Gayle is an occupational Eastern Health in July therapist who holds Cheryl Woollard joined The role of Executive 2004 and previously led a Master of Business Eastern Health in Director Human Maroondah Hospital Appointed Chief Nursing Administration from October 2008. She has Resources, Fundraising and Eastern’s Health’s Officer in February RMIT University. extensive experience in and Communications is acute services. Prior to 2010, David Plunkett Previously she was leadership roles in large, currently vacant Eastern Health, Zoltan has held various senior Director of Strategy, complex organisations. held several executive management positions Planning and Service Cheryl has held global and senior roles with over eight years at Improvement for Alfred roles in international Dental Health Services Eastern Health including Health and has held companies including Victoria, the former General Manager Clinical a number of strategic Autoliv, a Fortune Inner & Eastern Health and Corporate Support, planning, major project 500 company, and Air Care Network and the dual roles of Program and service planning International. She has Alfred Health. Zoltan Director Surgical roles at both The Alfred a Master of Business is a member of the Services Box Hill Hospital and Women’s and Administration in Australian Institute and Eastern Health Children’s Health Service. Human Resources and of Management and Clinical Program Leader Industrial Relations. Surgical Services and an associate Certified Practising Accountant. Director of Ambulatory He has undergraduate Care for Box Hill Hospital. degrees in business, Previously, David held information systems senior roles at Epworth and a Master of Business Richmond and Latrobe Administration. Regional Hospital. He holds a Master of Business Administration and is a surveyor with the Australian Council on Healthcare Standards. Also, he is a fully qualified perioperative (theatre) nurse.
Eastern Health Annual Report 2009-10 11 12 Eastern Health Annual Report 2009-10 Our people A great place to learn and work
Highlights
A new organisation development framework was implemented to support staff and build a strong culture
A total of 36 team leaders and managers completed the one-year accredited Certificate IV in Frontline Management and Diploma of Management
Majority of staff surveyed recommend Eastern Health as a good place to work
EasternEastern HealthHealth AnnualAnnual ReportReport 2009-102009-10 13 our people
Working at Eastern Health
We have 8206 staff and approximately 600 volunteers employed across 25 locations from Melbourne’s inner-east, outer-east and Yarra Ranges districts. While we are a growing and diverse organisation, not only geographically, we are focused on a common mission: to provide positive health experiences for people and communities in the east. We are grounded in our local communities and clear that our purpose is to help people feel better.
We provide a range of people policies and programs that value the work-life balance of our staff, recognise our efforts, ensure our safety and wellbeing at work and enhance Libby White is the Nurse Unit Manager for the paediatric ward at Box Hill Hospital our performance. We are committed to maximising retention and work to create an its values particularly compassion (73 per for our communities and meet our strategic open, cooperative environment. cent) and integrity (72 per cent) goals, it is also important to shape the capabilities of our workforce and enhance In our organisation, we value diversity and Most of our staff work in the areas of nursing, the culture of our organisation – who we are, regularly canvas the views or our staff via medical, allied and clinical support services what we stand for and what we do. surveys and strategic planning initiatives. (such as physiotherapy, occupational Staff are involved in a range of committees, therapy, radiology and pathology). They Organisational development and which contribute to the overall direction of are complemented by corporate support, workforce planning framework Eastern Health. administrative and clerical staff. We have embarked on an interesting and During 2009-10, we conducted three exciting journey to make Eastern Health an significant organisational surveys – the ‘Have The employment experience even better place to learn and work with the Your Say’ survey, the ‘Winning Insights’ survey We realise it is important for our staff to work development of a framework that enables and the strategic planning survey. The results in an organisation that provides more than an integrated and sustainable approach to of these surveys have been used to guide just employment. While we need to achieve all aspects of the employee lifecycle and operational improvements and inform our our mission of providing high quality care strategic planning process. organisational growth. It is assisting us in
Key findings of a survey of 100 managers throughout the organisation included: • 75 per cent would recommend Eastern Workforce data Health to family or friends as a good place to work 4000 • 74 per cent feel they are valued members of Eastern Health 3000 4000 • 87 per cent say they have a clear 3000 understanding of their role 2000 • 86 per cent say they have a clear 2000 understanding of the behaviours Eastern 1000 Health requires 1000 • 76 per cent believe Eastern Health has a 0 Full0 time Part time Casual Sessional sense of community responsibility as part Full time Part time Casual Sessional of its normal activities 2007-08 2008-09 2009-10 • Most believe Eastern Health lives up to 2007-08 2008-09 2009-10
14 Eastern Health Annual Report 2009-10 2500 2500 2009-102009-10 2000 2008-09 2000 2008-09 2007-08 1500 2007-08 1500 1000 1000 500 500 0 Administrative Corporate Hospital & Medical Medical Nursing Sessional 0 & clerical support medical o cers support* clinicians Administrative Corporate Hospital & Medical Medical Nursing Sessional & clerical support medical o cers support* clinicians our people
shaping the capabilities of our people and opportunity courses are now available orientation and also why staff leave enhancing the culture of our organisation. online for all staff to complete annually • Workforce planning to ensure that we have • A three-tier reward and recognition the appropriate number of employees and Progress continues to implement the framework with guidelines for local skills to deliver our services framework with half of the priority initiatives everyday recognition and a new values • Finalisation of the leadership capability undertaken in 2009-10. Highlights include: framework, which will assist development award program • A new orientation and induction model of future leaders both in clinical and • Redesign of our performance management for new staff involving a mandatory non-clinical areas process to ensure staff receive performance online orientation program for new staff, feedback and support two-way Various management and leadership completion of mandatory training courses, performance conversation enabling development courses are offered to clinical a buddy arrangement and a welcome recognition and improvement team leaders to enhance their people event with senior executives management practices. • The initiation of entry and exit surveys to • E-learning was introduced at Eastern Health help Eastern Health to understand how In 2009-10: to facilitate delivery of mandatory training new staff feel about their employment • A total of 36 team leaders and managers courses online – emergency management; completed the one-year accredited occupational health and safety; and equal experience after completing their Certificate IV in Frontline Management and Diploma of Management courses offered through Box Hill Institute whereby participants undertook work-based projects Breakdown of our workforce – equivalent full-time staff designed to improve operational processes • More than 100 new managers and team leaders underwent two days of orientation Labour category 2007/08 2008/09 2009/10 training to enhance their management Nursing 2220.3 2287.2 2416.1 skills and understanding the internal policies and procedures relating to people Administration and Clerical 633.3 675.5 727.3 and resource management, in order to Medical Support 378.8 389.2 418.1 prepare them for their new roles Hotel and Allied Services 277.8 267.7 281.1 • 100 key managers in the organisation participated in bi-monthly senior leadership Medical Officers 72.8 89.2 100.2 team meetings, which provides Hospital and Medical Officers 384 369.2 392.5 leadership development • More than 35 managers who were Sessional Clinicians 101.1 106.8 111.1 supporting frontline management course Ancillary Staff (Allied Health) 436 515.9 605.3 participants undertook half-day training to Total 4531.1 4700.6 5051.7 learn the art of coaching conversations and support creation of a learning culture in their work teams
2500 These new peopleJune initiatives FTE 2009/10 are well underway and further initiatives are planned 2000 June YTD FTE 2008/09 4000 for 2010-11 for attracting, retaining and June YTD FTE 2007/08 1500 developing our people and building a strong 3000 culture which will increase our capacity to 1000 2000 provide high quality care and service to our 500 communities in the east. 1000 0 Occupational health and safety Nursing 0 Administration Medical Hotel and Medical Hospital and Sessional Ancillary Sta and ClericalFull timeSupport Allied ServicesPart time O cers MedicalCasual O cers Clinicians Sessional(Allied Health) In 2009-10, we continued work on improving
* The medical support category includes health professionals 2007-08 2008-09 2009-10 our practices and systems to ensure a safe such as physiotherapists, speech pathologists, radiographers and medical scientists 2007-08 2008-09 2009-10 2500 Eastern Health Annual Report 2009-10 15 2009-10 2000 2008-09 2007-08 1500
1000
500
0 Administrative Corporate Hospital & Medical Medical Nursing Sessional & clerical support medical o cers support* clinicians our people
Des Smith (Senior Aboriginal Health Worker) and Jimmy Marks (Garden and Property Anna Barugh joined the Eastern Health Maintenance Officer with the home and community care program) are based atY arra Valley Fundraising Department in 2009 Community Health
workplace for our staff, volunteers, patients Brigade and other major stakeholders in a work-related concerns and is a free service and visitors. To support this, we review our practice emergency exercise involving all our to our staff. To ensure that we have a cost systems via an internal audit based on the hospitals in responding to a mass casualty effective and high quality EAP program and that all staff have access to the same range of Australian Standard 4801. incident. A number of lessons were learned and emergency systems improved. EAP services, we have recently tendered for an The OHS emergency-management EAP provider for Eastern Health. Together with WorkSafe Victoria, we procedures and other OHS course have been conducted an audit of our WorkCover and placed online via our e-learning centre. This Peer debriefing program return-to-work program, which has resulted has improved accessibility of staff training in an action plan that will help us better We operate a peer debriefing program and ease of completing the OHS mandatory support people returning to work early and coordinated by key senior staff who have courses. More than 400 staff have completed to increase managers’ understanding of this significant experience as multidisciplinary online training. important process. clinicians and managers. All debriefing requests are triaged by coordinators who With support from the Victorian Department The OHS team has been committed are responsible for ensuring appropriate and of Human Services, Eastern Health joined to improving safety culture across the timely interactions. Debriefing is provided by Victoria Police, Melbourne Metropolitan Fire organisation with training for managers trained debriefers across our organisation, and staff in all aspects of OHS. The team who are provided with supervision and has actively and directly promoted safety support by the coordinators. awareness, which has resulted in a reduction of injuries across the organisation. In 2009-10, 70 debriefs were held across Age breakdown 2009-10 Eastern Health. Reasons for the debriefings Employee assistance program included managing the impacts on staff from 30% patient incidents, adverse events, responses to We provide support to our staff via the 25% critical incidents and emergencies. employee assistance program (EAP). 20% Confidential assistance from external, trained Application of merit and 15% counsellors and psychologists enables equity principles 10% the early resolution of factors that may be We are an equal opportunity employer 5% impacting on a staff member’s wellbeing and effectiveness at work. Staff may access and treat all our people on their merits and 0% 17-19 20-29 30-39 40-49 50-59 60-69 70 + the program for personal and work-related without consideration of race, gender, age, matters. The program provides short-term marital status, religion or any other factor counselling and coaching for personal and that is unlawfully discriminatory. We are 70 and older
60-69 1630 Eastern Health Annual Report 2009-10 50-59 25 40-49 20 30-39 15 20-29 10 17-19 5
0 17-19 20-29 30-39 40-49 50-59 60-6970 and older
20000
15000
10000
5000 2007-08 2008-09 2009-10
Maroondah Hospital Box Hill Hospital Angliss Hospital our people
committed to providing a workplace that is with our suppliers. As part of this, Eastern as an employer of choice for both clinical and free of discrimination and harassment. Any Health has developed a Statement of Business non-clinical roles. form of unlawful discrimination or harassment Ethics, which outlines what we expect from is unacceptable and disciplinary action would our suppliers and what they can expect Professional development be taken against any staff member who were from us in our business dealings. This is to breach this. available on the Eastern Health website During 2009-10, we invested in a range of under ‘publications’. professional learning and development We are committed to the employment activities providing our people with a wide principles outlined in the Victorian range of learning experiences aligned with Government’s Public Administration Act Recruitment our organisation’s needs and staff members’ 2004, which are essential to an effective and Effective recruitment is vital to ensuring we professional development goals. harmonious workplace. Our people-policies have a sustainable workforce able to meet the and procedures support: healthcare needs of our eastern communities. • Employment decisions based on merit Developing our healthcare professionals In 2009-10, we introduced a new integrated • People being treated fairly and reasonably print and online recruitment advertising We are committed to supporting our current • Provision of equal opportunity campaign, in order to promote Eastern Health and future healthcare professionals and • Human rights as set out in the Victorian Government’s Charter of Human Rights and Responsibilities Act 2006 • People being provided with reasonable redress against unfair or unreasonable treatment • Fostering career pathways in the public healthcare sector
Most of our staff are women (approximately 80 per cent). The highest proportion is aged 40-49. Roughly one-quarter is aged 30-39 years and just over one-quarter aged 50-59 years.
Whistleblowers’ protection
We comply with the requirements of the Victorian Government’s Whistleblowers Protection Act 2001. Neither improper conduct nor the taking of reprisals against anyone who comes forward to disclose such conduct are acceptable to us. We distinguish whistleblowing from something that would be considered a grievance or internal organisational dispute.
No disclosures as per the Whistleblowers Protection Act 2001 were made in the year ended 30 June 2009.
Managing conflicts of interest
Eastern Health has launched a new policy and process to assist staff in managing real or Dr Leah Harcourt and Dr Bronwyn Cooke joined the Eastern Health intern program under perceived conflicts of interest when dealing a jobshare arrangement
Eastern Health Annual Report 2009-10 17 our people
have a comprehensive health education and and Gastroenterology) on gluten as a cause of Allied health education services research strategic plan and framework, which gastrointestinal symptoms in patients who do During 2009-10, the following allied health supports opportunities and future directions not have coeliac disease. She won the 2009 initiatives and activities were underway: for intradisciplinary, multidisciplinary and Australian Gastroenterology Douglas Piper • Completed a feasibility study of an Allied interdisciplinary education and research. Young Investigator Award, which is the third Health Clinical School in partnership with time in four years that Student placements for undergraduate, La Trobe University, which would build on the prize has been awarded to an pre-vocational graduate and postgraduate the existing and successful Physiotherapy Eastern Health researcher. programs, as well as staff development Clinical School and incorporate programs, continue to be a key priority Activities culminated in a research forum physiotherapy, occupational therapy, social for our organisation. Such programs held at Wantirna Health and attended by work, speech pathology and podiatry support our current and future workforce approximately 100 people. The guest speaker, • Established an Eastern Health Allied Health while ensuring that we have clinical Professor Richard Larkins, Emeritus Professor, Assistant Clinical School in partnership with practitioners who have sound professional Monash University, addressed the group on Swinburne TAFE knowledge and skills underpinning their the role of teaching in hospitals. Fifteen of our • Implemented undergraduate clinical practices, in the interests of high quality and invited researchers from allied health, medical placement programs with Monash effective patient care. and nursing presented their research. University for dietetics and occupational therapy In October 2009, a record number of Celebrating research • Participated in discussions to develop an Eastern Health speakers (nine in total) inter-professional learning ward, which We are committed to building a culture of gave presentations at the 2009 National is multidisciplinary research across our organisation, so that Allied Health Conference demonstrating • Continued to provide an increasing research becomes embedded in every day the organisation’s leadership and many number of students from all the Allied clinical practice. achievements in the allied health field. Health disciplines from a range of Our second Research Week was held in We appointed our inaugural Director of education partners. December 2009 including a roving poster Research for Eastern Health, Dr David Taylor, roadshow and the launch of our second in June 2010. A goal is to establish an office Medical education and training research report. The 70-page report of research amalgamated with our present In 2009, we introduced a new Postgraduate documents a wide range of recent research ethics service. The quantity and nature of Medical Education and Training (PGMET) projects involving Eastern Health staff. It research being undertaken within our health program. This has replaced the medical included a presentation by Jessica Biesiekierski service is being reviewed and a research plan education unit and is based on the Australian (Box Hill Hospital Department of Medicine is being developed. Curriculum Framework for Junior Doctors. It provides training and education opportunities for junior medical staff (JMO) in their first three years of pre-vocational training. Two medical education officers (MEO) work together with the supervisors of junior doctor training.
Our goal is to find innovative and engaging ways to both educate eastern JMOs and retain them. The Eastern Health intern orientation program, ‘The Amazing Case Race’, was a highly commended finalist in the Victorian Public Healthcare Awards in 2007 and has become essential for all new interns.
In 2010, with the help of unit, department and service heads, we revitalised our program to include a new segment titled ‘The Nick Jones is the Director of Pharmacy at Eastern Health Einstein Quiz’. This spiral learning tool will be
18 Eastern Health Annual Report 2009-10 our people
presented at the 2010 Prevocational Medical our sites including mental health services. Education Forum in Melbourne and will be Most graduates (78 per cent) from the submitted to the journal Medical Education. previous intake continued their careers with us, with some commencing further studies to The PGMET team also seeks to foster specialise in an area of nursing. interdisciplinary training (medical, nursing, allied health) by enabling all clinical staff to During 2009-10, we conducted Career access shared learning materials. For example, Development Program (CDP) courses in a the MEOs at Angliss, Box Hill and Maroondah range of clinical areas with 84 participants hospitals have been filming JMO education completing one. Also, 45 participating nurses content. These modules will be uploaded to and midwives undertook graduate certificate, our e-learning facility for access by staff at any graduate diploma or Master time, with the goal of creating more shared level courses in conjunction with our learning opportunities for hospital staff. university partners.
During 2009-10, staff in our Medical Workforce Lachlan MacBean leads Decision Eastern Health was honoured when Practice Unit continued Eastern Health’s credentialling Support at Eastern Health Development Manager, Peter James Centre program and are working to update all and Wantirna Health, Kath Riddell won outstanding senior medical staff contracts. In April 2010, with the support of Balwyn the prestigious 2009 Deakin-Health Super Recruitment of junior medical staff has been Rotary Club, Eastern Health received donated Leadership in Nursing and Midwifery Award. successful with effective management of funds to purchase a Noelle Birthing Simulator It recognised leadership in supporting the costs and little need for the use of locums. to enhance our obstetrics training program. care of complex, vulnerable patients in the Also, Medical Directors were appointed Box Hill Hospital is the only centre of its kind aged care and aged mental health care to Angliss and Maroondah hospitals. They in Victoria, and one of only three centres areas. The project identified a need to better will provide medical leadership and assist nationally, to provide high fidelity practical equip nurses who manage complex and in auditing services to ensure that a high skills training in obstetrics and midwifery vulnerable patients. It involved development standard of patient safety is maintained patient care. and implementation of key strategies to and that junior and senior medical staff are improve patient outcomes by establishing The Eastern Health Simulation Centre, located provided with local support and supervision. a permanent 24/7 nursing program, which at Box Hill Hospital, has become an integral benefits both staff part of our educational platform and supports Eastern Health Simulation Centre and patients. the organisation’s position nationally as a In 2009, a purpose-built clinical skills progressive healthcare service. simulation centre was commissioned The future as part of the Stage 1 Box Hill Hospital Nursing education services An ongoing challenge is to ensure we have redevelopment. Currently it provides clinical During 2009-10, we provided clinical the right people in the right jobs, in the training to approximately 200 staff and right time and place, in order to help us medical students via approximately 20 placements for 1946 undergraduate students execute our strategic directions and meet courses per month. from 22 higher education partners. Most of our students were from nursing and our strategic goals. Ongoing implementation Simulation training has been shown to midwifery courses, with some paramedic of our organisation development framework, enhance skill acquisition for the performance and Australian Defence Force (army) medic workforce planning and appropriate of complex tasks in the healthcare setting. students also attending for short placements. recruitment initiatives will help position The high fidelity simulation equipment allows We provided a total of 24,308 clinical shifts for Eastern Health as a place where people for interdisciplinary team training exercises undergraduate nurses and midwives, which is want to work, learn and progress their including the teaching and evaluation basic an increase of approximately 25 per cent from careers and ultimately ensure the and advanced life support techniques. the previous year’s activity and more growth sustainability of our organisation and serve Specialised clinical skills with a variety of is predicted for future years. our local communities. complex scenarios are taught, such as the care of a rapidly deteriorating patient, or A total of 172 graduate nurses and midwives rehearsing critical events of a cardiac arrest at began their careers at Eastern Health. They no risk to the patient. experience a variety of rotations throughout
Eastern Health Annual Report 2009-10 19 20 Eastern Health Annual Report 2009-10 Our community A great partner with our communities
Highlights
our auxiliaries raised approximately $455,400 to support our hospitals
our fundraising efforts brought in a total of $2m for our health service
nine volunteers received the 2009 Caroline Chisholm Award
online donations were introduced on the Eastern Health website
box Hill Hospital auxiliary kiosk marked 40 years of service
EasternEastern HealthHealth AnnualAnnual ReportReport 2009-102009-10 21 our community
Our organisation and communities benefit from a range of vibrant partnership, volunteer, community engagement and fundraising activities, providing vital opportunities for community participation in the provision of our healthcare services. Importantly, our volunteers provide valuable support to our staff and patients, helping to improve the safety, health and wellbeing of people in Melbourne’s eastern, outer-eastern and Yarra Ranges communities.
Volunteer services
Eastern Health is supported by more than 600 volunteers, who perform a range of operational and support roles. Annually they contribute approximately 65,000 volunteer hours to the organisation.
We have approximately 150 Australian Red Cross volunteers, called EDcare volunteers, working in the emergency departments of Box Hill and Maroondah Hospitals. These trained volunteers provide practical and emotional support, conversation, companionship and practical assistance, such as making phone calls for people attending our emergency department. A further 37 volunteers work in our Angliss Hospital emergency department.
We also have a volunteer transport service at some of our sites whereby approximately Volunteer Claudette Doak was awarded the 2009 Chairman’s Award for Community Support 20 drivers volunteer their time to assist patients who may otherwise have difficulty in attending appointments for their care. volunteers, auxiliary members or community of Edward Street Nursing Home. She In 2009-10, our volunteer transport drivers members who have served Eastern Health demonstrates a genuine concern for enabled us to provide transport for more facilities/programs in an exemplary way and residents and enriches their lives through than 2100 patients covering more than demonstrate Eastern Health’s values, as well as her company. 35,000 kilometres. the specific criteria of commitment, impact, initiative, need and spirit of volunteering. • Pamela Hendy – Box Hill Hospital Our volunteers are recognised for their Pamela is a volunteer of long standing at Box important contributions to our health service The following volunteers each received the Hill Hospital with some 27 years service in and the community through various internal Chairman’s Awards for Community volunteer transport. Pamela is recognised as a and external award programs. In December Support in 2009: mentor to the drivers and fellow coordinators 2009, the annual Chairman’s Awards for and has a genuine interest in her community Community Support were presented to • Claudette Doak – Edward Street and makes a real difference to the lives of three volunteers who work at our Angliss Nursing Home/Angliss Hospital many patients. and Box Hill hospitals, as well as Yarra Valley For more than ten years, Claudette has Community Health. The awards honour been a regular visitor to the residents
22 Eastern Health Annual Report 2009-10 our community
Volunteer Jeanny Heinen (centre) was awarded the 2009 Chairman’s Award for Community Support
• Jeanny Heinen – Yarra Valley important link with our local community hospitals via activities such as the hospital Community Health Service and the people who use our facilities. kiosks, foyer stalls, social clubs, stamp clubs Jeanney has supported the Yarra Valley All donations are important to Eastern and raffles. They also act as community Community Health’s ‘Women’s Out and About’ Health and the launch of online donation ambassadors for our organisation, for program for the past three-and-a-half years. facilities has made donating easier than example, by conducting regular tours for The program provides vital social connections ever. We are very grateful to all of our kindergarten groups. for women in the community and Jeanny supporters: committed donors, corporate This dedicated group of volunteers continue supports the program with great compassion partners, bequestors, volunteers, auxiliary the tradition of supporting their hospital and respect for clients. members and community groups. in their community. Their personal and Also, nine volunteers at Box Hill Hospital Our fundraising events provide a fun way fundraising efforts are inspiring; and their received Caroline Chisholm Awards 2009 to raise funds and engage with our friendliness and warmth encourage staff and for outstanding contributions to community and corporate partners. In patients alike. the community. 2009-10, these events raised more than $100,000. They provided the opportunity Patient satisfaction Fundraising and donations to celebrate being part of Melbourne’s eastern communities and join with We value and encourage feedback from Individual and community donations businesses small and large in raising funds patients about our services and participate continue to be integral to increasing resources to support the work at Angliss, Box Hill and in the Victorian Patient Satisfaction Monitor available across Eastern Health’s programs. Maroondah hospitals. We look forward to (VPSM), an independent survey of public During 2009-10, our fundraising efforts expanding our events calendar in 2011 and hospital care. The survey measures aspects generated a total of $2 million to support developing community programs through such as: Eastern Health across all our sites. These funds local schools. • discharge and follow-up enable us to buy extra equipment, improve • physical environment patient care and develop our research The development of the Eastern Health • complaints management programs. Many of our supporters are Foundation continues and the new • treatment and related information patients or relatives whose family members Foundation will be launched in 2011. • general patient information were patients and donations provide a very • access and admission tangible way for them to say thank you for the Auxiliaries In order to complement the consumer care they have received. For many years, our health service has been perspective uncovered in the VPSM, in Many of these relationships are long-lasting supported by dedicated and enthusiastic 2009-10 we undertook an organisation- and, like the auxiliaries, provide an auxiliary members who raise funds for our wide patient experience survey that rated
Eastern Health Annual Report 2009-10 23 our community
the standard of care and the demeanour of Compliments and complaints At most sites, we have Patient Relations staff. When we asked ‘What could we do to Managers who are available to address any We value written and verbal feedback from improve your hospital experience?’, patients matters raised by patients and their families the community about their experiences expressed concerns related to building and and work to achieve the best possible and perceptions of our care. Annually, we outcomes for those concerned. equipment. A total of 25 per cent of Angliss receive many unsolicited written letters Hospital responses and 19 per cent of Box Hill complimenting the care we have provided to responses reflected this. patients and their families. Primary care and population health advisory committee Staff responsiveness to patient needs and In 2009-10, we received 1699 compliments being treated with respect, dignity and and 734 complaints across Eastern Health The key role of the primary care and consideration for their privacy were rated the programs and sites. The highest areas of population health advisory committee highest by patients with more than 95 per commendation were staff demeanour and (PCPHAC) is to advise the Eastern Health cent of patients saying they were satisfied compassion. Most complaints related to Board of Directors about primary care with these aspects of their care. treatment and communication matters. initiatives that support the overall integration of hospital and community services. It helps to establish priorities that ultimately help to manage increasing demand for our healthcare services.
The PCPHAC includes members from a cross-section of our executive staff as well as representatives from general practice, community health, the Royal District Nursing Services, Primary Care Partnerships, local government and the Victorian Department of Health.
It promotes and monitors progress of pilot programs and new ventures, with broad representation from the acute and community sectors, helping to align initiatives that address common issues.
During 2009-10, the PCPHAC’s supported and monitored projects such as: • A training needs analysis and resultant training program for staff that work with people that have a chronic illness or complex care needs. • Issues for senior citizens in the eastern region and improved models of care • A forum with our community partners about the strategic direction for Eastern Health from 2010-2015 • Improved integration of Eastern Health’s primary mental health team and the community health psycho-social services
Its key priorities in 2010-11 are: • Being engaged in the primary health care Dr Sam Radford is the Medical Director for Organ and Tissue Donation at Eastern Health reform work towards creation of primary
24 Eastern Health Annual Report 2009-10 our community
More than 600 people participated in the 2009 Maroondah Hospital Fun Run
healthcare networks (Medicare locals) different backgrounds and represent the quality and falls committees. • Informing partners on the delivery of our community we serve. Committee members During 2009-10, the CAC’s key achievements strategic directions include patients, families, carers or friends of and activities have included the following: • The monitoring of common agreed patients, residents and citizens interested in • Initiated a community forum to support programs/projects that improve continuity health. Each member contributes their ideas development of the 2010-2015 Eastern of care from the hospital to the home and opinions formed from their community Health Strategic Plan involvement and activities, helping us to hear • Provided review and feedback on: Community advisory committee the views of the community and to respond – 2010-2015 Eastern Health Strategic Plan to them. Also, the CAC monitors progress We work closely with the community to – Eastern Health Patient Admission against our community participation plan. enhance the quality and accessibility of Handbook – Eastern Health signage our patient care. Our community advisory The CAC meets approximately six times each – consumer information and committee (CAC), established in 2001, plays year, usually at Box Hill Hospital. Standard communications a pivotal role is our community participation agenda items include items for discussion • Initiated a planning day with members of and consumer involvement processes. It aims with the Eastern Health Board of Directors, the Eastern Health Executive Committee to help us build consumer and community register of actions from suggestions, • Development of a Eastern Health views into all aspects of our operations, reports from members who attend other framework for consumer and community planning and policy development. committees such as our patient relations engagement/participation Our CAC includes up to 12 people from meetings, respecting patient choices, board
Eastern Health Annual Report 2009-10 25 26 Eastern Health Annual Report 2009-10 Our programs and services A provider of great healthcare
Highlights
improvements in accessibility of our services through reduced waiting times and treatment times for patients
we provided more than 230,800 allied health contacts to almost 46,000 clients
new programs introduced to support people with type 2 diabetes
Approximately 28,000 clients received ambulatory services
Amalgamation with Turning Point Alcohol and Drug Centre
Expansion of specialist clinics provided at Eastern Health
we exceeded our internal and external cleaning audit scores
EasternEastern HealthHealth AnnualAnnual ReportReport 2009-102009-10 27 our programs and services Acute care
> Acute care
Our acute program is the largest component of Eastern Health’s clinical services, with 128,104 discharges and 136,923 occasions of outpatient services in 2009-10. Our three emergency departments (at Angliss, Box Hill and Maroondah hospitals) received more than 137,169 presentations. Demand for acute inpatient services is increasing in line with the growth in emergency and elective surgery demand. Our clinical programs are emergency and general medicine, outpatient services, surgery and specialist medicine, as well as women’s and children’s services.
Highlights Associate Professor Gishel New is Director of Cardiology at Eastern Health • In January-March 2010, Eastern Health achieved its lowest ever number of patients improvement through applying redesign The following results have been achieved waiting 24 hours, second lowest rate of methodologies in Victorian hospitals. so far: ambulance bypass and met the 80 per • Improvements in accessibility of our Under the program, we are working toward cent target for patients requiring admission a range of improvements that will provide a services through reduced waiting times within eight hours better experience for patients and improve and treatment times for patients • Overall, we treated patients more quickly efficiency of care in the following areas: • A trend in reduction of errors with a dramatic decrease in the number • Patients who come to our emergency • Creation of the equivalent of 9.1 extra of patients waiting 24 hours in our departments requiring assessment and emergency department cubicles across emergency departments and most treatment and then are discharged home Eastern Health emergency patients (almost 70 per cent) • The medical patient journey from the discharged within four hours • An increase in the proportion of non- time they present to the emergency • A total of 4513 babies were born at admitted patients treated and discharged department to the time they are Eastern Health hospitals within a timely four-hour period discharged from hospital • Expansion of our integrated renal services, • Reductions in time-to-treatment for • The surgical patient journey from the time including establishment of renal transplant patients being discharged and treatment they are referred to the time they services together with Austin Health time for patients being discharged are discharged • Establishment of specialist endocrinology, • Clinical support services such as medical gastroenterology, respiratory, haematology imaging and pathology and renal clinics across Eastern Health • Reduction of our total elective surgery More than 500 staff have participated in waiting list from 4105 to 3385 patients – capacity-building activities, which have the first time in three years that Eastern extended their understanding and skills. Health has achieved its elective waiting Across all projects, more than 700 hours list target of system and procedure tracking was undertaken. Sixteen of the biggest projects were overseen by the Redesigning Hospital Redesigning hospital care Care Program Governance Group and In July 2008, the Victorian Department more than 50 improvement projects were of Health provided funding for a service undertaken. The program has provided redesign program across the public health opportunities for collaboration and sector: Redesigning Hospital Care Program underscored the importance of (RHCP). The program is a four-year statewide person-centred care in all our thinking More than 4500 babies were delivered at initiative designed to deliver health service and endeavours. Eastern Health hospitals in 2009-10
28 Eastern Health Annual Report 2009-10 Acute care our programs and services
We are working to continue fostering our 281 fewer patients waited longer than the Angliss, Box Hill and Maroondah hospitals. culture of continuous improvement and recommended time when compared against In 2009-10, Eastern Health emergency integrate redesign principles into core the same time last year. departments received more than 137,169 business practice, so that better practices Eastern Health’s performance in emergency attendances, of which 34,643 patients are part of normal work functions. Also, care was strong in 2009-10: we exceeded were admitted. we are continuing to develop staff in the benchmarks for time on ambulance bypass, use of redesign methodology across the There was a dramatic reduction in the achieving one per cent against a benchmark organisation. Other priorities are to strengthen proportion of patients who waited 24 hours of three per cent. This also compares the connection between routine quality work for admission to a ward bed: from 566 in favourably to our 2008-09 performance when and redesign and transition our redesign we were on bypass 2.4 of the time. There was 2008-09 to 50 in 2009-10. methodology from a ‘project’ approach to a seven per cent improvement in the number Our general medicine program is the largest everyday thinking and practice. of patients admitted from our emergency acute clinical program within Eastern Health, departments within eight hours compared to representing approximately 30 per cent Improvements in access 2009-10: for the first time, Eastern Health met of total acute discharges across our health the external benchmark of 80 per cent in early In 2009-10, significant improvement in access service. It includes specialist services such as 2010. There has been a 90 per cent reduction to our services and patient flow has occurred cardiology, endocrinology, gastroenterology, in the number of patients that have waited across Eastern Health. general medicine, haematology, oncology, more than 24 hours for admission from an intensive care/coronary care, neurology, In the area of elective surgery, we Emergency Department at Eastern Health. respiratory, rheumatology and integrated have operated on more patients, have Within the sub-acute setting, Eastern renal services. fewer patients waiting longer than the Health has also seen reduction in patient recommended time for their surgery and have waiting times to access sub-acute beds, Challenges and future plans fewer patients waiting for their surgery overall. improvements in length of stay and improved For the first time in three years, Eastern Health response to acute demand: most patients (90 Our emergency departments experienced a has achieved its total waiting list target, per cent) admitted to sub-acute care came range of challenges during the year, including which is especially significant given that from Eastern Health’s acute hospitals. increased demand for our services at all our more patients were referred to the Eastern sites: emergency attendances increased by Health elective surgery waiting list than ever more than 4100 and admissions increased Emergency and general medicine before. During 2009-10, we reduced our total by more than 2200. Continuing to manage elective surgery waiting list from 4105 to We are one of Victoria’s largest providers emergency department demand remains a 3385 patients. Also, we operated on 659 more of emergency services with emergency key challenge and we have developed various elective patients than the previous year and departments at our three main acute sites: strategies in response to this.
Emergency presentations/ Admissions via our Percentage of patients attendances emergency departments discharged within four hours
55,000 20,000 90
50,000 80 15,000
45,000 70
10,000 40,000 60
35,000 5000 50 2007-08 2008-09 2009-10 2007-08 2008-09 2009-10 2007-08 2008-09 2009-10
Angliss Hospital Box Hill Hospital Maroondah Hospital Angliss Hospital Box Hill Hospital Maroondah Hospital Maroondah Hospital Box Hill Hospital Box Hill Hospital Eastern Health Annual Report 2009-10 29 Angliss Hospital Angliss Hospital our programs and services Acute care
We are developing a new model of care in medicine across our health service supported by a framework of required standards. The aim is to provide a more collaborative and integrated approach to intensive care medicine. Therefore we have recruited an Eastern Health Director of Intensive Care who will begin at Eastern Health in 2010-11.
Symphony, a clinical information system designed for emergency departments, has been implemented at our Angliss and Box Hill hospital emergency departments with implementation at Maroondah Hospital to follow in November 2010. Symphony provides doctors, nursing and administrative staff with Members of the Eastern Health Access Taskforce meet fortnightly via teleconference comprehensive documentation, access to patient information and retrieval of real-time of care regardless of site or unit. Other smaller Specialty medicine patient data at the point of patient care. redesign projects are in place in order to Specialty medicine includes cardiology, The system is designed to improve patient improve the flow of general medical patients endocrinology, endoscopy, gastroenterology, outcomes, increase the volume of patients throughout Eastern Health. neurology, oncology, renal, respiratory and receiving care, reduce risk and decrease Attracting and retaining high quality clinicians rheumatology services. Specialty medicine waiting times for patients. remains a strong focus. More Eastern provides significant services across the New projects designed to enhance the Health appointments are being made, communities served by Eastern Health patient experience for acute medical rather than site-specific appointments, in including more than 46,000 inpatient inpatients, as well as patient flow within order to improve both the clinical training admissions and approximately 33,700 opportunities and clinical experience offered Eastern Health, have commenced. They specialist clinic (outpatient) attendances. include a new model of care for general to staff. The development of consistent medicine at Maroondah Hospital and standards of care will also enable us to link Developments in 2009-10 included the development of standards of care for patient care with medical workloads to ensure participation in a project, led by the Victorian all general medicine patients, which are adequate staff to provide the expected level Department of Human Services, to implement designed to standardise the expected level of patient care. testing for the National Bowel Screening
Percentage of patients Patients admitted following a Occasions of ambulance admitted within eight hours 24-hour stay in emergency bypass (percentage)
90 1200 8
1000 80 6 800
70 600 4
400 60 2 200
50 0 0 2007-08 2008-09 2009-10 2007-08 2008-09 2009-10 2007-08 2008-09 2009-10
Angliss Hospital Box Hill Hospital Maroondah Hospital Maroondah Hospital Maroondah Hospital Maroondah Hospital Box Hill Hospital Box Hill Hospital Box Hill Hospital 30 Eastern Health Annual Report 2009-10 Angliss Hospital Angliss Hospital Angliss Hospital
90
80
70
60
50 2007-08 2008-09 2009-10
Maroondah Hospital Box Hill Hospital Angliss Hospital Acute care our programs and services
Program and support for the development of enabling patients to have their renal Funds provided $19,950 to fund continuous stroke services at Maroondah Hospital. treatment coordinated and provided at positive airway pressure equipment and Eastern Health. educate patients starting this treatment. Integrated renal services In December 2009, renal transplant services The Eastern Health Respiratory Service is In 2009-10, Eastern Health Integrated Renal were established at Eastern Health in engaged in a range of clinical research Services was established as a hub service collaboration with Austin Health, including including engagement in Eastern Clinical providing comprehensive renal care for pre- and post-transplant education and care. Research Unit clinical trials on sleep apnoea patients experiencing renal disease. Care and is the recipient of two National Health is provided to patients throughout the Research has also begun with appointments and Medical Research Council grants. eastern metropolitan region, with satellite including a Renal Clinical Trials Co-coordinator haemodialysis services at Angliss Hospital and and Renal Research fellow, who are engaged Developments in other Peter James Centre and new units established in several trials. specialist services at Box Hill and Maroondah hospitals. Demand Endoscopy services, established at Yarra has been strong: more than 200 people Respiratory services Ranges Health in March 2009, have been receive dialysis at these units. Home dialysis Respiratory outpatient clinics are now increased during the past 12 months. This has training is offered via the Box Hill Hospital provided at Box Hill and Maroondah helped to reduce waiting lists at Box Hill and satellite and during the past 12 months, seven hospitals. They are comprehensive Maroondah hospitals. patients were trained to perform dialysis in multidisciplinary clinics involving lung In response to demand, we have increased their own homes. function testing, specialist nursing and our liver clinics. At Maroondah Hospital, our physiotherapy. A Chronic Obstructive During 2009-10, Box Hill Hospital was liver clinic is now offered weekly and capacity Pulmonary Disease (COPD) clinic is also designated a ‘hub’ service and now has a has been increased at each clinic. Our renovated 12-bed ward for renal patients, a provided at Angliss Hospital. projected increase in therapy for Hepatitis C five-station inpatient dialysis area and four The sleep studies laboratory at Box patients is approx 150 per cent from last year. single isolation rooms able to provide dialysis. Hill Hospital provides a diagnostic and Previously outpatients experiencing liver Also, the hospital’s intensive care unit can consultative service for adults who tumours were referred to Austin Health. provide dialysis for three patients at any one have sleep disorders, in particular sleep A multidisciplinary service has been time and the coronary care unit provides disordered breathing. The laboratory has established at Box Hill Hospital including for two patients. Eastern Health provides a been refurbished including new diagnostic a heptologist, radiologist, hepatic surgeon 24-hour acute dialysis on-call service. software and expansion of services, which and oncologist, which means we can offer Outpatient renal services are now provided has halved the waiting time for a sleep study patients comprehensive therapy closer to at Angliss, Box Hill and Maroondah hospitals, (from 12 to six months). Collier Charitable where they live.
Acute inpatient activity Acute inpatient activity Renal dialysis activity – acute discharges – acute medical discharges – occasions of service
60,000 20,000 15,000 Yarra Ranges Health Yarra Ranges Health Peter James Centre 50,000 Peter James Centre 12,000 Maroondah Hospital Maroondah Hospital 15,000 40,000 Maroondah Hospital Healesville & District Hospital Box Hill Hospital 9000 30,000 10,000 Healesville & District Hospital Box Hill Hospital Angliss Hospital 6000 20,000 Box Hill Hospital Angliss Hospital 5000 10,000 Angliss Hospital 3000
0 0 0 2007-08 2008-09 2009-10 2007-08 2008-2009 2009-10 2007-08 2008-2009 2009-10
Angliss Hospital Box Hill Hospital Maroondah Hospital Peter James Centre Healesville & District Hospital Yarra Ranges Health Angliss Hospital Box Hill Hospital MaroondahAngliss Hospital Hospital Box HillPeter Hospital James CentreAnglissMaroondah HospitalHealesville Hospital & DistrictBox Hill HospitalPeter Hospital James CentreYarraMaroondah RangesHealesville Health Hospital & District HospitalPeter James YarraCentre Ranges HealthHealesville & District Hospital Yarra Ranges Health
Eastern Health Annual Report 2009-10 31 our programs and services Acute care
The number of people waiting for elective surgery at Eastern Health has decreased by approximately 15 per cent on last year despite the addition of 200 more people to the list.
Sometimes a patient’s surgery needs to be postponed due to factors such as emergency demand, however, we work to minimise hospital-initiated postponements.
In 2009-10, fewer patients had their elective surgery postponed for hospital-initiated reasons: 172 fewer than the previous year. Also, fewer patients waited longer than the clinically recommended time: approximately 160 fewer than the previous year. This is an Professor Lawrence McMahon is Director of the Integrated Renal Service at Eastern Health improvement on the previous year and a continued area of focus. Challenges and future plans Surgical services
A key challenge is meeting increased demand We offer a range of general and specialist Challenges and future plans for our specialist medicine services, such surgical services at Angliss, Box Hill, Healesville as endoscopy, renal dialysis and oncology & District and Maroondah hospitals, as well Demand for our surgical services continues services. We have identified the following key as Yarra Ranges Health. Our surgical services to grow, in both elective and emergency priorities for 2010-11 including: include general; breast; colorectal; ear, nose surgery. Managing increasing demand and • Development and implementation of and throat; obstetrics and gynaecology; balancing the need for emergency and an organisation-wide approach to the orthopaedic; plastic; thoracic, urology and elective access to our surgical theatres are key provision of endoscopy services, in order to vascular surgeries. challenges. Other challenges are to ensure ensure high quality and timely services enough skilled staff to treat our patients and We provided more elective surgical services to • Advancement of alternative workforce that our services continue to be provided in a the community over the year, with a total of models including nurse practitioner financially sustainable manner. projects in specialist medicine with new 13,668 patients admitted. Our surgical waiting appointments in the stroke and renal areas list decreased over the course of the year with Work has commenced on a range of initiatives • Development of inpatient respiratory 682 more people receiving surgery than the to meet our challenges including: services across Eastern Health previous year. • Configuration of Eastern Health surgical
Elective surgery activity Surgical waiting list Hospital-initiated postponements – total admissions – per 100 scheduled admissions
7000 3000 12
6000 10 2000 5000 8 4000 1000 6 3000
2000 0 4 2007-08 2008-2009 2009-10 2007-08 2008-2009 2009-10 2007-08 2008-2009 2009-10
Angliss Hospital Box Hill Hospital Maroondah Hospital Maroondah Hospital Maroondah Hospital Maroondah Hospital Box Hill Hospital Box Hill Hospital Box Hill Hospital 32 Eastern Health Annual Report 2009-10 Angliss Hospital Angliss Hospital Angliss Hospital Acute care our programs and services
units, which brings together collective emergency paediatric presentations and education and training package expertise and a significant amount 7853 acute paediatric admissions. in partnership with the Newborn of knowledge. Emergency Transport Service. This allows Throughout the year, we continued to • Sustained focus on improving the for interdisciplinary training in neonatal develop our women’s and children’s services movement of patients through our service resuscitation management. across Eastern Health, including the following: • Continued expansion of services provided • Expansion of services in Yarra Ranges with at Yarra Ranges Health, with an additional an increase in antenatal clinics, lactation Challenges and future plans focus on creating capacity at our other services, foetal maternal assessment services acute sites. We have identified a range of priorities for and the introduction of gynaecology day • Improved coordination of the elective our maternity, paediatric and gynaecology surgery and outpatient services waiting list to ensure that the right patient services sites to help us meet current and • Extension of the perineal clinic at future challenges. These plans include: is offered surgery at the right location at Box Hill Hospital • A review of the maternity services across the right time. • Introduction of an onsite midwifery Eastern Health • Forecasting elective and emergency booking service at Angliss Hospital • A review of paediatric services across surgery demand, to determine whether • Establishment of onsite clinics for foetal Eastern Health improved planning for services can achieve maternal assessment at Angliss Hospital • Centralisation of service provision in improved access for our patients. lactation, childbirth education and Other projects and initiatives have included: domiciliary services Women’s and children’s services • Introduction of an electronic antenatal • Extension of antenatal services at history across Eastern Health’s maternity We are one of Victoria’s major providers Healesville and District Hospital and services of maternity services, offering a women’s Yarra Junction • Implementation of the Victorian Maternity and children’s program that comprises • Development of publicly-funded antenatal Record, which enables all women who clinics at Angliss Hospital gynaecological, maternity and paediatric use our maternity services to hold their services. We have women’s and children’s own medical record. Pregnant women Development of a vaginal birth after services at our three major acute hospitals can access their clinical information, keep caesarean strategy (VBAC) in alignment with (Angliss, Box Hill and Maroondah hospitals), as and carry this record to appointments. the Victorian maternity and newborn clinical well as Yarra Ranges Health and This provides greater continuity of care network VBAC section framework Healesville and District Hospital. and information sharing between client, Also, we plan to increase capacity for tertiary In 2009-10, 4456 mothers gave birth to clinicians and services. ultrasound services within the health service 4513 babies at Eastern Health hospitals. • Expected pathways of care for the and increase gynaecology services at the Across Eastern Health, we received 33,984 uncomplicated and complicated pregnant Angliss Hospital. woman project. This will provide clear pathways of care for women and the In 2009-10, we will continue to develop clinicians caring for women. The emphasis our organisation-wide model of care in is on right clinician, at the right time and at line with the Victorian Clinical networks for the right place. maternity and paediatric services. Other • Establishment of an organisation-wide priorities include: governance framework to support the • Continuation of work on developing Victorian Government’s ‘Vulnerable Babies, our women’s and children’s clinical Children and Young People’ framework governance framework • Implementation of the practical obstetric • Improvement of performance via use of multi-profession training program in health roundtable data to identify solutions to issues identified in benchmark reports partnership with Victorian Managed such as readmissions Insurance Authority. This education program is an interdisciplinary approach to training in response to obstetric emergency management. • Implementation of a pilot resuscitation
Eastern Health Annual Report 2009-10 33 our programs and services Allied health
> Allied health services
Our allied health services comprise the training and research, which is supported professions of dietetics, exercise physiology, by relationships with our community music therapy, neuropsychology, service, university and vocational education occupational therapy, physiotherapy, training partners. podiatry, psychology, social work and speech We continued our allied health research pathology. Services are provided across training scheme and provided numerous Eastern Health and in a range of settings, from presentations at national conferences emergency departments and inpatient wards including; the National Allied Health to ambulatory facilities and the community, Conference and National ‘Healthcare including patients’ homes and workplaces. without Walls’ Conference, as well as national Allied health professions have an important physiotherapy, dietetics, music therapy and role in ensuring necessary services are podiatry conferences. provided in the right place, in the right time and by the right person. The mother and baby program Challenges and future plans Highlights in action at Angliss Hospital An ongoing challenge is maintaining and building our allied health workforce. A • A grant from the National Health and • Establishment of an allied health number of strategies have been developed to Medical Research Committee for an ‘dashboard’, which enables monitoring of ensure a proactive approach to this challenge. evaluation of ‘out of business hours’ services clinical activity and supports appropriate For example, the establishment of enhanced in rehabilitation allocation of resources roles for allied health assistants to support • We were awarded inaugural research allied health professionals. scholarships for two senior staff to support During 2009-10, we provided more than significant research undertakings 230,800 allied health contacts to almost Also, we plan to evaluate three innovative • Implementation of primary contact 46,000 clients. Most allied health episodes proposals for alternative, interdisciplinary physiotherapy roles at Eastern Health’s of care were of routine priority although a roles and are seeking to build on three emergency departments significant number (23,979 episodes) were advanced professional roles, such as the • Commenced design of a clinical leadership classified urgent. primary contact physiotherapists in the development program emergency department and consultant • We were awarded funding from the To ensure we continue to provide high musculoskeletal physiotherapists working Victorian Department of Health for three quality, evidence-based services to our with orthopaedic outpatients. projects to evaluate innovative proposals patients, we maintain a strong focus on Our key priorities in 2010-11 include: for interdisciplinary roles in allied health continuous improvement, as well as teaching, • Implementation of a new Allied Health structure across our health service • Evaluation of an out of business hours Allied health episodes Allied health episodes of service in inpatient rehabilitation wards of care and priority care and care setting • Continued development of our allied
40,000 50,000 health clinical schools • Development of the profile of our allied 40,000 30,000 50,000 health services within Eastern Health and among partner organisations 30,000 40,000 20,000 20,000 30,000 10,000 20,000 10,000 10,000 0 0 urgent routine low ambulatory0 inpatient (ward) unknown ambulatory inpatient (ward) unknown
*Does not2007-08 include community2008-09 health data 2009-10 2007-082007-08 2008-092008-09 2009-102009-10
34 Eastern Health Annual Report 2009-10
2009-10 2009-10 2009-10 2008-09 2008-09 2008-09 2007-08 2007-08 2007-08 community health our programs and services
> Community health 30000 Target contact hours 25000 Number of contact hours 20000
15000
10000
5000
0 Our community health program supports the Angliss Box Hill Maroondah Yarra Valley YVCH YVCH YVCH Eastern Innovative Hospital Hospital Hospital Community (home & (early (healthy Centre health provision of primary care services from various Community health service Health (YVCH) community intervention mothers Against services for 1 care) chronic healthy Sexual Assault homeless locations across Melbourne’s east, outer-east contact hours disease babies youth risk management) program) and the Yarra Ranges including Angliss, Box 30000 Target contact hours Hill and Maroondah hospitals, as well as Number of contact hours 25000 Yarra Valley Community Health. The program Target contact hours Number of contact hours focuses on collaborative partnerships with 20000 primary care providers and eastern region 15000 primary care partnerships. These services 10000 support and continue care provided to patients following admission and discharge 5000 from acute hospitals. 0 Angliss Box Hill Maroondah Yarra Valley YVCH YVCH YVCH Eastern Innovative Hospital Hospital Hospital Community (home & (early (healthy Centre health Health (YVCH) community intervention mothers Against services for Highlights care) chronic healthy Sexual Assault homeless disease babies youth risk • Eastern Health became an accredited and management) program) registered member of the World Health Number of contact hours Organization health-promoting hospital Serving our community Partnerships Target contact hours network, following achievement of our tobacco-free and baby-friendly status In 2009-10, we exceeded all targets for Eastern Health has strong partnerships with • An achievement award by the Victorian community health service delivery, with our the seven independent community health Department of Health for the 2009 community health staff providing a total services offering primary care services that of 45,251 community health interactions NAIDOC celebrations also operate in our region. for 8539 clients. Overall we provided a total • Development of two new programs of 66,376 contact hours against a target of Community health services are often a first together with Ranges Community Health 58,612, or 7764 more hours. We provided a point of contact for residents as they provide designed to support people experiencing total of 16,898 contact hours in Aboriginal primary care such as access to general type 2 diabetes and new mothers community healthcare services (including practitioners and pharmacists. Government • Implementation of four sexual assault home and community care). funded primary care services offer clinical prevention programs by Eastern Centre treatment and rehabilitative services following Against Sexual Assault together with We have innovative programs developed injury and illness and help people to improve Knox Youth Services by dieticians, physiotherapists, community their health and wellbeing via access to health nurses, occupational therapists, podiatrists, education and health promotion programs. speech therapists and counsellors and work together in multidisciplinary teams to deliver Targeted programs are offered to prevent holistic health care. We experience highest people who are chronically ill from becoming Community health demand for the following services: sicker by helping them to manage their contacts 2009-10 • Programs that support new mothers, such conditions with the support and guidance as our ‘Mums in Training’ and ‘Mother and 25,000 10 of key workers. Health assessments are 25,000 10 Baby’ programs which are offered across undertaken by a team of healthcare 20,000 8 20,000 8 all sites professionals and care plans focus on • New lymphoedema clinics at Angliss 6 goals set together with clients. Wherever 15,000 15,000 6 and Box Hill hospitals, as well as possible our programs aim to provide help 4 4 10,000 10,000 Yarra Ranges Health through intervening early when problems • Paediatric dietetics services; paediatric 5000 2 2 are identified. 5000 occupational and speech therapy services 0 0 0 Eastern Health maintains strategic and Angliss0 Box Hill Maroondah Yarra Valley • Early intervention chronic disease Hospital AnglissHospital BoxHospital Hill CommunityMaroondah Yarra Valley management program for people developmental partnerships with a range Hospital Hospital HealthHospital Community Health experiencing type 2 diabetes of partners and stakeholders, in order to Number of contacts made • Tobacco-free clinics support the provision of seamless healthcare Number of clients • Family violence program for women for patients and clients. These partnerships AverageNumber number of of contacts contacts per made client Number of clients Average number of contacts per client Eastern Health Annual Report 2009-10 35
Number of contacts made Number of clients Number of contacts made Number of clients our programs and services community health
include the following organisations: 2010-11. It is expected that this, together with to explore sexual assault training and • Inner East Primary Care Partnership an executive and senior management module prevention opportunities. Our work with • Outer East Health and Community developed in conjunction with Monash Worawa College also continues with Support Alliance University, will support positive change and individual and group work provided to • Divisions of General Practice cultural competency across Eastern Health’s Aboriginal students. • Community Health Promotion Special acute, sub-acute and primary care services. • Sexual Assault Prevention Program for Interest Group Secondary Schools – ECASA has run three • Victorian Health Promotion Eastern Centre train-the-trainer programs to resource Hospital Network Against Sexual Assault community workers and school staff • Eastern Region Community Health Network • Workshops – ECASA has facilitated • Outer East Nutrition Network Eastern Centre Against Sexual Assault (ECASA) more than 30 workshops and forums with • Regional Family Violence Network provides free counselling services to people various target groups of professionals • Eastern Community Legal Centre who have been victims of recent or past including psychologists in private practice, • Child and family services networks sexual assault, as well as their families. ECASA school staff, domestic violence workers, • Local government community health and staff work to provide a timely, accessible and wellbeing planning committees responsive service including crisis counselling, family support workers, youth workers, group work, information and referral, support mental health and hospital emergency In 2009-10, partnership commitments on legal and medical issues, community department staff. to address Aboriginal health issues were education and professional training. expanded to include representation on Health promotion groups that have progressed a regional In 2009-10, ECASA handled more than 900 implementation plan for the Commonwealth cases of which 500 were new. Some 50 adult Health promotion is a key aspect of our Government’s ‘Closing the Health Gap’ crisis care presentations were received. A total community health program and works to initiatives, led by the Victorian Department of of 11 accelerated trauma recovery groups for enable and support people to improve their Health (eastern metropolitan region). women and one adult men’s group were held. health. We work together with other service Eastern Health has been involved in A range of partnership and community providers within and outside of Eastern Health developing a train-the-trainer cultural education activities were conducted to offer a range of programs and services competency resource package, including the following: for patients, staff and our communities. Our implementation of a pilot with an evaluation • Aboriginal community – development programs are designed to support healthy process having commenced. Eastern Health and strengthening of relationships lifestyles and provide greater opportunities for has received $100,000 to implement this with Aboriginal organisations to ensure those who have specific needs or are ‘at risk’ of training model across the organisation in improved access to ECASA services and experiencing poor health.
Aboriginal community healthcare
12,000 12,000
8000 8000 (none (none formally) formally) 4000 4000
0 Aboriginal0 health Aboriginal home Aboriginal health& community care Aboriginal home & community care
Number of contact hours Jackie Harney is the new Aboriginal Liaison Officer at Maroondah Hospital Target hoursNumber of contact hours Target hours 36 Eastern Health Annual Report 2009-10
Target hours Number of contact hours Target hours Number of contact hours community health our programs and services
The ‘Look Good... Feel Better’ program is now available to women in the outer-east
Our Health Promotion Plan 2009-12 identifies the Breathing New Life into Maternity Challenges and future plans four priorities: conference in Alice Springs. While limitations in physical infrastructure 1. Promoting mental health and wellbeing • Life Links group program that provides has been identified as a challenge in 2. Reducing tobacco-related harm support for people at risk of anxiety/ continuous improvement of our services, 3. Promoting accessible and nutritious food depression following diagnosis or recurring future investment is expected to enhance and chronic illness, was offered for patients the quality of our facilities and respond to 4. Reorientation of EH to a health following cardiac rehabilitation. It has been identified community needs. promoting service expanded to outer eastern Melbourne Primary healthcare is vitally important for Key achievements in health promotion during via partnerships with Knox Community keeping people healthy and improving Health Service and Knox Leisure works; and 2009-10 included: capacity for people to manage their own • Provision of professional development Manningham YMCA. health conditions with the help of health training and advice to staff who work with • We supported community members to education. Future initiatives aimed at clients who smoke, particularly staff in our manage their own health via our Health for preventative health and coordinated health maternity services, in order to support Life courses covering anxiety management, promotion activities is expected to enhance Eastern Health’s tobacco-free policy sleep solutions, reducing road rage, anger health and wellbeing within our community. • Training and promotion to support management, yoga, gentle exercise for Eastern Health’s community health staff agencies in the eastern metropolitan region seniors, walking and massage. There in developing a greater understanding of are utilising professional development in was a total of 2683 attendances from health promotion principles and practices health coaching skills which, together with 218 participants. • Growth in popularity of our ‘Health for Life’ new models of care, will support increased courses with 2683 attendances from In the area of mental health, we have worked community access to services. 218 participants towards a family violence initial needs We are working to implement the Eastern assessment tool for ‘at risk’ women accessing Throughout the year, we provided a wide Health Health Promotion Plan 2009-12 to maternity services. The development range of educational and support programs address chronic disease management, of standardised anxiety and depression support better access to healthy nutritious to the community including the following: food and increase awareness of the incidence • The ‘Ready Set Baby’ enhanced antenatal assessment tools was also implemented. of family violence. education program developed by Eastern Linkages with community support and Health was trialled in collaboration with health support services have remained a the Connections Child, Youth and Family strong emphasis in the delivery of our mental 1 Community health contact hours are set by agreement with the Victorian Department of Human Services in 2009. The program has been health programs. Jackie Harney is the new Aboriginal Liaison Officer at Maroondah Hospital Services and are a direct reflection of funding received accepted as a poster presentation at to provide primary care services.
Eastern Health Annual Report 2009-10 37 our programs and services continuing care
> Continuing care
Our continuing care program encompasses • Specialist clinics including dementia clinics, intervention and hospital based programs sub-acute services such as geriatric continence clinics, pain management for people with a chronic illness evaluation and management, palliative care, clinics, focal spasticity clinic, neurological rehabilitation, residential aged-care services clinics, complex care and aged care clinics, Aged-care consultation services and transition care. It also comprises the falls and balance clinics and movement health independence program, including the disorders clinics for people with The aged-care consultation services are in hospital admission risk program, hospital in Parkinson’s Disease highest demand among Eastern Health’s the home and post-acute care. We provide • Victorian Paediatric Rehabilitation Service inpatient consultation services. continuing care services from Angliss Hospital, • Chronic disease management During 2009-10, a total of 1286 patients were Peter James Centre and Wantirna Health. • Post-acute and post sub-acute care services seen at Maroondah Hospital and of them, Also, we provide geriatric evaluation and • Aged-care assessment services almost all were seen within one working day management at Healesville & District Hospital. of referral. At Box Hill Hospital, 974 referrals In 2009-10, approximately 28,000 clients were received and 3496 episodes of service received ambulatory services from Highlights were provided. The clinical nurse consultants Eastern Health. provided 2547 contacts and 949 geriatrician • Approximately 28,000 clients received In March 2010, we launched an electronic ambulatory services assessments were completed. The average • Introduced direct access to rehabilitation waitlist for ambulatory services, including time between referral and consultation programs from acute emergency centre- and home-based rehabilitation, was less than one day, demonstrating the departments, both inpatient and specialist clinics and chronic disease timeliness of services. management. Introduced to simplify access community-based, to help fast track Also, in 2009-10 our orthogeriatric service for patients and their carers, the new patients to rehabilitation programs geriatricians saw patients who were older electronic waitlist has helped to reduce the • Seven posters from Eastern Health’s than 65 and had hip fractures, for which they time to treatment and ensure patients and palliative care service were accepted for were being treated at Box Hill and Maroondah their families obtain access to appropriate display at the Palliative Care Australasia hospitals’ orthopaedic services. At Box Hill services for their needs. It also enables Conference 2009 Hospital, our cognitive service was involved general practitioners and other community • Our residential care outreach pilot was with up to 10 patients each week, assisting extended to the City of Maroondah refers to better understand our services with the diagnosis and management of • We streamlined our processes for referral and timeframes for care of their patients delirium and behavioural disturbances of patients to community rehabilitation seen or referred to Eastern Health’s in dementia. programs to help with timely discharge ambulatory services. and return to the community Geriatric medicine • An initiative to fast-track elective Aged-care assessment services orthopaedic patients into centre- and The geriatric medicine service continues to home-based rehabilitation services sped In 2009-10, we completed more than 8000 provide a broad range of input to services up rehabilitation services for patients assessments for older people who live in across Eastern Health, including acute • Introduction of specialised rehabilitation Melbourne’s east and need support or hospitals and sub-acute hospitals, outpatient units across sub-acute inpatient areas to evaluations related to their needs for care. clinics, transition care and community-based provide expertise in rehabilitation care and This is in line with last year’s activity. services such as the aged-care assessment treatment across programs and sites service. Also, we maintain geriatric medicine We also worked to improve our services via links with local private hospitals. initiatives such as: Ambulatory services • Beginning a redesign project towards Throughout 2009-10, Eastern Health Our ambulatory programs provide service implementation of an Integrated Access geriatricians and rehabilitation for a wide range of people in our community Unit and Model of Care for ambulatory specialists provided: in partnership with various community streams across Eastern Health • extensive teaching and supervision of final providers. These services include: • Participating in the Victorian Department year medical students at Monash University • Hospital in the home of Health’s review of the hospital in the • Teaching in the delirium inter-professional • Residential care outreach services home program learning program • Centre- and home-based rehabilitation • A pilot to establish pathways between early • Mentoring and support during basic
38 Eastern Health Annual Report 2009-10 Continuing care our programs and services
physician trainees training in preparation • The need to provide a flexible and for their specialist clinical examinations accessible service and respond to patients who are in urgent need of specialist Members of the geriatric medicine program palliative care are linked with a number of research • Working to ensure that patients who are projects including some conducted by referred to our inpatient unit need this kind postgraduate students. of specialist palliative care service, and that A planning process has been implemented their needs could not be equally well met and geriatricians within Eastern Health meet in the aged care setting or at home regularly, which supports better planning and • Collaboration with sub-acute and acute monitoring of services across Eastern Health. settings across Eastern Health, so that For example, a geriatrician has been seconded patients for whom a less interventional to the general medicine service at Box Hill approach is appropriate have the option of Hospital. Other benefits include monitoring using palliative services as required Professor Peteris Darzins is Director of of the timely provision of discharge Geriatric Medicine at Eastern Health In order to meet such challenges, our summaries, improved access to information plans include: technology and the standardisation of the • Development of a pathway for discharge approach to newly diagnosed Alzheimer’s as needs arose and providing support of dying patients from the emergency dementia in hospital. Also, we have services until patients could be admitted to a department back to their nursing homes palliative care bed. consolidated acute hospital geriatric medicine • Liverpool care pathway, which is a care consultation services to provide better Referrals to our palliative care consultation plan for assisting staff and families in the continuity of service. service (which operates primarily at Box Hill end-of-life care for patients who die while and Maroondah hospitals) increased with at Eastern Health Palliative care 1600 referrals from across Eastern Health, • Collaboration with Eastern Health’s which is approximately 25 per cent more neurology department on facilitating During 2009-10, we continued to increase than the previous year. Also, our palliative management of patients suffering from our inpatient palliative care services with outpatient clinic at Yarra Ranges Health, CJD (brain disease) approximately 800 patients admitted and which is staffed by a multidisciplinary team • Research into the areas of multidisciplinary an overall occupancy of approximately comprising social work and occupational management of anxiety and depression; 90 per cent. therapy integrated with day oncology terminal restlessness and delirium; audits We continued to provide multiple streams services, continued to increase its activity: into oxycontin use, methylnaltrexone and of care, providing a range of services for a 2259 occasions of care were provided for pain suffered by patients; and a needs wide range of needs such as end-of-life care, approximately 140 patients totalling more analysis of families of patients suffering pain management, control of symptoms and than 1500 hours. from brain tumours respite for carers’ relief. • Participation in the palliative care outcomes As well as meeting increased demand, we collaboration, which is a national database Most patients have a diagnosis of cancer have worked to improve the quality of our enabling us to benchmark results against or blood disorder although the proportion services via several staff-initiated projects. those of other services of patients suffering from non-malignant One such project is designed to examine conditions (such as heart of kidney failure pathways for returning seriously ill residential Rehabilitation program and chronic obstructive pulmonary disease) care patients to their home for end-of-life has increased, partly due to education and care, rather than admitting them for painful Our rehabilitation program focuses on advocacy in non-malignant and non- and futile investigations and treatment if that supporting patients and clients to become traditional referring units in the acute setting. is not appropriate. sufficiently independent to return home or to remain at home, thereby supporting their Palliative care nurse consultants continued to Eastern Health’s palliative care consultation lifestyle and mobility. provide support for patients not only in the service supports decision making in relation acute care setting but also in community- to goals of patient care, as well as education During 2009-10, we continued to develop based, sub-acute and home settings, referring about the role of palliative care. Key specialised inpatient rehabilitation patients to the inpatient palliative care unit challenges include: programs for musculoskeletal/amputee
Eastern Health Annual Report 2009-10 39 our programs and services continuing care
In 2009-10, 1490 patients were seen in residential facilities ensuring that care provided was in their own place of residence and helped reduce the need for these patients to come to hospital for general medical care.
The main source of rerrals has been the clients’ residential care facility, which indicates that the service has been well accepted.
The initiative, which began in Box Hill, was extended to the Maroondah municipality in February 2010. In 2010-11, it will be extended throughout the eastern metropolitan region with the aim to provide necessary medical Angus Stewart undergoes rehabilitation at Peter James Centre care to clients in residential facilities. The objective is to reduce the need to come to and neurological patients at Peter James challenges, our future plans include: hospital causing distress and confusion for Centre. Also, we restructured our allied health • Research activities such as participation in elderly clients and carers. Promotion of the therapy areas into streams. This enables staff a project funded by the National Health service to general practitioners, emergency to develop their clinical skills and specialise in and Medical Research Council on weekend departments and inpatient units will be a particular clinical areas of interest and helps to therapy and a project on patient activity focus in 2010-11. ensure patients receive care that meets their and participation During 2009-10, we provided ongoing needs. In line with this approach, a 10-bed • Reconfiguration of the ward environment support for clients in our residential care stroke rehabilitation unit has been set up at Peter James Centre to facilitate increased facilities. This commitment is underpinned by at Angliss Hospital, in order to develop the patient activity and participation recognition of the importance of: provision of specialist rehabilitation services. • Continued focus on reducing the length • Providing an acute response for the Continuous improvement is an important of patients’ hospital stay and providing comprehensive management of elderly focus. We participated in the National Stroke earlier integration with community therapy, complex clients including access to Foundation clinical and organisational sub- thereby allowing patients to return home supports for behavioural management of acute stroke audit, which has provided us with in a timely way complex clients national and site-specific reports on our stroke • Development of specialist clinics, particularly • Providing support to lower complexity rehabilitation programs, thereby allowing for complex multiple sclerosis and expansion of supported residential services’ benchmarking against similar hospitals. We spasticity clinics at Eastern Health accommodation to provide a began an interdisciplinary research project at comprehensive service • Ensuring access to a medical physician Peter James Centre, in order to evaluate the Residential care outreach impact of a leisure activity on patients’ level to assist residential care and the general of physical activity and participation in leisure The residential care outreach pilot program practitioners with medical management in outside of structured therapy sessions. We began as part of the Victorian Department of the community and support the reduction anticipate this will result in greater satisfaction Health’s 2008-09 winter bed strategy and is of avoidable hospital admissions with the inpatient rehabilitation experience, designed to reduce presentations by nursing • The essential role of residential care both for patients and staff. home residents at acute hospitals, as well as outreach to support medical management their length of stay when admitted. of clients who live in residential care Challenges in the delivery of our rehabilitation • Early identification of at-risk clients in the program include the increasing complexity In 2008-09, a total of 781 episodes of care were nursing home and support of the general of patients’ conditions and accessibility provided by this service with most clients (90 practitioner for medical management using of appropriate services, including per cent) seen within 24 hours of referral and the residential care outreach nurse and accommodation for younger patients who almost four in 10 (38 per cent) of emergency other resources have disabilities. To address these and other department presentations diverted. • Early identification of clients in emergency
40 Eastern Health Annual Report 2009-10 Continuing care our programs and services
departments, access to rapid diagnostics • Staff and residents at Mooroolbark psychosocial issues related to the medical to support medical management and participated in a research project treatment of cancer, particularly the need for active and facilitated transfer from the with Deakin University on behaviour appropriate follow-up. The Victorian Cancer emergency departments identification and effective strategies Consumer Advocacy Group has identified • Facilitated and coordinated discharge • At our Edward Street Nursing Home, survivorship as an emerging field for cancer from medical/surgical units using hospital continuous improvement with the aim of service opportunity for service improvement. in the home and/or residential care improving the quality of care to residents Therefore, the development of innovative outreach for clients admitted who reside has been an important focus. For example, models of follow-up and outpatient care is in nursing homes the introduction of laser identification a priority. Our new oncology rehabilitation bands for use when transferring residents program is designed provide an alternative Residential aged care between facilities, in order to ensure model of care for people in the east who have minimisation of risks associated with cancer. The program is supported by North Eastern Health provides residential aged identification, allergy/drug sensitivities, Eastern Metropolitan Integrated Cancer Service care facilities for approximately 120 residents falls and cognitive sensory impairments. and the Victorian Department of Health. across our four residential aged care facilities: Monda Lodge, Mooroolbark, Northside and In 2009-10, fast track centre and home-based Sub-acute ambulatory Edward Street Upper Ferntree Gully. rehabilitation services for people following are services elective orthopaedic surgery began. The Our four residential aged care facilities are fully During 2009-10, demand for our sub-acute program is being extended to include accredited by the Commonwealth Aged Care ambulatory care services continued to patients in sub-acute services, as well as acute Standards and Accreditation Agency. increase: we provided 74,129 contact service services. On average patients are seen for During 2009-10, key improvements and events. This measure of activity indicates home-based rehabilitation within 1.95 days of activities at our residential aged care a higher demand for services with more discharge home, thereby reducing the need facilities included: patients being referred for centre and home to remain in hospital. • Construction of a new activities room and based rehabilitation services and attendance Prevention of unnecessary hospital admissions establishment of a doctor’s clinic room at at the specialist clinics. and provision of care in the community when Monda Lodge, located on our Healesville site The Eastern Health oncology rehabilitation appropriate continues to be an important area • Increased emphasis on enhancing program is due to begin in July 2010. of focus. In 2009-10, we provided 439 more the lifestyle of residents at Northside episodes of care under our hospital admission including the promotion and supervision Although a relatively new initiative, cancer risk program than the previous year. of interesting activities such as outdoor rehabilitation is recognised as an essential gardening projects, creation of mosaics and step. Support for survivors and carers is In 2010-11, a key area of focus is the appropriate outings important in overcoming the medical and alignment of ambulatory services across
Transition care Transition care Transition care – admissions – bed days – length of stay
800 25,000 60
20,000 800 600 40 15,000 600 400 10,000 400 20 200 5000 200
0 0 0 0 Bed-based Community Bed-based Community Bed-based Bed-based CommunityCommunity
2007-08 2008-09 2009-10 2007-08 2008-09 2009-10 2007-08 2007-082008-092008-09 2009-102009-10
Eastern Health Annual Report 2009-10 41
2009-10 2009-10 2009-10 2009-10 2008-09 2008-09 2008-09 2008-09 2007-08 2007-08 2007-08 2007-08
800
600
400
200
0 Bed-based Community
2007-08 2008-09 2009-10
2009-10 2008-09 2007-08 our programs and services continuing care
Eastern Health, in order to improve and timely screening of patients to reduce services (for example, geriatric evaluation accessibility and coordination of access the risk of harm. management and rehabilitation) and to ambulatory services and ensure • A discharge planning project that considers ambulatory services to ensure clients are clients and carers receive safe, timely care the importance of including all services able to access the appropriate services and in the community. Some systems, which involved in the patient’s care supports to ensure better outcomes and are required to support an integrated system • Establishment of links between our health prevent premature entry to residential care of access including e-referral, e-waitlist and independence program, sub-acute, a 1300 number, are in place. These systems ambulatory services and our hospital Challenges and future plans will be underpinned with the creation of admission risk program, in order to ensure The challenge for our sub-acute bed-based a ‘no wrong door’ policy, which will help to services are delivered in accordance with and ambulatory services is to consider new ensure all patients appropriate care. Also, health independence guidelines and innovative ways to care for patients it will facilitate referrals to other agencies either in hospital or in their own homes – (including community healthcare) to ensure Transition and restorative care thereby allowing them to live independently our patients obtain the service that best and safely at home with community based meets their needs. In 2009-10, our transition care program provided 765 admissions for our aged care therapy initiatives and support services. Continued refinement of our services and clients across the eastern region, which is We will work with patients, carers and our development of support structures will 20 more than the previous year. The program communities to provide and promote enable ambulatory streams to deliver safe, provides care for older people at the end of understanding of advance care plans which high quality care in partnership with our their hospital admission by providing access can be brought into effect when appropriate. community providers. to supports in a home-like environment and supports their safe return home or to An advance care plan only comes into A review of our sub-acute and ambulatory consideration if a patient no longer has supported accommodation. It helps to services, as well as our hospital admission risk the capacity to make decisions about prevent premature entry into residential aged program, has resulted in the establishment of: their medical treatment. The two essential care by exploring all formal and informal • A risk minimisation project for screening components of an advance care plan involve supports for the client and family. The patients at the point of early entry the patient(s): interdisciplinary model of care focuses on to services. The importance of family • Documenting their wishes in the improvements in clients’ health and mobility. involvement and education of patient and Statement of Choices the family in the care plan is recognised. In 2010-11, we will focus on: • Discussing their wishes with their doctor, • A delirium project for assessment and • Rapid access for clients into transition and family or significant others screening of patients at point of entry, restorative care recognising the importance of appropriate • Working closely with acute, sub-acute
Growth of sub-acute inpatient activity Average length of stay in sub-acute Occasions of – sub-acute discharges inpatient services – number of days ambulatory services
1500 30 Wantirna Health 80,000 Wantirna Health 1500 80,000 Wantirna Health 1200 25 Peter James Centre Peter James Centre 1200 Peter James Centre 60,000 20 Maroondah Hospital 60,000 Maroondah Hospital 900 Maroondah Hospital 900 15 Healesville & District Hospital Healesville & District Hospital Healesville & District Hospital 40,000 40,000 600600 10 Angliss HospitalAngliss Hospital Angliss Hospital 20,000 20,000 300300 5
0 0 0 0 2007-08 2008-09 2009-10 0 2007-08 2008-09 2009-10 2007-08 2008-09 2009-10 Hospital in Sub-acute Hospital Post-acute Hospital in the Sub-acutehome ambulatory Hospital admission Post-acutecare the home ambulatorycare servicesadmissionrisk program care care services risk program
Angliss Hospital Maroondah Hospital Peter James Centre 2007-08 2008-09 2009-10 HealesvilleAngliss Hospital& District HospitalMaroondahWantirna Hospital Health AnglissPeter Hospital James CentreMaroondah Hospital 2007-08Peter James2008-09 Centre 2009-10 Healesville & District Hospital Wantirna HealthHealesville & District Hospital Wantirna Health 42 Eastern Health Annual Report 2009-10
2009-10 2008-09 2009-10 2007-08 2008-09 2007-08
1500 Wantirna Health 1200 Peter James Centre Maroondah Hospital 900 Healesville & District Hospital 600 Angliss Hospital 300
0 2007-08 2008-09 2009-10
Angliss Hospital Maroondah Hospital Peter James Centre Healesville & District Hospital Wantirna Health Mental health services our programs and services
> Mental health services
Eastern Health is a leading provider of mental healthcare services. We have more than 20 mental health service locations including inpatient and community settings. Our mental health services include services for children, adolescents, adults and the elderly. We also provide primary health, Turning Point Alcohol and Drug Centre incorporating eastern region alcohol and drug services and Spectrum statewide personality disorder service.
Highlights
• Development of the new mental health Consultant psychiatrist Dr Amy Rooke (centre) is pictured with trainees service plan 2010-2015 Dr Kirsten Borland and Dr Christopher Shing at the acute adult mental • Amalgamation with Turning Point Alcohol health inpatient unit 2 at Maroondah Hospital and Drug Centre • Redesign and integration of child and The amalgamation supports the Director of Turning Point has occurred. youth services to promote accessibility following aims: Professor Dan Lubman commenced in April • Reduced the number of patients who • Develop the strengths of both Turning 2010 and is working to promote Turning stayed in the emergency department more Point and Eastern Health’s alcohol and Point as a centre of excellence in the field of than eight hours other drug services addiction studies. • Enhance the capacities of both Turning Development of the new mental Point and Eastern Health in research and Relocation and upgrading health service plan 2010-2015 development of Healthlink services • Utilise Eastern Health’s strong corporate Building on service delivery improvements Healthlink is the telephone and web-based governance and management structures to that flowed from the Eastern Health Mental service operated within Turning Point. It support Turning Point while it focuses on its Health Service Plan 2005-2010, a plan for has contracts for service with Victorian, core business 2010-15 was developed for our mental health, Commonwealth and other state and territory • Increase clinical service delivery for people Turning Point, alcohol and drug program. In governments, as well as non-government facing alcohol- and drug-related harms developing the strategy, the reform domains organisations. Healthlink provides drug, • Use the synergies between the catchment- contained within the Victorian mental health alcohol and gambling counselling services. based and statewide services to develop reform strategy, Because Mental Health Matters, Current services include the 24/7 DirectLine, capacity in areas such as dual diagnosis, were considered and encapsulated. With Drug and Alcohol Clinical Advisory Service, translational research and addiction the intention to develop a contemporary Drug Diversion Line, Disposal Helpline, Youth medicine services. plan consistent with statewide direction, we Substance Abuse Service line, Counselling have developed a comprehensive service Eastern Health’s mental health, alcohol and Online and Gambler’s Help Line. plan that will provide a framework for service drug services have a strong history and The need to relocate Healthlink and improvement across Eastern Health and commitment to working in partnership improve its technology infrastructure was ensure future capacity will be in keeping with to improve outcomes for consumers of identified and a comprehensive upgrade the community’s needs. Eastern Health’s services. We have welcomed and replacement of outdated infrastructure the opportunity to strengthen our service has taken place. This will support Healthlink Amalgamation with the Turning delivery, education, training and research in in continue to develop and provide its Point Alcohol and Drug Centre Melbourne as well as extend our involvement innovative and progressive model of with services in Victoria and nationally. service provision. On 5 October 2009, Eastern Health was amalgamated with Turning Point Alcohol and The joint appointment with Monash Centre (Turning Point), in order to support the University to the position of Professor of organisation’s strategic direction. Addiction Studies and Services and Clinical
Eastern Health Annual Report 2009-10 43 our programs and services mental health services
Innovations in mental health We have completed a comprehensive service Challenges and future plans inpatient care redesign that will provide a new Child Youth An ongoing challenge in the provision of and Family Mental Health Service for people In early 2010, Eastern Health’s three acute mental health services is the shortage of up to 25 years their families. It provides a adult mental health inpatient units, at Box Hill labour resources, which requires us to plan coordinated, integrated approach, enhancing and Maroondah hospitals, were made ‘open’ our needs and recruit proactively. A number access and the provision of appropriate care wards. That is, the doors are physically open of priorities have been identified to help meet that considers a young person’s stage of life. most of the time. This supports provision of these and other challenges in the provision of care in the least restrictive manner, supports Regional partnerships with non-government effective and timely mental health services for movement around the units and provides a organisations and other relevant agencies the community. They include: friendlier and more comfortable environment will be strengthened to promote a health • Utilising the Eastern Health brand and for patients, staff and visitors. It also supports and wellbeing youth hub in Box Hill to strategic plan to promote Eastern health as easier integration of patients into the enhance engagement of youth and their an attractive place to work Average inpatient length of stay community following their hospital stay. families. It will support better mental health • Collaborating with Australian Catholic and wellbeing for community members via a University to consider the implementation At Maroondah Hospital’s two acute adult Service 2007-08 2008-09 2009-10 common referral pathway; engaging young of a major in mental health studies for mental health inpatient units, an area Child & adolescent mental health 10.8 11.5 11.3 people in seeking help for their own health undergraduate nursing students designated for women only (accessible via and wellbeing issues; enhancing intensive Adult 14.1 13.9 13.4 swipe card access) has been established to • Strengthening our partnerships within outreach support; and an agreed ‘no wrong Aged 29.7 30.3 29 enhance safety and sensitivity for the sector to ensure members of the door’ policy. The aim of the redesigned community receive appropriate treatment Total 16 16 15.5 vulnerable women. service is to reduce the prevalence of mental and care in a timely manner health problems and disorders among young • Development of innovative strategies New youth mental people, as well as the associated impacts on in the provision of care that promote health services their health, development and wellbeing. accessibility such as web-based therapies The Victorian mental health reform strategy, • Development of strategies to reduce We are continually working to ensure Because Mental Health Matters, was launched the incidence of re-admission after an mental health patients leave hospital as in February 2009. It highlights reforms for admission to an acute inpatient unit soon as they are ready and that they are well development of new service frameworks • Strengthening of the relationship between supported, in order to prevent readmission for people up to 25 years and their families. Turning Point Alcohol and Drug Centre wherever possible. Funding is provided for more clinical positions and the broader range of services provided specifically focused upon youth mental Mental health services staff work closely with by Eastern4000 Health, particularly in relation health, youth justice and youth Aboriginal our emergency departments to ensure a to research collaboration, education and 3000 mental health. timely transfer of patients. training opportunities
2000
1000 Mental health Average inpatient Emergency presentations community contacts length of stay – mental health and alcohol & drug 0 Angliss Hospital Box Hill Maroondah 150,000 40 Hospital Hospital Spectrum 4000Aged 150,000 2007-08 120,000 SpectrumAged Adult 30 2008-09 120,000 Aged 3000 Adult Child &2009-10 adolescent mental health 90,000 Adult 90,000 20 Child & adolescent mental health Child & adolescent mental health 2000 60,00060,000 10 30,00030,000 1000
00 0 0 2009-10 2007-082007-08 2008-092008-09 2009-10 2009-10 2007-08 2008-09 2009-10 Angliss Hospital 2008-09Box Hill Maroondah Hospital Hospital 2007-08 Child & adolescent mental health Adult Aged Spectrum 2007-08 Child & adolescent mental health AdultChild & Agedadolescent mentalSpectrum health Adult 2008-09Aged Spectrum 2009-10 44 Eastern Health Annual Report 2009-10
2009-10 2008-09 2007-08 outpatient services our programs and services
> Outpatient services
Outpatient services, also known as specialist in 2008-09. It is designed to coordinate the function is noted, they will be offered a review clinics, are provided from Angliss, Box Hill and management of patients who have hip and/or appointment to determine whether further Maroondah hospitals, as well as Yarra Ranges knee osteoarthritis and enables patients to be management is required. Health. They are specialist private and public prioritised on outpatient and elective surgery Another initiative of the service is the ‘Get clinics including general and specialist surgery waiting lists according to clinical need. fit for surgery’ program at Box Hill Hospital (such as orthopedics) and specialist medical The service supports appropriate use of and Whitehorse Community Health Centre. clinics (such as gastroenterology). specialist orthopaedic services, provides Such programs have been shown to support Highlights early comprehensive assessment of patients, patients’ recovery by reducing hospital stays, enables fast-tracking of patients to surgical complications and the need for rehabilitation, • Development of a communication system assessment as appropriate and provides as well as decreasing patients’ anxiety. which will facilitate contact with general early referral for conservative management. practitioners and patients Patients have indicated a high level of • Commencement of a redesign Challenges and future plans satisfaction with the service. project designed to improve the The ability to meet demand for our services in a patient experience In 2009-10, more than 500 patients attended timely way, particularly for non-urgent services, • Expansion of specialist clinics provided the OAHKS service at Box Hill and Maroondah is a continual challenge and area for focus. at Eastern Health hospitals. Of them, more than 40 per cent Also, infrastructure constraints at some of our • Introduction of short-message service were referred to an orthopaedic surgeon older sites provide a challenge in our ability to (mobile phone SMS) appointment and some 57 per cent were referred for expand services. We have a number of plans in reminder services at Box Hill and conservative management or discharged place to meet these challenges including: Maroondah hospitals because they did not need surgery. That • Appointment of an Associate Program is, patients were seen by an orthopaedic Director of Specialist Clinics for Eastern surgeon when they were ready for surgery More services Health, in order to progress service and patients who were not ready for development across Eastern Health During 2009-10, new specialist clinics were surgery were referred for more conservative • Continuing the redesign project established to expand services provided to treatments such as physiotherapy, to improve patients’ experience of our the community. hydrotherapy or dietetics. specialist clinics Also, the OAHKS service provides monitoring • Implementation of our new communication Osteoarthritis hip of patients listed for elective surgery. Patients system across Eastern Health and knee service are assessed periodically using a self-report • Implementation of an electronic The osteoarthritis hip and knee service questionnaire that helps to examine pain and Medicare billing system to streamline (OAHKS), was introduced at Eastern Health function. Where deterioration in a patient’s administrative processes
Specialist clinics established 2009-10 Specialist clinic activity – patient attendances Angliss Hospital Maroondah Hospital Yarra Ranges Health 100,000 Yarra Ranges Health Endocrinology Endocrinology Urology 80,000 Maroondah Hospital Gestational diabetes Gastroenterology Breast oncology Box Hill Hospital 60,000 Paediatric medicine Irritable bowel disease Dysplasia and colposcopy gynaecology Angliss Hospital 40,000 Plastics Liver Gastro-intestinal oncology 20,000 Renal Haematology Diabetes endocrinology 0 Respiratory Renal Oncology 2007-08 2008-2009 2009-10 Respiratory Lung and melanoma oncology Lymphoedema Angliss Hospital Box Hill Hospital Angliss Hospital Box Hill Hospital MaroondahMaroondah Hospital HospitalYarra Ranges PeterHealth James Centre Healesville & District Hospital Yarra Ranges Health
Eastern Health Annual Report 2009-10 45 our programs and services Patient support services
> Patient support services
Patient support services include medical • Expansion of our radiology service at commenced across all laboratories including imaging, pathology and pharmacy services Wantirna Health and Peter James Centre Box Hill Hospital’s intensive care unit. and are provided across all our sites. These • Introduction of evening outpatient During the past four years, pathology activity vital and integral diagnostic and associated ultrasound services at Maroondah Hospital has increased by 23.5 per cent across our services are part of the patient’s journey of • Upgrading of general x-ray equipment at health service with the largest increases care. Up to 70 per cent of patient diagnoses both Peter James Centre and Healesville experienced at our Maroondah laboratory, are based on these services and demand is and District Hospital which grew by 31.8 per cent over this period. expected to continue. Other support services • Installation of a new state-of-the-art are food, cleaning, waste management, stereotactic breast biopsy system at contract management, linen, security, meal Maroondah Hospital Pharmacy delivery and patient transport. • Installation of a new DEXA bone Pharmacy Departments are located at mineral density evaluation unit at Angliss, Box Hill and Maroondah hospitals, Maroondah Hospital Highlights as well as Peter James Centre and Wantirna • Completion of the first stage of the Health. Outpatient dispensing services • Implementation of the latest technologies Commonwealth Department of Health and are provided at Turning Point for clients in medicine management Ageing radiology accreditation process experiencing drug and alcohol problems. • We conducted 6 per cent more medical A new Director of Pharmacy was appointed imaging examinations than last year Pathology • In 2009-10, we processed a 7 per cent in November 2009 and two specialist increase in total pathology episodes on Laboratory services operate continuously clinical pharmacy positions have been the previous year with strongest growth at our Angliss, Box Hill and Maroondah established in the areas of nephrology at Maroondah Hospital (12.7 per cent) and laboratory sites. Daily phlebotomy ward and mental health. As well as providing growth at Angliss and Box Hill hospitals rounds are performed at these hospitals, as a clinical service to patients, these positions of approximately 5 per cent over the well as services to Peter James Centre and provide pharmaceutical advice across same period Wantirna Health. Community based services Eastern Health. operate at Box Hill, Tecoma and Yarra Ranges. • We exceeded our internal and external Five intern pharmacists are trained across cleaning audit scores New automated clinical chemistry analysers our health services, including rotation to have begun operation at our Angliss and other sites and attendance at regular group Medical imaging Maroondah hospital laboratories, with Box education sessions. In November 2009, all Hill to follow in July 2010. An improved, interns completed their registration exams In 2009-10, our medical imaging activity integrated network blood gas service and became fully qualified pharmacists. increased. We conducted almost 11,000 more medical imaging examinations than the previous year.
In 2009-10, we implemented new or Medical imaging activity enhanced medical imaging services and – examinations performed technologies including: 100,000 • Investment in a new state-of-the-art Peter James Centre/Wantirna Health SPECT/CT nuclear medicine camera at 80,000 Maroondah Hospital Maroondah Hospital; this technology Healesville & District Hospital 60,000 blends both CT and nuclear medicine Box Hill Hospital images to give doctors more 40,000 Angliss Hospital detailed information on the nature 20,000 of certain diseases • Introduction of a new mobile digital 0 radiography system at Box Hill Hospital for 2008-09 2009-10 use in the intensive care area Angliss Hospital Box Hill Hospital • Installation of a new multi-purpose digital Maroondah Hospital Peter James Centre fluoroscopyAngliss Hospital unit at Box Hill BoxHospital Hill Hospital HealesvilleMaroondah & District Hospital Peter James Centre Healesville & District Hospital Yarra Ranges Health
46 Eastern Health Annual Report 2009-10 Patient support services our programs and services
planned project ‘protected meal times’ aims to ensure patients receive the nutrition they need, cultural and dietary requirements are met and that their overall experience related to meals is positive.
Hospital food that is culturally and religiously acceptable is important not only for nutritional provision for patients but also for the patient’s wellbeing.
During March-May 2010, a project to investigate the provision and acceptability of culturally appropriate meals for inpatients of Eastern Health facilities was conducted. Dieticians at Eastern Health’s Nutrition Glenys Ross works in the kitchen at Healesville and District Hospital Departments supported dietetics students from Monash University in the collection of Support services management systems including the information on meal provision and patient installation of card balers and general food experiences during admission at five Eastern Health’s support services waste compactors, as well as expansion Eastern Health facilities. More than 300 include the management and/or direct of recycling streams. This has provided for inpatients from over 41 cultural groups were provision of cleaning services, catering increased recycling and better systems for surveyed. The recommendations include: services, distribution services, patient managing Eastern Health’s waste. • Provision of a limited selection of food support assistants, security services, options that are highly acceptable and grounds and gardens, linen services culturally appropriate and waste management. Our services Food services • Presentation of menus translated in are provided across the organisation via During 2009-10, we received positive languages other than English, a pictorial a combination of internal services and feedback on our food services provided menu and clearer explanation of specific contractual arrangements. throughout Eastern Health facilities. menu items Our achievements and activities in Together with other healthcare services, we • Creation of a consumer information 2009-10 included: participated in the monthly metropolitan brochure for each site, which outlines • Achievement of consistently high results meal service questionnaire coordinated by the food availability, menu layout, menu ordering process, how the menu caters for for both internal and external cleaning Victorian Department of Health. It involved different dietary requirements/preferences, audit scores, which exceed the standards surveying approximately 500 patients each answers to frequently asked questions and specified by the Victorian Department month at Angliss, Box Hill, Healesville & relevant contacts of Health and our contractual key District and Maroondah hospitals, as well as • Support for patients in ordering their own performance indicators Peter James Centre and Wantirna Health. We meals from the hospital menus, as required • Implementation of the new Cleaning benchmarked patient satisfaction in three key Standards for Victorian Health Facilities, areas: enjoyment of the meal, suitability of These recommendations are being together with a new cleaning auditing serving temperature and adequacy of serving considered as part of a review of Eastern software system to assist in monitoring the size. Our overall performance in the past year Health’s policy on inpatient food provision. new standards was favourable with the target of 85 per cent In 2010-11, we will implement the • Participation in the Victorian Department or higher achieved. Healthy Choices: Food and Drink Guidelines of Health’s ResourceSmart program, as A range of improvements in food services are for Victorian Public Hospitals within Eastern well as involvement in the development underway to improve processes and increase Health’s food services outlets including and improvement of environment and satisfaction related to patient meals. cafeterias and kiosks. sustainability programs and processes for Eastern Health Our support services and clinical areas are • Implementation of improved waste collaborating on a number of projects. One
Eastern Health Annual Report 2009-10 47 48 Eastern Health Annual Report 2009-10 Our sites A great patient experience
Highlights
in August 2009, Angliss Hospital celebrated its diamond anniversary and 70 years of service to the community
Maroondah Hospital was among five hospitals in Victoria selected to participate in the medicine redesign project
patient admissions at Box Hill Hospital rose by 5.7 per cent due to our new renal services
$3 million Victorian Government funding announcement for Healesville and District Hospital, which represents a significant investment in infrastructure at the site
together Peter James Centre and Wantirna Health admitted 125 more patients than last year
EasternEastern HealthHealth AnnualAnnual ReportReport 2009-102009-10 49 our sites
> Angliss Hospital
Angliss Hospital is a 230-bed facility located New facilities have been established at the in Upper Ferntree Gully at the foot of the hospital (level 1, opposite the courtyard) to Dandenong Ranges. We provide a wide range accommodate the library and Eastern Health of general health services to the community. Clinical School, which coordinates medical A residential aged care facility, known as the student training across Eastern Health. It will Edward Street nursing home, is co-located help to provide for a planned increase in with the hospital. Our community extends the number of medical students rotating to from the south of Knox to the south-west of Angliss Hospital. the Yarra Ranges, as well as the Croydon and Assistant Nurse Unit Manager Nicki Jewell, Ringwood areas of Maroondah. Our services who works in our day procedure unit, include emergency medicine, general surgery, received a June Allen Practice Enhancement general medicine, midwifery, paediatrics and Fellowship from the Nurses Board Victoria rehabilitation, as well as programs to care for (valued at $2000) to support development patients in their own homes. of a paediatric educational DVD for children having surgery. Highlights
• In August 2009, Angliss Hospital celebrated surgery, respiratory medicine, endocrinology, Challenges its diamond anniversary and 70 years of gestational diabetes, paediatric medicine, Our emergency department has continued service to the community plastics and renal clinics. to experience a significant increase in the • In November, 2009 the Angliss Hospital complexity and acuity of patients on the Angliss Hospital has expanded its antenatal Family Birth Centre celebrated its tenth previous year. Also, overall presentations at services with further clinics at Yarra Ranges anniversary and 2504 births since it opened our emergency department have increased Health and establishment of new maternity • A new nurse call system was installed at by 2.4 per cent. wards 2 east, 2 west and 1 west, replacing clinics at Angliss Hospital including: a system that was 40 years old. It provides • A foetal maternal assessment clinic Like many hospitals, an ongoing challenge is greater functionality with the ability to providing antenatal assessment and being able to attract staff with the appropriate distinguish between calls of varying monitoring services skills and expertise. Following an independent urgency alerting staff. • An early pregnancy bleeding clinic and a review of our medical workforce profile • Our emergency department was awarded midwifery-led ‘booking in’ clinic commissioned in 2008, we have implemented a number of recommendations including a grant from the Victorian Department of All these clinics have been developed to appointing a Director of Medicine, a dedicated Health to participate in a pilot program meet a growing demand for onsite publicly Director of Medical Services and Directors of with the Australian Red Cross to implement funded antenatal care and improved Obstetrics, Gynaecology and Anaesthetics. a volunteer program. This was successfully clinical governance of our birthing services. These senior medical roles will enhance the completed and a group of almost 40 Importantly, these developments ensure provision of high quality services, training and volunteers regularly attends to assist all women giving birth at Angliss Hospital support for junior medical staff and additional patients and visitors. expertise expected by our local community. • Three important new medical positions have access to a range of antenatal support were established including Royal Australia services and early risk identification during and New Zealand College of Obstetrics their pregnancy. Future plans and Gynaecology accreditation for a new There are planned increases in outpatient obstetrics and gynaecology registrar Community involvement clinics for 2010-11 for general surgery, and Australasian College of Surgeons On 15 March 2010, we held our annual paediatric medicine, general medicine, accreditation for two senior registrar endocrinology and gestational diabetes. training positions golf and bowls day, in which staff, local businesses and community groups came We will work to implement any together to enjoy the sports and raise money recommendations from the maternity More services for the hospital. Approximately 100 people services review currently being under taken During the past 12 months, we have participated in the thirteenth annual event, in collaboration with the Eastern Health commenced outpatient clinics in general which began in 1997. Women’s and Children’s program.
50 Eastern Health Annual Report 2009-10 our sites
> Maroondah Hospital
Maroondah Hospital, located in Ringwood Better access In 2009-10, Maroondah Hospital has six East, is a 326-bed metropolitan teaching approved advanced training positions in Maroondah Hospital is a popular health hospital that provides secondary acute care general medicine, as well as advanced service with Victoria’s largest group of and mental health services. Commissioned trainees in endocrinology, gastroenterology unstreamed general medicine patients at any in 1976, we have been providing public and oncology. given time. Despite increasing demand for healthcare services to the community of our services, we are continually working to Melbourne’s outer-east for more than 30 years. improve access to services and in 2009-10 we Community involvement Our services include emergency medicine, achieved the following improvements: general and specialist medicine, general We engage with our local communities • Despite more emergency presentations via and specialist surgery, ambulatory and through a range of events and groups ambulance, Maroondah Hospital was on allied health services. The hospital is a major including service clubs, church groups, local ambulance bypass less than 3 per cent of provider of specialist mental health services government and local businesses. the time throughout the year including contemporary inpatient facilities for • Since November 2009, no patient has On 25 October 2009, Maroondah Hospital adults and community mental health services hosted its third fun in which 600 people throughout Melbourne’s outer-east. waited more than 24 hours for admission to a hospital bed participated raising more than $6000 • More patients were admitted to a hospital in support of men’s health projects at Highlights bed within eight hours – this proportion Maroondah Hospital. • Opening of our Education Precinct, increased by 13.4 percentage points on the On 25 February 2010, Maroondah Hospital which provides teaching space for previous year hosted its fifth charity golf day, which medical students from Deakin and attracted 116 participants and raised Monash universities Teaching and training approximately $53,000. • The hospital’s new ward on level 3 east Funds raised at these events are used was officially opened Together with Angliss and Box Hill hospitals, to directly benefit patients of • Visits to Maroondah Hospital by Federal Maroondah Hospital is part of a robust Maroondah Hospital. Minister for Health and Ageing Nicola physician training program at Eastern Health. Roxon MP (December 2009) and then- In 2009-10, it had 20 Fellow of the Royal Prime Minister Kevin Rudd (March 2010) Australasian College of Physicians clinical Challenges and future plans • Maroondah Hospital was among five exam candidates. Basic and advanced While Maroondah Hospital has undergone hospitals in Victoria selected to participate physician trainees experience an active and significant capital and service development in the medicine redesign project broadening clinical training program. Eastern in recent years, an ongoing challenge is Health also has Australia’s first modular the management of increasing demand advanced training in acute care medicine, for services, particularly for emergency and a two-year program involving acute care orthopaedic services. medicine and intensive care medicine. In 2010-11, two new orthopaedic surgeons An annual host of the Royal Australasian will be joining the hospital to support care College of Physicians (RACP) clinical and management of orthopaedic patients. examination, Maroondah Hospital is a 12-candidate centre. In 2010-11, we will also We have plans expand our endoscopy host the special exit-level RACP overseas and respiratory services at the hospital trained physicians’ exam for specialists seeking and we are continuing to improve our entry to the Australian physician workforce. services by undertaking redesign projects in general medicine, outpatients, neurology Having grown rapidly during the past five and surgery. years, Maroondah Hospital has medical students from Monash and Deakin universities. A planned expansion of the Department of Medicine in late 2010 will make this a centre for training in general medicine.
Eastern Health Annual Report 2009-10 51 our sites
> Box Hill Hospital
Box Hill Hospital (opened 1956) is the largest of our acute hospitals and has more than 48,000 admissions each year. We have 365 inpatient beds, six operating theatres and an emergency department that receives more than 42,000 presentations each year. We provide a wide range of healthcare services including maternity, general medicine and surgery, emergency care, intensive care, post- acute care programs, mental health services, teaching and research. We are a university teaching hospital affiliated with Monash, La Trobe and Deakin Universities.
Highlights
Highlights over the year include: • The Victorian Government committed received 1560 more attendances than last year. by Peter James Centre together with the a further $407.5 million funding for Our priority is patient-centred care and this has Box Hill Hospital physiotherapy department redeveloping Box Hill Hospital with the been central to our re-design project. Initially and ward 1 east. Patients are referred to the first stage a project funded by the Victorian Department program via Box Hill Hospital’s osteoarthritis (5 Arnold Street Box Hill) completed in 2008 of Health to improve the patient journey for hip and knee service (OAHKS). The group- • Box Hill Hospital was officially accredited as people discharged home from the emergency based program assists people who are a ‘baby friendly’ hospital department, it has become an integral part of waiting for orthopaedic surgery and helps • Patient admissions rose by 5.7 per cent its culture and philosophy of care. to prevent health deterioration through due to our new renal services education and exercise designed to improve Occasions of ambulance bypass has • A total of 6177 patients on our elective their function, mobility and strength while decreased significantly: in 2008-09 Box Hill surgery waiting list received treatment waiting for surgery. Hospital was on bypass 4.3 per cent of the • Our patient flow project reduced the time and in 2009-10 this was more than number of patients who were cared for in halved to 2.1 per cent. Redevelopment of our emergency department for more than Box Hill Hospital 24 hours from 21 people in 2008-09 to two In February 2010, the Australian College of people in 2009-10 Midwives Executive Officer approved ‘Baby In December 2009, the Victorian Government Friendly Hospital’ accreditation for Box Hill announced $407.5 million funding for the Hospital. Birralee Maternity Unit underwent redevelopment of Box Hill Hospital. The Improvements in care a stringent audit by three international redevelopment will provide a new building The new rapid assessment medical unit board-certified lactation consultants. Our on the site where the Clive Ward building (RAMU) model of care has helped to reduce commitment to current, evidence-based currently stands and refurbishment of existing the general medical length of stay by breastfeeding practice and application of buildings. It is the largest single suburban 1.7 days, thus saving approximately 520 bed the ‘10 Steps to Successful Breastfeeding’ in health infrastructure project in Victoria, due for days per month. This innovative approach to all aspects of care of mother and child was completion in 2015. providing a consolidated and dedicated team independently evaluated by a community The redevelopment reflects the key of healthcare professionals to care for these representative, hospital midwifery requirements described by Eastern Health and patients has enhanced their experience of our representative and a neonatologist. The the Department of Health to meet the needs hospital. It has helped to reduce time spent achievement acknowledges that Box Hill of our local communities for the next decade in the emergency department and ensured a Hospital actively supports and promotes and beyond. The increased capacity will faster transfer to the appropriate point of care. breastfeeding. enable us to meet increasing demand with: Emergency demand continues to increase The ‘Get Fit for Hip and Knee Surgery’ • More than 100 more beds (including 30 and in 2009-10, our emergency department community rehabilitation program is held sub-acute beds)
52 Eastern Health Annual Report 2009-10 our sites
• An expanded emergency department within the intensive care unit and erection has contributed to purchasing medical • Six more surgical theatres and four of a platform spanning the west and north equipment such as vital signs monitoring refurbished theatres wings of the hospital to accommodate new equipment, electric low beds, wheelchairs • A major upgrade to critical care services air handling units for level 4 theatres and portable IV trolleys. including a new intensive care unit and • Construction of the steel structure to Throughout 2009-10, Box Hill Hospital’s new cardiology precinct support stage 1 of the new link-way that emergency department was well supported • Dedicated women’s and children’s precinct will connect the main hospital with Upton by 67 trained Australian Red Cross volunteer • New oncology and haematology ward House and the Adolescent Inpatient Unit staff, known as EDcare volunteers. They • New cardiac catheter and (AIPU) began. This will replace the present provide practical and emotional support endoscopy facilities link when it is demolished as part of the for patients and visitors when attending enabling works These great improvements will support our emergency department. staff in treating our patients efficiently and We welcome opportunities to consult and promptly in facilities specifically designed Community involvement engage with our local community, often for their needs. Box Hill Hospital has close ties with local providing guest speakers for local service Enabling works commenced in April 2010 to communities reflected by our robust clubs on a range of health-related topics. prepare the site for the new facility. All staff volunteer program. We have 350 volunteers who perform a range of operational and have been relocated from the Clive Ward Challenges and future plans building in preparation for its demolition support roles including operation of two with most having moved to the building at kiosks, volunteer-operated patient transport We are working to meet the challenge of 5 Arnold Street Box Hill. services, raffles, various stalls and operation maintaining services at Box Hill Hospital small change. with as little disruption as possible to staff Staff and the local community are being kept and patients during enabling works and The volunteer kiosk at Box Hill Hospital, up to date with the project’s progress by significant redevelopment of the hospital. bulletins and forums. which is staffed by some 120 volunteers and supervisors, celebrated 40 years of service in Improvement works for the four operating September 2009. theatres on level 4 of the hospital is planned Improvements to infrastructure for the end of 2010. They include installation Volunteers, supervisors, patients and staff During the past 12 months, significant of new air handling units, resurfacing of walls celebrated the milestone achievement in physical improvements have been made and upgrading of both the recovery room service to patients, staff and visitors. To mark across Box Hill Hospital in order to maintain and central sterile supply department. This the special occasion, the first 200 hundred services during the Box Hill Hospital upgrade will greatly assist in the management customers received birthday cupcakes. redevelopment project. These included: of elective and emergency surgery demand • Refurbishment of patient bathrooms, floors In its 40 years of operation, the kiosk has leading up to the completion of the Box Hill and the play room in the paediatric ward raised a remarkable $4,867,820, which Hospital redevelopment project in 2015. • Improvements to the hospital’s original operating theatres on level 2, including replacement of theatre lights, resurfacing of walls and removal of obsolete equipment to maximise storage. During this time, elective and emergency surgery was undertaken in the operating theatres on level 4. • Major structural works were undertaken on level 3 to accommodate a new Department of Respiratory Medicine and Sleep Studies • Improvements to the quality of air within the hospital were made with the Semon Wain is the Consultation Liaison/Psychiatric Nurse installation of a new air handling unit Consultant at Eastern Health, based at Box Hill Hospital
Eastern Health Annual Report 2009-10 53 our sites
> Yarra Ranges
Our Yarra Ranges service includes two Eastern Health sites in the outer east – Healesville and District Hospital and Yarra Ranges Health.
Healesville and District Hospital (established 1957) is a 19-bed acute hospital in the Yarra Valley that provides low-risk maternity services managed by local general practitioners and basic elective surgical services, as well as general medical and rehabilitation services. We serve an area of some 2000 square kilometres, including the townships of Healesville, Yarra Junction, Warburton and Yarra Glen, as well as smaller rural communities. We work closely with local health services to provide our community with a range of services that support their overall health and well being. patients. This has resulted in more patients Challenges Yarra Ranges Health (established in 2008) is being able to access their local hospital and With services across Yarra Ranges continuing a day facility centre located in Lilydale. We receive their care closer to home to grow, it is a very busy and dynamic provide a range of specialist day, rehabilitation • Development of specialist outpatient environment. Increasing client numbers and outreach services including day surgical services at Yarra Ranges Health, with many can result in increasing demand for space in services, chemotherapy, audiology services specialist clinics opening across the year which to treat our patients. It is also important and a youth mental health service. We including urology, oncology, gynaecology to maintain strong links within Eastern Health aim to improve access to healthcare in and diabetes/endocrinology is a key challenge for Yarra Ranges, in order to disadvantaged areas of Melbourne’s outer- ensure a sustainable service and provision of east and support demand-management Service development the best possible care for patients and clients. at our acute sites. Yarra Ranges is well placed to continue to Another challenge is to maintain service deliver high quality health services to the Highlights delivery at Healesville and District Hospital local community in the eastern region of throughout a significant infrastructure Highlights of our service over the year include: Melbourne. While many of our services grew upgrade. We will focus on ensuring that • The $3 million Victorian Government significantly during 2009-10, there is further patient services are not disrupted during funding announcement for Healesville room for expansion. For example, surgical this time. and District Hospital, which represents a services where appropriate patients awaiting significant investment in infrastructure at elective surgery may be able to have their Future plans the site operations at Yarra Ranges sooner. • Continued expansion of services at Yarra We look forward to continuing to work with Day oncology services, maternity antenatal/ Ranges Health has led to more patients the local community and key stakeholders postnatal care and specialist outpatient clinics being treated by our day surgery, day to provide high quality and accessible health are other areas of the Yarra Ranges service chemotherapy and maternity antenatal/ services to the patients in our local areas, that will continue to expand in the upcoming postnatal teams. Also, our outpatient as we progress the Healesville and District 12 months. rehabilitation and youth mental health Hospital redevelopment and continue to teams have seen more patients than ever We anticipate that with the strengthened expand our services at Yarra Ranges Health. • Strengthening of the inpatient medical inpatient medical cover at Healesville and support at Healesville and District Hospital, District Hospital, more patients will be able to with increased consultant medical and receive general medical or rehabilitation care junior medical staff coverage for our in their local hospital.
54 Eastern Health Annual Report 2009-10 our sites
> Peter James Centre and Wantirna Health
Peter James Centre (established 1985) in East Health led Eastern Health in an active • Refurbishment of the south ward and Burwood and Wantirna Health (established ageing project sponsored by the Victorian centre ward including establishment of 2007) are managed as one service. Together Department of Health. The outcomes from a satellite nurses’ station for close and they provide specialist aged-persons’ mental this project provide a safer environment for timely responsiveness health, geriatric medicine, palliative care, patients across Eastern Health. For example, • Refurbishment of bathrooms throughout rehabilitation, renal dialysis, residential care the project provides clinicians with tools and the facility services and a wide range of ambulatory education to reduce risks of falls, thereby • Improvements to onsite carparking and services, including home-based and centre- improving the quality of care offered for older cafeteria facilities based rehabilitation and specialist clinics. patients across the health service. • Development of the East West Day Room Peter James Centre provides rehabilitation as an area for therapy close to the wards In May-June 2010, Peter James Centre and aged-care services to people following and as a place for patients and their families and Wantirna Health held its second illness or surgery, or who have disabilities or to socialise annual workplace wellness expo. Internal chronic illness. It has 60 rehabilitation beds, • Refurbishment of the ambulatory areas and departments (such as dietetics, music therapy 38 complex rehabilitation beds, 30 residential allied health rehabilitation treatment areas and social work) and 20 external providers aged-persons’ mental health beds and 30 showcased their health services to staff, acute aged-persons’ mental health beds. patients and visitors. Demonstrations included Challenges and future plans Wantirna Health has a 30-bed palliative care massage, yoga and hearing tests. and 30-bed complex rehabilitation ward, as A priority is to ensure food services are well as ambulatory services. During 2009-10, we undertook a significant appropriate for the communities served by service reconfiguration at Peter James Centre, Peter James Centre and Wantirna Health, where there is a strong cultural presence of Highlights resulting in the streaming and consolidation of clinical expertise within specified wards. Italian, Greek and Chinese ethnic groups. • Together, Peter James Centre and Wantirna Wards specialising in areas such as neurology, Eastern Health’s Nutrition Department, Health admitted 125 more patients than orthogeriatrics, and geriatric evaluation and together with Monash University student last year management now provide patients with the dieticians, plan to investigate and promote • Refurbishment of several inpatient benefits of care provided by a multidisciplinary, the delivery of culturally appropriate meals for and ambulatory services across Peter expert team working to ensure appropriate patients at Peter James Centre and Wantirna James Centre care for our patients. This model of care Health in March 2011, as part of a food • Opening of a new children’s playground at provides efficient, high quality rehabilitation services learning placement. Wantirna Health’s palliative care unit services to all our patients, reducing the length • Leadership of an active ageing project In the area of teaching and research, Peter of hospital stay and ensuring all patients sponsored by the Victorian Department James Centre will be pivotal in a future receive appropriate, safe and timely treatment of Health to create a safer environment for research study on older drivers called from expert clinicians. older patients coming to Eastern Health AusCanDrive study, which is being funded by the Australian Research Council and will be Improvements to the located in the recently refurbished medical Improving services built environment and research precinct. Eastern Health is a Improvements have been made in medical partner in the study, designed to examine In August 2009, staff and members of the local staffing for the 38-bed geriatric evaluation the experiences of 200 drivers aged 75 or community celebrated the opening of a new and management unit at Peter James Centre. older over five years, in order to describe the outdoor children’s playground area at Wantirna The change has brought about a reduction in characteristics of safe older drivers. Health’s palliative care inpatient ward. The patients’ length of stay, allowing them to return construction and landscaping of the playground There are further plans to use the medical to their homes and communities sooner, and was made possible with the support of local and research precinct for teaching, research improvements in the quality of care. businesses, staff and their families. and audit activities designed to improve the Renal dialysis services, previously offered as processes of healthcare. Peter James Centre will mark its 25th an ambulatory service, were extended to anniversary in July 2010. To maintain the Plans to celebrate the 25th anniversary of inpatients at Peter James Centre, such that quality of care provided from this site, various Peter James Centre, which was commissioned bed-based dialysis services are now available. refurbishments have been undertaken in July 1985 and officially opened in Together Peter James Centre and Wantirna including: December of the same year, are underway.
Eastern Health Annual Report 2009-10 55 56 Eastern Health Annual Report 2009-10 Our corporate performance A great achiever in sustainability
Highlights
implementation of HealthSMART Clinicals continued with the first stage introduced at Box Hill Hospital
the Eastern Health Strategic Plan 2010-15 was developed
the Eastern Health library service was formed in January 2010 and has responded to 2500 requests and processed 3890 loans
EasternEastern HealthHealth AnnualAnnual ReportReport 2009-102009-10 57 our corporate performance
During 2009-10, we continued to strengthen safety and the provision of efficient, high organisations. Also, we held a community our corporate performance via strategic quality services and importantly, ensure risk- forum which helped to inform us approaches to all of our operations designed management is seen as a core component of about stakeholders’ perspectives of our to improve services, conserve resources and Eastern Health service delivery. organisation’s strengths and weaknesses and increase efficiencies. This is demonstrated in areas for focus. Risk-management is overseen by the Board our applications of strategic planning, quality Risk and Audit Committee. We also liaised and consulted with the and risk management and technologies, Victorian Department of Health throughout as well as our management of resources development of the strategic plan. and facilities. Eastern Health medico-legal service In April 2010, a new Strategic Plan was Quality and risk management Recent changes in Eastern Health’s inhouse developed and endorsed by the Eastern legal counsel have provided the opportunity Health Board of Directors and is pending The quality of our services and effective risk- to reconsider and reshape our medicolegal approval by the Victorian Minister for Health. management are ensured by our governance services. A review is underway with a view The new Eastern Health Strategic Plan framework, which encapsulates both clinical to introducing a new Eastern Health wide 2010-15 has been used to inform our annual and corporate governance. It supports an medico legal service. planning activities for 2010-11. environment that supports our mission of providing positive health experiences for people and communities in the east. Accreditation Privacy
We have key structures and processes in In 2008-09, we completed an accreditation We respect the private information that place, which enhance decision-making, review conducted by the Australian Council staff, patients and clients entrust to us and accountability, continuous evaluation and on Healthcare Standards (ACHS) and have are committed to protecting it. We are improvement of care and service delivery. been awarded full accreditation for four years. bound by a strict code of confidentiality and comply with all legislation related to privacy They are grouped under four governance Our four residential aged care facilities at and confidentiality including the following pillars: structures and relationships; Monda Lodge, Mooroolbark, Northside and Victorian Acts: compliance and accountability; strategy Edward Street have been fully accredited by • Health Services Act 1988 and direction; and performance monitoring. the Commonwealth Aged Care Standards and • Information Privacy Act 2000 These pillars influence how the objectives Accreditation Agency. of the organisation are set and achieved, • Health Records Act 2001 how risk is managed and assessed and how Strategy and planning performance is optimised. Freedom of information During 2009-10, we worked to develop Risk assessment and management support Eastern Health’s strategic plan for 2010-15. We comply with the Victorian Freedom of our approach to governance. We support a Information Act 1982 (FOI). During 2009-10, systematic, integrated and multidisciplinary This involved substantial consultation we responded to 1251 FOI requests as follows: approach to risk-management across both with staff, our local community and other clinical and corporate services. This approach external stakeholders such as community- Freedom of information requests 2009-10 relies on a top-down, bottom-up partnership based healthcare providers and other to support identification and responses to healthcare services. Number of requests 1251 identified risks. Using internal surveys and focus group Access provided in full 1124 We believe the adoption of a formal research, staff were encouraged to share Access provided in part 85 approach to risk management improves their views about areas on which the decision-making, performance, accountability organisation should focus during the next Access denied 1 and outcomes. five years. More than 500 staff responded Request withdrawn by applicant 4 to the surveys, providing input for the We have a risk-management policy to ensure Transferred to another agency 4 organisation’s directions. a coordinated, organisation-wide approach Requests not completed by 37 to risk management. It is designed to provide We consulted with primary healthcare 30 June 2010 opportunity for improvement in patient providers and some 80 external stakeholder
58 Eastern Health Annual Report 2009-10 our corporate performance
Competitive neutrality Publicly Owned Buildings 1994 and relevant In June 2010, we introduced the use of statutory regulations. 100 per cent recycled paper across our health We are committed to ensuring that services service following a successful trial. demonstrate both quality and efficiency. We ensure works are inspected by Competitive neutrality, which supports the independent building surveyors and maintain We have also worked to maintain and Commonwealth Government’s national a register of building surveyors, as well as enhance the financial sustainability of our competition policy, helps to ensure that the jobs they have certified and for which health service by implementing financial net competitive advantages that accrue occupancy certificates have been issued. improvement strategies totalling $13.1 million to a government business are offset. We cost savings in 2009-10. Particular areas of understand the requirements of competitive All building practitioners are required to show success include improvements in reduced use neutrality and act accordingly. evidence of current registration and must of nurse agency staff, improved management maintain their registration status throughout of staff leave and greater utilisation of private We support the principles of the the course of their work with us. health insurance among admitted patients artnerships Victoria policy, which relates to who have private health insurance. responsible expenditure and infrastructure All contractors engaged by us in construction projects, and the creation of effective projects are approved by the Victorian partnerships between private enterprise Department of Infrastructure. HealthSMART Clinicals and the public sector. Eastern Health implemented the first stage Sustainability initiatives (release 1a) of HealthSMART Clinicals at Victorian industry Box Hill Hospital on the 30 November 2009 During 2009-10, we continued to extend participation policy taking the first significant step towards a full our sustainability initiatives to encompass electronic medical record. We comply with the Victorian Industry key environmental areas such as recycling, Participation Policy Act 2003, which requires water saving, energy saving and reductions in This has provided benefits and more efficient local industry participation in supplies, taking carbondioxide emissions. processes such as: into account the value for money principle • A consolidated view of results and and transparent tendering processes. Since 2007, we have achieved a 46 per cent discharge summaries in the one place reduction in total waste (comprising clinical, across multiple visits recycling and landfill categories) across all Procurement benchmarking • Patient lists that enable quicker access to our facilities. During the same period, we also patient records and the ability to better We have purchasing and external contract achieved a 29 per cent reduction in waste track patients across the hospital policies in place, which help to ensure our sent to landfill. • The ability to electronically complete and procurement, tendering and awarding review discharge summaries Water conservation continues to improve. of contracts takes place consistently and • Automatic distribution of a discharge appropriately. Our practices reflect the Maroondah Hospital improved its cardboard summary to a general practitioner’s Victorian Government purchasing board recycling with a five tonne per month medical practice software to facilitate principles, policies and processes. improvement. more timely communication and a paperless process Overall, Eastern Health almost doubled its Consultancies • Mobile access supported by an extensive cardboard recycling on the previous year. wireless network to patient information at In 2009-10, we engaged 18 consultants to Since January 2010, more than 20,000 tonnes the bedside during medical rounds – for a total value of $327,393 in a wide range of cardboard has been recycled each month. example, a clinician can review results, of business support areas. There were no We have focused on reducing our check medical history and show a patient consultancies with fees greater than $100,000. carbondioxide emissions through better fleet his/her X-ray to involve them in the procurement initiatives with most of our medical consultation Buildings and facilities fleet made up of four-cylinder vehicles. Our The next release (1b) is due for We comply with building standards and replacement strategy is to purchase, where implementation at Box Hill Hospital from regulations, with all works completed in appropriate, four-cylinder vehicles that have August 2010. It is expected to provide 2009-10 undertaken according to the less than 185 grams carbondioxide emissions significant benefits in patient safety via timely Building Code of Australia, Standard for per kilometre travelled. warnings and alerts to clinicians at the point
Eastern Health Annual Report 2009-10 59 our corporate performance
of prescribing, notifying them of any potential At Angliss Hospital, the library and computer Responsible bodies’ declaration drug/drug and drug/allergy interactions. This laboratory have been located together with In accordance with the Financial Management release will enable clinicians to: the Eastern Health Clinical School in the newly Act 1994, I am pleased to present the report • Generate an electronic prescription for developed education precinct. Library staff of operations for Eastern Health for the year discharge medications for inpatients, have worked with the Victorian Department ending 30 June 2010. emergency and outpatient prescriptions of Health’s new vendor for the Clinicians • Automatically populate a list of medications Health Channel, in order to provide remote to the discharge summary access to a wide range of electronic health related content. Also, two more electronic Further releases will be implemented at bundles of full text journals were purchased, all other Eastern Health sites in 2010-11, Dr Joanna Flynn thereby expanding the available collection. which includes the ability for clinicians to Chair electronically order pathology and medical The Eastern Health library service continues Eastern Health Board of Directors imaging tests and use barcode technology to to support Eastern Health staff and students verify patient and medication. on placement with during their education and research journey with Eastern Health. The HealthSMART Clinicals project is a large Its services include training and database and complex one, in fact the largest clinical searching plus the acquisition, management project undertaken by Eastern Health and and dissemination of knowledge resources. Alan Lilly represents a major change in the way Chief Executive Officer clinicians manage day-to-day patient care. Eastern Health Eastern Health has been working with the Attestation on compliance with 19 August 2010 Victorian Government in developing and Australian/New Zealand Risk implementing this important resource for Management Standard Attestation on data accuracy clinicians in support of high quality safe I, Alan Lilly, certify that Eastern Health patient care. has risk management processes in place I, Alan Lilly, certify that Eastern Health has consistent with the Australian/New Zealand put in place appropriate internal controls Eastern Health library service Management Risk Standard and an internal and processes to ensure that the Victorian control system in place that enables Department of Health is provided with data An extensive review and restructure executives to understand, manage and that reflects actual performance. Eastern of Eastern Health’s library services was satisfactorily control risk exposures. The Risk Health has critically reviewed these controls completed in 2009, which culminated in and Audit committee verifies this assurance and processes during the year. the formation of an organisation-wide and that the risk profile of Eastern Health has service under the direction of the newly been critically reviewed within the last appointed Chief Librarian in January of 2010. 12 months. Consolidation of the service has streamlined processes and enabled resources to be shared more equitably throughout Eastern Health. In 2009-10, the Eastern Health library service Alan Lilly responded to 2500 requests for documents Chief Executive Officer and processed 3890 library loans. Eastern Health Alan Lilly 19 August 2010 Chief Executive Officer Eastern Health 19 August 2010
60 Eastern Health Annual Report 2009-10 our corporate performance
> Our operational performance – activity and funding 2009-10
Acute inpatient Target Result WIES public 67,668 64,710 WIES private 7624 10,285 Total WIES (public & private) 75,292 74,995 WIES renal 1729 1764 WIES DVA 1706 1754 WIES TAC 436 376 WIES Total 79,163 78,889
Sub-acute inpatient Target Result CRAFT 1053 1097 Rehab L1 (non-DVA) 1400 1010 Rehab L2 (non-DVA) 60 595 GEM (non-DVA) 28,837 29,694 Palliative Care – inpatient 10,266 10,260 Transition Care (non-DVA) bed day 25,956 22,809 Restorative care 2126 1915 Rehab 1 – DVA 63 162 Rehab 2 – DVA 2488 1686 GEM – DVA 2887 3094 Palliative care – DVA 1039 921 NHT – DVA 0 28
Ambulatory Target Result VACS – allied health 11,200 15,458 VACS – medical 83,379 91,523 Transition care (non-DVA) –home day 8030 5630 SACS – non-DVA 54,350 71,301 SACS – paediatric 665 781 Post-acute care 3510 3375 VACS – allied health DVA 0 38 VACS – medical DVA 276 114 SACS – DVA 1812 1653 Post-acute care – DVA 600 713
Aged Care Target Result Residential aged care 6998 7019
Community based services Target Result Community health – direct care 26,962 29,309
Eastern Health Annual Report 2009-10 61 our corporate performance
> Our operational performance 2009-10
Operating result Target Result Annual operating result before capital and specific items ($m) (2.5) (1.66)
Cash management/liquidity Target Result Creditors < 60 days 39 Debtors < 60 days 61 Net movement in cash balance ($m) (4.95) 2
Service performance Target Result WIES (public & private) performance to target (%) 98-102 99.6
Elective surgery Target Result Elective surgery admissions – quarter 1 3378 3685 Elective surgery admissions – quarter 2 3598 3366 Elective surgery admissions – quarter 3 2851 2840 Elective surgery admissions – quarter 4 3614 3777
Critical care Target Result Intensive care unit minimum operating capacity – Box Hill Hospital 0 instances reporting below 9 19 Intensive care unit minimum operating capacity – Maroondah Hospital 0 instances reporting below 5 0
Quality and safety Benchmark Result Health service accreditation full compliance full compliance Residential aged care accreditation full compliance full compliance Cleaning standards 85 96.2 Submission of data to VICNISS(1) (%) 100 100 VICNISS infection clinical indicators (2) No outlier (3) 2 outliers Hand hygiene program compliance (%) 60 75.8 ** Victorian Patient Satisfaction Monitor (4) 73 76.08*** *Average of cleaning standard audits for 7 Eastern Health sites for the month of June ** March Audit result ***Wave 17 result (July 2009‑December 2009). Average score for 5 Eastern Health sites (i.e. Angliss, Box Hill, Healesville, Maroondah and PJC)
Maternity Target Result Postnatal home care (%) 90 95.81
Mental Health Target Result 28 day readmission rate (%) 14 16.90
Notes: (1) VICNISS is the Victorian Hospital Acquired Infection Surveillance System (2) The VICNISS indicators are ICU central line associated bloodstream infection surveillance, Coronary artery bypass grafts—deep sternal wound infection surveillance, Hip arthroplasty surgical site infection surveillance and knee arthroplasty surgical site infection surveillance. (3) Outlier is where a hospital is identified as statistically significant for two successive quarters. Testing for statistical significance is performed each quarter, but is based on data from the most recent two quarters for all surgeries (except for joint replacements where comparisons are made on the most recent four quarters). Infection rates for the most recent two quarters are compared against the VICNISS aggregate rate. (4) The Overall Care Index (maximum score 100) is derived from relevant questions from the six key areas of satisfaction in the Victorian Patient Satisfaction Monitor.
62 Eastern Health Annual Report 2009-10 our corporate performance
Access performance
Emergency care Benchmark Result Percentage of operating time on hospital bypass 3 1 Percentage of emergency patients transferred to an inpatient bed within 8 hours 80 73 Percentage of non-admitted emergency patients with length of stay of less than 4 hours 80 69.9 Number of patients with length of stay in the emergency department greater than 24 hours 0 50 Percentage of triage category 1 emergency patients seen immediately 100 100 Percentage of triage category 2 emergency patients seen within 10 minutes 80 79.1 Percentage of triage category 3 emergency patients seen within 30 minutes 75 60.3
Elective surgery Benchmark Result Percentage of category 1 elective patients admitted within 30 days 100 100 Percentage of category 2 elective surgery patients waiting less than 90 days 80 62.9 Percentage of category 3 elective surgery patients waiting less than 365 days 90 84.2 Number of patients on the elective surgery waiting list (1) 3900 3385 Number of hospital-initiated postponements per 100 scheduled admissions 8 7.1
Notes: (1) The target shown is the number of patients on the elective surgery waiting list as at 30 June 2010
Eastern Health Annual Report 2009-10 63 our corporate performance
> Our operational performance – activity
Admitted patients Acute Sub-acute Mental Other Total health Separations Multi-day 51,789 3,275 2,797 57,861 Same day 76,328 25 48 76,401 Total separations 128,117 3,300 2,845 0 134,262 Elective 64,929 3,084 1,134 69,147 Emergency 53,420 13 1,445 54,878 Other 9,768 203 266 10,237 Total separations 128,117 3,300 2,845 134,262 Total WIES 78,889 Total bed days 305,169 73,899 36,306 415,374
Non-admitted patients Acute Sub-acute Mental Other Total health Emergency department presentations 131,647 5,522 137,169 Outpatient occasions of service (VACS & non-VACS clinics) 343,202 343,202 Other services -- occasions of service 74,832 203,307 45,360 323,499 Total occasions of service 474,849 74,832 208,829 45,360 803,870 Victorian Ambulatory Classification System (number of encounters) 88,654 88,654
64 Eastern Health Annual Report 2009-10 our corporate performance
> Our financial performance
The net entity result for the year is a Revenue of $19 million due to the higher cost base on deficit of $28.121 million (prior year deficit buildings given the revaluation in June 2009. Eastern Health’s revenue for the year was $0.580 million). $659.6 million which is an increase of $51.3 The increase in costs was due to rising The year on year deterioration in performance million or 8.4 per cent on the previous year. demand for services both existing and a resides essentially in the capital area: The increase in revenue includes: number of new facilities. This resulted in a • Reduced capital income $8 million - Government Grants of $31.6 million – $48.0 million (11.7%) increase in employment • Increased depreciation $19 million Operating Grants up $40.1 million costs especially: - Capital Grants decreased by $8.5 million - Additional staffing to cover demand The increased depreciation arises due to - Recoupment from Private Practice - Wage increases due to various award additional depreciation on the re-valued assets Agreements of $5.0 million or 35 per cent negotiations and from 2008-09 of $17.04 million. increase - Additional staff with the transfer of business The reduced capital income is a reflection of - Patients fees of $5.2 million or 22 per cent of Turning Point Alcohol & Drug Centre. the timing of projects and will increase over increase There was also an increase in medical, drugs coming years with the Box Hill Redevelopment - Revenue from the transfer of business from and food supplies of $10.3 million due to price Project. The total of $407.5 million is unlikely Turning Point Alcohol and Drug Centre to rises and demand pressures. to all be capital income as some portion will Eastern Health $9 million be direct equity injection by Government - Dialysis Recoveries of $1.4 million as Eastern Cash Investments but nonetheless will bolster the overall equity Health provides Hub dialysis service to position in future years. metropolitan area. At the end of 2009-10, Eastern Health’s cash investments totalled $37.2 million, which is a The key target of the net result before capital Expenses slight increase from $35.2 million in 2008-09. & specific items is reporting a deficit of $1.660 million (prior year $2.538 million). This Eastern Health’s expenses for the year were outcome measures up favourable against $687.7 million which is an increase of the target set of $2.5 million deficit by the $78.8 million or 12.9 per cent on the previous Department of Health and is only 0.2 percent year. The major reason for the increase in cost of operating revenues. is the additional depreciation costs this year
Summary of financial results
2009-10 2008-09 2007/08 2006/07 2005/06 $’000 $’000 $’000 $’000 $’000
Total revenue 659,606 608,343 593,543 514,279 479,906 Total expenses 687,727 608,923 545,000 505,845 472,544 Net result surplus/(deficit) (28,121) (580) 48,543 8,434 7,362
Retained surplus/(accumulated deficit) 23,335 52,595 54,324 8,824 (9,138)
Total assets 560,196 589,376 496,086 401,162 335,952 Total liabilities 174,598 154,951 142,127 126,935 115,026 Net assets 385,598 434,425 353,959 274,227 220,926
Total equity 385,598 434,425 353,959 274,227 220,926
Eastern Health Annual Report 2009-10 65 our corporate performance
> Our performance against strategic priorities 2009-10
Outcome Progress summary
1. Develop the Eastern Health strategic plan
Completion of an Eastern Health The Eastern Health Strategic Plan 2010-15 was successfully completed in April 2010. Eastern Health strategic plan that will provide has been verbally advised that this plan has been endorsed by the Victorian Minister for Health. a framework and roadmap for the provision of health services to people living in the eastern metropolitan region from 2010 to 2015
2. Redevelopment of Box Hill Hospital
Continue to work with the Victorian We are redeveloping Box Hill Hospital to support great health and wellbeing for people and Department of Health to progress communities in the east. The $407.5m redevelopment of emergency, surgery and critical care planning for the redevelopment services, announced in December 2009, will enhance inpatient and ambulatory services and of Box Hill Hospital as a means of provide additional capacity to care for people living in the east. The redevelopment will be responding to the health needs of supported by training, research and state-of-the-art diagnostic services. the community Preparations for the demolition of the Clive Ward Building are underway and a team is being mobilised to manage the project.
3. Develop a comprehensive Eastern Health workforce strategy
Implementation of the Eastern Progress continues on the implementation of the Eastern Health organisational development Health organisation-development strategy with 10 of 21 priority initiatives being undertaken in 2009-10. The key initiatives are a new strategy, including the leadership orientation and induction model for new staff, a mandatory online orientation program for new capability framework and staff, mandatory online occupational health and safety and equal opportunity courses, a new workforce plan, to ensure complete reward and recognition framework with guidelines for local everyday recognition and a new values alignment with our strategic plan award program, a redesigned performance management process and initiation of staff entry and exit surveys. The leadership capability framework has also been finalised. Programs to support leadership development are now offered to staff. Development of a comprehensive workforce plan has been identified as a key priority for 2010-11. A new Eastern Health website and new format for job advertisements were developed in 2009-10.
Strengthen clinical leadership and A new communication structure for senior medical staff was implemented in 2010, a new Clinical engagement across Eastern Health Executive Committee was established and clinical representation was ensured for Program Quality to improve clinical governance and Risk Committees across the organisation. These initiatives have strengthened clinical leadership capabilities and enhance job and engagement across Eastern Health. satisfaction among clinical staff The leadership capability framework was finalised and training programs to support management and leadership development across clinical and non-clinical areas of Eastern Health will commence in the latter half of 2010.
66 Eastern Health Annual Report 2009-10 our corporate performance
Outcome Progress summary
4. Improve patient access to health services across Eastern Health
Re-orientate systems and processes • A new Eastern Health organisational structure was implemented in February 2010. This to achieve an Eastern Health-wide new structure incorporates clinical programs, which are led and coordinated across all approach to access to clinical Eastern Health sites. services in the following areas: • Redesign of Hospital Care program has progressed. Progress has led to substantial improvements • Elective surgery in patient flow and waiting times within the emergency departments. • Emergency • A preliminary issues paper concerning Eastern Health’s outpatient services was completed • Outpatients and considered by the Executive Committee in February 2010. A Redesigning Hospital Care project has been funded by the Department of Health and has commenced as the next phase of this project. • An Eastern Health access taskforce was established in 2009 and a Director of Access was appointed to drive improvements in this important area. The strong organisation-wide focus on access has led to a significant improvement in access indicators across the health service including: - A 90% improvement in the number of emergency patients who were admitted to hospital within 24 hours - For the first time, achieving the external benchmark standard that 80% of patients requiring admission within the emergency department are admitted within 8 hours - Cut two-thirds off the time that our emergency departments are on ambulance bypass - 720 fewer patients waiting and ready for elective surgery compared with 12 months ago. - 659 more patients operated on from the elective waiting list this financial year compared with the previous year. For the first time in the past three years, Eastern Health achieved its waiting list targets with respect to elective admissions and operations performed. - 281 fewer patients waiting for elective admission over their recommended time at 30 June 2010, compared with 30 June 2009 • An Eastern Health access strategy was drafted in 2009-10, with a future focus on elective surgical throughput
Maximise inpatient bed utilisation Since the introduction of the Director of Inpatient Access role at Eastern Health in November across all Eastern Health sites to 2009, there have been a number of new initiatives that have improved patient access. A daily ensure the most efficient use of teleconference has been introduced, which gives a snapshot of bed availability across the health resources in providing health service and provides a forum for sharing of information to improve patient flow. At times of peak services to our community demand, this communication occurs twice daily. Reports have been established to provide daily bed utilisation across all Eastern Health sites. Fortnightly meetings have been established with key Eastern Health stakeholders, and members of the Executive Committee, to monitor Eastern Health access. Our sub-acute services have also played an important role in moving patients to the most appropriate place at the most appropriate time to allow more patients to access our emergency and acute hospital services.
Eastern Health Annual Report 2009-10 67 our corporate performance
Outcome Progress summary
5. Drive forward the Eastern Health research and education strategic plan
Actively engage university partners • Professor David Taylor was appointed Eastern Health Director of Research in June 2010 and strengthen education and • Work is underway to establish the Eastern Health Office of Research, led by the newly appointed research capabilities within Eastern Director of Research Health through: • The Eastern Health University Academic Council has been established and has been meeting • Appointment of an Eastern since October 2009. A Charter for the Council has been developed. Eastern Health and its Health Director of Research university partners are proceeding with implementation of the Charter. • Establishment of an Eastern • Capital redevelopment of an education precinct at Maroondah Hospital was completed in Health Office of Research December 2009, with staff and students moving into the facility in January 2010. Construction of • Establishment of an Academic the Practice Development Unit was completed in March 2010. Council in conjunction with key • Capital redevelopment of an education precinct at Angliss Hospital was completed in April 2010, university partners with staff and students moving into the new accommodation in May 2010. • Completion of the education precinct developments at Angliss and Maroondah hospitals
6. Further progress statewide programs and developments of high strategic value
In order to expand our health service capacity and deliver services to our community more efficiently, the following strategic projects and developments will be completed or substantially progressed:
Capital works and supporting Construction of the Maroondah PARC commenced in December 2009 and has progressed models of care for the Maroondah throughout 2009-10. The unit is scheduled to be completed in September 2010. Preventive and Recovery Care A model of care is being developed in collaboration with MIND Australia in preparation for opening (PARC) service in 2010-11.
Continue working with the Eastern Health, in collaboration with the Victorian Department of Health, completed a business case Department of Health to complete in support of an expansion of the CCU at Maroondah Hospital and submitted it to the Expenditure the business case proposal for the Review Committee. The redevelopment was not funded this year. Maroondah Hospital critical care unit (CCU) expansion
Finalise an agreed service profile The Victorian Government announced a $3m capital upgrade of Healesville and District Hospital for Healesville and District Hospital in May 2010. A major strategy was implemented at the Healesville and District Hospital in April and plan for capital development 2010, whereby patients who require general medicine and geriatric evaluation and management of this site are treated at the hospital as inpatients. The feasibility of other services at the site is also being considered in light of the capital upgrade and in consultation with the Victorian Department of Health and local community.
68 Eastern Health Annual Report 2009-10 our corporate performance
Outcome Progress summary
Service and capital planning, Eastern Health, in collaboration with the Victorian Department of Health, completed a business case including business case in support of occupying space within a Ringwood health precinct and submitted it to the ERC. The development, for the Ringwood redevelopment was not funded this year. Service and master planning for Angliss Hospital have not health precinct and review the commenced, however a comprehensive master planning process is scheduled to commence in service plan and master plan of 2010-11, which will consider Angliss Hospital as a priority. Angliss Hospital
Implementation of HealthSMART Release 1a of HealthSMART Clinicals ‘went live’ at Box Hill on 30 November 2010. Release 1b is Clinicals as the next step to fully scheduled to ‘go-live’ in August 2010. electronic patient records
Implementation of the Redesigning Redesign projects continue in line with Eastern Health agreed priorities and plans. The emergency Hospital Care Program agreed department non-admitted project was completed in April 2010. A surgical redesign project projects and redesign capability commenced in January 2010. This project focuses on utilisation of theatre to improve access for building process patients who need an operation. A medical redesign project continues and has been aligned with the Victorian Department of Health’s initiative focused on improving the journey for the short-stay medical patient. An analysis of the current issues within the outpatient service has commenced. The capability building program has progressed according to plan with the Victorian Department of Health.
Enhanced addiction medicine Turning Point Drug and Alcohol Centre amalgamated with Eastern Health in October 2009. through the amalgamation of Turning Point with Eastern Health.
Completion of the Eastern Health An Eastern Health Clinical Service Plan 2010-15 Discussion Paper was prepared for further consultation Clinical Service Plan 2009-15 in 2009. In light of planning for the Box Hill Hospital redevelopment and timing of strategic planning, this project was temporarily placed on hold. Completion of the Eastern Health Strategic Clinical Service Plan has been identified as a priority for the latter half of 2010.
Improved patient safety through An Eastern Health clinical governance framework, based upon the Victorian Clinical Governance enhanced clinical governance Framework, was developed and approved in 2010. The framework will be incorporated into Eastern monitoring and reporting across Health policy as a component of the governance policy review. Key performance indicators to the organisation measure our success against the clinical governance framework will be developed as part of our operations and improvement planning priorities for 2010-11. In June 2010, Eastern Health commenced mapping its incident management systems as a first step to properly identify improvements in this critical area of safety.
Active participation in the North Eastern Health has actively participated in this important collaborative project to support and Eastern Metropolitan Integrated facilitate the integration and coordination of cancer services across 10 tumour streams in the Cancer Service (NEMICS) north-eastern geographical region of Melbourne. Eastern Health’s Chief Executive Alan Lilly was appointed Chair of the NEMICS Governance Committee in June 2010. Achievements have included establishment of multidisciplinary meetings, supportive care screening, well-attended women’s forums, oncology IT systems development, successful professional development grant applications and various improvements in communication with general practitioners on treatment plans.
Eastern Health Annual Report 2009-10 69 70 Eastern Health Annual Report 2009-10 Our governance Overseen by a Board of nine Directors
Eastern Health Annual Report 2009-10 71 our Governance
8 2 4 3 5 6 7
1 9
Eastern Health is a public health service as The Directors contribute to the governance Martin Botros 1 defined the Health Services Act 1988 and is of Eastern Health collectively as a Board LLB, BPhysio, LLM (Health Law) PGradDip governed by a nine-person Board of Directors through attendance at meetings. The Board Legal Practice, PGradCert (Conflict Resolution) appointed by the Governor in Council on the meets monthly on average; 11 meetings are Appointed 1 July 2008 recommendation of the Victorian Minister for normally scheduled each financial year. Professional positions Health. The Board must perform its function Member – Executive Operations Group, and exercise its powers subject to any During 2009-10, Eastern Health’s Coroners Court of Victoria direction given by the Victorian Minister for nine Board Directors were: Member – Hearing Panel List, Health Health and subject to the principles contained Practitioner Regulation National Law within the Health Services Act 1988. Dr Joanna M Flynn 5 (Victoria) Act 2009 MBBS, MPH, DRANZCOG, FRACGP The Board provides governance of Eastern Tribunal Member – Football Federation Appointed Chair of Eastern Health 1 July 2009 Health and is responsible for its financial Victoria performance, strategic directions, the quality Current professional positions W. Kirby Clark 8 of its healthcare services and strengthening General Practitioner BCom, CA (Australia), CA (Canada) community involvement through greater Chair, Medical Board of Australia Appointed 1 July 2007 partnerships. The Board is responsible for ensuring that Eastern Health performs its Stuart Alford 2 Professional positions functions under section 65 of the Health BEcon (Hons), FCA, MAICD Chief Financial Officer & Deputy Chief Services Act 1988 including the requirement to Appointed 1 July 2009 Executive Officer, Australia Pacific Airports develop statements of priorities and strategic Professional positions Corporation Ltd plans; and to monitor compliance with these Director and Chair of Finance Committee, Director, Australia Pacific Airport statements and plans. The Board also has Kilvington Grammar (Melbourne) Pty Ltd responsibility for the appointment of the Chair of Finance and Audit Committee, Prince Director, Australia Pacific Airport Chief Executive Officer. The Eastern Health Henry’s Institute of Medical Research (Launceston) Pty Ltd by-laws enable the Board to delegate certain Chair of Audit Committee, Australian Director, Clark Heilemann Consulting Pty Ltd responsibilities. The by-laws are supported by Accounting Standards Board 9 the delegations of executive and operational Chair of Audit Committee, Australian Auditing Dr John Morris responsibility enabling designated executives and Assurance Standards Board MAdmin, PhD (Nuclear Physics), MSc, BSc and staff to perform their duties through Member of Audit Committee, Victorian Appointed 1 July 2009 exercising specified authority. Curriculum and Assessment Authority Professional positions Health Administration Consultant
72 Eastern Health Annual Report 2009-10 our Governance
Professor Pauline Nugent 7 Board committees Finance Committee BAppSc (Nursing Education), Med Chair: Stuart Alford The Eastern Health Board of Directors is Appointed 1 July 2009 Members: Kirby Clark, Dr Joanna Flynn and supported by several Board Committees. Each Dr John Morris Professional positions Board Committees’ terms of reference are Dean, Faculty of Health Sciences, Australian crucial to the functioning of the Committee The primary function of the Finance Catholic University and they are reviewed on an annual basis. Committee is to assist the Board in fulfilling Australian Representative, Global Alliance of Each Committee is required to report its responsibilities to oversee Eastern Health’s Nursing Education and Scholarship (GANES) to the Board through their minutes and assets and resources. It reviews and monitors Member, Council of Victorian Health Deans recommendations from these Committees the financial performance of Eastern Health Member, Academic Board, ACU National are brought to the Board. The Board, at in accordance with approved strategies, Member, Consultative Council for Human its meetings, discusses the Committee initiatives and goals. The Committee will make Research Ethics minutes that are introduced by the relevant recommendations to the Board regarding Committee Chair. Eastern Health’s financial performance and on Jeanette Ward 4 financial policy. Members meet monthly on BA (Hons), GAICD Board Forum for Medical Leaders average; 11 meetings are normally scheduled Appointed 1 July 2008 Chair: Dr Joanna Flynn each financial year. Professional positions Members: Jeanette Ward and Dr John Zelcer Quality committee Director, Te Anau Consulting The Board Forum for Medical Leaders provides Chair: Professor Pauline Nugent Director and Treasurer, Centre for a structured framework for discussion Members: Martin Botros, Michelle Wright Multicultural Youth between Eastern Health Board Directors, and Dr John Zelcer Executive Committee and senior medical Michelle Wright 3 staff, related to issues which may impact on The Quality Committee is responsible to LLM, BEc, LLB (Hons), GAICD medical staff and their working life at Eastern the Eastern Health Board for monitoring the Appointed 1 July 2005 Health. The Board Forum for Medical Leaders performance of Eastern Health in relation to Reappointed 1 July 2008 Committee forwards reports or matters whether: effective and accountable systems Current professional positions arising to the Board, other Board Committees are in place to monitor and improve the Member – The Alfred General Ethical or Executive Management Committees on quality and effectiveness of health services Issues Sub-Committee matters it considers as appropriate. provided by Eastern Health; any systemic Member, Approvals Committee, Special problems identified with the quality and Purpose Fund, Medibank Private Community Advisory Committee effectiveness of health services are addressed Chair: Martin Botros and results reported in a timely manner; and Dr John Zelcer 6 Members: Dr Joanna Flynn Eastern Health continuously strives to improve MBBS, BMed Sc (Hons), FANZCA, MAICD the quality of the health services it provides In accordance with the requirements of Appointed 1 July 2003 and to foster innovation. section 65ZB of the Health Services Act 1988, Reappointed 1 July 2006; 1 July 2009 the Community Advisory Committee is Primary Care & Population Professional Positions responsible to the Board to assist Eastern Health Advisory Committee Director, Health Informatics Society Health to integrate consumer and community Chair: Michelle Wright of Australia views at all levels of its operations, planning Members: Dr John Morris Director, Telehealth Strategies Pty Ltd and policy development; and to express The Primary Care and Population Health Clinical Advisor, National E-Health the views of the community to the Eastern Advisory Committee is responsible Transition Authority Health Board. for providing advice to the Board on: Members of the Committee representing the developments in the partnerships across the community in which Eastern Health operates primary care and acute health sectors in the are Sophy Athan, Sue Downes, Ken Falconer, Eastern Health catchment area; prioritisation Jane Johnson (resigned 03/02/10), Ivan Kayne of partnership initiatives in the Eastern Health OAM, Keyer Kelkar, Anne Noble and catchment area; and Primary Care Partnership Joanna Switserloot. and individual sector contributions in the
Eastern Health Annual Report 2009-10 73 our Governance
Eastern Health catchment area. In accordance Remuneration Committee The other objectives of Eastern Health, as a with the requirements of section 65ZB Chair: Dr Joanna Flynn public health service, are to: of the Health Services Act 1988, the Members: Martin Botros and a) provide high quality health services to Committee consists of members who Professor Pauline Nugent the community which aim to between them have: meet community needs effectively The primary purpose of the Remuneration • Expertise in or knowledge or the provision and efficiently Committee is to assist the Board to discharge of primary health services in the areas b) integrate care as needed across its responsibilities under government policy served by Eastern Health service boundaries, in order to achieve in relation to the remuneration of the • Expertise in identifying health issues continuity of care and promote the most Chief Executive and members of the affecting the population served by appropriate level of care to meet the executive committee. Eastern Health and designing needs of individuals strategies to improve the health of the c) ensure that health services are aimed Strategy, Planning and Eastern Health population at improvements in individual health Human Resource Committee • Knowledge of the health services provided outcomes and population health status Chair: Dr John Zelcer by the local government(s) in the areas by allocating resources according to best Members: Dr John Morris and Jeanette Ward served by Eastern Health practice healthcare approaches The Strategy, Planning and Human Resources d) ensure that the health service strives Risk & Audit Committee Committee is responsible to the Board for to continuously improve quality and Chair: Kirby Clark monitoring the performance of Eastern foster innovation Members: Stuart Alford, Professor Pauline Health in relation to whether Eastern Health e) support a broad range of high quality Nugent, Jeanette Ward and Michelle Wright adheres to its financial and business plans, health research to contribute to new strategic plans and statements of priorities knowledge and to take advantage of The Risk and Audit Committee is responsible and whether these plans are appropriate and knowledge gained elsewhere to the Eastern Health Board for monitoring in accordance with the Federal, State and local f) operate in a business-like manner which the performance of Eastern Health in government requirements. maximises efficiency, effectiveness relation to whether: Eastern Health’s audit and cost effectiveness and ensures the and accounting systems accurately reflect financial viability of the health service the financial position and viability of the Objectives, functions, g) ensure that mechanisms are available health service; effective and accountable power and duties to inform consumers and protect their risk management systems are in place; and Eastern Health’s core objective is to provide rights and to facilitate consultation with the organisation is compliant with relevant public health services in accordance with the the community legislation. In accordance with Standing principles established as guidelines for the h) operate a public health service as Direction from the Minister of Finance under delivery of public hospital services in Victoria authorised by or under the Act Financial Management Act 1994, members of under section 17AA of the Health Services i) carry out any other activities that may be the Committee are independent. Act 1988. conveniently carried out in connection with the operation of a public health service or calculated to make more efficient any of the health service’s assets or activities
74 Eastern Health Annual Report 2009-10 our Governance
> Disclosure index
The Eastern Health Annual Report 2009-10 has been prepared in accordance with all relevant Victorian legislation. This index has been prepared to enhance identification of our compliance with statutory disclosure requirements.
Legislation Requirement Page
Ministerial declarations Report of operations 28 Charter and purpose 8 FRD 22B Manner of establishment and the relevant Minister 8 FRD 22B Objectives, functions, powers and duties 8 FRD 22B Nature and range of services provided 9
Management and structure FRD 22B Organisational structure 76-77
Financial and other information SD 4.2(j) Accountable officer, signed-off report of operations 80 SD 4.5.5 Attestation on compliance with Australian/New Zealand risk-management standards 60 FRD 22B Operational and budgetary objectives for the entity and performance against those objectives 61 FRD 22B Workforce data disclosures 14 FRD 22B Occupational health and safety 15 FRD 22B Summary of financial results during the year 65 FRD 22B Significant changes in financial position during the year 65 FRD 22B Major changes or factors affecting performance 65 FRD 22B Application and operation of Freedom of Information Act 1982 58 FRD 22B Compliance with building and maintenance provisions of Building Act 1993 59 FRD 25 Victorian industry participation policy disclosure 59 FRD 22B Statement of national competition policy 59 FRD 22B Application and operation of Whistleblower Protection Act 2001 17 FRD 22B Details of consultancies greater than $100,000 – number and total cost 59 FRD 22B Details of consultancies less than $100,000 – number and total cost 59 FRD 10 Disclosure index 75 FRD 21A Responsible person and executive officer disclosures 115
Financial statements required under part seven of the Financial Management Act 1994 SD 4.2(b) Comprehensive operating statement 81 SD 4.2(b) Balance sheet 82 SD 4.2(b) Statement of changes in equity 83 SD 4.2(b) Cash flow statement 84 SD 4.2(c) Accountable officer’s declaration 80 SD 4.2(c) Compliance with Australian accounting standards and other authoritive pronouncements 80 SD 4.2(c) Compliance with ministerial directions 80 SD 4.2(d) Rounding of amounts 85
Legislation Freedom of Information Act 1982 Whistleblowers Protection Act 2001 Victorian Industry Participation Act 2003 Building Act 1993 Financial Management Act 1994 Audit Act 1994
Eastern Health Annual Report 2009-10 75 our Governance
> Organisational structure as at 30 June 2010
Victorian minister for health
Corporate Counsel Board of Directors wendy tabor
Chief Executive Manager, Corporate alan lilly Governance Support john ferraro
Executive Director Executive Director Executive Director (CFO) Executive Director Acute Health Corporate Projects & Sustainability Finance, Procurement & Quality, Planning & Innovation janet compton Zoltan Kokai Information Services Gayle Smith Peter Hutchinson
Chief of Clinical & Site Health Service Projects Finance Enterprise Quality Operations, Angliss Hospital & Risk Management EH Program Director Emergency & General Medicine Financial Sustainability Strategy Supply & Contracts Alison Patrick Strategy & Planning
EH Clinical Director Capital Projects ICT Emergency & General Redesigning Care & Innovation Medicine* A/Prof Christopher Gilfillan Engineering Performance Analysis Consumer Engagement
Chief of Clinical & Site Health Information Services Operations, Box Hill Hospital EH Program Director Women & Children A/Prof Denise Patterson EH Clinical Director Women & Children* Dr Malcolm Barnett
Chief of Clinical & Site Operations, Maroondah Hospital EH Program Director Specialist Medicine Lisa Shaw-Stuart EH Clinical Director Specialist Medicine* Prof Peter Gibson
Chief of Clinical & Site Operations, Yarra Ranges EH Program Director Surgery Martin Smith EH Clinical Director Surgery* Prof Michael Grigg
76 Eastern Health Annual Report 2009-10 our Governance
Executive Director Executive Director (CNMO) Executive Director Executive Director Human Resources, Fundraising Nursing, Access & Medical Services & Research Continuing Care, Community & Community Relations Patient Support Services Dr Colin Feekery & Mental Health Cheryl Woollard David Plunkett Neth Hinton
Human Resources Professional Nursing Professional Medical Professional Allied Health Services Portfolio Services Portfolio Services Portfolio
Fundraising Inpatient Access Research Chief of Clinical & Site Operations, PJC/Wantirna Health Communications EH Program Director Pharmacy Ethics Continuing Care Maria Tucker Payroll Pathology Library Services EH Clinical Director Continuing Care Community Relations Prof Peteris Darzins Radiology
EH Program Director Support Services Mental Health, Turning Point, Alcohol & Drugs Ben Kelly Infection Control EH Clinical Director Mental Health, Biomedical Engineering Turning Point, Alcohol & Drugs A/Prof Paul Katz
EH Program Director Community Health Jane Judd
Ambulatory Services
* Transitional appointments awaiting confirmation # Interim appointment
Eastern Health Annual Report 2009-10 77 78 Eastern Health Annual Report 2009-10 Eastern Health Financial Statements 2009–2010
Contents
80 Board Member’s, Accountable 100 Note 6 Cash and Cash Equivalents Officer’s and Chief Finance & 100 Note 7 Receivables Accounting Officer’s Declaration 101 Note 8 Other Financial Assets 81 Comprehensive Operating Statement 101 Note 9 Inventories for the Year ended 30 June 2010 101 Note 10 Prepayments 82 Balance Sheet as at 30 June 2010 102 Note 11 Property, Plant and 83 Statement of Changes in Equity for Equipment the Year ended 30 June 2010 103 Note 12 Intangibles Assets 84 Cash Flow Statement for the Year ended 30 June 2010 104 Note 13 Payables 85 Notes to the Financial Statements for 105 Note 14 Interest Bearing Liabilities the Year ended 30 June 2010 106 Note 15 Employee Benefits and 85 Note 1 Statement of Significant Related On-costs Provisions Accounting Policies 107 Note 16 Other Liabilities 92 Note 2 Revenue 107 Note 17 Equity & Reserves 93 Note 2a Analysis of Revenue by 108 Note 18 Reconciliation of Net Results Source for the Year to Net Cash Inflow/ 95 Note 2b Patient and Resident Fees (Outflow) from Operating Activities 108 Note 19 Financial Instruments 95 Note 2c Net Gain/(Loss) on Disposal of Non-Current Assets 113 Note 20 Commitments for Expenditure 95 Note 2d Assets Received Free of Charge or For Nominal Consideration 113 Note 21 Contingent Assets and Contingent Liabilities 96 Note 3 Expenses 114 Note 22 Segment Reporting 97 Note 3a Analysis of Expenses by Source 115 Note 23a Responsible Persons Disclosures 99 Note 3b Analysis of Expenses by Internal and Restricted Specific 116 Note 23b Executive Officer Purpose Funds for Services Disclosures Supported by Hospital and 117 Note 24 Remuneration of Auditors Community Initiatives 117 Note 25 Events Occurring After the 99 Note 4 Depreciation and Balance Sheet Date Amortisation 118 Auditor General’s Report for the Year 99 Note 5 Finance Costs ended 30 June 2010
EasternEastern HealthHealth AnnualAnnual ReportReport 2009-102009-10 79 eastern Health financial statements 2009/10
> Eastern Health Board Member’s, Accountable Officer’s and Chief Finance & Accounting Officer’s Declaration
We certify that the attached financial statements for Eastern Health have been prepared in accordance with Part 4.2 of the Standing Directions of the Minister for Finance under the Financial Management Act 1994, applicable Financial Reporting Directions, Australian Accounting Standards, Australian Accounting Interpretations and other mandatory professional reporting requirements.
We further state that, in our opinion, the information set out in the Comprehensive Operating Statement, Balance Sheet, Statement of Changes in Equity, Cash Flow Statement and notes to and forming part of the financial statements, presents fairly the financial transactions during the year ended 30 June 2010 and financial position of Eastern Health as at 30 June 2010.
We are not aware of any circumstance which would render any particulars included in the financial statements to be misleading or inaccurate.
We authorise the attached financial statements for issue on this day.
Chairperson Chief Executive Chief Finance Officer (On behalf of the Board) Alan Lilly Peter Hutchinson Dr Joanna Flynn
Dated 11 August 2010 (Box Hill – Melbourne)
80 Eastern Health Annual Report 2009-10 eastern Health financial statements 2009/10
> Eastern Health Comprehensive Operating Statement For the year ended 30 june 2010
2009/10 2008/09 Note $’000 $’000
Revenue from Operating Activities 2 643,412 583,998 Revenue from Non-Operating Activities 2 2,395 2,949 645,807 586,947
Employee Benefits 3 (455,915) (407,949) Fee for Service Medical Officers 3 (7,834) (7,564) Non Salary Labour Costs 3 (8,466) (12,417) Supplies & Consumables 3 (108,379) (98,151) Other Expenses From Continuing Operations 3 (60,878) (57,988) Indirect Contributions by Department of Health 3 (5,995) (5,416) (647,467) (589,485)
NET RESULT BEFORE CAPITAL & SPECIFIC ITEMS (1,660) (2,538)
Finance Costs 5 (573) (650) Capital Purpose Income 2 12,936 21,443 Gain/(loss) on Disposal of Non-Current Assets 2 284 (47) Specific Income 2d 579 - Depreciation & Amortisation 4 (39,687) (18,788)
NET RESULT FOR THE YEAR (28,121) (580)
OTHER COMPREHENSIVE INCOME Building impairment adjusted against Asset Revaluation Reserve 17,11 (20,706) - Net Fair value revaluation on Non-Financial Assets - 75,486
TOTAL COMPREHENSIVE RESULT FOR THE YEAR (48,827) 74,906
This Statement should be read in conjunction with the accompanying notes.
Eastern Health Annual Report 2009-10 81 eastern Health financial statements 2009/10
> Eastern Health Balance Sheet As at 30 june 2010
2009/10 2008/09 Note $’000 $’000
ASSETS Current Assets Cash and Cash Equivalents 6 37,177 35,196 Receivables 7 13,728 11,238 Other Financial Assets 8 1,479 1,020 Inventories 9 3,365 3,502 Prepayments 10 1,165 842 Total Current Assets 56,914 51,798
Non-Current Assets Receivables 7 9,669 7,104 Land 11 62,036 62,036 Buildings 11 379,192 419,792 Plant & Equipment & Motor Vehicles 11 38,362 37,941 Furniture and Fittings 11 10,123 9,980 Leasehold Improvements 11 174 245 Intangibles 12 3,726 480 Total Non-Current Assets 503,282 537,578 TOTAL ASSETS 560,196 589,376
LIABILITIES Current Liabilities Payables 13 44,294 38,215 Interest Bearing Liabilities 14 230 288 Employee Benefits and Related On-Costs Provision 15 96,043 89,207 Other Liabilities 16 5,345 3,624 Total Current Liabilities 145,912 131,334
Non-Current Liabilities Employee Benefits and Related On-Costs Provision 15 12,925 12,178 Interest Bearing Liabilities 14 15,761 11,439 Total Non-Current Liabilities 28,686 23,617 TOTAL LIABILITIES 174,598 154,951 NET ASSETS 385,598 434,425
EQUITY Asset Revaluation Reserve 17a 114,005 134,711 Restricted Specific Purpose Reserve 17a 16,748 15,609 Contributed Capital 17b 231,510 231,510 Accumulated Surplus/(Deficit) 17c 23,335 52,595 TOTAL EQUITY 385,598 434,425
This Statement should be read in conjunction with the accompanying notes.
82 Eastern Health Annual Report 2009-10 eastern Health financial statements 2009/10
> Eastern Health Statement of Changes in Equity For the year ended 30 june 2010
Transactions with the State Equity at Comprehensive in its capacity Equity at 1 July 2009 Result as owner 30 June 2010 2010 Note $’000 $’000 $’000 $’000
Accumulated Surplus/(Deficit) 17c 52,595 (28,121) - 24,474 Transfer (To)/ From Restricted Specific Purpose Reserve - (1,139) - (1,139) 52,595 (29,260) - 23,335
Contribution by Owners 17b 231,510 - - 231,510 Capital Appropriation - - - - 231,510 - - 231,510
Reserves Asset Revaluation Reserve 17a 134,711 (20,706) - 114,005 Restricted Specific Purpose Reserve 17a 15,609 1,139 - 16,748 150,320 (19,567) - 130,753 Total Equity at the end of the financial year 434,425 (48,827) - 385,598
Transactions with the State Equity at Comprehensive in its capacity Equity at 1 July 2008 Result as owner 30 June 2009 2009 Note $’000 $’000 $’000 $’000
Accumulated Surplus/(Deficit) 17c 54,324 (580) - 53,744 Transfer (To)/ From Restricted Specific Purpose Reserve - (1,149) - (1,149) 54,324 (1,729) - 52,595
Contribution by Owners 17b 225,950 - - 225,950 Capital Appropriation - - 5,560 5,560 225,950 - 5,560 231,510
Reserves Asset Revaluation Reserve 17a 59,225 75,486 - 134,711 Restricted Specific Purpose Reserve 17a 14,460 1,149 - 15,609 73,685 76,635 - 150,320 Total Equity at the end of the financial year 353,959 74,906 5,560 434,425
This Statement should be read in conjunction with the accompanying notes.
Eastern Health Annual Report 2009-10 83 eastern Health financial statements 2009/10
> Eastern Health Cash Flow Statement For the year ended 30 june 2010
2009/10 2008/09 Note $’000 $’000
CASH FLOWS FROM OPERATING ACTIVITIES
Operating Grants from Government 560,767 520,753 Patient and Resident Fees Received 26,292 24,642 Donations and Bequests Received 2 1,054 1,056 Recoupment from Private Practice for use of Hospital Facilities 19,846 13,786 GST Received from ATO 17,606 17,495 Other Receipts 28,187 22,665
Employee Benefits Paid (454,357) (409,170) Fee for Service Medical Officers 3 (7,834) (7,564) Payments for Supplies & Consumables (121,754) (116,740) Finance Costs 5 (573) (650) Other Payments (61,205) (59,354) Cash Generated from Operations 8,029 6,919
Capital Grants - Government 2 12,334 20,849 Capital Donations and Bequests Received 2 602 594
NET CASH INFLOW FROM OPERATING ACTIVITIES 18 20,965 28,362
CASH FLOWS FROM INVESTING ACTIVITIES Purchase of Properties, Plant & Equipment (24,716) (43,144) Proceeds from Sale of Properties, Plant & Equipment 2c 1,468 898
NET CASH OUTFLOW INVESTING ACTIVITIES (23,248) (42,246)
CASH FLOWS FROM FINANCING ACTIVITIES Contributed Capital from Government - 5,560 Loan from Treasury Corporation of Victoria 4,553 - Repayment of Loan from Treasury Corporation of Victoria (289) (191)
NET CASH INFLOW FROM FINANCING ACTIVITIES 4,264 5,369
NET INCREASE/(DECREASE) IN CASH HELD 1,981 (8,515)
CASH AND CASH EQUIVALENTS AT 1 JULY 2009 35,196 43,711
CASH AND CASH EQUIVALENTS AT 30 JUNE 2010 6 37,177 35,196
This Statement should be read in conjunction with the accompanying notes.
84 Eastern Health Annual Report 2009-10 eastern Health financial statements 2009/10
Note 1: Statement of Significant Accounting Policies
(a) Statement of Compliance sufficient regularity to ensure that the hand and at bank, deposits at call and highly carrying amounts do not materially differ liquid investments with an original maturity of These financial statements are a general- from their fair values; 3 months or less, which are readily convertible purpose financial report which has been • Derivative financial instruments, managed to known amounts of cash and are subject to prepared in accordance with the Financial investment schemes, certain debt insignificant risk of changes in value. Management Act 1994, applicable Australian securities, and investment properties after Accounting Standards (AASs) and Australian initial recognition, which are measured at (f) Receivables Accounting Interpretations and other fair value through profit and loss; and mandatory requirements. AASs includes Trade debtors are carried at nominal amounts • Available-for-sale investments which are Australian equivalents to the International due and are due for settlement within 30 days measured at fair value with movements Financial Reporting Standards. from the date of recognition. Collectability of reflected in equity until the asset is debts is reviewed on an ongoing basis and The financial statements also comply with derecognised. relevant Financial Reporting Directions (FRDs) debts which are known to be uncollectable Historical cost is based on the fair values issued by the Department of Treasury and are written off. A provision for doubtful of the consideration given in exchange Finance, and relevant Standing Directions debts is recognised when there is objective (SDs) authorised by the Minister for Finance. for assets. evidence that an impairment loss has occurred. Bad debts are written off Cost is based on the fair values of the The Health Service is a not-for-profit entity when identified. and therefore applies the additional Aus consideration given in exchange for assets. Receivables are recognised initially at fair value paragraphs applicable to “not-for-profit” In the application of AASs, management and subsequently measured at amortised entities under the AAS’s. is required to make judgments, estimates cost, using the effective interest rate method, and assumptions about carrying values less any accumulated impairment. (b) Basis of Accounting Preparation of assets and liabilities that are not readily and Measurement apparent from other sources. The estimates (g) Inventories The accounting policies set out below have and associated assumptions are based on been applied in preparing the financial historical experience and various other factors Inventories include goods and other property statements for the year ended 30 June 2010, that are believed to be reasonable under held either for sale or for distribution at no and the comparative information presented in the circumstance, the results of which form or nominal cost in the ordinary course of these financial statements for the year ended the basis of making the judgements. Actual business operations. Inventories include land 30 June 2009. results may differ from these estimates. held for sale and exclude depreciable assets.
Accounting policies are selected and applied The estimates and underlying assumptions Inventories held for distribution are measured in a manner which ensures that the resulting are reviewed on an ongoing basis. Revisions at cost, adjusted for any loss of service financial information satisfies the concepts of to accounting estimates are recognised in potential. All other inventories are measured relevance and reliability, thereby ensuring that the period in which the estimate is revised, at the lower of cost or net realisable value. the substance of the underlying transactions if the revision affects only that period, or in The bases used in assessing loss of service or other events is reported. the period of the revision and future periods if the revision affects both current and potential for inventories held for distribution The financial statements, except for cash future periods. include current replacement cost and flow information, have been prepared using technical or functional obsolescence. the accrual basis of accounting. Under the (c) Reporting Entity Technical obsolescence occurs when an accrual basis, items are recognised as assets, item still functions for some or all of the liabilities, equity, income or expenses when The financial statements include all the tasks it was originally acquired to do, but they satisfy the definitions and recognition controlled activities of Eastern Health. no longer matches existing technologies. criteria for those items, that is they are Its principle address is: Functional obsolescence occurs when an recognised in the reporting period to which 5 Arnold Street item no longer functions the way it did when they relate, regardless of when cash is Box Hill it was first acquired. received or paid. Victoria 3128 Cost is determined principally by the The financial statements are prepared weighted average method. in accordance with the historical cost (d) Rounding Of Amounts convention, except for the revaluation of All amounts shown in the financial statements (h) Intangible Assets certain non-financial assets and financial are expressed to the nearest $1,000 unless instruments, as noted. Particularly, exceptions Intangible assets represent identifiable otherwise stated. to the historical cost convention include: non-monetary assets without physical • Non-current physical assets, which substance such as patents, trademarks, (e) Cash and Cash Equivalents subsequent to acquisition, are measured computer software and development costs at valuation and are re-assessed with Cash and cash equivalents comprise cash on (where applicable).
Eastern Health Annual Report 2009-10 85 eastern Health financial statements 2009/10
Note 1: Statement of Significant Accounting Policies (continued)
Intangible assets are initially recognised at made in relation to the intended use of the Revaluation surpluses are normally not cost. Subsequently, intangible assets with land. Theoretical opportunities that may be transferred to accumulated funds on finite useful lives are carried at cost less available in relation to the asset(s) are not derecognition of the relevant asset. accumulated amortisation and accumulated taken into account until it is virtually certain In accordance with FRD 103D Eastern Health’s impairment losses. Costs incurred subsequent that any restrictions will no longer apply. non-current physical assets were assessed to to initial acquisition are capitalised when it Land and Buildings are recognised initially is expected that additional future economic determine whether revaluation of the at cost and subsequently measured at fair benefits will flow to the Health Service. non-current physical assets was required. value less accumulated depreciation Amortisation is allocated to intangible assets and impairment. (k) Depreciation with finite useful lives on a systematic (typically Plant, Equipment and Vehicles are straight-line) basis over the asset’s useful life. Assets with a cost in excess of $1,000 (2008-09 recognised initially at cost and subsequently Amortisation begins when the asset is available and 2009-10) are capitalised and depreciation measured at fair value less accumulated for use, that is, when it is in the location and has been provided on depreciable assets depreciation and impairment. Depreciated condition necessary for it to be capable so as to allocate their cost or valuation over historical cost is generally a reasonable proxy of operating in the manner intended by their estimated useful lives. Depreciation is management. The amortisation period and the for depreciated replacement cost because of generally calculated on a straight-line basis, at amortisation method for an intangible asset the short lives of the assets concerned. a rate that allocates the asset value, less any with a finite useful life are reviewed at least estimated residual value over its estimated (j) Revaluations of Non-Current at the end of each annual reporting period. useful life. Estimates of the remaining Physical Assets In addition, an assessment is made at each useful lives and depreciation method for all reporting date to determine whether there are Non-current physical assets measured at fair assets are reviewed at least annually. The indicators that the intangible asset concerned value are revalued in accordance with Financial depreciation charge is not funded by the is impaired. If so, the assets concerned are Reporting Directive (FRD) 103D Non-current Department of Health. tested as to whether their carrying value physical assets. This revaluation process Depreciation is provided on property, plant exceeds their recoverable amount. normally occurs at least every five years, and equipment, including freehold buildings, based upon the asset’s Government Purpose Intangible assets with indefinite useful but excluding land. Depreciation begins when Classification, but may occur more frequently lives are not amortised, but are tested for the asset is available for use, which is when if fair value assessments indicate material impairment annually or whenever there is an it is in the location and condition necessary changes in values. Independent valuers are indication that the asset may be impaired. for it to be capable of operating in a manner used to conduct these scheduled revaluations The useful life of intangible assets that are not intended by management. being amortised are reviewed each period to and any interim revaluations are determined in determine whether events and circumstances accordance with the requirements of the FRDs. The following table indicates the expected continue to support an indefinite useful life Revaluation increments or decrements arise useful lives of non-current assets on which the assessment for that asset. In addition, the from differences between an asset’s carrying depreciation charges are based. Health Service tests all intangible assets with value and fair value. indefinite useful lives for impairment by Revaluation increments are credited directly 2009/10 2008/09 comparing its recoverable amount with its to the asset revaluation reserve, except that, Buildings carrying amount: to the extent that an increment reverses a - Structure Shell 11-46 years 11-46 years Building Fabric • annually and revaluation decrement in respect of that class - Site Engineering 11-46 years 11-46 years • whenever there is an indication that the of asset previously recognised as an expense Services and intangible asset may be impaired. in net result, the increment is recognised as Central Plant income in the net result. Any excess of the carrying amount over the Central Plant recoverable amount is recognised as an Revaluation decrements are recognised - Fit Out 3-21 years 3-21 years impairment loss. immediately as expenses in the net result, - Trunk 3-21 years 3-21 years Reticulated Intangible asset with finite useful lives are except that, to the extent that a credit Building Systems amortised over a 3 year period (2008-09 balance exists in the asset revaluation Plant & 10-20 years 10-20 years 3 year period). reserve in respect of the same class of Equipment assets, they are debited directly to the Furniture & 10 years 10 years (i) Property, Plant and Equipment asset revaluation reserve. Fittings Crown Land is measured at fair value with Revaluation increases and revaluation Medical 8-15 years 8-15 years regard to the property’s highest and best use decreases relating to individual assets within Equipment after due consideration is made for any legal an asset class are offset against one another Communications 3 years 3 years or constructive restrictions imposed on the within that class but are not offset in respect & IT land, public announcements or commitments of assets in different classes. Motor Vehicles 5 years 5 years
86 Eastern Health Annual Report 2009-10 eastern Health financial statements 2009/10
Note 1: Statement of Significant Accounting Policies (continued)
As part of the Buildings valuation, building to be impaired given the buildings have (p) Goods and Services Tax values were componentised and each been vacated for demolition after the State Income, expenses and assets are recognised component assessed for its useful life which is Government announcement of a major net of the amount of associated GST, unless represented above. redevelopment at Box Hill Hospital. This the GST incurred is not recoverable from the impairment resulted in a write down of taxation authority. In this case it is recognised (l) Net Gain/(Loss) on Non-Financial Assets the buildings of $20.706 million which was as part of the acquisition of the asset or as Net gain/(loss) on non-financial assets debited to the asset revaluation reserve. part of the expense. includes realised and unrealised gains and Receivables and payables are stated inclusive losses from revaluations, impairments (m) Payables of the amount of GST receivable or payable. and disposals of all physical assets and These amounts consist predominately of The net amount of GST recoverable from, or intangible assets. liabilities for goods and services. payable to the taxation authority, is included with other receivables or payables in the Disposal of Non-Financial Assets Payables are initially recognised at fair value balance sheet. Any gain or loss on the sale of non-financial then subsequently carried at amortised cost Cash flows are presented on a gross basis. assets is recognised at the date that control and represent liabilities for goods and services The GST component of cash flows arising of the asset is passed to the buyer and provided to the Health Service prior to the from investing or financing activities which is determined after deducting from the end of the financial year that are unpaid, are recoverable from, or payable to the proceeds the carrying value of the asset at and arise when the Health Service becomes taxation authority, are presented as an that time. obliged to make future payments in respect of the purchase of these goods and services. operating cash flow. Impairment of Non-Financial Assets The normal credit terms are usually net 45 Commitments and contingent assets and days from the end of the month in which the Apart from intangible assets with indefinite liabilities are presented on a gross basis. useful lives, all other assets are assessed invoice is received. (q) Employee Benefits annually for indications of impairment, except for: (n) Provisions Wages and Salaries, Annual Leave, and • Inventories; Provisions are recognised when the Health Accrued Days Off • Assets arising from construction contracts Service has a present obligation, the future and; sacrifice of economic benefits is probable, Liabilities for wages and salaries, including • Financial assets. and the amount of the provision can be non-monetary benefits, annual leave, and accrued days off which are expected to be If there is an indication of impairment, the measured reliably. settled within 12 months of the reporting assets concerned are tested as to whether The amount recognised as a provision is the date are recognised in the provision for their carrying value exceeds their possible best estimate of the consideration required to employee benefits in respect of employee’s recoverable amount. Where an asset’s carrying settle the present obligation at the reporting service up to the reporting date and are value exceeds its recoverable amount, the classified as current liabilities and measured at difference is written off as an expense except date, taking into account the risks and their nominal values. to the extent that the write down can be uncertainties surrounding the obligation. debited to an asset revaluation reserve Where a provision is measured using the Those liabilities that the Health Service does amount applicable to that class of assets. cashflows estimated to settle the present not expect to settle within 12 months are obligation, its carrying amount is the present recognised in the provision of employee It is deemed that, in the event of the loss of value of those cashflows. benefits as current liabilities, measured at the an asset, the future economic benefits arising present value of the amounts expected to be from the use of the asset will be replaced (o) Interest Bearing Liabilities paid when the liabilities are settled using the unless a specific decision to the contrary remuneration rate expected to apply at the has been made. The recoverable amount Interest bearing liabilities in the Balance time of settlement. for most assets is measured at the higher of Sheet are recognised at fair value upon initial depreciated replacement cost and fair value recognition. Subsequent to initial recognition, Long Service Leave less costs to sell. Recoverable amount for interest bearing liabilities are measured at assets held primarily to generate net cash amortised cost with any difference between The liability for long service leave (LSL) is flows is measured at the higher of the present the initial recognised amount and the recognised in the provision for employee value of future cash flows expected to be redemption value being recognised in the benefits. obtained from the asset and fair value less profit and loss over the period of the interest Current liability – unconditional LSL costs to sell. bearing liability using the effective interest (representing 10 or more years of continuous During the year, the Clive Ward and associated method. Fair value is determined in the service) is disclosed as a current liability even buildings at Box Hill Hospital were considered manner described in note 19. where the Health Service does not expect to
Eastern Health Annual Report 2009-10 87 eastern Health financial statements 2009/10
Note 1: Statement of Significant Accounting Policies (continued) settle the liability within 12 months because it superannuation funds and contributions (r) Residential Aged Care Services will not have the unconditional right to defer made by the Health Service are as follows: The Mooroolbark, Northside and Edward the settlement should an employee take leave Street Nursing Homes and Monda Lodge within 12 months. Funds Contributions Hostel Residential Aged Care Service Paid or Payable The components of this current LSL are for the year operations are an integral part of the measured at: 2010 2009 Health Service and share its resources. An • Present value – component that the Health $’000 $’000 apportionment of land and buildings has Service does not expect to settle within Defined benefit plans: been made based on floor space. The results 12 months; and Health Superannuation 1,381 1,407 of the operations have been segregated • Nominal value – component that the Fund based on actual revenue earned and Health Service expects to settle within expenditure incurred by each operation. 12 months. Defined contribution The Mooroolbark, Northside and Edward plans: Non-Current Liability – Conditional LSL Street Nursing Homes and Monda Lodge Health Superannuation 26,928 24,439 (representing less than 10 years of continuous Hostel Residential Aged Care are Fund service) is disclosed as a non-current liability. substantially funded from Commonwealth HESTA Superannuation 6,926 5,321 bed-day subsidies. There is an unconditional right to defer Fund the settlement of the entitlement until the (s) Intersegment Transactions employee has completed the requisite years Total 35,235 31,167 of service. Conditional LSL is required to be Transactions between segments within the measured at present value. The Health Service does not recognise Health Service have been eliminated to reflect the extent of the Health Service’s operations Consideration is given to expected future any unfunded defined benefit liability in as a group. wage and salary levels, experience of respect of the superannuation plans because employee departures and periods of service. the entity has no legal or constructive (t) Leases Expected future payments are discounted obligation to pay future benefits relating to using interest rates of Commonwealth its employees; its only obligation is to pay Leases are classified at their inception as either Government guaranteed securities superannuation contributions as they fall operating or finance leases based on the in Australia. due. The Department of Treasury and Finance economic substance of the agreement so as to reflect the risks and rewards incidental to administers and discloses the State’s defined Superannuation ownership. benefit liabilities in its financial report. Leases of property, plant and equipment Defined contribution plans Termination Benefits are classified as finance leases whenever the Contributions to defined contribution terms of the lease transfer substantially all Termination benefits are payable when superannuation plans are expensed the risks and rewards of ownership to the employment is terminated before the normal when incurred. lessee. All other leases are classified as retirement date or when an employee operating leases. Eastern Health does not Defined benefit plans accepts voluntary redundancy in exchange have any finance leases. for these benefits. The amount charged to the Comprehensive Operating Leases Operating Statement in respect of defined Liabilities for termination benefits are benefit superannuation plans represents the recognised when a detailed plan for the Operating lease payments, including any contributions made by the Health Service termination has been developed and a valid contingent rentals, are recognised as an to the superannuation plan in respect to the expectation has been raised with those expense in the Comprehensive Operating current services of the current Health Service employees affected that the terminations will Statement on a straight line basis over the lease term, except where another systematic staff. Superannuation contributions are made be carried out. The liabilities for termination basis is more representative of the time to the plans based on the relevant rules of benefits are recognised in other creditors pattern of the benefits derived from the use of each plan. unless the amount or timing of the payments the leased asset. Employees of the Health Service are entitled is uncertain, in which case they are recognised to receive superannuation benefits and as a provision. (u) Income Recognition the Health Service contributes to both the Income is recognised in accordance with defined benefit and defined contribution On-Costs “AASB 118 Revenue” and is recognised as to plans. The defined benefit plan(s) provide Employee benefit on-costs such as payroll the extent it is earned. Unearned income at benefits based on years of service and final tax, workers compensation are recognised reporting date is reported as income received average salary. separately from the provisions for in advance and amount payable to the The name and details of the major employee employee benefits. Department of Health.
88 Eastern Health Annual Report 2009-10 eastern Health financial statements 2009/10
Note 1: Statement of Significant Accounting Policies (continued)
Amounts disclosed as revenue are, where Operating, Specific Purpose and Capital Services (RACS) and are also funded from applicable, net of returns, allowances and Funds. The Health Service’s Capital and other sources such as Commonwealth, duties and taxes. Specific Purpose Funds include unspent patients and residents, while Services capital donations and receipts from fund- Supported by Hospital and Community Government Grants and other transfers of raising activities conducted solely in respect Initiatives (Non HSA) are funded by the Health income (other than contributions by owners) of these funds. Service’s own activities or local initiatives and/ or the Commonwealth. Grants are recognised as revenue when (w) Economic Dependency the Health Service gains control of the (z) Property, Plant & Equipment underlying assets in accordance with AASB The Health Service is reliant on the Revaluation Reserve 1004 Contributions. For reciprocal grants, the Department of Health for a substantial part of Health Service is deemed to have assumed its revenue. The asset revaluation reserve is used to control when the performance has occurred record increments and decrements on the under the grant. For non-reciprocal grants, (x) Going Concern revaluation of non-current physical assets. the Health Service is deemed to have The financial statements are prepared on a assumed control when the grant is received (aa) Specific Restricted Purpose Reserve going concern basis. or receivable. Conditional grants may be A specific restricted purpose reserve is reciprocal or non-reciprocal depending on The Health Service has: established where the Health Service has the terms of the grant. • a loss from continuing activities of $28.121 possession or title to the funds but has no million for the year ended 30 June 2010 discretion to amend or vary the restriction Indirect Contributions (30 June 2009 $0.580 million loss) including and/or condition underlying funds received. net capital loss of $25.888 million (30 June • Insurance is recognised as revenue 2009 $2.608 million net capital income); following advice from the Department (ab) Contributed Capital • a working capital deficiency of $47.715 of Health. million at 30 June 2010 ($42.049 million Consistent with Australian Accounting • Long Service Leave (LSL) – Revenue is deficiency as at 30 June 2009); Interpretation 1038 ‘Contributions by Owners recognised monthly upon finalisation of • net cash inflows generated from operating Made to Wholly-Owned Public Sector Entities’ movements in LSL liability in line with the activities of $20.965 million for the year and FRD 119 ‘Contributions by Owners’, arrangements set out in the Metropolitan ended 30 June 2010 including capital appropriations for additions to the net asset Health and Aged Care Division Hospital base have been designated as contributed Circular 14/2009. income of $13.515 million ($28.362 million for the year ended 30 June 2009 including capital. Other transfers that are in the nature Patient Fees capital income of $21.443 million). of contributions or distributions that have also been designated as contributed capital are The Department of Health (DH) will provide Patient fees are recognised as revenue at the also treated as contributed capital. time invoices are raised. Eastern Health adequate cash flow support to enable it to meet its current and future (ac) Net Result before Capital & obligations as and when they fall due for a Private Practice Fees Specific Items period up to September 2011. DH monitors Private Practice fees are recognised as revenue the Health Service’s monthly financial The subtotal entitled “Net Result before at the time invoices are raised. operating performance, liquidity and cash Capital & Specific Items” is included in the position, its annual budget and compares Comprehensive Operating Statement to Donations and Other Bequests actual results against those budgeted. enhance the understanding of the financial Donations and bequests are recognised as performance of the Health Service. This DH has advised that as the main funder of revenue when received. If donations are for subtotal reports the result excluding items these services they will work closely with a special purpose, they may be appropriated such as capital grants, depreciation, and items both senior management and the Board of to a reserve, such as specific restricted of an unusual nature and amount such as the Health Service to ensure that all efforts purpose reserve. specific revenues and expenses. The exclusion are undertaken to meet both service and of these items is made to enhance matching financial targets. Interest Revenue of income and expenses so as to facilitate the comparability and consistency of results Interest revenue is recognised on a time (y) Services Supported By Health Services between years and Victorian Public Health proportionate basis that takes into account Agreement and Services Supported By Services. The Net Result before Capital & the effective yield of the financial asset. Hospital And Community Initiatives Specific Items is used by the management of The activities classified as Services Supported the Health Service, the Department of Health (v) Fund Accounting by Health Services Agreement (HSA) are and the Victorian Government to measure The Health Service operates on a fund substantially funded by the Department of the on-going results of Health Services in accounting basis and maintains three funds: Health and include Residential Aged Care operating hospital services.
Eastern Health Annual Report 2009-10 89 eastern Health financial statements 2009/10
Note 1: Statement of Significant Accounting Policies (continued)
Capital and specific items, which are excluded or rehabilitation facilities, or alcohol and drug Residential Aged Care including Mental from this sub-total, comprise: treatment units or hospitals specialising in Health (RAC incl. Mental Health) referred • Capital purpose income, which comprises dental services, hearing and ophthalmic aids. to in the past as psychogeriatric residential all tied grants, donations and bequests services, comprises those Commonwealth- received for the purpose of acquiring Mental Health Services (Mental Health) licensed residential aged care services in non-current assets, such as capital works, comprises all recurrent health revenue/ receipt of supplementary funding from DH plant and equipment or intangible assets. expenditure on specialised mental health under the mental health program. It excludes Consequently, the recognition of revenue services (child and adolescent, general and all other residential services funded under as capital purpose income is based on the adult, community and forensic) managed the mental health program, such as mental intention of the provider of the revenue at or funded by the state or territory health health-funded community care units (CCUs) the time the revenue is provided. administrations, and includes: Admitted and secure extended care units (SECs). • Specific income/expense, comprises the patient services (including forensic mental Other Services excluded from Australian following items, where material: health), outpatient services, emergency Health Care Agreement (AHCA) (Other) - Voluntary departure packages department services (where it is possible to comprises revenue/expenditure for services - Write-down of inventories separate emergency department mental not separately classified above, including: - Non-current asset revaluation increments/ health services), community-based services, Public health services including Laboratory decrements residential and ambulatory services. testing, Blood Borne Viruses/Sexually - Litigation settlements Transmitted Infections clinical services, Koori - Reversals of provisions Outpatient Services (Outpatients) comprises liaison officers, immunisation and screening - Assets provided or received free of charge all recurrent health revenue/expenditure services, Drugs services including drug • Depreciation and amortisation, as on public hospital type outpatient services, withdrawal, counselling and the needle and described in note 1 (k) and (h) where services are delivered in public hospital syringe program, Dental Health services • Expenditure using capital purpose income, outpatient clinics, or free standing day including general and specialist dental care, comprises expenditure which either falls hospital facilities, or rehabilitation facilities, school dental services and clinical education, below the asset capitalisation threshold set or alcohol and drug treatment units, or Disability services including aids and at $1,000 (2009: $1,000), or does not meet outpatient clinics specialising in ophthalmic equipment and flexible support packages asset recognition criteria and therefore aids or palliative care. to people with a disability, Community Care does not result in the recognition of an Emergency Department Services (EDS) programs including sexual assault support, asset in the balance sheet, where funding comprises all recurrent health revenue/ early parenting services, parenting assessment for that expenditure is from capital purpose expenditure on emergency department and skills development, and various support income. services that are available free of charge to services. Health and Community Initiatives public patients. also falls in this category group. (ad) Finance Costs Aged Care comprises revenue/expenditure Finance costs are recognised as expenses in (ag) New Accounting Standards and from Home and Community Care (HACC) the period in which they are incurred. Interpretations programs, Allied Health, Aged Care Finance costs include: Assessment and support services. Certain new accounting standards and - Interest on long term borrowings. interpretations have been published that are Primary Health comprises revenue/ not mandatory for 30 June 2010 reporting (ae) Functional and Presentation Currency expenditure for Community Health Services period. As at 30 June 2010, the following including health promotion and counselling, standards and interpretations have been The presentation currency of the Health physiotherapy, speech therapy, podiatry and issued but were not mandatory for financial Service is the Australian Dollar, which has also occupational therapy. years ending 30 June 2010. The Health Service been identified as the functional currency of has not and does not intend to adopt these the Health Service. Off Campus, Ambulatory Services standards earlier. (Ambulatory) comprises all recurrent health (af) Category Groups revenue/expenditure on public hospital type services, provided under the following The Health Service has used the following agreements: Services that are provided or category groups for reporting purposes for received by hospitals (or area health services) the current and previous financial years. but are delivered/received outside a hospital Admitted Patient Services (Admitted campus, services which have moved from a Patients) comprises all recurrent health hospital to a community setting since June revenue/expenditure on admitted patient 1998, services which fall within the agreed services, where services are delivered scope of inclusions under the new system, in public hospitals, or free standing day which have been delivered within hospitals hospital facilities, or palliative care facilities, i.e. in rural/remote areas.
90 Eastern Health Annual Report 2009-10 eastern Health financial statements 2009/10
Note 1: Statement of Significant Accounting Policies (continued)
Standard/Interpretation Summary Applicable Impact on Health Service’s for reporting Annual Statements periods beginning on or ending on
AASB 2009-5 Further amendments to Some amendments will result in accounting Beginning Terminology and editorial Australian Accounting Standards arising from changes for presentation, recognition or 1 Jan 2010 changes. Impact minor. the annual improvements project measurement purposes, while other amendments will relate to terminology and editorial changes. [ AASB 5, 8, 101, 107, 117, 118, 136, and 139]
AASB 2009-9 Amendments to Australian Applies to Health Services adopting Australian Beginning No Impact. Relates only Accounting Standards additional exemptions Accounting Standards for the first time, to ensure 1 Jan 2010 to first time adopters of for first-time adopters [AASB 1] Health Services will not face undue cost or effect Australian Accounting in the transition process in particular situations. Standards.
AASB 124 Related party disclosures (Dec 2009) Government related Health Services have been Beginning Preliminary assessment granted partial exemption with certain disclosure 1 Jan 2011 suggests that impact is requirements. insignificant. However, the Health Service is still assessing the detailed impact and whether to adopt early.
AASB 2009-12 Amendments to Australian This Standard amends AASB 8 to require an entity Beginning AASB 8 does not apply to Accounting Standards [AASB 5, 8, 108, 110, to exercise judgement in assessing whether 1 Jan 2011 Health Services therefore 112, 119, 133, 137, 139, 1023 & 1031 and a government and Health Services known to no impact expected. Interpretations 2, 4, 16 1039 and 1052] be under the control of that government are Otherwise, only editorial considered a single customer for purposes of changes arising from certain operating segment disclosures. amendments to other standard, no major impact. This standard also makes numerous editorial amendments to other AASs. Impacts of editorial amendments are not expected to be significant.
AASB 2009-14 Amendments to Australian Amendments to Interpretation 14 arising from Beginning Expected to have no Interpretation – Prepayments of a minimum the issuance of Prepayments of a minimum funding 1 Jan 2011 significant impact. funding requirement [AASB Interpretation 14] requirement.
AASB 9 Financial Instruments The standard simplifies requirements for the Beginning Detail of impact is still being classification and measurement of financial assets 1 Jan 2013 assessed. resulting from phase 1 of the IASB’s project to replace IAS 39 Financial instruments: recognition and measurement (AASB 139 financial instruments: recognition and measurement).
AASB 2009-11 Amendments to Australian This gives effect to consequential changes arising Beginning Detail of impact is still being Accounting Standards arising from AASB 9 [ from the issuance of AASB 9. 1 Jan 2013 assessed. AASB 1, 3, 4, 5, 7, 101, 102, 108, 112, 118, 121, 127, 128, 131, 132, 136, 139, 1023 and 1038 and Interpretations 10 and 12]
(ah) Comparative Information (ai) Commitments (aj) Contingent assets and contingent liabilities Where necessary, figures for the Commitments are not recognised on Balance previous year have been reclassified to Sheet. Commitments are disclosed at their Contingent assets and liabilities are not facilitate comparison. nominal value and are inclusive of the recognised in the Balance Sheet, but are GST payable. disclosed by way of note and, if quantifiable, are measured at nominal value. Contingent assets and contingent liabilities are presented inclusive of GST receivable or payable.
Eastern Health Annual Report 2009-10 91 eastern Health financial statements 2009/10
Note 2: revenue
HSA HSA Non HSA Non HSA Total Total 2009/10 2008/09 2009/10 2008/09 2009/10 2008/09 Notes $’000 $’000 $’000 $’000 $’000 $’000
Revenue from Operating Activities Government Contributions - Department of Health 537,445 498,771 - - 537,445 498,771 - State Government - Other 2,440 2,519 - - 2,440 2,519 - Commonwealth Government 15,777 14,222 - - 15,777 14,222
Total Government Grants 555,662 515,512 - - 555,662 515,512 Indirect Contributions by Department of Health** - Insurance 5,994 5,416 - - 5,994 5,416 - Long Service Leave 6,420 5,402 - - 6,420 5,402
Total Indirect Contribution by Department of Health 12,414 10,818 - - 12,414 10,818
Patient and Resident Fees - Patient and Resident Fees 2b 22,898 18,149 - - 22,898 18,149 - Residential Aged Care 2b 6,106 5,632 - - 6,106 5,632
Total Patient and Resident Fees 29,004 23,781 - - 29,004 23,781
Business Units Recoupment for use of Hospital Facilities - - 3,560 3,172 3,560 3,172 Donations & Bequests - - 1,054 1,056 1,054 1,056 Car Park - - 2,256 1,966 2,256 1,966 Education & Training - - 216 1,140 216 1,140 Food & Domestic Services - - 668 700 668 700 Pharmacy Services - - 438 429 438 429 Research - - 869 808 869 808 Commissions - - 1,941 1,750 1,941 1,750 Other (includes any activity not stated above) - - 4,249 1,017 4,249 1,017
Total Business Units - - 15,251 12,038 15,251 12,038
Recoupment from Private Practice for use of Hospital Facilities 15,721 11,086 - - 15,721 11,086 Other Revenue from Operating Activities 12,195 5,460 3,165 5,303 15,360 10,763 Sub-Total Revenue from Operating Activities 624,996 566,657 18,416 17,341 643,412 583,998
Revenue from Non-Operating Activities Interest - - 2,348 2,902 2,348 2,902 Property Income - - 47 47 47 47 Net Assets Received Free of Charge 2d - - 579 - 579 - Sub-Total Revenue from Non-Operating Activities - - 2,974 2,949 2,974 2,949
Capital Purpose Income State Government Capital Grants - Redevelopment Grant - - 12,334 20,849 12,334 20,849 Net Gain/(Loss) on disposal of non-current assets 2c - - 284 (47) 284 (47) Donations & Bequests - - 602 594 602 594
Sub-Total Revenue from Capital Purpose Income - - 13,220 21,396 13,220 21,396 Total Revenue 2a 624,996 566,657 34,610 41,686 659,606 608,343
**Indirect contributions by Department of Health Department of Health makes certain payments on behalf of Eastern Health. These amounts have been brought to account in determining the operating result for the year by recording them as revenue and expenses.
92 Eastern Health Annual Report 2009-10 eastern Health financial statements 2009/10
Note 2a: Analysis of revenue by source
RAC including Admitted Out- Ambul- Mental Mental Aged Primary Patients patients EDS atory Health Health Care Health Other Total 2009/10 2009/10 2009/10 2009/10 2009/10 2009/10 2009/10 2009/10 2009/10 2009/10 Notes $,000 $,000 $,000 $,000 $,000 $,000 $,000 $,000 $,000 $,000
Revenue from Services Supported by Health Services Agreement Government Grants 356,453 1,021 28,928 71,075 71,603 2,856 5,735 6,110 11,881 555,662 Indirect Contributions by Department of Health** 12,414 ------12,414 Patient and Resident Fees 2b 14,397 368 - 6,947 1,084 6,106 71 - 31 29,004 Recoupment from Private Practice for use of Hospital Facilities 14,296 291 - 489 - - - 536 109 15,721 Education & Training 364 - - 2 - - - - 385 751 Donations & Bequests ------2 2 Other Revenue 6,866 47 2 235 617 - 62 161 3,452 11,442 Sub-Total Revenue from Services Supported by Health Services Agreement 404,790 1,727 28,930 78,748 73,304 8,962 5,868 6,807 15,860 624,996
Revenue from Services Supported by Hospital & Community initiatives Business Units ------15,251 15,251 Investment Income ------2,348 2,348 Property Income ------47 47 Other Income ------3,744 3,744 Other Activities Capital Purpose Income 2 ------13,220 13,220 Sub-Total Revenue from Services Supported by Hospital & Community Initiatives ------34,610 34,610
Total Revenue from All Sources 404,790 1,727 28,930 78,748 73,304 8,962 5,868 6,807 50,470 659,606
**Indirect contributions by Department of Health Department of Health makes certain payments on behalf of Eastern Health. These amounts have been brought to account in determining the operating result for the year by recording them as revenue and expenses. RAC = Residential Aged Care EDS = Emergency Department Services
Eastern Health Annual Report 2009-10 93 eastern Health financial statements 2009/10
Note 2a: Analysis of revenue by source (continued)
RAC including Admitted Out- Ambul- Mental Mental Aged Primary Patients patients EDS atory Health Health Care Health Other Total 2008/09 2008/09 2008/09 2008/09 2008/09 2008/09 2008/09 2008/09 2008/09 2008/09 Notes $,000 $,000 $,000 $,000 $,000 $,000 $,000 $,000 $,000 $,000
Revenue from Services Supported by Health Services Agreement Government Grants 325,948 4,788 27,848 68,902 68,206 743 5,351 6,210 7,516 515,512 Indirect Contributions by Department of Health** 10,818 ------10,818 Patient and Resident Fees 2b 11,297 264 - 6,319 152 5,632 117 - - 23,781 Recoupment from Private Practice for use of Hospital Facilities 10,469 48 - 346 - - - 223 - 11,086 Education & Training 59 - - 4 1 - - - 1 65 Donations & Bequests ------Other Revenue 4,204 95 3 206 613 5 114 116 39 5,395 Sub-Total Revenue from Services Supported by Health Services Agreement 362,795 5,195 27,851 75,777 68,972 6,380 5,582 6,549 7,556 566,657
Revenue from Services Supported by Hospital & Community initiatives Business Units ------12,038 12,038 Interest ------2,902 2,902 Property Income ------47 47 Other Income ------5,303 5,303 Other Activities Capital Purpose Income 2 ------21,396 21,396 Sub-Total Revenue from Services Supported by Hospital & Community Initiatives ------41,686 41,686
Total Revenue from All Sources 362,795 5,195 27,851 75,777 68,972 6,380 5,582 6,549 49,242 608,343
**Indirect contributions by Department of Health Department of Health makes certain payments on behalf of Eastern Health. These amounts have been brought to account in determining the operating result for the year by recording them as revenue and expenses. RAC = Residential Aged Care EDS = Emergency Department Services
94 Eastern Health Annual Report 2009-10 eastern Health financial statements 2009/10
Note 2b: Patient and Resident Fees
2009/10 2008/09 $’000 $’000
Patient and Resident Fees Raised Recurrent: Admitted/Outpatients/EDS/Ambulatory - Inpatients 21,061 17,304 - Outpatients 651 576 Aged - Outpatients 71 117 Residential Aged Care (RAC) - Generic 2,895 2,604 - Psychogeriatric 3,150 2,995 - Residential Accommodation Payments(*) 61 33 Mental Health 1,084 152 Other 31 - Total Recurrent 29,004 23,781
Capital Purpose: Residential Accommodation Payments(*) - - Total Capital - -
(*) This includes accommodation payments, interest earned on accommodation bonds and retention amounts.
Note 2c: Net Gain/(Loss) on Disposal of Non Current Assets
2009/10 2008/09 $’000 $’000
Proceeds from Disposal of Non Current Assets Plant & Equipment - Other Plant & Equipment - - - Major Medical 23 12 - Computers & Communication - - Intangibles - - Furniture & Fittings 2 - Motor Vehicles 1,443 886 Total Proceeds from Disposal of Non Current Assets 1,468 898
Less: Written Down Value of Non Current Assets Sold Plant & Equipment - Other Plant & Equipment - 2 - Major Medical 92 184 - Computers & Communication 5 2 Intangibles - - Furniture & Fittings 37 4 Motor Vehicles 1,050 753 Total Written Down Value of Non Current Assets Sold 1,184 945
Net Gains/(Losses) on Disposal of Non Current Assets 284 (47)
Note 2d: Assets Received Free of Charge or For Nominal Consideration
2009/10 2008/09 $’000 $’000
During the reporting period, the fair value of assets received free of charge as part of the transfer of business of Turning Point Alcohol & Drug Centre was: 579 - TOTAL 579 -
Eastern Health Annual Report 2009-10 95 eastern Health financial statements 2009/10
Note 3: Expenses
HSA HSA Non HSA Non HSA Total Total 2009/10 2008/09 2009/10 2008/09 2009/10 2008/09 Notes $’000 $’000 $’000 $’000 $’000 $’000
Employee Benefits Salaries and Wages 397,702 357,508 5,141 3,559 402,843 361,067 Workcover 4,505 3,103 (209) 26 4,296 3,129 Long Service Leave 12,898 11,380 94 70 12,992 11,450 Superannuation 35,495 32,072 289 231 35,784 32,303 Total Employee Benefits 450,600 404,063 5,315 3,886 455,915 407,949
Non Salary Labour Costs Fees for Visiting Medical Officers 7,674 7,457 160 107 7,834 7,564 Agency Costs - Nursing 6,966 9,842 - - 6,966 9,842 Agency Costs - Other 1,451 2,573 49 2 1,500 2,575 Total Non Salary Labour Costs 16,091 19,872 209 109 16,300 19,981
Supplies & Consumables Drug Supplies 30,954 27,140 6 4 30,960 27,144 Medical, Surgical Supplies and Prosthesis 58,106 52,884 136 120 58,242 53,004 Pathology Supplies 4,825 4,102 3 (15) 4,828 4,087 Food Supplies 13,983 13,547 366 369 14,349 13,916 Total Supplies & Consumables 107,868 97,673 511 478 108,379 98,151
Other Expenses from Continuing Operations Domestic Services and Supplies 11,663 10,843 205 124 11,868 10,967 Fuel, Light, Power & Water 3,739 3,274 14 16 3,753 3,290 Insurance costs funded by Department of Health 5,995 5,416 - - 5,995 5,416 Motor Vehicle Expenses 2,264 888 4 4 2,268 892 Postal & Telephone 2,263 1,960 308 59 2,571 2,019 Repairs and Maintenance 5,171 5,280 570 575 5,741 5,855 Maintenance Contracts 6,223 5,646 (171) 39 6,052 5,685 Patient Transport 4,932 4,609 1 1 4,933 4,610 Administrative Expenses 7,515 6,494 251 910 7,766 7,404 Computers & Communications 829 762 305 103 1,134 865 Printing & Stationery 2,347 2,724 203 300 2,550 3,024 Recruitment & Advertising 869 1,242 44 53 913 1,295 Training & Development 4,139 3,774 343 591 4,482 4,365 Bad & Doubtful Debts 632 534 30 42 662 576 Lease Expenses 3,042 2,457 58 65 3,100 2,522 Other Administrative Expenses 3,351 5,052 - - 3,351 5,052 Total Other Expenses from Continuing Operations 64,974 60,955 2,165 2,882 67,139 63,837
Depreciation & Amortisation 4 - - 39,687 18,788 39,687 18,788 Audit Fees Auditor General 24 107 99 - - 107 99 Other 199 115 1 3 200 118 Total Expenses 639,839 582,777 47,888 26,146 687,727 608,923
96 Eastern Health Annual Report 2009-10 eastern Health financial statements 2009/10
Note 3a: Analysis of Expenses by Source
RAC including Admitted Out- Ambul- Mental Mental Aged Primary Patients patients EDS atory Health Health Care Health Other Total 2009/10 2009/10 2009/10 2009/10 2009/10 2009/10 2009/10 2009/10 2009/10 2009/10 Notes $,000 $,000 $,000 $,000 $,000 $,000 $,000 $,000 $,000 $,000
Services Supported by Health Services Agreement Employee Benefits 280,912 4,110 43,423 41,910 54,481 7,477 3,935 4,746 9,606 450,600 Non Salary Labour Costs 12,316 7 1,121 230 1,630 271 - 378 138 16,091 Supplies & Consumables 93,600 287 2,450 7,724 761 345 32 82 2,587 107,868 Other Expenses 18,606 85 2,887 15,694 18,174 988 841 3,329 4,370 64,974 Sub-Total Expenses from Services Supported by Health Services Agreement 405,434 4,489 49,881 65,558 75,046 9,081 4,808 8,535 16,701 639,533
Services Supported by Hospital & Community Initiatives Employee Benefits ------5,315 5,315 Non Salary Labour Costs ------209 209 Supplies & Consumables ------511 511 Other Expenses ------2,165 2,165 Sub-Total Expenses from Services Supported by Hospital and Community Initiatives ------8,200 8,200
Depreciation & Amortisation 4 ------39,687 39,687 Audit Fees Auditor General 24 107 ------107 Other 192 - - - - 1 - 3 4 200 Total Expenses 405,733 4,489 49,881 65,558 75,046 9,082 4,808 8,538 64,592 687,727
Eastern Health Annual Report 2009-10 97 eastern Health financial statements 2009/10
Note 3a: Analysis of Expenses by Source (continued)
RAC including Admitted Out- Ambul- Mental Mental Aged Primary Patients patients EDS atory Health Health Care Health Other Total 2008/09 2008/09 2008/09 2008/09 2008/09 2008/09 2008/09 2008/09 2008/09 2008/09 Notes $,000 $,000 $,000 $,000 $,000 $,000 $,000 $,000 $,000 $,000
Services Supported by Health Services Agreement Employee Benefits 252,944 2,916 39,478 38,549 49,917 7,188 3,544 5,529 3,998 404,063 Non Salary Labour Costs 14,957 15 1,710 522 2,069 406 - 163 30 19,872 Supplies & Consumables 84,738 225 2,420 6,913 893 375 20 6 2,083 97,673 Other Expenses from Operating Activities 19,744 287 2,786 15,397 16,357 586 918 2,316 2,564 60,955 Sub-Total Expenses from Services Supported by Health Services Agreement 372,383 3,443 46,394 61,381 69,236 8,555 4,482 8,014 8,675 582,563
Services Supported by Hospital & Community Initiatives Employee Benefits ------3,886 3,886 Non Salary Labour Costs ------109 109 Supplies & Consumables ------478 478 Other Expenses from Continuing Operations ------2,882 2,882 Sub-Total Expenses from Services Supported by Hospital and Community Initiatives ------7,355 7,355
Depreciation & Amortisation 4 ------18,788 18,788 Audit Fees Auditor General 24 99 ------99 Other 106 - - - - 1 - 3 8 118 Total Expenses 372,588 3,443 46,394 61,381 69,236 8,556 4,482 8,017 34,826 608,923
98 Eastern Health Annual Report 2009-10 eastern Health financial statements 2009/10
Note 3b: Analysis of Expenses by Internal and Restricted Specific Purpose Funds for Services Supported by Hospital and Community Initiatives
2009/10 2008/09 $’000 $’000
Private Practice and Other Patient Activities 2,277 1,891 Car Park 1,156 637 Property Expenses - - Education & Training 495 642 Food & Domestic Services 447 660 Patient Welfare Funds - - Others 2,737 2,359
Other Activities Fundraising and Community Support 223 334 Research and Scholarships 865 832
TOTAL 8,200 7,355
Note 4: Depreciation and Amortisation
2009/10 2008/09 $’000 $’000
Depreciation Buildings 26,264 7,784 Plant & Equipment - Other Plant & Equipment 76 625 - Major Medical 7,084 5,500 - Computers and Communication 2,512 2,030 Furniture and Fittings 1,395 1,287 Motor Vehicles 1,199 933 Total Depreciation 38,530 18,159
Amortisation Leasehold Improvements 80 223 Software 1,077 406 Total Amortisation 1,157 629
Total Depreciation & Amortisation 39,687 18,788
Note 5: Finance Costs
2009/10 2008/09 $’000 $’000
Interest on Long Term Borrowings 573 650
TOTAL 573 650
Eastern Health Annual Report 2009-10 99 eastern Health financial statements 2009/10
Note 6: Cash and Cash Equivalents For the purpose of the Cash Flow Statement, cash assets includes cash on hand and in banks and short term deposits which are readily convertible to cash on hand, and are subject to an insignificant risk of change in value, net of outstanding bank overdrafts.
2009/10 2008/09 $’000 $’000
Cash on Hand 34 32 Cash at Bank 4,526 5,904 Short Term Money Market 32,617 29,260 TOTAL 37,177 35,196
Represented by: Cash for Health Service Operations (as per Cash Flow Statement) 37,177 35,196 TOTAL 37,177 35,196
Note 7: Receivables
2009/10 2008/09 $’000 $’000
CURRENT Contractual Trade Debtors 5,614 5,391 Patient Fees 7,129 4,416 Accrued Investment Income 264 222 Accrued Revenue - Other - 237 Less Allowance for Doubtful Debts Trade Debtors (138) (202) Patient Fees (849) (539) 12,020 9,525 Statutory GST Receivable 1,708 1,713 1,708 1,713 TOTAL CURRENT RECEIVABLES 13,728 11,238
NON CURRENT Statutory Long Service Leave - Department of Health 38,838 32,570 Less: Contribution received from Department of Health (29,169) (25,466)
TOTAL NON CURRENT RECEIVABLES 9,669 7,104 TOTAL RECEIVABLES 23,397 18,342
(a) Movement in the Allowance for Doubtful Debts Balance at the beginning of the year 741 884 Amounts written off during the year - - Amounts recovered during the year - - Increase/(decrease) in allowance recognised in the profit & loss 246 (143) Balance at the end of the year 987 741
(b) Ageing analysis of receivables Please refer to note 19(b) for the ageing analysis of receivables
(c) Nature and extent of risk arising from receivables Please refer to note 19(b) for the nature and extent of credit risk arising from receivables
100 Eastern Health Annual Report 2009-10 eastern Health financial statements 2009/10
Note 8: Other Financial Assets
Specific Specific Operating Operating Purpose Purpose Capital Capital Fund Fund Fund Fund Fund Fund Total Total 2009/10 2008/09 2009/10 2008/09 2009/10 2008/90 2009/10 2008/09 Notes $,000 $,000 $,000 $,000 $,000 $,000 $,000 $,000
CURRENT Australian Dollar Term Deposits - - 1,479 1,020 - - 1,479 1,020 NON CURRENT Australian Dollar Term Deposits ------
TOTAL - - 1,479 1,020 - - 1,479 1,020 Presented by: Money Held in Trust - - 1,479 1,020 - - 1,479 1,020
TOTAL - - 1,479 1,020 - - 1,479 1,020
(a) Ageing analysis of other financial assets Please refer to note 19(b) for the ageing analysis of other financial assets
(b) Nature and extent of risk arising from other financial assets Please refer to note 19(b) for the nature and extent of credit risk arising from other financial assets
Note 9: Inventories
2009/10 2008/09 $’000 $’000
Pharmaceuticals - at cost 1,510 1,586 Medical and Surgical Lines - at cost 979 1,136 Other - at cost 876 780
TOTAL INVENTORIES 3,365 3,502
Note 10: Prepayments
2009/10 2008/09 $’000 $’000
CURRENT Maintenance Contracts 714 557 Other 451 285
TOTAL PREPAYMENTS 1,165 842
Eastern Health Annual Report 2009-10 101 eastern Health financial statements 2009/10
Note 11: Property, Plant & Equipment
2009/10 2008/09 $’000 $’000
Land - Land at Cost - - Less Impairment - -
- Land at Fair Value 62,036 62,036 Less Impairment - Total Land 62,036 62,036
Buildings -Buildings at Cost 74,056 51,165 Less Accumulated Depreciation (3,953) (915) 70,103 50,250
- Buildings Under Construction at cost 9,106 25,517
- Buildings at Fair Value 323,319 344,025 Less Accumulated Depreciation (23,336) - 299,983 344,025 Total Buildings 379,192 419,792
Leasehold Improvements - Leasehold Improvements 1,395 1,386 Less Accumulated Depreciation (1,221) (1,141) Total Leasehold Improvements 174 245
Plant and Equipment - Plant at Fair Value - - Less Accumulated Depreciation - - - - -Medical Equipment at Fair Value 60,350 53,187 Less Accumulated Depreciation (32,616) (25,969) 27,734 27,218 - Computers and Communication at Fair Value 16,074 15,656 Less Accumulated Depreciation (12,231) (11,613) 3,843 4,043 1,694 2,547 Total Plant and Equipment 33,271 33,808
Motor Vehicles -Motor Vehicles at Cost 6,991 5,772 Less Accumulated Depreciation (1,900) (1,639) Total Motor Vehicles 5,091 4,133
Furniture and Fittings -Furniture and Fittings at cost 14,974 13,973 Less Accumulated Depreciation (4,851) (3,993) Total Furniture and Fittings 10,123 9,980
TOTAL 489,887 529,994
102 Eastern Health Annual Report 2009-10 eastern Health financial statements 2009/10
Note 11: Property, Plant & Equipment (continued) Reconciliation of the carrying amounts of each class at the beginning of the previous and current financial year is set out below.
Buildings & Leasehold Plant & Furniture & Motor Land Improvements Equipment Fittings Vehicles Total $’000 $’000 $’000 $’000 $’000 $’000
Balance as at 1 July 2008 49,792 341,458 32,621 4,080 3,160 431,111 Additions - 18,432 13,438 8,208 2,645 42,723 Disposals - - (188) (18) (739) (945) Classified as held for Sale ------Revaluation increments/(decrements) 12,244 63,242 - - - 75,486 Net transfers free of charge - 4,912 (3,909) (1,003) - - Depreciation and Amortisation (note 4) - (8,007) (8,154) (1,287) (933) (18,381)
Balance as at 1 July 2009 62,036 420,037 33,808 9,980 4,133 529,994
Additions - 6,379 9,232 1,575 3,207 20,393 Disposals - - (97) (37) (1,050) (1,184) Classified as held for Sale ------Building Impairment* - (20,706) - - - (20,706) Net transfers free of charge ------Depreciation and Amortisation (note 4) - (26,344) (9,672) (1,395) (1,199) (38,610)
Balance as at 30 June 2010 62,036 379,366 33,271 10,123 5,091 489,887
Land and Buildings carried at valuation
An independent valuation of the Health Service's property, plant and equipment was performed by the Valuer-General Victoria to determine the fair value of the land and buildings. The valuation, which conforms to Australian Valuation Standards, was determined by reference to the amounts for which assets could be exchanged between knowledgeable willing parties in an arm's length transaction. The Valuation was based on independent assessments. The effective date of the valuation was 30 June 2009.
Plant and Equipment has been valued at fair value in accordance with FRD 103D. The fair value was determined by depreciated replacement costs.
* During the year, the Clive Ward and associated buildings at Box Hill Hospital were considered to be impaired given the buildings have been vacated for demolition after the State Government announcement of a major redevelopment at Box Hill Hospital. This impairment resulted in a write down of the buildings of $20.706 million which was debited to the asset revaluation reserve.
Note 12: Intangible Assets For the purpose of the Cash Flow Statement, cash assets includes cash on hand and in banks and short-term deposits which are readily convertible to cash on hand, and are subject to an insignificant risk of change in value, net of outstanding bank overdrafts.
2009/10 2008/09 $’000 $’000
Intangibles Software 9,829 5,497 Less Accumulated Amortisation (6,103) (5,017) 3,726 480
TOTAL 3,726 480
Eastern Health Annual Report 2009-10 103 eastern Health financial statements 2009/10
Note 12: Intangible Assets (continued) Reconciliation of the carrying amounts of intangible assets at the beginning and end of the previous and current financial year:
Software Other Total $’000 $’000 $’000
Balance as at 1 July 2008 465 - 465 Additions 421 - 421 Disposals - - - Classified as held for sale - - - Amortisation (note 4) (406) - (406)
Balance as at 1 July 2009 480 - 480
Additions 4,323 - 4,323 Disposals - - - Classified as held for sale - - - Amortisation (note 4) (1,077) - (1,077)
Balance as at 30 June 2010 3,726 - 3,726
Note 13: Payables
Total Total 2009/10 2008/09 $’000 $’000
Current Contractual Trade Creditors 23,370 19,056 Accrued Expenses 12,264 12,939 Superannuation 4,256 3,993 Work Cover 819 370 Tax Payable 3,585 1,857 44,294 38,215
TOTAL CURRENT 44,294 38,215
(a) Maturity analysis of payables Please refer to note 19(c) for the ageing analysis of payables
(b) Nature and extent of risk arising from payables Please refer to note 19(c) for the nature and extent of credit risk arising from payables
104 Eastern Health Annual Report 2009-10 eastern Health financial statements 2009/10
Note 14: Interest Bearing Liabilities
2009/10 2008/09 Note $’000 $’000
CURRENT Australian Dollar Borrowings - Other 230 288 Total Australian Dollars Borrowings 230 288
Total Current 230 288
NON CURRENT Australian Dollar Borrowings - Other 15,761 11,439 Total Australian Dollars Borrowings 15,761 11,439
Total Non-Current 15,761 11,439
TOTAL INTEREST BEARING LIABILITIES 15,991 11,727
The interest bearing liabilities relate to three loans.
A loan facility of $4.7 million from Treasury Corporation of Victoria (TCV) to finance the construction of the car park facility at Maroondah Hospital. As at year end, $3.403 million (2008/09 $3.535 million) was still owed. The loan is repayable over 20 years. The repayments commenced a month after final draw down being 15 December 2005. The interest rate applicable is fixed at 5.8628% pa for the life of the loan.
A loan facility of $1.5 million from Treasury Corporation of Victoria (TCV) to finance the construction of the car park facility at the Angliss Hospital. As at year end, $1.338 million (2008/09 $1.423 million) was still owed. The loan is repayable over 14 years. The repayments commenced a month after final draw down being 28 June 2008. The interest rate applicable is fixed at 7.23% pa for the life of the loan.
A loan facility of $11.5 million from Treasury Corporation of Victoria (TCV) to finance the construction of the car park facility at the Box Hill Hospital. As at year end $11.25 million (2008/09 $6.697Million) had been drawn to finance the disbursement to the contractors. The loan is repayable over 23 years. The repayments are expected to commence in September 2010. The interest rate applicable is 4.665% pa, which is 0.115% above TCV 11am rate. In terms of the loan agreement, the lender has a right to fix the rate of interest at TCV transfer pricing curve plus 0.215% in consultation with the borrower on final draw down.
An interest free loan from the Department of Health for provision of Environmental Efficiency Improvements was repaid during year. The balance of the loan is nil at year end (2008/09 $72k).
(a) Maturity analysis of interest bearing liabilities Please refer to note 19(c) for the ageing analysis of interest bearing liabilities.
(b) Nature and extent of risk arising from Interest bearing liabilities Please refer to note 19(c) for the nature and extent of credit risk arising from interest bearing liabilities.
(c) Defaults and breaches During the current and prior year, there were no defaults or breaches of any of the loans.
Eastern Health Annual Report 2009-10 105 eastern Health financial statements 2009/10
Note 15: Employee Benefits and Related on-costs Provisions
2009/10 2008/09 $’000 $’000
CURRENT PROVISIONS Employee Benefits Unconditional and Expected to be utilised within 12 months 47,086 44,792 Unconditional and Expected to be utilised after 12 months 41,283 37,487 Sub-Total 88,369 82,279
Provisions related to employee benefit on-costs Unconditional and Expected to be utilised within 12 months 3,545 3,179 (nominal value) Unconditional and Expected to be utilised after 12 months 4,129 3,749 (present value) 7,674 6,928 TOTAL CURRENT PROVISIONS 96,043 89,207
NON CURRENT PROVISIONS Employee Benefits 11,750 11,071 Provisions related to employee benefit on-costs 1,175 1,107
TOTAL NON-CURRENT PROVISIONS 12,925 12,178
CURRENT EMPLOYEE BENEFITS Unconditional Long Service Leave entitlements 42,161 36,847 Annual Leave Entitlements 33,321 31,172 Accrued Salaries and Wages 11,278 12,769 Accrued Days Off 1,248 1,260 Sabbatical Leave 361 230
NON CURRENT EMPLOYEE PROVISIONS Conditional Long Service Leave entitlements (present value) 11,750 11,071 TOTAL EMPLOYEE BENEFITS 100,119 93,349
ON-COSTS Current On-Costs 7,674 6,928 Non-Current On-Costs 1,175 1,107 TOTAL ON-COSTS 8,849 8,035
TOTAL EMPLOYEE BENEFITS AND RELATED ON-COSTS 108,968 101,384 Movement in Long Service Leave: Balance at start of year 52,710 45,849 Provision made during the year 13,029 11,414 Settlement made during the year (6,437) (4,553)
BALANCE AT END OF YEAR 59,302 52,710
106 Eastern Health Annual Report 2009-10 eastern Health financial statements 2009/10
Note 16: Other Liabilities
2009/10 2008/09 Note $’000 $’000
CURRENT Income in Advance - Department of Health 2,694 2,567 - Other 926 37 Other Liabilities 246 - 3,866 2,604
Patient Monies held in Trust 1,479 1,020
TOTAL 5,345 3,624
Patient Monies held in trust represented by the following assets: Other Financial Assets 8 1,479 1,020
TOTAL 1,479 1,020
Note 17: Equity & Reserves
2009/10 2008/09 $’000 $’000
(a) Reserves Asset Revaluation Reserve Balance at the beginning of the reporting period 134,711 59,225 Revaluation Increments/(Decrements) - Land - 12,244 - Buildings (20,706) 63,242 Balance at the end of the reporting period 114,005 134,711
Represented by: - Land 34,700 34,700 - Buildings 79,305 100,011 Balance at the end of the reporting period 114,005 134,711
Restricted Specific Purpose Reserve Balance at the beginning of the reporting period 15,609 14,460 Transfer to and from Restricted Specific Purpose Reserve 1,139 1,149 Balance at the end of the reporting period 16,748 15,609 Total Reserves 130,753 150,320
(b) Contributed Capital Balance at the beginning of the reporting period 231,510 225,950 Capital contribution received from Victorian Government - 5,560 Balance at the end of the reporting period 231,510 231,510
(c) Accumulated Surpluses/(Deficits) Balance at the beginning of the reporting period 52,595 54,324 Net Result for the Year (28,121) (580) Transfer to and from Restricted Specific Purpose Reserve (1,139) (1,149) Balance at the end of the reporting period 23,335 52,595
(d) Total Equity at the end of financial year 385,598 434,425
Eastern Health Annual Report 2009-10 107 eastern Health financial statements 2009/10
Note 18: Reconciliation of Net Result for the Year to Net Cash Inflow/(Outflow) from Operating Activities
2009/10 2008/09 $’000 $’000
Net Result for the Year (28,121) (580) Depreciation & Amortisation 39,687 18,788 Net (Gain)/Loss from Sale of Plant & Equipment (284) 47
Change in Operating Assets and Liabilities (Increase)/Decrease in Receivables (5,301) (2,089) (Increase)/Decrease in Other Current Assets (186) (635) Increase/(Decrease) in Provision for Doubtful Debts 246 (143) Increase/(Decrease) in Other Current Liabilities 1,262 1,736 Increase/(Decrease) in Payables 6,079 1,278 Increase/(Decrease) in Employee Benefits 7,584 9,960
NET CASH INFLOW/(OUTFLOW) FROM OPERATING ACTIVITIES 20,966 28,362
Note 19: Financial Instruments
(a) Financial Risk Management Objectives and Policies The Health Service’s principal financial instruments comprise of: - Cash Assets - Term Deposits - Receivables (excluding statutory receivables) - Payables (excluding statutory payables) - Accommodation Bonds
The Financial Management Act procludes the Health Service from borrowing without approval from the Treasurer of Victoria. The Health Service has an approved investment policy. This policy stipulates that short term investments must have an A1+ credit rating. All the Health Service’s investments are short term.
Details of the significant accounting policies and methods adopted, including the criteria for recognition, the basis of measurement and the basis on which income and expenses are recognised, in respect of each class of financial asset, financial liability and equity instrument are disclosed in note 1 to the financial statements.
The main purpose in holding financial instruments is to prudentially manage Eastern Health’s financial risk within the Government policy parameters.
Categorisation of financial instruments
2009/10 2008/09 Note Category $’000 $’000
Financial Assets Financial Assets Cash and cash equivalents 6 N/A 37,177 35,196 Receivables 7 Loans and Receivables 23,397 18,342 Other Financial assets 8 Patient Trust Monies 1,479 1,020
Financial Liabilities Financial Liabilities measured at Payables 13 amortised cost 44,294 38,215 Financial Liabilities measured at Interest Bearing Liabilities 14 amortised cost 15,991 11,727 Financial Liabilities measured at Other Liabilities 16 amortised cost 5,345 3,624
108 Eastern Health Annual Report 2009-10 eastern Health financial statements 2009/10
Note 19: Financial Instruments (continued)
(b) Credit Risk Exposure Credit risk represents the loss that would be recognised if counterparties fail to meet their obligations under the respective contracts at maturity. The credit risk on financial assets of the entity has been recognised on the balance sheet as the carrying amount, net of any provisions for doubtful debts. There is no significant exposure to any individual debtor except to the Department of Health.
Eastern Health’s exposure to credit risk and effective interest rates by ageing periods is set out in the following table For interest rates applicable to each class of asset refer to the individual notes to the financial statements
Ageing analysis of financial asset as at 30/06/2010
Not past Past Due But Not Impaired due Imparied Carrying and Not less than 1-3 3 month - 1-5 Over Financial Amount Impaired 1 month month 1 Year Years 5 Years Assets $’000s $’000s $’000s $’000s $’000s $’000s $’000s $’000
Interest rate exposure as at 30 June 2010 Financial Assets Cash and Cash Equivalents 37,177 37,177 ------Receivables 23,397 16,837 2,386 2,073 2,101 - - - Other Financial Assets 1,479 1,479 ------Total Financial Assets 62,053 55,493 2,386 2,073 2,101 - - -
Interest rate exposure as at 30 June 2009 Financial Assets Cash and Cash Equivalents 35,196 35,196 ------Receivables 18,342 14,229 1,474 1,495 1,144 - - - Other Financial Assets 1,020 1,020 ------Total Financial Assets 54,558 50,445 1,474 1,495 1,144 - - -
Eastern Health Annual Report 2009-10 109 eastern Health financial statements 2009/10
Note 19: Financial Instruments (continued)
(c) Liquidity risk
The interest bearing liabilities relate to three loans.
A loan facility of $4.7 million from Treasury Corporation of Victoria (TCV) to finance the construction of the car park facility at Maroondah Hospital. As at the year end, $3.403 million(2008-09 $3.535 million) was still owed. The loan is repayable over 20 years. The repayments commenced a month after the final draw down being 15 December 2005. The interest rate applicable is fixed at 5.8628% pa for the life of the loan.
A loan facility of $1.5 million from Treasury Corporation of Victoria (TCV) to finance the construction of the car park facility at the Angliss Hospital. As at the year end $1.338 million (2008-09 $1.423 million) had been drawn to finance the disbursement to the contractors. The loan is repayable over 14 years commencing a month after the final draw down. The repayments commenced on the month after the final draw down being 28 June 2008. The interest rate applicable is 7.23% pa for the life of the loan.
A loan facility of $11.5 million from Treasury Corporation of Victoria (TCV) to finance the construction of the car park facility at the Box Hill Hospital. As at the year end $11.25 million (2008-09 $6.697 million) had been drawn to finance the disbursement to the contractors. The loan is repayable over 23 years. The repayments are expected to commence in September 2010. The interest rate applicable is 4.665% pa, which is 0.115% above TCV 11am rate. In terms of the loan agreement, the lender has a right to fix the rate of interest at TCV transfer pricing curve plus 0.215% in consultation with the borrower on final draw down.
An interest free loan from the Department of Health for provision of Environmental Efficiency Improvements was repaid during the year. The balance was the loan was nil at year end (2008-09 $72k.)
The following table discloses the contractual maturity analysis for Eastern Health’s financial liabilities. For Interest rates applicable to each class of liability refer to individual notes to the financial instruments.
Maturity analysis of financial liabilities as at 30/06/2010
Maturity Dates Carrying Contractual less than 1-3 3 month - 1-5 Over 5 Amount Cash Flows 1 month month 1 Year Years Years $’000s $’000s $’000s $’000s $’000s $’000s $’000s
2010 Financial Liabilities Trade Creditors and Accruals 44,294 44,294 28,791 15,503 - - - Bank Overdrafts ------Interest Bearing Liabilities 15,991 15,991 19 39 172 1,153 14,608 Other Liabilities 5,345 1,479 - - 1,479 - - Total Financial Liabilities 65,630 61,764 28,810 15,542 1,651 1,153 14,608
2009 Financial Liabilities Trade Creditors and Accruals 38,215 38,215 24,840 13,375 - - - Bank Overdrafts ------Interest Bearing Liabilities 11,727 11,727 18 37 167 1,047 10,458 Other Liabilities 3,624 1,020 - - 1,020 - - Total Financial Liabilities 53,566 50,962 24,858 13,412 1,187 1,047 10,458
110 Eastern Health Annual Report 2009-10 eastern Health financial statements 2009/10
Note 19: Financial Instruments (continued)
(d) Market Risk
Eastern Health’s exposures to market risk are primarily through interest rate risk with only insignificant exposure to foreign currency and other price risk. Objectives, policies and processes used to manage each of these risks are disclosed in the paragraph below.
Currency risk
Eastern Health is exposed to insignificant foreign currency risk through its payables relating to purchases of supplies and consumables from overseas. This is because of a limited amount of purchases denominated in foreign currencies and a short timeframe between commitment and settlement.
Interest rate risk
Exposure to interest rate risk might arise primarily through Eastern Health’s interest bearing liabilities. Minimisation of risk is achieved by mainly undertaking fixed rate or non- interest bearing financial instruments. For financial liabilities, the Health Service mainly undertake financial liabilities with relatively even maturity profiles.
Interest rate exposure of Financial Assets and Liabilities as at 30 June
Weighted Interest Rate Exposure Average Fixed Variable Non Effective Carrying Interest Interest Interest Interest Amount Rate Rate Bearing Rates (%) $’000s $’000s $’000s $’000s
Interest rate exposure as at 30 June 2010 Financial Assets Cash and Cash Equivalents 5.76% 37,177 32,617 4,526 34 Receivables - 23,397 - - 23,397 Other Financial Assets 5.76% 1,479 1,479 - - Total Financial Assets 62,053 34,096 4,526 23,431
2010 Financial Liabilities Trade Creditors and Accruals 44,294 - 44,294 - Bank Overdrafts - - - - Interest Bearing Liabilities 5.13% 15,991 4,741 11,250 - Other Liabilities 5,345 - 5,345 - Total Financial Liabilities 65,630 4,741 60,889 -
Interest rate exposure as at 30 June 2009 Financial Assets Cash and Cash Equivalents 3.74% 35,196 29,260 5,904 32 Receivables - 18,342 - - 18,342 Other Financial Assets 3.74% 1,020 1,020 - - Total Financial Assets 54,558 30,280 5,904 18,374
2009 Financial Liabilities Trade Creditors and Accruals 38,215 - 38,215 - Bank Overdrafts - - - - Interest Bearing Liabilities 4.48% 11,727 4,958 6,697 72 Other Liabilities 3,624 - 3,624 - Total Financial Liabilities 53,566 4,958 48,536 72
Eastern Health Annual Report 2009-10 111 eastern Health financial statements 2009/10
Note 19: Financial Instruments (continued)
Sensitivity Disclosure Analysis
Taking into account past performance, future expectations, economic forecasts, and management’s knowledge and experience of the financial markets, Eastern Health believes the following movements are ‘reasonably possible’ over the next 12 months (Base rates are sourced from the Reserve Bank of Australia) - A parallel shift of +0.5% and -0.5% in market interest rates (AUD) from year end of 6% - A parallel shift of +0.5% and -0.5% in inflation rate from year end rates of 2%
The following table discloses the impact on the net operating result and equity for each category of financial instruments held by Eastern Health at year end as presented to key management personnel, if changes in the relevant risk occur.
Interest Rate Exposure Other Price Risk
Carrying -0.5% +0.5% -0.5% +0.5% Amount Profit Equity Profit Equity Profit Equity Profit Equity 2010 $’000s $’000s $’000s $’000s $’000s $’000s $’000s $’000s $’000s
Financial Assets Cash and cash equivalents 37,177 (186) (186) 186 186 - - - - Receivables 23,397 ------Other Financial assets 1,479 (7) (7) 7 7 - - - -
Financial Liabilities Payables 44,294 ------Interest Bearing Liabilities 15,991 56 56 (56) (56) - - - - Other Liabilities 5,345 ------
Interest Rate Exposure Other Price Risk
Carrying -0.5% +0.5% -0.5% +0.5% Amount Profit Equity Profit Equity Profit Equity Profit Equity 2009 $’000s $’000s $’000s $’000s $’000s $’000s $’000s $’000s $’000s
Financial Assets Cash and cash equivalents 35,196 (147) (147) 147 147 - - - - Receivables 18,342 ------Other Financial assets 1,020 (5) (5) 5 5 - - - -
Financial Liabilities Payables 38,215 ------Interest Bearing Liabilities 11,727 34 34 (34) (34) - - - - Other Liabilities 3,624 ------
112 Eastern Health Annual Report 2009-10 eastern Health financial statements 2009/10
Note 20: Commitments for Expenditure
2009/10 2008/09 $’000 $’000
Capital Commitments: (Commitments* for the acquisition of fixed assets.) Payable Land and Buildings 419,607 15,740 Plant & Equipment - Medical Equipment 3,073 3,597 - Computer Equipment 6,734 7,396 - Other Equipment 445 1,788 - Motor Vehicles 262 595 Total Capital Commitments 430,121 29,116 Payable No later than one year 34,234 25,727 Later than one year but not later than 5 years 245,887 3,389 Later than 5 Years 150,000 - TOTAL 430,121 29,116
Operating Commitments: (Commitments* for operating expenditure under contracts for the supply of services, materials and other but not recognised as liabilities) Supplies & Consumables - Medical 7,527 7,604 - Other 49,903 85,042 Maintenance Contracts - Medical 1,996 3,254 - Information Technology 3,560 2,282 Total Operating Commitments 62,986 98,182 Payable No later than one year 42,035 45,562 Later than one year but not later than 5 years 20,951 52,620 Later than 5 Years - - TOTAL 62,986 98,182 Lease Commitments: Commitments in relation to leases contracted for at the reporting date: Operating Lease 886 1,802 Total Lease Commitments 886 1,802 Payable No later than one year 562 1,057 Later than one year but not later than 5 years 324 745 Later than 5 Years - - TOTAL 886 1,802
*Contracted commitments relates to contracts to expend amounts greater than $100,000 per year per contract.
Note 21: Contingent assets & contingent liabilities
2009/10 2008/09 $’000 $’000
Capital Grant from DH - Medical Records Scanning System 2,000 -
Total Contingent Assets & Contingent Liabilities 2,000 -
Eastern Health Annual Report 2009-10 113 eastern Health financial statements 2009/10
Note 22: Segment Reporting
Net Result Acquisition Non Cash from of Property Expenses Segment Segment Ordinary Segment Segment Segment Plant & Depreciation Other Than Revenue Expenditure Activities Assets Liabilities Equity Equipment & Amortisation Depreciation $,000 $,000 $,000 $,000 $,000 $,000 $,000 $,000 $,000
2009/10 Segment Hospital 650,644 678,646 (28,002) 544,515 171,678 372,837 24,652 39,523 (38) Nursing Homes 7,775 7,876 (101) 10,916 1,216 9,700 61 138 - Hostel 1,187 1,205 (18) 4,765 1,704 3,061 3 26 - TOTAL 659,606 687,727 (28,121) 560,196 174,598 385,598 24,716 39,687 (38)
2008/09 Segment Hospital 599,943 600,371 (428) 578,838 152,173 426,665 43,101 18,602 190 Nursing Homes 7,395 7,363 32 10,690 1,515 9,175 31 159 - Hostel 1,005 1,189 (184) 4,180 1,263 2,917 12 27 - TOTAL 608,343 608,923 (580) 593,708 154,951 438,757 43,144 18,788 190
Geographical Segment
The Health Service operates predominantly in Melbourne (Eastern suburbs and Healesville), Victoria. More than 90% of revenue, net loss from ordinary activities and segment assets relate to operations in Melbourne (Eastern suburbs and Healesville), Victoria.
Business Segments
Hospital This segment includes all activities directed to people who need medical or nursing care before resuming their normal lives in the community.
Nursing Homes / Hostels The Commonwealth Government regulates and partly funds the provision of residential care for frail, older people who can no longer live independently in their own home. There are two levels of care and although they are officially called low level residential care and high level residential care they are still widely known and referred to as hostels and nursing homes, respectively.
Before a person can enter a hostel or nursing home they must be assessed and approved for care by an Aged Care Assessment Team (ACAT). ACATs are generally made up of local doctors, nurses, social workers and the like and they are usually located at hospitals, aged care centres or community centres.
- Nursing Home This segment includes all activities associated with both the Aged Care and Psychogeriatric Nursing Homes forming part of the Health Service. Residents typically are those people who have been assessed by ACAT or Psychogeriatric Assessment Team (PGAT) as requiring high level residential care.
- Hostel This segment includes all activities typically associated with residents who have been assessed by ACAT as requiring a low level residential care.
114 Eastern Health Annual Report 2009-10 eastern Health financial statements 2009/10
Note 23a: Responsible Persons Disclosures
In accordance with the Ministerial Directions by the Minister of Finance under the Financial Management Act 1994, the following disclosures are made regarding responsible persons for the reporting period.
Period
Responsible Minister : The Honourable Daniel Andrews, MLA, Minister of Health 1/07/2009 - 30/6/2010
Governing Boards Dr Joanna Flynn 1/07/2009 - 30/6/2010 Ms Jeanette Ward 1/07/2009 - 30/6/2010 Dr John Morris 1/07/2009 - 30/6/2010 Mr Stuart Alford 1/07/2009 - 30/6/2010 Ms Michelle Wright 1/07/2009 - 30/6/2010 Mr Martin Botros 1/07/2009 - 30/6/2010 Mr W Kirby Clark 1/07/2009 - 30/6/2010 Professor Pauline Nugent 1/07/2009 - 30/6/2010 Dr John Zelcer 1/07/2009 - 30/6/2010
Accountable Officer : Mr Alan Lilly 1/07/2009 - 30/6/2010
Remuneration of Responsible Persons The number of Responsible persons are shown in their relevant income bands:
Income Band No of No of Directors & Directors & Accountable Officer Accountable Officer 2009/10 2008/09
$30,001 - $40,000 8 8 $50,001 - $60,000 - 1 $60,001 - $70,000 1 1 $70,001 - $80,000 - 1 $310,001 - $320,000 1 - $340,001 - $350,000 - 1 Total remuneration received or due and receivable by Responsible Persons from Eastern Health amounted to: $627,507 $791,158
Amounts relating to Responsible Ministers are reported in the financial statements of the Department of Premier and Cabinet.
Other Transactions of Responsible Persons and their Related Parties There were no transactions between the Health Service and the Responsible Persons or their Related Parties.
Eastern Health Annual Report 2009-10 115 eastern Health financial statements 2009/10
Note 23b: Executive Officer Disclosures
Executive Officers’ Remuneration The number of executive officers, other than Ministers and Accountable Officers, and their total remuneration during the reporting period are shown in the first two columns in the table below in the relevant income bands. The base remuneration of executive officers is shown in the third and fourth columns. Base Remunerations is exclusive of of bonuses, long service leave payments, redundancy payments and retirement benefits.
Total Total Base Base Remuneration Remuneration Remuneration Remuneration 2009/10 2008/09 2009/10 2008/09 No. No. No. No. $30,001 - $40,000 - - - 1 $70,001 - $80,000 2 - 2 - $80,001 - $90,000 - 1* - - $90,001 - $100,000 - - 1 - $100,001 - $110,000 - - 1 1 $120,001 - $130,000 - 1 - 1 $150,001 - $160,000 1* - 1 1 $160,001 - $170,000 - 1 - - $170,001 - $180,000 - - - 1 $180,001 - $190,000 - 1 - 2 $190,001 - $200,000 - 3 - 1 $200,001 - $210,000 1 1 3 2 $210,001 - $220,000 2* 1 1 1 $220,001 - $230,000 2 1 1 - $230,001 - $240,000 1* - - - $240,001 - $250,000 1 - - - $280,001 - $290,000 - 1* 1 - $290,001 - $300,000 1 - - - Total remuneration for the reporting period for Executive Officers included above amounted to: $2,171,915 $2,077,971 $1,852,459 $1,785,765
* Includes termination payment
Remuneration for Executive Officers and the Accountable Officer is determined by the Government Sector Executive Remuneration Panel (GSERP).
116 Eastern Health Annual Report 2009-10 eastern Health financial statements 2009/10
Note 24: Remuneration of Auditors
Auditors fees paid or payable to the Victorian Auditor General’s Office for audit of Eastern Health’s financial statements
2009/10 2008/09 $’000 $’000
Audit fees paid or payable to the Victorian Auditor-General's Office for the audit of Eastern Health current financial report 107 99
Total Paid or Payable 107 99
Note 25: Events Occurring After the Balance Sheet Date
At the time the report was being prepared the directors are not aware of any events that could have a material impact on the financial statements.
Eastern Health Annual Report 2009-10 117 eastern Health financial statements 2009/10
118 Eastern Health Annual Report 2009-10 eastern Health financial statements 2009/10
Eastern Health Annual Report 2009-10 119 > Glossary
Acute episode A rapid onset and/or short course of illness
Acute hospital Short-term medical and/or surgical treatment and care facility
ACHS The Australian Council of Healthcare Standards is the main independent authority on the measurement and implementation of quality improvement systems for Australian healthcare organisations
Allied health Allied health professions are clinical healthcare professions such as audiology, psychology, nutrition and dietetics, occupational therapy, orthotics and prosthetics, physical therapies including physiotherapy, speech pathology and social work
Ambulatory care Care given to a person who is not confined to a hospital/requiring hospital admission but rather is ambulatory and, literally, able to ‘ambulate’ or walk around
CAC The Community Advisory Committee is the peak body for consumer participation and community involvement at Eastern Health
CALD Culturally and Linguistically Diverse
Chronic condition A condition of at least six months’ duration that can have a significant impact on a person’s life and requires ongoing supervision by a health professional
Community A service that delivers a wide range of primary health and other support services to meet local community needs health service
DHS Victorian Department of Human Services
Elective surgery Hospitals use urgency categories to schedule surgery to make sure that patients with the greatest clinical need are treated first. Each patient’s clinical urgency is determined by their treating specialist. Three urgency categories are used throughout Australia. • Urgent – admission within 30 days or condition(s) has the potential to deteriorate quickly to the point that it may become an emergency • Semi-urgent – admission within 90 days. The person’s condition causes some pain, dysfunction or disability. It is unlikely to deteriorate quickly/unlikely to become an emergency. • Non-urgent – admission sometime in the future (within 365 days). The person’s condition causes minimal or no pain, dysfunction or disability. It is unlikely to deteriorate quickly/unlikely to become an emergency
Emergency triage Five defined triage categories as determined by the Australasian College of Emergency Medicine with the desirable time when treatment should commence for patients in each category who present to an emergency department. • Category 1 – resuscitation; seen immediately • Category 2 – emergency; seen within 10 minutes • Category 3 – urgent; seen within 30 minutes • Category 4 – semi-urgent; seen within one hour • Category 5 – non-urgent; seen within two hours
Endocrinology A branch of medicine dealing with disorder of the endocrine system and its specific secretions called hormones
Endoscopy A medical procedure that means looking inside and typically refers to looking inside the body for medical reasons using an instrument called an endoscope
Gastroenterology A branch of medicine whereby the digestive system and its disorders are studied
GP A general practitioner is a medical practitioner who provides primary care and specialises in family medicine
HARP The hospital admission risk program is a Victorian Government strategy to provide a service for people who may benefit from receiving services in a community setting rather than a hospital setting
HealthSMART Victoria’s whole-of-health information and communication strategy
Haematology A study of blood, blood-forming organs and blood diseases
HITH The hospital in the home program involves care, which may otherwise be provided in hospital, provided in the comfort of a person’s own home, school, or work environment
120 Eastern Health Annual Report 2009-10 ICU An intensive care unit provides comprehensive care for people who are critically ill
Inpatient A patient whose treatment needs at least one night’s admission in an acute or sub-acute hospital setting
Integrated care Care provided to a person that is coordinated and connected across the continuum of services and among providers in all sectors and levels
Integrated A service providing comprehensive care for people with kidney disease and end-stage renal failure from chronic renal service disease management, to pre-dialysis, dialysis and transplantation
Mental health State of wellbeing in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community
Model of care Describes the processes that result in efficient scheduling of patient treatments and procedures
Neurology A medical specialty dealing with disorders of the nervous system including the diagnosis and treatment of all categories of disease involving the central, peripheral and autonomic nervous systems, including their coverings, blood vessels and tissue such as muscle
Nurse practitioner A registered nurse who has completed specific advanced nursing education and training in the diagnosis and management of common as well as a few complex medical conditions and is able to provide a broad range of health care services
Oncology The branch of medicine dealing with tumors (cancer) and is concerned with diagnosis, treatment and palliative care
Outpatient A person who is not hospitalised overnight but who may visit a hospital, clinic, or associated facility or may be visited in the home by a clinician for diagnosis, ongoing care or treatment
PCP A primary care partnership is service agencies working together under a memorandum of understanding motivated to improve relationships and achieve better health and wellbeing outcomes for the community
Person-centred care Provision of healthcare configured around the needs of the person
Physician A person who practices medicine and is concerned with maintaining or restoring human health through the study, diagnosis, and treatment of disease and injury
Rehabilitation Rehabilitation is the combined and coordinated use of medical, social, educational and vocational measures for training or retraining the individual to their highest possible level of function
Respiratory The medical specialty that deals with diseases of the lungs and the respiratory tract
Rheumatology The medical specialty devoted to the diagnosis and therapy of rheumatic diseases which mainly deal with clinical problems involving joints, soft tissues and the allied conditions of collective tissues
SACS Sub-acute ambulatory care services is a government program that provides person-centred, interdisciplinary care support via flexible service delivery in a range of settings aimed to support improving and maintaining a person’s functional capacity and maximising their independence
Specialist medicine Deals with a specific area of medicine
Sub-acute illness Between acute and chronic illness
Stakeholder Any person, group or organisation that can lay claim on an organisation’s attention, resources or output, or is affected by that output
Surgeon A person who performs surgery
Surgery A medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a condition such as disease or injury, to help improve bodily function or appearance, or sometimes for some other reason
VACS Victorian ambulatory classification system
Eastern Health Annual Report 2009-10 121 > Contact us
Eastern Health Eastern Health includes:
5 Arnold Street Angliss Hospital Box Hill ph 03 9764 6111 Victoria 3128 Australia Box Hill Hospital ph 03 9895 3333 PO Box 94 Box Hill Healesville and District Hospital Victoria 3128 ph 03 5962 4300
ph 03 9895 3333 Maroondah Hospital fax 03 9895 3176 ph 03 9871 3333 Email [email protected] ABN 68 223 819 017 Peter James Centre ph 03 9881 1888
Turning Point Alcohol & Drug Centre ph 03 8413 8413
Wantirna Health ph 03 9955 1200
Yarra Ranges Health ph 03 9091 8888
Yarra Valley Community Health ph 1300 130 381
Produced by the Department of Communications and Community Relations at Eastern Health. Designed by Motion. Printed by Southern Colour on carbon neutral, FSC certified, recycled paper. Photography by Daniel O’Brien.
122 Eastern Health Annual Report 2009-10 > Strategic Plan 2010-15
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Eastern Health Annual Report 2009-10 123 124Authorised Eastern by Health Eastern Annual Health Report EH0910 2009-10 AR001