Contents

Health Needs Assessment 2017 Summary 3 Socioeconomic status 4 Aboriginal and Torres Strait Islander peoples 5 Maternal and infant health 6 Young people 7 Older people 8 Population health 9

Murrumbidgee Primary Health Network acknowledges the Traditional Custodians of the land in the Murrumbidgee region. We pay respect to past and present Elders of this land: the Wiradjuri, Yorta Yorta, Baraba Baraba, Wemba Wemba and Nari Nari peoples. Murrumbidgee Primary Health Network gratefully acknowledges the financial and other support from the Australian Government Department of Health. The Primary Health Networks Programme is an Australian Government Initiative.

2 l MURRUMBIDGEE PHN: HEALTH NEEDS ASSESSMENT 2017 SUMMARY Health Needs Assessment 2017 Summary

Murrumbidgee Primary Health Network shares borders MPHN covers a geographic area of 124,413 square with Western NSW, South Eastern NSW, ACT, Gippsland kilometres. MPHN has 22 local government areas and Murray PHNs in Victoria. Its boundaries align with the and has been divided into four sectors for planning Murrumbidgee Local Health District (MLHD). purposes.

MURRUMBIDGEE PHN: HEALTH NEEDS ASSESSMENT 2017 SUMMARY l 3 Socioeconomic status What we will be doing The Index of Relative Socio-Economic disadvantage around Griffith and ; • consider the variation in • commission services in a way that Disadvantage measures how well Lake Cargelligo and Tullibigeal; , disadvantage across MPHN for ensures the service is targeted to people in an area are faring by Leeton, , , targeted integration and redesign those who experience disadvantage looking at low-income earners, those and Gillenbal; and suburbs of care and commissioning of • use a systematic approach and work with lower educational attainment, including Ashmont, San Isidore and Kapooka. services to ensure access to primary with an interagency focus involving high unemployment and dwellings The most highly disadvantaged areas in the and specialist healthcare services, other providers such as housing and without a motor vehicle. There are Murrumbidgee for Aboriginal and Torres Strait addressing potential barriers such as education to ensure that the social households within the region that Islander peoples are around Young, , affordability, transport and cultural factors that influence health are experience greater disadvantage than and Griffith. acceptability addressed NSW, the most disadvantaged areas within MPHN are , Hay and Murrumbidgee, with pockets of high

Characteristics of residents in MPHN include: • Lower levels of education – year • Incomes – more families report incomes 12 education 30% (42% NSW); less than $600 a week 17% (14% NSW); university education 20% (30% incomes of over $2,000 a week 21% (32% NSW) NSW) • Lower levels of health literacy, • Unemployment in the Aboriginal evidenced by poor understanding population is higher, 17% than whole of of health behaviours contributing region population 4% (5.4% NSW) to chronic disease, low uptake • Aged care pension and concession cards of cancer screening, late stage 35% in , and Murray detection of cancer and chronic areas, compared with 21 % in kidney disease (MPHN Clinical and 23% in Wagga Wagga (24% NSW) Council consultations, 2016)

Disadvantage can be measured by the following;

4 l MURRUMBIDGEE PHN: HEALTH NEEDS ASSESSMENT 2017 SUMMARY Aboriginal and Torres Strait Islander peoples

Maternal and child health – 68% times the rate of non-Aboriginal Aboriginal women had first antenatal people for mental health related What we will be doing visit before 20 weeks (88% NSW); disorders; Aboriginal children 49% of Aboriginal mothers reported markedly over-represented for • participate in the Aboriginal Health • fund a partnership between Aboriginal smoking during pregnancy (7% NSW); childhood mental health disorders Consortium and assist with the community services and employment 12% of low birth weight babies born (36% of separations) implementation of the Aboriginal Health providers to support Aboriginal and to Aboriginal mothers (6.4% NSW) Plan which has a focus on maternal and Torres Strait Islander people whose Alcohol and Other Drugs – child health, chronic disease, cancer drug use is impacting on their ability to Smoking rates – hospitalisation Aboriginal people hospitalised treatment and prevention (screening) gain or maintain employment and/or data shows Aboriginal people are for alcohol related issues at 2.5 and mental health participate in education hospitalised for smoking related issues times the rate of non-Aboriginal at 2.7 times the rate of non-Aboriginal people (1,641 per 100,000 vs • support general practice to implement • work with the Aboriginal Health people non-Aboriginal 662 per 100,000); quality improvement systems for recalls Consortium to develop an Aboriginal feedback from stakeholder and reminders, community awareness of health workforce strategy Respiratory disease – chronic consultations identified screening services, support for delivery • provide immunisation support to obstructive pulmonary disease 4.5% concerning alcohol consumption of culturally appropriate screening general practice (3.9% non-Aboriginal); asthma 20% in vulnerable groups including • ensure that MPHN general practice • build relationships with Aboriginal (13% non-Aboriginal) of general Aboriginal people weight management includes specific medical services and other relevant practice presentations targets for overweight Aboriginal people health service providers of care Aboriginal health workforce – • commission culturally appropriate coordination to Aboriginal people Diabetes – 8.2% of general practice data not available presentations (7.3% non-Aboriginal) mental health and suicide prevention • contribute to closing the gap in life services which meet local community expectancy by improved access to Breastscreen – participation lower for Childhood immunisation – needs culturally appropriate Aboriginal Aboriginal women 34% (40% NSW) 92.8% of Aboriginal children • support young people who are specific and mainstream primary care fully immunised at 1 year of age engaging in risky substance use or services (including but not limited Mental health related disorders – (93.3% NSW); similar rates to NSW experiencing addiction through funding to general practice, allied health and account for 40% of hospitalisations at 2 years of age; at 5 years, 97% of headspace services specialists) for Aboriginal and Torres of Aboriginal people 15-19 years; of Aboriginal children were fully Strait Islander peoples Aboriginal people hospitalised at 2.6 immunised (93% NSW)

MURRUMBIDGEE PHN: HEALTH NEEDS ASSESSMENT 2017 SUMMARY l 5 Maternal and What we will be doing • develop a 0-2 year olds strategy for infant health maternal and child health that includes smoking cessation advice Maternal and infant health – 76% of non- • localise and provide access to Aboriginal women first antenatal visit before Murrumbidgee HealthPathways for 20 weeks (88% NSW); 15% of non-Aboriginal healthcare professionals for a number mothers smoked during pregnancy (7% NSW) of relevant conditions Child development – the Australian Early • provide psychological services to Development Census is a nationwide measure children and young people utilising that looks at how well children are developing technology and face to face service by the time they reach school, 21% of children provision are developmentally vulnerable in one or • commission a low intensity more domain, similar to NSW (20%); 30%-42% intervention for new parents, women vulnerable in one or more domains in Urana, at risk of perinatal depression and Hay, Boorowa, Harden and Murrumbidgee parents of children at risk of mental health/behavioural issues Severity of mental health disorders – 4-11 • fund the paediatric consultancy years; mild 10.4%, moderate 3.2%, severe 1.2%, service overall 14.7% (14.2% ) • undertake co-design with general Alcohol and other drugs – inadequate access practitioners, the Murrumbidgee Local to alcohol and other drugs counselling or Health District (MLHD), Calvary Health, rehabilitation services specifically for pregnant consumers with lived experience and women and new mothers. Stakeholders Murrumbidgee Family and Community identified concerning use of alcohol and Services to provide low to medium other drugs in pregnancy, and continued use intensity alcohol and other drugs in early childhood. Providers and consumers interventions to pregnant women and identified a need for a service that combines new mothers family and parenting support/education/skill • provide immunisation support to development and alcohol and other drugs general practice support/treatment • participate in the Child Health Consortium Childhood Immunisation – 95.7% of non- Aboriginal children fully immunised at 1 year of age (93.3% NSW); at 2 years, 94% of non-Aboriginal children fully immunised (91.1% NSW); at 5 years, 96% of non-Aboriginal children fully immunised (93.5% NSW)

6 l MURRUMBIDGEE PHN: HEALTH NEEDS ASSESSMENT 2017 SUMMARY Young people

What we will be doing

Overweight and obesity – 23% Lack of support – consultations with of secondary school aged children stakeholders and the Youth Reference • fund the Wagga Wagga and • rollout the LifeSpan approach overweight or obese (21% NSW) Group indicate children and young people Griffith headspace centres to to suicide prevention in nine experience difficulty coping with parental deliver services which meet the targeted communities, developing Mental health related disorders – substance abuse (particularly alcohol) and persons individual needs utilising community partnerships account for nearly half the hospitalisations the importance of improving nutritional technology and face to face • localise and provide access of young non-Aboriginal people (15-19 health and increasing physical activity of service provision and including to a range of youth related years); severity of mental health disorders school aged children counselling of alcohol and other Murrumbidgee HealthPathways for – 12-17 years; mild 6.8%, moderate 5.1%, drugs support healthcare professionals severe 3.0%, overall 14.8% (13% Australia) Smoking – in young people (12-17 years) • consider the capacity for • support the Youth Reference Group headspace to provide health Intentional self-harm – hospitalisations declining; in 2014, 4.9% of secondary and develop strategies to engage coaching regarding lifestyle issues higher for 15-24 years than their school aged children smoked, compared with young people more broadly such as overweight and obesity counterparts in other NSW PHNs, females to 14% in 2005 across the region, particularly in more at risk than males; highest in Adequate physical activity – 27% aged • continue to promote access to The more disadvantaged areas and Cootamundra, Young, and Leeton 12-17 (21% NSW) Way Back Support Service where there are limited options for mental health services

MURRUMBIDGEE PHN: HEALTH NEEDS ASSESSMENT 2017 SUMMARY l 7 What we will be • establish a rural Palliative Care Alliance • work with local communities and Older people • explore the use of technology to service providers to build capacity support access to palliative care and capability in palliative and end doing of life care, including: In 2016, 45,755 (19%), people aged over 65 years • continue to facilitate the (16% NSW); by 2036, projected growth of 44%, Murrumbidgee Aged Care • addressing equity of access lower than NSW (67%); variation between sectors to equipment, and • support the early identification Consortium to support system reform with Wagga Wagga projected to increase by 72%, and advocate for services for older • developing after-hours 29%, Border 37% and Western 48% of decline in older people to encourage timely access to primary people in their communities medication management protocol in rural and remote Hospitalisations – in 2013-14 exacerbation of care services • explore options for expansion and communities respiratory conditions, heart failure, rehabilitation • localise and provide access to sustainability of Vitality Passport and follow up post-operative care account for 41% Murrumbidgee HealthPathways addressing frailty and falls prevention of hospitalisations; chronic obstructive pulmonary for healthcare professionals related in the community disease accounts for one fifth hospitalisations, with to conditions affecting the older majority (78%) over 65 years of age person • develop strategies to promote Fall related hospitalisations – higher amongst better understanding of My Aged females 65+ compared to males 65+ (females Care gateway through information 3,533.4 per 100,000 vs males 2,586.9 per 100,000) sessions with aged care providers Pneumococcal vaccination – 52% (47% NSW) and the community • build capability and capacity of Influenza vaccination – 67% (64% NSW) local communities to support people with dementia and their Local Health Advisory Committees forums, carers clinical council consultations, and aged care survey identified a number of issues including: • develop strategies to promote better understanding and uptake • difficulties in accessing and interpreting My of advance care planning, including Aged Care online information uploading to My Health Record • need for additional supports to enable people • provide clinical and non-clinical to continue to live independently for as long as general practice staff, and possible including: home care support; social residential aged care facility support for carers and community transport registered nurses to extend their • more information about putting advance care scope of practice with access to directives in place credentialed training and adequate • limited availability of respite and dementia care procedures and supervision options particularly in smaller towns • target continuous professional • increasing complexity of health needs of older development for aged care people, and developing the knowledge and providers and general practitioners skills of general practitioners, nurses and allied to improve capacity for growing health professionals demands of ageing population and increasing rates of dementia and other age related conditions Dementia – related hospitalisation rates have • work with general practice to adopt been decreasing over past 15 years for all age a palliative approach to chronic groups (2001-02: 526.6 per 100,000 to 2014-15: care management 313.8 per 100,000)

8 l MURRUMBIDGEE PHN: HEALTH NEEDS ASSESSMENT 2017 SUMMARY Population health

Potentially preventable hospitalisations – Cervical screening – lower screening 6.9% of all hospitalisations potentially rates , Snowy Valley, and preventable highest rate among all PHNs in Murrumbidgee. The Border Sector Clinical NSW. Chronic conditions include: chronic Council identified a gap in women’s health obstructive pulmonary disease, asthma services in the sector and chronic recurring lung infections (Bronchiectasis), congestive heart failure, Bowel screening – 37% (35% NSW) angina and hypertension, diabetes and iron Overweight or obese – adults 64% (53% NSW); deficiency anaemia; , Lake Cargelligo, obesity rates in the Murrumbidgee highest Harden, West Wyalong, Urana and Henty compared with all other NSW PHNs; highest health services consistently in top 10 facilities high body mass attributed hospitalisations with highest rates of potentially preventable among all PHNs 630.0 per 100,000 (436.8 per hospitalisations 100,000 NSW) Diabetes – 1.8 times NSW (higher than all Injuries – recent meetings of the local health other PHNs in NSW); 7.1% of general practice advisory committees highlighted farm injury as presentations (5.1% Australia) key area of concern Causes of death – ischaemic heart disease Mental Health – in 2015, 10.8% of persons aged (i.e. heart attack) (163.4 per 100,000 v 155.7 per 16 years and over experienced high or very high 100,000 NSW) psychological distress (11.8% NSW) Chronic Kidney Disease – 1.6% of general Alcohol and Other Drugs – alcohol attributed practice presentations (0.9% Australia) hospitalisations 727.3 per 100,000 (671.6 per High blood pressure – 33% over 16 years 100,000 NSW); drug related hospitalisations reported having high blood pressure (28% accounted for 68% of alcohol and other drugs NSW); 16% of general practice presentations admissions across age groups, alcohol related (11% Australia) accounting for 32%; drug related hospitalisations increasing for methamphetamines; local clinical Respiratory disease – 1.6 times higher (2,683.3 and stakeholder groups identify higher rates per 100,000 vs 1,731.3 per 100,000 NSW) of alcohol and other drugs use in vulnerable highest of all PHNs in NSW; chronic obstructive groups pulmonary disease – 3.5% of general practice presentations (2.6% Australia); highest smoking Suicide – 2011-2015, 23% of deaths, injury and attributed hospitalisations among all PHNs at poisoning (26.5% NSW) 2015 suicide rates 14.7 830 per 100,000 (542 per 100,000 NSW) per 100,000 (10.6 per 100,000 NSW)

Cancer incidence – 520.5 per 100,000 (498.8 Expressed needs in MPHN’s assessment include per 100,000 NSW) with urogenital including mental health needs of lesbian, gay, bisexual, prostate cancer slightly higher contributor to transgender and/or intersex, needs of those the higher incidence who experience family and domestic violence and the limited coordination of care for people Breastscreen – participation lower for with Parkinson’s disease culturally and linguistically diverse women 30% (46% NSW)

MURRUMBIDGEE PHN: HEALTH NEEDS ASSESSMENT 2017 SUMMARY l 9 in recruiting and retaining general Digital Health – 74 general practices, practitioners in smaller communities, 30 pharmacies, 31 hospitals, and 11 which is likely to be linked to challenging aged care facilities are registered with on-call demand and workload. Twenty My Health Record; 751 shared health one of thirty nine towns have one or summaries and 51,261 people have a My two doctors and the majority also have Health Record community hospitals or multi-purpose services where general practitioners operate as visiting medical officers and Service issues – there is a lack of mental hence have high on-call demands health and alcohol and other drug services, in particular, in areas not near Specialist services – medical specialist major cities within the region. Outreach services focused around larger population services are patchy and may not meet centres requiring people to travel to the needs of people in more rural areas. Wagga Wagga, Griffith, or out of region Anecdotally there is a lack of awareness (dependent on location) to access of services in the after-hours period for specialist services mental health and alcohol and other drugs issues Mental health nurses – undersupply of mental health and alcohol and other There is a lack of skills in health providers drugs nurses on a population basis for the delivery of suicide risk assessment, compared with national supply (1:1,917 management and post response. Given MPHN, 1:1,037 Aust) the higher suicide rates in MPHN this is a significant issue Allied health services – 2014, 50-60% allied health professionals (podiatry, General practitioner workforce – occupational therapy, physiotherapy, all areas other than Leeton, Griffith, psychology) based in Wagga Wagga. Wagga Wagga, Deniliquin and Tumut Around half the podiatrists and identified as Districts of Workforce physiotherapists (47%) worked in private Shortage; recommended GP:population practice, 29% of psychologists and 22% ratio 1:1,000 for office based practice of occupational therapists worked in this and 1:750 where general practitioner setting. The extent to which private allied provides visiting medical officer services. health providers are able to recruit and GP:population ratios vary from 1:1,509 retain workers is not known in Riverina, 1:1,395 in Western, 1:1,393 in Border to 1:1,353 in Wagga Wagga. MPHN Consultation with the community is working towards 80% of communities has indicated that there is a lack of having a GP:population ratio of 1:1,200 coordinated care between healthcare professionals particularly for management Local Health Advisory Committee forums of chronic disease have identified particular difficulties

10 l MURRUMBIDGEE PHN: HEALTH NEEDS ASSESSMENT 2017 SUMMARY What we will be doing

• fund allied health services in rural • participate in consortium models for • fund alcohol and other drugs • support registered nurses to extend areas with realignment of funding Aboriginal health, child and maternal specialist treatment services which their focus into mental health through and services towards models of care health, youth health, aged care and provide pro-active and targeted supported training and supervision • investigate alternate models for early mental health services for people waiting to access through team care detection of chronic disease • work in partnership with MLHD in a residential care and appropriate and • provide general practitioners with sustained support on discharge from • provide a range of strategies for consortium arrangement to jointly special interests program residential services training and upskilling in chronic facilitate allied health and care • provide assistance to general disease management coordination services, while ensuring • work in close partnership with practice for system changes, continuity of services ACON and other key stakeholders to • promote screening to enable early quality improvement activities develop projects and programs to detection of cancer • fund team based clinical care and accreditation activities to coordination, psychological services meet the needs of the lesbian, gay, improve managed care capability by • provide funding for a Parkinson’s and tele-psychological services, and bisexual, transgender and/or intersex embedding data analytics and quality support nurse low intensity mental health services community improvement methodologies • support general practice to improve • promote and provide a continuum • fund care and access to crisis • support and consider expansion of the capability and capacity to manage of primary mental health services support to women who experience general practice screening program chronic conditions within a person-centred stepped care violence in the after-hours period and to implement quality improvement • collaborate to develop an Integrated approach of people moving up and investigate their future needs systems for recalls and reminders, Care Strategy and Integrated System down through high and low intensity • provide support to general practice community awareness of screening of Care services as required for digital health including My Health services, support for delivery of • collaborate with pharmacy, allied • commission primary mental healthcare Record, secure messaging delivery culturally appropriate screening health and other providers to prepare services for people with severe and telehealth opportunities to reach ‘hard to for the healthcare home model mental illness including clinical care • prepare general practice, allied reach’ groups such as culturally and • develop and implement a model for coordination for people with severe health, pharmacy, specialists and the linguistically diverse and Aboriginal the person centred healthcare home and complex mental illness who are community for the introduction of peoples with an emphasis on supported self- managed in primary care the ’Opt out‘ My Health Record • improve access to primary care management • maintain a single entry point for • promote and facilitate a range of services in the after hours period • explore options for expansion and referrals in to primary mental professional development programs including GP services, pharmacy and sustainability of the Murrumbidgee healthcare commissioned services and events across the region mental health services Lifestyle and Weight Management in MPHN through the regional • support visiting medical officers • develop mental health and alcohol and Program assessment service by participation in the Medical other drugs regional plans • implement HealthPathways to • fund the digital marketing campaign Succession Committee • facilitate rollout of the LifeSpan improve diagnosis, management for the promotion of after-hours • support medical workforce program to build a safety net for and appropriate referral of health mental health service availability recruitment and retention the community by connecting conditions and coordinating new and existing • investigate models to facilitate post • work with councils and communities interventions and programs, • expand and promote Murrumbidgee discharge for mental health in the to ensure services meet community and building the capacity of the HealthPathways through after-hours period needs community to better support people engagement of relevant clinicians • support mental health and alcohol and facing a suicide crisis and use of best practice guidelines other drugs general practice liaison position

MURRUMBIDGEE PHN: HEALTH NEEDS ASSESSMENT 2017 SUMMARY l 11 12 l MURRUMBIDGEE PHN: HEALTH NEEDS ASSESSMENT 2017 SUMMARY