Lower Eyre Health Service Plan 2011 2020 FINAL

Lower Eyre 10 Year Local Health Service Plan

2011 – 2020

Lower Eyre Health Advisory Council Lower Eyre Health Service Country Health SA Local Health Network

10 Year Local Health Service Plan

Lower Eyre Health Service

2011 - 2020

Table of Contents

1. Executive Summary ...... 3 2. Catchment Summary ...... 5 3. Needs Analysis Summary ...... 7 4. Local Implications of Statewide plans...... 10 5. Planning Principles...... 11 6. Service Delivery Plan...... 12 6.1 Core Services to be Sustained ...... 12 6.2 Strategies for new / expanded services ...... 16 7. Key Requirements for Supporting Services...... 17 7.1 Safety & Quality...... 17 7.2 Patient Journey ...... 18 7.3 Cultural Respect...... 19 7.4 Engaging with our community...... 19 7.5 Local Clinical Networks ...... 20 8. Resources Strategy ...... 21 8.1 Workforce...... 21 8.2 Infrastructure ...... 22 8.3 Finance ...... 23 8.4 Information Technology ...... 23 8.5 Risk Analysis...... 24 9. Appendix ...... 25 9.1 Leadership Structure ...... 25 9.2 Methodology...... 25 9.3 Review Process...... 25 9.4 Glossary...... 25

Date: 15 June 2011

1. Executive Summary

The Lower Eyre Health Service has taken the lead and determining role in the development of the 10 Year Local Health Service Plan, with the support of the Country Health SA Local Health Network (CHSALHN) Planning Projects Team. The Lower Eyre Health Advisory Council (HAC) has worked closely with the Lower Eyre Health Service in the planning and implementation of the community consultation and the oversight of the planning process.

The catchment area for the Lower Eyre Health Service includes the catchment areas encompassed by the Tumby Bay and Cummins Hospitals within the District Councils of Tumby Bay and Lower Eyre Peninsula. The catchment includes the townships of Tumby Bay, Cummins, Port Neill, Lipson, Koppio, Edillilie, Mount Hope, Coffin Bay and Lock. Cummins and Tumby Bay are located approximately 50-65 kilometres from the Port Lincoln Country General Hospital, and over 600 kilometres from Adelaide. The Eyre Peninsula experiences a high degree of isolation in relation to local and intrastate transport options.

The resident population for the Lower Eyre catchment is 6,622 (DPLG Population Projections 2011). People from Aboriginal and Torres Strait Islander backgrounds comprise 1.5% of the total population. The structure of the population represents some differences when compared with country South Australia including a lower proportion in the 15-24 and 25-44 year age groups, and a higher proportion in the 45-64 and 65-84 years age groups. The projected population for the catchment area is estimated to increase by 8% by the year 2021. The Eyre Peninsula region attracts an average of 349,000 overnight visitors and 304,000 domestic same day visitors per annum. The catchment reflects a very high to moderate level of socioeconomic disadvantage.

The Lower Eyre Health Service, in partnership with Health Advisory Council members, undertook the needs analysis by making inferences about the health needs. The needs analysis has included the findings from a community and staff/stakeholder questionnaires distributed and analysis of the service profile and other relevant data. 260 individual community questionnaires responses were received, 47 individual staff/stakeholder survey responses were received. The needs analysis process identified priority areas including:

• Strong community and clinician feedback to maintain existing health services. • The high proportion of emergency inpatient admissions, admissions for older people admitted and chronic disease related admissions and an increasing proportion of mental health inpatient admissions. • Ageing community and large numbers of seasonal visitors. • Statewide plans for strengthening clinical services. • The level and range of emergency presentations, particularly demand for emergency mental health presentations. • Current numbers of residents accessing care outside of the catchment. • High fertility rate. • Recommendations from the current Multipurpose Service (MPS) Plan. • Geographic isolation.

The Lower Eyre Health Advisory Council and Eyre Aboriginal Health Advisory Committee acknowledge the importance of reviewing the plans and progress annually.

This final 10 Year Local Health Service Plan sets out to sustain and strengthen its existing services across both Cummins and Tumby Bay Health Services such as acute inpatient care, 24 hour, seven days/week emergency services, community and allied health, aged care and other core services. It also sets out to sustain and strengthen elective surgery and shared GP-midwifery care birthing in Cummins. The aim is for the Lower Eyre Health Service to enhance areas including:

• Improved access to mental health care. • Improved support for chronic disease self management.

• Clear pathways to enable community access to visiting specialist services in Country General Hospitals in Port Lincoln and Whyalla. • Rehabilitation in the community setting and access to packages of care in the community such as Transitional Care Packages in partnership with the Port Lincoln Health Service, working in alignment with the Statewide Rehabilitation Plan. • Flexible use of residential places and partnerships with non-government organisations (NGOs) to provide respite care. • Dementia specific accommodation options. • Enhanced clinical support services available locally to reduce the need for people to travel to Port Lincoln or Adelaide. • Seeking regular dental health care for residential aged care and the broader community. • Exploring initiatives such as telehealth, transport options to Port Lincoln, care coordination and other patient journey initiatives. • Recruitment, development and retention of a suitably skilled workforce. • Continual improvement and patient-centred approach underpinning service delivery.

It will be important to monitor and determine the extent of community and health needs which the proposed port facility and mining across the Eyre Peninsula may have in the Lower Eyre. Regular evaluation and revision will occur over the life of this Plan to ensure that health services are contemporary and responsive to the needs of the communities.

2. Catchment Summary

Introduction

The Lower Eyre region includes the catchment areas encompassed by the Tumby Bay and Cummins Hospitals within the District Councils of Tumby Bay and Lower Eyre Peninsula. Cummins and Tumby Bay are located approximately 50-65 kilometres from the Port Lincoln Country General Hospital, and over 600 kilometres from Adelaide. The catchment includes the townships of Tumby Bay, Cummins, Port Neill, Lipson, Koppio, Edillilie, Mount Hope, Coffin Bay and Lock.

Source: http://www.abs.gov.au/

Population

The resident population for the Lower Eyre catchment is 6,622 (DPLG Population Projections 2011), with approximately 52% residing in the Cummins catchment area. People from Aboriginal and Torres Strait Islander backgrounds comprise 1.5% of the total population compared with 3.1% across country South Australia. Approximately 1.1% of the population speak a language other than English at home, compared with 3.9% across country South Australia.

The population structure of the Lower Eyre catchment represents some differences when compared with country South Australia including a lower proportion in the 15-24 and 25-44 year age groups, and a higher proportion in the 45-64 and 65-84 years age groups. The projected population for the catchment area is estimated to increase by 8% by the year 2021. The fertility rate for the Lower Eyre Peninsula SLA (2.05) and the Tumby Bay SLA (2.73) is above replacement level and higher than the South Australian rate (1.82). The average indirect standardised death rate for the Lower Eyre Peninsula SLA (7.6) and the Tumby Bay SLA (6.8) is higher than the South Australian rate (6.1).

The Eyre region (which in addition to Lower Eyre also includes Whyalla, Ceduna, Streaky Bay, Elliston, Port Lincoln, Cleve, Cowell, Kimba and Wudinna) attracts approximately 350,000 overnight visitors, and 304,000 same day visitors (from other parts of the Eyre Peninsula) on an annual basis. Visitors to the area are more likely to be 65 years and over, and travelling without children.

Table 1: Lower Eyre catchment population

Country South No. % SA Australia % % Total Population 6,622

Males 3,475 52.5% 50.5% 49.4% Females 3,148 47.5% 49.5% 50.6%

0-14 yrs 1,196 18.1% 20.4% 18.5% 15-24 yrs 659 10.0% 11.4% 13.3% 25-44 yrs 1,508 22.8% 25.1% 26.7% 45-64 yrs 2,089 31.6% 27.3% 26.1% 65-84 yrs 1,052 15.9% 13.9% 13.4% 85 yrs and over 117 1.8% 1.8% 2.0%

Aboriginal & Torres Strait 94 1.5% 3.1% 1.7% Islander*

CALD (Speaks a language 67 1.1% 3.9% 12.2% other than English at home)* Source: Projected population by age and sex – SLAs in South Australia, 30 June 2011, Department of Planning and Local Government *Source: 2006 ABS Census

Socioeconomic factors

The majority of the region is considered remote. The Lower Eyre catchment experiences a range of socioeconomic disadvantage from high to relatively low. The Cummins, Lock, Tumby Bay and Port Neill townships experience a moderate degree of disadvantage. Lower than average median individual, family and household incomes in these townships is shown when compared with country South Australia. The prevalence of chronic disease for people in the Eyre region aged 16 years and over is significantly higher for arthritis, asthma and osteoporosis. In addition, the Eyre region demonstrates higher risk factors than country South Australia for alcohol consumption (short and long term), overweight, high cholesterol, insufficient physical activity, and ex-smoking status.

The Eyre Peninsula’s largest industries are agriculture, aquaculture and fishing, followed by tourism and mining. The region produces more than 45% of the State’s wheat crop, and 20% of its barley crop. Aquaculture has undergone the largest regional economic growth in the past 10 years. Agriculture and fishing comprises nearly 40% of total employment in the Lower Eyre region, followed by retail trade (8%), and health care and social assistance (8%). The catchment area is part of a large proportion of the state which has designated drought affected status.

The Eyre Peninsula experiences a high degree of isolation in relation to local and intrastate transport options. The Australian Red Cross operates a community passenger transport network on the Eyre Peninsula for people who have no access to other means of transport for medical appointments. The Premier Stateliner Bus Service operates a service from Port Lincoln to Adelaide return, stopping in Tumby Bay. Flights are available between Port Lincoln and Adelaide.

3. Needs Analysis Summary

The Lower Eyre Health Service, in partnership with the Health Advisory Council, undertook the needs analysis by making inferences about health needs. The needs analysis has included the findings from a community and staff/stakeholder survey, face to face workshops with key stakeholders, and analysis of the Local Health Service Profile and other relevant data. 260 individual community survey responses, 47 individual staff/stakeholder survey responses, and staff and key stakeholders participated across three needs analysis sessions.

The focus of the community consultation process was to understand the priority health needs and gaps in the existing service profile. Key emerging themes consistently identified through the community consultation process included:

• The top 5 services utilised by the community include visits to the GP, physiotherapy, podiatry, accessing medical specialists and care in an emergency. • The majority of residents that access care outside of the catchment, travel to medical specialist appointments. • The key gaps in services included medical diagnostics, complimentary alternative care (eg. chiropractor), maternity, surgery, dental care and visiting specialists. • The key problems associated with accessing health services both locally and outside of Lower Eyre included waiting times and access to transport. • Access to allied and community health services made up nine of the top ten services which were most beneficial for managing their health.

The needs analysis process identified a vast range of strengths, weaknesses, opportunities and threats across service category areas. The Lower Eyre Health Service identified priorities for each major service category to clearly focus on the most important areas for the final 10 Year Local Health Service Plan:

Acute Care • The high proportion of emergency inpatient admissions, strong community feedback and ageing community reiterate the need to maintain access to acute inpatient care. • The increasing proportion of mental health inpatient admissions and strong community feedback note the need to improve access to mental health care. • The high proportion of older people admitted, chronic disease related admissions along with clinician feedback and statewide directions which acknowledge the importance of improving support for chronic disease self management.

Emergency • The level and range of emergency presentations, large numbers of seasonal visitors, staff age and community and clinician feedback reiterated the need to maintain access to 24 hour, seven days/week emergency triage and assessment; emergency trauma and resuscitation, mental health service and increase use of technology for diagnosis and treatment in emergencies. • Increasing demand for emergency mental health, strong clinician feedback and statewide directions for mental health highlight the need to improve access to mental health emergency responses.

Elective Surgery • Strong community and clinician feedback emphasises the need to maintain safe elective surgical services at Cummins Hospital and to ensure streamlined transition from pre-anaesthetics to post- surgery occurs.

Medical Specialists • Community and clinicians have identified the need to maintain and improve current level of visiting specialist services available locally, develop pathways to enable community access to visiting

specialist services in Country General Hospitals in Port Lincoln and Whyalla and telehealth services for diagnostic, consulting and follow up care services.

Palliative Care • Statewide directions for palliative care support local needs identified by burden of disease data, community and clinician feedback on the need to maintain comprehensive, flexible palliative care services in the community and hospital. • The Eyre AHAC emphasised the consideration of the sensitivities of Aboriginal people and communities around death and dying, particularly choice in place of death and dying.

Mental Health • The statewide directions for mental health have supported local needs identified by community, clinicians and burden of disease data. Community responsive mental health services in partnership with the mental health team are needed given the current numbers of residents accessing care outside of the catchment. There is support for on going mental health rehabilitation in the community setting and prevention, promotion and early intervention programs.

Maternal and Birthing • The high fertility rate, age demographics and a strong desire by the community and clinicians has reiterated the need to maintain a safe low-risk shared GP-midwifery care birthing service in Cummins. • Statewide directions for maternal care, community midwifery evaluations and community and clinician feedback has encouraged the strengthening of the Community Midwifery service across the Lower Eyre catchment and to support mothers and families to return following delivery in another hospital.

Rehabilitation • The Statewide Rehabilitation Plan in conjunction with community and clinician feedback supports the need for ongoing rehabilitation in the community setting and access to packages of care in the community such as Transitional Care Packages. • Local clinicians have identified the opportunity to develop rehabilitation services and pre- habilitation services in partnership with the Port Lincoln Health Service, working in alignment with the Statewide Rehabilitation Plan.

Community and Allied Health • The need for enhancing flexible community and allied health service was identified by the community surveys. • Eight of the top 10 beneficial services for maintaining good health were allied and community health. Evidence for enhancing community and allied health services was built up through monitoring: o Waiting lists/appointment schedules /referrals. o Statewide directions for GP Plus services. o Chronic disease, burden of disease statistics. o Multipurpose Service (MPS) project reports. • The Eyre AHAC identified that where primary health care services are ongoing or expanded / new which impact on Aboriginal people or are in addition to existing primary health care services provided by Aboriginal Health Services, the Health Unit must consult and involve the Local Aboriginal Health Service in the planning and implementation of such services.

Aged Care • Statewide directions for the care of older persons, ageing of the community, community and clinician feedback have highlighted the need to maintain Aged Care Service including enhanced Ageing in Place and to implement the MPS recommendations. • Clinicians have identified the opportunity to build partnerships with community and the Local Council to enhance service delivery options in the community.

Respite • The MPS recommendations, statewide directions for the care of older persons, ageing of the community and clinician feedback have identified the value in providing adequate respite through flexible use of residential places, partnerships with Non-Government Organisations (NGOs) to provide respite care services and dementia specific accommodation options.

Clinical Support Services • Community and clinicians identified the opportunity to enhance clinical support services available locally to reduce the need for people to travel to Port Lincoln or Adelaide, necessitated by the geographic isolation.

Oral Health • The lack of existing dental services, community feedback and linkages between poor oral health and general health, particularly for the elderly, precipitating malnutrition, pain and other disease processes highlighted the need for regular dental health care for residential aged care and the broader community.

Economic Development • Centrex are proposing to establish a port facility at Sheep Hill, north of Tumby Bay. Drilling is being carried out to establish mining potential on Eastern Eyre Peninsula.

4. Local Implications of Statewide plans

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

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

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

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

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

5. Planning Principles

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

1. Focusing on the needs of patients, carers and their families utilising a holistic care approach.

2. Ensuring sustainability of country health service provision.

3. Ensuring effective engagement with local communities and service providers.

4. Improving Aboriginal health status.

5. Contributing to equity in health outcomes.

6. Strengthening the IT infrastructure.

7. Providing a focus on safety and quality.

8. Recognising that each health service is part of a total health care system.

9. Maximising the best use of resources.

10. Adapting to changing needs.

6. Service Delivery Plan

6.1 Core Services to be Sustained

Note: Services only provided directly in particular catchment areas are indicated by the initial: C=Cummins T=Tumby Bay Service Category Service Description Target Group Directions over next 10 years Community & Allied • Local primary health care and health promotion All people in • Maintain comprehensive, flexible community and Health initiatives, general counselling, community nursing catchment – with allied health service services, and day care activities focus on: • Recruitment and retention of professional staff • Domiciliary Care services from Port Lincoln • Early childhood • Expand services to deliver GP Plus Services • Specific out of hospital strategies • Youth • Consult and involve Local Aboriginal Health • Access to child and youth health services • Frail/Aged Service in the planning and implementation of • Access to local and visiting Allied Health services • Aboriginal people primary health care services • Access to specialised chronic disease practitioners • Implement the recommendations from the MPS • Access to Community Midwifery services project including: • Community Health managed from Port Lincoln o Improve ‘seamless’ movement through all • Chronic Disease Management services (acute/community) o Community Care Coordinator role • Improve chronic disease management in primary health care settings Emergency Service • 24 hour, 7 day/week emergency triage and All people in, or visit, • Maintain access to 24 hour, 7 day/week assessment; emergency trauma and resuscitation, the catchment emergency triage and assessment; emergency mental health service trauma and resuscitation, mental health service • Appropriately staffed and supported by medical and • Improve access to mental health emergency nursing staff responses • Provide immediate care/treatment to stabilise patients • Recruit, train and retain a skilled workforce provides the medical and nursing services necessary • Increase use of technology for diagnosis and to stabilise critically ill patients prior to retrieval treatment in emergencies • Treatment for/management of appropriate (non-life • Continue to strengthen networks with Medstar to threatening) conditions support retrievals and remote advice • Inpatient diagnosis, monitoring and treatment of • Strengthen relationships with South Australian appropriate conditions Ambulance Service (SAAS) • Strengthen relationships with Country General Hospital Acute Inpatient Care • Admissions for management of minor (lower risk) All people in, or visit, • Maintain access to acute inpatient care assessments and treatments; Intermediate care the catchment • Recruit, train and retain a skilled workforce including recuperative care, acute medical, mental • Improve access to hospital based mental health health, chemotherapy care • Access to General Practitioner Practice service to • Develop partnerships with the primary health care 12

provide both acute illness management and general sector to better manage chronic disease self practitioner consulting for less severe illnesses management 1 • Admissions for surgical and birthing (C) • Strengthen relationships with Country General Hospital Elective Surgery • Minor surgical procedures All people in • Maintain a safe elective surgical service at • Operating theatre staffed and equipped to support a catchment Cummins Hospital range of lower risk and appropriate surgeries (C) • Recruit, train and retain a skilled workforce • Build on partnership with Cummins Medical Clinic to ensure streamlined transition from pre- anaesthetics to post-surgery Maternal & Birthing • Antenatal and postnatal care All women having • Maintain a safe low-risk midwifery birthing service Services • Admissions for post natal maternal and neonatal care babies, and their in Cummins 2 • Community midwifery and parenting programs families in the • Maintain and strengthen the community midwifery • Obstetric shared care programs (C) catchment service across the Lower Eyre catchment • Low risk single births 24 hours 7 days/week including • Recruitment and retention of staffing for emergency and elective caesarean qualified/experienced midwives sections (C) • Continue up-skilling of all staff to provide support for midwifery service • Maintain partnership with medical practice to support shared care • Implement Baby-Friendly Health Services initiative, hospital and community • Support mothers and families to return follow delivery in another hospital Medical Specialist • Access to visiting medical specialist consultations All people in • Maintain and improve current level of visiting Services catchment specialist services available locally • Develop pathways to enable community access to visiting specialist services in Country General Hospitals in Port Lincoln and Whyalla 3 • Support telehealth services for diagnostic, consulting and follow up care services Mental Health • Local admissions for mental health including voluntary All people in • Establish local Mental Health Network admissions to general ward, respite and short stay catchment – with • Implement the provisions of the new Mental options focus on: Health Act from 1st July 2010 • Access to specialist mental health services via • Youth • Strengthened primary mental health care services telehealth • Aged through improved partnerships with general • Aboriginal people practice and other primary care providers

1 Chronic Disease Action Plan for South Australia 2009-2018 2 Standards for Maternal and Neonatal Services in SA, 2009 3 Strategy for Planning Country Health Services in South Australia 13

• Continue local voluntary admissions for mental health care • Improved access to specialist mental health services through increased visiting services and utilisation of telehealth network for video conferencing consultations and assessments • Deliver community responsive mental health services in partnership with the Mental Health Team • Support on going mental health rehabilitation in the community setting • Improve capacity for early identification and referral to appropriate services both within the health sector and in the community. • Encourage the use of 3-step mental health plans with associated education Rehabilitation • Admissions for recuperative and maintenance care • In partnership with the Port Lincoln Health

• Multi-discipline outpatient rehabilitation Service, develop rehabilitation services, in alignment with the Statewide Rehabilitation Plan 4 • Support on going rehabilitation in the community setting • Deliver pre-habilitation services • Expand access to packages of care in the community such as Transitional Care Packages • Support Country General Hospital • Increased utilisation of allied health assistants Respite Services • Access to residential and hospital aged care respite All people in • Provide adequate respite through flexible use of catchment – with residential places. focus on: • Partnerships with NGOs to provide respite care • Frail/Aged services • People with a • Develop dementia specific accommodation disability options • Aboriginal people • Support Country General Hospital aged care respite Aged Care • Low and high care residential aged care (Tumby Bay • Frail / Aged • Maintain Aged Care Service including enhanced and Cummins) provide 44 residential places Ageing in Place • Access to visiting aged care assessment • Recruitment and retention of skilled workforce • Domiciliary Care in home and the community • Maintain Accreditation standards delivered by Port Lincoln Health and NGOs • Build partnerships with community and the Local

4 Statewide Rehabilitation Service Plan 2009-2017 14

• CACPs and HACC type services are delivered by Council to enhance service delivery options in the community health and private providers (Port Lincoln community 5 Health Services Domiciliary Care and West Coast • Implement MPS Project recommendations Home care) based in Port Lincoln including: • Packages of care (Transitional Care Packages o Community care coordinator and lifestyle and (TCPs), GP Plus Services have commenced recreation coordinator • Community nursing service supports older persons in o Consider managing HACC services their homes o Develop model of excellence for the provision • Lifestyle and recreation programs for ageing of services for older people in our community community members. • Strength and exercise regimes to enhance lifestyle of aging community members Palliative Care • Palliative care beds including support for more All people in • Maintain comprehensive, flexible palliative care complex medical care catchment services 6 • In-home support • Provide extended hours of care for palliative care • Access to palliative care multi-D support teams services in the community • Access ‘Palliative care end of life choices’ program • Ensure service consider the sensitivities of Aboriginal people and communities around death and dying, particularly choice in place of death and dying • Liaison with Port Lincoln Palliative Care Services Clinical Support Services • Point of care testing All people in, or visit, • Maintain and improve current level of clinical • Access to pharmacy services the catchment support services available locally • 24 hour, 7 day/week pathology laboratory through • Expanded Point of Care testing to enable Port Lincoln Health Service treatment to be completed close to home • Access to basic X-ray capabilities • Utilise advances in technology to increase local • Access to ultra sound capacity (C) access to clinical support services Oral Health • Visiting oral health services available through school All people in • See section 6.2 dental program catchment – with • Expansion of trained clinical staff • Utilise expertise of locally trained clinical staff focus on: • Early childhood • Frail/Aged

5 Health Services Framework for Older People 2009-2016 6 Palliative Care Services Plan 2009-2016 15

6.2 Strategies for new / expanded services

Service objective: Increase access to local dental care Target Group: Lower Eyre Catchment Critical milestones: Dental hygienist service established, access to private dentist

Outcomes Strategies Time Frames Regular dental health care for residential aged care • Forge partnerships with dental service to support dental hygienist visits Ongoing over the (residential and inpatient) next three years • Support training of staff in dental hygiene • Support visiting oral health services available through school dental program Access to affordable dental services as appropriate to need of • Purchase sessions from private dentist as part of the MPS strategy Ongoing over the community and residents • Investigate opportunities to enhance transport options to Port Lincoln services next three years

Increase capacity for tasks involving economic development • Supporting Medical • Advertising • Registrations

7. Key Requirements for Supporting Services

7.1 Safety & Quality

Objective: Continue to improve the quality and safety of care in a sustainable manner Critical milestones: NA

Outcomes Existing Strategies Sustained Strategies for the Future Continual improvement and patient-centred • Maintain Safety & Quality work groups (eg. aged • Work towards comprehensive medical assessments approach underpinning service delivery care, acute care) and care plans • Continue to support chronic disease management • Strengthen safety assessments for staff working in and care planning in partnership with the GP clinic the community and homes • Maintain ACHS accreditation • Contribute to a country-wide accreditation • Adherence to the Aged Care Act framework • Audit programs in place to ensure client satisfaction • Improve the use of knowledge, information • Implement the Australian Charter of Health Care management and technology to increase the quality Rights and safety • Implement strategies to improve the state and • Enhance clinician involvement in clinical national patient safety priority areas governance leadership • Further expansion of statewide and Country Health SA clinical networks Strengthen Cluster • Reference to SA Health Guidelines and Standards (Clinical Review/Q&R/OHSWIM)

7.2 Patient Journey

Objective: Increase the accessibility of the health system to reduce the impact on the patient journey Critical milestones: NA

Outcomes Existing Strategies Sustained Strategies for the Future Supported patient journey for patients which have • Continue to strengthen ties with the Country • Expand Ageing in Place strategies to travel out of Lower Eyre for care General Hospital in Port Lincoln, particularly for • Strengthen networks with Statewide services, enhancing access to medical specialists particularly for enhancing access to medical • Maintain ties with transport and retrieval services specialists including SA Ambulance Service (SAAS), Royal • In cases where a patient needs to be transferred to Flying Doctor Service (RFDS), Angel Flight, Red a metropolitan site, the country team to be involved Cross early on in the patients’ care to support continuity of • Maintain access to retrieval services MedSTAR care • Red Cross volunteer driver program • Explore transport options from towns in the catchment to Port Lincoln once/twice weekly. • Enhance relationships with external alternative transport Greater range of service provided locally • Maintain sufficient ‘fleet’ of vehicles to support • Implement clinical pathways in partnership with patient journey community services and GP practice to ensure • Maintain access to basic radiology services and continuity of care and availability of the most point of care testing appropriate service option to meet the individual needs • Explore expanded services in clients homes and the local community • Utilise enhanced ICT capability to support referrals, treatment plans and transfer of care • Expand Point of Care testing to enable treatment to be completed close to home • Explore opportunities for people to undertake restorative care locally, following a transfer from a larger hospital. • Expanded telehealth services for diagnosis, consultation and follow up • Explore which medical specialist services may be able to provide outreach consultations in Cummins and Tumby

7.3 Cultural Respect

Objective: Increase our capacity to contribute to the priority of closing the gap in Aboriginal health life expectancy Critical milestones: NA

Outcomes Existing Strategies Sustained Strategies for the Future Health Service is culturally safe and accessible • Maintain access to cultural awareness • Increase the uptake of Aboriginal Health Impact Statements • Engage closely with the Aboriginal communities within the catchment to improve uptake of services that are available • Ensure all health service programs have an understanding of the specific needs of the Aboriginal community • Employ and train more Aboriginal people across all levels of the workforce Health service needs of the Aboriginal community • Enhance formal/informal links with Aboriginal Health are understood Services • Recognise the two homelands within the catchment area and ensure their needs are considered in planning, implementing and evaluating this plan

7.4 Engaging with our community

Objective: Increase the capacity for the community to contribute to the planning, implementation and evaluation of our services Critical milestones: NA

Outcomes Existing Strategies Sustained Strategies for the Future Health service needs of the community are • Support the Lower Eyre Health Advisory Council to • Explore opportunities for ongoing and meaningful understood implement their ongoing role of engaging with their discussion with the community through local community and local stakeholders. community groups, existing specialty groups and • Continue to facilitate local support groups persons which have expressed an interest in • Support health action groups in Cummins and engaging with the health service Tumby Bay to liaise closely with the Lower Eyre • Actively engage community participation from Health Advisory Council and the Health Services population groups that have the greatest burden of • Develop well coordinated volunteer program disease • Maintain active consumer participation in service • Explore increased opportunities for utilising planning and delivery community input into client support 19

• Review community involvement in committee • Volunteer support structures and develop meaningful and relevant • Improve marketing and public relations terms of reference • Improve access to health information • Recognise the two homelands within the catchment area and ensure their needs are considered in planning, implementing and evaluating this plan • Raising the profile of Lower Eyre Health Advisory Council

7.5 Local Clinical Networks

Objective: Enhance relationships with other services locally, regionally and statewide Critical milestones: NA

Outcomes Existing Strategies Sustained Strategies for the Future Formal ties with health service organisations in and • Support and encourage strong links between acute, • Improve ‘seamless’ movement through all services visiting the region aged care and community services • Build partnerships with local emergency response • Streamline access to health services in Port Lincoln services such as SA Ambulance and Country Fire to support a wider range of more complex services, Service volunteers such as specialists, pathology and radiology • Build partnership with the Medical Clinic to continue • Enhance collaboration with visiting services based to streamline pathways between primary care and from Port Lincoln such as palliative care, community other health services and allied health services and mental health • Build partnerships with Community, NGOs and • Continue to work closely with external services for Local Council to enhance service delivery options in community needs such as NGO respite program, the community counselling services • Build closer partnerships with the Country General • Support close ties with local GPs, dentists and other Hospitals in Port Lincoln and Whyalla private health providers to provide local services Formal ties with statewide and Country Health SA • Strengthen networks with metropolitan and • Further expansion of statewide and Country Health clinical networks Statewide services to sustain outpatient SA clinical networks chemotherapy services, access to iCCNet, MedStar, • Strengthen ties with the GP Plus Service centres Rural and Remote Mental Health Service and other across SA clinical services. • Build strong partnerships with tertiary centres and Port Lincoln Country General Hospital for services including geriatric evaluation and management and rehabilitation • Advocate with child and adolescent mental health service to enhance continuity of care locally

8. Resources Strategy

8.1 Workforce

Objective: Improve our ability to recruit, develop and retain a skilled health workforce Critical milestones : NA

Outcomes Existing Strategies Sustained Strategies for the Future Highly skilled and qualified workforce • On-line competencies for nursing staff • Support training for staff in emergency mental • Regular and ongoing staff development and training health response, pre-habilitation, rehabilitation, opportunities acute care Recruitment and retention of the workforce to • Allied health assistant models in place • Explore staffing methodology for residential aged support the service profile • Implement variety of strategies to recruit and retain care a skilled workforce (actively support scholarships, • Build flexible work arrangements to meet community cadetships, incentives, CHSALHN recruitment care needs programs) • Implement the service delivery change management • Use of flexible recruitment practices, including process with staff and clinicians specific consideration of accommodation needs of • Encourage and recruit Aboriginal people across all staff levels of the health service • Enhanced workforce retention strategies, particularly for allied health professionals • Expand on Tumby Bay flexible staffing model • Exit interviews form an integral part of all future planning • Upgrade staff accommodation at Tumby Bay and Cummins in planned upgrades • Expand workforce to meet growing service delivery needs, i.e. allied health assistants, para-medical aides, community carers and support recruitment and retention of medical staff • Undertake succession planning based on demand and service related need • Service delivery change management processes • Consider partnerships with other emergency services such as the SA Ambulance Services and Country Fire Service • Implement new positions including the community care coordinator, proposed midwifery position and lifestyle and recreation coordinator

8.2 Infrastructure

Objective: Increase the capability of the infrastructure to support the planned service levels are provided and maintained within local communities Critical milestones : NA

Outcomes Existing Strategies Sustained Strategies for the Future Facilities which meet service delivery demands and • Continue to prioritise building maintenance • Fire compliance and privacy/access standards work equitable access requirements for future investment, as identified is undertaken. through the CABS and Traffic Light Audits • Progress the Tumby Bay Primary Health Centre • Planned replacement schedule redevelopment • Complete funded redevelopment of Medical Clinics • Manage completion of funded projects at Cummins and Tumby Bay • Explore feasibility of dedicated rehabilitation areas, • Complete funded redevelopment of Accident and in alignment with the State-wide Rehabilitation Plan Emergency in Cummins and development in the Country General Hospital at • Port Lincoln • Ensure day activity spaces at both Cummins and Tumby Bay are available • Identify and take action to ensure community access needs for people with disabilities are met • Capital master plan forms the basis for all major developments • Explore improved accommodation for workforce • Enable infrastructure to support dementia specific accommodation and respite accommodation Updated and maintained equipment • Maintain well equipped theatre which meets • Ensure future capital budgets support workforce and standards training requirements

• Maintain well equipped delivery suite and emergency equipment • Maintain sufficient ‘fleet’ for requirements • Recognise strong community support both monetary and volunteer • Maintain well equipped operating theatre (C) • Maintain well equipped delivery suite (C)

8.3 Finance

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

Outcomes Existing Strategies Sustained Strategies for the Future Sustainable funding to achieve the planned service • Maintain funding to support the existing services to • Develop business cases to seek funding to profile be sustained. implement new services, infrastructure • Evaluate grant funded programs such as Regional developments and equipment needs Primary Health Service (RPHS) to ensure that • Actively seek packages of care resources to support financial sustainability is achieved to maintain enhanced community care services existing successful initiatives • Build upon the flexibility of the MPS program to support community needs • Promotion of community support for funding projects

8.4 Information Technology

Objective: Increase access to communication and information technology systems to strengthen health care Critical milestones : NA

Outcomes Existing Strategies Sustained Strategies for the Future Increase access to communication and information • Continue to enhance remote access to services • Investigate the installation of infrastructure to technology systems to strengthen health care such as Rural and Remote Mental Health, MedStar, support wider use of telehealth for consultations, Poisons Information Centre, IMVS online pathology follow up and emergency diagnosis and treatment results reporting • Expand use of technology for point of care testing • Expand access to computers and Internet for • Train our staff and clinicians to effectively utilise clinicians telehealth technology • Maintain IT networking between GP clinic and • Implement digital radiology facility at local level hospital • Increased computer/ Internet access for • Maintain support for video-phone links between staff/training Cummins based GPs and clients throughout the • Resident call bell system and staff duress alarm catchment system implemented • Ensure consultation with ICT for future developments

8.5 Risk Analysis

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

Outcomes Existing Strategies Sustained Strategies for the Future Successful implementation of the service directions • Risk registers both CHSALHN cluster and Lower • Develop an implementation, monitoring and review identified in the 10 Year Health Service Plan Eyre Health Service specific strategy for the 10 Year Health Service Plans • Hospital and health service accreditation • Continue to maintain a system of early identification of risks • Ongoing contribution and participation in the CHSALHN Risk Management policy framework • Ongoing participation and contribution to other CHSALHN nominated Risk Management activities • Continue to develop Risk Register for Eyre and Western Cluster

9. Appendix

9.1 Leadership Structure

The Lower Eyre Health Advisory Council and the Lower Eyre Health Service jointly led the development of the 10 Year Health Service Plan, with the support of the CHSALHN Planning Projects Team.

9.2 Methodology

June 2009 HAC engaged in the planning process. Aug-Sept 2009 Community and staff / stakeholder questionnaires distributed widely

Nov-Dec 2009 Questionnaire results summarised in a report

Dec 2009 Preliminary service profile drafted, finalised in January 2010 Feb 2009-Mar 2010 Needs analysis undertaken drawing from community and stakeholder feedback, service profile priorities statewide planning implications and other information April 2010 Draft health service plan developed by CHSALHN, for review and endorsement by the HAC for release for wider feedback May 2010 Community consultation on Draft Health Service Plan June 2010 Re-draft Plan to include community feedback; Plan to HAC for endorsement 30 June 2010 Final Plan submitted to CHSALHN through to the Minister for Health

9.3 Review Process

The monitoring and evaluation strategy for this Plan will be developed for the Final version. Feedback is sought through the consultation phase for this Plan.

9.4 Glossary

24/7 24 hour – 7 days/ week CACP Community Aged Care Package CHSALHN Country Health SA Local Health Network DPLG Department of Planning and Local Government GP General Practitioner HAC Health Advisory Council HACC Home and Community Care iCCnet Integrated Cardiovascular Clinical Network of South Australia ICT Information and Communication Technology MPS Multipurpose Services NGO Non-Government Organisation RFDS Royal Flying Doctor Service SAAS SA Ambulance Service

SLA Statistical Local Area SWOT analysis Strategy development tool which identifies strengths, weaknesses, opportunities, threats Telehealth Access to clinicians by video-conference or phone