mmt Consultancy Services Review of a proposal to establish a Multipurpose Service for the Central Highlands in the context of the Tasmanian Health Plan MMT CONSULTANCY SERVICES PTY LTD in association with FRESBOUT CONSULTING INTERNATIONAL JULY 2008 The Evaluators, Marguerite Tohl and Dr Ron van Konkelenberg (assisted by Philip Hefferan) would like to acknowledge the valuable assistance provided by the Members of the Steering Committee and the Executive officer, Catherine Featherstone. We would also like to thank the people who provided information and the people who met with the Evaluators or were interviewed by telephone. In particular, we would like to acknowledge the time and the considerable input given to the Evaluators by the community in the Central Highlands, the staff of the Ouse District Hospital and other interested stakeholders. CONTENTS 1 EXECUTIVE SUMMARY ...........................................................................................................6 1.1 APPRAISAL OF MPS ............................................................................................................7 1.2 CONCLUSION.......................................................................................................................8 1.3 SUMMARY OF OTHER FINDINGS...................................................................................13 1.4 SERVICE IMPROVEMENT................................................................................................15 2 INTRODUCTION .......................................................................................................................18 2.1 BACKGROUND ..................................................................................................................18 2.2 REVIEW TASKS..................................................................................................................18 2.3 EVALUATION STEERING COMMITTEE ........................................................................19 2.4 METHODOLOGY................................................................................................................19 3 POPULATION PROFILE..........................................................................................................21 3.1 DEMOGRAPHICS ...............................................................................................................21 3.2 GENERAL PRACTICE PATIENT POPULATION.............................................................23 4 HEALTH AND AGED CARE SERVICE NEED .....................................................................25 4.1 NEEDS IDENTIFIED BY THE COMMUNITY ..................................................................25 4.2 GP PATIENT NEED.............................................................................................................26 4.3 NEEDS IDENTIFIED BY OTHER STAKEHOLDERS.......................................................27 4.4 COMMUNITY NEED IDENTIFIED BY THE DHHS.........................................................28 4.5 AGED CARE SERVICE NEED ...........................................................................................28 4.6 REHABILITATION SERVICES FOR OLDER PEOPLE....................................................30 5 SUMMARY OF CURRENT SERVICES PROVIDED IN THE REGION............................31 6 HOSPITAL SERVICES PROVIDED........................................................................................32 6.1 OUSE DISTRICT HOSPITAL .............................................................................................32 6.2 LONG TERM TREND - ADMISSIONS ..............................................................................32 6.3 ALL HOSPITAL ADMISSIONS FOR CENTRAL HIGHLANDS RESIDENTS................34 6.4 24/7 ACCIDENT AND EMERGENCY SERVICE ..............................................................36 7 QUALITY AND SAFETY ..........................................................................................................38 8 AMBULANCE SERVICES & GP ASSIST...............................................................................39 8.1 AMBULANCE SERVICES..................................................................................................39 8.2 GP ASSIST ...........................................................................................................................40 9 AGED CARE SERVICES...........................................................................................................42 9.1 RESIDENTIAL HIGH CARE PLACES IN ODH.................................................................42 9.2 COMMUNITY AGED CARE PACKAGES.........................................................................43 9.3 HOME AND COMMUNITY CARE PROGRAM................................................................44 9.4 RESIDENTIAL AGED CARE PLACES..............................................................................46 10 OTHER SERVICES................................................................................................................48 10.1 GENERAL PRACTICE........................................................................................................48 10.2 REGIONAL HEALTH SERVICE ........................................................................................49 10.3 CARER SUPPORT AND RESPITE .....................................................................................49 10.4 TRANSPORT .......................................................................................................................49 10.5 ATTRACTING FUNDING ..................................................................................................50 10.6 AVAILABLE FACILITIES..................................................................................................50 10.7 OTHER RESIDENTIAL AGED CARE FACILITIES .........................................................50 11 CURRENT STAFFING ..........................................................................................................52 12 COST OF HOSPITAL BEDS AND AGED CARE PLACES..............................................55 13 OPPORTUNITY COSTS, SCALE AND PATIENT SAFETY ...........................................56 13.1 OPPORTUNITY COST ..............................................................................................................56 13.2 SCALE AND PATIENT SAFETY.................................................................................................56 MMT Consultancy Services July 08 - 3 - 14 OUTCOME OF COMMUNITY CONSULTATIONS.........................................................58 14.1 FIRST CONSULTATION ....................................................................................................58 14.2 SECOND CONSULTATION ...............................................................................................58 14.3 IMPACT IF HOSPITAL CLOSED.......................................................................................59 14.4 COMMUNITY PERCEPTION OF HOSPITAL...................................................................60 15 FINDINGS ...............................................................................................................................62 16 OPTIONS & VIABILITY OF A MULTIPURPOSE SERVICE ........................................68 16.1 OPTIONS IDENTIFIED.......................................................................................................68 16.2 APPRAISAL OF THE MPS..................................................................................................68 17 SERVICE IMPROVEMENT .................................................................................................72 17.1 SUMMARY OF SERVICE NEED .......................................................................................73 17.2 SERVICE IMPROVEMENT................................................................................................73 18 ATTACHMENT 1 – STAKEHOLDERS CONSULTED ....................................................76 19 ATTACHMENT 2 – FIRST COMMUNITY CONSULTATION.......................................78 20 ATTACHMENT 3 – CODES FOR TOWNS ........................................................................82 21 ATTACHMENT 4 – INFORMATION REVIEWED ..........................................................83 22 ATTACHMENT 5 – RHS ACTIVITY 2007.........................................................................84 Figures Figure 1: Central Highlands Population................................................................................... 21 Figure 2: Numbers of people aged 75+ years......................................................................... 22 Figure 3: Number of Ouse GP patients by age ....................................................................... 23 Figure 4: Location of Ouse GP patients .................................................................................. 24 Figure 5: Number of Bothwell GP patients by age .................................................................. 24 Figure 6: Types of chronic conditions of GP patients.............................................................. 27 Figure 7: Hospital admissions July 2003 to May 2008............................................................ 33 Figure 8: Ambulance transports –volunteer and paramedic 2001/02 – 2005/06 .................... 39 Figure 9: Percentage of people who received HACC services in 2006/07 ............................. 44 Figure 10: Difference between percentage of clients receiving