St George Integrated Health Services Plan 2018 St George Integrated Health Services Plan | Page PB Written and prepared by: Strategy and Planning Unit Directorate of Planning, Population Health and Equity South Eastern Sydney Local Health District Locked Mail Bag 21 TAREN POINT NSW 2229 Phone: (02) 9540 8181 Fax: (02) 9540 8164 This work is copyright. It may be reproduced in whole or in part to inform people about the strategic directions for health care services in the South Eastern Sydney Local Health District (SESLHD), and for study and training purposes, subject to inclusion of an acknowledgement of the source. It may not be reproduced for commercial usage or sale. Reproduction for purposes other than those indicated above requires written permission from the South Eastern Sydney Local Health District. TABLE OF CONTENTS FOREWORD 6 EXECUTIVE SUMMARY 7 1. BACKGROUND 11 1.1 Principles 12 1.2 Consultation process to develop this Plan 12 1.3 Strategic planning and policy context 14 1.3.1 Government priorities 14 1.3.2 Greater Sydney Commission District Plans 14 1.3.3 SESLHD’s strategic planning framework 15 1.3.4 St George Hospital Development Control Plan 15 1.3.5 St George Mental Health Service 16 1.3.6 Calvary Health Care Kogarah 16 1.3.7 Sutherland Hospital and Community Health Services 16 1.3.8 NSW Health Pathology 17 1.3.9 Central and Eastern Sydney Primary Health Network 17 1.3.10 Universities 17 1.4 South Eastern Sydney Local Health District 18 1.5 St George Hospital and Community Health Services Integrated Health Services Campus 19 1.5.1 Recent Capital Developments on the SGH Integrated Health Campus 20 1.5.2 Future Requirements 21 2. THE CASE FOR CHANGE 22 2.1 Our community and their health and wellbeing 23 3. CREATING A NEW HEALTH AND CARE SYSTEM 25 3.1 Transformational change 26 3.1.1 SESLHD Journey to Excellence and the Triple Aim 26 3.1.2 What others are doing well around the world 28 3.2 Shifting the balance in health and social care 29 3.3 Opportunities for transformation 30 4. MAKING IT HAPPEN 31 4.1 Improving population health and wellbeing 31 4.1.1 Integrating across the health and social care system 32 4.1.2 Community led health and wellbeing 36 4.1.3 Reducing inequity in priority populations 40 4.1.4 Investing in the early years 44 4.1.5 Staying healthy in the middle years of life 47 4.1.6 Helping people to live well with long term conditions that are simple or stable 48 4.1.7 Supporting independence and healthy active ageing 51 4.1.8 Helping people to live well with complex comorbidities, including dementia and frailty 53 4.1.9 Providing access to Mental Health Services 59 4.2 Improving patient/client experience of care (including quality, access, reliability and satisfaction) 62 4.2.1 Providing safe, reliable and quality care 62 4.2.2 Caring for women, babies and families 66 4.2.3 Rapid support in times of crisis 68 4.2.4 Streamlined surgery 72 4.2.5 Good acute care and post discharge planning and support 75 4.2.6 Access to prehabilitation, rehabilitation and reablement 80 4.2.7 Effective planning and care for end of life 83 4.3 Building better value, financial responsibility and sustainability across the system 88 4.3.1 Embedding continuous quality improvement and innovation across the system 92 4.3.2 Enabling an empowered workforce 93 4.3.3 Technology enabled 95 4.3.4 Strength in education and teaching 100 4.3.5 Evidence led decision making 102 4.3.6 Partnerships that deliver 106 4.3.7 Developing new funding models 107 5. LOOKING AHEAD – COMPLETING THE TRANSFORMATION 110 5.1 An Integrated Heathcare campus for the Future 110 5.1.1 Providing a Rehabilitation Precinct 111 5.1.2 Providing appropriate Aged Care Services 112 5.1.3 Providing Palliative Care 113 5.1.4 Refurbished Birthing Suites 114 5.1.5 Providing a Short Stay Surgical Precinct 115 5.1.6 Delivering joined up holistic care with outpatient and community based services 116 5.1.7 Providing appropriate Diagnostic Imaging capacity 124 5.1.8 Providing world class Research and Teaching and Education facilities 125 5.2 Capital Implications 127 5.2.1 Current and future capital implications 127 5.2.2 Other capital implications 128 5.2.3 Providing appropriate infrastructure 129 5.3 Scenario Projections 135 5.3.1 Scenario Subacute Inpatient Activity Projections 136 5.3.2 Scenario Non Admitted Projections 143 5.3.3 Scenario High Volume Short Stay Projections 145 5.3.4 Scenario Birthing Suite projections 146 5.3.5 Support Service Projections 147 REFERENCES 149 Appendix 1: Abbreviations 159 Appendix 2: Consultation Reports 162 Aboriginal Health 163 Aged Care Services 165 Allied Health 169 Ambulatory and Outpatient Department 173 BreastScreen NSW South Eastern Sydney and Illawarra Screening and Assessment Service 177 Calvary Health Care Kogarah - Palliative Care 179 Calvary Health Care Kogarah - Rehabilitation and Aged Care Service 184 Cancer and Blood Disorders Services 188 Cardiology Services 191 Chest Clinic 194 Child, Youth and Family Health Services 197 Clinical Genetics 202 Community Services - Older People 206 Corporate Services 208 Dermatology 212 Diversity Health Services 214 Drug and Alcohol Services 217 Ear, Nose and Throat Services 219 Endocrinology and Diabetes Education Centre 222 Eye Clinic (Short St) 228 Gastroenterology / Hepatobiliary Services 230 General Practice 234 HIV / Immunology and Infectious Diseases 236 Information Technology 238 Kogarah Community Nursing Services 241 Medical Imaging 243 Medicine 1 and General Medicine Outpatients 246 Mental Health 249 Multicultural Health Stakeholders Advisory Committee 252 Needle and Syringe Program 254 Neurology Services 256 NSW Health Pathology - St George Laboratory 259 Nuclear Medicine 263 Oral Health Services 265 Paediatric Service 267 Pain Management Service 273 Palliative Care 276 Peritonectomy 279 Pharmacy 282 Rehabilitation 285 Renal Medicine 289 Research and Education 292 Respiratory Services 294 Rheumatology 297 Sexual Health Services 300 Surgical Services 303 Surgical Speciality Nursing Services 307 Trauma Service 311 Urogynaecology Unit, including the Pelvic Floor, Bladder and Anorectal Physiology Laboratory 313 Women’s and Children’s Health 318 Appendix 3: Projection methodologies 321 Appendix 4: Health Services Plan development process 335 Health Services Planning 335 Scope of this Plan 335 Governance framework for the Plan 336 Governance 337 Consultation list 338 Appendix 5: Aboriginal Health Impact Statement 340 Appendix 6: Government priorities 345 NSW “Making it happen” State Priorities 345 National Clinical Care Standards 345 Other Commonwealth and State key priorities 346 Appendix 7: SESLHD’s strategic planning framework 347 Appendix 8: Ministry of Health Letter of Approval 350 FOREWORD The St George Integrated Health Services Plan outlines our aspirations for the delivery of health care to residents in the Georges River Council area, the former Rockdale LGA and beyond. It aims to provide predictive, preventive, personalised and participatory care to address the physical, emotional and social wellbeing of the community and allow for innovative models of care to reduce the demand on acute services. The Plan is underpinned by the South Eastern Sydney Local Health District’s Journey to Excellence –2018-2021 strategy, which outlines a major program of transformation that is underway across our organisation. From the first general meeting for the St George’s Cottage Hospital in 1892 and the opening of an eight-bed hospital two years later, the health service has served the changing and growing needs of the local community whilst also developing over time as an internationally recognised trauma and teaching hospital. In recent years, a new Emergency Department and an Acute Services Building have been built, with investment of $318 million from the NSW Government. There is now an urgent need for an increase in capacity for subacute services (including rehabilitation, aged care and palliative care), birthing suites, High Volume Short Stay Surgery (HVSSS), diagnostic imaging, ambulatory, community health and home-based services. This also moves us closer to the vision for the Kogarah campus identified in the NSW Government’s Towards our Greater Sydney 2056. The proposed service redevelopment and clinical redesign outlined in this Plan aims to reduce the demand for acute and emergency services and improve efficiencies in whole of hospital flow, length of stay and most importantly, improve the patient experience and health outcomes. A key focus is on timely access to appropriate specialist care and support, enabling people to maximise their independence and self-manage their own health care. An extensive consultation process was undertaken with a wide range of clinicians and managers, other service providers and key stakeholders, including the Central and Eastern Sydney Primary Health Network, general practitioners, consumers and non-government and university representatives. The service needs identified in the Plan are robust, address the changing patterns of community needs and expectations and identify contemporary and emerging models to provide the most effective use of available and future resources. A comprehensive review of service activity and projected demand was undertaken and validated by clinicians. We hope you will support our Plan for transforming St George Hospital and Health Services to secure better health and wellbeing outcomes for our community. Michael Still MBA Gerry Marr SESLHD Board Chair SESLHD Chief Executive St George Integrated Health Services Plan | Page 6 EXECUTIVE SUMMARY The St George Integrated Health Services CONTEXT Plan (IHSP) provides an opportunity to outline the transformation we aspire to in The St George Hospital and Community Health Services the delivery of health care to the population (SGH & CHS) Campus is undergoing a process of transformation with new purpose built facilties that we serve.