A Healthy Future for Western Australians Report of the Health Reform Committee March 2004 A Healthy Future for Western Australians Report of the Health Reform Committee March 2004 Report of the Health Reform Committee WESTERN AUSTRALIA DEPARTMENT OF HEALTH This work is copyright. It may be reproduced in whole or part for study or training purposes, subject to the inclusion of an acknowledgement of the source. Commercial usage or sale is not permitted. Further copies of this report can be downloaded from the Department of Health’s website www.health.wa.gov.au/hrc March 2004. Report of the Health Reform Committee Jim McGinty MLA Eric Ripper MLA Minister for Health Treasurer 30th Floor 28th Floor Allendale Square Governor Stirling Tower 77 St Georges Terrace 197 St Georges Terrace Perth WA 6000 Perth WA 6000 Dear Ministers The Health Reform Committee has pleasure in submitting this report of the Committee's deliberation on the Western Australian public health system. The Committee members would like to acknowledge the extraordinary level of assistance received in the report's preparation. We are particularly grateful for the contributions of: G doctors, nurses and allied health professionals within the Western Australian health system G interstate experts in specific clinical areas G administrators both within Royal Street, Treasury and in the Area Health Services G the Health Consumers' Council (WA) G the media in providing a vehicle for debate on key topic areas, and G the State Government in allowing the review to proceed in an open and transparent fashion. The work of the Committee was overseen by a small team headed with leadership by Prudence Ford and comprising of team members Jodie South, Kate Bullen, Brett Bell, Jamil Khan, Vijaya Ramamurthy, Janice Cozens, Trish Hind, Samantha Bailey and Jennie Hoefgen. This team provided documentation, undertook and oversighted research, liaised with the clinical workforce and community and ensured a smooth administration process. Their work was of outstanding quality and the Health Reform Committee is greatly indebted to them. Naturally, the content of the report is the collective responsibility of Committee members. Yours sincerely Health Reform Committee Professor Michael Reid (Chair) Mr Mike Daube, Director General, Department of Health, Western Australia Mr John Langoulant, Under Treasurer, Department of Treasury and Finance Ms Rita Saffioti, Director, Economic Policy Unit, Department of the Premier and Cabinet Mr Danny Cloghan, Chief of Staff, Minister for Health i Report of the Health Reform Committee ii Report of the Health Reform Committee Table of Contents Executive Summary v Introduction 1 Chapter 1 - The Need for Change 5 Chapter 2 - Population Health, Primary and Community Care 21 Chapter 3 - Improving Access to Hospital Services 41 Chapter 4 - Specific Clinical Services 57 Chapter 5 - Creating a More Efficient System 71 Chapter 6 - Developing a Sustainable Workforce 83 Chapter 7 - Organisational Structure 91 Chapter 8 - Accountability, Resource Allocation and Governance 103 Chapter 9 - Costs and Benefits of Reform 113 Chapter 10 - Implementation and Change Management 121 Attachments Appendix A - Terms of Reference 127 Appendix B - Consultation 128 Appendix C - Different Levels of Care 134 Appendix D - Glossary 137 Appendix E - List of Abbreviations 140 iii Report of the Health Reform Committee iv Report of the Health Reform Committee Executive Summary The State Government appointed the Health Reform Committee in March 2003, reporting through the Minister for Health and the Treasurer, to the Expenditure Review Committee of Cabinet. The Terms of Reference for the review required the Committee to develop a vision for the Western Australian health system while ensuring that the growth of the health budget was sustainable. In undertaking the review, the Health Reform Committee: G received a large number of public submissions G held regular meetings with clinical groups and other key stakeholders G engaged the Health Consumers' Council (WA) to consult with members of the community G released 12 discussion papers, and G undertook reviews in areas of interest. The need for change in the public health system is clear. Like many other health systems in Australia and internationally, Western Australia has: G an ageing and growing population G widening gaps in health status between the wealthy and the poor, and between the Aboriginal and non-Aboriginal population G escalating demands for emergency care and hospital beds G a substantial emphasis on tertiary hospital care to the detriment of secondary hospitals and Executive Summary population-based approaches G projected workforce shortages G rapidly changing demographics in the metropolitan area G significantly increased requirements for mental health, aged care and rehabilitation services, and G increasing difficulty in continuing to fund the escalating costs of the health system without severely compromising other responsibilities. While the need for change is accepted by all, the risk is that incremental change will continue to suffice - for example, through refurbishing and expanding existing hospitals on their current inappropriate locations, unplanned and uncoordinated expansion of tertiary hospital services, paying lipservice to the importance of primary and community-based care, or rewarding financial mismanagement through budget enhancements. What is clear is that incremental reform is no longer the pathway to a financially sustainable vision for Western Australia. A fundamental reprioritisation of the public health system is needed, and should be carried out over the next decade, in a systematic and integrated way. An increased focus on health promotion, improved interface between general practice and the public health system and enhanced community-based aged care, mental health and Aboriginal health services will not only improve the health status of Western Australians, but will reduce the growth in demand for hospital emergency care and beds. Much of the demand for hospital services is for conditions that are clearly preventable with appropriate health promotion and prevention strategies. Substantial investment in these strategies is warranted and necessary. v Report of the Health Reform Committee Investment is needed to assist people to navigate the health system. This includes both technology to facilitate the movement of information throughout the health system, such as electronic health records and unique patient identifiers, and in clinical guidelines to bring greater consistency to clinical practice. Significant reconfiguration of hospital services in Western Australia is proposed. This is necessary to rectify historically poor planning decisions, to reflect rapidly changing demographics, to improve access to hospital care and to ease the burden and reduce dependency on tertiary hospitals. In the country, the proposals enunciated in the 2003 'Country Health Services Review' to further develop multi purpose services, integrated district health services and regional hospitals, are fully supported. In the metropolitan area over the next 10 years: G Rockingham/Kwinana District, Joondalup Health Campus, Swan District and Armadale Kelmscott Memorial hospitals should be expanded to approximately 300 beds each G other metropolitan hospitals should specialise in rehabilitation, mental health and aged care services G there should be designation of two tertiary hospitals with one north and one south of the river, and G the Women's and Children's Hospitals should be co-located with an adult tertiary hospital. For reasons of safety, quality, workforce sustainability and efficiency some specialisation of tertiary services at each of the adult tertiary hospitals is proposed. Major trauma, neurosurgery and heart, lung and renal transplantation should not be duplicated. Developing better links between the primary care and the hospital system, reconfiguring hospital services in Perth and limiting the proliferation of some clinical specialities will benefit both access to Executive Summary emergency departments and elective surgery waiting times. This will be achieved through: G better use of secondary (general) hospitals G some separation of elective and trauma care, which will enhance both access to emergency departments and elective surgery wait times, and G greater emphasis on primary and community care that will decrease demands on the hospital system. The growth in health expenditure over recent years has averaged around 8.5% per annum, compared to a growth of around 5% for all other State Government agencies. This is unsustainable. A multipronged strategy is urgently needed to ensure financial sustainability which: G endeavours to keep people out of expensive hospital care through improved health promotion, prevention and community-based care G shifts the balance from high cost tertiary care (about 80% of admissions to Perth's tertiary hospitals are for secondary type services and general hospital care1) G improves clinical practices in hospitals - focusing on reducing length of stay, increasing day of surgery admissions, increasing day procedures and improved utilisation reviews, where clinically appropriate 1 Information provided to Health Reform Committee by Strategic Planning Directorate, Department of Health, 2004. vi Report of the Health Reform Committee G achieves greater efficiency in existing services such as pathology, pharmacy, food, procurement and the overall cost structure of hospitals, and G improves the