Message from the Board Chair and Chief Executive

Transcription

1 CONTACT US For more information 63 Johnston Street (Locked Bag 10) Wagga Wagga NSW 2650 Phone: (02)

2 Strategic Plan

3 Message from the Board Chair and Chief Executive It is with much pleasure we present to you the Murrumbidgee Local Health District (MLHD) Strategic Plan to The Plan is the District s overarching strategic document outlining our corporate program for the next three years. The Strategic Plan aims to build on the strengths of our organisation and further develop the capability and sustainability of MLHD into the future. The Plan draws on extensive consultation with consumers, staff, health professionals and other stakeholders undertaken in recent months in communities across the Murrumbidgee District and closely aligns to the State s key strategic directions for public health. This plan is reviewed on a regular basis by the MLHD Board with the latest review undertake in August This review reaffi rmed the MLHDs commitment to improving health outcomes for people in our Rural Health District. It also developed clear goals for the organisation to meet community expectations, prepare for the future and have a sustainable and effi cient service In implementing the Strategic Plan, MLHD is committed to providing the best possible health care to improve the health and well-being of our residents in future years. Gayle Murphy Chair, MLHD Board Susan Weisser Chief Executive

4 About This Plan What is the purpose of this plan? The Murrumbidgee Local Health District (MLHD) Strategic Plan outlines the course that the District intends to take over the next three years in order to achieve its vision of being the leading rural provider of individualised health care. The plan identifi es the most important issues MLHD has to address in order to provide relevant and sustainable health services for the Murrumbidgee communities into the future. How will the plan be used? The Plan is an active document and will be used to report to the MLHD communities and Ministry of Health on progress with the development of the District s services. Whilst the Plan has been developed on the basis of currently identifi ed needs, it is recognised that State and National health reform programs may lead to changing roles for the Local Health District (LHD) and the plan will be reviewed and updated as necessary. How was the plan developed? The MLHD was formed in January 2011 as a result of the National and New South Wales health reform program. A Governing Board was appointed to establish and oversight the effective governance of the District and to set the District s strategic direction. In May 2011 the Governing Board undertook a review to identify the strengths on which the MLHD could build and the major issues which MLHD needed to address. A wide-spread consultation program was undertaken from October 2011 to May 2012 with staff, clinicians and local communities. Through Local Health Service Advisory Committees (LHAC), community members in each of the MLHD communities were invited to provide their views on key issues and directions for the health service. A summary of matters raised through each forum is provided in Appendix 1 A Draft Strategic Plan was developed from these consultations and circulated for comment to a range of agencies, local councils, staff, clinicians and to local communities via their Local Health Service Advisory Committees before fi nalisation. What will we see as a result of this plan? The plan outlines the key decisions that the MLHD has to get right in order to thrive and meet the needs of its communities over the coming years. Implementation of this plan will see: A health service that is more responsive to the needs of patients, providing the Right Care to the Right Patient in the Right Setting at the Right Time (Models of Care). A health service that openly engages with the people and communities it serves and works in partnership with them and other organisations to agree priorities and deliver services in a way that suits rural communities and improves health. A health service that is sustainable, that has a suffi cient and highly skilled workforce and that effectively manages its services within the available funding streams. Page 3.

5 Murrumbidgee Local Health District About us Murrumbidgee Local Health District (MLHD) is 125,561 sq/ km in area and encompasses 29 Local Government Areas in the central south of NSW: Berrigan, Bland, Boorowa, Carrathool, Conargo, Coolamon, Cootamundra, Corowa, Deniliquin, Greater Hume, Griffi th, Gundagai, Harden, Hay, Jerilderie, Junee, Lachlan (part), Leeton, Lockhart, Murray, Murrumbidgee, Narrandera, Temora, Tumbarumba, Tumut, Urana, Wagga Wagga, Wakool and Young and also includes providing services to the Albury City population. Most of the Local Health District (LHD) is considered inner, regional or outer regional with the north western LGA of Hay classifi ed as remote. Our Role MLHD is established to operate public hospital and health institutions and provide health services to communities within its geographical area. Our primary purpose is to: Provide relief to sick and injured people through the provision of care and treatments and Promote, protect and maintain the health of the community. The NSW State Plan identifi es two key goals for NSW health services: Keeping people healthy and out of hospital Providing world class service with timely access and effective infrastructure Priorities identifi ed for all LHDs in NSW are to focus on patient-centred care, effective administration of services, greater local decision-making and enhanced clinician and community engagement. Our Population As of June 2010, MLHD has an estimated resident population of 297,476. This population has grown by 4.5 per cent since 2005 and is projected to grow by 3.2% from 2011 to 2021 to reach approximately 301,000 people and 307,000 by This is a slow growth rate compared to total NSW fi gures which increased by 7% from 2005 to 2010 and are projected to increase by 11.1 per cent from 2001 to 2021 and a further 10.1 per cent from 2021 to The population is ageing with people aged 75 years and over making up an estimated 7.7 per cent of the total population in 2011 (around 22,000 people) and projected to increase to 13 per cent in 2031 (around 40,000 people). By comparison the aged population in NSW was projected to be 6.8 per cent in 2011 increasing to 10.3 per cent in An overview of the population and population health is provided in Appendix 2. Our Commitment Purpose The best health outcomes for people in our Rural Health District Vision MLHD will be a quality provider of Rural Health Care recognising the total health care needs of individuals, patients and communities Values To reach our vision the organisation will work with our clinicians, staff, communities and partners in a way that promotes: Collaboration Openness Respect Empowerment Goals To achieve the MLHD Purpose and Vision the MLHD has identifi ed four areas in which it needs to succeed. Meeting current community expectations Preparing for the future Financial sustainability Organisational effi ciency The goals for each of these four areas are identifi ed below:

6 Our Population s Health The health of individuals and communities are affected by a range of factors including age and sex of individuals and a number of behavioural and external factors Determinants of health include: Social Factors such as income, employment, education, family structure and crime rates. Environmental factors such as rurality, air and water quality, pollution Health related behaviours - activity, nutrition, sun protection, smoking, drug and alcohol consumption As indicated in Appendix 2, the major health issues for the Murrumbidgee population are: Ageing population Aboriginal Health (Refer Appendix 3) Overweight/Obesity Alcohol Consumption Smoking Cardiovascular Disease Injury Mental Health Meeting current community expectations The right care, to the right patients, in the right setting at the right time All persons have equal opportunity to achieve their own best health outcomes Communities own and actively manage their health outcomes The services adapt to the emerging and changing needs Staff are valued and acknowledged Communities, clinicians and other stakeholders are engaged Partnerships foster better outcomes Preparing for the future Emerging health related issues and trends are identifi ed Knowledge Management addresses and informs future decision making Stakeholder participation is encouraged and valued in the determination of future direction Good Governance frameworks drives the vision Financial Sustainability Maximise revenue streams and minimise expenditure streams Achieve Budget and Quality, Safety and Performance targets Have Audit and Business system that manage risk Organisational efficiency A skilled and sustainable workforce Technology improves health service delivery Partnerships and relationships enhance health outcomes Infrastructure supports services Systems support quality and effectiveness Health Information is accessible Page 5.

7 Our Services The MLHD provides a wide range of inpatient acute and sub-acute services along with a comprehensive span of community based health services. Community based population health, primary and secondary care services include: Child, Youth and Family Services Child and Family Health Immunisation (including infant, adolescent & adult services) Sustaining NSW Families Programs Building Strong Foundations for Aboriginal Children Families and Communities Programs Out of Home Care Health Assessments and Coordination Statewide Eyesight for Preschoolers Screening Statewide Infant Screening Hearing Child Protection (including Physical Abuse and Neglect of Children services) Domestic and Family Violence Services Sexual Assault Services Victims of Crime Services Youth Health Services Community-based Specialist Drug and Alcohol Services Prevention and Promotion Specialist Drug & Alcohol Services (including services to the criminal justice system and across government) Needle and Syringe Program services Specialist Drug & Alcohol Treatment Services Chronic Care, Rehabilitation and Aged Health Services Aged Health (geriatric medicine, aged care assessment and transitional aged care) Chronic Care (Connecting Care, other Chronic Care Services, and HealthOne NSW services Dementia Services Home and Community Care Palliative Care Rehabilitation Services Oral Health Services Oral health promotion Early Childhood Oral Health Program services Specialist and special needs dental services Dental services for Aboriginal communities and older people Clinical training placements of dental and oral health students Dental services delivered through Justice Health Mental Health, Drug and Alcohol Services Community-based Specialist Mental Health Services, including Community-based Care and Support Consumer advocacy Family and Carer Participation and Support Services Prevention & Promotion Specialist Adult Specialist Child and Adolescent Specialist Older Person s Mental Health Services Priority Population Services Health Protection/ Public Health Health Development Aboriginal Health Breast Cancer & Cervical Screening Carer Support Services Disability Services Men s Health Multicultural Health Refugee Health Women s Health Specialist HIV and Related Programs (HARP) services including - HIV and Hepatitis C outpatient - sexual health and specialist sexually transmitted infections (STI) clinics - any other funded HARP clinical services - Needle / Syringe Program Service

8 Corporate The table below summarises the health service facilities within MLHD. Regional Referral Base Hospital & Health 1 Wagga Wagga Service Rural Base Hospital & Health Service 1 Griffi th District Level Hospitals & Health Services 8 Deniliquin, Tumut, Young, Cootamundra, Corowa (+Residential Aged Care), Leeton (+Residential Aged Care), Narrandera, Temora Community Level Hospitals & Health Services 10 Finley, Holbrook, Murrumburrah/Harden, Wyalong, Barham,, Hay, Hillston (future MPS), Lockhart (future MPS), Tocumwal Multi Purpose Services 11 Batlow, Berrigan, Coolamon, Culcairn, Boorowa, Gundagai, Henty, Jerilderie, Junee, Lake Cargelligo, Tumbarumba, Urana, Affi liated Health Organisations 2 Mercy Health Service Albury & Mercy Care Centre Young Other Services 3 Albury Community Health, South West Brain Injury Service, Albury Nolan House acute mental health inpatient services & Albury Community Mental Health/D&A services Community Health Posts 14 Adelong, Ardlethan, Barellan, Barmedman, Coleambally, Darlington Point, Mathoura, Moama, Moulamein, Tarcutta. The Rock, Tooleybuc, Ungarie, Weethalle Principles Planning for population health and the provision of health services needs to be responsive to changing population needs and health issues outlined above. MLHD seeks to build a fl exible and responsive health service that can be shaped to individual communities Planning and delivery of services within MLHD will be guided by the following fi ve principles. Healthcare Quality and Safety providing the Right Care, to the Right Patient in the Right Setting at the Right Time. Health Equity enabling all persons within the LHD to have equal opportunity to achieve their best health level Healthcare Access providing available, accessible, acceptable and affordable health care services. Healthcare Sustainability providing services that balance the ongoing needs of the MLHD communities with maintainable workforce and fi nancial resources. Health Ownership where people and communities are respected and encouraged to own and manage their health and actively participate in their health care. The above principles will underpin clinical service plans for the District. In developing Clinical Service Plans MLHD will also be looking to: Utilise existing infrastructure on a whole of District basis - where patients of Murrumbidgee LHD are provided care through the service or facility that best meets their care needs, irrespective of location. This will ensure that utilisation of services and facilities are maximised and that they act in a coordinated way to provide a District-wide approach to service delivery. Develop clearly defi ned roles and responsibilities for services and facilities at a District, sub-district and local level. This will establish strong clinical networks for the management and coordination of different levels of care. Clinical Service Plans will map these roles and responsibilities and show clear pathways for people across the District to access the full range of primary, secondary and tertiary health care either within or external to the District. Page 7.

9 Strategic Directions and Priority Actions Following an extensive consultation program, the Murrumbidgee Local Health District has identified strategic priorities in six key areas: 1. Providing healthcare in ways that meet the needs of rural commu 2. Building a skilled and sustainable workforce 3. Improving clinician and community engagem 4. Expanding innovative use 5. Fosterin Strategic Direction 1. Providing healthcare in ways that meet the needs of rural communities Priority Action 1.1 Research, develop and implement new models of care which are accessible, sustainable and relevant to rural communities. Implementation of care models that maximise the provision of care in locations close to home and/or reduce the amount of time patients spend in hospital Improved indicators on Aboriginal Health Priority Action 1.2 Develop District Clinical Service Plans covering wellness, primary care, secondary care and/or access to tertiary care services for key service areas. Completion of comprehensive Clinical Service Plans for Maternity, Renal, Rehabilitation, Aged Care, Chronic Care, Palliative Care, Emergency &Critical Care, Surgical Services, Aboriginal Health, Mental Health, Drug & Alcohol, Population Health and Primary Health Care Priority Action 1.3 Develop Health Pathways and providing information and assistance mechanisms for small communities that currently have little or no health presence. The number of small communities with a point of help to facilitate access to health information and services The use of locally established communication channels for dissemination of health information in small communities Strategic Direction 2. Building a skilled and sustainable workforce Priority Action 2.1 Recruitment - Become the Best First Employer through provision of supported work opportunities and mentoring for new graduates and those newly entering the workforce with an emphasis on recruitment of local people. Increased number of graduate and training places available, Increased provision of mentoring and education roles in the LHD Increased numbers of graduates taking permanent positions in the organisation on completion of their program Increased number of people recruited from local Murrumbidgee area Priority Action 2.2 Retention - Become the Preferred Rural Health Employer through provision of career pathways and opportunities. Improved retention rate of medical, nursing and allied health staff Decrease in the use of locum and temporary staff Achievement of Aboriginal Workforce employment goals. Priority Action 2.3 Culture - Develop a positive workplace culture which facilitates respect amongst staff and recognises and promotes leadership, innovation and quality performance. An active staff recognition program Improved employee engagement rating from staff surveys Reduction in number of behaviour related complaints amongst staff Reduction in number of hours lost due to stress or psychological issues Improved retention rate of staff Strategic Direction 3. Improving clinician and community engagement Priority Action 3.1 Consult and engage with communities and stakeholders to enable their input into development and implementation of health service decisions. Community and consumer representation and input into health service plans Aboriginal, Youth, Ethnic and other population group input into health service plans and models of care Priority Action 3.2 Foster Local Health Advisory Committees and Clinician forums through open and timely communication. Number of active LHAC, MPS Committees and Clinical Councils in existence and outcomes of local activities undertaken

10 nities ent of information technology effective partnerships 6. Providing infrastructure to support clinical service plans Strategic Direction 4. Expanding innovative use of information technology Priority Action 4.1 Provide technology that responds to and supports increased access to clinical information and services. Development of virtual outreach services between major centres and small communities for Specialist and multidisciplinary care Use of telemedicine services for emergency assessments in communities without medical offi cer coverage Use of telehealth services for implementation of multidisciplinary and allied health care plans Priority Action 4.2 Upgrade information communications and technology infrastructure. Completion of Information Communication and Technology (ICT) plan for MLHD Incorporation of upgraded ICT capacity in capital works program Incorporation of ICT needs in Clinical Service Implementation Plans Strategic Direction 5. Fostering effective partnerships Priority Action 5.1 Establish cooperative and collaborative liaison with the three Medicare Locals within the MLHD to improve population health and primary health care services. Improved information exchange and transfer of care between acute and community based service providers Active cross representation and collaboration on District and Medicare Local committees and projects Priority Action 5.2 Provide a coordinated approach to health service planning and delivery. Completion of Population Health and Primary Health Care Plans in collaboration with Medicare Locals and other institutions/agencies Provision of a coordinated response to emerging health issues e.g. Murray Darling Basin Plan between government agencies, Councils, Medicare Locals and private providers Priority Action 5.3 Partner with tertiary education institutions to provide integrated local training and education opportunities for staff to maintain and develop skills. Number of joint training programs available Number of collaborative arrangements between institutions and LHD Strategic Direction 6. Providing infrastructure and systems to support clinical service plans Priority Action 6.1 Upgrade major regional referral centre facilities to reduce number of patients having to travel outside of the District for care and improve access for public patients. Progression on the Wagga Wagga Base Hospital (WWBH) Redevelopment program Securement of funding for remaining Stages of the WWBH redevelopment Priority Action 6.2 Provide infrastructure that supports delivery of clinical services and clinical service plans and provides for fl exibility of services in communities. Continued progression of the Multi Purpose Service program Development of an Asset Management plan that refl ects and supports clinical service plans Continued refurbishment and upgrade of District facilities through Rural Minor Capital Works and other Programs Increased expenditure as a proportion of total expenditure on upgrade of plant and equipment Priority Action 6.3 Improve systems and processes that support quality clinical services and reduce red tape Accreditation of Services Implementation of streamlined business processes Page 9.

11 APPENDIX 1 - POPULATION PROFILE The Murrumbidgee Local Health District Murrumbidgee LHD is 125,561 sq/km in area and encompasses 29 Local Government Areas in the central south of NSW (Figure 1): Berrigan, Bland, Boorowa, Carrathool, Conargo, Coolamon, Cootamundra, Corowa, Deniliquin, Greater Hume, Griffi th, Gundagai, Harden, Hay, Jerilderie, Junee, Lachlan (part), Leeton, Lockhart, Murray, Murrumbidgee, Narrandera, Temora, Tumbarumba, Tumut, Urana, Wagga Wagga, Wakool and Young and also includes providing services to the Albury City population. Most of the LHD is considered inner regional or outer regional with only the north western LGA of Hay classifi ed as remote. Its population: The MLHD as of June 2010, has an estimated resident population of 297,476. This population has grown by 4.5 per cent since 2005 and is projected to grow by 3.2% in 2011 to 2021 to reach approximately 301,000 people and 307,000 by This is a slow growth rate compared to total NSW fi gures which increased by 7% from 2005 to 2010 and are projected to increase by 11.1 per cent from 2001 to 2021 and a further 10.1 per cent from 2021 to The population is ageing (Figure 2) with people aged 75 years and over making up an estimated 7.7 per cent of the total population in 2011 (around 22,000 people) and projected to increase to 13 per cent in 2031 to around 40,000 people. The aged population in NSW was projected to be 6.8 per cent in 2011 increasing to 10.3 per cent in From the 2006 Census (Figure 3)

12 Cultural and linguistic diversity: The people of MLHD were mostly born in Australia or were from English speaking countries. Only 4.1 per cent per cent of the MLHD population were born in a non- English speaking country (NESB COB) and 4.1 per cent stated speaking a language other than English (LOTE) at home, compared to 17.3 per cent and 20.0 per cent in NSW respectively. Less than one per cent of the MLHD population had diffi culty speaking English compared to 3.7 per cent in NSW. People of Aboriginal background made up 3.1 per cent of the MLHD population compared to 2.1 per cent of all NSW. The majority of religious affi liations reported were Christian-based (78.5 % in MLHD and 67.7% in NSW). Education: Seventy per cent of sixteen year olds were full-time participants in secondary school compared to 74 per cent in NSW. Education to Year 12 (or equivalent) was reported by 29.7 per cent of the adult population compared to 42.4 per cent of NSW. University education of Bachelor degree or higher were reported by 19.8 per cent of the MLHD population compared to 30.2 per cent in NSW. Adults in MLHD were more likely to have Level III and IV trade certifi cates than adults in NSW (34.6% MLHD compared to 25.1% NSW). Seventy-nine per cent of 15 to 19 year olds in MLHD and in NSW were either learning or earning in The working population: On 2006 Census night 5.5 per cent of the labour force of MLHD reported to be looking for work compared to 5.9 per cent of the NSW labour force. Retail trade and agriculture were the main industries of employment (14.8% and 14.4% respectively) followed by manufacturing (11.3%) then health and community services (10.0%). In NSW the main employer was the retails trade (14.1%) followed by property and business services (11.5%) then health and community services and manufacturing (10.7% and 10.3% respectively). The main occupations of employment in MLHD were intermediate clerks, sales and service workers (15.0%), followed by professionals (14.6%) then tradespersons and related workers (13.2%) and managers and administrators (13.0%). The NSW workforce had proportionally more people classifi ed as professionals (20.3%) and intermediate clerks, sales and service workers (16.9%) and fewer managers and administrators (9.4%) than MLHD. In September 2008 the unemployment rate in MLHD was 3.5 per cent and the LGAs with highest unemployment were Junee (5.1%), Leeton, Deniliquin and Albury (all 4.2%), unemployment for NSW was 4.6 per cent. Socioeconomic disadvantage: The Index of Relative Socioeconomic Disadvantage (IRSD) indicates areas with higher proportions of disadvantaged households. The IRSD is calculated at Collection District (CD) level (approx 200 households) within LGAs. The score for an LGA is an average of the CD scores. The LGAs with low average IRSD scores are considered to be the most disadvantaged these are Narrandera, Junee, Cootamundra, Hay and Urana. The LGAs with the least disadvantaged households were Conargo, Greater Hume Shire, Lockhart and Wagga Wagga. The LGAs of Wagga Wagga, Cootamundra, Albury and Young had one or more collections districts with the lowest IRSD scores in the LHD, indicating some pockets of disadvantage in these LGAs. Families: There were approximately 105,000 occupied private dwellings in the MLHD in 2006, 71,000 family households (67.8% of households) with 71,839 families (some households accommodate more than one family) and Page 11.

13 26,700 lone person households (25.5%). Of the 71,839 families 28,857 (40.2%) were couple families with no children, 31,115 (43.3%) couples with children, and 10,831 (15.1%) one parent families. NSW had a higher proportion of one parent families (16.1%) than MLHD and more couple families with children (46.2%), most likely due to a younger age structure than MLHD. More families, proportionally, reported incomes of less than $500 a week in MLHD compared to NSW (14.9% and 13.1% respectively), 11.8% of families reported incomes of over $2,000 a week compared to 21.7% of families in NSW. There were 8,038 children under 15 years in jobless families (or 14.4% of all children under 15 years compared to 15.9% in NSW), this varied by LGA with the highest percentage of children in jobless families in Urana (21.6%), Cootamundra (19.2%) and Narrandera (19.1%) and the lowest in Conargo (3.4%) and Wakool (6.3%). Income support: Murrumbidgee LHD had 32,913 aged pensioners in June 2008, 71 per cent of the eligible population compared to 69 per cent in NSW. In June 2009 there were 22,983 Health Care Card holders in MLHD and 52,411 Pensioner Concession Card holders making a total of 75,394 concession card holders or 26.2 per cent of the total population compared to 23.3 per cent in NSW. The percentage of concession card holders ranged from 33.9 per cent in Berrigan and Cootamundra to 21.4 per cent in Wagga Wagga. Disability: On Census night August 2006, 11,291 people were reported as needing assistance with core activities, which made up 4.3% of the population compared to 4.3% of NSW. For people aged 10yrs to 40 yrs approximately 2 per cent reported needing help with core activities, this proportion increased with age from 4 per cent of yr olds, 10 per cent of yr olds, 30 per cent of yr olds and over 60 per cent of people aged over 90 years. There were 11,006 people aged 16 years or over in MLHD in June 2008 who were receiving a disability support pension, making up 6.1 per cent of the eligible population, compared to 5.1 per cent in all NSW. Cootamundra (9.8%), Boorowa (9.5%), Harden (8.5%) and Young (8.1%), had the highest percentages of their populations on disability pensions among MLHD LGAs, and Wagga Wagga (5.0%) and Gundagai (5.0%) the lowest. Its health Note: Health indicators are reported separately for MLHD and Albury LGA in most instances Data are sourced from the NSW Health Statistics website: Rates quoted are age-adjusted (age-standardised) for comparison across years and geographic areas Deaths: Life expectancy for a person born from 2003 to 2007 in MLHD is 80.4 years (77.7 for males and 84.0 for females) this is signifi cantly lower than NSW at 81.6 years. The age-adjusted all cause death rate in MLHD is signifi cantly higher than expected based on NSW rates (634.4 per 100,000 population compared to per 100,000 in NSW) with Albury LGAs death rate of per 100,000 not signifi cantly different from NSW. There was an average of 1,861 deaths in MLHD and 319 deaths in Albury LGA ( ). Potentially avoidable deaths are those premature deaths (occurring before age 75 years) that theoretically could have been avoided given our current understanding of disease causes, prevention and health care. Both MLHD and Albury LGA had avoidable death rates within expected ranges based on NSW averages (MLHD: 163.5/100,000; Albury: 168.6/100,000; NSW: 154.4/100,000), however these accounted for an annual average of 411 deaths in MLHD and 78 deaths in Albury LGA ( ). In NSW death rates for avoidable causes were seen to increase with geographic remoteness, particularly in males. The avoidable death category has been divided into causes that are amenable to health care and those that are deemed preventable. Albury and MLHD had death rates from causes amenable to health care within expected limits based on NSW rates however Murrumbidgee had a signifi cantly higher preventable cause death rate than expected (MLHD: 102.9/100,000; Albury: 102,2/100,000; NSW: 91.3/100,000). There has been a signifi cant and continuing decline in rates of death from preventable causes and those amenable to health care since the 1980s. Hospitalisations: In fi nancial year there were 122,955 episodes of hospital care for residents of the MLHD (including Albury). The age-adjusted rates of hospitalisation were signifi cantly higher than the NSW averages for both sexes separately and combined. MLHD had the second highest rate of hospitalisation among NSW LHDs (MLHD (inc Albury): 38,813.6/100,000; NSW: 34,245.0/100,000).

14 Potentially preventable hospitalisations (PPH) are those which are considered avoidable through prevention or appropriate primary care (also known as Ambulatory Care Sensitive Conditions), they made up 9,805 episodes in MLHD at a signifi cantly higher rate than NSW (MLHD: 3,554.4/100,000; NSW: /100,000) and 1,300 episodes in Albury at a rate of 2,419.0 per 100,000 (not signifi cantly different from NSW). The most significant cause of hospitalisation in MLHD ( ) was injury and poisoning (17,459 hospitalisations per year or 14.2%) followed by digestive system diseases (13,546, 11.0%), factors infl uencing health care (non-dialysis) (13,048 episodes, 10.6%); and symptoms signs and abnormal fi ndings (10,495, 8.5%). For MLHD residents (including Albury) the age-adjusted rates of hospitalisation by cause were signifi cantly higher than the rates for a large number of causes (Table 1). In relation to preventable hospitalisation (PPH) rates by condition type ( ) the most common in MLHD was chronic obstructive pulmonary disease (1,378 hospitalisations, 5.8 average bed days and 8,050 total bed days); followed by dehydration and gastroenteritis (1,075 hospitalisations, 2.1 average bed days and 2,239 bed days); and diabetes complications (1091 hospitalisations, 4.6 average bed days, 4,995 total bed days). The age-adjusted rates of PPH by condition were signifi cantly higher than the rates for all NSW for diabetes; dehydration and gastroenteritis; COPD; urinary tract infections; dental conditions; asthma; congestive heart failure; ENT infections; convulsions and epilepsy; angina; infl uenza and pneumonia; and hypertension. Table 1 - Hospitalisations by cause and sex, Murrumbidgee LHD (including Albury), MLHD (inc. Albury) NSW LHD Cause of hospitalisation Sex Number Per cent of hosp s Rate per 100,000 pop LL 95% CI UL 95% CI Rate per 100,000 pop. LL 95% CI UL 95% CI Infectious diseases Males HIGH Females 1, HIGH Persons 2, HIGH Malignant neoplasms Males 3, HIGH Females 1, Same Persons 5, HIGH Other neoplasms Males 1, Same Females 1, LOW Persons 2, Same Blood & immune Males Same diseases Females Same Persons 1, Same Endocrine diseases Males Same Females 1, Same Persons 1, Same vs. NSW* Page 13.

15 MLHD (inc. Albury) NSW LHD Mental disorders Males 1, LOW Females 1, LOW Persons 3, LOW Nervous & sense Males 3, Same disorders Females 3, HIGH Persons 6, Same Cardiovascular diseases Males 4, HIGH Females 3, HIGH Persons 8, HIGH Respiratory diseases Males 3, HIGH Females 3, HIGH Persons 7, HIGH Digestive system Males 6, HIGH diseases Females 7, HIGH Persons 13, HIGH Skin diseases Males Same Females HIGH Persons 1, HIGH Musculoskeletal Males 3, HIGH diseases Females 3, HIGH Persons 6, HIGH Genitourinary diseases Males 2, HIGH Females 3, HIGH Persons 6, HIGH Maternal, neon. & Males 1, HIGH congenital Females 6, HIGH Persons 8, HIGH Symptoms & abnormal Males 5, HIGH fi ndings Females 5, HIGH Persons 10, HIGH Injury & poisoning Males 9, HIGH Females 7, HIGH Persons 17, HIGH Dialysis Males 4, LOW Females 2, LOW Persons 6, LOW Other factors infl. health Males 6, HIGH Females 6, LOW Persons 13, LOW Other Males Same Females LOW Persons Same Total Males 60, HIGH Females 62, HIGH Persons 122, HIGH * Statistically signifi cant difference from NSW age-standardised rates, based on 95% confi dence limits.

16 Injury There were 93 injury deaths per year in in MLHD and 19 in Albury LGA. The age-adjusted rate of 39.1 per 100,000 in MLHD was signifi cantly higher than the NSW rate of 32.4 per 100,000, the Albury rate of 37.7 per 100,000 was not signifi cantly different from NSW. MLHD recorded the highest death rate from injury for males across all NSW LHDs in The major causes of injury death varied for males and females with suicide making up 34 per cent of male injury deaths followed by motor vehicle transport deaths (28.2%) and falls (8.0%); for women falls accounted for 32.4 per cent of injury deaths, motor vehicle transport 25.9 per cent and exposure to unspecifi ed factor 15.7 per cent. Injury and poisoning hospitalisations have been increasing steadily since the early 1990 s. Injury and poisoning was recorded as the principal diagnosis in a total of 17,459 episodes of care in for MLHD and Albury residents however these data can contain multiple hospital episodes per the one injury event due to statistical discharge where the patient is transferred to another hospital or patient type-changes from acute to rehabilitation status. In order to count injury events resulting in hospitalisations the type change and statistical discharge episodes are excluded from the data, this gives 7,488 injury related hospitalisation in MLHD and 1,235 in Albury LGA for The age adjusted hospitalisation rate of 2,977.3 per 100,000 in MLHD and 2,371.3 per 100,000 in Albury were signifi cantly higher than the NSW rate of 2,226.2 per 100,000. MLHD had the overall highest rate of hospitalisation for injury among all NSW LHDs for both males and females. Approximately 3,400 injury hospitalisations in MLHD and Albury were fall-related making up 40 per cent of all injury hospitalisations; 950 motor vehicle transport related (12%); and 900 (10%) were other specifi ed injury causes. Cardiovascular disease: There were 650 deaths in MLHD and 113 in Albury LGA from cardiovascular disease (CVD) in 2007 and on average 136 premature CVD deaths (people aged years) per year in in MLHD and 27 in Albury LGA. The age-adjusted death rates of 81.8 per 100,000 in MLHD and 92.2 per 100,000 in Albury LGA were higher, but not signifi cantly so, than the NSW rate of 79.1/100,000. The majority of CVD deaths were due to coronary heart disease (43.5%) followed by stroke (19.7%), heart failure (10.2%) and peripheral vascular disease (4.6%). Coronary heart disease and stroke deaths have been decreasing steadily since the late 1980 s with heart failure and peripheral vascular disease death rates remaining fairly constant. Since the 1990 s, age-adjusted CVD hospitalisation rates have been decreasing in MLHD for stroke and heart failure and increasing for coronary heart disease and peripheral vascular disease. In there were 8,923 hospitalisations in total for CVD, (31% for coronary heart disease, 11% for stroke, 9% for heart failure, 5% for peripheral vascular disease and 41% other CVD). The age-adjusted rate of hospitalisation for CVD in MLHD (including Albury) in of 2,530.6 per 100,000 was signifi cantly higher than NSW at 1,744.9 per 100,000. Coronary heart disease made up 31 per cent of all CVD hospitalisations in MLHD, stroke 11 per cent; heart failure 9 per cent and peripheral vascular disease 5 per cent. Hospitalisations for cardiovascular procedures (used to restore adequate blood fl ow to blocked arteries) were highest for residents of the South West Sydney LHD and lowest in the Far West LHD, Murrumbidgee LHD including Albury residents had a CVD procedure rate of per 100,000 which was lower, but not signifi cantly, than NSW at per 100,000. Page 15.

17 Diabetes: There were 445 diabetes related deaths in MLHD in 2007 with an age-adjusted rate of per 100,000 a rate similar to NSW at per 100,000. Diabetes related deaths are those where diabetes is either the underlying cause or it is an associated cause of death. In there were 1,200 hospitalisations where diabetes was the principal diagnosis in MLHD at an age-adjusted rate of per 100,000 and 182 for Albury residents (338.8 per 100,000) the MLHD rate was signifi cantly higher than NSW at per 100,000. In the 2010 NSW Health Survey 7.1 per cent of adults in MLHD (excluding Albury) said they had been diagnosed with diabetes or high blood glucose (not during pregnancy) this was a similar prevalence to all NSW adults at 7.4 per cent. Respiratory disease: Respiratory diseases deaths made up 8.4 per cent of deaths in NSW, the main types are asthma, chronic obstructive pulmonary disease (COPD); infl uenza and pneumonia; other acute respiratory infections; and lung cancer. There were 7,368 hospitalisations for respiratory disease in MLHD and Albury in making up 6 per cent of all hospitalisations at an age-adjusted rate of 2,341 per 100,000 which was signifi cantly higher than NSW at 1,534 per 100,000 (Table 1). COPD Chronic Obstructive Pulmonary Disease (COPD) accounted for an average of 78 deaths per year (2006 to 2007) in MLHD (age adjusted rate: 26.1/100,000) and 14 deaths per year in Albury LGA (23.6/100,000) neither area was signifi cantly different from NSW at 21.6 per 100,000. Rates of hospitalisation for COPD in MLHD were however the highest of all NSW LHDs, for people aged 65 years and over at 2,550.4 per 100,000 and also signifi cantly higher than NSW at 1,471.4 per 100,000. COPD hospitalisations for all ages were signifi cantly higher in MLHD (396.7 per 100,000) than NSW (239.5 per 100,000) however Western NSW LHD (418.3/100,000) had the highest rate among LHDs. Rates of COPD hospitalisation for Albury residents were lower than expected based on NSW rates for all ages (184.0/100,000) and for 65 years and over (970.4/100,000). Cigarette smoking is the main risk factor for both COPD and lung cancer and the current incidence rates of these conditions refl ect smoking rates 20 years and more in the past. Asthma There were 609 hospitalisations of Murrumbidgee LHD residents (including Albury LGA) of all ages in at a rate of per 100,000 population, which was signifi cantly higher than the NSW rate of per 100,000. The hospitalisation rate for those aged 5-34 years, where asthma is more clearly diagnosed and likely to be acute, was per 100,000 which was also signifi cantly higher than the NSW rate for the same ages at per 100,000. In the 2010 NSW Health Survey, 15.7 per cent of the adult population reported having current asthma (symptoms or treatment for asthma in the past 12 months) which was higher than NSW at 11.3 per cent, but not significantly so. In rural and remote areas there is often an increased likelihood of admission to hospital for care that may be provided on an outpatient basis in an urban area. Influenza and pneumonia There were 1,211 hospitalisations of Murrumbidgee LHD residents of all ages (age-adjusted rate: per 100,000) and 186 for Albury LGA (age-adjusted rate: per 100,000), both rates were signifi cantly higher than the NSW rate of 283.5/100,000. There were 97 hospitalisations for those aged 0-4 years (age-adjusted rate: /100,000) in MLHD and 642 for persons aged 65 years and over (age-adjusted rate: /100,000), the rate for the older population was signifi cantly higher than NSW at /100,000. In older people in MLHD, the rate of infl uenza and pneumonia hospitalisations for males was nearly double that of females. Due to small numbers of admissions in the Albury LGA no data are available for the 0-4 year age group, the age-adjusted rate for the 65+ age group of per 100,000 was not signifi cantly different than NSW. MLHD had the second highest rates of hospitalisations for males and females among NSW LHDs, Western NSW LHD had the highest. Infl uenza and pneumonia hospitalisations are considered to be partly preventable through immunisation. The number of potentially preventable hospitalisations due to infl uenza and pneumonia in Murrumbidgee LHD in was 370 at an age-standardised rate of per 100,000 population, this rate was signifi cantly higher than NSW at 59.9 per 100,000 and accounted for a total of 2,165 bed days and on average 5.9 bed days per admission. In 2010 the NSW Health Survey reported that 67.1 per cent of the MLHD population aged 65 years or over had been immunised against fl u in the previous 12 months and 52.6 per cent had been vaccinated against pneumococcal pneumonia in the past 5 years, both immunisation rates were slightly lower than NSW but not signifi cantly so.

18 Mental health (suicide and self harm): In period, an average of 24 deaths for males and 2 deaths for females were recorded annually as suicide in the MLHD, the same total number as for motor vehicle transport related deaths. The age-adjusted rate of suicide for MLHD was 12.3 per 100,000 compared to 7.3 per 100,000 in NSW in There were 442 (162 males, 281 females) hospital admissions where selfharm was recorded as the external cause at a rate of 198 per 100,000 population for all ages and 420 per 100,000 for year olds. In Albury LGA a further 117 self-harm hospitalisations were recorded in at a rate of per 100,000 persons all ages and per 100, year olds. In the 2010 NSW Health Survey 9.5 per cent of adults in MLHD had high to very high psychological distress (assessed by the K10 10-item questionnaire that measures the level of psychological distress in the most recent 4-week period) the prevalence of distress was lower than NSW at 11.0 per cent, but not signifi cantly so. Cancer Cancer is Australia s leading cause of disease burden. It accounts for almost one-fifth of years of healthy life lost due to premature death, disease, and injury. In 2008 in NSW the fi ve leading types of new cases of cancer in descending order were: prostate cancer, colorectal cancer; breast cancer; melanoma and lung cancer. Breast cancer In 2008 in MLHD there were 165 new cases of breast cancer (age-adjusted rate: 120.2/100,000) diagnosed amongst residents, 79 (48%) of these were for women aged years (age-adjusted rate: 285.1/100,000), these rates were within expected ranges compared to NSW at per 100,000 women all ages and per 100,000 women aged years. There were a further 40 new cases of breast cancer (age-adjusted rate: 149.8/100,000) for Albury residents in 2008 with 19 in women years (age-adjusted rate: 358.7/100,000), rates were not signifi cantly different from NSW. There were 26 breast cancer deaths in MLHD in 2007 with an age-standardised rate of 16.2 per 100,000 which was lower but not signifi cantly different from the NSW rate of death of 22.1 per 100,000 women of all ages. BreastScreen NSW fi gures show that 14,840 women were screened in the 2 year period 2009 to 2010 in MLHD covering 52.7 per cent of eligible women (50-69 year olds) a further 2,690 women were screened in the Albury LGA covering 46.8 per cent of the eligible women, other LHDs in NSW ranged from a high of 60 per cent coverage in Hunter New England LHD to a low of 44.4 per cent in Far West LHD. The incidence of breast cancer has increased in Murrumbidgee LHD since the late 1980 s particularly in women aged years, however the death rates have decreased marginally, indicating increased detection and better survival. Lung cancer In 2008 in MLHD there were 125 new cases of lung cancer diagnosed at an age-adjusted incidence of 41.8 per 100,000 population this was similar to the NSW rate of 42.5 per 100,000 population. There were 95 deaths in MLHD and 18 deaths in Albury LGA from lung cancer at age-adjusted rates for 31.9 per 100,000 and 34.1 per 100,000 respectively, neither were signifi cantly different to the NSW rate of 33.2 per 100,000. The incidence of lung cancer for males in MLHD has been decreasing since the late 1980 s as has the rate of death, however for women the incidence and death rates have been increasing, this is in-line with the general trend in NSW. Colorectal cancer In 2008 in MLHD there were 178 new cases of colorectal cancer diagnosed at an age-adjusted incidence of 59.8 per 100,000 population in Albury there were 36 new cases (age-adjusted rate: 64.7/100,000), these rates were similar to the NSW rate of 61.4 per 100,000 population. There were 53 deaths in MLHD and 14 deaths in Albury LGA from colorectal cancer at ageadjusted rates for 18.0 per 100,000 and 25.8 per 100,000 respectively, neither were signifi cantly different to the NSW rate of 18.0 per 100,000. The incidence of colorectal cancer for males and females MLHD has fl uctuated annually slightly since the late 1980 s however the rate of death has decreased. Page 17.

19 Melanoma In 2008 in MLHD there were 125 new cases of melanoma diagnosed at an age-adjusted incidence of 44.4 per 100,000 population, this rate was similar to the NSW rate of 47.4 per 100,000 population, in the previous year (2007) there were 19 new cases in Albury LGA at a rate of 36.7 per 100,000. Small numbers of deaths from melanoma mean there is annual variation, in 2007 in MLHD there were too few deaths to include in reports however in 2006 there were 19 deaths. The age-adjusted rate in NSW is around 6 per 100,000 population. In NSW the incidence of melanoma for males has increased signifi cantly since the late 1980 s and increased slightly in females, the rate of death however, has remained fairly constant. Prostate cancer In 2008 in MLHD there were 348 new cases of prostate cancer diagnosed at an age-adjusted incidence of per 100,000 population in Albury there were 63 new cases (age-adjusted rate: 252.9/100,000), these rate for MLHD was higher than the NSW rate of per 100,000 population. There were 44 deaths in MLHD in 2007 and 11 deaths in Albury LGA from colorectal cancer at age-adjusted rates for 34.7 per 100,000 and 48.3 per 100,000 respectively; neither were signifi cantly different to the NSW rate of 30.2 per 100,000. The incidence of prostate cancer for males in MLHD and in NSW has increased signifi cantly since the late 1980 s, due in part to increased awareness, screening and detection, while the death rate has remained similar and decrease slightly. Cervical cancer In MLHD 2006, 2007 and 2008 there were a total of 15 new cases of cervical cancer diagnosed and at an ageadjusted incidence of 9.2 per 100,000 in 2007 compared to the NSW rate of 10.4 per 100,000 population, Albury data is not reported due to small numbers. There were 45 deaths in total in NSW in 2007 and none recorded from in MLHD. Cervical cancer cases and deaths decreased in NSW between 1998 and 2007 and in 2008 it was the fourteenth most common female cancer. It can be prevented through the early detection of precancerous lesions by two-yearly Pap tests of women aged years. The biennial screening rate is calculated by the NSW Cervical Screening Program (CSP) from the number of women aged years who had a Pap test at least once during a two-year reporting period, as a per cent of the target population of eligible NSW women residents aged years. The percentage of eligible women in NSW who had their Pap test by December 2010 was 56.4 per cent for MLHD the rate was 54.2 per cent. BEHAVIOURS Smoking Tobacco smoking is the single most preventable cause of ill health and death in Australia, contributing to more drugrelated hospitalisations and deaths than alcohol and illicit drug use combined. It is a major risk factor for coronary heart disease, stroke, peripheral vascular disease, cancer and a variety of other diseases and conditions. The per cent of the MLHD adult population reporting to be current smokers had been declining steadily since 1997 until a recent spike in male smokers was recorded by the NSW Health Survey in In 2009 the smoking prevalence of 18.3 per cent was signifi cantly lower than the 1997 prevalence of 25.9 per cent. The increase from 2009 to 2010 could be an artefact of small numbers, as the increase of male smokers from 17.9 per cent to 26.6 per cent is not statistically signifi cant. The 2010 prevalence of adult smokers in MLHD of 21.8 per cent was higher than the NSW prevalence of 15.8 per cent (but not signifi cantly), the rate in Albury LGA was 17.5 per cent. Smoking was believed to have contributed to 3,307 hospitalisations in the MLHD in at an age-adjusted rate of 1,116.5 per 100,000 population, in Albury there were 286 hospitalisations at a rate of per 100,000, the MLHD rate was signifi cantly higher than NSW at per 100,000. MLHD had the highest rate of smoking attributable hospitalisations among NSW LHDs. Unlike the trend in NSW the MLHD is experiencing an increase is smoking attributable hospitalisations particularly in males in recent years, rates have been decreasing for males in Albury LGA, but increasing for women, where as in NSW the rates have been steady for women but decreasing for males. Alcohol Long term adverse effects of high consumption of alcohol on health include contribution to cardiovascular disease, some cancers, nutrition-related conditions, risks to unborn babies, cirrhosis of the liver, mental health conditions, tolerance and dependence, long term cognitive impairment, and self- harm (National Health and Medical Research Council 2009). In the 2010 NSW Health survey risk consumption of alcohol was defi ned as: consuming more than 2 standard drinks on a day when drinking alcohol. Adult males in MLHD had one of the highest rates of risk consumption among NSW LHDs at 55.3 per cent, signifi cantly higher than NSW at 40.2 per cent. Females in MLHD had the same rate as NSW with 19.9 per cent of adult females drinking at risk levels. Albury LGA females had the

20 highest rate of risk drinking compared to NSW LHDs and at 44.4 per cent of adult females was signifi cantly higher than NSW overall (19.9%) with males at 48.8 per cent which was not signifi cantly higher than NSW. There has been a slight increase in risk alcohol consumption in MLHD males since 2002 with rate among females remaining fairly constant, in Albury LGA due to small numbers surveyed annually, the rates fl uctuate from year to year, for NSW overall, there has been a slight decrease in male rates of consumption and little change in females. Alcohol attributable hospitalisations are those where the consumption of alcohol is believed to make up a percentage of hospitalisations for certain causes, such as injury and cardiovascular disease as well as liver disease and mental health conditions. Alcohol consumption in MLHD contributed to 2,077 hospital admissions in and 337 admissions for Albury LGA residents. The age-adjusted rate of alcohol attributable hospitalisations in MLHD in for males was per 100,000 and for females per 100,000, both of which were signifi cantly higher than the NSW rates for males of per 100,000 and per 100,000 for females. Ageadjusted rates in Albury LGA were signifi cantly different from NSW at per 100,000 for males and per 100,000 for females. The age-adjusted rates of alcohol attributable hospitalisations in MLD is 1.5 times higher in than it was in , in Albury LGA the rates have increased by around 1.2 times in the same time period and 1.3 times for all NSW. Physical activity In the 2010 NSW Health survey 60.4 per cent of adult males and 45.7 per cent of adult females reported undertaking adequate physical activity in MLHD, the results for Albury LGA were 51.1 per cent of males and 43.5 per cent of females, neither were signifi cantly different to NSW at 60.0 per cent of adult males and 50.7 per cent of adult females. In the New South Wales Population Health Survey, adequate physical activity is calculated from questions asked in the Active Australia Survey, and is defined as undertaking physical activity for a total of at least 150 minutes per week over 5 separate occasions. The total minutes are calculated by adding minutes in the last week spent walking continuously for at least 10 minutes, minutes doing moderate physical activity, and minutes doing vigorous physical activity multiplied by 2. Since 1997 in MLHD, Albury LGA and all NSW, the proportion of adults undertaking adequate physical activity has been increasing. Obesity/ high BMI related illness Excess weight, especially obesity, is a risk factor for cardiovascular disease, Type 2 diabetes, some musculoskeletal conditions and some cancers. As the level of excess weight increases, so does the risk of developing these conditions. In addition, being overweight can hamper the ability to control or manage chronic disorders (AIHW Cat. no. AUS ). The NSW Health Survey reported that in MLHD signifi cantly more adult males and females were overweight or obese (as measured by self-reported height and weight used to calculate Body Mass Index) when compared to NSW (MLHD: males 71.4%, females 57.2%; NSW: males 60.7%, females 48.0%). Obesity rates were higher in Albury LGA also, but not signifi cantly due to small numbers with 75.5 per cent of males overweight or obese and 57.8 per cent of females. IN MLHD, Albury LGA and all NSW the proportion of adult who are overweight or obese has been gradually increasing since 1997 to High body mass attributable hospitalisations are those where high body mass (BM) is considered to have contributed to the underlying illness, for example a proportion of diabetes and cardiovascular disease admissions. The MLHD had the highest age-adjusted rate of high BM attributable admissions among all LHDs in NSW for males and females separately and for the population as a whole. In in MLHD, 3,094 admissions were attributed to high BM at an age-adjusted rate of per 100,000 population, there were 276 admissions in Albury LGA (age-adjusted rate: 502.1/100,000). The MLHD rate was signifi cantly higher than NSW and close to double the NSW rate of per 100,000 population. In NSW, BM attributable admissions have remained relatively stable since the late 1980 s however in MLHD they have been increasing and in Albury LGA the rates have increased for females and decreased for males. Page 19.