Significant Issues impacting the WA Country Health Service

Transcription

1 Significant Issues impacting the WA Country Health Service Priorities for WA Country Health Service Annual Report Page 59 Appendices

2 The WA Country Health Service adopted a new strategic direction during with Revitalising WA Country Health Service outlining the way forward for health service delivery in regional WA. It follows on from the WA Country Health Service Strategic Plan titled Foundations for Country Health Services. This vision for revitalising country health services has been backed by significant investment from the State Government through its Royalties for Regions program and through the support of industry and our partner health service providers. As a result an enormous amount of service and infrastructure development has occurred during the past financial year and is continuing across the WA Country Health Service (WACHS). These developments are predicated by the four pillars on which WACHS stands: securing a fair share for country health; service delivery according to need; closing the gap to improve Aboriginal health; and workforce stability and excellence. Securing a fair share for country health Albany Hospital Redevelopment The State Government has contributed $166 million to the Albany Hospital redevelopment including $31 million from the Royalties for Regions Funding Program. John Holland has been announced as the successful contractor to build the new Albany Health Campus with construction due to start in Agreement is also being negotiated with the Commonwealth Government for the provision of additional facilities to enhance cancer services and patient accommodation to the value of $5.7 million. Negotiations are continuing with private health providers for potential additional private health services to be included on the Albany Health Campus. Broome Hospital redevelopment Stage two of the Broome Hospital redevelopment comprises the construction of two new facilities for Broome, the Acute Psychiatric Unit and the Paediatric Ward. Both of these buildings will be built simultaneously with a total budget of $17.3 million. Stage 2 went to tender in March 2010; and the successful builder (Norbuild) was appointed in July Construction will commence in late July; and on completion of Stage 2, Broome Hospital will be a 65 bed facility (not including emergency treatment bays). Esperance Hospital Facility and service redevelopment planning has been completed and has included extensive consultation with all key stakeholders. The services plan will inform the design and master planning for the Esperance Hospital redevelopment, which will include improving emergency, maternity, ambulatory care and community based primary health care services. It also supports co-location of general practitioner (GP) services on site at the hospital. Critical care at Bunbury Hospital WACHS is undertaking a major redevelopment of critical care facilities and services at Bunbury Hospital. The project will provide both a four bed intensive care unit service and an expanded emergency department capacity. Refurbishment and equipping of the current high dependency unit to create the four bed intensive care unit (ICU) will be completed by early The total project capital funding of $14.9 million is available with $14.1 million from the Commonwealth. The project involves a set of highly interdependent capital and service developments. Radiation Oncology Service WACHS is undertaking a major project to establish radiation oncology facilities and services at the South West Health Campus in Bunbury. This project has an estimated total capital cost of $15.2 million and is jointly funded by the State and Commonwealth, with the latter providing $6 million. Construction work on the radiotherapy centre commenced in March 2010 and is planned for completion in April Construction will be followed by installation and commissioning of Page 60 WA Country Health Service Annual Report

3 the major items of radiation oncology equipment, including a linear accelerator. The new facility is scheduled to open in June This project is a first for rural Western Australia. It is planned that the centre will provide local radiation oncology services for approximately 70 per cent of those South West residents who require this type of cancer treatment. Busselton Health Campus WACHS is currently planning for a major $77.4 million redevelopment of the Busselton Hospital on the current hospital site. Aurora Projects has been engaged to finalise detailed scoping work in order for this project to be progressed. Construction is scheduled to commence in mid 2012 and be completed in mid A number of options including the co-location of the mental health clinic and the involvement of the private sector in delivering various services are being reviewed by Government. Environmental issues are an important consideration in determining the master plan for the redevelopment. Port Hedland Hospital The Port Hedland Hospital is being replaced by a new $136.7 million 68 bed hospital in South Hedland. Transition planning to the new Hedland Health Campus is under way. The health campus incorporates acute inpatient services, community mental health, population health, community aged care and support services. Construction is due to be completed in October The project remains on time and budget at this stage. Nickol Bay Hospital Royalties for Regions has committed $150 million to redevelop the Karratha Health Campus (Nickol Bay). Services planning is currently being finalised which will inform the capital design and master planning of the facility. It is anticipated that the redevelopment will be finalised by the end of Kalgoorlie Health Campus WACHS is currently undertaking a major $55.8 million redevelopment of the Kalgoorlie Health Campus. The four stage redevelopment includes new palliative care, medical imaging and emergency department, together with a significant refurbishment of out-patients and allied health areas. The new palliative care unit has commenced construction and is due for completion in February A recent Commonwealth initiative announced this year for a new $4.5 million cancer centre will also be incorporated within the current scope of works. East Kimberley Development Package As part of the National Partnership Agreement, WACHS has been granted $50 million to implement a number of targeted priority infrastructure projects across the East Kimberley. These projects include: $3.4 million to upgrade Wyndham health facility and associated staff accommodation; $20 million for a new ambulatory care facility and $4 million for short term patient accommodation expansion at Kununurra Hospital; $3.2 million for Wyndham residential rehabilitation facilities; $4 million for remote aged care facilities and $5.5 million for the remote clinics at the Warmun and Kalumburu communities; $4.3 million for environmental health upgrades; $0.6 million for sobering up centres at Wyndham and Kununurra; and $5 million for health service provider housing in Kununurra. $1.2 million for medical and imaging equipment The State Government s Royalties for Regions program has provided $1.2 million for the purchase of medical equipment across WACHS. In addition, six 16 slice computed tomography (CT) scanners have been installed or are close to being installed in Karratha, Esperance, Carnarvon, Geraldton, Kalgoorlie and Narrogin hospitals. Pilbara Revitalising Health Services Initiative The Pilbara Health Partnership is a threeyear $38.2 millon partnership between the State Government s Royalties for Regions program and major Pilbara industries (BHP- Billiton Iron Ore, Woodside, Chevron, North West Shelf Venture and Rio Tinto) that aims to boost health services in the region. This partnership funded the installation of a CT WA Country Health Service Annual Report Page 61

4 scanner at Nickol Bay Hospital in Karratha this year, and the installation of new medical equipment at Tom Price, Newman, Port Hedland, Nickol Bay and Onslow hospitals. Other initiatives include boosting emergency response capacity through the strengthening of volunteer ambulance services and emergency management education and training to improve disaster responses in the region. It is also planned to boost the number of emergency, surgical and paediatric medical specialists based in Karratha. These new specialists will reduce the number of emergency evacuations to Port Hedland and Perth and increase the number of more complex surgical interventions carried out in Karratha. The employment of an emergency department nurse practitioner at Newman Hospital will also improve emergency services at the hospital. A helipad will be built at Nickol Bay Hospital. An indigenous employment initiative will provide scholarships, training and employment opportunities to Aboriginal people in the Pilbara to encourage them to take up roles in the health service. Two sexual health nurses will be employed at Port Hedland and Newman, and women s and children s health services enhanced at Tom Price. Minor works and health service planning will be undertaken at small hospitals including Tom Price, Newman and Paraburdoo. Service delivery according to need The State Government s innovative Four Hour Rule Program (FHR) to improve the way hospital patients receive unplanned and emergency care is now under way Statewide. The FHR is being implemented across Western Australian hospitals to ensure that the majority of patients arriving at emergency departments are admitted, discharged or transferred within a four-hour timeframe, unless required to remain with the emergency department for clinical reasons. Albany, Broome, Geraldton, Kalgoorlie, Port Hedland and Nickol Bay hospitals have joined the King Edward Memorial Hospital and the Peel Health Campus in the third wave of WA hospitals to commence the program. Royal Perth, Sir Charles Gairdner, Princess Margaret and Fremantle hospitals were the first WA hospitals to start the program in April Rockingham General, Armadale- Kelmscott Memorial, Swan District and Bunbury hospitals and the Joondalup Health Campus followed, joining the program in October Each hospital has been given two years to implement the major change. Elective Surgery WACHS continues to have a strong focus on managing a growing elective surgery waitlist with increased surgical throughput and particular strategies to address over boundary cases. WACHS Kimberley are investing resources to tackle specialist referral and wait list management issues to ensure patients in the Kimberley have timely access to elective care, particularly aboriginal children. WACHS is proposing to target an additional 1,600 cases in in order to maintain reasonable waiting times with growing demand for elective surgery. Cancer Centres The Commonwealth has approved $ million for rural cancer services infrastructure funding over the next three years. Improved cancer services facilities will be developed at Geraldton, Albany, Kalgoorlie, Northam and Narrogin. For example, in Geraldton service model planning will inform the design of the new cancer centre services in Geraldton. It is anticipated that capacity for seven chemotherapy chairs will be built along with patient accommodation units for patients travelling from other parts of the region to Geraldton for treatment. This centre will also have capacity for office, group and meeting space for a variety of health professionals involved in supporting people with cancer and their families. The services will provide multi-disciplinary, holistic, patient-centred care closer to home for more people. The facilities will be the base for providing chemotherapy treatments. It is expected that approximately 25 per cent of patients with more complex cancers will always need to travel to Perth for specialist treatment. Aged Care Several programs are under way across the WACHS to improve access to aged care Page 62 WA Country Health Service Annual Report

5 services and services for younger people with disabilities including: Friend In Need Emergency (FINE) funding for two positions in the South West and Great Southern in , expanding to other regions over The program is attached to larger emergency departments to coordinate care for at risk older patients who are admitted to emergency; COAG funding over four years for subacute care, which includes rehabilitation services; visiting geriatrician and psycho geriatrician specialists to all regions; part-time clinical support positions in all regions for visiting geriatricians; day therapy in Albany, Bunbury, Geraldton, Northam and Kalgoorlie (and community physiotherapy in Northam); expansion of inpatient rehabilitation units in Albany and Geraldton, and new units in Bunbury and Kalgoorlie; community rehabilitation in Albany, Geraldton and Bunbury; appointment of a full time geriatrician to the South West; older adult mental health positions in Goldfields, Wheatbelt and South West regions, and continued growth in Home and Community Care programs across country regions with growth funding in of $2.3 million. Mental health services planning WACHS is currently considering and will be responding to the consultation paper WA Mental Health, Towards Submissions will be made to the new Mental Health Commission. The new Strategic Directions for mental health services across WA will be informed by this paper and the discussions it generates, and will guide mental health service planning across WACHS to Community mental health services are provided in all WACHS regions. These are available to all age groups and are delivered in clinics and patients homes, in hospitals, and via outreach services to remote communities. Services provided include assessment and treatment interventions for moderate to severe mental illness. The challenges of providing a range of services across the spectrum of care require that mental health teams in rural and remote areas work in partnerships with other service providers and agencies. Three WACHS regions (Goldfields, Great Southern and South West) have inpatient mental health facilities at their principal hospital sites. Vital areas of progress in have been: Older Adult Mental Health: working in partnership with aged care services, funding has been obtained to improve subacute mental health care to older people. This will include visiting psychogeriatrician services as well as seed funding for community teams. Aboriginal Mental Health: WACHS has developed and submitted a position paper and business case to the Mental Health Commission for funding under the COAG National Partnership Agreement to improve the health of Aboriginal people. Broome Acute Psychiatric Unit: construction has commenced on a new inpatient mental health facility in Broome. This will service the northwest regions with completion anticipated in late Specific mental health initiatives across WACHS include: The Drumbeat Program - a music-based therapy program helping at-risk youngsters in Narrogin to develop a greater sense of health and wellbeing. Drumbeat targets year olds who are faced with a range of recognised risk factors including mental health disorders, drug and alcohol misuse and criminal activity. The program is delivered by the Rural Community Support Service (RCSS) and is designed to reach those young people for whom traditionally based therapies have failed. RCSS is run by the WACHS Great Southern Mental Health Service and is funded by the Commonwealth Department of Health and Ageing. WACHS Great Southern has also been offering adult, youth and Indigenous Mental Health First Aid courses to members of the public, government agencies and private and not-for-profit organisations across the southern Wheatbelt for the past four years. This award winning two-day course, funded by the Commonwealth Department of Health and Ageing, has been designed to provide WA Country Health Service Annual Report Page 63

6 important skills on how to support people in a mental health crisis situation or who are developing a mental health disorder. Renal Dialysis Plan WACHS is finalising a 10 year plan for renal dialysis. The number of people on dialysis in rural and remote WA is projected to increase from 320 in 2010 to over 650 in The plan aims to keep people closer to home by increasing the number of people on home dialysis, and exploring alternative options such as placing dialysis facilities (chairs) in some small hospitals and remote clinics. An agreement has been reached with the Northern Territory governments to ensure that renal patients from the Central Desert area can access treatment at the closest appropriate service, regardless of what side of the border they live. The Western Australian and the Northern Territory government are also undertaking joint planning for the Central Desert to ensure that future health needs are met through a cooperative relationship between health service providers. Wheatbelt Health Memorandum of Understanding The Wheatbelt Health Memorandum of Understanding (MOU) signed in 2008, established a framework for communication on health planning issues across the key stakeholders in the region. Signatories are WACHS Wheatbelt, the Wheatbelt Development Commission, three Wheatbelt zones of the Local Government Association and the Wheatbelt General Practice Network. The Wheatbelt Health MOU group initiated the Wheatbelt Planning Initiative to provide a reliable and representative documentation of community perceived health needs and suggestions for meeting them. The review produced a final report which is valued by key stakeholders as a comprehensive account and sound reflection of community views, aspirations and perceived needs regarding health services. This report will inform Wheatbelt services planning. Eastern and Southern Wheatbelt planning Service planning is currently underway to inform service and capital developments at Merredin, Narrogin and surrounding smaller sites. The intent is to strengthen the services at the larger hubs and provide greater capacity for district community based services to outreach to the smaller sites, and for the smaller sites to have more capacity to provide local community based health care services. Services planning for Geraldton and Carnarvon health campuses Services planning for Geraldton Health Campus and Carnarvon Health Campus will inform the future service and facility requirements at these sites, to meet the needs of the growing population. Telehealth Telehealth is the use of technology to complement service delivery by improving access to safe, high quality health care for regional residents, reducing inequities that arise because of distance, and providing education and training opportunities to local health workers in rural and remote areas. For example, an ophthalmologist in his private rooms is able to examine live eye images streamed via specialised equipment to a video unit without the patient having to travel. A recent initiative includes a telehealth Corrective Services program that has led to a reduction in the number of prisoner escorts and prisoner attendances at public hospitals. Regular virtual outpatient services are provided across WACHS in the specialities of burns, plastics, neurology, gastroenterology, amputee clinics, gerontology, pain management, infectious diseases, orthopaedic clinics, ophthalmology and otology. Extensive upgrades to technology and bandwith throughout WACHS has improved the quality of service for video connections, and extended the service to 350 sites across the State. About 98% of these are Internet Protocol (IP) enabled, meaning that there are no call costs, making the video connection for health both cost efficient and effective. There has been a steady uptake of telehealth services across rural and remote WA. In the Kimberley the number of video conferencing units has risen from nine in 2008 providing services to 15 patients per month to 27 units in 2010 with the number of patients using the service rising to 80 patients per month. In the Pilbara the use of videoconferencing for clinical services trebled between 2007 and 2009 with close to 450 occasions of service recorded in In the first half of 2010 this number has already been exceeded with 483 Page 64 WA Country Health Service Annual Report

7 telehealth consultations occurring between January and June. Under Royalties for Regions and the industry supported Pilbara Health Initiative, multi-purpose practitioner carts have been installed in five emergency departments across the region. These carts will support clinical consultation and also enable medical peripheral equipment such as a vital signs monitor and video-scopes to be attached. Patient Assisted Travel Scheme The Patient Assisted Travel Scheme (PATS) election commitment has been fully implemented. Royalties for Regions provided an additional $30.8 million from to to reduce the financial burden on country residents who need to travel more than 100kms one way to access the nearest medical specialist services. Improvements to financial subsidies included increases for kilometre road travel and patient accommodation subsidies, as well as increased support to patients, particularly the aged, disabled and people who require treatment for cancer and a simplified and equitable accessible system to the Scheme including the development of a seamless web based data management system to ensure more timely processing of applications. Trends since January 2009 to date show an increase in demand for PATS with over 59,000 trips provided between April 2009 and March 2010 supported by Scheme expenditure across WACHS of over $25 million. Feedback from country areas indicates the improvements have met with approval of country residents. Royal Flying Doctor Service In the State Government approved increased funding of $68.5 million over five years to the Royal Flying Doctor Service (RFDS) to build its capacity to achieve clinically appropriate response times. The increase has funded five new aircraft to replace existing ageing aircraft and two additional aircraft, increasing the RFDS fleet from 11 to 13 aircraft. A third additional aircraft is due for purchase in The increased capacity has resulted in improved response times for inter-hospital patient transfers, with further improvements expected in , with the third additional aircraft. Funds of up to $3 million over three years were also approved for the RFDS in to underwrite a new medical jet service. The service is a three year pilot program being established by the RFDS, with the support of Rio Tinto Iron Ore. The service will reduce the flight times for interhospital patient transfers for critically ill country patients in the Northwest, being transported to tertiary hospitals in Perth for treatment. Closing the gap to improve Aboriginal Health Over the next three years, WA Health is investing $117 million in the Closing the Gap in Aboriginal Disadvantage National Partnership Agreement which addresses five priority areas: tackling smoking; healthy transition to adulthood; making Indigenous health everyone s business; primary health care services that can deliver, and fixing the gaps and improving the patient journey. The State will contribute a further $11.25 million over the next four years for Element 3 of the Indigenous Early Childhood Development National Partnership Agreement, while the Commonwealth has contributed $17.12 million for Element 2 to target: Increased access to antenatal care, prepregnancy and teenage sexual and reproductive health, and Increased access to, and use of, maternal and child health services by Aboriginal families. A critical component of the COAG process entailed provision of support from the nine WA metropolitan and regional Aboriginal Health Planning Forums. These forums were responsible for developing overarching Aboriginal Health Plans and coordinated responses for the submission of health service proposals to meet Closing the Gap and Indigenous Early Childhood Development objectives and outcomes. Over 160 service proposals were developed, of which 120 were endorsed by the Aboriginal Health Planning Forum for implementation on a regional or state-wide basis. Contracts with agencies for the provision of these services were finalised in July WA Country Health Service Annual Report Page 65

8 Workforce stability and excellence Rural Generalist Pathway The Rural Generalist Pathway focuses on developing medical graduates in country WA through the internship year and beyond to boost the regional medical workforce. The focus is on providing doctors with wide ranging skills in general practice, obstetrics, anaesthetics and other areas. It is anticipated this program will produce 40 rural generalist doctors to work in rural and remote WA per year. The State Government s Royalties for Regions program has provided $8.5 million over three years for travel and accommodation for these doctors. Staff Accommodation The Area Health Service currently owns 576 staff houses and manages 454 leases for staff. The organisation continues to increase investment in improving both the standard of and access to, suitable accommodation for its staff across regional WA. For instance, lease payments for staff accommodation in were $17 million across WACHS, representing a significant increase in investment from preceding years. The increase in investment in staff accommodation leases has been augmented by a substantial capital investment in staff accommodation via initiatives such as the Capital Expenditure Program. This funding has seen $36.6 million invested in purchasing or constructing new staff accommodation across WACHS. It is expected that total funds will be expended by the end of In line with State Government policy, WACHS is working with Government Regional Officers Housing Unit (GROH) and the Department of Housing and Works (DHW), to transfer Area Health Service owned housing stock, occupied by permanent or long-term employed staff, to GROH. This initiative will reduce WACHS s exposure to the current housing challenge. WACHS Mid-West is working closely with Geraldton University Centre, Durack Institute of Technology, St John of God Hospital, the Combined Universities Centre for Rural Health, Rural Clinical School and other adjacent health services to develop a proposal to extend the existing Durack Accommodation Village to form a more comprehensive village that is capable of housing a wide range of health and education staff and students. WA Country Health Service Nursing and Midwifery Leadership Forum 2010 The Nursing and Midwifery Leadership Forum was held on 18 and 19 February 2010 in Perth and was sponsored by the WA Health Nursing and Midwifery Office. This was the fourth WACHS Nurses Leadership Forum since the first was held in The Forum was designed to provide an opportunity for nurses and midwives across WACHS to: share their innovative ideas; develop and enhance networks; and showcase improvements being made in patient care. The WACHS Nursing and Midwifery Leadership Development Framework was launched at the Forum and was the first in a series of leadership master classes. The Forum was a great success with 105 senior nurses and midwives attending over the two days. It provided opportunities for nurses and midwives to network with their rural and remote peers, and share ideas through the formal array of power point presentations and regional poster displays. Forum features were a Master Class and Open Space plus an opportunity to undertake a site visit to a series of departments at Royal Perth Hospital. A follow up Master Class has been delivered with more classes planned via video conferencing facilities for nurses and midwives across WACHS. The next Forum is planned for February 2011 with a focus on aged care, midwifery and community health. Cultural Awareness Training WACHS has contracted the Aboriginal Health Council of WA (AHCWA) to develop and deliver cultural awareness training across the state. This work will complement the WACHS Aboriginal Reconciliation Framework which is currently being developed. Funding of $80,000 provided in will train a specific number of WACHS employees in cultural awareness competencies. An independent evaluation will be conducted Page 66 WA Country Health Service Annual Report

9 using this grant to provide recommendations for future cultural awareness strategies across the organisation. Service provision During the period April 2009 to March 2010 WACHS hospitals experienced a 10 per cent increase in total separations. However, the volume of beddays, both acute and residential, only increased by 2.1 per cent from 487,093 beddays in to 497,378 in Attendances across the five Triage categories at WACHS emergency services increased by 2.8 per cent in compared to although the number of emergency attendances with the more serious triage categories of 1, 2 and 3 rose by 6.5 per cent, 46.8 per cent and 6.4 per cent respectively. Non-admitted occasions of service also continued to rise with an increase by 1.7 per cent in following a 1.0 per cent increase in There was a 16.6 per cent increase in the number of PATS trips provided April 2009 to March 2010, a reflection of the increased resources provided to the Scheme. In 2009, 4,390 babies were born in WACHS public hospitals. In 2009 mental health ambulatory service occasions increased 25.6 per cent with the total number of persons receiving these services increasing by 12.6 per cent compared to WA Country Health Service Annual Report Page 67

10 Overview Activity Figure 10: Residential and Acute Care beddays Note: Bed-day data for all WACHS hospitals excluding Boarders. Figure 11: Non-admitted occasions (hospital and nursing post) 1,000, , , , , Figure 12: Total trips for the WACHS Patient Assisted Transport Scheme 60,000 55,000 50,000 45,000 40,000 35,000 30, , , , , , , , , ,000 Acute Care Beddays Residential Care Beddays WACHS Figure 13: Elective Surgery Cases 16,000 14,000 12,000 10,000 8,000 6,000 4,000 2, ,484 13,321 13,849 14,304 15, Figure 14: Emergency service attendances 375, , , ,000 15,696 WACHS Page 68 WA Country Health Service Annual Report

11 Priorities for The State Budget provided a major funding boost for WA Health, and country health services in particular stand to benefit from the introduction of important new initiatives. Health Infrastructure The commencement and accelerating pace of construction on a number of additional major WACHS infrastructure projects means that budgeted expenditure on these capital works during will be $160.5 million, up 40 per cent on planned capital spending in The substantial effort that has gone into the planning and design of these facilities is now coming to fruition in their physical construction. Major project spending in includes: Port Hedland Hospital ($40.2 million of a total budget of $137 million); Albany Hospital ($32 million of a total budget of $166 million); Kalgoorlie Hospital ($10.7 million of a total budget of $55.8 million); and Development of health services in the Kimberley ($70 million) WACHS s capital works program is further expanded in the State Budget with the allocation of an additional $220 million from the Royalties for Regions Fund for new capital works in country Western Australia. The centrepiece of this investment in our regions is $150 million for a new hospital at Nickol Bay (Karratha), recognising the growing demand for health care services in the State s north-west. Construction of the new hospital is expected to start in and be completed in Additional Royalties for Regions funding has also been provided to: Refurbish the Exmouth health clinic ($8.1 million) by to better cater for dental, mental health, pathology, occupational health and community health; Upgrade Carnarvon Hospital ($20.8 million) for mental, allied and community health; a new dental facility, as well as redevelopments to day surgery and pathology renovations; Upgrade Esperance Hospital ($18.8 million contribution to $31.8 million total project cost) due to start in The hospital will have substantially improved emergency, maternity, obstetrics and medical imaging services. It will also provide a one-stop shop for ambulatory care, community and allied health services which will have strong links with local GP services; and Upgrade health infrastructure in remote indigenous communities ($22.2 million). Planning will continue or commence on the: $77 million Busselton Hospital development construction to start in 2012; $13.9 million redevelopment of Harvey Hospital with construction to start in 2012; $9 million redevelopment of Merredin Hospital; and $9 million redevelopment of Narrogin Hospital. Emergency Ambulance Services The Budget allocates additional funding of $41.1 million over four years to improve emergency ambulance services across country WA. This includes $26.1 million from the Royalties for Regions fund for country ambulance service enhancements. This funding will be used to significantly improve ambulance service capacity and ambulance response times in major regional centres as part of a new performance-based service agreement with St John s Ambulance commencing in The funding will also provide much needed support for volunteer ambulance crews in country WA by funding the placement of additional community paramedics in specific locations over the four years, and providing additional regionally based support to St John Ambulance staff and volunteers in the country. In the first year of the agreement there will be funding for up to ten community paramedics to be located around WA in priority locations to be agreed between WACHS and St John Ambulance. Funding for these community paramedic positions includes an extra $6.7 million over four years through the Pilbara WA Country Health Service Annual Report Page 69

12 Priorities for (continued) Health Initiative which will provide five paramedic positions in the Pilbara. The Pilbara Health Initiative is a $38.3 million partnership between the State Government and major Pilbara industries to boost health services in the region. Under the partnership agreement, $32.96 million of funding is being provided through the Royalties for Regions Pilbara Revitalisation Plan, with the Chamber of Minerals and Energy s Pilbara Industry s Community Council (PICC) Health Initiative members (BHP Billiton Iron Ore, Chevron Australia Pty Ltd, North West Shelf Joint Venture, Rio Tinto and Woodside Energy) contributing $5.28 million. Royalties for Regions funding will enable enhanced ambulance services to be provided by WACHS in the Kimberley and new services in the Pilbara at Nullagine and Marble Bar. Both the Kimberley and Pilbara will be able to purchase new ambulances over the four years; seven in the Kimberley and two in the Pilbara. Improved clinical coordination for patients needing to be transported for emergency treatment from location to location will also be supported. A subsidy scheme will be introduced for indigenous communities in rural and remote communities currently serviced by their local St John Ambulance sub centre, who will be able to subscribe for an annual St John Ambulance membership. Child Development Services The Budget allocates additional funding of $1.7 million over four years to support young country Western Australian children in need of speech pathology, occupational therapy, physiotherapy, and other clinical support services. The funding will enable an additional 16 specialist child health professionals to be appointed in , targeting reductions in waiting times for all disciplines. The new funding will address key priorities from the report by Parliament s Education and Health Standing Committee, Invest Now or Pay Later: Securing the Future of Western Australia s Children. Four Hour Rule The implementation of the Four Hour Rule Program into WACHS commenced in October 2009 with Bunbury Hospital, followed by other country hospitals starting the program in May The focus will be on streamlining and enhancing patient care and will provide an opportunity to review treatment methods currently in place and implement changes, where required, to streamline and improve the patient s care in hospital. Bunbury hospital has set a target of 85 per cent of patients being seen in the emergency department and admitted, discharged or transferred within four hours to be achieved by October The other five WACHS hospitals to take on the challenge to implement the Four Hour Rule are, Albany, Broome, Nickol Bay (Karratha), Port Hedland and Geraldton. Activity Based Funding / Management The introduction of the Activity Based Funding (ABF) and Activity Based Management (ABM) approach to plan, budget, allocate and manage activity and financial resources will be a major initiative in ABF / ABM will be the tool which assists the capturing of consistent information on activity and the costs of delivery of services to enhance public accountability, drive technical efficiency in the delivery of health services and support improved clinical outcomes for patients. It will aid the management of variation in costs and practices to improve efficiency and effectiveness and provide evidence based mechanisms to reward good practice and support quality initiatives. ABF / ABM will provide WA Health with a whole system management framework that integrates clinical services, planning, funding, resource allocation, resource utilisation and quality management. The WACHS Area Office and the regions are working with the Department of Health to implement the principles of ABF / ABM and apply the funding concept to operations particularly for admitted, emergency and nonadmitted service provision. Improving Aboriginal Health Work will continue to support the implementation of service initiatives under the Closing the Gap in Aboriginal Disadvantage and Indigenous Early Childhood Development National Partnership. These Page 70 WA Country Health Service Annual Report

13 initiatives are taken to help improve the health and lives of Aboriginal people living in rural and remote Western Australia. The implementation of these initiatives will require an increased Aboriginal workforce across government providers, Aboriginal community controlled services and other private and non government agencies. The recruitment and retention of an Aboriginal workforce has been identified as a critical factor in the delivery of these services and programs. Approximately 75 new positions, to be filled by Aboriginal people, will be created within WACHS as part of these initiatives. A $1.2 million State Government Royalties for Regions funded cardiac program called Cardio-vision will provide better care and improve the health of Aboriginal people in the Pilbara who suffer from heart failure and acute coronary syndrome. Mental health The new Strategic Directions for mental health services across WA will be informed by the consultation paper WA Mental Health, Towards 2020 being prepared by the newly formed Mental Health Commission. During the WA Country Health Service will continue its work towards developing a plan for mental health including mental health promotion and an integrated service delivery model for drug and alcohol and mental health disorders. Medical workforce recruitment Through the State Government Royalties for Regions program $8.5 million has been provided over three years to support travel and accommodation for doctors taking up the Rural Generalist Pathway program. It is expected that this initiative, which focuses on developing medical graduates in country WA through the internship and beyond, will significantly boost the regional medical workforce, producing 40 rural generalist doctors to work in rural and remote WA each year. These doctors will have wide ranging skills in general practice, obstetrics, anaesthetics and other areas. E-Health WACHS will develop and implement a strategy for e-health records and health communication that will enable the secure electronic exchange of clinical information, and strengthen links to regional and metropolitan hospitals and private providers through the use of telehealth and other e- health services. Aged Care Work will continue to improve access to aged care services and services for younger people with disabilities during This will include improving access to residential aged care through initiatives such as the COAG Long Stay Older Persons Initiative. The Friend in Need Emergency program will be expanded to cover six regions during and the Wheatbelt in to better coordinate care for at risk older patients who are admitted to hospital emergency departments in country WA. WA Country Health Service Annual Report Page 71