Gippsland Regional Palliative Care Plan

Transcription

1 Gippslnd Regionl Pllitive Cre Pln The Gippslnd Region: The City of Ltrobe nd the Shires of Bss Cost, Bw Bw, Est Gippslnd, South Gippslnd nd Wellington Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln

2 Glossry of Abbrevitions ABS DHS GP GRPCP LGA AUSTRALIAN BUREAU OF STATISTICS DEPARTMENT OF HUMAN SERVICES GENERAL PRACTITIONER REGIONAL PALLIATIVE CARE CONSORTIUM LOCAL GOVERNMENT AREA Gippslnd Regionl Pllitive Cre Consortium [GRPCP] June 2005 This pln ws prepred for GRPCP by: Plexus Consulting Tel: (03) E-mil: Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln

3 CONTENTS FOREWORD OVERVIEW OF THE REGION GEOGRAPHICAL AND ENVIRONMENTAL DATA Projected Growth The Chnging Age Structures Culturl Diversity SOCIO-ECONOMIC INDICATORS: Welfre Pyments Employment nd Unemployment Eduction nd Trining Fmilies, Households nd Homes Vehicle Ownership nd Trvel Income Distribution nd Disdvntge THE REGIONAL PALLIATIVE CARE CONSORTIUM MEMBERSHIP VISION THE PLANNING PROCESS Objectives Plnning Approch Plnning Stges PRIORITIES AND CHALLENGES FOR PERCEIVED LOCAL SERVICE SYSTEM STRENGTHS REPORTED GAPS IN THE LOCAL SERVICE SYSTEM PRIORITIES FOR PALLIATIVE CARE DEVELOPMENT IN THE REGION Plnning Approch IMPLEMENTATION TIMEFRAME Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln

4 4 APPENDIX 1: PALLIATIVE CARE AND THE POLICY CONTEXT THE NATURE OF PALLIATIVE CARE SOCIAL HEALTH AND HEALTH PROMOTION FRAMEWORKS Socil Helth Helth Promotion Qulity of Life THE NATIONAL PALLIATIVE CARE STRATEGY THE VICTORIAN GOVERNMENT PALLIATIVE CARE PROGRAM OVERVIEW OF CURRENT LITERATURE AND RESEARCH Other Pllitive Cre Approches APPENDIX 2: DEMOGRAPHIC AND SOCIAL PROFILE OVERVIEW REGIONAL OVERVIEW GEOGRAPHICAL AND ENVIRONMENTAL DATA Bss Cost Shire Bw Bw Shire Est Gippslnd Shire Ltrobe City South Gippslnd Shire Wellington Shire DEMOGRAPHIC DATA Ntionl fetures from the 2001 Census DEMOGRAPHY OF Popultion nd Popultion Chnge in Gippslnd Culturl Diversity in Gippslnd Socio-Economic Indictors: Welfre Pyments Socio-Economic Indictors: Employment nd Unemployment Socio-Economic Indictors: Eduction nd Trining Socio-Economic Indictors: Fmilies, Households nd Homes Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln

5 5.5.7 Socio-Economic Indictors: Vehicle Ownership nd Trvel Socio-Economic Indictors: Income Distribution nd Disdvntge APPENDIX 3: BURDEN OF DISEASE DATA TOP CAUSES OF DEATH LENGTH OF LIFE INCORPORATING QUALITY OF LIFE APPENDIX 4: SERVICE DELIVERY DATA REPORTING RATIOS CONTACT DATA Trends in service delivery Site of deth Admission nd service contct relted dt tbles Summry of dmissions by qurter Dischrge relted dt tbles SERVICE DELIVERY DATA AND FUNDING CANCER STREAMS: PERCENTAGE OF CANCERS FOR PEOPLE RESIDENT IN EACH LGA FOR THAT YEAR APPENDIX 5: DEFINITION AND PRINCIPLES GUIDING ROLE DELINEATION: DEPARTMENT OF HUMAN SERVICES, VICTORIA DEFINITIONS PRINCIPLES DESIGNATED SERVICE LEVELS APPENDIX 6: PALLIATIVE CARE SERVICE MAP SERVICES INCLUDED IN THE SERVICE MAP AREAS SERVICED SERVICES PROVIDED Home or community bsed 1-to-1 direct cre Assessment nd Cse Mngement Respite Group Activities Consultncy Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln

6 9.3.6 Centre Bsed Cre Other Services SERVICEPROFILE Community Services Pllitive Cre Beds Consultncy Grief nd Berevement Totl Clients: One-to-One Services Group Activities nd Other Progrms Other Services Hour Service SERVICE PROVIDER PROFILE Pllitive Cre Physicins: Employed Pllitive Cre Physicins: Privte Other Employed Medicl Generl Prctitioners: Bulk Billing Generl Prctitioners: Fee-For-Service Clinicl Nurse Consultnts Clinicl Nurse Specilists Other Division Division 2 Nurses Physiotherpists Occuptionl Therpists Speech Pthologists Counsellors Socil Workers Diversionl Therpy Other Allied Helth Pstorl Cre Executive Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln

7 Support Stff Volunteer Coordintors Other Stff Totl Stffing VOLUNTEER PROFILE Policies, Orienttion nd Trining Progrms Volunteers: Key Issues LINKS Acute/Sub-Acute Services Community Bsed Services STATE-WIDESERVICES APPENDIX 7: SUMMARY OF RESULTS: PRESS GANEY SURVEY BACKGROUND SURVEY COVERAGE AND SUMMARY OF RESULTS APPENDIX 8: PARTIES CONSULTED IN DEVELOPMENT OF THE PALLIATIVE CARE STRATEGIC PLAN Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln

8 FOREWORD It is with plesure tht the Gippslnd Regionl Pllitive Cre Consortium presents this Strtegic Pln The Consortium is in its erly stges of development. Nevertheless, it is evident tht its opertions nd plnning re providing the frmework for identifying emerging issues nd priorities, developing our service system, nd for directing our member gencies efforts in ddressing locl needs. We believe tht, through our methods of opertion, we re incresingly tpping into the expertise of our members, unifying gency efforts, nd helping to build cpcity within our communities nd the cpcity within member gencies to deliver high qulity services. In the process, we re mking our opertions nd chievements more trnsprent, thereby enhncing ccountbility to our locl communities. The Consortium hs developed n integrted plnning frmework tht will drive our opertions; nd will ensure prtnership, integrtion, sustinbility, nd continuous development. This Strtegic Pln reflects our commitment to continuous development of our service system in the yers hed. It hs been developed from consulttions with service providers, gencies own consulttions with their constituents, nd nlysis of Gippslnd demogrphic, helth nd socil dt. This pln hs severl purposes: to identify our strengths nd our progress in chieving outcomes; to repprise emerging issues nd priority needs in our communities; to rticulte our vision, vlues nd opertionl principles; to identify environmentl nd opertionl fctors tht my present brriers; nd to identify objectives, opportunities nd strtegies to consolidte nd build on our chievements, nd to increse our collective efficiency nd effectiveness in providing relevnt nd coordinted services over the next five yers. Gippslnd is growing nd rpidly geing region, nd we re experiencing service pressures. While most of our pln is focussed on the continuous improvement of our current opertions, we hve identified severl priority inititives tht will require dditionl resources. They re to: Develop more conducive physicl environments for inptient services within the cute setting: $100,000 [once off] Estblish two dditionl pllitive cre beds in the region: $245,904 [recurrent] Expnd the UBF by the equivlent of funding for two dditionl beds to llow greter provision in the home [including respite nd overnight plcement of crers]: $245,904 [recurrent] Estblish Regionl Consulttion Service: $40,000 [recurrent] Achieve the role delinetion rrngements tht will best support pllitive cre cross Gippslnd: $750,000 [recurrent] Ensure ccess to berevement supports nd services including post deth nd nd volunteer coordintion: $250,000 [recurrent] Incorporte ongoing client nd crer feedbck into the cre coordintion process: $8000 [recurrent] Develop system of LGA bsed clinicl supervision / mentoring to provide consulttion services to providers in outlying res, nd in generlist services: $120,000 [recurrent] for bckfill of PC Coordintors We re committed to continuous development, better service provision, nd focus on the needs of our communities s the driving force in wht we do. Anne Curtin Chir Strtegic Pln Working Prty Gippslnd Regionl Pllitive Cre Consortium June 2005 Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln

9 1 OVERVIEW OF THE REGION The Gippslnd Region is striking for its demogrphic vrition. The Region is locted south est of Melbourne, covers n re of 10,930 squre kilometres, nd stretches from the outer estern boundry of metropolitn Melbourne. DEPARTMENT OF HUMAN SERVICES REGIONS The estimted resident popultion of Gippslnd on June 30th 2003 ws 162,424 persons. Gippslnd hs six locl government res: Bss Cost Shire Bw Bw Shire Est Gippslnd Shire Ltrobe City South Gippslnd Shire Wellington Shire THE REGION Gippslnd is expected to experience strong popultion growth from 2001 to 2031 with continued demnd for costl living. Growth will vry considerbly cross the region, with those res closest to Melbourne nd to the cost [primrily the Bss Cost nd Bw Bw Shires] experiencing the strongest growth, nd the rurl hinterlnd to the est experiencing popultion decline. A recent discussion pper [April 2005] relesed by the Deprtment of Humn Services on current thoughts for the bsis for lloction of pllitive cre resources to regions, sttes tht some socio-economic fctors, inter li, my be tken into ccount in the distribution process. Some key demogrphic nd socio-economic fctors nd vritions within the Gippslnd Region re summrised below. [A detiled demogrphic nlysis comprises Appendix 2 of this pln.] Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln

10 1.1 GEOGRAPHICAL AND ENVIRONMENTAL DATA PROJECTED GROWTH In terms of popultion size, Ltrobe is fr nd wy the lrgest LGA. Compred with Ltrobe, Welllington, Est Gippslnd, nd Bw Bw [in descending order of popultion] re little over hlf its size, while Bss Cost nd South Gippslnd re little over third of its size. The estimted resident popultion of Bss Cost is projected to increse by n nnul verge of 1.92 per cent compred with projected verge nnul increse of 0.87 per cent in the Victorin popultion nd 0.79 per cent in regionl Victori over the sme period. During tht sme period, Est Gippslnd is projected to increse by n verge nnul rte of 0.62 per cent, South Gippslnd by 0.67 per cent per yer, nd Bw Bw by n verge nnul increse of 0.92 per cent. The estimted resident popultion of Ltrobe is projected to decrese slightly with n verge nnul decrese of 0.05 per cent, s is the popultion of Wellington [n verge nnul decrese of 0.00 per cent] THE CHANGING AGE STRUCTURES The most striking feture of the popultion profile is the difference in the ge structure cross the region. In 2001, the percentge of people under 40 yers of ge ws 56.5% in Victori nd 53.6% in regionl Victori. Ltrobe hd the sme percentge s the Stte [with 56.6%], followed by Bw Bw with 54.2%, Welllington with 53.4%, 53% for Gippslnd s whole, South Gippslnd with 50.0%, Est Gippslnd with 46.5% nd Bss Cost with only 44.4%. By 2011, these figures re projected to reduce to 51.9% for Victori nd 47.6% for regionl Victori. The popultion under 40 is projected to be 48.5% in Ltrobe [below the Victorin percentge but still higher thn tht in regionl Victori], 46.7% in Bw Bw nd Wellington, 45.6% for Gippslnd s whole, 43.2% in South Gippslnd, 40.3% in Bss cost nd 37.9% in Est Gippslnd. In 2001, 17.3 per cent of the Victorin popultion nd 19.5 per cent in regionl Victori were ged 60 yers or more. The percentge of this cohort ws 28.6 per cent in Bss Cost, 18.1 per cent in Bw Bw, 25.1 per cent in Est Gippslnd, 17.3 per cent in Ltrobe, 21.1 per cent in South Gippslnd, nd 18.5 per cent in Wellington, nd 19.7 per cent in Gippslnd overll. In the period to 2031, this ge group is expected to increse to 29.0 per cent of the Victori popultion, nd to 35.9 per cent of regionl Victorin popultion. In the sme period, this cohort is expected to grow to 35.9 per cent in the Bss Cost, 38.0 per cent in Bw Bw, 49.8 per cent in Est Gippslnd, 38.8 per cent in Ltrobe, 42.1 per cent in South Gippslnd, 40.7 per cent in Wellington, nd to 39.6 per cent in Gippslnd overll CULTURAL DIVERSITY Bss Cost is the most culturlly diverse LGA in Gipplnd, lthough even there the percentge born overses is much lower thn the Stte verge. Bw Bw closely followed by Est Gippslnd nd Wellington hve the highest proportions of Austrlin born residents. The size of Indigenous Austrlin popultions gin vries mrkedly cross the region, from 0.5% nd 0.6% in Bss Cost nd South Gippslnd respectively, to 2.6% of the popultion in Est Gippslnd. All six LGAs hve proportion of the Indigenous Austrlin popultion tht is equl to or significntly lrger thn the Victorin verge. 1.2 SOCIO-ECONOMIC INDICATORS: WELFARE PAYMENTS Rtes of ccess to welfre pyments or benefits re generlly verge to high in the Gippslnd region. Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln

11 Consistent with the ge structure, there is high rte of ccess to the ged pension in Bss Cost, Est Gippslnd, nd South Gippslnd [Est]. There is high rte of ccess to the Disbility Support Pension in Est Gippslnd, Ltrobe, South Gippslnd [Est], nd Wellington; high ccess to the Newstrt Allownce nd the Single Prenting Pyment in Est Gippslnd nd Ltrobe; nd high ccess to Other pensions nd llownces in Est Gippslnd, Ltrobe nd Est Gippslnd [South]. There is low rte of ccess to the Newstrt llownce in Bw Bw nd South Gippslnd [Centrl], nd to the Youth Allownce in Bss Cost [the ltter being gin consistent with the ge structure of tht LGA]. Overll there is n impression of reltively high rtes of welfre dependence EMPLOYMENT AND UNEMPLOYMENT Ltrobe hs very different profile to the other LGAs in regrd to employment indictors. The rte of unemployment in Ltrobe is nerly double the Stte verge, while it is bove the Stte verge in Est Gippslnd, Bss Cost, nd Wellington, mrginlly lower thn the verge in Bw Bw, nd lower gin in South Gippslnd. A mrkedly higher percentge of those ged over 65 yers re still in the workforce, even when compred with the rest of regionl Victori, in South Gippslnd, followed by higher thn verge rtes in Bw Bw, Est Gippslnd nd Wellington. The rte in Bss Cost is the sme s for the rest of regionl Victori nd the verge for Gippslnd, but still considerbly higher thn the Stte verge. Ltrobe, on the other hnd, hs mrkedly smller proportion of people ged over 65 still in the workforce. Generlly the mix of industries in which people find employment nd the mix of occuptionl ctegories is very similr to tht found in rurl Victori overll. As one would expect, there is very high rte of employment in the griculture, forestry nd fishing industries in South Gippslnd, in prticulr, followed by Wellington, Bw Bw, Est Gippslnd nd Bss Cost, with smller percentge thn the Stte verge in Ltrobe. This pttern is consistent with tht for continued employment over the ge of 65 yers. There re higher rtes of employment cross the region, compred with the Stte s whole, in mining; nd in electricity, gs nd wter supply; nd in the retil trde in ll LGAs except South Gippslnd. There re lso high employment rtes in ccommodtion, cfes nd resturnts in Bss Cost nd Est Gippslnd, in culturl nd recretionl services in Bss Cost, nd in Government dministrtion nd defence in Ltrobe nd Wellington. There is much higher proportion of people, compred with the Stte verge, employed s mngers nd dministrtors in ll LGAs except for Ltrobe, where the proportion is significntly lower thn for the Stte. All LGAs hve lower proportion employed in professionl cpcities compred with the Stte verge, but the rtes re close to the verge for regionl Victori. There is higher proportion employed s trdespersons in Ltrobe thn elsewhere in the region, in regionl Victori, nd in the Stte. Consistent with the verge for regionl Victori, there re high rtes of employment s lbourers nd relted res, except, once gin for Ltrobe EDUCATION AND TRAINING All six LGAs, nd prticulrly Ltrobe, hve rtes well bove the Victorin verge for people completing Certificte qulifictions. All hve rtes below the Stte verge for completion of Diploms, nd well below the Stte verge, but closer to the verge for regionl Victori, for completion of Bchelor nd Postgrdute Degrees. All LGAs hd levels of computer nd internet use tht were below the Stte verge, with the highest rtes of use, which were close to the regionl Victorin verge, in Bw Bw, Ltrobe nd Wellington. Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln

12 1.2.4 FAMILIES, HOUSEHOLDS AND HOMES The mix of fmily types nd household sizes generlly deprts from the verge for Victori. All LGAs, except for Bw Bw, hve fewer couple fmilies with children, with Bss Cost nd Est Gipplnd hving mrkedly fewer thn the Stte verge. The remining three LGAs hve rtes similr to those in regionl Victori. Ltrobe hs higher percentge of one prent fmilies thn the Stte verge, with Bss Cost, Est Gippslnd nd South Gippslnd hving lower rtes thn the verge for regionl Victori. [This is gin firly consistent with the ge structure in those ltter LGAs]. Concomitntly, ll LGAs, except for Bw Bw hve higher percentge of lone person households thn the Stte verge. Bss Cost, Est Gippslnd nd, to lesser degree, Ltrobe hve rtes tht re lso higher thn the regionl Victorin verge. The vst mjority of the popultion live in seprte houses, s opposed to semidetched bodes, flts or prtments, with the highest rtes in South Gippslnd followed by Bw Bw, Wellington, Bss Cost, Ltrobe nd Est Gippslnd [with ll but Est Gippslnd lso hving higher proportion living in seprte houses thn the verge for regionl Victori]. Property prices hve incresed mrkedly in Bss Cost, Wellington nd South Gippslnd in the lst four yers, with lesser, but still significnt, increses in the remining three LGAs VEHICLE OWNERSHIP AND TRAVEL Vehicle ownership rtes gin vry. The number of households without vehicle is significntly higher in Ltrobe thn for the Stte nd regionl verges. A significntly lower proportion of households do not hve vehicle in Bw Bw nd South Gippslnd thn the regionl Victorin verge. A high percentge of households in these two LGAs lso hve three or more vehicles, s do those in Wellington INCOME DISTRIBUTION AND DISADVANTAGE The distribution of individul incomes flls into cler rurl pttern, with over 60% of individuls in ll six LGAs hving n income between $100 nd $500 per week, nd over 45% of households in ll six LGAs hving weekly income of $700 or less. Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln

13 2 THEREGIONAL PALLIATIVECARECONSORTIUM A Heds of Agreement, dted Februry 18 th. 1998, gve effect to the Gippslnd Community Bsed Pllitive Cre Consortium. It comprised six member gencies: the Centrl Wellington Helth Service, the West Gippslnd Helthcre Group, Wonthggi nd District Hospitl, Lkes Entrnce Community Helth Centre, Ltrobe Community helth Service, nd the Gippslnd Southern Helth Service. 2.1 MEMBERSHIP An ddendum to the 1998 Heds of Agreement creted the current Gippslnd Regionl Pllitive Cre Consortium [GRPCC]. The current greement is effective from Februry 1 st to June 30 th GRPCC members re the: Birnsdle Regionl Helth Service Bss Cost Community Helth Centre Bss Cost Regionl Helth Centrl Gippslnd Helth Service Gippslnd Southern Helth Service Kooweerup Regionl Helth Service Gippslnd Lkes Community Helth Ltrobe Community Helth Service Ltrobe Regionl Hospitl Omeo District Hospitl Orbost Regionl Helth West Gippslnd Helthcre Group Regionl plnning: plnning services for people with life-thretening illness nd implementing plnned inititives following pprovl by the Deprtment of Humn Services [DHS] Role designtion of hospitls in the region, ensuring consistent ccess to specilist pllitive cre services Co-ordintion of cre: developing nd implementing processes nd systems for co-ordinted nd integrted cre for people with life-thretening illness Determintion of priorities for future service development nd funding in conjunction with DHS stff to support the implementtion of the regionl plns. 2.2 VISION The members of the GRPCC re committed to working with ech other, Governments nd the community so ll Victorins with progressive lifethretening illness nd their fmilies nd crers will hve ccess to high qulity service system which fosters innovtion nd provides co-ordinted cre nd support tht is responsive to their needs. 1 The vision of the GRPCC is to estblish frmework for promoting nd delivering high qulity pllitive helth cre services in prtnership with clients, crers, fmilies nd the community into the next decde nd beyond for the people in Gippslnd Region tht: Are of high qulity Are esily ccessible, equitble nd trgeted to the highest needs in our communities Yrrm nd District Helth Service. The Heds of Agreement Addendum identifies four mjor roles for the Consortium: 1 Gippslnd Regionl Pllitive Cre Consorti Addendum to Gippslnd Regionl Community Bsed Pllitive Cre Heds of Agreement Dted 18 Februry 1998 Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln

14 Promote qulity of life nd re cognisnt tht qulity of life judgements cn be mde properly only by the individul [since qulity of life will be defined differently by different people] Are relevnt, responsive, dptble nd flexible Provide choice nd encourgement to seek lterntives, nd tht ssist clients to select supports, rrngements nd lifestyle options tht re flexible, tilored, innovtive, client gol directed, purposeful nd monitored Are individul nd fmily-centred Tht recognise clients uniqueness s individuls Are prticiptory, collbortive, supportive, respectful of utonomy, nd re empowering for clients, nd their crers nd fmilies, nd tht foster feelings of security Reflect the diversity within our communities nd the rnge of needs within them, nd re sensitive to culturl vlues Recognise nd support the fmily s the unit of cre for mny Minimise intrusion nd disruption Are integrted with other services nd supports to ensure n effective continuum of cre nd semless provision Are efficiently delivered. We re committed to: Providing cler points of entry to the service system, nd minimising the sources of holistic needs ssessment nd support plnning Ensuring ese of ccess to cler, ccurte, timely nd comprehensive informtion Optimised client independence nd utonomy with blnce between duty of cre (the helth nd sfety of clients) nd degree of selfdetermintion / risk-tking The promotion of helth nd well being nd pproches tht help prevent illness while recognizing the need for tretment services Building knowledge within our communities bout helth issues nd the socil nd environmentl fctors tht impct on helth nd well being Openly shring our ides, knowledge nd skills to enhnce our collective effort in promoting the helth nd well being in our communities Inter-disciplinry nd inter-sectoril collbortion, nd prtnerships between nd locl coordintion of primry nd specilist service delivery, primry cre services, privte providers, clients nd crers Coordinted nd integrted plnning nd service delivery. We recognise tht coordinted cre tht is holistic nd client centred is hllmrk of good prctice Accountbility Evidenced bsed pproches. The socil model of helth nd holistic pproches to service delivery [see Appendix 1], with due recognition of psycho-emotionl, socil, spiritul nd berevement spects nd their inter-reltionships, nd of interventions undertken to meliorte ssocited distress [such s nturl therpies, counselling nd self help groups]. We re committed to the totl cre of body, mind nd spirit Addressing brriers to ccess Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln

15 2.3 THE PLANNING PROCESS The GRPCC is committed to developing n integrted, overrching plnning frmework tht will drive opertions, nd will ensure prtnership, integrtion, sustinbility, nd continuous development OBJECTIVES The objectives of the GRPCC strtegic plnning process re to: Identify the priority pllitive cre needs of the locl communities with meningful input from people with life-thretening illnesses, fmilies nd crers Develop service mp of ll inptient nd community bsed pllitive cre services in the Gippslnd Region Identify nd nlyse existing service gps Develop strtegies nd priorities for service development in the future for the Regionl Consorti providers to strengthen ptients ccess to the pllitive pproch nd pproprite ccess to specilist services Develop Gippslnd Regionl Pllitive Cre Pln for the future for how pllitive cre services re to be delivered cross the region, with strtegies nd priority ctions to ddress service gps, enhnce current strengths nd to ensure strong linkges with the Integrted Cncer Centre t Ltrobe Regionl Hospitl PLANNING APPROACH quntittive sources, ddressing both bredth nd depth, in mking judgements, documenting experiences nd in developing future directions. Process indictors re being used to exmine ctivities nd modus operndi within the service system including service rech nd resource intensity, to identify the criticl service elements, while impct nd outcome indictors re the bsis of exmintion of the extent to which chnges hve resulted from the services, nd to investigte fctors tht fcilitte successful service impct nd outcomes nd fctors tht hinder these effects. A structured combintion of bredth nd depth strtegies for dt collection is being employed. Bredth ctivities include nlysis of dt on utilistion, gps, nd consumer feedbck, nd review of provider documents nd relted spects of their work. Depth ctivities include key informnt interviews nd focus groups with nd/or surveys with the most relevnt stkeholders [e.g. purchsers, mngers, providers, nd representtive clients nd crers] PLANNING STAGES This pln hs been developed on the bsis of nlysis of policy documenttion [see Appendix 1], demogrphics [see Appendix 2], nd regionl helth nd service delivery dt [see Appendices 3 nd 4]; the Gippslnd service mpping tool [see Appendix 6]; the outcomes of two workshops held with key regionl providers to exmine the strengths, gps nd priorities, nd strtegies for development of the locl service system; nd two surveys, one for Generl Prctitioners nd the other for interfcing services such s Shire home support services nd ged cre [see Appendix 8]. The strtegic plnning process is depicted in the following digrm. The plnning pproch is incorporting both qulittive nd quntittive mesures, nd nlysis is drwing together dt from qulittive nd Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln

16 SUMMARY OF PROJECT STAGES PRELIMINARY PHASE PHASE 1 PHASE 2 PHASE 3 Erly nlysis Detiled project pln Key questions Review of documents & dt Further nlysis / Refinement of key questions Dt gthering Limited consulttion Workshop 1: Identifiction of issues, gps, priorities, strtegies Dt synthesis nd nlysis Interim priorities & strtegies Drft pln & Service mpping Distribution of surveys to Generl Prctitioners nd to interfcing gencies Finl Workshop: Refine issues, priorities & strtegies Further nlysis FINAL PLAN & SERVICE MAP Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln

17 3 PRIORITIES AND CHALLENGES FOR This Drft Regionl Pllitive Cre Pln , the result of the efforts of GRPCC member gencies nd their commitment to continuous development of our service system in the yers hed, hs been developed from limited consulttions, t this point, nd nlysis of Gippslnd policy, demogrphic, helth nd service delivery dt. 3.1 PERCEIVEDLOCAL SERVICESYSTEM STRENGTHS The Gippslnd Region covers wide geogrphicl re, nd dispersed popultion. It includes rnge of communities of vrying sizes. [See the Gippslnd demogrphic profile in Appendix 2]. Similrly service gencies vry mrkedly in their resource bse nd cpcity. Locl providers, in workshop in Mrch 2005, identified mny strengths in pllitive cre service delivery. Perceived service strengths vry cross the region, however, nd hence the following inventory does not necessrily pply to the entire region. Wht re chievements in prts of the region, remin chllenges for others. Detiled consulttions will elicit those vritions nd other service delivery strengths, gps nd priorities. Sense of the services being prt of the community: Providers relish the opportunity tht comes from working in smller nd closer knit communities. They know mny of the clients before illness strikes, reltionship exists, nd trust is either lredy estblished or redily developed. These re fctors tht re importnt in ll helth delivery, but prticulrly in pllitive cre. Co-ordinted cre: Mny prts of the service system re reported s working together very well, with exmples given of semless nd holistic delivery, nd effective inter-disciplinry communiction, temwork, nd cre plnning. Coordintion of cre between services ws described s hving fmily dynmic. Lrger services were reported s supporting smller ones in providing nd co-ordinting cre. Twenty-four hour on cll services were deemed to work well where they re vilble, tht being minly in more populted res. Holistic delivery: It is deemed tht there is choice within the system, prticulrly in terms of where clients choose to die. Service inititives include the development of berevement progrm for fmilies in the Est Gippslnd, nd Sle hs Grief nd Loss Counsellor [for one dy per week]. Equipment: Providers report good ccess to equipment, with supplies being supplemented by community contribution of funds for the purchse of dedicted pllitive cre equipment, nd there being redy shring of equipment cross the region. Collbortion nd prtnerships between gencies: Networking, collegility nd problem solving between services nd stff were identified s strengths, with trnsprency nd shring of informtion, documents etc. cross services nd gencies. There is sense of moving forwrd. The Pllitive Cre Service Project Worker, who ws seen s supportive inititive nd s contributing to pllitive cre service integrtion in the region. Generl Prctitioners: Providers generlly experience good reltionships with most GPs, nd believe tht the mjority of the ltter hve good opinion of nd respect for pllitive cre tems. It ws cknowledged, however, tht there is more choice of GPs, nd tht it is esier to find pllitive cre friendly prctitioners, in res with lrger popultions. Where working reltionships were not optimum, this ws ttributed to personlity issues, individuls lcking interest in pllitive cre, or some GPs in smll rurl communities lcking knowledge, hving limited or no bck-up, being thinly stretched, or hving diversion of opinion bout pproprite tretment. Dedicted, multi-skilled stff nd support: Pllitive cre workers dediction nd multi-skilling, so necessry in smller communities, is mjor strength. Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln

18 There is deemed to be generlly good support for stff through eduction, supervision nd counselling. Volunteers: Some res in prticulr enjoy the contribution of strong, welltrined group of volunteers. This works well if where there is dedicted volunteer coordintor. Provision of trining is hrd in smll communities, nd there is tendency for volunteers to hve to trvel to regionl centre for trining. Volunteers tend to lose the knowledge quickly if they re not pplying it. Prior knowledge of the ptient cn be problem in smll communities. An inititive of note is the Volunteers Specil Interest Group. Access to beds: Direct ccess to beds is deemed plus where there is n integrted cre model. Ltrobe Hospitl nd Community Services hve good protocols, for exmple. Some fmily friendly inptient nd other services re vilble, but some hospitls do not hve fcilities for fmily members. Secondry consulttion: There is good, ccessible consulttion with tertiry cre, some of which is Melbourne bsed, through both telephone consulttions nd visits. 3.2 REPORTED GAPS IN THE LOCAL SERVICE SYSTEM Given the size nd diversity of the Gippslnd Region, issues nd priorities for ction hve been presented t this stge in four ctegories, nmely, in the Gippslnd Region in generl, nd in three geogrphicl res: Est, Centrl nd South-West Gipplnd. The dditionl chllenges nd needs in res with popultions of lesser density re noted. Region wide gps nd issues include the following. Co-ordinted cre: Coordinted cre tht is trnsferble to other geogrphicl res, pthwys nd continuum of cre requires development. This includes developing models of coordinted cre tht re pertinent to chronic disese mngement, nd tighter cse mngement to use scrce resources prudently. Access to pproprite multi-disciplinry inputs cn be difficult, gin prticulrly in popultions of lesser density. Another issue here is the lck of informtion vilble to providers bout services nd supports tht re vilble. It is hoped tht the service mpping exercise will provide vluble reference source for providers. Options nd models for fter hours cre re needed in smller communities where stffing levels pose serious chllenges to instituting mngeble rrngements. Skill development nd mintennce: There re concerns bout the bility to ccess personnel with the required skills nd expertise, including multi-skilled nurses. There re dditionl demnds, prticulrly on services nd stff in smller communities nd in generlist services, including the provision of trining, supervision nd clinicl support; role strin in generlist services; tension from the dul role of community member nd nurse; nd mintining the skill bse where intermittent demnd cn erode skills nd knowledge. Stff in generlist gencies re not lwys confident in mnging pllitive cre ptients, nd over servicing my result. Technologicl dvnces [e.g. in phrmcology, pin mngement] mke mintennce of knowledge nd confidence chllenging. There re lso needs to keep GPs informed nd up-to-dte, nd to develop the skill bse in ged cre services to enble pllition mngement. Choice nd ccess to inptient beds: The need for ccess to locl beds hs been highlighted. For exmple, Orbost hs no dedicted beds nd there is considerble demnd on generlist services. Direct ccess to more pproprite [nd free-stnding] beds in plesing environments hs been rised s priority need. There re no true hospice beds in Gippslnd. Such fcilities would provide greter client choice. Plnning for future demnd: Models, linked to evidence, to meet current nd future needs re required. Gippslnd is fcing n geing popultion, nd more so in some prts thn elsewhere in Victori, s result of people moving to these res to retire [see the Gippslnd demogrphic profile in Appendix 2]. Adequte resourcing: The distribution of resources, including ccess to secondry consulttion, trining nd bck-up, is n issue for exmintion s this Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln

19 strtegic plnning process continues. Resourcing of smller gencies will be nlysed. Fmily nd client s the unit of cre nd focus: Models for provision of client focused, flexible service provision need explortion to ensure tht services re tilored to needs rther thn the budget or to trditionl mens of delivery. The needs of crers nd fmilies re n inherent prt of the client s support system. This hs implictions for post deth requirements. Recognition of the responsibility of clients nd crers is lso required. The rurl sitution, distnces nd rod conditions: These present undenible chllenges, nd require explortion of lterntive models, inter li, for twentyfour hour cre. It is recognised tht models tht work well in metropolitn res do not necessrily trnslte to rurl res, nd tht one model will not be useful in ll res within rurl region. Mintennce of stndrds: The impct of the new Pllitive Cre Stndrds on smll services is of concern. Inter-gency collbortion: While there is high degree of collbortion in the region, there re further opportunities for shring cross services. Development nd mintennce of volunteers nd community input: Volunteers re n importnt djunct to pllitive cre provision, prticulrly in rurl res. Recruitment, trining, keeping them interested, nd dy-to-dy mngement in generl re ongoing tsks. Similrly community input, whether it be supporting procurement of fcilities or involvement of people with pllitive cre needs in ctivities, mkes service provision in smller communities more vible. It cn lso dd considerbly to the qulity of life for both the client nd community member or group. Community eduction nd helth promotion: A prticulr need is informtion nd eduction for the community, fmilies nd clients, to enble them to feel more comfortble nd ccepting of deth t home. 3.3 PRIORITIES FOR PALLIATIVE CARE DEVELOPMENT IN THE REGION The following hve emerged to dte s priority res in Gippslnd. They hve not been prioritised s this stge, nor hve models for or mens of implementtion been fleshed out or costed. Some cn no doubt be chieved within existing lloctions, while others will require short-term or ongoing resources. They re: Coordinted cre, trnsferble cre, pthwys nd semless service provision Links nd prtnerships with e.g. GPs, specilists, ged cre Skill development nd mintennce, nd ccess to dvice, prticulrly for generlist gencies where exposure is intermittent, GPs nd for personnel in the ged cre sector Geogrphiclly ccessible beds Access to cre in hospice environments both for respite nd to provide client choice in the plce to die Access to respite Shring trining, policies etc. between providers [sub-regionlly nd regionlly] Recruitment, mintennce nd support of volunteers Community eduction to id normlistion of deth The following tbles summrise the priority gols, strtegies nd ctivities for the Gippslnd Region. They re presented within the seven key principles of the DHS Strengthening Pllitive Cre policy. 2 The timelines for ech strtegy nd ctivity re in Section Strengthening pllitive cre. A policy for helth nd community cre providers Continuing Cre Unit, Progrms Brnch, Metropolitn Helth nd Aged Cre Services Division, Victorin Government Deprtment of Humn Services, October Summrised from pp. 3-7 Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln

20 PRINCIPLE NO. 1: People with life-thretening illness nd their crers nd fmilies hve informtion bout options for their future cre nd re ctively involved in those decisions in the wy tht they wish Expected Outcomes: All cre plns re developed nd implemented bsed on the informed decisions nd needs of the person with life-thretening illness nd their fmilies nd crers People with life-thretening illness will be encourged nd supported in developing n dvnced cre pln to meet their future need REGION PRIORITIES AND STRATEGIES: PRINCIPLE NO. 1 GOALS STRATEGIES ACTIVITIES LEAD Gol P1,G1: To ensure tht providers, people with lifethretening illness nd their crers hve ccess to full informtion bout options for cre P1, G1, S1: Distribute the consolidted service dt from the mpping tool to locl pllitive cre providers so they hve more informtion bout vilble services nd supports P1, G1, S2: Up-dte nd re-distribute the service mpping dt nnully P1, G1, S3: Produce nd distribute user friendly formts of vilble services nd options for clients nd fmilies/crers P1, G1, S4: Produce nd distribute user friendly formts of vilble services nd options for other helth providers in the Gippslnd region P1, G1, S5: Provide ll GPs nd other relevnt providers with full informtion on the locl Community Pllitive Cre Tem including personnel, contct detils nd service vilbility P1, G1, S6: Develop website for profiles of services nd expertise vilble in the region P1, G1, S7: Ensure ll pllitive clients re wre of their rights nd the necessry processes for end of life decision mking Ensure convenient formts for pllitive cre providers in hrd nd electronic formts in the first instnce Revise formt nnully Distribute Collte results Re-distribute dt Select content Formt Print nd distribute in hrd copy in the first instnce Select content Formt Print nd distribute in hrd nd electronic formts in the first instnce Compile Distribute in hrd copy in the first instnce Keep up-to-dte nd redistribute s required Explore the fesibility of shring website with GRICS Develop website Lod nd mintin up-to-dte regionl service informtion for providers, clients nd fmilies Reserch current policies Develop regionl End of Life Decision Mking Policy AGENCY/PERSON & RESOURCES Consultnt through Consortium Consortium Consortium Consortium All Community Pllitive Cre Tems Consortium Consortium MEASURES OF SUCCESS Locl providers hve up-to-dte informtion on services vilble, contct detils for Community Pllitive Cre Tems etc. All pllitive clients re wre of their rights nd the necessry processes for end of life decision mking Informed decision mking Incresed choice Website developed Website is mintined nd informtion kept up-todte Providers, clients nd fmilies ccess to up-to-dte resource informtion Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln

21 Gol P1,G2: To ensure the ctive involvement of clients nd crers in decision mking processes Distribute to ll gencies for internl pprovl processes Consortium & service mngers All providers to ensure client wreness Direct cre providers Ensure informed involvement of clients nd crers in needs ssessment, cre plnning nd service provision [see detils under P4, G1, S1 below] P1, G2, S1: All providers to ensure client ccess to the necessry processes for end of life decision mking P1, G2, S2: Ensure pllitive cre providers ct in ccord with expressed clients wishes re end of life decisions P1, G2, S3: Fcilitte pproprite mbulnce service protocols nd prctice re respecting client wishes [e.g. N.F.R.] COMMENTS, ISSUES, SUPPORTING DATA: All providers to ensure client ccess Service mngers to ensure complince Nominte Consortium representtives Initite discussion with mbulnce uthorities Direct cre providers Direct cre providers Consortium: Designted representtives Incresed client nd crer involvement in decision mking Incresed choice The client nd fmily s the unit of cre nd focus Flexible service provision tilored to needs Recognition of the rights nd responsibility of clients nd crers All pllitive clients re ssisted, where pproprite, to exercise their rights re end of life decisions All providers give effect to clients end of life decisions The service system is difficult for providers to nvigte, nd extremely difficult for consumers/fmilies. Effective client choice nd successful nvigtion of the service system require redily ccessible nd up-to-dte service informtion. Consumer expecttions hve incresed nd clients re better informed. They expect choice in services nd supports, nd involvement in decision-mking. It is impertive tht clients re wre of their rights nd re ssisted to exercise them, where pproprite, re end of life decision-mking. It is concomitntly impertive tht ll providers ct upon expressed client wishes. The 2004 Press Gney survey [1/1/04 31/5/04] yielded very low response rtes [i.e. Birnsdle 4 responses; Bss Cost 1; Centrl Gippslnd 16; Ltrobe 26; South Gippslnd 7; West Gippslnd 14; Wonthggi 3], nd s such ny conclusions must be very tenttive [see below nd Appendix 7]. The priority issues in Gippslnd, rising from tht survey, bsed on correltion with overll stisfction follow. The impression from these two tbles is tht issues relted to communiction, eduction nd informtion re even more of priority in Gippslnd thn they re for Victori s whole. Clinicl issues feture much less highly thn for Victori s whole. Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln

22 Priority of issues bsed on correltion with overll stisfction: Source: Press Gney survey [1/1/04 31/5/04] Gippslnd: Victori: Principle No. 2: People with life-thretening illness nd their crers nd fmilies hve cre tht is underpinned by the pllitive pproch Expected Outcomes: People with life-thretening illness, their crers nd fmilies receive optiml cre through the doption of the pllitive pproch by ll helth, community, residentil ged nd disbility cre services The unique needs of the individul with life-thretening illness nd their crers nd fmilies will be ddressed by developing nd implementing n greed cre pln REGION PRIORITIES AND STRATEGIES: PRINCIPLE NO. 2 GOALS STRATEGIES ACTIVITIES LEAD AGENCY/PERSON & RESOURCES MEASURES OF Gol P2,G1: To ensure client nd P2, G1, S1: Estblish the bsic tenets of pllitive cre service provision Define pllitive cre for the region Determine: Wht re we doing? Who re we doing it for? Hve we lost focus of wht people need / wnt? Consortium with project ssistnce Estblishing tenets: Strtegic Pln Implementtion Funding SUCCESS Incresed choice The client nd fmily s the Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln

23 fmily centred cre tht is holistic nd provides totl cre of the mind, body nd spirit P2, G1, S2: Adopt KPIs for the region for delivery in ccord with the pllitive pproch nd to ensure complince with Pllitive Cre stndrds P2, G1, S3: Assist smller services to meet the new Pllitive Cre Stndrds Apprise delivery ginst tenets Devise stff development mens & implementtion pln Stff development costs to be determined post pprisl Develop KPIs Consortium with project ssistnce Strtegic Pln Implementtion Funding Distribute to ll gencies for internl pprovl processes Identify eduction nd other requirements for implementtion Implement Evlute complince nd KPI impct on service delivery Assess the requirements of smller services Identify resources nd mens of ssistnce tht lrger gencies in the region, where pproprite, cn lend Implement Consortium & Mngement of service gencies Implementtion costs to be determined post development of the KPIs [when the inputs needed for provider complince cn be ssessed] Consortium Implementtion costs to be determined post ssessment of the requirements of smller services Incorporte systems for holistic needs ssessment, cre plnning nd service provision/procurement in models of coordinted cre [see detils under P4, G1, S1 below] P2, G1, S4: Develop/explore service delivery pproches tht re culturlly pproprite for indigenous Austrlins nd other culturlly nd linguisticlly diverse communities P2, G1, S5: Include the Aboriginl Liison Pllitive Cre Project Worker [for Victori] to become member of the Consortium P2, G1, S6: Develop more conducive physicl environments for inptient services within the cute setting P2, G1, S7: Develop regionl privcy nd informtion Conduct n udit of ccess by indigenous Austrlins nd other culturlly nd linguisticlly diverse communities Assess the culturl ppropriteness of current provision models nd pproches Develop/explore service delivery pproches tht re culturlly pproprite Assess implementtion requirements Implement Evlute Extend invittion Seek inititive funds of $100,00 Crete refurbishment lloction Assess redevelopment needs Allocte resources nd implement Develop regionl protocols to enble informtion shring nd thereby fcilitte coordintion of cre/ cre pthwys for Consortium with project ssistnce Strtegic Pln Implementtion Funding for development of pproches Implementtion costs to be determined post development of pproches Consortium Consortium / DHS Consortium with project ssistnce unit of cre nd focus Flexible service provision tilored to needs Clients wre of privcy policy Services provided in ccord with privcy policy Access to inptient cre in more conducive environments Mintennce of stndrds Incresed stisfction / positive feedbck from clients nd fmilies Incresed deths t home: bseline of yer More culturlly pproprite provision Incresed uptke by indigenous Austrlins nd other culturlly nd linguisticlly diverse communities: bseline of yer Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln

24 protocols P2, G1, S8: Assist, where pproprite, other gencies [e.g. ged cre, disbility, GPs] to provide cre in ccord with the pllitive pproch registered clients Distribute to ll gencies for internl pprovl processes Conduct workshop with Coordintors re implementtion All providers to ensure client wreness nd to provide services in ccord Identify provider needs: follow-up individul gencies who did not respond to the survey distributed s prt of this strtegic plnning process Identify the most pproprite mens of ssisting with complince Submit tender to the Commonwelth Government to provide regionl pllitive cre eduction for ged cre personnel nd doctors Continuously develop interfces with those gencies, especilly residentil disbility nd ged cre services, nd Locl Government home help services Consortium & Service mngers Service mngers nd direct cre providers Consortium Consortium / ll gencies Implementtion costs to be determined post ssessment of service requirements All gencies Address the knowledge gp of helth professionls through provision of informtion re vilble pllitive cre services [See P1, G1, S4 & 5 bove] Ensure ccess to berevement supports nd services including post deth [see detils under P3, G1, S7 below] COMMENTS, ISSUES, SUPPORTING DATA: The Consortium is committed to n holistic service delivery pproch, s is consistent with current ntionl nd interntionl trends [See overview of current literture in Appendix 1: section 4.5]. There is view tht the pllitive cre system is losing sight of the simplicity of wht we do, nd clrifiction, s bsis of ongoing service development is required. The development of KPIs nd monitoring the service system ginst them will fcilitte service delivery in ccord with Pllitive Cre stndrds. Smller gencies my need ssistnce within the region to comply. Direct ccess to beds in more plesing physicl environments hs been rised s priority need. The region hs reltively smll numbers of people born overses. Bss Cost is the most culturlly diverse LGA in Gipplnd, lthough even there the percentge born overses is much lower thn the Stte verge. Prts of the region hve significnt indigenous popultions. The percentge of the popultion identifying s indigenous is the sme in Bss Cost s for Victori s whole [0.5%]. The percentge in the remining LGAs is higher thn tht for Victori with 0.6% in South Gippslnd, 0.8% in Bw Bw nd Welllington, 1.1% in Ltrobe, nd 2.6% in Est Gippslnd. Over the lst three yers, Est Gippslnd hs provided dt on 8 indigenous clients nd Wellington on 4. The others hve not coded nyone s indigenous. The Providing culturlly pproprite pllitive cre to Indigenous Austrlins Resource Kit 3 will be mjor resource in the region s development work. The rtes of tke-up for the yer will provide the bseline mesurement for service penetrtion over the period of implementtion of this strtegic pln. Below re sttistics on the site of deth of pllitive clients [summrised from regionl pllitive cre service dt]. It is hoped, with more community support services, tht people incresingly choose to die t home. Home deths will be one of the regionl KPIs [ to be dopted: see P2, G1, S2 bove]. There is lso resource constrint to be considered here, nd strengthened volunteer input [see Gol P6,G1 below] will fcilitte chievement of this KPI. 3 Providing culturlly pproprite pllitive cre to Indigenous Austrlins Resource Kit. Prepred for the Austrlin Government Deprtment of Helth nd Ageing by Mungbreen Aboriginl Corportion, Wodong Institute of TAFE, nd Mercy Helth Service, Albury (Pllitive Cre). Cnberr, Austrllin Government Deprtment of helth nd Ageing, 2004 Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln