OUR COMMUNITY: OUR SERVICES... a snapshot. Working together to improve the health and wellbeing of our community

Transcription

1 OUR COMMUNITY: OUR SERVICES... a snapshot Working together to improve the health and wellbeing of our community

2 Our Community, Our Services..a snapshot Locked Mail Bag 21 TAREN POINT NSW 2229 This work is copyright. It may be reproduced in whole or in part to inform people about the strategic directions for healthcare services in the South Eastern Sydney Local Health District, and for study and training purposes, subject to inclusion of an acknowledgement of the source. It may not be reproduced for commercial usage or sale. Reproduction for purposes other than those indicated above requires written permission from the South Eastern Sydney Local Health District. Website: South Eastern Sydney Local Health District (SESLHD) Prepared by the Strategy and Planning Unit, Directorate, Planning and Population Health. Updated August For further information, contact the SESLHD Strategy and Planning Unit on (02)

3 About this snapshotthis snapshot This snapshot is about the residents of, and the services provided by, the South Eastern Sydney Local Health District (SESLHD). The snapshot provides a bird s eye view about people s health, access to and use of services, and experiences using these services. This document was initially targeted at community members, clinicians, managers, and initially targeted at community members clinicians managers and other staff and stakeholders who were involved in the review of the District s interim Strategic and Health Care Services Plans, but it is hoped that the information presented here will be used more broadly. This document provides a series of snapshots of our residents and services with comparisons over time, between population groups, between services, or with benchmarks in order to provide perspective and context for: id i d The main health and service areas where we are doing well, and others where we could be doing better. Recent challenges for our health system and those that will emerge over the next 5 10 years. Inequities in health status and service use, quality and outcomes within our own in status and service use quality and our own District. This document is not intended to be a comprehensive report card about the health and health service needs of our residents and patients. Nor does it attempt to provide a comprehensive overview of services provided. For many of the issues and measures reported in this document, interested readers are referred to more information in other National, State and District publications. f ti i th ti t d t i t ti These other publications include: A series of publications prepared for the Local Health District, which are accessible at NSW Health s new interactive Health Statistics NSW tool, which is accessible at The Public Health Information Development Unit s A Social Atlas of Australia 2010, accessible via an interactive mapping tool at mapping/ 01

4 An overview of the snapshot of The table on the following page provides a summary assessment for many of the major issues addressed in this report. The assessment for each particular issue has been determined by comparisons of one or more indicators, in terms of: Trend comparison over time i.e. for recent years and/ or projections i i i Variation between District and elsewhere comparison of the whole District (or whole Sectors, i.e. north and south of the District) generally with NSW as a whole (i.e. NSW average, or NSW benchmarks or targets) Variation within District comparisons between sub populations or services within the District. Sub populations for comparison have been defined by, for example: Local Government Area of residence, Aboriginality or homelessness. Services for comparison have been defined by facility or workforce (e.g. professional group). Where more than one indicator has been assessed for a particular issue, the summary assessment has generally been determined by the indicator/ comparison of most concern. Readers should refer to the page numbers for the relevant data and information. The assessment has been left blank (light blue) where the appropriate data were not available and/or relevant. Legend: Trend Adverse trend Deteriorating Variation of District/ whole Sector vs NSW SESLHD worse (usually higher) Variation within District between sub populations or services Large differences (i.e. much worse/ higher for at least one sub population / facility) Stable or no clear trend Similar Some differences Favourable trend improving SESLHD better (usually lower) lower) Similar 02

5 ISSUE one or more indicators related to: to: Trend Our Community health risks & conditions, impacts & outcomes Variation of Variation within District District/whole between sub Sector vs NSW populations or services Smoking 49, 80, 81, 115 Alcohol 49, 54 Physical activity 49, 50, 81 Overweight & obesity 49, 50, 51, 81 Relevant pages Cardiovascular diseasedisease 48, 52, 66, 81, 110, 132, Cancer 48, 114 Respiratory disease 48, 49, 52, 66, 132 Mental Health & suicide 48, 57, 65, 79, 81 Falls in the Community 58, 95 Gendered violence 56 Diabetes 50, 51, 52, 66, 132, Kidney disease 53, 79, 81 Sexually transmissible infections 55, 116 Dementia 59 Avoidable deaths 48, 64 Preventable hospitalisations 52, 66, 81, 132 Our Services utilisation and costs, quality and safety Expenditure 124, 125, 126 Hospital demand/ capacity 127, 128, 129, 131 Private health insurance 68, 69 GP supply 67 Health care interpreter use/ demand 83 Antenatal care 80, 84 Dental treatments & assessments 100 Unplanned readmissions 99 Emergency representations 98 Elective surgery access 101 Community Mental Health follow up 103 Mental Health readmissions 104 Immunisation 94 Maternal & birth outcomes 80, 84 Patient experiences & satisfaction 105 Falls in hospital 95, 96 Infections & hand hygiene 92, 93 Medication errors

6 A quick guide to the snapshot Volume Section Subject Page About this snapshot Purpose and scope 1 An overview of snapshot Broad level guide to contents 2 3 Executive summary Contents Complete guide to contents of Volumes 1 & 2 11 Volume 1: 1. Our Community Population size and age 15 Our District Population growth & projections Socioeconomic disadvantage Our Health System Health reform Planning framework Services and partners Our Workforce Age distribution & Aboriginality Professional groups Job satisfaction i 35 Volume 2: Is there a case for change? 1. Our community s health: Is it improving? Health risks & impacts smoking, alcohol, overweight & obesity Deaths avoidable, heart disease, stroke Chronic conditions & preventable hospitalisations diabetes, kidney, heart, respiratory, falls, dementia Sexually transmissible infections Mental Health, Alcohol and other Drugs, Violence Health equity: Socioeconomic disadvantage are we achieving Population groups Aboriginal, unemployed, in public housing, it? homeless, culturally and linguistically diverse, refugees, marginalised youth, people with disability, Gay, Lesbian, Bisexual, Transgender Health status & issues Deaths (avoidable, suicide), Preventable hospitalisations (acute, chronic), Mental Health (funding, non admitted services), Mothers and babies General practitioners, private insurance Patient centred care: are we doing it? Safe and quality care: hand hygiene, infections, medication errors, falls in hospitals, patient satisfaction Preventivecare: Immunisation Unplanned readmissions & emergency representations Access: surgery & procedures, dental Community Mental health follow up The cutting Cardiovascular disease & cancer edge: are we Smoking there? HIV infections High cost complex case mix High Volume Short Stay Surgery Electronic Medical Record Value for money: are we using our dollars wisely? Expenditure: trends & distribution Activity trends: emergency, admissions (including diabetes and other potentially preventable hospitalisations), bed occupancy, orthopaedic procedures

7 About the traffic light rating the traffic rating system Volume 2 of this document, Is there a case for change? presents a large amount of information which aimed to help the Local Health District evaluate its position in relation to the health of its population, and the degree to which it is delivering patient centred, safe, high quality and efficient services and programs. A traffic light rating system (the coloured dots at the top of each page) has been used throughout Volume 2 to assist the reader to synthesise the information presented and to highlight, at a glance, the areas of relative success through to significant challenges. The rating of each element is based on a number of factors, including trends over time and comparisons within or outside the District. In many cases, the application of a summary traffic light rating is complex, for example: In some cases the overall population is faring well but particular groups within it are not achieving the same advantages. the advantages. For certain indicators the District compares well to the NSW average but the overall trend over time is deteriorating. In this way it is not a definitive, single dimensional rating, akin to the way progress for `key performance indicators is often evaluated in terms of variance against specified targets. Rather, the traffic lighting system used here is based on our synthesis of a number of relevant factors in each case. We have applied the following broad meanings to the three traffic light colours: Green: We re doing ok or well. Orange: We re doing ok but with some areas of concern or work needed. Red: We re re concerned and further investigation and/or focus are needed. and/or focus are needed Summaries of the traffic light ratings are provided as part of the Executive Summary and in Appendix A

8 Executive summary Volume 1: Our District Our Community Our population is growing and ageing. SESLHD s population will grow by nearly 6% by The fastest growing age group will be years (36% growth). g g g y g Equity is an undisputed principle of our health system equity of access, equity of outcomes and equity of health status of individuals and groups. However gaps remain between population groups within our District. Ou ur Dis istrict Although SESLHD overall has a relatively advantaged population, there are pockets of distinct socioeconomic disadvantage within our borders. Botany Bay, Inner socioeconomic disadvantage our Bay Sydney and Rockdale Local Government Areas experience relatively high levels of disadvantage. Disadvantage translates to a higher risk of disease, injury and disability, and earlier death and lower levels of health status of individuals and their families. Our Health System The Australian and NSW health systems are currently undergoing periods of significant change. The District has an opportunity to grasp the momentum of these changes and determine new pathway forward that will help address our future challenges. SESLHD is well placed among NSW Local Health Districts in that it hosts a high concentration of super specialised and statewide services, along with a full complement of local hospital, community based and population health programs and services. However, our services make up only part of the system we work in partnership with carers and families, and service providers such as General Practitioners, other private health care and hospital providers, other Government and Non Government Organisations, and aged care and disability agencies. Working effectively with our partners should maximise experiences and outcomes for our should experiences and outcomes for patients and the broader community. Emphasis on building operationally practical working relationships with newly formed Medicare Locals is a priority and opportunity for the District. Increasing collaboration with our teaching and research partners holds strategic value, in that it can advance the profile and contribution of our specialised services within their fields, and also fulfils our obligation as specialised providers to develop their also fulfils our obligation as specialised providers to develop the next generation of clinicians

9 Executive summary continued Our Workforce Our workforce is our greatest asset. We need to take prudent steps to ensure that our workforce is adequately supplied, allocated to where they are needed, skilled and content within their roles and continuously develop both individual and team skills. Our workforce is ageing, which will present a challenge for ensuring adequate workforce supply in the coming decades. Over half of our workforce is aged over 40 years, and 10% are 60 years or over. We need to better balance the age of our workforce to ensure sustainability into the future and ensure appropriate succession planning. We also need to diversify our workforce to ensure it better reflects our population s diversity and health care needs. For example, Aboriginal people are under represented in many professional groups. The 2011 Your Say Workplace Survey highlighted many positive employee experiences among staff, as well as pointing to some priorities for action. Positive staff experiences related to Employee Engagement and Workplace Culture appear related to Engagement and appear to be as common in SESLHD as in NSW Health overall. Overall 25% of respondents reported that they believed that workplace culture had improved in the last 12 months. Volume 2: Is there a case for change? Our community s health: Is it improving? The health of residents, on average, compares favourably with the rest of NSW, and trends over the last decade are encouraging. However, there are some large gaps in health outcomes and access to services between population groups within our District, as well as some concerning trends for the overall catchment population. Ou ur Dis istrict Overweight and obesity are increasing. Since 1997, the proportion of overweight or obese residents aged 16 years and over has increased by about a third, from 35% to 46%. This is a prime driver for the escalating rate of hospitalisations for diabetes among our residents. In turn, the increasing prevalence of diabetes is driving increases in people requiring dialysis for chronic kidney disease

10 Executive summary continued An estimated 22,000 residents are severely impaired by mental illness during any 12 month period, with a further 37,000 moderately impaired. Risky drinking and related hospitalisations are much higher among Northern Sector residents than the NSW average. Falls hospitalisation rates are much higher than the NSW average among LGAthe average among LGA s s residents, as well as Botany Bay and Randwick Bay and LGA residents. Based on current trends, diabetes, followed by falls, are expected to have the greatest future impacts on our health system. Ou ur Dis istrict Health equity: are we achieving it? SESLHD s population is diverse, and made up of many discreet communities. We have significant cultural and linguistic diversity. Our residents are, on average, relatively advantaged, although there are groups within our community who experience significant disadvantage and the health problems that are associated with this. Aboriginal people experience significant social and health disadvantage. For example, registration rates for end stage renal disease among Aboriginal people are about seven times higher than among non Aboriginal people. By geography, people living in the Botany Bay Local Government Area are at highest risk of a range of health problems, as reflected in their relatively high `potentially preventable hospitalisation rates. Suicide rates are relatively high in are relatively high in inner and eastern Sydney. Access to health services by socioeconomically disadvantaged people is often compromised. SESLHD is home to a large share of NSW s populations with special risks and/or care needs such as homeless people, refugees, people who inject drugs, people living with HIV, hepatitis C and hepatitis B, marginalised youth, and gay, lesbian, bisexual and transgender communities. Other groups with specific l d ii Oh ih ifi risks and/or care needs are people with mental illness, chronic disease, dementia, and disability. Notably, Public Mental Health services in SESLHD are underfunded compared to the state average. The per capita funding in SESLHD is only 55% of the NSW average for public facilities. SESLHD currently provides only about 40% of the estimated need among SESLHD residents for non admitted Mental Health public sector services

11 Executive summary continued Patient centred care: are we doing it? Timely access to elective surgery has been steadily improving over the past four years. At June 2011, the District was nearly meeting the current 95% target for the nearly the current target timeliness of admissions for clinical priority categories 1 3. Meanwhile, 30% of dental patients are waiting longer than the recommended times for assessment/treatment. The vast majority of patients are satisfied with their care. However, Aboriginal people and younger people are generally less satisfied with their care. Blood borne infection rates have generally declined in recent years within SESLHD facilities, and our staff s hand washing rates compare favourably with the rest of NSW. Medication incidents and patient falls remain the top two causes of adverse incidents. Rates of emergency department representations and readmissions have been fairly stable at SESLHD facilities overall in recent years. However, recent trends in many of these indicators for SESLHD as a whole often mask large differences between our facilities. The cutting edge: are we there? Large declines in deaths from a range of conditions, including cardiovascular disease, cancer and HIV infections, point to successes across the continuum of and infections to successes across the continuum of prevention and care. About 14% of High Cost Complex Casemix (HCCC) activity in the NSW public hospital system occurs in SESLHD hospitals. The District aims to build upon our existing Centres and Services of Excellence to become a state, national and internationally recognised Local Health District. We aim to optimise learning, teaching and research expertise by attracting and collaborating with leading researchers and clinicians to tt b ith l di h d li i i t remain at the cutting edge of health care. Investing in information and health technology (such as the electronic health record) and infrastructure (including state of the art buildings and equipment) will help ensure our patients continue to receive world class care and improved health outcomes. Other benefits include the delivery of safer more cost effective procedures. Ou ur Dis istrict 02 09

12 Executive summary continued Value for money: are we using our dollars wisely? Demands on our health system and health expenditure are continuing to rise. These are being driven by a range of factors including increasing rates of chronic disease, a growing and ageing population, new medical technologies (which have helped increase life spans), and community expectations. Ou ur Dis istrict Bed occupancy rates are high and increasing at some of our facilities. Meanwhile, many hospitalisations are preventable, through improved and better coordinated prevention and care in the community. in the community. Through ensuring our services are clinically effective, safe, efficient and centred around the needs of patients and the community, together we will achieve a strong health service system now and into the future

13 Contents Section Title Page VOLUME 1 1. Our Community Catchment population is growing and ageing 18 Pockets of socio economic disadvantage Our Health System National health reform 24 New funding model 25 Health reform in NSW 26 Our health system 27 Our planning framework 28 Our hospital and health services 29 Services provided to other Districts and Health Services 30 Our teaching and research roles and research roles 31 Our partners in service provision 32 Our centres of excellence Our Workforce Our workforce is ageing 38 VOLUME 2 Our workforce 39 Aboriginal employees form 0.9% of total SESLHD workforce 40 Employee engagement and workforce culture 41 Workplace experiences mainly positive 42 Section 1. Our community s health: is it improving? Avoidable deaths down 48 Priority health hrisks 49 Overweight and obesity rising fast 50 Low rates of hospitalisation due to excess weight, but not for all 51 Diabetes escalating while other chronic disease hospitalisations plateau 52 Kidney disease increasing rapidly 53 Alcohol related hospitalisations high in the north 54 Chlamydia increasing steeply 55 Gendered violence widespread 56 22,000 residents severely impaired by mental illness 57 High falls related hospitalisation rates 58 Double the number of people with dementia by

14 Contents continued Section Title Page VOLUME 2 Section 2. Health equity: are we achieving it? Inequities in avoidable deaths opportunity for prevention 64 Suicide rates high in inner and eastern Sydney 65 Gap in preventable hospitalisations 66 Fewer GPs in areas of greatest need 67 Variable private health insurance coverage 68 Use of private health insurance 69 Unemployment an indicator of disadvantage 70 Public housing density another indicator of disadvantage 71 High rates of homelessness 72 Homeless people stay longer 73 Public Mental Health relatively under funded in SESLHD 74 Mental health services not matching need, gap increasing 75 Young people at risk 76 Aboriginal communities 77 Aboriginal people over represented in our hospitals 78 Disproportionate activity for the Aboriginal population 79 Timely antenatal care, but smoking common among Aboriginal women 80 Other priorities for `closing the gap among Aboriginal people 81 A large diverse population 82 Increasing and unmet demand for health care interpreters 83 Birth outcomes among Culturally and Linguistically Diverse women 84 Refugee population 85 30,000 residents with profound or severe disability 86 Gay, Lesbian, Bisexual and Transgender communities 87 Section 3: Patient centred care: are we doing it? Infection control we know what we need to do 92 Health care associated infections better but room to improve 93 Immunisation coverage improving 94 Injuries from falls increasing 95 Four falls for every 1,000 bed days 96 Medication errors 97 Revisits to Emergency stable overall, but vary between facilities