2014 15 Statement of Priorities Agreement between Minister for Health and Ambulance Victoria Department of Health
Contents Background 3 Policy directions 3 Part A: Strategic overview 6 Mission statement 6 Service profile 6 Strategic planning 6 Strategic priorities 7 Part B: Performance priorities 10 Safety and quality performance 10 Financial sustainability performance 10 Access performance 11 Part C: Activity and funding 12 Accountability and funding requirements 14 Signature 14 Page 2 Statement of Priorities 2014 15
Background The Statements of Priorities (SoP) is the key accountability agreement between Ambulance Victoria (AV) and the Minister for Health. The annual agreement facilitates the delivery of or substantial progress towards the key shared objectives of financial viability, improved access and quality of service provision and are aligned to government policy directions and priorities. The preparation and agreement of the annual Statement of Priorities is a requirement under the Ambulance Services Act 1986. A Statement of Priorities consists of three parts: Part A provides an overview of the service profile, strategic priorities and deliverables AV will achieve in the year ahead. Part B lists the key financial, access and service performance priorities and agreed targets. Part C lists funding and associated activity. Policy directions The Victorian Health Priorities Framework 2012 2022 (VHPF) sets out the following 5 key outcomes the health system should strive to achieve by 2022: People are as healthy as they can be (optimal health status) People are managing their own health better People enjoy the best possible health care service outcomes Care is clinically effective and cost-effective and delivered in the most clinically effective and costeffective service settings The health system is highly productive and health services are cost-effective and affordable It also articulates seven priorities which reflect the Government s policy ambition to build a strong health system for all Victorians. The focus is on: developing a system that is responsive to people s needs improving every Victorian s health status and experiences expanding service, workforce and system capacity increasing the system s financial sustainability and productivity implementing continuous improvements and innovation increasing accountability and transparency making better use of e-health and communications technology These priorities are fundamental to Part A of the SoP and are required to be addressed by AV. Statement of Priorities 2014 15 Page 3
Government commitments Victoria s health system continues to lead the nation in providing responsive, integrated and innovative health care options. To support a growing population and increased demand for services, the Government has a clear plan to provide quality health care for all Victorians. The Government also recognises that improving patient access to health services is fundamental to Victorians quality of life. In this context, the department will work with service partners to build a health system that is integrated and responsive to the changing needs of the community. Specific commitments made by the Government in 2014 15 relate to: Growing health services Growing essential hospital services including capacity for critical care, emergency department presentations and maternity services across the system. Boosting health service capacity over the winter months in order to improve patient access during periods of significant increase in demand. Boosting elective surgery capacity to meet increasing levels of demand and treat more Victorian elective surgery patients sooner. Increasing funding to meet growth in demand for ambulance services. Growing the Victorian Patient Transport Assistance Scheme to enhance access to health services for rural and regional Victorians. Increasing funding to emergency departments to better identify, respond and intervene early in instances of family violence and sexual assault. Improving bariatric patient care and access to services through consolidating services and increasing the number of bariatric procedures undertaken. Health workforce Supporting and strengthening Victoria s health and mental health workforce through the People in Health workforce development initiative. Supporting productive and effective health workforces through initiatives to extend health professionals' scope of practice and build multidisciplinary health teams. Supporting health services to respond to clinical and non-clinical violence and aggression by patients, staff and visitors. Capital Investing in Ambulance Victoria s helicopter fleet ($550 million). Improving community health infrastructure ($14 million for new Melton Community Health Centre). Supporting additional health capital projects and infrastructure improvements including the Latrobe Regional Hospital redevelopment, Boort Hospital redevelopment, expansion of Healesville Hospital and expansion of the Austin Hospital short stay unit. Boosting community health services, with the new Barwon Health North facility and a new community health building for Moyne Community Health Service in Port Fairy. Supporting the replacement of critical engineering infrastructure in hospitals, such as lifts, boilers and electrical equipment. Continuing the replacement of medical equipment in metropolitan and rural health services. Health Innovation and Reform Council Supporting the Health Innovation and Reform council (HIRC), an independent body which provides advice to the Minister and the Secretary on the effective efficient delivery and management of quality health services and the continuing reform of the public health system. Page 4 Statement of Priorities 2014 15
Mental health and other initiatives Implementing mental health initiatives and growing mental health services including three new prevention and recovery care units. Continuing housing support for people with a mental illness through the Doorways project. Boosting alcohol and drug services, including expanding drug treatment services to support more effective education and treatment responses. Supporting Victorians with diabetes manage their conditions with free access to insulin syringes and pen needles through the National Diabetes Syringe Scheme (NDSS). Increasing support for older people through the Home and Community Care (HACC) program to assist them to remain living in their homes for longer. Statement of Priorities 2014 15 Page 5
Part A: Strategic overview Mission statement Ambulance Victoria (AV) is a critical part of Victoria s health care system. AV improves the health of the community by delivering innovative, high quality ambulance services. Service profile AV provides the following range of integrated services: Emergency medical response and out-of-hospital care Emergency medical transport by road or air Non-emergency patient transport Major incident management and response Medical retrieval of critically ill adult patients (including advice and bed co-ordination) Assistance for patients to access appropriate care when paramedic care or transport is not required Support for other health services in some rural communities where the full range of services is not easily accessible Community education in pre-ambulance arrival emergency care The AV Membership Subscription Scheme (ambulance insurance) A program of research in clinical and operational practice First aid at public events by arrangement. Strategic planning AV s vision for its future is in its draft Strategic Plan 2013-2016 and is subject to further consideration. Page 6 Statement of Priorities 2014 15
Strategic priorities The Victorian Government s priorities and policy directions are outlined in the Victorian Health Priorities Framework 2012 2022. In 2014 15, AV will contribute to the achievement of these priorities by: Priority Action Deliverable Developing a system that is responsive to people s needs Develop an organisational policy for the provision of safe, high quality end of life care. Implementation of relevant Year 1 measures as outlined in Victoria s Advance Care Planning Strategy; have the conversation: a Strategy for Victorian health services 2014-2018. Work collaboratively with health services to achieve timely transfer of patients. Implementation of Recommendations 1 and 2 of the Ambulance Transfer Taskforce in line with DH and stakeholder requirements: R1. AV to ensure that patients are transported to the nearest hospital Emergency Department in accordance with clinical need and ensure optimal distribution of ambulance arrivals across hospitals to avoid, as far as possible, the clustering of arrivals; R2. AV will notify the receiving Emergency Department of any patient that is en route and prior to arrival. Improving every Victorian s health status and experiences Progress partnerships with other services to improve outcomes for regional and rural patients. Ensure systems utilise consumer feedback to improve person and family centred care and patient experience. Optimise alternatives to transport, when clinically safe to do so. Increase RefCom referrals to local service providers in regional and rural areas subject to provider availability. Participate in the independent evaluation of RefCom. Participate in the independent evaluation of RefCom. Statement of Priorities 2014 15 Page 7
Expanding service, workforce and system capacity Implement a workforce immunisation plan that includes pre-employment screening and immunisation assessment for existing staff that work in high risk areas in order to align with Australian infection control and immunisation guidelines. Build workforce capability and sustainability by supporting formal and informal clinical education and training for staff. Implementation of AV s 2015 Staff Flu Vaccination Program. Delivery of the Trauma Education Initiative to provide educational resources for clinicians on early care for major trauma patients outside of a metropolitan trauma service, including the development of the Trauma Education Victoria website, a review of the major trauma guidelines and the development of 12 webbased learning modules by the end of 2014-15. Optimise workforce productivity through identification and implementation of workforce models that enhance capacity and support flexibility. With Health Purchasing Victoria, undertake a state-wide tender for Non-Emergency Patient Transport to increase workforce capability and achieve value for money. Increasing the system s financial sustainability and productivity Work collaboratively with the department on service and capital planning to develop service and system capacity. Improve outcomes for people with heart disease by addressing the strategic directions of Victoria s Heart Health: improved services and better outcomes for Victorians. Identify opportunities for efficiency and better value service delivery. Collaborative development of AV s Operational Improvement Plan for service and capital with the Department. Delivery of agreed governmentfunded service expansions as scheduled and within budget. Roll out and integration of prehospital thrombolysis capability into all rural regions by the end of 2014-15. Improve AV s capacity to coordinate 000 demand to the most appropriate service stream. Specifically, this includes completing a feasibility assessment of a new triage system by the end of 2014-15. Reduce administrative costs. Implement and integrate the new Funding Model and Fee Schedule into AVs systems and practice from1 July 2014. Set efficiency targets and implement a savings efficiency plan for 2014-15. Integration and impact of new funding model monitored through the minireview of the new funding model led by the Department. Page 8 Statement of Priorities 2014 15
Implementing continuous improvements and innovation Strengthen research linkages with academic and other institutional networks through establishing formal collaborative arrangements with relevant institutes. Collaborate with Monash University on the NHMRC funded Australian Resuscitation Outcomes Consortium (Aus-ROC) Centre for Research Excellence. In particular execute the MOU regarding provision of cardiac arrest data to the National Registry. Maintain the MOU with Turning Point Drug and Alcohol Centre, Eastern Health and Monash University regarding ambulance attendances to drug and alcohol and mental health presentations; and establish collaborative projects utilising the data. Increasing accountability & transparency Undertake an annual board assessment to identify and develop board capability to ensure all board members are well equipped to effectively discharge their responsibilities. Improve data reporting systems to increase accountability and transparency. Establish co-supervisory arrangements with universities for post graduate students undertaking ambulance based research. Strengthened board capability through conducting a board review and addressing opportunities for improvement The Victorian Ambulance Dataset progressively implemented from 1 July 2014. Improving utilisation of e-health and communications technology Trial, implement and evaluate strategies that use e-health as an enabler of better patient care. Appropriate data collection and reporting to implement the new Funding Model and Fee Schedule embedded across AV by the end of 2014. Arrivals Boards 1 implemented across key major hospitals. Investigate options for improving clinical triaging software that better matches the patient s acuity and needs with the resource required. Complete a feasibility assessment of a new triage system by the end of 2014-15. 1 The intent and scope of Arrivals Boards is as outlined in Recommendation 2 of the Ambulance Transfer Taskforce s final report. Statement of Priorities 2014 15 Page 9
Part B: Performance priorities Safety and quality performance Key performance indicator Target Patient experience and safety and quality Percentage of audited emergency cases statewide meeting clinical practice standards 95 Percentage of audited non-emergency cases statewide meeting clinical practice standards 95 Percentage of audited cases attended by CERT meeting clinical practice standards 90 Percentage of emergency patients satisfied or very satisfied overall with their last experience with AV (1) 95 Percentage of patients (adult and paediatric) experiencing severe traumatic pain whose level of pain is reduced significantly (2) 90 Percentage of adult VF/VT cardiac arrest patients with vital signs at hospital (3) 45 Percentage of adult VF/VT cardiac patients surviving to hospital discharge 20 Percentage of adult patients defined as major trauma transported to the highest level designated trauma service within 45 minutes travel time (from scene) 80 Percentage of adult patients suspected of having a stroke, who were transported to a stroke unit with thrombolysis facilities within 60 minutes 80 Health Care Worker Immunisation - influenza (4) 75 (1) Based on results of the Council of Ambulance Authorities survey and excluding not applicable/ don t know responses. (2) Patients with an initial pain score greater than 7 and a reduction score of 2 or more. (3) Cardiac arrest excluding those witnessed by a paramedic occurring in patients 15 or older where resuscitation is attempted and the arrest rhythm on first ECG assessment was either Ventricular Fibrillation (VF) or Ventricular Tachycardia (VT). (4) High coverage rates for immunisation in healthcare workers are essential to reduce the risk of transmission in healthcare settings. The target requires 75 per cent of AV s staff who are permanently, temporarily or casually employed by AV through the influenza period (March to July) to be immunised. Financial sustainability performance Key performance indicator Target Finance Annual operating result ($m) Creditors Debtors ($0.000m)* < 60 days < 60 days *From 1 July 2014, a new funding model and billing guidelines were introduced outlining new fee schedules and responsibilities for payments. AV and the Department of Health will work together to monitor, review and address the impacts that these changes may have on AV s financial position. Page 10 Statement of Priorities 2014 15
Access performance Key performance indicator Target* Timely response Percentage of ambulance transfers within 40 minutes 90 Percentage of emergency (Code 1) incidents responded to within 15 minutes statewide 1 85 Percentage of emergency (Code 1) incidents responded to within 15 minutes in centres with a population greater than 7,500 1 90 Percentage of Community Emergency Response Team (CERT) arrival prior to ambulance at cases where CERT is dispatched 85 Percentage of 000 events where the caller receives advice or service from another health provider as an alternative to emergency ambulance response in the metropolitan area. 2 10 * Please note that these are established benchmark targets. To meet these targets, AV forecasts that it will need to manage an estimated 904,600 incidents in 2014-15. Of these, 616,100 will be 000 incidents and 288,500 will be booked non-emergency incidents. AV and the Department of Health are continuing to work together to explore opportunities to introduce service improvements which will improve AV s ability to meet these targets. (1) Metropolitan response times are based on data from the Computer Aided Dispatch system. Rural response times are based on data sourced from Patient Care Records completed by paramedics. (2) Noting that this KPI will be independently reviewed in 2014-15, with changes considered in 2015-16 to reflect that RefCom is now a state-wide service.. Statement of Priorities 2014 15 Page 11
Part C: Activity and funding Output Funding 2014-15 Estimated Activity* 34 2014-15 Budget ($M) Total Emergency Road Transports - Statewide 389,264 CSO 222,506 $282.91 MSS 73,006 $93.30 DVA 21,165 $27.28 TAC 10,750 $13.91 VWA 3,332 $4.27 Total Non-Emergency Stretcher Transports - Statewide 200,317 CSO 113,720 $40.93 MSS 22,172 $7.86 DVA 24,901 $8.53 TAC 1,145 $0.43 VWA 669 $0.26 Total Non- Emergency Clinic Car Transports - Statewide 91,455 CSO 78,247 $7.75 MSS 8,920 $0.88 DVA 2,243 $0.22 TAC 17 $0.0017 VWA 12 $0.0012 Total Treat No Transports - Statewide 83,334 CSO 46,125 $22.19 MSS 16,409 $7.89 DVA 3,418 $1.64 TAC 3,919 $1.89 VWA 472 $0.23 Total Fixed Wing Transports - Statewide 5,331 CSO 1,159 $5.39 MSS 490 $2.28 DVA 155 $0.72 TAC 152 $0.71 VWA 86 $0.40 3 Note that via transport fees, all funders also make a contribution to the delivery of AV s Secondary Triage service - RefCom and Adult Retrieval Services. In 2014-15, RefCom is estimated to manage 70,000 calls statewide. 4 Note that total statewide activity and budget figures for each type of AV s services include other funders amounts see below. Page 12 Statement of Priorities 2014 15
Total Rotary Transports - Statewide 1,927 CSO 239 $6.29 MSS 261 $6.87 DVA 6 $0.16 TAC 519 $13.66 VWA 82 $2.16 Total CSO transports and Treat No Transports -Statewide 5 461,996 $334.047 6 Total Statewide transports other funders 7 115,331 $113.050 Government subsidy for the Membership Subscription Scheme $59.080 Other specified grants and activities Department of Health $22.971 Call Taking and Dispatch Department of Justice $11.600 * Activity levels have been estimated using historical data. A new funding model has been introduced in 2014-15 and may impact on estimated activity. AV and the Department of Health will work together to monitor, review and consider the impacts that these changes may have. Capital Funding 2014-15 Budget Minor works, motor vehicle and equipment - CSO and MSS capital grant 8 $22.690 Minor works, motor vehicle and equipment - Other funders capital grant $12.300 Department of Health capital funding - other activities $6.940 ($M) 5 Note that while CSO funding is linked to activity from 2014-15, this is at the aggregate level only. AV retains the operational flexibility to manage volumes across its Service Lines and movement between Service Lines is appropriate and anticipated. To have met performance expectations in 2014-15, AV needs to deliver to the total CSO transports and Treat No Transports state-wide figure (within a +/- 5% range). 6 Note this includes the transfer of $250,000 from the Department of Health to AV for Western Australian and South Australian interstate patients. 7 Note that in this context, other funders refers to patients with and without private health insurance and transports undertaken for private healthcare facilities and public health services. Please note that total statewide transport activity and budget figures include other funders. 8 Noting that across all funders, in 2014-15 AV is expected to receive capital funding of $34.99M for minor works, motor vehicle and equipment. Statement of Priorities 2014 15 Page 13
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