Gippsland Regional Palliative Care Plan 2005-2009

Gippslnd Regionl Pllitive Cre Pln 2005-2009 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 2005-2009 1

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) 93291083 E-mil: info@plexusconsulting.com.u Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 2

CONTENTS FOREWORD...8 1 OVERVIEW OF THE REGION...9 1.1 GEOGRAPHICAL AND ENVIRONMENTAL DATA... 10 1.1.1 Projected Growth... 10 1.1.2 The Chnging Age Structures... 10 1.1.3 Culturl Diversity... 10 1.2 SOCIO-ECONOMIC INDICATORS:... 10 1.2.1 Welfre Pyments... 10 1.2.2 Employment nd Unemployment... 11 1.2.3 Eduction nd Trining... 11 1.2.4 Fmilies, Households nd Homes... 12 1.2.5 Vehicle Ownership nd Trvel... 12 1.2.6 Income Distribution nd Disdvntge... 12 2 THE REGIONAL PALLIATIVE CARE CONSORTIUM... 13 2.1 MEMBERSHIP... 13 2.2 VISION... 13 2.3 THE PLANNING PROCESS... 15 2.3.1 Objectives... 15 2.3.2 Plnning Approch... 15 2.3.3 Plnning Stges... 15 3 PRIORITIES AND CHALLENGES FOR 2005-2009... 17 3.1 PERCEIVED LOCAL SERVICE SYSTEM STRENGTHS... 17 3.2 REPORTED GAPS IN THE LOCAL SERVICE SYSTEM... 18 3.3 PRIORITIES FOR PALLIATIVE CARE DEVELOPMENT IN THE REGION... 19 3.3.1 Plnning Approch... 37 3.4 IMPLEMENTATION TIMEFRAME... 37 Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 3

4 APPENDIX 1: PALLIATIVE CARE AND THE POLICY CONTEXT... 48 4.1 THE NATURE OF PALLIATIVE CARE... 48 4.2 SOCIAL HEALTH AND HEALTH PROMOTION FRAMEWORKS... 49 4.2.1 Socil Helth... 49 4.2.2 Helth Promotion... 50 4.2.3 Qulity of Life... 50 4.3 THE NATIONAL PALLIATIVE CARE STRATEGY... 51 4.4 THE VICTORIAN GOVERNMENT PALLIATIVE CARE PROGRAM... 51 4.5 OVERVIEW OF CURRENT LITERATURE AND RESEARCH... 55 4.5.1 Other Pllitive Cre Approches... 57 5 APPENDIX 2: DEMOGRAPHIC AND SOCIAL PROFILE... 59 5.1 OVERVIEW... 59 5.2 REGIONAL OVERVIEW... 59 5.3 GEOGRAPHICAL AND ENVIRONMENTAL DATA... 60 5.3.1 Bss Cost Shire... 60 5.3.2 Bw Bw Shire... 61 5.3.3 Est Gippslnd Shire... 63 5.3.4 Ltrobe City... 64 5.3.5 South Gippslnd Shire... 65 5.3.6 Wellington Shire... 67 5.4 DEMOGRAPHIC DATA... 68 5.4.1 Ntionl fetures from the 2001 Census... 68 5.5 DEMOGRAPHY OF... 69 5.5.1 Popultion nd Popultion Chnge in Gippslnd... 69 5.5.2 Culturl Diversity in Gippslnd... 72 5.5.3 Socio-Economic Indictors: Welfre Pyments... 77 5.5.4 Socio-Economic Indictors: Employment nd Unemployment... 79 5.5.5 Socio-Economic Indictors: Eduction nd Trining... 81 5.5.6 Socio-Economic Indictors: Fmilies, Households nd Homes... 82 Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 4

5.5.7 Socio-Economic Indictors: Vehicle Ownership nd Trvel... 85 5.5.8 Socio-Economic Indictors: Income Distribution nd Disdvntge... 86 6 APPENDIX 3: BURDEN OF DISEASE DATA... 89 6.1 TOP CAUSES OF DEATH... 89 6.2 LENGTH OF LIFE... 91 6.3 INCORPORATING QUALITY OF LIFE... 93 7 APPENDIX 4: SERVICE DELIVERY DATA... 98 7.1 REPORTING RATIOS... 98 7.2 CONTACT DATA... 99 7.2.1 Trends in service delivery...100 7.2.2 Site of deth...100 7.2.3 Admission nd service contct relted dt tbles...102 7.2.4 Summry of dmissions by qurter...104 7.2.5 Dischrge relted dt tbles...105 7.3 SERVICE DELIVERY DATA AND FUNDING...109 7.4 CANCER STREAMS: PERCENTAGE OF CANCERS FOR PEOPLE RESIDENT IN EACH LGA FOR THAT YEAR...110 8 APPENDIX 5: DEFINITION AND PRINCIPLES GUIDING ROLE DELINEATION: DEPARTMENT OF HUMAN SERVICES, VICTORIA... 113 8.1 DEFINITIONS...113 8.2 PRINCIPLES...113 8.3 DESIGNATED SERVICE LEVELS...113 9 APPENDIX 6: PALLIATIVE CARE SERVICE MAP... 115 9.1 SERVICES INCLUDED IN THE SERVICE MAP...115 9.2 AREAS SERVICED...116 9.3 SERVICES PROVIDED...117 9.3.1 Home or community bsed 1-to-1 direct cre...117 9.3.2 Assessment nd Cse Mngement...118 9.3.3 Respite...119 9.3.4 Group Activities...120 9.3.5 Consultncy...121 Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 5

9.3.6 Centre Bsed Cre...122 9.3.7 Other Services...123 9.4 SERVICEPROFILE...124 9.4.1 Community Services...124 9.4.2 Pllitive Cre Beds...125 9.4.3 Consultncy...126 9.4.4 Grief nd Berevement...127 9.4.5 Totl Clients: One-to-One Services...128 9.4.6 Group Activities nd Other Progrms...129 9.4.7 Other Services...131 9.4.8 24 Hour Service...133 9.5 SERVICE PROVIDER PROFILE...135 9.5.1 Pllitive Cre Physicins: Employed...135 9.5.2 Pllitive Cre Physicins: Privte...136 9.5.3 Other Employed Medicl...136 9.5.4 Generl Prctitioners: Bulk Billing...136 9.5.5 Generl Prctitioners: Fee-For-Service...137 9.5.6 Clinicl Nurse Consultnts...138 9.5.7 Clinicl Nurse Specilists...139 9.5.8 Other Division 1...140 9.5.9 Division 2 Nurses...141 9.5.10 Physiotherpists...142 9.5.11 Occuptionl Therpists...143 9.5.12 Speech Pthologists...144 9.5.13 Counsellors...145 9.5.14 Socil Workers...146 9.5.15 Diversionl Therpy...147 9.5.16 Other Allied Helth...148 9.5.17 Pstorl Cre...148 9.5.18 Executive...149 Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 6

9.5.19 Support Stff...150 9.5.20 Volunteer Coordintors...151 9.5.21 Other Stff...152 9.5.22 Totl Stffing...152 9.6 VOLUNTEER PROFILE...153 9.6.1 Policies, Orienttion nd Trining Progrms...154 9.6.2 Volunteers: Key Issues...155 9.7 LINKS...156 9.7.1 Acute/Sub-Acute Services...156 9.7.2 Community Bsed Services...165 9.8 STATE-WIDESERVICES...175 10 APPENDIX 7: SUMMARY OF RESULTS: PRESS GANEY SURVEY 2004... 179 10.1 BACKGROUND...179 10.2 SURVEY COVERAGE AND SUMMARY OF RESULTS...179 11 APPENDIX 8: PARTIES CONSULTED IN DEVELOPMENT OF THE PALLIATIVE CARE STRATEGIC PLAN 2005-2009... 182 Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 7

FOREWORD It is with plesure tht the Gippslnd Regionl Pllitive Cre Consortium presents this Strtegic Pln 2005-2009. 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 2005 2009 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 2005-2009 8

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 http://www.dhs.vic.gov.u/regionl/hume/mps 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.] http://www.dhs.vic.gov.u/regionl/gipps/mps/shire.htm Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 9

1.1 GEOGRAPHICAL AND ENVIRONMENTAL DATA 1.1.1 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]. 1.1.2 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. 1.1.3 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: 1.2.1 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 2005-2009 10

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. 1.2.2 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. 1.2.3 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 2005-2009 11

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. 1.2.5 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. 1.2.6 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 2005-2009 12

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. 2005 to June 30 th. 2009. 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 2005-2009 13

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 2005-2009 14

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. 2.3.1 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. 2.3.2 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]. 2.3.3 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 2005-2009 15

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 2005-2009 16

3 PRIORITIES AND CHALLENGES FOR 2005-2009 This Drft Regionl Pllitive Cre Pln 2005-2009, 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 2005-2009 17

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 2005-2009 18

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 3.4. 2 Strengthening pllitive cre. A policy for helth nd community cre providers 2004 09. Continuing Cre Unit, Progrms Brnch, Metropolitn Helth nd Aged Cre Services Division, Victorin Government Deprtment of Humn Services, October 2004. Summrised from pp. 3-7 Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 19

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 2005-2009 20

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 2005-2009 21

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 2005-2009 22

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 2004-2005 yer More culturlly pproprite provision Incresed uptke by indigenous Austrlins nd other culturlly nd linguisticlly diverse communities: bseline of 2004-2005 yer Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 23

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 2004-2005 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 2005-2009 24

A sizeble number of registered clients die in residentil ged cre fcilities [see tble below]. The ged cre sector hs structured processes nd progrms to further doption of the pllitive pproch. These include the PEPA progrm nd recently relesed guidelines Guidelines for pllitive pproch in residentil ged cre [Deprtment of Helth nd Ageing, 2004]. Clients in these residentil fcilities require the sme level of expertise [e.g. in pin mngement] nd coordinted cre pthwys, through specilist nurse, s do other clients. Pllitive cre services hve n opportunity to engge with other providers through comprehensive cre plnning nd coordintion processes [see P4, G1, S1 below] nd to thereby ssist them to provide cre in ccord with the pllitive pproch. Similrly, pllitive cre services hve n opportunity, through cre plnning nd coordintion processes, to engge with other Generl Prctitioners nd doctors in Emergency deprtments. Overses Trined doctors bring rnge of culturl differences in ttitudes nd views of pllition cre, deth nd dying. Tenders re being sought by the Commonwelth Government for the provision of pllitive cre eduction pckges for ged cre nd medicl providers, nd the Consortium will consider submitting proposl. : SITE OF DEATH 1 st Qtr 2002-03 2003-04 2004-05 2nd Qtr 3 rd Qtr 4 th Qtr Home 30% 48% 38% 20% 33% 42% 38% 37% 45% 33% 32% 54% 37% Hosp Public - pll bed 38% 35% 17% 37% 44% 24% 12% 29% 19% 39% 39% 25% 32% Hosp Public - non- ll bed 13% 3% 31% 39% 12% 13% 23% 17% 26% 0% 14% 0% 15% Hosp Privte - publicly funded - pll bed 2% 1% 3% 0% 0% 0% 11% 2% 0% 11% 1% 0% 2% Hosp Privte - publicly funded - non-pll bed 6% 1% 3% 0% 0% 8% 1% 1% 0% 0% 1% 8% 2% Hosp Privte - other 0% 1% 0% 1% 0% 1% 0% 8% 0% 0% 3% 0% 2% Residentil cre - nursing home/hostel/srs 11% 10% 7% 3% 12% 12% 14% 4% 10% 17% 10% 13% 10% All 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 1 st Qtr 2nd Qtr 3 rd Qtr 4 th Qtr 1 st Qtr 1 st or 3 rd. Qtr* 2nd Qtr 3 rd Qtr All yers Principle No. 3: People with life-thretening illness nd their crers nd fmilies hve ccess to specilist pllitive cre services when required Expected Outcomes: Ptients with life-thretening illness nd complex needs hve pproprite nd timely ccess to specilist pllitive cre through n integrted service system All crers nd fmily members ssessed with complex grief nd berevement re provided with informtion bout nd ccess to pproprite counselling nd support REGION PRIORITIES AND STRATEGIES: PRINCIPLE NO. 3 GOALS STRATEGIES ACTIVITIES LEAD AGENCY/PERSON & RESOURCES Gol P3,G1: To fcilitte equitble ccess to P3, G1, S1: Estblish two dditionl pllitive cre beds in the region Identify pproprite bed distribution s per pln developed for P4, G2, S5 below Seek inititive funds for two dditionl beds This will require inititive funds: $245,904 MEASURES OF SUCCESS Two dditionl beds by July 2006 P3, G1, S2: Expnd the UBF Identify pproprite distribution s per pln developed for P4, G2, S5 below This will require inititive $245,904 dditionl Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 25

specilist pllitive cre services by the equivlent of funding for two dditionl beds to llow greter provision in the home [including respite nd overnight plcement of crers] Seek inititive funds for expnsion of the UBF by the equivlent of funding for two dditionl beds funds: $245,904 UBF funds by July 2006 P3, G1, S3: Estblish Regionl Consulttion Service Investigte options for estblishment of Regionl Consulttion Service [24 hour ccess to specilist physicins] including: Up-skilling nd supporting GPs with n interest in PC including funding/bckfill Funding models such s MSOAP Extending the Kooweerup model of service contrct with n outer metropolitn tertiry fcility to provide cross the region Consorti & DHS Redy ccess to required medicl expertise Determine preferred pproch Seek inititive funds for estblishment: $40,000 Implement Evlute P3, G1, S4: Achieve the role delinetion rrngements tht will best support pllitive cre cross Gippslnd Anlyse the DHS discussion pper on role delinetion [when relesed] ginst Gippslnd region needs Identify the vrious levels of service e.g: Level 3: Ltrobe Level 2: Six sites e.g. Korumburr/Leongth, WGHG, Sle, Wonthggi, Birnsdle nd Kooweerup Levels 1: All other hospitls in the region Consortium nd DHS in conjunction with Regionl CEOs $10-15,000 for consultnt to negotite with sites nd develop proposl Levels 1, 2, 3 delineted for cute hospitls in the region Achievement of designted levels by end 2009 Agree position with DHS Discuss with CEOs/DONs Identify needs for chievement of role delinetion levels by end 2009 Seek development funds: totl $750,000 Level 3: 6 sessions per week @ $25,000 per session Level 2: 4 sessions per week @ $25,000 per session Develop pln Implement P3, G1, S5: Explore options for fter hours cre models in smller communities Audit current provision Identify gps/ needs Develop options/models Identify opportunities for tpping into existing services Consortium with project ssistnce Esier ccess to nd mngeble rrngements for fter hours cre in smller communities Identify resources required Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 26

P3, G1, S6: Ensure ccess to berevement supports nd services including post deth P3, G1, S7: Fcilitte effective pin mngement P3, G1, S8: Develop protocols for symptom mngement in the home i.e. ccess to mediction nd orders [S4 nd S8] P3, G1, S9: Ensure tht the community services re ble to directly ccess beds Negotite with individul gencies for provision through existing resources Implement Audit current provision / identify gps Determine needs of bereved persons: identify rel cost Explore models for provision especilly in popultions of lesser density Develop simple, user-friendly BRAT for use region-wide to cpture t risk fmilies/friends Determine dditionl costs to gencies Develop pln for implementtion Implement Seek inititive $250,000 funds for berevement nd support nd volunteer coordintion distributed on the following bsis: Bss Cost $36,285; Bw Bw $33,510; Est Gippslnd $48,530; Ltrobe $66,235; South Gippslnd $26,680; Wellington $38,760 Develop core curriculum in grief nd berevement counselling in Gippslnd Identify provider trget group nd ssess knowledge / gps Determine pproprite mens for knowledge updtes Develop pln for implementtion Implement Conduct literture serch to identify drug rrngements Develop protocols Seek endorsement of vrious mngement bodies Implement Review protocols Develop criteri nd policy/protocols for ccess Identify those hospitls where direct ccess is not vilble Negotite chnge in rrngements Implement Incorporte complimentry therpies in cre plnning nd provision [see under P4, G1, S1 below] Consortium with project ssistnce Inititive funds [$250,000] for berevement nd support nd volunteer coordintion With Gippslnd Centre for Grief: Monsh Rurl Helth Gippslnd Pllitive Cre Service Project Worker Consortium & Mngement of service gencies Consortium Further links nd prtnerships with e.g. GPs, specilists, ged cre through their incorportion in models of coordinted cre [see under P4, G1, S3 nd P4, G1, S4 below] Berevement needs cptured Costs & funding shortflls identified Incresed continuum of cre Consistent mens of identifiction Greter detection of t risk people Approprite trining vilble in Gippslnd Clients symptoms mnged to llow them to be comfortble when dischrged Improved pin mngement Criteri nd policy/protocols for ccess developed Direct ccess to beds by community services Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 27

COMMENTS, ISSUES, SUPPORTING DATA: Demogrphic trends [n geing popultion] together with technologicl dvnces [people living longer with life-thretening illnesses] re resulting in incresed demnd for services. Client needs re incresingly complex. Flexible funding in rurl res is importnt to increse provision in the home generlly, to increse the flexibility required in res with less infrstructure, nd to respond to inconsistent service demnd in res with lesser popultion density. An increse in the UBF fund would fcilitte this flexibility. At the sme time, dditionl beds re wrrnted. While the current lloction is lrgely in line with the DHS lloction formul of 50 beds per one million popultion, the Gippslnd region is high need re. The demogrphic nlysis in Appendix 2 indictes tht Gippslnd: Is expected to experience strong popultion growth from 2001 to 2031 with continued demnd for costl living with those res closest to Melbourne nd to the cost [primrily the Bss Cost nd Bw Bw Shires] experiencing the strongest growth. In this period, the resident popultion of Victori is estimted to increse 0.87 per cent per yer nd tht of regionl Victori by 0.79 per cent per yer, compred with 1.92 per cent per yer in Bss Cost, 0.92 per cent in Bw Bw, 0.67 per cent in South Gippslnd nd 0.62 per cent in Est Gippslnd. The popultion of Wellington is projected to remin stble, while Ltrobe is projected to experience n verge nnul decrese of 0.05 per cent Is projected to experience greter growth in the popultion ged 60 yers plus thn Victori s whole, nd thn rurl Victori in generl. In the period to 2001 2031, the percentge of the Victorin popultion ged 60 yers or more is expected to increse from 17.3 to 29.0 per cent [11.7% increse], with n increse from 19.5 to 35.9 per cent in rurl Victori [16.4% increse], from 28.6 to 35.9 per cent in Bss Cost [7.3 % increse], from 18.1 to 38.0 per cent in Bw Bw [19.9% increse], from 25.1 to 49.8 per cent in Est Gippslnd [24.7% increse], from 17.3 to 38.8 per cent in Ltrobe [21.5% increse], from 21.1 to 42.1 per cent in South Gippslnd [21.0% increse], from 18.5 to 40.7 per cent in Wellington [22.2% increse], nd from 19.7 to 39.6 per cent in Gippslnd overll [19.9% increse]. Rtes of ccess to welfre pyments or benefits re generlly verge to high 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 At the time of the lst census, ll six LGAs hd 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, nd hd levels of computer nd internet use tht were below the Stte verge All LGAs, except for Bw Bw hd higher percentge of lone person households thn the Stte verge. Bss Cost, Est Gippslnd nd, to lesser degree, Ltrobe hd rtes tht re lso higher thn the regionl Victorin verge The number of households without vehicle ws significntly higher in Ltrobe thn for the Stte nd regionl verges Over 60% of individuls in ll six LGAs hd n income between $100 nd $500 per week, nd over 45% of households in ll six LGAs hd weekly income of $700 or less. The current resource distribution results in some inequity of ccess. This is excerbted by the dispersed popultion nd distnces required for mny to trvel to services in the lrger centres. Anlysis of pllitive bed usge does not dequtely reflect service ccess, s mny of the smller services provide significnt levels of pllitive cre with little or no specific funding, e.g. bed ccess in Est Gippslnd is inequitble, nd Kooweerup hs no specific lloction. Regionl service dt indictes significnt proportion of deths in other thn pllitive cre beds: : SITE OF DEATH 1 st Qtr 2002-03 2003-04 2004-05 2nd Qtr 3 rd Qtr 4 th Qtr Home 30% 48% 38% 20% 33% 42% 38% 37% 45% 33% 32% 54% 37% Hosp Public - pll bed 38% 35% 17% 37% 44% 24% 12% 29% 19% 39% 39% 25% 32% Hosp Public - non- ll bed 13% 3% 31% 39% 12% 13% 23% 17% 26% 0% 14% 0% 15% Hosp Privte - publicly funded - pll bed 2% 1% 3% 0% 0% 0% 11% 2% 0% 11% 1% 0% 2% Hosp Privte - publicly funded - non-pll bed 6% 1% 3% 0% 0% 8% 1% 1% 0% 0% 1% 8% 2% Hosp Privte - other 0% 1% 0% 1% 0% 1% 0% 8% 0% 0% 3% 0% 2% Residentil cre - nursing home/hostel/srs 11% 10% 7% 3% 12% 12% 14% 4% 10% 17% 10% 13% 10% 1 st Qtr 2nd Qtr 3 rd Qtr 4 th Qtr 1 st Qtr 1 st or 3 rd. Qtr* 2nd Qtr 3 rd Qtr All yers Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 28

All 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% * Bss Cost dt only The regionl mpping tool hs cptured broder picture of service delivery nd will be useful resource in future nlysis nd distribution of resources. Redy ccess to Pllitive Cre Physicin nd/or experienced medicl expertise in the region is required. Severl potentil solutions hve been identified for explortion. Mngeble rrngements for fter hours cre re needed in smller communities. Distnces re problemtic, prticulrly for night cll outs. Pllitive cre beds re not directly ccessible in some prts of the region. Role delinetion of ech hospitl, with requirements for multi-disciplinry tem with leder qulified in pllitive cre, nd with greter ccountbility for bed usge nd dys, ought ssist with direct ccess. Principle No. 4: People with life-thretening illness nd their crers nd fmilies hve tretment nd cre tht is coordinted nd integrted cross ll settings Expected Outcomes: Services re coordinted in the best wy to meet the needs of people with life-thretening illness nd their crers nd fmilies People with life-thretening illness will be ble to clerly identify the key professionl contct in the provision of their cre REGION PRIORITIES AND STRATEGIES: PRINCIPLE NO. 4 GOALS STRATEGIES ACTIVITIES LEAD egol P4,G1: To enhnce cre coordintion nd service ccess nd ensure tht the service system is positioned to meet current nd future client needs P4, G1, S1: Develop model[s] of coordinted cre: tht is pertinent to chronic disese mngement tht incorportes the SCoTT requirements with clerly identified entry points nd pthwys for pllitive cre with proctive, effective nd rigorous client need ssessment nd individulised cre plnning bsed on full informtion on vilble options tht incorportes dischrge plnning with stndrdised documenttion tht incorportes the needs of crers tht fcilittes choice tht is flexible nd tilored to individul need tht emphsises prtnerships with clients nd fmily/crers nd involve them in decision mking tht cptures clients through diverse Design models/pproches including dmission criteri, referrl processes, informtion to ccompny the client on trnsfer Assess pplicbility of the Integrted Cncer Service [ICS] Ptient Mngement Frmework [vilble in July 2005] for inclusion of relevnt spects in the ssessment processes Pilot the tools, pproch Refine Roll-out cross the region Evlute AGENCY/PERSON & RESOURCES Consortium with project ssistnce MEASURES OF SUCCESS Stndrdistion of documenttion Cre tht is trnsferble Incresingly semless provision Incresed co-ordintion Reduced dupliction Smoother trnsition Access to required multi-disciplinry inputs Consistent ssessment cross region nd for ll clients Rnge of service needs of clients with complex needs identified Incresing uniformity in dischrge plnning, dmission criteri nd cre plnning cross the region More effective triging Better symptom mngement Incresed timeliness of referrls nd for service delivery Incresed number of clients with dvnced cre directives Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 29

episodes of cre tht covers the rnge of physicl, socil, emotionl etc. support needs: [e.g. including complementry therpies] tht includes pthwys of clinicl cre tht involves other helth providers in cre pln development tht involves GPs nd other relevnt providers s core members of cre tems tht strengthens the cute/community service interfce nd fcilitte timely referrl of clients tht minimises dupliction tht ensures tighter cse mngement to use scrce resources prudently tht incorportes stndrds for cre [i.e. for ssessment, cre plnning nd delivery] tht incorportes monitoring of the cre pln ginst delivery nd outcomes to identifying gps in provision Positive feedbck from fmilies/clients Service efficiencies through rigorous trgeting Effective cute/community service interfce Incresed direct ccess to beds P4, G1, S2: Incorporte ongoing client nd crer feedbck into the cre coordintion process Seek inititive funds of $8000 per nnum Design nonymous survey forms for clients nd for crers Consortium with project ssistnce Ongoing client nd crer [client deidentified] feedbck reported nnully to the Consortium Determine stges of cre t which surveys should be given to clients nd crers Administer Provide surveys with postge pid envelopes to neutrl recipient Compile results nd present nnully for considertion of service mngers nd the Consortium P4, G1, S3: Estblish stronger links nd reltionships with the ged cre sector nd HACC providers P4, G1, S4: Strengthen prtnerships nd reltionships with doctors: GPs nd specilists Involve ged cre nd HACC providers in holistic cre plnning nd service coordintion Provide ongoing dvice Involve GPs in holistic cre plnning nd service coordintion [i.e. s prt of the pllitive cre tem] Meet regulrly with interested GPs All gencies All gencies Coordinted, integrted cre Incresed respect of different sectors Collegility/support of helth professionls Incresed ppliction of the pllitive pproch cross gencies P4, G1, S5: Insert regulr strtegic pln implementtion updtes in the GRICS newsletter Consortium Regulr rticles to inform key stkeholders of progress Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 30

Gol P4,G2: To further system coordintion nd collbortion between gencies nd services P4, G2, S1: Ensure the development of the Gippslnd Regionl Pllitive Cre Consortium s the primry mens of service coordintion nd collbortion in the region to: Advnce service system integrtion Shre resources Minimise dupliction of effort i.e. dt gthering, leflets, publictions, stndrdised guidelines Amlgmte the Pllitive Cre Community Advisory Committee with the Consortium Develop relevnt policies nd protocols for the effective opertion of the Gippslnd Consortium Explore opportunities for shring policy development, procedures etc Prioritise, stremline nd stndrdise documenttion, dt mngement nd reporting Develop rigorous KPIs Consortium with project ssistnce s required Optimum collbortion Miniml dupliction Qulity optimised through pooling of expertise Providers in smller gencies nd communities optimlly supported Consistent regionl pproch Access to expertise not redily vilble loclly Adopt consistent stndrds Estblish sub-regionl networks of to collbortively gree cler objectives nd outcomes nd to develop strtegies tht dovetil with the Regionl Pllitive Cre Pln P4, G2, S2: Consortium to ssume responsibility for regionl pllitive cre resource determintion on the bsis of: the DHS WREN formul/resource Alloction Model Service dt Demogrphic nd Burden of Disese dt Determine principles for lloctions Anlyse dt Determine lloctions Ongoing monitoring Consortium $15,000 to stndrdise dt collection cross the region More equitble lloctions P4, G2, S3: Develop business pln/ funding & service greement for the Led Agency Role with: Cler terms of reference nd role Agreed outcomes Agreed reporting system Dedicted resources llocted in ccord with the tsks to be performed Develop MOU between Led Agency nd Consortium Consortium to llocte resources in ccord with tsks Consortium to monitor MOU Consortium / Led gency Cler nd greed role, tsks nd outcomes for Led Agency by September 2005 Accountbility for PC resources: Trgets met Accurte reporting to support lloction nd future resource lloctions P4, G2, S4: Ensure equitble distribution of regionl pllitive cre resources i.e. tht lloctions re consistent with service delivery outputs, growth, popultion distribution nd community needs Identify resource growth in Gippslnd for pllitive cre over pst 5 yers Identify the cost/impct of pllitive cre service delivery Anlyse the mix of bed-bsed nd community-bsed specilist pllitive cre services Identify pllitive cre bed dys cross the region [funded & unfunded ] Anlyse the distribution of beds nd resource lloction Consortium with project ssistnce Consultnt; pproximte ly $15,000 / Consortium / Led gency Ech hospitl to Report tht identified shortfll in funding: current nd future Accurte inptient ctivity obtined Loclly ccessible beds strtegiclly plced cross the region Equitble lloctions Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 31

for inptient services ginst need Identify the rnge of required supports for clients with complex needs Anlyse current distribution of service coordintion resources Develop pln for: Stndrdising resource lloction for beds nd community services [including distribution of dditionl beds nd, if wrrnted, existing beds, to services currently without designted, funded pllitive cre bed dys] Equitble ccess to home cre Redistribution s required to ensure equitble lloction nd to ensure, s fr s is prcticble, tht inptients beds re geogrphiclly ccessible [e.g. lest one dedicted bed in ech locl re] Implement pln provide dt Consultnt to nlyse P4, G2, S5: Mnge implementtion of the Gippslnd Regionl Pllitive Cre Pln Monthly reporting t Consortium meeting of ctions nd progress ginst timeline COMMENTS, ISSUES, SUPPORTING DATA: P4, G2, S6: Strengthen links with GRICS with minimised dupliction of effort P4, G2, S7: Strengthen links with locl PCPs nd Divisions of Generl Prctice Qurterly pprisl nd refinement of strtegies nd ctivities Conduct mid-term evlution of chievements [Mid 2007] Estblish the reltive roles of the Gippslnd Pllitive Cre Consortium nd the GRICS Executive Group/Reference Group Arrnge cross-over membership Collborte on projects nd inititives of mutul interest to minimise dupliction of effort Consortium, Gippslnd Helth Service Prtnership, GRICS Executive Group Cler roles nd terms of reference by September 2005 Cross over membership on Consortium nd GRICS Executive/Reference Group by September 2005 Minimised dupliction of effort Collbortion on projects nd inititives of mutul interest Locl gency involvement All gencies Effective interfce between pllitive cre providers nd other helth nd community services The Consortium is committed to n integrted service delivery pproch nd the enhncement of cre pthwys, s is consistent with current ntionl nd interntionl trends [See overview of current literture in Appendix 1: section 4.5]. Gol P4,G1: 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]. Mny residents, hving moved wy from their fmilies, hve few or no locl fmily supports. Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 32

Effective coordintion t the client level is vrible cross the region. Nvigtion issues cnnot be under-estimted. The system is difficult for providers to negotite, nd extremely difficult for consumers/fmilies. Models, linked to evidence, to meet current nd future needs re required. The rurl sitution, distnces nd rod conditions present undenible chllenges, nd require explortion of lterntive models. 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. A vluble resource is: Ellershw, J. & Wilkinson, S. ed. Cre of the dying: A pthwy to excellence [Oxford University press]. Sound holistic nd coordinted cre, incorporting the client nd crer s vitl prt of the cre plnning process, require ctive nd ongoing monitoring of cre ppropriteness nd client stisfction. These re best guged by routine/regulr informtion gthering t propitious stges of cre. 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 Appendix 8]. Engging GPs effectively into integrted cre, given the clinicl nd dministrtive demnds on their prctices, is n ongoing chllenge. Communiction between GPs nd other service providers cn be brrier. However, some GPs, in responding to the survey distributed s prt of development of this pln, hve suggested/requested inclusion in the core tem nd regulr meetings bout client cre. Potentil obstcles to building stronger reltionships with the ged cre sector re the differing service cultures, resources, distnce, nd the isoltion of residentil ged cre fcilities. In responding to the Service Mpping Tool, sizeble proportion of gencies indicted no or poor links withged cre services. Gol P4,G2: Committed ledership will be required to drive these strtegic priorities ctivities, s re clrifiction of the roles nd principles of opertion of the Consortium, development of KPIs, trnsprency nd ccountbility. The Consortium is well plced to monitor service usge/provision nd determine regionl resource lloction, nd concerted effort by ll to improve dt colltion nd reporting will provide the bsis for decision mking. Infrstructure nd IT support/softwre for service reporting is n ongoing issue, prticulrly for smller gencies. It is impertive for close links nd minimised dupliction of effort with GRICS. Service nd policy coordintion will be furthered through closer links with PCPs [gencies generlly reported miniml involvement with the ltter in the Service Mpping exercise: see Appendix 6] nd Divisions of Generl Prctice. In responding to the Service Mpping Tool, sizeble proportion of gencies indicted no or poor links with both Divisions of Generl Prctice nd Primry Cre Prtnerships. Principle No. 5: People with life-thretening illness nd their crers nd fmilies hve ccess to qulity services nd skilled stff to meet their needs Expected Outcomes: People with life-thretening illness nd their crers nd fmilies receive cre nd support from suitbly qulified service providers nd trined volunteers All stff nd volunteers involved in the cre of people with life-thretening illness nd their crers nd fmilies prctice the pllitive pproch People with life-thretening illness nd their crers nd fmilies receive the best cre vilble bsed on current reserch evidence REGION PRIORITIES AND STRATEGIES: PRINCIPLE NO. 5 GOALS STRATEGIES ACTIVITIES LEAD AGENCY/PERSON & RESOURCES Gol P5,G1: To ensure ccess to ppropritely skilled personnel to meet current nd future needs P5, G1, S1: Identify the skill nd support requirements in service gencies/providers, including GPs [through the Divisions of Generl Prctice], community residentil units, nd ged cre fcilities P5, G1, S2: Pln nd deliver eduction progrms tht re stndrdised, trnsprent, evidence bsed Determine required competencies Conduct n udit of the skill nd support requirements Determine gps Development of resource document for medicl prctitioners bsed on the work in Mllee Loddon Engge Divisions of Generl Prctice Identify pproprite timing, venue to meet GP needs Consortium & ll gencies with project ssistnce s required Bckfill for PC Coordintors: $120,000 per MEASURES OF SUCCESS Skill requirements identified Shred trining Required skill bse is mintined nd pproprite skills cn be ccessed Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 33

nd trnsportble for doctors [including GPs], helth workers, community hospitls, ged cre nd volunteers round deth nd dying P5, G1, S3: Identify wys in which successful trining pproches developed by individul services cn be pooled nd shred cross the region thereby developing some specilistion in trining P5, G1, S4: Access existing trining progrms [e.g. developed by Pllitive Cre Victori] where pproprite P5, G1, S5: Explore incresed use of technology [e.g. video conferencing, tele-medicine] for secondry consulttion, trining, nd support Liise with the Gippslnd Nursing Eduction Workforce Strtegy Coordintor [NEWS] Coordintor re stndrdised, trnsprent, evidenced bsed, trnsportble eduction Identify best mens of implementtion [e.g. on-line core competency components] Develop pln tht includes theory nd prctice Identify current, effective trining / development pproches nd prticulr expertise tht would be useful to others Exmine the fesibility of shring cross the region Gther informtion on existing progrms Assess them in light of locl skill udit Negotite ccess Identify trget groups nd potentil tke-up Identify mens Cost options nnum Inititive funds will be required for technologiclly bsed methodologies Recruitment of people with pproprite skills/knowledge Flexible lerning in timely nd effective mnner to meet individul needs Equitble ccess to secondry consulttion, trining nd bck-up Locl ccess to informtion mentoring P5, G1, S6: Develop system of LGA bsed clinicl supervision / mentoring to provide consulttion services to providers in outlying res, nd in generlist services Seek inititive funds: $120,000 per nnum for bckfill of PC Coordintors Determine costs i.e. EFT bckfill Expnd the existing role nd expertise of Pllitive Cre Coordintors to fcilitte support, mentoring, networking nd best prctice Evlute P5, G1, S7: Investigte opportunities for incresed content in forml tertiry trining courses Consortium / Tertiry institutions P5, G1, S8: Develop strtegies for ddressing workforce supply issues Identify current nd potentil future workforce shortflls Explore lterntive helth worker roles i.e. UK model Explore opportunities to expnd the existing role nd expertise of volunteers Consortium with project ssistnce s required Build the cpcity of other providers [e.g. home cre workers] nd volunteers, given potentil nursing shortge in the future, to provide pllition supports [e.g. with respite nd emotionl support] COMMENTS, ISSUES, SUPPORTING DATA: There re concerns bout the bility to ccess personnel with the required skills nd expertise, including multi-skilled nurses. Stff in generlist gencies nd remote res tend to be multi-skilled, hve miniml supports, nd re not lwys confident in mnging pllitive cre clients. Mintining expertise where there is intermittent demnd is n ongoing problem. Over servicing my result. Additionl demnds/chllenges for services nd stff in smller communities nd in generlist services include Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 34

role strin nd tension from the dul role of community member nd nurse. Trining ccess issues include funding, bckfill nd distnce. Technologicl dvnces [e.g. in phrmcology, pin mngement] mke mintennce of knowledge nd confidence chllenging. Development of the qulity of specilist cre t the GP nd nurse levels is priority. GPs in remote res re geing. There is some recruitment of younger GPs. Options nd experience in pllitive cre cn be limited. Principle No. 6: People with life-thretening illness nd their crers nd fmilies re supported by their communities Expected Outcomes: Communities re ble to ctively support friends, fmily, neighbours, work nd socil contcts who hve life-thretening illness nd their crers nd fmilies Community wreness of the needs of nd supports for people with life-thretening illness nd their crers nd fmilies is enhnced through community promotion nd eduction REGION PRIORITIES AND STRATEGIES: PRINCIPLE NO. 6 GOALS STRATEGIES ACTIVITIES LEAD Gol P6,G1: To develop nd mintin the input of volunteers nd the community Gol P6,G2: To provide community eduction to further cceptnce of deth nd people with end of life needs AGENCY/PERSON & RESOURCES MEASURES OF SUCCESS P6, G1, S1: Seek inititive funds for volunteer coordintion [see P3, G1, S7 bove] Thriving volunteer group P6, G1, S2: Explore opportunities to shre volunteers nd volunteer coordintion cross gencies nd use the Consortium, where fesible, s mens of pooling the mngement of volunteer recruitment nd trining P6, G1, S3: Investigte wys to mintin volunteer enthusism P6, G2, S1: Support nd develop helth promoting pllitive cre projects including relistic concept of deth project Scope nd ssess existing progrms/models Stndrdise / develop criteri for the recruitment of volunteers Estblish common policies cross the region re e.g. reimbursement of volunteer expenses Estblish pllitive cre volunteer support groups with structured ctivities Identify leders within volunteer groups Pln nd conduct mrketing progrm to promote pllitive cre culture: Educting the community nd helth professionls on sensitive issues round deth, dying nd disese Aiding normlistion of deth Rising wreness re whose responsibility cre is Identify estblished community groups to be trgeted with eduction Pln publicity/good news stories/public speking nd employ volunteers to cmpign for pllitive cre Recruit volunteer input Explore multimedi options for delivery e.g. TV, rdio, newsppers etc. Link with Ltrobe Uni H.P.P.C. Unit Consortium to estblish Pllitive Cre volunteer specil interest sub-group Consortium specil interest group Optiml volunteer nd community input in hnds on cre Shred responsibility for mintennce of pool of motivted nd skilled volunteers Incresed comfort with the relities of deth nd dying Incresing community comfort with deth t home Incresed referrl to Pllitive Cre Incresed number of volunteers Incresed stisfction for community Closer links with prtners Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 35

P6, G2, S2: Develop protocol to support, educte the community re end of life choices/issues Adopt community development pproch Access work undertken by Austin Hospitl, Box Hill Hospitl & review their Advnced Cre Progrm Contct Peter Hudson University re their booklet for community eduction Consortium Incresed knowledge nd skills Shred responsibility Fundrising / community support COMMENTS, ISSUES, SUPPORTING DATA: Gol P6,G1: Volunteers re n importnt djunct to pllitive cre provision, prticulrly in rurl res. 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. Recruitment, trining, keeping them interested, nd dy-to-dy mngement in generl re ongoing tsks. Est Gippslnd, in prticulr, is lcking supporting structure for volunteers. Some regions reimburse cr costs while in others no costs re reimbursed. Gol P6,G2: Discussing deth is not something with which Austrlin society is generlly comfortble. A prticulr need is informtion nd eduction for the community, fmilies nd clients, to fcilitte enble them to feel more comfortble nd ccepting of deth t home. Other issues include resources [time nd cost], distnce nd reluctnce to engge. Principle No. 7: Crers of people with life-thretening illness re supported by helth nd community cre providers Expected Outcomes: The helth nd wellbeing of the crer is enhnced by improved ccess to pproprite respite cre nd support services Crers re dequtely supported so they cn provide cre to the person with life-thretening illness in line with the ptient s nd crer s wishes Crers bility to nvigte the system will be strengthened through the provision of informtion bout vilble services nd supports REGION PRIORITIES AND STRATEGIES: PRINCIPLE NO. 7 GOALS STRATEGIES ACTIVITIES LEAD AGENCY/PERSON & RESOURCES MEASURES OF Gol P7,G1: To strengthen crer support Include crer needs in cre plnning [see P4, G1, S1 bove] Produce user friendly formts of vilble services nd options for clients nd fmilies/crers [see P1, G1, S3 bove] Ensure informed involvement of clients nd crers in needs ssessment, cre plnning nd service provision [see P1, G1 nd P4, G1, S1 bove] P7, G1, S1: Develop respite options COMMENTS, ISSUES, SUPPORTING DATA: Develop n option for n overnight sty by volunteers Commonwelth Crer Respite progrm UBF Develop protocols for direct dmission with written drug orders Ensure ccess to berevement supports nd services including post deth [see P3, G1, S7 bove] Consortium SUCCESS Inclusion of crer needs in cre plnning Tke-up of respite options The needs of crers nd fmilies re n inherent prt of the client s support system. This hs implictions for post deth requirements. Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 36

3.3.1 SUMMARY The strtegies nd ctivies identified bove, ddress, we believe, the priority issues in our locl service system. We hve specified chllenging yet chievble set of strtegies, projects nd inititives, the successful completion of which will enhnce our collective service cpcity nd will result in positive outcomes for our clients. Successful implementtion of this pln is relint on further collbortion nd consulttion in the region over the life of the pln [2005 2009], on support from DHS regionl personnel, nd on the commitment of CEOs to the pln nd to the completion of the vrious projects identified bove nd, in prticulr, to the estblishment nd implementtion of criteri for ccess to pllitive cre beds. Implementtion needs to be driven by the Gippslnd Reginl Pllitive Cre Consortium, with progress constntly pprised, nd the pln continuously up-dted s prt of rolling process. Lstly, successful implementtion will be relint on the ppointment of key personnel to undertke the vrious projects nd ctivities under the uspice nd stewrdship of the Consortium. The timelines for chievement of our strtegies nd ssocited ctivites follow. 3.4 IMPLEMENTATION TIMELINES TIMEFRAME FOR STRATEGIC PLANIMPLEMENTATION STRATEGIES & ACTIVITIES N.B. SHADING: GOALS; STRATEGIES; ACTIVITIES; TIMEFRAME 2005 2006 2007 2008 2009 July Oct Jn Apr July Oct Jn Apr July Oct Jn Apr July Oct Jn Apr July Oct Gol P1, G1: To ensure tht providers, people with life-thretening 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 providers so they hve more informtion bout vilble services nd supports [in hrd nd electronic formts in the first instnce] 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 [in hrd copy in the first instnce] P1, G1, S4: Produce nd distribute user friendly formts of vilble services nd options for other helth providers in the Gippslnd region [in hrd nd electronic formts in the first instnce] 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 Compile nd distribute in hrd copy in the first instnce Keep up-to-dte nd redistribute s required P1, G1, S6: Develop website for profiles of services nd expertise vilble in the region Explore the fesibility of shring website with GRICS Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 37

TIMEFRAME FOR STRATEGIC PLANIMPLEMENTATION STRATEGIES & ACTIVITIES Develop website Lod nd mintin up-to-dte regionl service informtion for providers, clients nd fmilies N.B. SHADING: GOALS; STRATEGIES; ACTIVITIES; TIMEFRAME P1, G1, S7: Ensure ll pllitive clients re wre of their rights nd the necessry processes for end of life decision mking Reserch current policies Develop regionl End of Life Decision Mking Policy Distribute to ll gencies for internl pprovl processes All providers to ensure client wreness Gol P1,G2: To ensure the ctive involvement of clients nd crers in decision mking processes 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.] Nominte Consortium representtives nd initite discussions 2005 2006 2007 2008 2009 July Oct Jn Apr July Oct Jn Apr July Oct Jn Apr July Oct Jn Apr July Oct Gol P2, G1: To ensure client nd fmily centred cre tht is holistic nd provides totl cre of the mind, body nd spirit 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? Apprise delivery ginst tenets Devise stff development mens & implementtion pln P2, G1, S2: Adopt KPIs for the region for delivery in ccord with the pllitive pproch nd to ensure complince with Pllitive Cre stndrds Develop KPIs Distribute to ll gencies for internl pprovl processes Identify eduction nd other requirements for implementtion Implement Evlute complince nd KPI impct on service delivery P2, G1, S3: Assist smller services to meet the new Pllitive Cre Stndrds Assess the requirements of smller services Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 38

TIMEFRAME FOR STRATEGIC PLANIMPLEMENTATION STRATEGIES & ACTIVITIES Identify resources nd mens of ssistnce tht lrger gencies in the region, where pproprite, cn lend Implement N.B. SHADING: GOALS; STRATEGIES; ACTIVITIES; TIMEFRAME 2005 2006 2007 2008 2009 July Oct Jn Apr July Oct Jn Apr July Oct Jn Apr July Oct Jn Apr July Oct P2, G1, S4: Develop/explore service delivery pproches tht re culturlly pproprite for indigenous Austrlins nd other culturlly nd linguisticlly diverse communities Conduct n udit of ccess by indigenous Austrlins nd other culturlly nd linguisticlly diverse communities Assess the culturlly ppropriteness of current provision models nd pproches Develop/explore service delivery pproches tht re culturlly pproprite Assess implementtion requirements P2, G1, S5: Include the Aboriginl Liison Pllitive Cre Project Worker [for Victori] to become member of the Consortium Implement P2, G1, S6: Develop more conducive physicl environments for inptient services within the cute setting Seek inititive funds of $100,00 Crete refurbishment lloction Assess redevelopment needs Allocte resources nd implement P2, G1, S7: Develop regionl privcy nd informtion protocols Develop regionl protocols to enble informtion shring nd thereby fcilitte coordintion of cre/ cre pthwys for 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 P2, G1, S8: Assist, where pproprite, other gencies [e.g. ged cre, disbility, GPs] to provide cre in ccord with the pllitive pproch 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 Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 39

TIMEFRAME FOR STRATEGIC PLANIMPLEMENTATION STRATEGIES & ACTIVITIES 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 Gol P3, G1: To fcilitte equitble ccess to specilist pllitive cre services P3, G1, S1: Estblish two dditionl beds in the region Identify pproprite bed distribution s per pln developed for P3, G1, S1 Seek inititive funds for two dditionl beds N.B. SHADING: GOALS; STRATEGIES; ACTIVITIES; TIMEFRAME 2005 2006 2007 2008 2009 July Oct Jn Apr July Oct Jn Apr July Oct Jn Apr July Oct Jn Apr July Oct P3, G1, S2: 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] Identify pproprite distribution s per pln developed for P3, G1, S1 Seek inititive funds for expnsion of the UBF by the equivlent of funding for two dditionl beds P3, G1, S3: Estblish Regionl Consulttion Service [24 hour ccess to specilist physicins] Investigte options for estblishment of Regionl Consulttion Service including: Up-skilling nd supporting GPs with n interest in PC including funding/bckfill Funding models such s MSOAP Extending the Kooweerup model of service contrct with n outer metropolitn tertiry fcility to provide 24 hour ccess to specilist physicins cross the region Determine preferred pproch Seek inititive funds for estblishment: $40,000 Implement Evlute P3, G1, S4: Achieve the role delinetion rrngements tht will best support pllitive cre cross Gippslnd Anlyse the DHS discussion pper on role delinetion [when relesed] ginst Gippslnd region needs Identify the vrious levels of service e.g: Level 3: Ltrobe Level 2: Six sites e.g. Korumburr/Leongth, WGHG, Sle, Wonthggi, Birnsdle nd Kooweerup Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 40

TIMEFRAME FOR STRATEGIC PLANIMPLEMENTATION STRATEGIES & ACTIVITIES Levels 1: All other hospitls in the region Agree position with DHS Discuss with CEOs/DONs Identify needs for chievement of role delinetion levels by end 2009 Seek development funds: Level 3: 6 sessions per week @ $25,000 per session Level 2: 4 sessions per week @ $25,000 per session Develop pln Implement P3, G1, S5: Explore options for fter hours cre models in smller communities Audit current provision Identify gps / needs Develop options/models including opportunities for tpping into existing services Identify resources required Negotite with individul gencies for provision through existing resources Implement P3, G1, S6: Ensure ccess to berevement supports nd services including post deth Audit current provision / identify gps Determine needs of bereved persons: identify rel cost Explore models for provision especilly in popultions of lesser density Develop simple, user-friendly BRAT for use region-wide to cpture t risk fmilies/friends Determine dditionl costs to gencies Develop pln Implement Seek inititive $250,000 funds for berevement nd support nd volunteer coordintion distributed on the following bsis: Bss Cost $36,285; Bw Bw $33,510; Est Gippslnd $48,530; Ltrobe $66,235; South Gippslnd $26,680; Wellington $38,760 N.B. SHADING: GOALS; STRATEGIES; ACTIVITIES; TIMEFRAME 2005 2006 2007 2008 2009 July Oct Jn Apr July Oct Jn Apr July Oct Jn Apr July Oct Jn Apr July Oct Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 41

TIMEFRAME FOR STRATEGIC PLANIMPLEMENTATION STRATEGIES & ACTIVITIES Development of core curriculum in grief nd berevement counselling in Gippslnd P3, G1, S7: Fcilitte effective pin mngement Identify provider trget group nd ssess knowledge / gps Determine pproprite mens for knowledge updtes Develop pln N.B. SHADING: GOALS; STRATEGIES; ACTIVITIES; TIMEFRAME 2005 2006 2007 2008 2009 P3, G1, S8: Develop protocols for symptom mngement in the home i.e. ccess to mediction nd orders [S4 nd S8]Implement Conduct literture serch to identify drug rrngements Develop protocols Seek endorsement of vrious mngement bodies Implement Review protocols P3, G1, S9: Ensure tht the community services re ble to directly ccess beds Develop criteri nd policy/protocols for ccess Identify those hospitls where direct ccess is not vilble Negotite chnge in rrngements Implement July Oct Jn Apr July Oct Jn Apr July Oct Jn Apr July Oct Jn Apr July Oct Gol P4, G1: To enhnce cre co-ordintion nd service ccess nd ensure tht the service system is positioned to meet current nd future client needs P4, G1, S1: Develop model[s] of coordinted cre Design models/pproches including dmission criteri, referrl processes, informtion to ccompny the client on trnsfer Assess pplicbility of the Integrted Cncer Service [ICS] Ptient Mngement Frmework [vilble in July 2005] for inclusion of relevnt spects in the ssessment processes Pilot the tools, pproch Refine Roll-out cross the region Evlute P4, G1, S2: Incorporte ongoing client nd crer feedbck into the cre coordintion process Seek inititive funds of $8000 per nnum Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 42

TIMEFRAME FOR STRATEGIC PLANIMPLEMENTATION STRATEGIES & ACTIVITIES Design nonymous survey forms for clients nd for crers Determine stges of cre t which surveys should be given to clients nd crers Administer Provide surveys with postge pid envelopes to neutrl recipient Compile results nd present nnully for considertion of service mngers nd the Consortium P4, G1, S3: Estblish stronger links nd reltionships with the ged cre sector nd HACC providers Involve ged cre nd HACC providers in holistic cre plnning nd service coordintion Provide ongoing dvice P4, G1, S4: Strengthen prtnerships nd reltionships with doctors: GPs nd specilists Involve GPs in holistic cre plnning nd service coordintion [i.e. s prt of the pllitive cre tem] Meet regulrly with interested GPs P4, G1, S5: Insert regulr strtegic pln implementtion updtes in the GRICS newsletter Gol P4,G2: To further system coordintion nd collbortion between gencies nd services N.B. SHADING: GOALS; STRATEGIES; ACTIVITIES; TIMEFRAME 2005 2006 2007 2008 2009 July Oct Jn Apr July Oct Jn Apr July Oct Jn Apr July Oct Jn Apr July Oct P4, G2, S1: Ensure the development of the Gippslnd Regionl Pllitive Cre Consortium s the primry mens of service coordintion nd collbortion in the region to dvnce service system integrtion; shre resources; nd minimise dupliction of effort i.e. dt gthering, leflets, publictions, stndrdised guidelines Amlgmte the Pllitive Cre Community Advisory Committee with the Consortium Develop relevnt policies nd protocols for the effective opertion of the Gippslnd Consortium Explore opportunities for shring policy development, procedures etc Prioritise, stremline nd stndrdise documenttion, dt mngement nd reporting Develop rigorous KPIs Adopt consistent stndrds Estblish sub-regionl networks of to collbortively gree cler objectives nd outcomes nd to develop strtegies tht dovetil with the Regionl Pllitive Cre Pln Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 43

TIMEFRAME FOR STRATEGIC PLANIMPLEMENTATION STRATEGIES & ACTIVITIES N.B. SHADING: GOALS; STRATEGIES; ACTIVITIES; TIMEFRAME 2005 2006 2007 2008 2009 July Oct Jn Apr July Oct Jn Apr July Oct Jn Apr July Oct Jn Apr July Oct P4, G2, S2: Consortium to ssume responsibility for regionl pllitive cre resource determintion on the bsis of the DHS WREN formul/resource Alloction Model; service dt; demogrphic nd Burden of Disese dt Determine principles for lloctions Anlyse dt Determine lloctions Ongoing monitoring P4, G2, S3: Develop business pln/ funding & service greement for the Led Agency Role with cler terms of reference nd role; greed outcomes; greed reporting system; dedicted resources llocted in ccord with the tsks to be performed Develop MOU between Led Agency nd Consortium Consortium to llocte resources in ccord with tsks Consortium to monitor MOU P4, G2, S4: Ensure equitble distribution of regionl pllitive cre resources i.e. tht lloctions re consistent with service delivery outputs, growth, popultion distribution nd community needs Identify resource growth in Gippslnd for pllitive cre over pst 5 yers Identify the cost/impct of pllitive cre service delivery Anlyse the mix of bed-bsed nd community-bsed specilist pllitive cre services Identify pllitive cre bed dys cross the region [funded & unfunded ] Anlyse the distribution of beds nd resource lloction for inptient services ginst need Identify the rnge of required supports for clients with complex needs Anlyse current distribution of service coordintion resources Develop pln for: Stndrdising resource lloction for beds nd community services Equitble ccess to home cre Redistribution s required to ensure equitble lloction nd to ensure, s fr s is prcticble, tht inptients beds re geogrphiclly ccessible with t lest one dedicted bed in ech locl re Implement pln P4, G2, S5: Mnge implementtion of the Gippslnd Regionl Pllitive Cre Pln Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 44

TIMEFRAME FOR STRATEGIC PLANIMPLEMENTATION STRATEGIES & ACTIVITIES Monthly reporting t Consortium meeting of ctions nd progress ginst timeline Qurterly pprisl nd refinement of strtegies nd ctivities Conduct mid-term evlution of chievements [Mid 2007] P4, G2, S6: Strengthen links with GRICS with minimised dupliction of effort Estblish the reltive roles of the Gippslnd Pllitive Cre Consortium nd the GRICS Executive Group/Reference Group Arrnge cross-over membership Collborte on projects nd inititives of mutul interest to minimise dupliction of effort P4, G2, S7: Strengthen links with locl PCPs nd Divisions of Generl Prctice Locl gency involvement Gol P5, G1: To ensure ccess to ppropritely skilled personnel to meet current nd future needs N.B. SHADING: GOALS; STRATEGIES; ACTIVITIES; TIMEFRAME 2005 2006 2007 2008 2009 July Oct Jn Apr July Oct Jn Apr July Oct Jn Apr July Oct Jn Apr July Oct P5, G1, S1: Identify the skill nd support requirements in service gencies/providers, including GPs [through the Divisions of Generl Prctice], community residentil units, nd ged cre fcilities Determine required competencies Conduct n udit of the skill nd support requirements Determine gps Development of resource document for medicl prctitioners bsed on the work in Mllee Loddon P5, G1, S2: Pln nd deliver eduction progrms tht re stndrdised, trnsprent, evidence bsed nd trnsportble for doctors [including GPs], helth workers, community hospitls, ged cre nd volunteers round deth nd dying Engge Divisions of Generl Prctice Identify pproprite timing, venue to meet GP needs Liise with the Gippslnd Nursing Eduction Workforce Strtegy Coordintor [NEWS] Coordintor re stndrdised, trnsprent, evidenced bsed, trnsportble eduction Identify best mens of implementtion [e.g. on-line core competency components] Develop pln tht includes theory nd prctice P5, G1, S3: Identify wys in which successful trining pproches developed by individul services cn be pooled nd shred cross the region thereby developing some specilistion in trining Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 45

TIMEFRAME FOR STRATEGIC PLANIMPLEMENTATION STRATEGIES & ACTIVITIES Identify current, effective trining / development pproches nd prticulr expertise tht would be useful to others Exmine the fesibility of shring cross the region P5, G1, S4: Access existing trining progrms [e.g. developed by Pllitive Cre Victori N.B. SHADING: GOALS; STRATEGIES; ACTIVITIES; TIMEFRAME 2005 2006 2007 2008 2009 July Oct Jn Apr July Oct Jn Apr July Oct Jn Apr July Oct Jn Apr July Oct P5, G1, S5: Explore incresed use of technology [e.g. video conferencing, tele-medicine] for secondry consulttion, trining, nd support Identify trget groups nd potentil tke-up Identify mens Cost options P5, G1, S6: Develop system of LGA bsed clinicl supervision / mentoring to provide consulttion services to providers in outlying res, nd in generlist services Seek inititive funds: $120,000 per nnum for bckfill of PC Coordintors Determine costs i.e. EFT bckfill Expnd the existing role nd expertise of Pllitive Cre Coordintors to fcilitte support, mentoring, networking nd best prctice Evlute P5, G1, S7: Investigte opportunities for incresed content in forml tertiry trining courses P5, G1, S8: Develop strtegies for ddressing workforce supply issues Identify current nd potentil future workforce shortflls Explore lterntive helth worker roles i.e. UK model Explore opportunities to expnd the existing role nd expertise of volunteers Build the cpcity of other providers [e.g. home cre workers] nd volunteers, given potentil nursing shortge in the future, to provide pllition supports [e.g. with respite nd emotionl support] Gol P6, G1: To develop nd mintin the input of volunteers nd the community P6, G1, S1: Seek inititive funds for volunteer coordintion [see P3, G1, S7 bove] P6, G1, S2: Explore opportunities to shre volunteers nd volunteer coordintion cross gencies nd use the Consortium, where fesible, s mens of pooling the mngement of volunteer recruitment nd trining Scope nd ssess existing progrms/models Stndrdise / develop criteri for the recruitment of volunteers Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 46

TIMEFRAME FOR STRATEGIC PLANIMPLEMENTATION STRATEGIES & ACTIVITIES Estblish common policies cross the region re e.g. reimbursement of volunteer expenses P6, G1, S3: Investigte wys to mintin volunteer enthusism Estblish pllitive cre volunteer support groups with structured ctivities Identify leders within volunteer groups N.B. SHADING: GOALS; STRATEGIES; ACTIVITIES; TIMEFRAME Gol P6,G2: To provide community eduction to further cceptnce of deth nd people with end of life needs P6, G2, S1: Support nd develop helth promoting pllitive cre projects including relistic concept of deth project Pln nd conduct mrketing progrm to promote pllitive cre culture: Educting the community nd helth professionls on sensitive issues round deth, dying nd disese Aiding normlistion of deth Rising wreness re whose responsibility cre is Identify estblished community groups to be trgeted with eduction Pln publicity/good news stories/public speking nd employ volunteers to cmpign for pllitive cre Recruit volunteer input Explore multimedi options for delivery e.g. TV, rdio, newsppers etc. Link with Ltrobe Uni H.P.P.C. Unit Adopt community development pproch P6, G2, S2: Develop protocol to support, educte the community re end of life choices/issues Access work undertken by Austin Hospitl, Box Hill Hospitl & review their Advnced Cre Progrm Contct Peter Hudson University re their booklet for community eduction Gol P7,G1: To strengthen crer support P7, G1, S1: Develop respite options Develop n option for n overnight sty by volunteers Develop protocols for direct dmission with written drug orders 2005 2006 2007 2008 2009 July Oct Jn Apr July Oct Jn Apr July Oct Jn Apr July Oct Jn Apr July Oct Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 47

4 APPENDIX 1: PALLIATIVE CARE AND THE POLICY CONTEXT 4.1 THE NATURE OF PALLIATIVE CARE The World Helth Orgniztion describes pllitive cre s follows: Pllitive cre is n pproch tht improves the qulity of life of ptients nd their fmilies fcing the problem ssocited with life-thretening illness, through the prevention nd relief of suffering by mens of erly identifiction nd impeccble ssessment nd tretment of pin nd other problems, physicl, psychosocil nd spiritul. Pllitive cre provides relief from pin nd other distressing symptoms; ffirms life nd regrds dying s norml process; intends neither to hsten or postpone deth; integrtes the psychologicl nd spiritul spects of ptient cre; offers support system to help ptients live s ctively s possible until deth; offers support system to help the fmily cope during the ptients illness nd in their own berevement; uses tem pproch to ddress the needs of ptients nd their fmilies, including berevement counselling, if indicted; will enhnce qulity of life, nd my lso positively influence the course of illness; is pplicble erly in the course of illness, in conjunction with other therpies tht re intended to prolong life, such s chemotherpy or rdition therpy, nd includes those investigtions needed to better understnd nd mnge distressing clinicl complictions. 4 Pllitive Cre Austrli (PCA) defines pllitive cre s: cre provided for person with n ctive, progressive, dvnced disese, who hs little or no prospect of cure, nd for whom the primry tretment gol is qulity of life. Pllitive cre is interdisciplinry cre, delivered by coordinted medicl, nursing, llied helth nd socil services nd integrting the physicl, psychologicl, socil nd spiritul spects of cre. 5 Pllitive cre is delivered in vrious settings including cute settings, bed-bsed pllitive cre (hospices), dy centres nd in the community. 6 of provider re identified: 4 Three ctegories Pllitive Cre Provider is medicl, nursing or llied helth professionl who provides primry cre with pllitive pproch to ptients with lifelimiting illness. A Specilist Pllitive Cre Provider is medicl, nursing or llied helth professionl recognised s specilist by n ccrediting body (or who primrily works in pllitive cre if n ccrediting body is not vilble), who provides primry or consulttive cre to ptients with lifelimiting illness A Specilist Pllitive Cre Service is service provided by cohesive interdisciplinry network of Specilist Pllitive Cre Providers. 7 World Helth Orgnistion, http://www.who.int/cncer/pllitive/en/, Mrch 2005 5 Pllitive Cre Austrli. Austrli s Future in Pllitive Cre Reserch A collbortive Approch. Scoping study to determine priorities for pllitive cre reserch in Austrli. Cnberr, Pllitive Cre Austrli, September 2002 6 Box M. Pllitive Cre Policy, Issues nd Environment. Journl of the Helth Issues Centre Inc., Summer 2003; 77:10 Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 48

Demnd for pllitive cre services in Austrli is expected to increse. Chllenges hve risen from demogrphic nd socil trends, including geing of the popultion, incresing culturl diversity, the incresing number of people who will be dignosed with nd will die of cncer, n incresing number of people with non-mlignnt conditions requiring longer periods of support, incresing numbers of single-person households nd thus fewer crers, more people presenting with incresingly complex symptoms t lter stges of their illnesses, nd chnges in consumer expecttions nd incresing wreness bout pllitive cre services. 8 Pllitive cre services hve developed in rther d hoc wy in Austrli nd overses, 9 nd hve continued to evolve nd chnge in Victori nd the ntion over the lst few decdes. 4.2 SOCIAL HEALTH AND HEALTH PROMOTION FRAMEWORKS Contemporry models of pllitive cre incorporte two mjor frmeworks, socil helth nd helth promotion, nd their ssocited principles. 4.2.1 SOCIAL HEALTH A socil helth pproch combines popultion helth perspective for ddressing the helth of identified popultions through developing nd strengthening communities, nd primry helth cre perspective tht seeks to protect nd promote the helth of defined communities nd to ddress individul nd popultion helth problems t n erly stge. 10 7 Pllitive Cre Austrli, op.cit., 2002 8 Ibid. 9 Currow D.C. & Nightingle E.M. A plnning guide: Developing consensus document for pllitive cre service provision. Med J Aust 2003; 179 (6 Suppl): S23-S25 10 Commonwelth Deprtment of Helth nd Fmily Services, Austrlin Helth Ministers Council, 1998 A core spect of socil helth is n holistic pproch to the individul nd their qulity of life tht recognises nd ddresses the individul s physicl, socil, emotionl, psychologicl nd spiritul needs nd their inter-reltionships. Pllitive cre trditionlly covers brod spectrum of interventions directed towrds people with life-limiting illness tht significntly interferes with their cognitive, emotionl or socil bilities. In the socil helth context, intervention my lso refer to the rnge of ctivities undertken to meliorte ssocited distress. These my include nturl therpies, counselling nd self help groups. Services re provided through rnge of public nd privte prctitioners either independently or in collbortion. Incresing evidence exists to indicte tht certin forms of tretment for pllitive cre re more effective thn others. A socil view of helth sets wider prmeters for pllitive cre providing frmework for n improved response to the identified needs of people nd locl communities through process of greter collbortion. Coordinted cre tht is holistic nd client centred is hllmrk of good prctice. Johnson & Lehy identified the following fetures of holistic, client-centred coordinted cre: Cler points of entry to the service system Minimising the sources of holistic needs ssessment nd support plnning Simple, consumer-friendly processes within frme of reference of the client functioning in multiple communities nd systems 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 Brod (ll relevnt life domins) nd rigorous ssessment with continuous re-ssessment of the client s idiosyncrtic needs nd circumstnces (s opposed to the needs of workers or gencies) Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 49

Detiled support plnning (cross ll relevnt life domins) with continuous monitoring, review, relignment nd optiml semless support/integrtion (of cute cre/tretment, disbility supports, institutionl nd community bsed cre, minstrem/generic ccess, contingency/crisis rrngements, personl network development, nd crer support) Inter-disciplinry nd inter-sectorl collbortion Prtnerships between nd locl coordintion of primry nd specilist service/support delivery, primry cre services, privte providers, clients nd crers Minimising client cpture through choice, encourgement to seek lterntives, nd ssisting clients to select supports, rrngements nd lifestyle options (beyond the worker s profession, skills nd gency menu) tht re flexible, tilored, innovtive, client gol directed, purposeful nd monitored Flexible nd cost-effective support sourcing (including brokerge) Detiled nd rigorous prctice, IT, nd other systems to ensure the linkges nd synergy necessry for system efficiency, effectiveness, consistency, nd equity 11 These fetures re pplicble to high qulity pllitive cre service systems. 4.2.2 HEALTH PROMOTION Helth promotion hs been defined s []n ctive process of disese prevention encompssing eductionl components, including individul nd group chnge nd socil influence techniques which, together with environmentl, legisltive nd orgnistionl intervention, mke up rnge of strtegies for better helth. 12 The Ottw Chrter for helth promotion sttes tht [h]elth promotion is the process of enbling people to increse control over, nd to improve, their helth. To rech stte of complete physicl, mentl nd socil well being n individul or group must be ble to identify nd relise spirtions, to stisfy needs nd to chnge or cope with the environment. 13 The Ottw Chrter outlines five specific gols for helth promotion ction under the new public helth. These re: Developing helthy public policy Developing personl skills Strengthening community ction Creting supportive environments Reorienting helth services The vlue of pllitive cre s vehicle of helth promotion hs been strongly promoted in some res but needs further considertion. 14 4.2.3 QUALITY OF LIFE An importnt element of how people vlue their lives which hs gined in recognition in recent yers is qulity of life. It is rgued tht qulity of life judgements cn be mde properly only by the individul. Qulity of life my be defined quite differently by different people. This is significnt with respect to helth promotion pproch tht emphsises the importnce of enbling people to mke the decisions bout their own qulity of life, rther thn imposing 11 Colleen Johnson Consulting nd Robert Lehy Consulting, Brwon South-West Region Mentl Helth Services Strtegic Service Pln, Victorin Deprtment of Humn Services, 2000 12 Egger, G. Sprks, R. & Lwson, J. Helth Promotion Strtegies nd Methods. Austrli, McGrw-Hill Book Compny, 1992 13 World Helth Orgnistion. The Ottw Chrter for Helth promotion. Genev, Interntionl CoWorld Helth Orgnistion, 1986 14 Kelleher A. Helth Promoting Pllitive Cre. OUP,1999 Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 50

judgements on them. This is philosophicl element in ny considertion of helth nd helth promotion ctivities. Physicl helth is not necessrily positive end in itself. Indeed, the Ottw Chrter for Helth Promotion sttes tht Helth is resource for everydy life, not the objective of living. 15 The extent to which people vlue their helth depends on how they feel bout their life s whole. This hs been described s sking helth for wht? 16 4.3 THE NATIONALPALLIATIVE CARE STRATEGY In October 2000 the Austrlin Helth Ministers' Advisory Council endorsed the Ntionl Pllitive Cre Strtegy. The Strtegy is prtnership between the Austrlin Government, Stte nd Territory governments, pllitive cre service providers nd community-bsed orgnistions cross Austrli, nd guides the development nd implementtion of pllitive cre policies, strtegies nd services tht re consistent cross Austrli, nd the delivery of qulity pllitive cre tht is ccessible to ll people who re dying. 17 It ims [t]o develop nd implement pllitive cre policies, strtegies nd services tht re consistent cross Austrli, nd the delivery of qulity pllitive cre tht is ccessible to ll people who re dying, nd hs three gols: Awreness nd understnding: To improve community nd professionl wreness nd understnding of, nd professionl commitment to, the role of pllitive cre prctices in supporting the cre needs of people who re dying nd their fmilies of cre Qulity nd effectiveness: To support continuous improvement in the qulity nd effectiveness of ll pllitive cre service delivery cross Austrli Prtnerships in cre: To promote nd support prtnerships in the provision of cre for people who re dying nd their fmilies, nd the infrstructure for tht cre, to support delivery of high qulity, effective pllitive cre cross ll settings 18 Commonwelth funding of $201.2 million hs been llocted over the five yers of the Austrlin Helth Cre Agreements (2003-2008) for pllitive cre. Of this, $188 million is brodly llocted on per cpit bsis to Sttes nd Territories for continued service provision, nd $13.2 million for the Commonwelth Government to implement ntionl progrm of inititives. In ddition to this funding, the Federl Government lso committed $55 million over four yers in the 2002 Federl budget for ntionl ctivities to support improvements in the stndrd of pllitive cre offered in locl communities. Funding for ntionl ctivities, known s the Ntionl Pllitive Cre Progrm, is being implemented cross the following six brod priority res: Provision of n expnded rnge of medictions for pllitive cre in the community Assistnce for fmilies nd incresed support to other cre networks Eduction, trining nd support for the primry cre workforce Incresing the rnge nd rech of pllitive cre services Cpcity building in the pllitive cre reserch community Performnce informtion development 4.4 THE VICTORIAN GOVERNMENT PALLIATIVE CARE PROGRAM 15 World Helth Orgnistiion, op.cit., 1986 16 Mrsick, V. proctive lerning in primry helth cre: n dult eduction model, Interntionl Journl of Lifelong Eduction, 7(2), 12.2 1998 17 http://www.helth.gov.u/internet/wcms/publishing.nsf/content/pllitivecrestrtegy.htm The Victorin Government continues to support pllitive cre with incresed funding to the sector. The Lbor Prty s Helthy Communities policy sttes tht 18 Ibid. Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 51

it will ensure policy, plnning nd funding reflect current nd future pllitive needs nd ppropritely distribute bed-bsed services while creting more effective nd efficient links between hospitls nd other pllitive cre services. 19 The Deprtment of Humn Services provides funds for specilist pllitive cre services cross the Stte of Victori in both inptient nd community settings through the Pllitive Cre Progrm. These specilist services ddress specific issues such s the mngement of pin nd other symptoms ssocited with terminl illness nd to provide psychologicl, socil nd spiritul support where required or if requested. Acdemic positions nd clinicl trining positions re lso funded. Current service provision development in Victori is lrgely bsed on the work of the 1993 Ministeril Tsk Force on pllitive cre. 20 The Pllitive Cre Progrm ims to chieve n integrted service cross ll spects of cre, nd is supported by the following underlying principles: Cre is holistic, multidisciplinry nd client-centred Cre includes medicl, nursing, llied helth nd volunteer services Support is provided for fmilies nd friends, including grief nd berevement support Ptients cn mke informed choices bout their cre including the type of cre nd where the cre is delivered Service delivery is semless between the loctions where cre is delivered, whether tht be in the community or in helth cre fcility informs the bsis on which future funding will be llocted. The tble below summrises the key components of the pln. The policy stresses tht integrtion of services is fundmentl to chieving the idel service system. A key pltform is the estblishment of regionl consorti of specilist pllitive cre providers to further the integrtion of cre cross the service system. The pllitive cre consorti will hve four mjor roles within their geogrphic re: Regionl service plnning nd implementing plnned service development priorities following pprovl by the Deprtment of Humn Services Designting clerly defined roles for hospitls within the region to ensure consistent ccess to specilist pllitive cre services Developing nd implementing processes nd systems for coordinted nd integrted cre for people with life-thretening illness Determining priorities for future service development nd funding in conjunction with deprtmentl stff to support the further implementtion of the regionl plns. 22 The Consorti nd the Deprtment will gree on priorities for new funding inititives within ech region. DHS relesed mjor policy document, Strengthening pllitive cre A policy for helth nd community cre providers 2004 09, in October 2004. 21 The policy provides the frmework for pllitive cre service delivery in Victori, nd 19 Box, op.cit., 2002 20 Deprtment of Humn Services, Victori. Strtegic Frmework Issues Pper, September 2003 21 Strengthening pllitive cre. A policy for helth nd community cre providers 2004 09. Continuing Cre Unit, Progrms Brnch, Metropolitn Helth nd Aged Cre Services Division, Victorin Government Deprtment of Humn Services, October 2004 22 Ibid, p. 4 Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 52

CORE COMPONENTS: STRENGTHENING PALLIATIVE CARE. A POLICY FOR HEALTH AND COMMUNITY CARE PROVIDERS 2004 09 23 All Victorins with progressive life-thretening illness nd their fmilies nd crers will hve ccess to high qulity service system which fosters innovtion nd provides coordinted cre nd support tht is responsive to their needs VISION POLICY AIMS To strengthen service delivery for people with life-thretening illness nd their crers nd fmily through: Improving the equity of ccess to specilist pllitive cre services for people with life-thretening illness Building effective nd efficient links between hospitls nd specilist pllitive cre services Building effective nd efficient links between specilist pllitive cre services nd other relevnt community, helth nd llied helth providers, including disbility services nd residentil ged cre EXPECTED POLICY OUTCOMES All ptients with life-thretening illness nd their fmilies nd crers will hve ccess to cre pproprite to their needs, wherever they live in Victori, through regionl integrted pllitive cre service systems People with life-thretening illness nd their crers nd fmilies will be provided with semless, qulity cre by cre providers using common protocols, service tools nd policies within ech integrted pllitive cre service system People with life-thretening illnesses nd complex needs will hve pproprite nd timely ccess to specilist pllitive cre services through direct cre or in-rech nd consultncy services no mtter where they live in Victori PRINCIPLES 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 hve cre tht is underpinned by the pllitive pproch hve ccess to specilist pllitive cre services when required GUIDING PRINCIPLES 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 needs 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 Ptients with life-thretening illness nd complex needs hve pproprite nd timely ccess to specilist pllitive cre through n integrted service system All crers nd fmily members ssessed with complex grief nd berevement re provided with informtion bout nd ccess to pproprite counselling nd support 23 Ibid, summrised from pp. 3-7 Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 53

hve tretment nd cre tht is coordinted nd integrted cross ll settings hve ccess to qulity services nd skilled stff to meet their needs re supported by their communities Crers of people with life-thretening illness re supported by helth nd community cre providers Services re coordinted in the best wy to meet the needs of people with life-thretening illness nd their crers nd fmilies. People with life-thretening illness will be ble to clerly identify the key professionl contct in the provision of their cre People with life-thretening illness nd their crers nd fmilies receive cre nd support from suitbly qulified service providers nd trined volunteers All stff nd volunteers involved in the cre of people with life-thretening illness nd their crers nd fmilies prctice the pllitive pproch. People with life-thretening illness nd their crers nd fmilies receive the best cre vilble bsed on current reserch evidence Communities re ble to ctively support friends, fmily, neighbours, work nd socil contcts who hve life-thretening illness nd their crers nd fmilies Community wreness of the needs of nd supports for people with life-thretening illness nd their crers nd fmilies is enhnced through community promotion nd eduction The helth nd wellbeing of the crer is enhnced by improved ccess to pproprite respite cre nd support services Crers re dequtely supported so they cn provide cre to the person with life-thretening illness in line with the ptient s nd crer s wishes Crers bility to nvigte the system will be strengthened through the provision of informtion bout vilble services nd supports STRATEGIES In plnning cre for people with life-thretening illness nd their crers nd fmilies, the idel service system needs to ensure: The helth nd residentil cre workforce prctises the pllitive pproch There is equitble ccess to level of specilist pllitive cre cross the stte The mix of bed-bsed nd community-bsed specilist pllitive cre services is pproprite Cre nd referrl pthwys re clerly defined nd options re identified. Communiction strtegies ensure generl prctitioners, community cre providers nd other heth providers re fully informed of, nd ble to prticipte in, the cre pln for ptients under their cre Effective nd efficient links exist between hospitls nd community services Sufficient numbers of ppropritely trined specilist pllitive cre providers re vilble to provide cre cross region. Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 54

4.5 OVERVIEW OF CURRENT LITERATURE AND RESEARCH Sunders summrises the development of pllitive cre thus: An encounter with one ptient in 1948 ws the ctlyst for the Hospice Movement. The chllenge to undertke pproprite pin nd symptom control together with experience in further listening to ptients in the smll number of homes especilly plnned for dying people, finlly cme together during the 1960s s the impetus for the first modern hospice which opened in 1967. Since then, pllitive cre hs been developing worldwide nd hs shown tht the bsic principles demonstrted in those erly yers cn be interpreted in vrious cultures nd with different levels of resources. Symptom control by multiprofessionl tem bcked by reserch nd eduction of both professionls nd public hs spred both into home cre nd into generl hospitls. The fmily is seen s the unit of cre s it finds its own potentil, serches for mening nd mkes the chievements possible t the end of life. 24 Corner rgues tht the bsic tenets underlying pllitive cre pproches need mjor rethink: The discourse surrounding cncer is tht of wrfre nd of militristic endevour imed t helping those with the disese survive [T]he biomedicl response to cncer nd its tretment hs estblished pproches which neglect the more dy to dy experiences of people living with the disese, nd the suffering, disbility nd distress tht it cuses. A rdicl reconstruction of the culture surrounding cncer is clled for, so tht new environment of cre might be offered. This should be more prticiptory, collbortive nd empowering of people with cncer nd their fmilies. It should lso shift the dominnt theme in cncer mngement from 'survivl' to the here nd now, nd to the needs nd problems people hve. An rgument is mde for the contribution tht nursing might mke to such reconstruction through developing new pproches to symptom nd problem mngement, [nd] reorgnising cncer services so tht they re more supportive nd ptient focused 25 A rnge of needs is identified in current literture. Mny studies stress the importnce of due recognition of socil nd psychoemotionl issues. One describes pllitive cre requirements s philosophy of cre tht recognizes the ptients' inherent worth s humn beings nd their uniqueness s individuls. "Doing the best" includes respecting utonomy through gentle truth-telling, helping the ptient nd fmily to set tretment gols, nd providing for symptom control, continuing ttentive cre nd ccompniment throughout the course of the illness. Totl cre includes physicl, emotionl nd spiritul spects, is sensitive to culturl vlues nd is best provided by n interdisciplinry tem. 26 A study of ptient ctivity in hospice nd in n oncologicl unit showed tht being ptient, especilly in the ltter, ppered very lonely experience with limited socil interction nd purposeful ctivity. Nursing cre ws minly relted to 'doing' rther thn 'being' [i.e. nurses most often hd some tsk to ccomplish when with ptients]. The study emphsizes the importnce of incresing understnding of the use of time nd the combintion of doing nd being s good nursing cre of the dying. 27 It is climed tht psycho-oncology is underdeveloped in Austrli, nd tht there is scope for substntil growth in preventive nd supportive work, through 25 Corner J. Inugurl lecture. Nursing nd the counter culture for cncer in Eur J Cncer Cre (Engl). 6(3):174-81, Sep 1997 26 Ltimer E.J. Ethicl cre t the end of life in CMAJ, 30; 158(13):1741-7, Jun 1998 24 Sunders, C. The evolution of pllitive cre in Ptient Educ Couns. 41(1):7-13, Aug 2000 27 Rsmussen B.H & Sndmn P.O. How ptients spend their time in hospice nd in n oncologicl unit in J Adv Nurs, 28(4):818-28, Oct 1998 Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 55

interventions for existentil issues, coping issues, nxiety nd depression. Individul nd fmily-centred cre is seen s priorities in this context. 28 There is strong theme in the literture, s one would expect, on the control of pin nd other symptoms. Aulbert rgues tht freeing sick people nd emncipting them from pin nd unendurble symptoms is one of the conditions tht sick nd dying people need most nd s one of the principl functions of pllitive cre, together with the chievement of the best qulity of life for ptients nd their fmilies. He sees psychosocil, socil nd spiritul problems s prmount. Psychosocil support plys vitl role in the ssessment nd tretment of nxiety nd depression in ptients with dvnced illness. Approprite intervention of psychosocil distress in ptients nd fmilies cn ese the fmily berevement period. It cn lso decrese occuptionl stress nd burnout in the professionl cregivers. One is the prevention nd control of distressing symptoms. Aulbert lso rgues tht control of pin nd other symptoms needs to occur in the totl cre of body, mind nd spirit. 29 A similr theme is dopted by Elliott, who rgues tht: Pin control t the end of life is lmost lwys chievble regrdless of the cuse Pin ssessment is the most importnt step towrd chieving optiml nlgesi. A comprehensive pproch tht integrtes ptient preferences nd mngement of psychosocil nd spiritul/existentil components of the ptient's pin nd suffering with physicl components will improve nlgesi, reduce the burden of the illness nd its tretment, nd improve the ptient's qulity of life. 30 Further, Bostrom et. l conclude tht pin mngement requires multidimensionl pproch. Their study imed to determine ptients' experiences of cre relted to pin mngement nd to discover possible correltions between pin control nd other spects of cre. The ptients in tht study experienced sttisticlly significnt (P < 0.01) improvement in cre fter being referred to pllitive cre, despite pin control not hving been optimized. Ptients' description of 'pin control' hd sttisticlly significnt correltion with their 'feeling of security' nd 'continuity of cre' throughout the sme period. The conclusion is tht cre provided in PC is vitl to successful pin mngement. Pin control depends not only on nlgesics but lso on mny other spects of cre provided by the nurse. Continuity of cre nd the opportunity to tlk increses the ptients' feeling of security, which is lso of utmost importnce to successful pin mngement. 31 Tierney et. l looked t subjective mesures of cre mong hospice ptients, with the im of ssessing the reltionships between hospice ptients' physicl nd psychologicl symptoms, qulity of life, nd stisfction with inptient cre. They concluded tht stisfction with hospice cre ws ssocited with qulity of life more thn symptoms, lthough symptoms becme importnt lter during inptient stys. 32 Kristjnson et. l rgue for ttention to the needs of the fmilies of ptients, nd emphsise the need for systems pproch to fmily cre. Fmilies of ptients receiving pllitive cre re profoundly ffected by the chllenges of the illness. They observe cre tht the ptient receives, provide cre for the ptient, nd receive support from helth professionls in the form of informtion, counselling, or prcticl ssistnce. As they witness nd prticipte in the ptient's cre, they judge the qulity of cre tht the ptient receives. They often see themselves s the ptient's cre dvoctes nd my hrbour regret nd guilt if they believe tht the ptient did not hve the best possible cre. 28 Kissne D.W. & Smith G.C. Consulttion-liison psychitry in n Austrlin oncology unit in Aust N Z J Psychitry, 30(3):397-404, June 1996 29 Aulbert E. Principles of symptom control in pllitive medicine [Article in Germn] in Zentrlbl Chir, 123(6):632-6, 1998 30 Elliott T.E. Pin control t the end of life in Minn Med. 80(11):27-32, Nov1997 31 Bostrom B, Sndh M, Lundberg D, Fridlund B. Cncer ptients' experiences of cre relted to pin mngement before nd fter pllitive cre referrl in Eur J Cncer Cre (Engl), 13(3):238-45, July 2004 32 Tierney R.M., Horton S.M., Hnnn T.J., Tierney W.M. Reltionships between symptom relief, qulity of life, nd stisfction with hospice cre in Pllit Med, 12(5):333-44, Sep 1998 Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 56

The illness experience profoundly ffects fmily members' psychologicl nd physicl helth; recognition of this hs coined the term "hidden ptients." 33 A study of the culture-specific pllitive cre needs of ethnic minority ptients ttending dy-cre centre, found tht the ptients expressed bsic humn needs rther thn culture-specific ones nd tht cculturtion, where ptients 'fit in' with the dominnt culture, ws predominnt. The uthors rgue therefore tht stereotypicl culturl cre my not lwys be pproprite, s micro-cultures nd individul diversity within cultures exist. 34 Athlin et. l stress the need for cre continuity, which they rgue is optimlly delivered by primry nursing system in tem setting. Phenomen relting to the philosophy of primry nursing nd the hospice movement (continuity; closeness; ccountbility 24 h/dy; individulized cre; stisfied physicl, psychologicl, socil, nd spiritul needs; nd support to reltives) were experienced by the reltives, nurses, nd physicin s "good cre." 35 4.5.1 OTHER PALLIATIVE CARE APPROACHES Other studies nd rticles focus on prticulr pproches, services or interventions. One explored the experiences of terminlly ill ptients tking prt in n exhibition of their cretive rts work in the St Christopher's Hospice dy centre in London, which ims to fcilitte n environment in which rnge of socil nd cretive opportunities is offered following the theoreticl bckground of Mslow's nd Rogers' theories of personl growth nd cretivity. 33 Kristjnson LJ, Aoun S. Pllitive cre for fmilies: remembering the hidden ptients in Cn J Psychitry, 49(6):359-65, June 2004 34 Diver F., Molssiotis A., Weeks L. The pllitive cre needs of ethnic minority ptients ttending dy-cre centre: qulittive study in Int J Pllit Nursing, 9(9):389-96, Sep 2003 35 Furker, E., Jnsson, C., Norberg, L.A. Appliction of primry nursing within tem setting in the hospice cre of cncer ptients in Cncer Nursing, 16(5):388-97, Oct 1993 Anlysis identified the min themes s enjoyment, enthusism, excitement, pride, chievement, stisfction, sense of purpose, mutul support nd permnence. These themes were interpreted s positive expressions of self-esteem, utonomy, socil integrtion nd hope. It is suggested tht it ws possible to identify hope s the essence of the phenomenon, nd tht this is importnt in pllitive cre where trditionlly continution of ctive medicl intervention hs been equted with provision of hope. 36 Lngley-Evns nd Pyne conducted n ethnogrphic investigtion of pllitive dy cre unit with the im of exploring communiction processes mongst ptients with terminl disese in n 'open wreness' context. Anlysis of the dt showed tht ptients redily tlked bout cncer, illness nd deth in the dy cre environment. Five themes were identified in the content of such 'deth tlk': tlk bout illness, symptoms nd tretment, stories bout illness nd deth, tlk bout ptient deths, tlk regrding berevement, nd tlk concerning personl mortlity. In ddition to content, it is mintined tht the form of the ptients' tlk is pertinent to n understnding of the discursive context of pllitive dy cre. It is proposed tht the light-herted nd humorous nture of ptient 'deth tlk' serves n importnt psychologicl function in llowing ptients to distnce themselves from their own deths whilst simultneously permitting n cknowledgement of their terminl condition. This suggests tht the provision of n pproprite 'socil' environment for ptients with terminl disese my be s importnt to ptients s one-to-one counselling by clinicl nurse specilists. 37 Results of studies of the use of mssge, complementry therpies, hypnotherpy nd music hve been published. A rndom, controlled pilot study ws crried out to exmine the effects of djunctive romtherpy mssge on mood, qulity of life nd physicl symptoms in ptients with cncer. Mood, physicl symptoms nd qulity of life 36 Kennett C.E. Prticiption in cretive rts project cn foster hope in hospice dy centre in Pllit Med, 14(5):419-25, Sep 2000 37 Lngley-Evns A, Pyne S. Light-herted deth tlk in pllitive dy cre context in J Adv Nursing, 26(6):1091-7, Dec 1997 Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 57

improved in both groups with no sttisticlly significnt difference between groups in ny of the outcome mesures. Despite lck of mesurble benefit, ll ptients were stisfied with the romtherpy nd wished to continue. 38 Hypnotherpy offered to 256 pllitive cre outptients in hospice dy cre setting over 2.5 yer period resulted in 61% reporting improved coping with their illness, nd 7% reporting hrmful or negtive effects. Amongst those whose coping ws unchnged, mny found the therpy plesnt experience. 85% of respondents ppended positive comments to their questionnire returns. The reserchers conclude tht [d]espite the limittions of retrospective questionnire, our findings suggest tht hypnotherpy, used within strict guidelines in ptients with dvnced cncer, is sfe complementry therpy to enhnce coping. 39 Iglesis ddresses the use of hypnoticlly fcilitted therpy in the mngement of intrctble pin, nuse, nd vomiting in 3 end-stge, terminlly ill cncer ptients, finding tht []fter 6 sessions grounded in the principles of Existentil Psychotherpy, the intrctble sttus of the physicl symptomtology remitted, nd the ptients responded to medicl mngement. 40 Clements-Cortes discusses the role of music therpy in pllitive cre nd the function music plys in ccessing emotion. Techniques used in ssisting clients to express their thoughts nd feelings re described, nd cse exmples of three pllitive cre clients t Bycrest Centre for Geritric Cre re presented. Clements-Cortes sttes tht [t]he gols set for these ptients were to decrese depressive symptoms nd socil isoltion, increse communiction nd self- expression, stimulte reminiscence nd life review, nd enhnce relxtion. The clients were ll successful in reching their individul gols. 41 O'Cllghn nd McDermott investigted the relevnce of music therpy i.e. wht did the music therpy do nd did it help? Fifty-seven percent of the ptients who prticipted hd dvnced or end stge cncer. The reserchers stte tht [m]ny ptients', visitors' nd stff members' ffective, contempltive, nd imgined moments in music therpy ffirmed their "liveness," resonting with n expnded consciousness, in context where life's vulnerbility is constntly pprent. 42 Geisler hs compiled n overview of compnion-niml-ssocited medicl reserch nd ptient stories tht illustrte the roles of compnion nimls in end-of-life cre, concluding tht: Reserch hs shown tht compnion niml or pet cn help person better cope with stressful life events, prevent loneliness, decrese depression, improve ctivities of dily living (ADLs), nd increse socil interctions. Pets in nursing homes hve been ssocited with decresed psychotropic mediction usge nd greter thn 50 percent reduction in helthcre costs. Despite reserch in other res of helthcre, there is limited dt concerning the use of compnion nimls in pllitive cre. 43 38 Wilcock A. et. l Does romtherpy mssge benefit ptients with cncer ttending specilist pllitive cre dy centre? in Pllit Med, 18(4):287-90, My 2004 39 Finly I.G. & Jones O.L. Hypnotherpy in pllitive cre in J R Soc Med, 89(9):493-6, Sep 1996 40 Iglesis A. Hypnosis nd existentil psychotherpy with end-stge terminlly ill ptients in Am J Clin Hypn, 46(3):201-13, Jn 2004 41 Clements-Cortes A. The use of music in fcilitting emotionl expression in the terminlly ill in Am J Hosp Pllit Cre, 21(4):255-60, Jul-Aug 2004 42 O'Cllghn C. & McDermott F. Music therpy's relevnce in cncer hospitl reserched through constructivist lens in J Music The, 41(2):151-85, Summer 2004 43 Geisler A.M. Compnion nimls in pllitive cre: stories from the bedside in Am J Hosp Pllit Cre, 21(4):285-8, Jul-Aug 2004 Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 58

5 APPENDIX 2: DEMOGRAPHIC AND SOCIAL PROFILE 5.1 OVERVIEW This summry provides n overview of Gippslnd s demogrphic nd socioeconomic profiles. The Demogrphic Profile relies lrgely on the Austrlin Bureu of Sttistics 2001 Census (ABS) popultion dt. 44 5.2 REGIONAL OVERVIEW The Gippslnd 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. It includes the populr tourist destintions of Phillip Islnd, the Gippslnd Lkes nd Wilson s Promontory, the Ltrobe Vlley which is well known for the electricity genertion industry, nd dirying frming districts. Mjor centres in the Gippslnd region include Trrlgon, Moe, Morwell nd Wrrgul. The estimted resident popultion of Gippslnd on June 30th 2003 ws 162,424 persons. 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 44 A census is n pproximtely comprehensive dt collection ctivity using highly stndrd set of questions. Since it ttempts to be comprehensive it is (idelly) not subject to smpling error nd therefore dt cn be reported without stndrd error estimtes. In terms of the ntionl census, while it offers the potentil for comprisons overtime, chnges in definitions nd methodology cn mke this problemtic, especilly for the more complex vribles. The denomintor for census is pproximtely the whole popultion s compred with those who hve hd certin experience or used certin service (registers), or smple (surveys). growth, nd the rurl hinterlnd to the est experiencing popultion decline. The future of the Gippslnd region is strongly relted to proximity to metropolitn Melbourne in the west, prospects for economic nd employment growth in the Ltrobe Vlley, nd tourist growth in costl nd mountin regions to the south nd est. In the ten yers from 1991, the popultion of Gippslnd incresed from 155,674 to 159,510 people in 2001, which ws n verge nnul increse of 0.24 per cent, compred with 0.84 per cent verge nnul growth rte for Victori nd 0.53 per cent for regionl Victori. The estimted resident popultion of the Gippslnd region is projected to increse from 159,510 people in 2001 to 195,392 people by 2031 [n increse of 35,882 people], equting to n verge nnul increse of 0.68 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. Nturl decrese (births minus deths) will ccount for n pproximte decrese of 1,497 persons over this period, while net migrtion, mostly within regionl Victori nd from djcent municiplities, will ccount for n pproximte increse of 34,385 persons. In 2001, the proportion of people in Gippslnd ged 60 yers or more ws 19.7 per cent, compred with 17.3 per cent in Victori nd 19.5 per cent in regionl Victori. In the period to 2031, this ge group is expected to increse by 973,244 persons in Victori [to 29.0 per cent of the popultion], of whom 345,459 persons will be in regionl Victori [to 35.9 per cent of the popultion], nd 45,920 in Gippslnd Region [bringing this ge group to 39.6 per cent of the Gippslnd popultion]. Tht is, numbers of those ged 60 yers nd over will more thn double from 2001 to 2031. Household growth is lso expected to be strong in the sme period s verge household sizes decline stedily. The totl number of households in Gippslnd is projected to increse from 64,843 households in 2001 to 93,587 households Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 59

in 2031 [n increse of 29,655 households], compred with projected increse of 885,577 households for Victori, nd 258,916 households in regionl Victori over the sme period. The verge household size is 2.495. 45 DEPARTMENT OF HUMAN SERVICES REGIONS Gippslnd hs six locl government res: Bss Cost Shire Bw Bw Shire Est Gippslnd Shire Ltrobe City South Gippslnd Shire Wellington Shire 5.3 GEOGRAPHICAL AND ENVIRONMENTAL DATA 5.3.1 BASS COAST SHIRE Bss Cost is locted 120 kilometres south-est of Melbourne nd covers n re of 859 squre kilometres. The three lrgest employment sectors include griculture, mnufcturing nd retil trde. Mjor centres include Wonthggi, Cowes nd Inverloch. The shire is mjor holidy nd retirement re for both the Melbourne nd Gippslnd regions, with Phillip Islnd mjor focus. http://www.dhs.vic.gov.u/regionl/hume/mps THE REGION The estimted resident popultion of Bss Cost on June 30th 2003 ws 27,650 persons. In the ten yers from 1991, the popultion of Bss Cost incresed from 20,150 to 25,631 people, which ws n verge nnul increse of 2.44 per cent, compred with 0.84 per cent verge nnul growth rte for Victori nd 0.53 per cent for regionl Victori. http://www.dhs.vic.gov.u/regionl/gipps/mps/shire.htm 45 Victori in Future 2004, Deprtment of Sustinbility nd Environment Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 60

nd 0.79 per cent in regionl Victori over the sme period. Nturl decrese (births minus deths) will ccount for n pproximte decrese of 2,052 persons, while net migrtion, mostly within regionl Victori nd to or from djcent municiplities, will ccount for n pproximte increse of 21,800. Popultion growth in Bss Cost will be driven by the desire to live nd retire in costl res tht re reltively close to Melbourne. In 2001, the proportion of people in Bss Cost ged 60 yers or more ws 28.6 per cent, compred with 17.3 per cent in Victori nd 19.5 per cent in regionl Victori. In the period to 2031, this ge group is expected to increse by 973,244 persons in Victori [to 29.0 per cent of the popultion], of whom 345,459 persons will be in regionl Victori [to 35.9 per cent of the popultion], nd 11,105 in the Bss Cost [bringing this ge group to 40.6 per cent of the locl popultion]. The totl number of households in Bss Cost is projected to increse from 11,330 households in 2001 to 22,787 households in 2031 [n increse of 11,457 households], compred with projected increse of 885,577 households for Victori, nd 258,916 households in regionl Victori over the sme period. 46 5.3.2 BAW BAW SHIRE The shire is predominntly rurl-bsed with rich horticulturl, dirying nd forestry res. It is mjor exurbn growth re for the south-estern suburbs of Melbourne, the focus of which is on Drouin nd Wrrgul. The estimted resident popultion of Bw Bw on June 30th 2003 ws 37,251 persons. The estimted resident popultion of Bss Cost is projected to increse from 25,631 people in 2001 to 45,379 by 2031 [n increse of 19,748 people], equting to n verge nnul increse of 1.92 per cent, compred with projected verge nnul increse of 0.87 per cent in the Victorin popultion In the ten yers from 1991, the popultion of Bw Bw incresed from 33,788 people to 36,404 people in 2001, which ws n verge nnul increse of 0.75 per cent, compred with 0.84 per cent verge nnul growth rte for Victori nd 0.53 per cent for regionl Victori. 46 Ibid. Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 61

Bw Bw is locted 100 kilometres est of Melbourne nd covers n re of 4,031 squre kilometres. Mjor centres include Wrrgul, Drouin nd Trflgr. The estimted resident popultion of Bw Bw is projected to increse from 36,404 people in 2001 to 47,928 people by 2031 [n increse of 11,524 people], equting to n verge nnul increse of 0.92 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. Nturl increse (births minus deths) will ccount for n pproximte increse of 1,419 persons over this period, while net migrtion, mostly within regionl Victori nd to or from djcent municiplities, will ccount for n pproximte increse of 10,104 persons. Bw Bw is projected to experience popultion growth in the western prt of the Shire s the result of overspill from Melbourne's south-estern growth corridor, with significnt growth in other prts of Bw Bw not expected. In 2001, the proportion of people in Bw Bw ged 60 yers or more ws 18.1 per cent, compred with 17.3 per cent in Victori nd 19.5 per cent in regionl Victori. In the period to 2031, this ge group is expected to increse by n extr 973,244 persons in Victori [to 29.0 per cent of the popultion], of whom 345,459 persons will be in regionl Victori [to 35.9 per cent of the popultion], nd 11,604 in Bw Bw [bringing this ge group to 38.0 per cent of the locl popultion]. The totl number of households in Bw Bw is projected to increse from 13,872 households in 2001 to 21,626 households in 2031 [n increse of 7,754 households], compred with projected increse of 885,577 households for Victori, nd 258,916 households in regionl Victori over the sme period. 47 http://www.bwbwshire.vic.gov.u/pge/pge.sp?pge_id=343&h=1&p=1 47 Ibid. Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 62

5.3.3 EAST SHIRE http://www.bwbwshire.vic.gov.u/pge/pge.sp?pge_id=343&h=1&p=1 EAST SHIRE Est Gippslnd is locted 400 kilometres est of Melbourne nd covers n re of 20,941 squre kilometres. Mjor centres include Birnsdle, Lkes Entrnce nd Orbost. The shire's economy is bsed on tourism nd trditionl primry industries (griculture, horticulture, forestry nd fishing). The popultion is centred round the Gippslnd Lkes re which is gret ttrction to visitors nd retirees. The estimted resident popultion of Est Gippslnd on June 30th 2003 ws 40,074 persons. In the ten yers from 1991, the popultion of Est Gippslnd incresed from 37,319 people to 39,439 people in 2001, which ws n verge nnul increse of 0.55 per cent, compred with 0.84 per cent verge nnul growth rte for Victori nd 0.53 per cent for regionl Victori. http://www.lkesndwilderness.com.u/mjortowns.sp.htm The estimted resident popultion of Est Gippslnd is projected to increse from 39,439 people in 2001 to 47,517 people by 2031 [n increse of 8,078 people], equting to n verge nnul increse of 0.62 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. Nturl decrese (births minus deths) will ccount for n pproximte decrese of 5,186 persons over this period, while net migrtion, mostly within regionl Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 63

Victori nd to or from djcent municiplities, will ccount for n pproximte increse of 13,264 persons. Est Gippslnd is expected to remin populr with retirees from Melbourne, the Ltrobe Vlley nd Sle, with popultion growth likely to be concentrted round Pynesville nd Lkes Entrnce nd with Birnsdle cting s service centre. Popultion loss is expected in other prts of the municiplity. In 2001, the proportion of people in Est Gippslnd ged 60 yers or more ws 25.1 per cent, compred with 17.3 per cent in Victori nd 19.5 per cent centre for the region. In the period to 2031, this ge group is expected to increse by n extr 973,244 persons in Victori [to 29.0 per cent of the popultion], of whom 345,459 persons will be in regionl Victori [to 35.9 per cent of the popultion], nd 13,791 in Est Gippslnd [bringing this ge group to 49.8 per cent of the locl popultion]. The totl number of households in Est Gippslnd is projected to increse from 16,690 households in 2001 to 23,814 households in 2031 [n increse of 7,124 households], compred with projected increse of 885,577 households for Victori, nd 258,916 households in regionl Victori over the sme period. 48 In the ten yers from 1991, the popultion of Ltrobe decresed from 75,254 people to 70,643 people in 2001, which ws n verge nnul decrese of 0.63 per cent, compred with 0.84 per cent verge nnul growth rte for Victori nd 0.53 per cent for regionl Victori. The estimted resident popultion of Ltrobe on June 30th 2003 ws 70,214 persons. The estimted resident popultion of Ltrobe is projected to decrese slightly from 70,643 people in 2001 to 69,563 people by 2031 [ decrese of 1,080 people], equting to n verge nnul decrese of 0.05 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. Nturl increse (births minus deths) will ccount for n pproximte increse of 2,109 persons over this period, while net migrtion, mostly within regionl Victori nd to or from djcent municiplities, will ccount for n pproximte decrese of 3,189 persons. Although Ltrobe will gin young school levers from surrounding rurl res, it my lso loose young dults looking for further eduction nd work opportunities in Melbourne. 5.3.4 LATROBE CITY Ltrobe is locted 120 kilometres est of Melbourne nd covers n re of 1,395 squre kilometres. Mjor centres include Trrlgon, Moe, Morwell nd Churchill. The Ltrobe Vlley genertes most of Victori's electricity. Other mjor industries include timber processing, the mnufcturing of pper products, nd the provision of services to the Gippslnd region. The economic decline experienced cross the stte in the erly 1990s hs been more protrcted in Ltrobe, with mny jobs ssocited with the power genertion industry being lost nd not replced by others. 48 Ibid. Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 64

THE CITY OF LATROBE In 2001, the proportion of people in Ltrobe ged 60 yers or more ws 16.8 per cent, compred with 17.3 per cent in Victori nd 19.5 per cent in regionl Victori. In the period to 2031, this ge group is expected to increse by n extr 973,244 persons in Victori [to 29.0 per cent of the popultion], of whom 345,459 persons will be in regionl Victori [to 35.9 per cent of the popultion], nd 15,142 in Ltrobe [bringing this ge group to 38.8 per cent of the locl popultion]. The totl number of households in Ltrobe is projected to increse from 28,121 households in 2001 to 34,057 households in 2031 [n increse of 5,936 households], compred with projected increse of 885,577 households for Victori, nd 258,916 households in regionl Victori over the sme period. 49 5.3.5 SOUTH SHIRE South Gippslnd is locted 130 kilometres south-est of Melbourne nd covers n re of 3,305 squre kilometres. Mjor centres include Leongth, Korumburr nd Mirboo North. South Gippslnd is predominntly rurl region, with number of smller, well estblished townships. The Shire is n importnt beef production nd dirying re, nd is populr with tourists, with the nturl hbitt nd scenery of Wilsons Promontory ttrcting cmpers nd hikers. Like other costl res in Victori, South Gippslnd hs become ttrctive to retirees nd people seeking lnd to build second/holidy homes, mny of which re lter used for permnent occupncy. The estimted resident popultion of South Gippslnd on June 30th 2003 ws 26,648 persons. In the ten yers from 1991, the popultion of South Gippslnd incresed from 25,841 people to 26,159 people in 2001, which ws n verge nnul increse http://www.dse.vic.gov.u/plnningschemes/ltrobe/mp.html 49 Ibid. Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 65

of 0.12 per cent, compred with 0.84 per cent verge nnul growth rte for Victori nd 0.53 per cent for regionl Victori. Much of South Gippslnd Shire is projected to experience popultion decline over the next thirty yers with the exception of Leongth nd costl res such s Venus By. The estimted resident popultion of South Gippslnd is projected to increse from 26,159 people in 2001 to 31,934 people by 2031 [n increse of 5,775 people], equting to n verge nnul increse of 0.67 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. Nturl decrese (births minus deths) will ccount for n pproximte decrese of 105 persons over this period, while net migrtion, mostly within regionl Victori nd to or from djcent municiplities, will ccount for n pproximte increse of 5,880 persons. With n geing popultion much of this increse is expected to be driven by migrtion from Melbourne nd other prts of the stte. In 2001, the proportion of people in South Gippslnd ged 60 yers or more ws 21.1 per cent, compred with 17.3 per cent in Victori nd 19.5 per cent in regionl Victori. In the period to 2031, this ge group is expected to increse by n extr 973,244 persons in Victori [to 29.0 per cent of the popultion], of whom 345,459 persons will be in regionl Victori [to 35.9 per cent of the popultion], nd 7,923 in South Gippslnd [bringing this ge group to 42.1 per cent of the locl popultion]. The totl number of households in South Gippslnd is projected to increse from 10,332 households in 2001 to 14,832 households in 2031 [n increse of 4,500 households], compred with projected increse of 885,577 households for Victori, nd 258,916 households in regionl Victori over the sme period. 50 50 Ibid. Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 66

5.3.6 WELLINGTON SHIRE Wellington is locted 200 kilometres est of Melbourne nd covers n re of 10,924 squre kilometres. Mjor centres include Sle, Mffr, Yrrm nd the Longford gs plnt, RAAF bse nd the Ninety Mile Bech. Heyfield. Wellington is lrge Shire with strong griculturl bse nd importnt secondry nd tertiry industries, notbly in the lrgest centre, Sle, nd hs mjor prison, persons over this period, while net migrtion, mostly within regionl Victori nd to or from djcent municiplities, will ccount for n pproximte decrese of 103 persons. Young people in regions like Wellington will be ttrcted to regionl centres nd Melbourne for eduction nd employment opportunities. The estimted resident popultion of Wellington on June 30th 2003 ws 41,190 persons. In the ten yers from 1991, the popultion of Wellington decresed from 42,845 people to 41,462 people in 2001, which ws n verge nnul decrese of 0.33 per cent, compred with 0.84 per cent verge nnul growth rte for Victori nd 0.53 per cent for regionl Victori. With no mjor regionl city nd predominntly rurl lnd use, the popultion of Wellington is projected to decrese from 41,462 people in 2001 to 41,446 people by 2031 decrese by people between 2001 nd 2031 [ decrese of 16 people], equting to n verge nnul decrese of 0.00 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. Nturl increse (births minus deths) will ccount for n pproximte increse of 87 http://www.wellington.vic.gov.u/files/wellington_shire_rurl_districts_mpv4 5.pdf Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 67

In 2001, the proportion of people in Wellington ged 60 yers or more ws 18.5 per cent, compred with 17.3 per cent in Victori nd 19.5 per cent in regionl Victori. In the period to 2031, this ge group is expected to increse by n extr 973,244 persons in Victori [to 29.0 per cent of the popultion], of whom 345,459 persons will be in regionl Victori [to 35.9 per cent of the popultion], nd 9,169 in Wellington [bringing this ge group to 40.7 per cent of the locl popultion]. The totl number of households in Wellington is projected to increse from 16,052 households in 2001 to 19,202 households in 2031 [n increse of 3,150 households], compred with projected increse of 885,577 households for Victori, nd 258,916 households in regionl Victori over the sme period. 51 5.4 DEMOGRAPHIC DATA In describing the popultion of n re, the Austrlin Bureu of Sttistics uses three definitions: Enumerted counts: where people were on Census night Usul residence counts: Census figures bsed on where people stte their usul residence is locted Estimted Resident Popultion (ERP): this is the officil popultion estimte used for the lloction of Government funds. It includes estimtes of people temporrily overses nd other corrections. The ABS releses popultion projections but these re frequently modified by Stte deprtments of plnning or infrstructure bsed on their knowledge of future plnning intentions. The following popultion projections re bsed on dt from the Victorin Deprtment of Infrstructure. 51 Ibid. 5.4.1 NATIONAL FEATURES FROM THE 2001 CENSUS 52 The 2001 Census reveled continuing geing of the Austrlin popultion s result of low fertility nd incresed life expectncy. Between 1996 nd 2001 the medin ge of the Austrlin popultion incresed from 34 to 35 yers while the proportion over 65 incresed from12.1% to 12.6%. The proportion ged from 0-14 yers decresed from 21.5% in 1996 to 20.7% in 2001. These figures suggest tht the declining birth rte is, if nything, greter cuse of the incresing verge ge of the popultion thn is incresed life expectncy. The proportion of femles to mles hs remined stble t 50.7% femles to 49.3% mles. While most people in Austrli re Austrlin born (71.8%), the proportion hs decresed since 1996 (73.9%). This reflects the fct tht immigrtion hs mde greter contribution to popultion growth thn hve births over the intervening period. Reflecting this, the proportion of people who only spoke English t home decresed from 81.4% in 1996 to 79.1% in 2001. The proportion of the popultion tht identified themselves s being of indigenous origin incresed from 2.0% in 1996 to 2.2% in 2001. The number of dwellings incresed by 8.5% between 1996 n 2001 figure which fr outstrips popultion growth. This reflects the tendency towrds smller household units, in prticulr on increse in the number of single-person households (up to 22.9% from 22.1%). Similrly the increse in the number of fmily units (6%) lso exceeded popultion growth. The proportion of fmilies mde up of couples with children fell from 49.6% to 47% while the proportion of couples without children incresed (35.7% from 34.1%), s did the proportion of lone prent fmilies (15.4% from 14.5%). In reltion to lone prent fmilies, the ABS note tht the proportion hs incresed from only 5.7% in 1971. The increse in fmilies of couples without children is in prt due to the decision by greter number of couples not to hve children or to postpone hving children. More significnt however, is the fct tht mny of the children of the bby boomers hve left 52 ABS publiction 2015.0 Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 68

home leding to n incresing proportion of middle ged nd older couple fmilies. In terms of the proportion of people living lone, men under 50 yers of ge re more likely to live lone thn women (6.0% compred with 3.9%), while women bove the ge of 50 re much more likely to live lone thn men (23.3% compred with 13.7% nd 47.7% compred with 21.5% for women nd men over 75). The high proportion of older women living lone hs been ssocited with problems of isoltion in res with high proportions of people who hve used lnguge other thn English in the home. In mny such households the women hd less well developed English skills nd fewer out-ofhome reltionships thn the men who hd lived in their home. 5.5 DEMOGRAPHY OF The following tble indictes both the census night popultion nd estimted resident popultion for ech locl government re s well s for regionl Victori nd Victori s whole. The estimted resident popultion (ERP) figures re generlly more useful thn the Census night figures. Rw figures for the ERP hve been provided s they ssist in plnning (eg determining qunt of services required) while proportions, expressed s percentges hve lso been provided s they help to show trends nd comprisons more clerly. 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. Concomitntly, the projected popultion ged 70 yers nd over is 10.6% in Victori, 12.6% in regionl Victori, 12.4% in Bw Bw nd Ltrobe, 13% in Wellington, 13.5% in Gippslnd s whole, 14.0% in South Gippslnd, 17.1% in Bss Cost, nd 18.0% in Est Gippslnd. The number of births per 1000 women of childbering ge is bove the Stte verge in Wellington, Bw Bw nd South Gippslnd, the sme or very close to the Stte verge in Est Gippslnd, Ltrobe nd Gippslnd s whole, nd below the Stte verge in Bss Cost. 5.5.1 POPULATION AND POPULATION CHANGE IN 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 Bost nd South Gippslnd re little over third of its size. Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 69

POPULATION LGA BASS COAST BAW BAW EAST LATROBE SOUTH WELLLINGTON REGIONAL VICTORIA VICTORIA POPULATION 2001 Young children: 0-9 1,493 1,493 2,621 5,074 1,718 2,769 10,950 91,103 309,381 Youth: 10-24 2,010 2,010 3,701 7,626 2,447 4,084 15,829 129,996 480,999 Erly dulthood 25-39 2,176 2,176 3,528 7,418 2,310 3,760 15,513 131,535 557,393 Femle Midlife+: 40-64 4,370 4,370 5,875 10,830 4,452 6,615 25,636 210,101 738,644 65-69 839 839 688 1,284 582 786 3,406 27,436 89,321 70-79 2,344 2,344 1,918 2,441 1,589 2,317 9,605 51,077 162,769 Elderly: 80+ 736 736 773 1,299 651 837 3,462 31,040 99,924 Totl 13,129 13,129 18,416 35,972 13,167 20,382 80,995 672,288 2,438,431 Young children: 0-9 1,546 2,860 2,606 5,318 1,877 3,039 11,350 96,232 325,476 Youth: 10-24 1,814 3,216 3,008 7,634 2,174 4,042 16,273 135,099 496,792 Erly dulthood 25-39 2,376 3,820 3,619 6,919 2,602 4,471 14,679 127,738 542,947 Mle Midlife+: 40-64 4,146 5,889 6,863 10,917 4,457 6,924 25,587 211,468 727,827 65-69 801 676 1,121 1,193 583 796 3,267 26,724 84,377 70-79 1,373 1,078 1,790 1,998 929 1,341 5,398 43,658 135,147 Elderly: 80+ 446 449 611 692 370 467 1,961 17,158 53,729 Totl 12,502 17,988 19,618 34,671 12,992 21,080 78,515 660,231 2,366,295 Young children: 0-9 3,051 5,282 4,907 10,392 3,461 5,779 22,300 187,335 634,857 Youth: 10-24 4,064 7,652 7,028 15,260 5,031 8,529 32,102 267,249 977,791 Persons Erly dulthood 25-39 4,274 6,806 6,395 14,337 4,604 7,839 30,192 259,273 1,100,340 Midlife+: 40-64 8,542 11,770 13,694 21,747 8,941 13,557 51,223 421,569 1,466,471 65-69 1,640 1,364 2,181 2,477 1,165 1,582 6,673 54,160 173,698 70-79 2,878 3,672 3,609 4,439 1,936 2,872 11,597 94,735 297,916 POPULATION PROJECTIONS 2006 PROJECTION Elderly: 80+ 1,182 1,222 1,625 1,991 1,021 1,304 5,423 48,198 153,653 Totl 25,631 36,404 39,439 70,643 26,159 41,462 159,510 1,332,519 4,804,726 Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 70

POPULATION LGA BASS COAST BAW BAW EAST LATROBE SOUTH WELLLINGTON REGIONAL VICTORIA VICTORIA 0-9 3,152 4,750 4,384 8,950 3,159 5,159 20,105 175,475 614,047 10-24 4,778 8207 7,068 15,093 5,203 8,444 33,393 278,432 1,028,256 25-39 4,621 6366 5,818 12,786 4,308 7,042 28,227 251,953 1,113,548 40-64 10,183 13256 14,846 23,348 9,786 14,185 56,802 467,282 1,626,548 65-69 1,883 1715 2,607 2,821 1,395 1,849 7,846 62,429 196,418 70-79 3,065 2,542 3,962 4,596 2,063 2,906 12,306 97,887 304,449 80+ 1,727 1579 2,361 2,860 1,327 1,775 7,498 61,920 193,943 Totl 29,408 38416 41,046 70,454 27,243 41,361 166,176 1,395,381 5,077,209 2011 PROJECTION 0-9 3,089 4,376 4,058 7,939 3,005 4,709 18,483 163,007 595,411 10-24 5,150 8176 6,499 14,272 4,844 7,883 32,554 281,966 1,034,332 25-39 4,818 6249 5,519 12,020 4,316 6,798 27,535 248,052 1,137,347 40-64 11,399 14405 15,610 24,195 10,219 14,454 60,441 503,562 1,769,159 65-69 2,369 2116 3,174 3,400 1,818 2,245 9,746 75,767 233,126 70-79 3,281 3,003 4,537 4,997 2,310 3,215 13,636 107,549 329,690 80+ 2,273 1966 3,090 3,715 1,647 2,214 9,615 76,200 232,549 Totl 32,380 40292 42,487 70,537 28,162 41,519 172,009 1,456,104 5,331,614 2001 PERCENTAGE 0-9 11.9% 14.5% 12.4% 14.7% 13.2% 13.9% 14.0% 14.1% 13.2% 10-24 15.9% 21.0% 17.8% 21.6% 19.2% 20.6% 20.1% 20.1% 20.4% 25-39 16.7% 18.7% 16.2% 20.3% 17.6% 18.9% 18.9% 19.5% 22.9% 40-64 33.3% 32.3% 34.7% 30.8% 34.2% 32.7% 32.1% 31.6% 30.5% 65-69 6.4% 3.7% 5.5% 3.5% 4.5% 3.8% 4.2% 4.1% 3.6% 70-79 11.2% 6.3% 9.2% 6.3% 7.4% 6.9% 7.3% 7.1% 6.2% 80+ 4.6% 3.4% 4.1% 2.8% 3.9% 3.1% 3.4% 3.6% 3.2% Totl 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 2011 PERCENTAGE 0-9 9.5% 10.9% 9.6% 11.3% 10.7% 11.3% 10.7% 11.2% 11.2% 10-24 15.9% 20.3% 15.3% 20.2% 17.2% 19.0% 18.9% 19.4% 19.4% Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 71

POPULATION LGA BASS COAST BAW BAW EAST LATROBE SOUTH WELLLINGTON REGIONAL VICTORIA VICTORIA 25-39 14.9% 15.5% 13.0% 17.0% 15.3% 16.4% 16.0% 17.0% 21.3% 40-64 35.2% 35.8% 36.7% 34.3% 36.3% 34.8% 35.1% 34.6% 33.2% 65-69 7.3% 5.3% 7.5% 4.8% 6.5% 5.4% 5.7% 5.2% 4.4% 70-79 10.1% 7.5% 10.7% 7.1% 8.2% 7.7% 7.9% 7.4% 6.2% 80+ 7.0% 4.9% 7.3% 5.3% 5.8% 5.3% 5.6% 5.2% 4.4% Totl 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% BIRTHS Number (2002) 266 416 394 925 295 492 2,724 16,014 61,959 Births per 1000 effective femle resident (EFR) ged 15-44 (2002) 60.1 62.2 60.6 60.5 62.0 64.1 60.5 61.3 60.5 5.5.2 CULTURAL DIVERSITY IN The following tbles were extrcted from 2001 Census dt. 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. Of those born overses, most re from the U.K., Polnd, Irelnd nd Yugoslvi in Bss Cost; from the U.K., New Zelnd, Itly nd Germny in Bw Bw; from the U.K., Itly, the Netherlnds nd Germny in Est Gippslnd; form the U.K., Germny, Mlt nd New Zelnd in the Ltrobe; form the U.K., Netherlnds nd New Zelnd in South Gippslnd; nd from the U.K., Netherlnds, New Zelnd, nd Germny in Wellington. Agin, the proportion of the popultion tht only speks English is fr higher in ech LGA thn in Victori s whole. The primry lnguges spoken t home, other thn English re Itlin, Germn, Netherlndic, Polish, nd Greek. 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. Aboriginl community res re indicted on the mp following the next tble. Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 72

LGA BASS COAST BAW BAW EAST LATROBE STH WELLLINGTON REGIONAL VICTORIA VICTORIA COUNTRY OF BIRTH Austrli 76.5% 86.1% 85.0% 80.64 83.9% 84.5% 81.78 84.97 71.05 Cnd 0.1% 0.1% 0.1% 0.09 0.1% 0.1% 0.09 0.07 0.12 Chin 0.0% 0.0% 0.0% 0.08 0.0% 0.0% 0.06 0.07 0.8 Croti 0.1% 0.1% 0.0% 0.15 0.1% 0.1% 0.1 0.22 0.41 Egypt 0.1% 0.0% 0.0% 0.04 0.0% 0.0% 0.04 0.03 0.25 Fiji 0.1% 0.0% 0.0% 0.05 0.0% 0.1% 0.05 0.04 0.15 Frnce 0.1% 0.0% 0.1% 0.03 0.0% 0.0% 0.03 0.04 0.09 Germny 0.7% 0.5% 0.6% 0.92 0.6% 0.6% 0.74 0.54 0.62 Greece 0.1% 0.1% 0.1% 0.22 0.1% 0.1% 0.16 0.16 1.25 Hong Kong 0.1% 0.0% 0.0% 0.06 0.0% 0.0% 0.04 0.04 0.35 Indi 0.1% 0.1% 0.1% 0.12 0.1% 0.1% 0.1 0.1 0.66 Indonesi 0.0% 0.0% 0.0% 0.05 0.0% 0.0% 0.04 0.04 0.24 Irelnd 0.3% 0.2% 0.1% 0.22 0.2% 0.2% 0.21 0.16 0.25 Itly 1.1% 0.6% 0.7% 1.25 1.1% 0.3% 1.05 0.78 1.95 Kore, Republic of 0.0% 0.0% 0.0% 0.03 0.0% 0.0% 0.02 0.02 0.08 Lebnon 0.0% 0.0% 0.0% 0.01 0.0% 0.1% 0.01 0.02 0.31 Mcedoni, FYROM 0.0% 0.0% 0.0% 0.01 0.0% 0.0% 0.01 0.08 0.42 Mlysi 0.1% 0.1% 0.1% 0.16 0.0% 0.1% 0.1 0.09 0.54 Mlt 0.2% 0.1% 0.1% 0.74 0.0% 0.1% 0.38 0.15 0.48 Netherlnds 1.0% 1.0% 0.7% 1.3 1.4% 0.8% 1.19 0.64 0.51 New Zelnd 0.9% 0.7% 0.7% 0.67 0.8% 0.8% 0.75 0.75 1.2 Philippines 0.1% 0.2% 0.2% 0.39 0.1% 0.2% 0.25 0.18 0.49 Polnd 0.1% 0.1% 0.1% 0.3 0.1% 0.2% 0.2 0.15 0.43 Singpore 0.0% 0.0% 0.0% 0.11 0.0% 0.0% 0.06 0.04 0.17 South Afric 0.1% 0.1% 0.1% 0.13 0.1% 0.1% 0.12 0.11 0.34 Sri Lnk 0.1% 0.1% 0.1% 0.08 0.1% 0.1% 0.08 0.05 0.58 Turkey 0.0% 0.0% 0.0% 0.01 0.0% 0.0% 0.01 0.09 0.33 United Kingdom 7.8% 4.1% 4.5% 5.09 4.7% 4.0% 5.24 3.72 4.46 United Sttes of Americ 0.2% 0.2% 0.1% 0.14 0.1% 0.1% 0.14 0.14 0.24 Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 73

LGA BASS COAST BAW BAW EAST LATROBE STH WELLLINGTON REGIONAL VICTORIA VICTORIA Viet Nm 0.0% 0.0% 0.0% 0.03 0.0% 0.2% 0.03 0.06 1.23 Yugoslvi, Federl Republic 0.1% 0.2% 0.1% 0.2 0.1% 0.2% 0.16 0.21 0.43 Born elsewhere overses 0.9% 0.8% 0.8% 1.48 0.7% 1.1% 1.1% 1.13 4.07 Not stted 9.2% 4.4% 5.4% 5.18 5.4% 5.7% 5.67 5.11 5.52 Totl 23,967 34,631 37,796 66,819 24,525 39,158 149,942 1,272,873 4,612,097 Indigenous Austrlins 0.5% 0.8% 2.6% 1.1% 0.6% 0.8% 0.5 LANGUAGE SPOKEN AT HOME English Only 87.8% 93.1% 92.6% 88.8% 92.0% 90.5% 90.29 90.9% 80.0% Arbic 0.0% 0.0% 0.0% 0.1% 0.0% 0.0% 0.06 0.1% 1.0% Austrlin Indigenous 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.01 0.0% 0.0% Cntonese 0.1% 0.1% 0.1% 0.2% 0.1% 0.1% 0.12 0.1% 1.3% Mndrin 0.0% 0.0% 0.0% 0.2% 0.0% 0.0% 0.09 0.1% 0.8% Other Chinese lnguges 0.0% 0.0% 0.1% 0.0% 0.0% 0.0% 0.01 0.0% 0.3% Crotin 0.1% 0.1% 0.0% 0.2% 0.0% 0.1% 0.11 0.3% 0.6% French 0.1% 0.0% 0.1% 0.1% 0.1% 0.1% 0.06 0.1% 0.2% Germn 0.4% 0.3% 0.4% 0.5% 0.4% 0.3% 0.42 0.3% 0.4% Greek 0.2% 0.1% 0.2% 0.7% 0.2% 0.2% 0.4 0.3% 2.7% Hindi 0.0% 0.0% 0.0% 0.1% 0.0% 0.0% 0.03 0.0% 0.2% Hungrin 0.1% 0.1% 0.0% 0.1% 0.0% 0.1% 0.05 0.1% 0.2% Indonesin 0.0% 0.0% 0.1% 0.0% 0.0% 0.0% 0.03 0.0% 0.2% Itlin 1.4% 0.9% 0.9% 1.8% 1.5% 0.3% 1.48 1.2% 3.2% Jpnese 0.1% 0.0% 0.0% 0.0% 0.0% 0.0% 0.02 0.0% 0.1% Khmer 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.01 0.0% 0.2% Koren 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.02 0.0% 0.1% Mcedonin 0.0% 0.0% 0.0% 0.0% 0.0% 0.01 0.1% 0.7% Mltese 0.1% 0.0% 0.1% 0.0% 0.0% 0.29 0.1% 0.5% Netherlndic 0.4% 0.4% 0.3% 0.6% 0.5% 0.3% 0.48 0.2% 0.2% Persin 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.1% Polish 0.1% 0.2% 0.1% 0.5% 0.0% 0.2% 0.19 0.1% 0.4% Portuguese 0.0% 0.0% 0.0% 0.0% 0.0% 0.01 0.0% 0.1% Russin 0.0% 0.0% 0.0% 0.3% 0.0% 0.0% 0.04 0.0% 0.3% Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 74

LGA BASS COAST BAW BAW EAST LATROBE STH WELLLINGTON REGIONAL VICTORIA VICTORIA Smon 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.01 0.0% 0.1% Serbin 0.0% 0.1% 0.0% 0.0% 0.0% 0.0% 0.07 0.1% 0.3% Sinhlese 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.01 0.0% 0.3% South Slvic nfd 0.0% 0.0% 0.0% 0.1% 0.0% 0.1% 0.05 0.1% 0.1% Spnish 0.1% 0.0% 0.0% 0.0% 0.0% 0.1% 0.08 0.1% 0.5% Tglog 0.0% 0.1% 0.1% 0.1% 0.1% 0.1% 0.02 0.1% 0.4% Tmil 0.0% 0.0% 0.0% 0.1% 0.0% 0.0% 0.01 0.0% 0.2% Turkish 0.0% 0.0% 0.0% 0.2% 0.0% 0.0% 0.03 0.1% 0.6% Vietnmese 0.0% 0.0% 0.0% 0.0% 0.0% 0.1% 0.59 0.1% 1.4% Other 0.4% 0.4% 0.4% 0.0% 0.3% 0.4% 4.9 0.7% 2.2% Not stted 8.4% 3.8% 4.2% 0.0% 4.5% 6.7% 4.4% Totl 23,965 34,635 37,779 66,818 24,532 39,164 149,737 1,272,799 4,612,097 Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 75

Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 76

5.5.3 SOCIO-ECONOMIC INDICATORS: WELFARE PAYMENTS Rtes of ccess to welfre pyments or benefits re generlly verge to high in the Gippslnd region. 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. LGA AGE PENSION DISABILITY SUPPORT PENSION SELECTED INCOME SUPPORT CUSTOMERS - AT JUNE 30 TH. 2003: RAW NUMBERS NEWSTART ALLOWANCE PARENTING PAYMENT - SINGLE YOUTH ALLOWANCE OTHER PENSIONS AND ALLOWANCES TOTAL SELECTED INCOME SUPPORT CUSTOMERS PERCENTAGE OF LONG-TERM NEWSTART ALLOWANCE CUSTOMERS BASS COAST [BAL] 2,876 770 511 445 316 710 5,627 63.9 BASS COAST [PH. ISL] 1,362 294 206 191 119 316 2,488 59.5 BAW BAW [E] 406 149 94 n.. n.. 152 974 n.. BAW BAW [W] 2,951 941 429 667 471 821 6,280 n.. BAW BAW [S] 449 140 101 100 70 141 1,002 63.6 EAST 5,857 1,878 1,295 1,016 852 1,829 12,727 64.5 EAST [BAL] 241 107 103 46 49 124 669 60.5 LATROBE 7,994 3,773 2,769 2,338 1,796 3,108 21,778 68.8 STH [C] 1,277 360 236 212 250 377 2,712 59.1 STH [E] 765 263 122 106 100 267 1,623 58.8 STH [W] 876 295 172 148 174 298 1,964 55.1 WELLINGTON 4,485 1,712 1,145 944 907 1,493 10,687 60.1 [W] 18,570 6,875 4,561 4,225 3,314 6,075 43,621 65.2 [E] 10,342 3,590 2,440 1,959 1,760 3,323 23,414 62.5 TOTAL 28,912 10,465 7,001 6,184 5,074 9,398 67,035 VICTORIA 472,069 158,795 128,396 97,439 102,609 155,077 1,114,386 59.5 Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 77

SELECTED INCOME SUPPORT CUSTOMERS - AT JUNE 30 TH. 2003: AS A PERCENTAGE OF THE POPULATION AGED 15 YEARS AND OVER LGA POPULATION 15 YEARS + AGE PENSION DISABILITY SUPPORT PENSION NEWSTART ALLOWANCE PARENTING PAYMENT - SINGLE YOUTH ALLOWANCE OTHER PENSIONS AND ALLOWANCES TOTAL SELECTED INCOME SUPPORT CUSTOMERS BASS COAST [BAL] 15,810 18.2% 4.9% 3.2% 2.8% 2.0% 4.5% 35.6% BASS COAST [PH. ISL] 6,831 19.9% 4.3% 3.0% 2.8% 1.7% 4.6% 36.4% BASS COAST TOTAL 22,641 18.7% 4.7% 3.2% 2.8% 1.9% 4.5% 35.8% BAW BAW [E] 3,141 12.9% 4.7% 3.0% 4.8% 31.0% BAW BAW [W] 22,398 13.2% 4.2% 1.9% 3.0% 2.1% 3.7% 28.0% BAW BAW [S] 3,396 13.2% 4.1% 3.0% 2.9% 2.1% 4.2% 29.5% BAW BAW TOTAL 28,935 13.2% 4.3% 2.2% 2.7% 1.9% 3.9% 28.5% EAST 32,425 18.1% 5.8% 4.0% 3.1% 2.6% 5.6% 39.3% EAST [BAL] 2,040 11.8% 5.2% 5.0% 2.3% 2.4% 6.1% 32.8% EAST TOTAL 34,465 17.7% 5.8% 4.1% 3.1% 2.6% 5.7% 38.9% LATROBE 58,217 13.7% 6.5% 4.8% 4.0% 3.1% 5.3% 37.4% STH [C] 10,140 12.6% 3.6% 2.3% 2.1% 2.5% 3.7% 26.7% STH [E] 4,758 16.1% 5.5% 2.6% 2.2% 2.1% 5.6% 34.1% STH [W] 6,227 14.1% 4.7% 2.8% 2.4% 2.8% 4.8% 31.5% STH TOTAL 21,125 13.8% 4.3% 2.5% 2.2% 2.5% 4.5% 29.8% WELLINGTON 32,364 13.9% 5.3% 3.5% 2.9% 2.8% 4.6% 33.0% [W] 128,033 14.5% 5.4% 3.6% 3.3% 2.6% 4.7% 34.1% [E] 64,890 15.9% 5.5% 3.8% 3.0% 2.7% 5.1% 36.1% TOTAL 192,923 15.0% 5.4% 3.6% 3.2% 2.6% 4.9% 34.7% VICTORIA 3,952,210 11.9% 4.0% 3.2% 2.5% 2.6% 3.9% 28.2% In the tble bove pink shding indictes proportion more thn 25% bove the stte verge while green shding indictes proportion lower thn 75% of the stte verge. Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 78

5.5.4 SOCIO-ECONOMIC INDICATORS: EMPLOYMENT AND UNEMPLOYMENT The striking thing bout the employment indictors is tht Ltrobe hs very different profile to the other LGAs. 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. 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. 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 Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 79

BASS COAST BAW BAW EAST LGA LATROBE SOUTH WELLLINGTON REGIONAL VICTORIA VICTORIA EMPLOYMENT: HOURS WORKED IN PREVIOUS WEEK Full-time employed 52.3% 58.4% 51.8% 53.7% 58.6% 57.9% 55.5% 58.2% 60.6% Prt-time employed 36.0% 31.7% 35.9% 31.4% 32.1% 31.5% 32.2% 31.4% 29.7% Employed - Not stted 3.3% 3.4% 3.5% 2.7% 3.2% 2.8% 3.0% 3.0% 2.9% Unemployed 8.5% 6.6% 8.8% 12.2% 6.0% 7.8% 9.2% 7.4% 6.8% Totl lbour force 9,068 16,141 15,680 29,074 11,169 17,048 65,452 580,669 2,234,075 Not in the lbour force 8,742 9,333 13,022 20,374 7,130 11,939 45,579 369,990 1,277,942 Not stted - In lbour force 1,581 936 1,255 1,908 798 1,336 5,223 38,986 156,367 LABOUR FORCE PARTICIPATION: AGE GROUP (YEARS) 15-19 yers 7.9% 8.0% 7.4% 8.9% 6.7% 7.6% 7.9% 7.8% 6.8% 20-24 yers 8.9% 8.4% 7.1% 10.5% 6.8% 8.5% 8.9% 9.3% 10.8% 25-34 yers 19.8% 18.6% 17.6% 21.4% 17.8% 18.1% 19.8% 20.3% 24.3% 35-44 yers 25.8% 26.2% 25.3% 25.9% 25.0% 25.9% 25.8% 25.7% 25.0% 45-54 yers 24.5% 24.6% 26.1% 23.5% 26.0% 26.0% 24.5% 23.8% 21.7% 55-64 yers 10.5% 10.9% 13.2% 8.5% 13.0% 10.7% 10.5% 10.4% 9.4% 65 yers nd over 2.7% 3.3% 3.3% 1.3% 4.7% 3.2% 2.7% 2.7% 1.9% Totl Lbour Force 9,070 16,137 15,680 29,074 11,173 17,050 65,454 580,633 2,234,075 EMPLOYMENT BY INDUSTRY [ % ] Agriculture, Forestry nd Fishing 9.13 14.81 12.44 2.82 24.64 16.39 10.6 11.2 3.5 Mining 0.31 0.44 0.34 1.3 0.51 1.5 0.81 0.4 0.2 Mnufcturing 9.04 10.59 9.4 12.23 9.88 7.94 10.95 13.4 15.3 Electricity, Gs nd Wter Supply 0.86 1.67 0.87 6.97 1.12 1.85 3.74 1.1 0.6 Construction 10.89 7.47 6.73 7.18 6.48 6.26 7.65 6.7 6.6 Wholesle Trde 3.66 5.58 4.26 3.65 5.01 3.29 4.38 4.4 5.6 Retil Trde 15.68 13.57 16.29 17.05 13.26 15.36 15.31 15.3 14.8 Accommodtion, Cfes, Resturnts 8.35 3.65 7.57 3.98 3.65 4.44 4.45 4.9 4.3 Trnsport nd Storge 3.18 3.49 3.35 2.47 3.18 3.23 2.96 3.5 3.8 Communiction Services 0.94 1.09 0.98 1.15 0.95 0.92 1.07 1.3 2.0 Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 80

LGA BASS COAST BAW BAW EAST LATROBE SOUTH WELLLINGTON REGIONAL VICTORIA VICTORIA Finnce nd Insurnce 1.62 1.61 1.41 2.68 1.47 1.57 2.05 2.0 3.9 Property nd Business Services 6.24 6.06 5.71 7.54 4.82 6.15 6.5 6.6 11.4 Government Admin & Defence 2.85 2.45 2.58 4.25 2.05 5.52 3.21 3.3 3.0 Eduction 6.99 9.16 8.57 8.23 6.97 7.74 8.07 7.5 7.1 Helth nd Community Services 10.91 9.99 11.41 10.71 9.13 9.92 10.28 10.8 9.7 Culturl nd Recretionl Services 3.32 1.88 1.96 1.66 1.71 1.61 1.96 2.0 2.6 Personl nd Other Services 3.51 3.84 3.52 3.7 2.57 4.09 3.51 3.4 3.3 Non-clssifible 0.62 0.72 0.6 0.75 0.36 0.5 0.66 0.5 0.6 Not stted 1.92 1.92 2.01 1.68 2.23 1.72 1.87 1.8 1.8 Totl 8,289 15,069 14,305 25,527 10,489 15,714 59,374 537,642 2,082,216 OCCUPATION [ % ] Mngers nd dministrtors 12.48 15.63 11.68 6.14 24.15 16.13 12.61 12.90 % 9.52 % Professionls 13.78 15.3 14.94 14.36 12.16 14.47 14.13 14.94 % 19.17 % Associte professionls 12.94 10.04 12.52 11.44 10.33 10.87 11.1 11.15 % 11.36 % Trdespersons nd relted 14.91 13.6 12.21 16.34 11.87 14.21 14.66 13.46 % 12.20 % Advnced clericl nd services 3.01 3.26 2.98 2.69 2.88 2.64 2.91 2.85 % 3.64 % Intermedite clericl, sles & services 12.5 12.41 13.78 16.19 10.76 13.17 13.76 13.88 % 16.10 % Intermedite production & trnsport 7.54 9.01 8.92 10.53 8.44 7.78 9.35 8.55 % 8.08 % Elementry, clericl, sles, service 9.7 8.58 9.5 11.31 6.82 9.1 9.6 9.41 % 9.60 % Lbourers nd relted 10.65 10.09 10.97 8.78 10.29 9.48 9.64 10.78 % 8.25 % Indequtely described/not stted 2.48 2.09 2.48 2.24 2.3 2.14 2.25 2.09 % 2.1 % Totl (No.) 8,301 15,077 14,293 25,536 10,491 15,724 59,405 537,744 2,082,216 5.5.5 SOCIO-ECONOMIC INDICATORS: 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 2005-2009 81

LGA REGIONAL BASS COAST BAW BAW EAST LATROBE SOUTH WELLLINGTON VICTORIA VICTORIA EDUCATION - HIGHEST QUALIFICATION OBTAINED [ % ] Postgrdute Degree 0.51 0.85 0.59 0.73 0.63 0.49 0.7 0.80 1.78 Grdute Diplom nd Grdute Certificte 1.14 1.61 1.23 1.05 1.22 1.13 1.22 1.37 1.76 Bchelor Degree 5.44 6.82 5.67 5.59 6.21 5.72 5.95 6.80 10.7 Advnced Diplom nd Diplom 5.12 5.28 5.42 4.44 4.82 4.77 4.8 5.18 6.12 Certificte 17.14 17.51 16.34 19.07 17.16 17.07 18.08 16.5 14.5 Not stted 54.26 56.64 58.29 57.73 58.33 56.49 12.24 11.5 11.5 Not pplicble 16.4 11.29 12.45 11.39 11.62 14.33 57 57.9 53.7 Totl 19,391 26,410 29,957 51,356 19,097 30,323 116,254 989,650 3,668,384 INTERNET AND COMPUTER USAGE (2002) [ % ] Used the internet 25.18 32.75 28.54 32.6 30.4 31.78 31.24 32.04 % 38.61 % Did not use the internet 67.21 63.75 67.7 63.8 65.54 62.02 64.45 64.06 % 57.01 % Not stted 7.61 3.51 3.76 3.6 4.05 6.2 4.31 3.90 % 4.37 % Used computer t home 33.17 42.06 36.38 32.93 39.81 40.96 40.18 39.71 % 43.39 % Did not use computer 59.83 55.22 60.5 63.43 56.73 53.46 56.19 57.02 % 52.83 % Not stted 7.0 2.72 3.12 3.64 3.45 5.58 3.64 3.27 % 3.78 % 5.5.6 SOCIO-ECONOMIC INDICATORS: 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 Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 82

mjority of the popultion live in seprte houses, s opposed to semi-detched 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. BASS COAST BAW BAW EAST LGA LATROBE SOUTH WELLLINGTON REGIONAL VICTORIA VICTORIA FAMILYTYPES AND HOUSEHOLD STRUCTURES HOUSEHOLD TYPE: PERCENTAGE Couple fmily with children 23.8% 35.1% 26.5% 32.4% 33.3% 33.1% 31.7% 32.7% 35.7% Couple fmily without children 32.8% 27.8% 32.9% 24.6% 30.9% 28.6% 27.7% 27.6% 24.6% One prent fmily 9.6% 10.7% 9.8% 12.7% 8.1% 10.1% 11.0% 10.5% 10.6% Other fmily 0.7% 0.9% 0.6% 0.9% 0.6% 0.7% 0.8% 0.9% 1.4% Totl fmily households 66.9% 74.5% 69.9% 70.5% 73.0% 72.5% 71.2% 71.8% 72.3% Group household 2.4% 2.1% 2.5% 2.8% 2.0% 2.0% 2.4% 2.9% 3.8% Lone person household 30.6% 23.3% 27.6% 26.7% 25.0% 25.4% 26.3% 25.4% 23.8% Totl [No.] 9,636 12,615 14,743 25,383 9,192 14,292 56,826 471,317 1,667,687 TENURE - OCCUPIED PRIVATE DWELLINGS [ 2001] [ % ] % % Fully owned 49.77 46.76 50.52 43.1 50.31 45.21 46.26 45.56 % 42.92 % Being purchsed 20.96 29.09 21.18 29.76 26.37 26.21 27.49 26.90 % 27.77 % Rented - government 2.03 2.49 3.4 5.9 1.7 3.29 3.78 3.87 % 3.17 % Rented - privte nd other rentl type 14.89 14.59 17.06 15.54 12.37 16.23 14.7 16.60 % 18.95 % Other tenure type 3.1 3.09 3.38 2 4.59 3.9 2.85 3.00 % 2.41 % Not stted - Occupied privte dwellings by tenure 9.25 3.99 4.47 3.7 4.67 5.17 4.91 4.08 % 4.78 % Totl [No.] 10,547 12,931 15,460 26,022 9,573 14,939 59,073 487,708 1,731,343 PERSONS IN OCCUPIED PRIVATE DWELLINGS [2001] % % Seprte house 93.46 94.6 90.57 92.89 95.82 94.07 93.86 92.36 % 84.38 % Semi-detched, row/terrce, etc 1.68 1.1 1.46 2.33 1.45 2.02 1.8 2.11 % 6.36 % Flt, unit or prtment 2.79 2.44 4.24 3.48 1.05 2.48 2.73 3.55 % 7.85 % Other - Persons in Occupied Privte 1.34 1.36 2.76 0.67 1.28 0.9 1.04 1.36 % 0.77 % Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 83

Dwellings Not Stted - Persons in Occupied Privte Dwellings 0.72 0.5 0.98 0.63 0.39 0.52 0.58 0.62 % 0.65 % Totl 23,471 33,985 36,509 65,410 24,068 37,519 146,934 1,231,447 4,493,372 AVERAGEHOUSEHOLD SIZE [2001] Seprte house 2.3 2.73 2.48 2.66 2.58 2.62 2.59 2.65 2.81 Semi-detched, row/terrce, etc 1.66 1.76 1.66 1.43 1.51 1.6 1.51 1.61 1.98 Flt, unit or prtment 1.39 1.45 1.5 1.39 1.3 1.38 1.39 1.53 1.71 Other - Averge household size 1.63 1.93 1.77 1.66 1.8 1.84 1.75 1.83 1.88 Totl - Averge household size 2.23 2.63 2.37 2.52 2.52 2.52 2.49 2.53 2.6 HOUSEHOLD SIZE HOUSEHOLDS [2001] MEDIANHOUSE PRICE 1 person 30.63 23.37 27.58 26.71 24.97 25.46 26.35 25.4 23.8 2 persons 39.93 34.4 39.45 32.65 36.26 34.97 34.86 34.8 32.3 3 persons 11.41 14.06 12.50 15.09 13.5 13.84 13.98 14.6 16.3 4 persons 10.95 15.45 11.95 15.43 13.76 14.7 14.4 14.6 16.6 5 persons 5.01 8.95 5.90 7.35 7.86 7.86 7.39 7.5 7.7 6 or more persons 2.08 3.77 2.63 2.78 3.65 3.18 3.02 3.1 3.2 Totl 9,629 12,618 14,740 25,399 9,195 14,296 56,841 471,317 1,667,687 Medin house price 99,500 100,000 96,000 67,500 88,000 77,500 2000 Medin unit/prtment price 115,000 85,000 99,000 62,000 82,500 60,000 Medin vcnt house block 30,000 40,000 31,500 34,000 21,500 12,000 Number of house sles 1,348 728 893 1,584 630 826 Medin house price 130,000 122,500 105,000 70,000 93,000 82,000 2001 Medin unit/prtment price 145,000 95,000 92,500 60,000 92,000 66,000 Medin vcnt house block 42,000 43,000 38,000 37,000 22,000 16,500 Number of house sles 1,507 852 1,130 1,727 832 1,061 Medin house price 172,500 148,000 129,000 82,000 130,000 90,000 2002 Medin unit/prtment price 189,000 127,000 105,000 73,000 105,000 79,000 Medin vcnt house block 75,000 57,500 40,000 41,000 45,000 15,000 Number of house sles 1,411 778 1,325 1,908 763 1,257 2003 Medin house price 215,000 175,500 165,000 115,000 159,000 132,000 Medin unit/prtment price 230,000 145,000 150,000 92,500 147,848 112,500 Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 84

Medin vcnt house block 109,000 65,000 54,000 52,000 70,000 35,000 Number of house sles 1,367 827 1,246 1,801 754 1,074 Medin house price 223,000 187,555 185,000 131,000 182,500 150,000 2004 Medin unit/prtment price 240,000 152,000 175,000 110,000 170,000 136,000 Medin vcnt house block 125,000 72,000 65,000 64,500 80,000 53,500 Number of house sles 788 510 606 1,081 416 670 Medin house price 124% 88% 93% 48% 107% 94% Increse 2000-04 Medin unit/prtment price 109% 79% 7% 77% 106% 127% Medin vcnt house block 317% 80% 106% 90% 272% 346% 5.5.7 SOCIO-ECONOMIC INDICATORS: 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. BASS COAST BAW BAW EAST LGA LATROBE SOUTH WELLLINGTON REGIONAL VICTORIA VICTORIA MOTOR VEHICLES PER HOUSEHOLD [%] No motor vehicles 7.55 6.06 7.8 10.07 5.51 7.18 8 7.69 8.99 1 motor vehicle 41.44 32.35 38.82 37.42 33.41 35.41 36.38 34.76 34.74 2 motor vehicles 30.93 38.43 34.91 34.2 37.44 35.68 35.07 36.13 35.57 3 or more motor vehicles 9.62 18.17 12.68 12.73 17.85 15.35 14.2 15.96 14.37 Not stted - Motor vehicles 10.46 4.99 5.79 5.57 5.79 6.38 6.35 5.46 6.33 Totl (No.) 10,549 12,931 15,462 26,021 9,572 14,941 59,073 487,738 1,731,343 TRAVEL TO WORK [%] Trin 0.07 0.72 0.02 0.27 0.06 0.31 0.44 3.41% Bus 0.25 0.31 0.81 0.36 0.45 0.32 0.51 0.84% Trm 0.1 0.03 0.02 0.01 0.02 0.03 0.02 1.47% Cr, s Driver 59.06 60.44 56.26 67.73 0.3% 55.79 61.98 60.18 61.31% Cr, s Pssenger 5.52 5.21 6.18 5.99 5.82 5.43 5.70 5.27% Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 85

LGA BASS COAST BAW BAW EAST LATROBE SOUTH WELLLINGTON REGIONAL VICTORIA VICTORIA Wlk 4.8 4.52 5.5 2.65 52.5% 6.07 4.13 5.07 3.11% Bicycle 0.89 0.29 1.27 0.73 4.3% 1.68 0.58 1.13 0.91% Other mode 2.75 3.13 3.87 1.84 6.7% 3.35 2.69 2.97 2.32% Multiple mode 0.89 1.42 1.27 1.03 0.4% 1.28 1.14 1.27 3.31% Worked t home 9.96 10.92 9.64 3.46 4.1% 11.55 8.91 8.77 5.19% Did not go to work 13.47 10.98 12.78 14.07 1.2% 11.95 12.48 11.92 10.66% Not stted - Trvel to work 2.24 2.04 2.37 1.86 18.5% 1.99 2.02 2.04 2.21% Totl 8,300 15,076 14,301 25,530 10,490 15,722 59,396 537,742 2,082,216 5.5.8 SOCIO-ECONOMIC INDICATORS: 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. BASS COAST BAW BAW EAST LATROBE SOUTH WELLLINGTON GROSSWEEKLYINCOME [2001] Individul LGA REGIONAL VICTORIA VICTORIA Negtive/ Nil Income 4.6% 6.4% 5.4% 6.1% 6.5% 6.3% 6.0% 5.57% 6.33% $1-$119 5.7% 7.8% 6.9% 8.0% 7.6% 7.4% 7.5% 7.23% 6.97% $120-$299 37.0% 28.2% 35.9% 32.6% 29.8% 30.0% 31.9% 30.41% 25.90% $300-$499 18.8% 18.9% 20.2% 16.6% 19.2% 17.7% 17.9% 18.83% 16.58% $500-$699 11.2% 13.4% 11.8% 11.0% 12.8% 11.7% 11.9% 13.38% 13.80% $700-$999 6.7% 10.0% 7.1% 9.4% 8.8% 9.1% 9.0% 9.74% 11.81% $1,000-$1,499 3.1% 5.6% 3.3% 6.5% 4.5% 5.1% 5.4% 5.05% 6.68% $1500 nd over 1.5% 1.9% 1.4% 2.3% 2.3% 2.7% 2.1% 2.13% 3.93% Not Stted 11.4% 7.8% 7.9% 7.4% 8.5% 10.2% 8.4% 7.67% 8.02% Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 86

Household LGA BASS COAST BAW BAW EAST LATROBE SOUTH WELLLINGTON REGIONAL VICTORIA VICTORIA Totl 19,394 26,410 29,959 51,358 19,101 30,323 116,263 989,646 3,668,384 PROPORTIONS RELATED NATIONAL QUINTILES AND MEDIANS 53 Ist Qurtile 26.5% 26.2% 27.5% 29.2% 27.1% 27.5% 27.7% 25.80% 25.32% 2nd Qurtile 36.3% 28.5% 34.6% 29.5% 30.1% 29.6% 30.5% 29.67% 24.20% 3rd Qurtile 24.0% 25.8% 24.5% 21.1% 25.3% 23.6% 23.3% 25.65% 25.20% 4th Qurtile 13.3% 19.5% 13.3% 20.2% 17.6% 19.2% 18.5% 18.87% 25.28% Proportion below Medin 62.8% 54.7% 62.1% 58.7% 57.2% 57.1% 58.2% 55.5 % 49.5 % Negtive nd nil 0.7% 0.9% 0.8% 0.5% 1.1% 0.7% 0.7% 0.60% 0.69% $1 to $199 6.3% 4.7% 5.9% 6.5% 5.0% 4.9% 5.8% 4.83% 3.91% $200 to $299 11.9% 8.0% 11.0% 9.7% 9.0% 9.2% 9.6% 9.26% 7.15% $300 to $499 26.1% 18.7% 25.2% 20.0% 21.6% 20.5% 21.0% 19.88% 15.62% $500 to $699 14.3% 12.8% 14.6% 12.1% 12.8% 13.3% 12.8% 13.19% 11.42% $700 to $999 12.4% 15.1% 13.6% 13.6% 14.5% 14.4% 13.9% 14.78% 14.34% $1,000 to $1,499 9.9% 15.6% 10.3% 14.7% 13.2% 13.6% 13.9% 14.72% 16.50% $1,500 to $1,999 4.5% 7.5% 4.3% 7.1% 6.2% 7.0% 6.6% 6.96% 10.40% $2,000 or more 2.4% 4.5% 2.4% 4.3% 4.2% 4.2% 4.0% 4.22% 8.40% Not stted 11.5% 12.2% 11.9% 11.5% 12.3% 12.1% 11.8% 11.54% 11.57% Totl 9,632 12,618 14,742 25,399 9,196 14,297 56,845 471,313 1,667,687 PROPORTIONS RELATED NATIONAL QUINTILES AND MEDIANS Ist Qurtile 36.7% 25.9% 34.4% 30.5% 29.5% 28.6% 30.3% 27.95% 21.18% 2nd Qurtile 27.7% 24.9% 28.6% 23.6% 25.4% 25.6% 37.6% 25.53% 21.73% 3rd Qurtile 15.6% 21.9% 16.5% 20.1% 19.8% 19.9% 19.7% 20.86% 22.59% 4th Qurtile 8.6% 15.1% 8.6% 14.4% 13.0% 13.8% 13.4% 14.12% 22.93% Proportion below Medin 64.4% 50.8% 63.0% 54.1% 54.9% 54.2% 67.9% 53.5 % 42.9 % 53 The qurtiles re rrnged in order of incresing income. If the tble indictes tht 27% of people in region re in the first qurtile, it is sying tht 27% of the people re mong the 25% with the lowest income ntionlly, i.e. the region hs more thn verge people in tht income group. Similrly proportion greter thn 50% below the medin, indictes tht there re more thn the verge number of people hving mong the lowest hlf of incomes ntionlly. Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 87

Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 88

6 APPENDIX 3: BURDEN OF DISEASE DATA Despite the fct tht dt from the Burden of Disese (BoD) studies conducted in the mid 1990s is now out of dte, it is the most epidemiologiclly sophisticted dt we hve vilble. In ddition, the ssessment of impct in comprble terms, tht consider both loss of length nd qulity of life, is vluble. Indeed for helth service plnning, the concept of time lived with helth problems is probbly more importnt thn mortlity. We look forwrd to the imminent relese of more current Burden of Disese dt, nd will include its nlysis in our strtegic pln implementtion ctivities. 6.1 TOP CAUSES OF DEATH The top 25 cuses of deth, rnked, re presented by LGA in the following tble: RANKING OF DEATHS AND TOP 25 CAUSES FOR MALES & FEMALES, 1996 RANK DISEASE DEATHS % RANK DISEASE DEATHS % BASS COAST BAW BAW 1 Ischemic hert disese 67 27.2 1 Ischemic hert disese 74 29.5 2 Stroke 23 9.3 2 Stroke 20 8.1 3 Lung cncer 15 6.0 3 Lung cncer 13 5.1 4 COPD 14 5.6 4 COPD 12 4.8 5 Colon/Rectum Cncer 10 4.1 5 Colon/Rectum Cncer 12 4.7 6 Dibetes mellitus 8 3.2 6 Dibetes mellitus 7 2.7 7 Prostte cncer 7 2.8 7 Dementi 6 2.5 8 Dementi 6 2.5 8 Brest cncer 6 2.4 9 Brest cncer 6 2.3 9 RTA 5 2.1 10 Nephritis/nephrosis 5 2.2 10 Lower respirtory trct infections 5 2.1 11 Hypertensive hert disese 4 1.8 11 Suicide 5 2.0 12 Lower respirtory trct infections 4 1.7 12 Prostte cncer 5 1.8 13 RTA 3 1.4 13 Stomch cncer 4 1.5 14 Cncer of the oesophgus 3 1.3 14 Cncer of the oesophgus 3 1.4 15 Cirrhosis 3 1.2 15 Nephritis/nephrosis 3 1.4 16 Aortic neurysm 3 1.1 16 Peripherl vsculr disese 3 1.4 17 Other neoplsms 3 1.1 17 Hypertensive hert disese 3 1.3 18 Lymphom 3 1.1 18 Pncretic cncer 3 1.2 19 Stomch cncer 3 1.1 19 Inflmmtory hert disese 3 1.2 20 Prkinson's 3 1.1 20 Other Endo nd metb disorders 3 1.2 21 Suicide 2 1.0 21 Other crdiovsculr disese 3 1.1 22 Asthm 2 0.9 22 Lymphom 3 1.1 23 Peripherl vsculr disese 2 0.9 23 Ovrin cncer 2 0.8 Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 89

24 Leukemi 2 0.9 24 Other neoplsms 2 0.8 25 Inflmmtory hert disese 2 0.9 25 Other respirtory disese 2 0.8 EAST GIPPLAND LATROBE 1 Ischemic hert disese 108 29.0 1 Ischemic hert disese 130 24.9 2 Stroke 36 9.5 2 Stroke 49 9.4 3 Lung cncer 25 6.8 3 Lung cncer 39 7.4 4 COPD 25 6.6 4 COPD 29 5.5 5 Colon/Rectum Cncer 17 4.6 5 Colon/Rectum Cncer 23 4.3 6 Dementi 9 2.5 6 Dibetes mellitus 15 2.9 7 Prostte cncer 9 2.5 7 Dementi 12 2.2 8 Dibetes mellitus 9 2.3 8 RTA 9 1.8 9 Hypertensive hert disese 6 1.7 9 Suicide 9 1.7 10 Pncretic cncer 6 1.7 10 Brest cncer 9 1.7 11 Brest cncer 6 1.5 11 Prostte cncer 9 1.7 12 Suicide 5 1.4 12 Hypertensive hert disese 8 1.5 13 RTA 5 1.4 13 Other crdiovsculr disese 7 1.3 14 Nephritis/nephrosis 5 1.4 14 Leukemi 7 1.3 15 Leukemi 5 1.3 15 Peripherl vsculr disese 6 1.2 16 Lower respirtory trct infections 5 1.3 16 Inflmmtory hert disese 6 1.2 17 Lymphom 4 1.1 17 Nephritis/nephrosis 6 1.2 18 Aortic neurysm 4 1.0 18 Other respirtory disese 6 1.2 19 Bldder cncer 4 1.0 19 Other neoplsms 6 1.1 20 Cirrhosis 4 1.0 20 Pncretic cncer 6 1.1 21 Peripherl vsculr disese 4 1.0 21 Stomch cncer 6 1.1 22 Other respirtory disese 3 0.9 22 Aortic neurysm 6 1.1 23 Other crdiovsculr disese 3 0.9 23 Lower respirtory trct infections 5 1.0 24 Melnom 3 0.9 24 Cirrhosis 5 1.0 25 Other neoplsms 3 0.8 25 Lymphom 5 1.0 SOUTH WELLINGTON 1 Ischemic hert disese 58 26.8 1 Ischemic hert disese 97 30.1 2 Stroke 20 9.2 2 Stroke 27 8.4 3 Lung cncer 12 5.7 3 Lung cncer 17 5.4 4 COPD 11 5.3 4 COPD 16 4.9 5 Colon/Rectum Cncer 9 4.0 5 Colon/Rectum Cncer 13 4.0 6 Dibetes mellitus 7 3.0 6 Dibetes mellitus 11 3.3 7 Prostte cncer 6 2.6 7 Dementi 9 2.8 8 Dementi 5 2.5 8 Prostte cncer 8 2.4 9 Brest cncer 5 2.3 9 Hypertensive hert disese 6 1.7 10 Nephritis/nephrosis 5 2.2 10 Suicide 5 1.6 11 Hypertensive hert disese 4 1.8 11 Peripherl vsculr disese 5 1.4 12 RTA 4 1.8 12 Lymphom 5 1.4 Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 90

13 Lower respirtory trct infections 4 1.7 13 RTA 4 1.4 14 Cirrhosis 3 1.3 14 Other crdiovsculr disese 4 1.2 15 Suicide 3 1.3 15 Other respirtory disese 4 1.2 16 Other neoplsms 3 1.3 16 Aortic neurysm 4 1.2 17 Cncer of the oesophgus 3 1.2 17 Brest cncer 4 1.1 18 Lymphom 3 1.2 18 Cncer of the oesophgus 4 1.1 19 Aortic neurysm 2 1.1 19 Pncretic cncer 3 1.1 20 Stomch cncer 2 1.1 20 Other neoplsms 3 1.0 21 Prkinson's 2 1.0 21 Inflmmtory hert disese 3 1.0 22 Asthm 2 0.9 22 Flls 3 0.9 23 Inflmmtory hert disese 2 0.9 23 Other Endo nd metb disorders 3 0.9 24 Peripherl vsculr disese 2 0.9 24 Ovrin cncer 3 0.9 25 Leukemi 2 0.8 25 Stomch cncer 3 0.9 6.2 LENGTH OF LIFE This tble of Burden of Disese presents the min cuses of yers of life lost (YLL). RANKING OF YLL AND TOP 25 CAUSES FOR MALES & FEMALES, 1996 RANK DISEASE DEATHS % RANK DISEASE DEATHS % BASS COAST BAW BAW 1 Ischemic hert disese 562 24.1 1 Ischemic hert disese 612 23.4 2 Stroke 180 7.7 2 Stroke 172 6.6 3 Lung cncer 163 7.0 3 Lung cncer 150 5.7 4 COPD 122 5.2 4 Colon/Rectum Cncer 137 5.2 5 Colon/Rectum Cncer 106 4.5 5 Suicide 121 4.6 6 Brest cncer 76 3.3 6 RTA 113 4.3 7 RTA 69 3.0 7 COPD 103 3.9 8 Dibetes mellitus 65 2.8 8 Brest cncer 87 3.3 9 Prostte cncer 57 2.4 9 Dibetes mellitus 66 2.5 10 Suicide 47 2.0 10 Stomch cncer 45 1.7 11 Dementi 36 1.6 11 Lymphom 45 1.7 12 Nephritis/nephrosis 36 1.5 12 Cncer of the oesophgus 43 1.6 13 Cirrhosis 34 1.5 13 Dementi 41 1.6 14 Lymphom 34 1.5 14 Prostte cncer 41 1.5 15 Asthm 32 1.4 15 Lower respirtory trct infections 35 1.3 16 Cncer of the oesophgus 31 1.3 16 Pncretic cncer 34 1.3 17 Hypertensive hert disese 30 1.3 17 Birth trum & sphyxi 32 1.2 18 Stomch cncer 27 1.2 18 Nephritis/nephrosis 29 1.1 19 Lower respirtory trct infections 25 1.1 19 Inflmmtory hert disese 29 1.1 Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 91

20 Aortic neurysm 24 1.0 20 Brin cncer 22 0.9 21 Leukemi 24 1.0 21 Peripherl vsculr disese 21 0.8 22 Inflmmtory hert disese 23 1.0 22 Drowning 19 0.7 23 Ovrin cncer 23 1.0 23 Leukemi 18 0.7 24 Pncretic cncer 20 0.8 24 Cirrhosis 18 0.7 25 Melnom 19 0.8 25 Other trffic ccidents 18 0.7 EAST GIPPLAND LATROBE 1 Ischemic hert disese 873 23.7 1 Ischemic hert disese 1192 20.7 2 Lung cncer 305 8.3 2 Lung cncer 450 7.8 3 Stroke 256 6.9 3 Stroke 409 7.1 4 COPD 212 5.8 4 COPD 259 4.5 5 Colon/Rectum Cncer 179 4.9 5 Colon/Rectum Cncer 257 4.4 6 Suicide 121 3.3 6 RTA 223 3.9 7 RTA 114 3.1 7 Suicide 207 3.6 8 Dibetes mellitus 84 2.3 8 Brest cncer 138 2.4 9 Brest cncer 76 2.1 9 Dibetes mellitus 138 2.4 10 Prostte cncer 74 2.0 10 Leukemi 103 1.8 11 Pncretic cncer 64 1.7 11 Inflmmtory hert disese 83 1.4 12 Leukemi 63 1.7 12 Dementi 74 1.3 13 Dementi 56 1.5 13 Brin cncer 74 1.3 14 Melnom 48 1.3 14 Prostte cncer 71 1.2 15 Hypertensive hert disese 47 1.3 15 Cirrhosis 71 1.2 16 Cirrhosis 46 1.3 16 Pncretic cncer 58 1.0 17 Lymphom 44 1.2 17 Hypertensive hert disese 56 1.0 18 Nephritis/nephrosis 39 1.1 18 Lymphom 55 1.0 19 Low birth weight 39 1.0 19 Liver cncer 52 0.9 20 Inflmmtory hert disese 35 0.9 20 Melnom 52 0.9 21 Ovrin cncer 34 0.9 21 Drug buse/dependency 51 0.9 22 Aortic neurysm 34 0.9 22 Nephritis/nephrosis 51 0.9 23 Stomch cncer 33 0.9 23 Ovrin cncer 51 0.9 24 Kidney cncer 31 0.8 24 Kidney cncer 51 0.9 25 Peripherl vsculr disese 29 0.8 25 Stomch cncer 50 0.9 SOUTH WELLINGTON 1 Ischemic hert disese 485 22.8 1 Ischemic hert disese 818 25.6 2 Stroke 156 7.3 2 Stroke 197 6.2 3 Lung cncer 138 6.5 3 Lung cncer 192 6.0 4 COPD 98 4.6 4 Colon/Rectum Cncer 155 4.8 5 Colon/Rectum Cncer 94 4.4 5 COPD 136 4.3 6 RTA 86 4.0 6 Suicide 111 3.5 7 Brest cncer 71 3.3 7 Dibetes mellitus 102 3.2 8 Suicide 59 2.8 8 RTA 99 3.1 Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 92

9 Dibetes mellitus 53 2.5 9 Prostte cncer 62 1.9 10 Prostte cncer 46 2.2 10 Lymphom 54 1.7 11 Cirrhosis 36 1.7 11 Dementi 52 1.6 12 Lymphom 33 1.5 12 Brest cncer 51 1.6 13 Dementi 33 1.5 13 Inflmmtory hert disese 42 1.3 14 Nephritis/nephrosis 30 1.4 14 Pncretic cncer 41 1.3 15 Asthm 29 1.4 15 Ovrin cncer 39 1.2 16 Hypertensive hert disese 27 1.3 16 Hypertensive hert disese 38 1.2 17 Cncer of the oesophgus 26 1.2 17 Cncer of the oesophgus 37 1.1 18 Stomch cncer 24 1.1 18 Aortic neurysm 36 1.1 19 Inflmmtory hert disese 22 1.0 19 Leukemi 36 1.1 20 Lower respirtory trct infections 22 1.0 20 Melnom 33 1.0 21 Ovrin cncer 21 1.0 21 Kidney cncer 32 1.0 22 Brin cncer 21 1.0 22 Congenitl hert disese 31 1.0 23 Melnom 21 1.0 23 Cirrhosis 29 0.9 24 Leukemi 21 1.0 24 Peripherl vsculr disese 29 0.9 25 Aortic neurysm 19 0.9 25 Stomch cncer 25 0.8 6.3 INCORPORATING QUALITY OF LIFE The Burden of Disese (BoD) studies did not only consider yers of life lost (YLL) but lso the number of yers which person lived with disbility. Ech medicl condition ws ssigned weighting depending on the severity of disbility nd suffering usully ssocited with tht condition. Ech yer lived with disbility (YLD) ws considered to be equl to certin proportion of yer of life lost; so, for exmple, 2 yers lived with condition tht involves gret suffering my be considered equl to one yer of life lost. By dding yers of life lost nd the weighted yers of life lived with disbility, the reserchers clculted figure clled the disbility djusted life yer (DALY) nd looked t DALYs lost due to different conditions, clsses of condition nd lso risk fctors. There hve been both ntionl nd Victorin studies undertken. The regionl dt is bsed on the Victorin study. RANKING OF DALY AND TOP 25 CAUSES FOR MALES & FEMALES, 1996 RANK DISEASE DEATHS % RANK DISEASE DEATHS % BASS COAST BAW BAW 1 Ischemic hert disese 629 16.2 1 Ischemic hert disese 679 14.5 2 Stroke 249 6.4 2 Stroke 239 5.1 3 COPD 186 4.8 3 COPD 180 3.8 4 Lung cncer 180 4.6 4 Colon/Rectum Cncer 168 3.6 5 Dementi 149 3.8 5 Lung cncer 167 3.6 6 Colon/Rectum Cncer 138 3.6 6 Dementi 161 3.4 7 Dibetes mellitus 122 3.1 7 Depression 153 3.3 Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 93

8 Brest cncer 107 2.7 8 RTA 135 2.9 9 Osteorthritis 103 2.7 9 Dibetes mellitus 133 2.8 10 Depression 96 2.5 10 Asthm 128 2.7 11 Asthm 94 2.4 11 Suicide 121 2.6 12 Hering loss 89 2.3 12 Brest cncer 120 2.6 13 Prostte cncer 86 2.2 13 Osteorthritis 116 2.5 14 RTA 79 2.0 14 Hering loss 93 2.0 15 Prkinson's 57 1.5 15 Alcohol buse/dependency 71 1.5 16 Suicide 47 1.2 16 Prostte cncer 65 1.4 17 Lymphom 40 1.0 17 Other unintentionl 61 1.3 18 Other vision disorders 40 1.0 18 GAD 59 1.3 19 Nephritis/nephrosis 40 1.0 19 Prkinson's 51 1.1 20 Alcohol buse/dependency 37 0.9 20 Stomch cncer 51 1.1 21 Peripherl vsculr disese 36 0.9 21 Lymphom 51 1.1 22 Cirrhosis 36 0.9 22 Drug buse/dependency 48 1.0 23 Inflmmtory hert disese 36 0.9 23 Lower respirtory trct infections 47 1.0 24 GAD 35 0.9 24 Peripherl vsculr disese 45 1.0 25 Lower respirtory trct infections 35 0.9 25 Cncer of the oesophgus 45 1.0 EAST GIPPLAND LATROBE 1 Ischemic hert disese 962 15.4 1 Ischemic hert disese 1320 13.2 2 Stroke 351 5.6 2 Stroke 537 5.4 3 COPD 344 5.5 3 Lung cncer 473 4.7 4 Lung cncer 328 5.3 4 COPD 466 4.7 5 Colon/Rectum Cncer 223 3.6 5 Depression 349 3.5 6 Dementi 220 3.5 6 Dementi 319 3.2 7 Depression 191 3.1 7 Dibetes mellitus 316 3.2 8 Dibetes mellitus 188 3.0 8 Colon/Rectum Cncer 306 3.1 9 Osteorthritis 179 2.9 9 Asthm 288 2.9 10 RTA 148 2.4 10 Osteorthritis 277 2.8 11 Asthm 141 2.3 11 RTA 242 2.4 12 Hering loss 135 2.2 12 Suicide 208 2.1 13 Suicide 121 1.9 13 Brest cncer 189 1.9 14 Brest cncer 119 1.9 14 Alcohol buse/dependency 177 1.8 15 Prostte cncer 106 1.7 15 Hering loss 176 1.8 16 Alcohol buse/dependency 75 1.2 16 Drug buse/dependency 138 1.4 17 Prkinson's 73 1.2 17 GAD 122 1.2 18 Leukemi 68 1.1 18 Inflmmtory hert disese 110 1.1 19 Pncretic cncer 66 1.1 19 Leukemi 109 1.1 20 GAD 65 1.0 20 Prkinson's 107 1.1 21 Melnom 64 1.0 21 Prostte cncer 103 1.0 22 Peripherl vsculr disese 60 1.0 22 Peripherl vsculr disese 89 0.9 Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 94

23 Other vision disorders 58 0.9 23 Brin cncer 77 0.8 24 Inflmmtory hert disese 54 0.9 24 Cirrhosis 75 0.8 25 Lymphom 53 0.9 25 Other vision disorders 73 0.7 SOUTH WELLINGTON 1 Ischemic hert disese 544 14.5 1 Ischemic hert disese 900 15.8 2 Stroke 217 5.8 2 Stroke 278 4.9 3 COPD 163 4.4 3 COPD 237 4.2 4 Lung cncer 153 4.1 4 Depression 217 3.8 5 Dementi 128 3.4 5 Lung cncer 212 3.7 6 Colon/Rectum Cncer 122 3.3 6 Dementi 207 3.6 7 Depression 119 3.2 7 Colon/Rectum Cncer 191 3.3 8 Dibetes mellitus 114 3.0 8 Dibetes mellitus 189 3.3 9 Asthm 112 3.0 9 Asthm 151 2.7 10 RTA 100 2.7 10 Osteorthritis 145 2.5 11 Brest cncer 99 2.7 11 RTA 134 2.4 12 Osteorthritis 94 2.5 12 Hering loss 113 2.0 13 Hering loss 78 2.1 13 Suicide 111 2.0 14 Prostte cncer 69 1.8 14 Prostte cncer 91 1.6 15 Suicide 59 1.6 15 Brest cncer 90 1.6 16 Prkinson's 49 1.3 16 Alcohol buse/dependency 85 1.5 17 Alcohol buse/dependency 48 1.3 17 GAD 75 1.3 18 GAD 43 1.2 18 Lymphom 62 1.1 19 Lymphom 38 1.0 19 Prkinson's 61 1.1 20 Flls 38 1.0 20 Peripherl vsculr disese 58 1.0 21 Cirrhosis 37 1.0 21 Inflmmtory hert disese 57 1.0 22 Other vision disorders 36 1.0 22 Flls 53 0.9 23 Nephritis/nephrosis 34 0.9 23 Other vision disorders 48 0.8 24 Inflmmtory hert disese 34 0.9 24 Melnom 47 0.8 25 Melnom 32 0.9 25 Pncretic cncer 43 0.8 The following tble indictes the top 25 cuses for Yers Lived with Disbility [YLD]. RANKING OF YLD AND TOP 25 CAUSES FOR MALES & FEMALES, 1996 RANK DISEASE DEATHS % RANK DISEASE DEATHS % BASS COAST BAW BAW 1 Dementi 113 7.3 1 Depression 153 7.4 2 Osteorthritis 102 6.6 2 Dementi 120 5.8 3 Depression 95 6.1 3 Asthm 117 5.7 4 Hering loss 89 5.7 4 Osteorthritis 114 5.5 5 Stroke 69 4.5 5 Hering loss 93 4.5 Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 95

6 Ischemic hert disese 67 4.3 6 COPD 77 3.7 7 COPD 64 4.1 7 Stroke 67 3.3 8 Asthm 62 4.0 8 Ischemic hert disese 66 3.2 9 Dibetes mellitus 57 3.7 9 Dibetes mellitus 66 3.2 10 Prkinson's 40 2.6 10 Alcohol buse/dependency 64 3.1 11 Other vision disorders 40 2.6 11 GAD 59 2.9 12 GAD 35 2.3 12 Other unintentionl 57 2.8 13 Alcohol buse/dependency 34 2.2 13 Other vision disorders 41 2.0 14 Colon/Rectum Cncer 32 2.1 14 Prkinson's 40 2.0 15 Brest cncer 31 2.0 15 Brest cncer 33 1.6 16 Prostte cncer 29 1.8 16 Socil phobi 32 1.5 17 Benign prosttic hypertrophy 26 1.7 17 Colon/Rectum Cncer 31 1.5 18 Flls 23 1.5 18 Schizophreni 29 1.4 19 Other unintentionl 23 1.5 19 Bipolr disorder 29 1.4 20 Peripherl vsculr disese 22 1.4 20 Attention-deficit disorder 28 1.4 21 Lung cncer 17 1.1 21 Infertility 27 1.3 22 Socil phobi 16 1.0 22 Prostte cncer 25 1.2 23 Dentl cries 15 1.0 23 Benign prosttic hypertrophy 25 1.2 24 Schizophreni 15 0.9 24 Peripherl vsculr disese 23 1.1 25 BPD 14 0.9 25 Dentl cries 22 1.1 EAST GIPPLAND LATROBE 1 Depression 191 7.5 1 Depression 349 8.3 2 Osteorthritis 177 6.9 2 Osteorthritis 272 6.5 3 Dementi 165 6.5 3 Asthm 260 6.2 4 Hering loss 135 5.3 4 Dementi 245 5.8 5 COPD 132 5.2 5 COPD 207 4.9 6 Asthm 115 4.5 6 Dibetes mellitus 178 4.2 7 Dibetes mellitus 104 4.1 7 Hering loss 176 4.2 8 Stroke 95 3.7 8 Alcohol buse/dependency 158 3.8 9 Ischemic hert disese 89 3.5 9 Stroke 128 3.0 10 Alcohol buse/dependency 71 2.8 10 Ischemic hert disese 128 3.0 11 GAD 65 2.5 11 GAD 122 2.9 12 Prkinson's 59 2.3 12 Prkinson's 73 1.7 13 Other vision disorders 58 2.3 13 Other vision disorders 73 1.7 14 Brest cncer 43 1.7 14 BPD 72 1.7 15 Colon/Rectum Cncer 43 1.7 15 Socil phobi 69 1.7 16 Benign prosttic hypertrophy 38 1.5 16 Bipolr disorder 67 1.6 17 RTA 33 1.3 17 Schizophreni 66 1.6 18 Prostte cncer 32 1.3 18 Infertility 58 1.4 19 Socil phobi 32 1.2 19 Attention-deficit disorder 57 1.4 20 Peripherl vsculr disese 31 1.2 20 Benign prosttic hypertrophy 53 1.3 Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 96

21 Schizophreni 29 1.1 21 Brest cncer 51 1.2 22 Attention-deficit disorder 28 1.1 22 Colon/Rectum Cncer 50 1.2 23 Bipolr disorder 28 1.1 23 Heroin dependency nd poly drug 48 1.1 use 24 Infertility 27 1.0 24 Dentl cries 46 1.1 25 Dentl cries 26 1.0 25 Peripherl vsculr disese 45 1.1 SOUTH WELLINGTON 1 Depression 118 7.3 1 Depression 125 10.0 2 Dementi 96 5.9 2 Dementi 108 8.7 3 Osteorthritis 94 5.8 3 Osteorthritis 90 7.2 4 Asthm 83 5.1 4 Asthm 68 5.5 5 Hering loss 78 4.8 5 GAD 47 3.8 6 COPD 65 4.0 6 Dibetes mellitus 39 3.2 7 Stroke 61 3.8 7 Brest cncer 39 3.1 8 Dibetes mellitus 60 3.7 8 Other vision disorders 37 3.0 9 Ischemic hert disese 60 3.7 9 Stroke 35 2.8 10 Alcohol buse/dependency 46 2.9 10 Hering loss 34 2.8 11 GAD 43 2.7 11 COPD 32 2.5 12 Other vision disorders 36 2.2 12 Ischemic hert disese 30 2.4 13 Prkinson's 35 2.1 13 Prkinson's 28 2.2 14 Brest cncer 28 1.8 14 Alcohol buse/dependency 25 2.0 15 Flls 28 1.7 15 Eting disorders 22 1.8 16 Colon/Rectum Cncer 27 1.7 16 Socil phobi 21 1.7 17 Other unintentionl 24 1.5 17 Flls 20 1.6 18 Prostte cncer 23 1.4 18 Infertility 19 1.5 19 Benign prosttic hypertrophy 22 1.4 19 Schizophreni 17 1.4 20 Socil phobi 22 1.4 20 Bipolr disorder 17 1.3 21 Schizophreni 20 1.2 21 Rheumtoid rthritis 16 1.2 22 Peripherl vsculr disese 20 1.2 22 Colon/Rectum Cncer 15 1.2 23 Attention-deficit disorder 19 1.2 23 Dentl cries 13 1.1 24 Bipolr disorder 19 1.2 24 Incontinence 13 1.0 25 BPD 19 1.2 25 BPD 12 1.0 Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 97

7 APPENDIX 4: SERVICE DELIVERY DATA Service delivery dt is required from ech region on qurterly bsis. The dt ddresses issues such s client demogrphics, dmission nd dischrge rtes, type nd loction of service delivery deths nd loction of deth. Potentilly the dt hs gret utility in terms of identifying trends in service delivery nd benchmrking service delivery between regions both in Gippslnd nd cross the stte. This dt would be most useful if ble to demonstrte trends in demnd over time. Unfortuntely the nlysis of time series dt from the Gippslnd regions is frught with difficulty becuse of the incompleteness of the dt nd inccurcies in the dt. From the lst three yers the region should hve provided totl of 77 qurters of contct dt in relity there ws only dt bout dmissions from 66 qurters (86%) nd on dischrges from 49 qurters (64%). In ddition there were mny nomlies in the dt including: Mny clients being entered with the one Ptient ID; in one cse the sme ptient ID ws ssocited with fifteen different dtes of birth The ppernce tht dt ws ll entered t the end of the qurter nd everyone ws coded the sme in terms of contct recipient, loction, services etc. The ppernce tht in some cses dt ws entered by people who either didn t know the codes to use or didn t know wht hd ctully occurred with the client to be ble to code the contct Lots of missing dt of which the most problemtic is missing ptient IDs nd missing contct dte Inconsistency between gencies in how codes were defined nd used Dt in inconsistent formts (eg numbers nd dtes entered s text) Difficulty identifying first contcts with clients hence whether they re new dmission. These difficulties required the doption of multiple compenstory strtegies, ech of which ws imperfect in its bility to overcome the problems but which, tken together llow firly good pproximtions to the true vlues to be mde. Some of the min strtegies used were: Creting synthetic ptient IDs by combining the existing IDs with dte of birth nd gender Combining dt from ll qurters into super tbles so tht true first contcts could be identified Using some dt elements (eg totl number of contcts or totl number of dischrges s indictors of the mount of dt vilble nd reporting other dt s rtios in reltion to these see below) Ignoring coding dt from qurters where every contct ws ssigned the sme code Sensitivity nlysis, mking two estimtes bsed on different ssumptions bout the dt nd ssessing whether these differences were significnt 7.1 REPORTING RATIOS The min strtegy used to overcome the problem of gretly differing mounts of dt cross qurters ws to ttempt form of stndrdistion by reporting rtios of the dt items of interest ginst vribles tht reflect the number of cses vilble cross ll regions. Reporting in this wy mkes the dt less subject to vrition becuse, for exmple, in one qurter seven re provided dt while in the next only four did. Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 98

This cn be illustrted in the following two grphs of berevement service provision. The first grph reports the totl number of services delivered. The overll trend in the dt is muddied by the vrible mount of dt vilble cross the ten qurters. The second grph reports berevement services s rtio of the totl number of dischrges on which dt ws vilble. While berevement services do not directly relte to dischrges the totl number of dischrges is good mrker of the completeness of the dt. The result is tht in the second grph the trend to incresing provision of berevement services is much clerer (with the exception of the second qurter of 2002-03). Figure 1: Berevement counselling - rw figures For dischrge relted dt the rtio used ws either with totl dischrges or totl deths. With dmission nd service delivery relted dt the rtio used ws with totl contcts. 7.2 CONTACT DATA The grphs on the next few pges highlight trends relted to some of the min contct dt ctegories. Following this re tbles with the complete sets of contct dt grouped by region (cross ll qurters) nd by qurters (cross ll regions). (For discussion of berevement service dt see section on rtios bove). Figure 2: Berevement counselling - rtio of berevement counselling to dischrges Routine berevement counselling in progress Rtio of berevement counselling to dischrges 120 1.60 Num relted persons 100 80 60 40 20 Rtio of berevement counselling to dischrges 1.40 1.20 1.00 0.80 0.60 0.40 0.20 0 02-03 q1 02-03 q2 02-03 q3 02-03 q4 03-04 q1 03-04 q2 Qurters 03-04 q3 03-04 q4 04-05 q1 04-05 q2 0.00 02-03 q1 02-03 q2 02-03 q3 02-03 q4 03-04 q1 03-04 q2 Qurters 03-04 q3 03-04 q4 04-05 q1 04-05 q2 Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 99

7.2.1 TRENDS IN SERVICE DELIVERY There re no cler trends in terms of the recipients of contcts, lthough there seems to be modest increse in the proportion of contcts tht re with other professionl/service providers nd with ptients lone. There hs been modest increse in the proportion of contcts occurring in the ptients home (less thn 80% overll verge for the first five qurters compred to nerly 90% for the second five qurters). Figures 3 & b: Contct setting nd recipient type for contcts Contct setting Contct recipient type 60.0% 120.0% 50.0% 100.0% % of contcts 80.0% 60.0% 40.0% Home All Hospitl % of contcts 40.0% 30.0% 20.0% Ptient/client only Ptient/client only nd relted person(s) Relted person(s) only 20.0% 0.0% 02-03 q1 02-03 q2 02-03 q3 02-03 q4 03-04 q1 03-04 q2 Qurters 03-04 q3 03-04 q4 04-05 q1 04-05 q2 All other 10.0% 0.0% 02-03 q1 02-03 q2 02-03 q3 02-03 q4 03-04 q1 03-04 q2 Qurters 03-04 q3 03-04 q4 04-05 q1 04-05 q2 Other professionl/service provider 7.2.2 SITE OF DEATH The loction in which people die is considered to be n indictor of ccess to pllitive cre nd of the qulity nd comprehensiveness of the cre. A higher proportion dying t home is considered to indicte more dequte community pllitive cre services. Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 100

The grph indictes tht the proportion of deths in public hospitl pllitive cre beds hs been up nd down over the four yers, the proportion of deths t home hs decresed mrginlly while the proportion of deths in other settings hs incresed. Other settings include other hospitl beds nd nursing homes non-pllitive hospitl beds ccount for pproximtely hlf of the other settings nd nursing homes/hostels/srs for bout 25%. Figure 4: Loction of deth Loction of deth 50.0% 45.0% 40.0% 35.0% % of deths 30.0% 25.0% 20.0% 15.0% Home Hosp Pub - pll bed 10.0% 5.0% All other 0.0% 02-03 q1 02-03 q2 02-03 q3 02-03 q4 03-04 q1 03-04 q2 03-04 q3 03-04 q4 04-05 q1 04-05 q2 Qurters Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 101

7.2.3 ADMISSION AND SERVICE CONTACT RELATED DATA TABLES The following tbles show contct detils grouped first of ll by region nd secondly by qurter. Figures re presented s percentges of totl contcts. It is importnt to note tht there re significnt limittions to the dmissions dt due to difficulty in identifying the true first contct in mny cses. 7.2.3.1 Summry of dmissions by region In the tble below, the percentges re bsed on the verge qurterly number of contcts (yellow highlighted row). Blue shding indictes 30% less thn the overll verge, while ornge shding indictes 30% higher thn the overll verge. Green shding in the lst column indictes greter thn 5% of overll contcts. It is generlly useful to interpret consistent ptterns of difference which my be relted to lrge blocks of one colour. For exmple the lrge number of ornge cells for Bss Cost, both for services provided nd for service providers, indictes tht ptients t Bss re more likely to receive multidisciplinry service with more thn one service type. PERCENTAGES OF TOTAL CONTACTS BASS COAST SAN REMO BASS BAW BAW EAST LATROBE STH WELLINGTON Adm/contcts: Num qtrs w dt 10 7 9 10 9 10 11 66 Adm/contcts: % of possible qurters 91% 64% 82% 91% 82% 91% 100% 86% Adm/contcts: Qurters with dt vilble All but 04- All but 02-03 qs All but 02- All but 04-05 q All but All but 04-05 All 05 q3 (qulity suspect for some) 2 & 3 nd q4 of 03-04 nd 04-05 03 qs 3 & 4 3 02-03 q4 nd 04-5 q3 q3 Admissions ESTIMATED Num qtrs with dm figure 6 7 2 4 9 10 11 Averge qtrly dmissions 16.8 7.0 37.0 7.8 29.0 12.9 22 132.3 Num qtrs with people seen (not just dm) 4 0 7 6 0 0 0 Averge qtrly people seen (not just dm) 16.25 87.7 33.5 All Contcts During Period Averge qurterly contcts 788.5 323.9 1080.5 230.1 934.5 891.5 946 5195.1 CON 6 - Contct Recipient Type Ptient/client only 38.3% 20.4% 30.4% 54.5% 20.0% 41.1% 27.7% 32.7% Ptient/client only nd relted person(s) 48.0% 54.3% 44.9% 32.6% 38.3% 31.8% 41.3% 41.0% Relted person(s) only 4.3% 7.5% 13.6% 9.5% 24.1% 9.8% 10.1% 12.2% Other professionl/service provider 9.4% 17.9% 11.1% 3.4% 17.6% 17.3% 20.8% 14.1% TOTAL CONTACTS 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% CON 7 - Contct Setting OVERALL Home 64.4% 79.6% 71.0% 90.8% 70.8% 63.0% 62.7% 70.0% Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 102

PERCENTAGES OF TOTAL CONTACTS BASS COAST SAN REMO BASS BAW BAW EAST LATROBE STH WELLINGTON ESTIMATED Hosp Pub - pll bed 0.7% 0.0% 4.4% 0.0% 1.3% 7.7% 4.4% 3.2% Hosp Pub - non- pll bed 0.2% 0.0% 0.4% 0.0% 0.6% 3.4% 4.7% 1.5% Hosp Pvt - publicly funded - pll bed 0.3% 0.0% 0.3% 0.0% 0.3% 0.0% 0.2% 0.2% Hosp Pvt - publicly funded - non-pll bed 0.0% 0.0% 0.2% 0.0% 0.2% 0.0% 0.1% 0.1% Hosp Pvt - other 0.0% 0.0% 0.0% 0.0% 0.1% 0.0% 0.4% 0.1% Hosp - outptient 0.0% 0.0% 0.3% 0.0% 0.4% 1.1% 0.1% 0.3% Res cre - nursing home/hostel/srs/comm 1.4% 0.9% 3.3% 0.0% 4.1% 5.9% 0.6% 2.7% hospice Res cre - pll bed 0.0% 0.0% 0.1% 0.0% 0.3% 0.3% 0.1% 0.1% Other 12.4% 19.1% 18.5% 1.2% 16.3% 18.8% 15.3% 15.2% CON 8 - Mode of Contct CON 9 - Service Provided OVERALL Fce to Fce - office hours 51.6% 66.7% 74.1% 73.9% 40.1% 70.8% 54.4% 61.3% Fce to Fce - fter hours 11.8% 10.1% 18.5% 3.8% 15.6% 2.4% 7.5% 11.0% Telephone - office hours 13.4% 15.9% 3.7% 1.2% 23.7% 23.0% 14.6% 13.5% Telephone - fter hours 3.4% 4.6% 2.1% 0.1% 13.2% 0.7% 2.9% 4.0% Written 0.6% 1.0% 0.0% 0.0% 0.3% 3.8% 6.2% 1.8% Group 0.4% 0.2% 0.4% 0.0% 0.0% 0.5% 2.5% 0.6% Other 0.1% 1.2% 0.3% 0.1% 0.3% 0.2% 0.6% 0.3% Clinicl Consultncy/Cre 43.2% 56.6% 51.7% 68.6% 56.4% 55.9% 39.4% 51.9% Personl Cre 33.1% 15.7% 22.8% 10.2% 1.9% 15.8% 14.3% 16.6% Spiritul/Emotionl Support/Counselling 41.8% 54.9% 55.5% 42.8% 10.4% 34.8% 38.6% 38.9% Home Cre/Support 27.0% 10.3% 2.1% 19.9% 0.6% 37.9% 6.4% 13.5% Eduction 49.0% 48.1% 16.4% 19.5% 4.4% 7.2% 2.1% 17.1% Cse Mngement/Cre Co-ordinton 44.4% 50.0% 26.3% 6.8% 25.6% 30.8% 23.7% 28.2% CON 10 - Service Provider Nurse 67.4% 98.6% 83.9% 72.7% 96.1% 94.6% 79.6% 84.4% Medicl Officer 2.0% 0.5% 0.3% 1.4% 0.0% 0.0% 0.9% 0.7% Allied Helth Professionl 1.6% 0.4% 0.3% 0.8% 0.0% 4.4% 0.0% 1.0% Chplin/Pstorl Crer 0.0% 0.0% 0.3% 0.0% 0.0% 0.1% 0.0% 0.1% Counsellor/Berevement Counsellor 4.1% 0.0% 0.8% 2.1% 0.0% 4.7% 3.8% 2.3% Complimentry Therpist 0.0% 0.0% 0.0% 0.0% 0.0% 0.2% 0.2% 0.1% Volunteer 6.6% 0.9% 7.6% 6.0% 1.5% 2.8% 1.2% 4.1% Other 0.0% 0.0% 0.6% 2.9% 0.0% 0.8% 8.3% 1.9% Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 103

7.2.4 SUMMARY OF ADMISSIONS BY QUARTER In the tble below, the percentges re bsed on the totl qurterly number of contcts (yellow highlighted row). Blue shding indictes 30% less thn the overll verge, while ornge shding indictes 30% higher thn the overll verge. Overll the ptterns of service delivery seem to hve been firly consistent cross the three yers with the exception of the res highlighted in the grphs bove. AVERAGE PER REGION BY QUARTER JULY 02 TO MAR 05 Adm/contcts: Number of regions with dt Adm/contcts: % of possible regions Adm/contcts: Areswith dt vilble Admissions 02-03 02-03 02-03 02-03 03-04 03-04 03-04 03-04 04-05 04-05 04-05 Q3 OVERALL Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 7 6 5 5 7 7 7 6 6 7 1 64 100% 86% 71% 71% 100% 100% 100% 86% 86% 100% 1% 83% All All but Sn Remo All but Sn Remo, Bw Bw All but Bw Bw, LTrobe All All All All but Sn Remo All but Bw Bw All Wellington only Qurterly Totl Contcts 5441 5046 3517 4293 4,055 4540 4186 4106 3,372 4,789 981 44,326 All Contcts During Period CON 6 - Contct Recipient Type Ptient/client only 34.5% 20.2% 36.4% 40.5% 33.9% 27.2% 39.9% 42.5% 41.2% 35.6% 30.3% 34.9% Ptient/client only nd relted 39.6% 53.5% 39.3% 42.6% 36.5% 40.6% 36.0% 32.3% 29.6% 34.2% 42.1% 38.5% person(s) Relted person(s) only 14.3% 12.9% 12.5% 6.4% 11.9% 12.3% 12.6% 11.8% 11.8% 13.2% 15.2% 12.2% Other professionl/service provider 11.6% 13.3% 11.8% 10.4% 17.7% 19.9% 11.5% 13.3% 17.4% 17.1% 12.4% 14.4% TOTAL CONTACTS 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% CON 7 - Contct Setting Home 47.8% 73.9% 79.2% 75.3% 77.2% 68.7% 77.5% 74.7% 77.0% 74.7% 74.3% 72.1% Hosp Pub - pll bed 2.1% 5.0% 2.0% 1.1% 1.5% 2.5% 3.3% 4.6% 1.9% 4.9% 6.7% 3.1% Hosp Pub - non- pll bed 0.4% 0.9% 4.9% 1.4% 2.5% 1.4% 1.3% 2.0% 2.0% 0.9% 6.1% 1.7% Hosp Pvt - publicly funded - pll 0.0% 0.6% 0.3% 0.0% 0.1% 0.1% 0.1% 0.2% 0.0% 0.2% 0.2% 0.2% bed Hosp Pvt - publicly funded - nonpll 0.0% 0.4% 0.0% 0.0% 0.1% 0.3% 0.0% 0.0% 0.0% 0.0% 0.0% 0.1% bed Hosp Pvt - other 0.1% 0.0% 0.0% 0.1% 0.0% 0.5% 0.0% 0.0% 0.0% 0.1% 0.0% 0.1% Hosp - outptient 0.0% 1.0% 0.1% 0.2% 0.1% 0.3% 0.0% 0.0% 0.0% 0.2% 0.0% 0.2% All Hospitl 2.7% 7.9% 7.4% 2.8% 4.3% 5.1% 4.8% 6.9% 3.9% 6.3% 13.0% 5.3% Res cre - nursing home/hostel/srs/comm hospice 1.9% 3.1% 2.1% 1.7% 2.1% 2.7% 2.6% 3.5% 1.3% 1.3% 0.9% 2.2% Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 104

02-03 02-03 02-03 02-03 03-04 03-04 03-04 03-04 04-05 04-05 04-05 Q3 OVERALL JULY 02 TO MAR 05 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Res cre - pll bed 0.0% 0.2% 0.0% 0.0% 0.0% 0.4% 0.0% 0.0% 0.0% 0.0% 0.1% 0.1% Other 6.1% 14.7% 14.3% 9.7% 16.7% 17.1% 13.4% 13.3% 15.6% 19.1% 7.5% 13.9% AVERAGE PER REGION BY QUARTER CON 8 - Mode of Contct Fce to Fce - office hours 46.6% 67.2% 60.5% 57.2% 65.0% 57.5% 70.3% 69.7% 66.1% 66.4% 59.5% 62.5% Fce to Fce - fter hours 4.5% 7.1% 9.0% 7.8% 10.6% 10.6% 12.2% 11.0% 5.5% 10.8% 7.4% 8.9% Telephone - office hours 8.5% 14.0% 13.5% 13.5% 15.6% 17.9% 11.5% 12.3% 18.2% 14.0% 16.2% 13.8% Telephone - fter hours 1.0% 2.9% 4.6% 4.2% 4.5% 4.6% 3.7% 4.2% 3.6% 4.6% 3.4% 3.7% Written 0.7% 2.7% 2.3% 1.2% 2.6% 2.6% 1.4% 2.8% 2.8% 1.6% 6.9% 2.1% Group 0.1% 0.1% 0.7% 0.0% 0.7% 0.8% 0.5% 0.3% 2.7% 1.5% 0.0% 0.7% Other 0.3% 0.2% 0.2% 0.1% 0.2% 0.1% 0.4% 0.4% 0.6% 0.2% 2.3% 0.3% CON 9 - Service Provided Clinicl Consultncy/Cre 32.4% 44.6% 52.9% 54.0% 61.4% 53.9% 63.8% 56.3% 47.4% 51.1% 53.0% 51.5% Personl Cre 16.3% 19.2% 15.4% 19.9% 7.5% 12.5% 14.7% 20.0% 18.2% 20.9% 22.9% 16.7% Spiritul/Emotionl 29.7% 36.8% 32.2% 49.0% 40.1% 35.4% 44.5% 33.8% 26.4% 39.5% 42.6% 36.9% Support/Counselling Home Cre/Support 9.8% 20.2% 20.0% 22.8% 11.7% 6.7% 19.8% 20.0% 11.1% 10.0% 6.6% 14.7% Eduction 10.2% 15.9% 19.1% 28.8% 14.4% 15.7% 18.9% 14.4% 18.2% 15.7% 2.9% 16.5% Cse Mngement/Cre Coordinton 14.5% 23.7% 37.7% 29.1% 25.7% 34.5% 25.3% 25.2% 27.7% 28.7% 21.5% 26.7% CON 10 - Service Provider Nurse 85.1% 69.3% 87.1% 84.4% 90.0% 85.6% 97.5% 94.2% 92.0% 94.6% 83.7% 87.9% Medicl Officer 0.3% 0.5% 1.3% 1.2% 0.3% 0.3% 0.3% 0.2% 0.0% 1.3% 0.0% 0.6% Allied Helth Professionl 0.4% 0.5% 0.9% 0.5% 0.3% 0.9% 1.1% 0.9% 1.1% 2.5% 0.0% 0.9% Chplin/Pstorl Crer 0.3% 0.0% 0.0% 0.0% 0.0% 0.0% 0.1% 0.3% 0.0% 0.0% 0.0% 0.1% Counsellor/Berevement 2.3% 2.9% 1.4% 0.6% 0.4% 3.6% 0.6% 0.2% 0.3% 1.6% 11.1% 1.6% Counsellor Complimentry Therpist 0.0% 0.3% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.1% 0.0% 0.0% Volunteer 4.8% 4.0% 2.0% 1.3% 3.9% 4.3% 1.4% 1.2% 3.3% 3.3% 0.0% 3.0% Other 0.7% 3.2% 2.3% 2.5% 4.1% 1.9% 1.3% 1.4% 2.3% 1.9% 2.0% 2.1% 7.2.5 DISCHARGE RELATED DATA TABLES It is worth noting tht the dischrge relted dt is considerbly less complete thn the dmission nd service relted dt. 7.2.5.1 Summry of dischrges by region: Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 105

In the tble below, the percentges re bsed on the verge qurterly number of dischrges (yellow highlighted row). Blue shding indictes 30% less thn the overll verge, while ornge shding indictes 30% higher thn the overll verge. Green shding in the lst column indictes greter thn 5% of overll dischrges. Some notble findings in the following tble include the high proportion of dischrges through trnsfer (rther thn deth) in Bss Cost nd Est Gippslnd nd the low rte of deths t home in South Gippslnd. While it is tempting to speculte tht these differences relte to the performnce of services in these res, it is possible tht they relte completely to circumstntil issues like, for exmple, the locl vilbility of high cre hospitl beds. So, for exmple, it is possible tht the high rte of trnsfer from Bss Cost nd Est Gippslnd reflects lck of services for people requiring more intensive medicl cre, while it is lso possible tht the higher rte of deths in hospitl (rther thn t home) in South Gippslnd reflects ptients coming into the re s they pproch deth if they require more intensive, hospitl bsed services. PERCENTAGES OF TOTAL DISCHARGES BASS COAST SAN REMO BASS BAW BAW EAST LATROBE STH WELLINGTON Dischrge: Num qtrs w dt 6 7 2 4 9 10 11 49 Dischrges: % of possible qurters 55% 64% 18% 36% 82% 91% 100% 64% Dischrges: Qurters with dt vilble 02-03 q1-4; 03-04 q 1-2 All but 04-05 q3 All Dischrges All but 02-03 qs 2 & 3 nd q4 of 03-04 nd 04-05 02-03 q1-2 02-03 ll qtrs All but 02-03 q4 nd 04-5 q3 ESTIMATED Averge Qurterly Totl Dischrges 23.7 7.0 20.0 8.3 29.3 12.0 19.4 119.7 PAT 14 - Mode of Seprtion Dischrge home 8.9% 0.0% 12.5% 7.8% 10.4% 2.5% 4.0% 7.5% Dischrge /trnsfer to hosp - pll bed 17.1% 16.2% 0.0% 9.8% 3.1% 0.0% 0.0% 5.9% Dischrge /trnsfer to hosp - non-pll bed 4.1% 0.0% 0.0% 7.8% 0.0% 2.5% 0.8% 1.8% Dischrge /trnsfer to res cre - nursing 1.4% 0.0% 0.0% 5.2% 2.1% 2.5% 2.0% 1.8% home/hostel/srs Dischrge /trnsfer to res cre - pll bed 0.8% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.1% Dischrge /trnsfer to nother pll service 6.2% 12.7% 0.0% 5.2% 0.0% 3.8% 4.6% 3.7% Sttisticl seprtion - type chnge 2.1% 0.0% 2.5% 3.9% 0.0% 0.0% 2.4% 1.5% Died 59.5% 71.1% 85.0% 44.4% 79.2% 84.7% 86.2% 74.5% Other 0.0% 0.0% 0.0% 15.7% 5.2% 3.8% 0.0% 3.0% TOTAL DISHARGES 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% PAT 16 - Site of Deth Home 41.3% 32.8% 40.0% 24.5% 39.5% 17.0% 27.2% 33.8% Hosp Pub - pll bed 38.6% 25.0% 37.1% 18.4% 17.3% 40.8% 41.1% 27.5% Hosp Pub - non- ll bed 0.0% 14.0% 0.0% 49.0% 19.4% 21.7% 15.6% 13.1% Hosp Pvt - publicly funded - pll bed 0.0% 0.0% 5.7% 0.0% 0.0% 4.3% 4.3% 1.8% Hosp Pvt - publicly funded - non-pll bed 14.4% 15.0% 0.0% 0.0% 3.0% 0.0% 1.7% 4.1% OVERALL Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 106

Hosp Pvt - other 4.3% 13.3% 0.0% 0.0% 9.1% 1.7% 0.9% 4.0% Res cre - nursing home/hostel/srs 1.3% 0.0% 17.1% 0.0% 8.6% 14.5% 9.2% 7.2% Res cre - pll bed 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% Other 0.0% 0.0% 0.0% 8.2% 3.0% 0.0% 0.0% 1.2% PAT 18 - Mode Of Seprtion of Relted Person(s) Forml closure of cse 45.1% 33.8% 15.0% 7.8% Unvilb le Referrl to further berevement counselling 10.3% 12.7% 20.0% 0.0% Unvilb le Routine berevement counselling in progress 82.8% 68.5% 220.0% 19.6% Unvilb le 60.3% 87.1% 35.0% 3.1% 0.0% 5.9% 39.0% 185.3% 91.0% 7.2.5.2 Summry of dischrges by qurter In the tble below, the percentges re bsed on the totl qurterly number of dischrges (yellow highlighted row). Blue shding indictes 30% less thn the overll verge, while ornge shding indictes 30% higher thn the overll verge. The most significnt trends relted to loction of deth nd incresing berevement services hve lredy been highlighted in the grphs presented previously. AVERAGE PER REGION BY QUARTER JULY 02 TO MAR 05 Dischrge: Num regions w dt Dischrges: % of possible regions Dischrges: Regions with dt vilble Dischrges 02-03 02-03 02-03 02-03 03-04 03-04 03-04 03-04 04-05 04-05 04-05 Q3 OVERALL Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 7 6 5 5 5 5 4 3 4 4 1 49 100% 86% 71% 71% 71% 71% 57% 43% 57% 57% 14% 64% All All but Sn Remo All but Sn Remo, Bw Bw All but Bw Bw, LTrobe All but Bw Bw, Est Gipps All but Bw Bw, Est Gipps All but Bw Bw, Est Gipps, Bss Cost LTrobe, Wellingt on, Sth Gipps only All but Bw Bw, Est Gipps, Bss Cost All but Bw Bw, Est Gipps, Bss Cost Wellington only Qurterly Totl Dischrges 114 68 62 109 107 84 60 72 67 71 18 832 Qurterly Totl Deths 99 59 48 105 103 74 51 56 64 65 14 738 PAT 14 - Mode of Seprtion Percentges of totl dischrges Dischrge home 4.4% 5.9% 6.5% 3.7% 0.9% 0.0% 6.7% 18.1% 1.5% 4.2% 22.2% 5.2% Dischrge /trnsfer to hosp - pll 3.5% 4.4% 4.8% 11.0% 9.3% 1.2% 0.0% 0.0% 0.0% 0.0% 0.0% 4.0% bed Dischrge /trnsfer to hosp - non- 0.9% 1.5% 3.2% 0.9% 0.0% 1.2% 0.0% 1.4% 0.0% 0.0% 0.0% 0.8% Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 107

AVERAGE PER REGION BY QUARTER 02-03 Q1 02-03 Q2 02-03 Q3 02-03 Q4 03-04 Q1 03-04 Q2 03-04 Q3 03-04 Q4 04-05 Q1 04-05 Q2 04-05 Q3 OVERALL JULY 02 TO MAR 05 pll bed Dischrge /trnsfer to res cre - 2.6% 2.9% 1.6% 0.9% 0.0% 0.0% 1.7% 1.4% 0.0% 1.4% 0.0% 1.2% nursing home/hostel/srs Dischrge /trnsfer to res cre - 0.0% 0.0% 0.0% 0.9% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.1% pll bed Dischrge /trnsfer to nother pll 1.8% 2.9% 8.1% 2.8% 2.8% 6.0% 5.0% 1.4% 0.0% 1.4% 0.0% 3.0% service Sttisticl seprtion - type chnge 1.8% 0.0% 1.6% 0.0% 0.9% 3.6% 0.0% 0.0% 0.0% 0.0% 0.0% 0.8% Died 82.5% 82.4% 72.6% 78.0% 86.0% 88.1% 85.0% 77.8% 98.5% 91.5% 77.8% 83.9% Other 2.6% 0.0% 1.6% 1.8% 0.0% 0.0% 1.7% 0.0% 0.0% 1.4% 0.0% 1.0% TOTAL DISHARGES 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0 % PAT 16 - Site of Deth Percentges of totl deths 100.0% 100.0 % 100.0% 100.0% 100.0% Home 39.4% 45.8% 37.5% 31.4% 40.8% 32.4% 33.3% 39.3% 34.4% 29.2% 71.4% 37.0% Hosp Pub - pll bed 42.4% 40.7% 29.2% 41.0% 28.2% 21.6% 35.3% 35.7% 25.0% 41.5% 14.3% 34.0% Hosp Pub - non- ll bed 8.1% 1.7% 16.7% 17.1% 16.5% 32.4% 5.9% 8.9% 21.9% 7.7% 0.0% 14.0% Hosp Pvt - publicly funded - pll 1.0% 0.0% 0.0% 0.0% 1.9% 0.0% 7.8% 0.0% 0.0% 0.0% 7.1% 1.1% bed Hosp Pvt - publicly funded - nonpll 2.0% 3.4% 8.3% 5.7% 4.9% 2.7% 2.0% 1.8% 0.0% 3.1% 0.0% 3.4% bed Hosp Pvt - other 0.0% 0.0% 0.0% 2.9% 1.9% 1.4% 5.9% 0.0% 6.3% 9.2% 0.0% 2.6% Res cre - nursing 6.1% 6.8% 6.3% 1.9% 5.8% 9.5% 9.8% 14.3% 12.5% 9.2% 7.1% 7.6% home/hostel/srs Res cre - pll bed 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% Other 1.0% 1.7% 2.1% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.4% All other 18.2% 13.6% 33.3% 27.6% 31.1% 45.9% 31.4% 25.0% 40.6% 29.2% 14.3% 29.0% TOTAL DEATHS 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0 % PAT 18 - Mode Of Seprtion of Relted Person(s) 100.0% 100.0 % 100.0% 100.0% 100.0% Percentges of totl dischrges Forml closure of cse 17.5% 23.5% 35.5% 28.4% 22.4% 77.4% 76.7% 23.6% 83.6% 77.5% 27.8% 42.9% Referrl to further berevement 7.0% 2.9% 4.8% 6.4% 4.7% 1.2% 1.7% 0.0% 1.5% 0.0% 0.0% 3.4% counselling Routine berevement counselling 21.9% 142.6% 40.3% 52.3% 72.0% 88.1% 105.0 144.4% 85.1% 133.8% 72.2% 82.6% in progress % Percentges of totl deths Forml closure of cse 20.2% 27.1% 45.8% 29.5% 23.3% 87.8% 90.2% 30.4% 87.5% 84.6% 35.7% 48.4% Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 108

AVERAGE PER REGION BY QUARTER JULY 02 TO MAR 05 Referrl to further berevement counselling Routine berevement counselling in progress 02-03 02-03 02-03 02-03 03-04 03-04 03-04 03-04 04-05 04-05 04-05 Q3 OVERALL Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 8.1% 3.4% 6.3% 6.7% 4.9% 1.4% 2.0% 0.0% 1.6% 0.0% 0.0% 3.8% 25.3% 164.4% 52.1% 54.3% 74.8% 100.0% 123.5 % 185.7% 89.1% 146.2% 92.9% 93.1% 7.3 SERVICE DELIVERY DATA AND FUNDING The following tble explores the use of historicl ptterns of demnd versus popultion chrcteristics in reltion to existing nd proposed funding formule. In the tble, green shding indictes reltive overfunding bsed on the selected criteri, wheres red indictes reltive underfunding. It is importnt to note tht the estimted funding discrepncies re much greter in reltion to historicl funding criteri thn they re in reltion to popultion bsed criteri, nd tht the WREN formul mtches t lest one demogrphic indictor (number of people > 70) mrginlly better thn the RREF formul. While it is not surprising tht the formule mtch demogrphics (since they re lrgely demogrphiclly bsed), the mismtch between the formule nd historicl worklods is significnt. It is possible tht in certin cses the historicl worklod my give better indiction of the need for funding thn regionl demogrphics, s, for exmple where one re ttrcts more severely ill people who come into the region to ccess high cre services. UBF 04-05 UBF 03-04 RREF Alloction used by CGHS Current WREN figures used by DHS RREF bsed lloction 2003-04 RREF bsed lloction 2004-05 WREN bsed lloction 2004-05 Avge pts pr qtr Avge new pts per qtr Worklod indictor (verge of previous 2 columns) Work %- RREF % Work %- WREN % 70+ popul tion 70+ pop%- RREF % 70+ pop%- WREN % BASS COAST 11% 8% 11% 15% 11% 11% 15% 12% 14% 13% 2% -2% 16% 4% 1% BAW BAW 18% 14% 14% 13% 14% 14% 13% 22% 24% 23% 9% 10% 13% -1% 0% EAST 11% 21% 19% 19% 19% 19% 19% 9% 10% 10% -10% -10% 21% 1% 1% LATROBE 18% 27% 26% 26% 26% 26% 26% 13% 14% 14% -12% -13% 24% -1% -2% STH 17% 11% 12% 11% 12% 12% 11% 9% 13% 10% -2% 0% 11% -1% 0% WELLINGTON 26% 19% 18% 16% 18% 18% 16% 34% 25% 30% 12% 15% 15% -3% 0% Gippslnd 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 109

7.4 CANCER STREAMS: PERCENTAGE OF CANCERS FOR PEOPLE RESIDENT IN EACH LGA FOR THAT YEAR LOCA GOVT AREA BREAST CENTRAL NERVOUS SYSTEM COLO-RECTAL Plese note tht this dt is qulified. It does not relibly indicte incidence e.g. it does not distinguish individul clients from presenttions nd occsions of service. It is suggested tht this dt could be substntited or otherwise by compring it with sme-dy oncology seprtion nd episodes of cre. Red shding mens tht the proportion of people with tht cncer ws more thn 25% higher thn for the region s whole over the whole four yers. Thus if cell in yer totls row is shded red it mens tht the cncer hd first presenttion rte greter thn 25% higher thn for the four yers s whole. Similrly green shding indictes rte 25% lower thn the overll 4 yer verge. So for exmple, in the following tble brest cncer rtes were high in number of res in 2000-01 but substntilly lower in subsequent yers nd lowest in 2004-05. GENITO- URINARY GYNAECOLOGICAL HAEMATOLOGICAL MALIGNANCIES HEAD AND NECK LUNG SKIN (MELANOMA) UPPER GASTRO- INTESTINAL 2000-2001 Bss Cost (S) 15.6% 0.0% 6.8% 8.9% 3.1% 4.7% 1.6% 6.8% 43.8% 8.9% Bw Bw (S) 14.0% 0.4% 17.4% 11.4% 2.1% 9.7% 2.5% 5.1% 31.8% 5.5% Est Gippslnd (S) 20.5% 0.3% 18.4% 10.9% 6.3% 13.9% 1.8% 10.0% 10.3% 7.6% L Trobe (S) 14.5% 0.8% 16.4% 17.5% 4.0% 10.8% 3.8% 8.3% 16.9% 7.0% South Gippslnd (S) 16.4% 1.1% 11.6% 9.5% 3.7% 12.7% 1.1% 8.5% 27.0% 8.5% Wellington (S) 12.7% 2.5% 15.3% 14.8% 7.6% 9.3% 1.7% 7.2% 20.8% 8.1% Out of region 18.7% 0.9% 14.0% 14.0% 3.7% 12.1% 0.9% 9.3% 16.8% 9.3% 2000-2001 Totl 16.0% 0.8% 15.0% 12.8% 4.6% 10.6% 2.2% 7.9% 22.5% 7.6% 2001-2002 Bss Cost (S) 6.2% 1.1% 6.8% 6.8% 2.8% 6.8% 2.8% 7.3% 53.7% 5.6% Bw Bw (S) 8.7% 0.5% 9.7% 12.2% 3.6% 17.9% 2.0% 6.6% 30.6% 8.2% Est Gippslnd (S) 14.7% 1.8% 16.8% 13.3% 4.2% 13.7% 2.8% 10.9% 12.6% 9.1% L Trobe (S) 12.6% 2.8% 14.4% 17.2% 4.6% 10.9% 2.8% 11.6% 16.1% 7.0% South Gippslnd (S) 15.6% 3.1% 15.1% 10.4% 5.2% 10.9% 0.0% 8.9% 26.6% 4.2% Wellington (S) 14.9% 1.4% 23.0% 10.8% 5.0% 8.1% 2.7% 8.6% 18.0% 7.7% Out of region 12.1% 3.0% 11.1% 25.3% 1.0% 10.1% 4.0% 5.1% 23.2% 5.1% 2001-2002 Totl 12.4% 1.9% 14.5% 13.2% 4.1% 11.4% 2.4% 9.0% 24.1% 7.0% 2002-2003 Bss Cost (S) 8.8% 1.5% 8.4% 9.2% 1.1% 8.1% 5.5% 5.1% 48.7% 3.7% Bw Bw (S) 8.8% 1.5% 19.8% 9.9% 2.7% 13.0% 1.9% 4.6% 31.7% 6.1% Est Gippslnd (S) 11.4% 0.4% 11.7% 13.0% 4.3% 8.5% 2.0% 10.5% 33.0% 5.2% L Trobe (S) 15.9% 0.8% 17.3% 13.6% 2.0% 13.6% 2.5% 10.2% 17.8% 6.2% South Gippslnd (S) 14.4% 3.3% 14.9% 12.2% 5.5% 11.0% 1.7% 12.2% 17.7% 7.2% Wellington (S) 14.0% 1.1% 23.2% 15.5% 3.0% 13.3% 0.4% 10.7% 14.8% 4.1% Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 110

LOCA GOVT AREA BREAST CENTRAL NERVOUS SYSTEM COLO-RECTAL GENITO- URINARY GYNAECOLOGICAL HAEMATOLOGICAL MALIGNANCIES HEAD AND NECK LUNG SKIN (MELANOMA) UPPER GASTRO- INTESTINAL Out of region 9.1% 1.3% 26.0% 14.3% 0.0% 18.2% 1.3% 7.8% 22.1% 0.0% 2002-2003 Totl 12.1% 1.2% 16.0% 12.5% 2.9% 11.4% 2.3% 8.9% 27.6% 5.1% 2003-2004 Bss Cost (S) 6.8% 1.6% 7.6% 12.0% 0.8% 4.4% 1.6% 5.2% 53.0% 6.8% Bw Bw (S) 13.4% 0.7% 16.6% 8.1% 2.1% 11.0% 0.7% 8.5% 33.2% 5.7% Est Gippslnd (S) 12.5% 0.4% 11.8% 13.7% 2.4% 7.3% 1.2% 5.9% 40.2% 4.7% L Trobe (S) 13.8% 1.6% 14.8% 16.4% 3.4% 13.2% 1.8% 8.8% 17.4% 8.8% South Gippslnd (S) 10.8% 1.9% 14.1% 12.7% 9.4% 13.1% 3.3% 7.5% 22.5% 4.7% Wellington (S) 14.3% 1.7% 18.7% 15.3% 1.7% 13.3% 1.7% 11.2% 16.0% 6.1% Out of region 18.5% 1.5% 13.8% 10.8% 1.5% 7.7% 0.0% 6.2% 33.8% 6.2% 2003-2004 Totl 12.5% 1.2% 13.9% 13.3% 3.0% 10.1% 1.6% 7.7% 30.8% 6.2% 2004-2005 Bss Cost (S) 8.0% 2.7% 9.8% 10.7% 0.9% 3.6% 1.8% 5.4% 52.7% 4.5% Bw Bw (S) 12.6% 0.9% 9.0% 3.6% 4.5% 8.1% 3.6% 3.6% 47.7% 6.3% Est Gippslnd (S) 8.9% 0.0% 14.1% 14.7% 3.7% 9.4% 1.6% 6.8% 36.1% 4.7% L Trobe (S) 17.4% 1.3% 18.1% 18.8% 4.0% 12.1% 0.7% 6.7% 13.4% 7.4% South Gippslnd (S) 3.4% 0.8% 20.2% 9.2% 4.2% 11.8% 0.8% 4.2% 39.5% 5.9% Wellington (S) 7.5% 2.3% 18.0% 12.0% 2.3% 13.5% 0.8% 13.5% 21.1% 9.0% Out of region 0.0% 0.0% 28.1% 12.5% 6.3% 6.3% 0.0% 3.1% 37.5% 6.3% 2004-2005 Totl 9.4% 1.2% 15.6% 12.2% 3.4% 9.8% 1.4% 6.7% 34.0% 6.3% Four yer totl 12.8% 1.3% 14.9% 12.8% 3.5% 10.7% 2.0% 8.2% 27.4% 6.4% Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 111

LGA DESC_IN BREAST CENTRAL NERVOUS SYSTEM RECTAL COLO- GENITO- URINARY GYNAECOLOGICAL HAEMATOLOGICAL MALIGNANCIES HEAD AND NECK LUNG SKIN (MELANOMA) UPPER GASTRO- INTESTINAL Cncers by LGA by strem for whole four yers number of individuls from ech strem within ech LGA Bss Cost (S) 91 13 78 96 17 58 29 59 503 59 1003 Bw Bw (S) 125 9 169 104 30 132 21 65 365 68 1088 Est Gippslnd (S) 242 10 248 230 71 178 32 154 491 107 1763 Ltrobe (S) 225 22 247 253 54 188 39 144 259 113 1544 South Gippslnd 114 19 132 98 52 107 13 76 229 54 894 (S) Wellington (S) 153 20 229 162 45 133 17 116 204 77 1156 Out of region 51 6 64 62 8 44 6 26 92 21 380 Grnd Totl 1001 99 1167 1005 277 840 157 640 2143 499 7828 Cncers by LGA by strem for whole four yers percentge of cncers from ech strem within ech LGA Bss Cost (S) 9.1% 1.3% 7.8% 9.6% 1.7% 5.8% 2.9% 5.9% 50.1% 5.9% 100.0% Bw Bw (S) 11.5% 0.8% 15.5% 9.6% 2.8% 12.1% 1.9% 6.0% 33.5% 6.3% 100.0% Est Gippslnd (S) 13.7% 0.6% 14.1% 13.0% 4.0% 10.1% 1.8% 8.7% 27.9% 6.1% 100.0% Ltrobe (S) 14.6% 1.4% 16.0% 16.4% 3.5% 12.2% 2.5% 9.3% 16.8% 7.3% 100.0% South Gippslnd 12.8% 2.1% 14.8% 11.0% 5.8% 12.0% 1.5% 8.5% 25.6% 6.0% 100.0% (S) Wellington (S) 13.2% 1.7% 19.8% 14.0% 3.9% 11.5% 1.5% 10.0% 17.6% 6.7% 100.0% Out of region 13.4% 1.6% 16.8% 16.3% 2.1% 11.6% 1.6% 6.8% 24.2% 5.5% 100.0% Grnd Totl 12.8% 1.3% 14.9% 12.8% 3.5% 10.7% 2.0% 8.2% 27.4% 6.4% 100.0% In this tble the most significnt finding is tht Bss Cost hd pproximtely twice the verge proportion of Melnoms. The proportion of Melnoms from Bw Bw ws lso higher thn verge, prticulrly s the verge is elevted by the very high Bss Cost rte. Ltrobe hd modertely higher thn verge proportion of people presenting with genito-urinry cncers, while Wellington hd substntilly higher thn verge proportion of colo-rectl cncers. The other vritions in incidence occur in rrer cncers nd the vritions my be due to chnce. Grnd Totl Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 112

8 APPENDIX 5: DEFINITION AND PRINCIPLES GUIDING ROLE DELINEATION: DEPARTMENT OF HUMAN SERVICES, VICTORIA 8.1 DEFINITIONS Specilist pllitive cre: Cre tht reflects expertise in complex symptom control, loss, grief nd berevement, long with sufficient time vilble to spend with ptients nd their fmilies to ddress complex issues. These services my ccept prime responsibility for cre, or work indirectly through dvising ptients professionl crers. (Kristjhnso, Toye & Dwson, 2003) Designted pllitive cre unit: Inptient cre funded by the Pllitive Cre Progrm of the Victorin Deprtment of Humn Services. The unit cn be stndlone fcility or locted within n cute or sub-cute cre fcility. It provides symptom control, respite cre nd end-of-life cre. A designted pllitive cre unity must hve onsite ccess to the following tem members: specilist pllitive nurse, medicl support tht hs specilist pllitive cre trining, nd multi-disciplinry stff with trining in grief nd berevement cre. Role delinetion: Defines the bility of hospitls to respond to the pllitive cre needs of people with life-thretening illness nd their crers nd fmilies. Role designtion is bsed on the pllitive cre skill level vilble within the hospitl; the bility of the hospitl to provide out-of-hours consultncy dvice; nd the bility of the hospitl to provide inptient respite nd stbilistion of symptoms. 8.2 PRINCIPLES People should hve ccess to the cre they need in their own community Crers of people with life thretening illness re supported by helth nd community cre providers People with life-thretening illness nd their crers nd fmilies hve ccess to specilist pllitive cre services when required People with life-thretening illness nd their crers nd fmilies hve tretment nd cre tht is coordinted nd integrted cross ll settings People with life-thretening illness nd their crers nd fmilies hve ccess to qulity services nd skilled stff to meet their needs 8.3 DESIGNATED SERVICE LEVELS DHS is yet to finlise the criteri for service levels. Further clrifiction is expected in July 2005. The following description hs been extrcted from the Strengthening Pllitive Cre Policy. 54 Role designtion: A process tht determines tht support services nd stff profile re provided to ensure tht clinicl services re ppropritely provided. The role level of service describes the complexity of the clinicl ctivity undertken by tht service, nd is chiefly determined by the presence of medicl, nursing nd other multi-disciplinry professionls who hold qulifictions comptible with the defined level of cre. DESIGNATED SERVICE LEVEL Level One DRAFT DESCRIPTORS AND CRITERIA Level one services cn include smller community hospitls ccessing specilist community-bsed pllitive cre services on n s-needed bsis. Level one services night hve specific beds tht re identified s being pproprite for pllitive cre ptients. 54 Op. cit. p19 Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 113

Level Two Level Three A specilist pllitive cre in-rech service includes, t minimum, pllitive cre nurse who hs ccess to guidnce from pllitive cre physicin or sufficiently trined medicl prctitioner who hs forml links with pllitive cre physicin. There is ccess to stff experienced in providing grief nd berevement services. An onsite specilist pllitive cre service includes, t minimum, pllitive cre physicin or sufficiently skilled medicl prctitioner who hs forml links with pllitive cre physicin nd pllitive cre trined nurse. There is onsite vilbility of stff experienced in providing grief nd berevcement services. Secondry specilist pllitive cre consulttion is vilble Mondy to Fridy within usul business hours. Designted pllitive cre beds re vilble nd where possible meet the requirements of the Hospice unit generic brief (Deprtment of Humn Services 2000); for exmple, metropolitn nd regionl hospitls with lrge dedicted pllitive cre inptient units. Stff re employed onsite (not in-rech) nd re vilble on 24-hour bsis. A pllitive cre tem includes pllitive cre physicin or sufficiently skilled medicl prctitioner who hs forml links with pllitive cre physicin, pllitive cre trined nurse, stff experienced in providing grief nd berevement services. There is 24-hour secondry consulttion service. There is direct cceptnce of ptients from community-bsed specilist pllitive cre providers. Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 114

9 APPENDIX 6: PALLIATIVE CARE SERVICE MAP 9.1 SERVICES INCLUDED IN THE SERVICE MAP The following gencies submitted informtion bout their services: LGA SERVICE ADDRESS TELEPHONE NO. BASS COAST BAW BAW / CARDINIA EAST LATROBE Bss Cost Regionl Helth Grhm Street, Wonthggi 3995 0356713333 Bss Cost Community Helth Service 1 Bck Bech Rd Sn Remo VIC 3925 0356785388 Kooweerup Regionl Helth Service Rossiter Rd Kooweerup 3981 0359979679 Neerim District Helth Service Min Rd, Neerim South 3831 0356281226 West Gippslnd Helthcre Group Lndsborough Rd, Wrrgul 3820 0356230614 Birnsdle Regionl Helth Service PO Box 474 Birnsdle 3875 0351503423 Buchn Bush Nursing 61 Min St, Buchn 3885 0351559222 Cnn Vlley Bush Nursing c/o PO Cnn River 0351586274 Gelntipy District Bush Nursing 1 Sleyrd Rd, Gelntipy 3885 0351550274 Gippslnd Lkes Community Helth PO Box 429 Lkes Entrnce 3909 0351558300 Now Now Community Helth Service c/o Post Office, Now Now 3887 0351557294 Omeo District Helth & Ensy Community Helth PO Box 42 Omeo 3898 0351590100 Orbost Regionl Helth Browning Street, Orbost 0351546601 Swifts Creek Bush Nursing PO box 212, swifts Creek 3896 0351594210 Ltrobe Community Helth Service 81-83 Buckley St, Norwell / PO Box 960 3840 0351365433 Ltrobe Regionl Hospitl PO Box 424, Trrlgon 3844 0351738036 Mryvle Privte Hospitl McDonld St, Morwell 3840 0351321201 SOUTH South Gippslnd Hospitl PO Box 104, Foster 3960 0356839777 South Gippslnd Pllitive Cre Service [incorp GSDHS & SGH] 0356675661 Wellington Pllitive Cre Service 0351438800 WELLINGTON Yrrm nd District Helth Service 85-91 Commercil Rod Yrrm 3971 0351820222 STATEWIDE SERVICES Peter McCllum Cncer Institute Victorin Peditric Pllitive Cre Progrm 3rd Floor South Est Building, Royl Children s Hospitl, Flemington Rd, Prkville 3052 0393455374 Motor Neurone DAV 265 Cnterbury Rod, Cnterbury, 3126 0398302122 Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 115

9.2 AREAS SERVICED SERVICES INCLUDED IN SERVICE MAP LGA SERVICE AREASSERVICED SERVICE SITES BASS COAST BAW BAW / CARDINIA EAST Bss Cost Comm. Helth Serv Western hlf of the Bss Cost Shire Sn Remo Bss Cost Regionl Hlth Bss Cost Regionl Helth, Wonthggi South-est section of Bss Cost Shire Hospitl Kooweerup Reg Hlth Serv Crdini, Bss Cost nd rurl component of Csey ie costl villges Kooweerup RHS site only Neerim District Hlth Serv Bw Bw shire - north of Wrrgul Neerim District Helth Service West Gippslnd Hlthcre Grp Bw Bw Shire Hospitl bsed service Birnsdle Reg Hlth Serv Est Gippslnd: Birnsdle nd surrounding districts Buchn Bush Nursing 25 kms round Buchn Buchn Bush Nursing Assoc Cnn Vlley Bush Nursing Cnn River, Noorinbee, Noorinbee North, Chndlers Creek, Buldh, Club Terrce, Combienbr, Wingn, Tmboon Inlet, Tonghi Creek Cnn Vlley Bush Nursing Centre Gelntipy District Bush Nursing W-Tree, Gelntipy, Butcher's Ridge, Seldom Seen Suggen Beuggen, Blck Mountin Gelntipy BNC Gippslnd Lkes Comm Hlth Western border the Tmbo River nd Estern Border Stoney Creek nd incorportes the towns of Lkes Entrnce, Klimn, Metung, Swn Rech nd Lke Tyres Bech Lkes Entrnce Now Now Comm Hlth Serv Now Now nd west to Hospitl Creek, nd est to Toorloo Arun Now Now Omeo District Hlth/Ensy Comm Hlth Omeo region includes Omeo, Benmbr, Dinner Plin, Cssilis, Swifts Creek nd Ensy communities. Omeo District Helth & Ensy Community Helth Centre Orbost Reg Helth Orbost, Mro Orbost Reginl Helth Swifts Creek Bush Nursing Bush Nursing Centre situted in the town Swifts Creek 20 km rdius from centre of town centre Ltrobe Comm Hlth Serv Ltrobe City Morwell LATROBE Ltrobe Reg Hospitl Gippslnd region: more specificlly likely to be people from Ltrobe or Bw Bw Shires LRH Mryvle Privte Hospitl Mryvle Privte Hospitl: in-hospitl terminl or interim cre only South Gippslnd Hospitl SOUTH Foster & District: from Inverlock to Henly to Mirboo North Foster Hospitl South Gippslnd Pll Cre Serv In the client's homes or in hospitl i.e. Gippslnd Southern Helth Service [ Korumburr & Foster Hospitls, Leongth cmpus] Wellington Pll Cre Serv Sle, brokering t times to Yrrm, Drgo WELLINGTON Shire of Wellington Rosedle nd Lochsport Yrrm & Dist Hlth Serv Wellington Shire: SLA Alberton Peter McCllum Cncer Inst In hospitl t Est Melbourne only In hospitl STATEWIDE Victorin Peditric Pll Cre Prog Sttewide nd some interstte for children treted t Royl Children s Hospitl. The Royl Children s Hospitl, Monsh Medicl SERVICES Victorin Peditric Pllitive Cre Progrm is consulttion-liison model of cre Centre, Very Specil Kids Motor Neurone DAV Crnbourne, Cnterbury, Mldon, Dimond Sttewide Creek Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 116

9.3 SERVICES PROVIDED 9.3.1 HOME OR COMMUNITY BASED 1-TO-1 DIRECT CARE LGA BASS COAST BAW BAW / CARDINIA EAST LATROBE SERVICE HOME OR COMMUNITY BASED 1-TO-1 DIRECT CARE HOME OR COMMUNITY 1-TO-1 CARE NURSE PROVIDED BY ALLIED HEALTH Bss Cost Comm. Helth Serv Bss Cost Regionl Hlth Kooweerup Reg Hlth Serv Neerim District Hlth Serv PARAMEDICAL West Gippslnd Hlthcre Grp As required e.g. music therpy, counselling, mssge Birnsdle Reg Hlth Serv Trined Pllitive Volunteers Buchn Bush Nursing Cnn Vlley Bush Nursing Gelntipy District Bush Nursing Gippslnd Lkes Comm Hlth Berevement STAFF Now Now Comm Hlth Serv Omeo District Hlth/Ensy Comm Hlth Orbost Reg Helth Swifts Creek Bush Nursing Ltrobe Comm Hlth Serv Ltrobe Reg Hospitl Mryvle Privte Hospitl SOUTH South Gippslnd Hospitl South Gippslnd Pll Cre Serv Complementry therpies WELLINGTON STATEWIDE SERVICES Wellington Pll Cre Serv Yrrm & Dist Hlth Serv Peter McCllum Cncer Inst Victorin Peditric Pll Cre Prog Motor Neurone DAV OTHER Loss, Grief nd Berevement Coordintor; Medicl Adviser; Complimentry therpist; Centrl Gippslnd Helth Service Porters Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 117

9.3.2 ASSESSMENT AND CASE MANAGEMENT LGA SERVICE ASSESSMENT CASE MANAGEMENT BASS COAST BAW BAW / CARDINIA EAST LATROBE Bss Cost Comm. Helth Serv Bss Cost Regionl Hlth Kooweerup Reg Hlth Serv Neerim District Hlth Serv West Gippslnd Hlthcre Grp Birnsdle Reg Hlth Serv Buchn Bush Nursing Cnn Vlley Bush Nursing Gelntipy District Bush Nursing Gippslnd Lkes Comm Hlth Now Now Comm Hlth Serv Omeo District Hlth/Ensy Comm Hlth Orbost Reg Helth Swifts Creek Bush Nursing Ltrobe Comm Hlth Serv Ltrobe Reg Hospitl Mryvle Privte Hospitl SOUTH South Gippslnd Hospitl South Gippslnd Pll Cre Serv Wellington Pll Cre Serv WELLINGTON Yrrm & Dist Hlth Serv STATEWIDE SERVICES Peter McCllum Cncer Inst Victorin Peditric Pll Cre Prog Motor Neurone DAV Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 118

9.3.3 RESPITE LGA BASS COAST BAW BAW / CARDINIA EAST LATROBE SOUTH SERVICE Bss Cost Comm. Helth Serv Bss Cost Regionl Hlth Kooweerup Reg Hlth Serv IN- HOME OUT OF HOME NURSE ALLIED HEALTH PARAMEDICAL Neerim District Hlth Serv West Gippslnd Hlthcre Grp Birnsdle Reg Hlth Serv Buchn Bush Nursing Cnn Vlley Bush Nursing Gelntipy District Bush Nursing Gippslnd Lkes Comm Hlth Now Now Comm Hlth Serv Omeo District Hlth/Ensy Comm Hlth Orbost Reg Helth Swifts Creek Bush Nursing Ltrobe Comm Hlth Serv Ltrobe Reg Hospitl Mryvle Privte Hospitl South Gippslnd Hospitl South Gippslnd Pll Cre Serv PROVIDED BY STAFF VOLUNTEERS OTHER Arrnged through Commonwelth Crer Respite nd Shire Wellington Pll Cre Serv Crer Respite Centre WELLINGTON Yrrm & Dist Hlth Serv Volunteers not PC specific STATEWIDE SERVICES Peter McCllum Cncer Inst Victorin Peditric Pll Cre Prog Motor Neurone DAV Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 119

9.3.4 GROUP ACTIVITIES LGA SERVICE SOCIAL, RECREATIONAL CARER SUPPORT HEALTH PROMOTION, EDUCATION BASS COAST BAW BAW / CARDINIA EAST LATROBE SOUTH Bss Cost Comm. Helth Serv Bss Cost Regionl Hlth Kooweerup Reg Hlth Serv Neerim District Hlth Serv West Gippslnd Hlthcre Grp Birnsdle Reg Hlth Serv Buchn Bush Nursing Cnn Vlley Bush Nursing Gelntipy District Bush Nursing Gippslnd Lkes Comm Hlth Now Now Comm Hlth Serv Omeo District Hlth/Ensy Comm Hlth Orbost Reg Helth Swifts Creek Bush Nursing Ltrobe Comm Hlth Serv Ltrobe Reg Hospitl Mryvle Privte Hospitl South Gippslnd Hospitl South Gippslnd Pll Cre Serv STATEWIDE SERVICES Wellington Pll Cre Serv WELLINGTON Yrrm & Dist Hlth Serv Peter McCllum Cncer Inst Victorin Peditric Pll Cre Prog Motor Neurone DAV Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 120

9.3.5 CONSULTANCY LGA SERVICE ON-SITE OUTREACH BASS COAST BAW BAW / CARDINIA EAST LATROBE Bss Cost Comm. Helth Serv Bss Cost Regionl Hlth Kooweerup Reg Hlth Serv Neerim District Hlth Serv West Gippslnd Hlthcre Grp Birnsdle Reg Hlth Serv Buchn Bush Nursing Cnn Vlley Bush Nursing Gelntipy District Bush Nursing Gippslnd Lkes Comm Hlth Now Now Comm Hlth Serv Omeo District Hlth/Ensy Comm Hlth Orbost Reg Helth Swifts Creek Bush Nursing Ltrobe Comm Hlth Serv Ltrobe Reg Hospitl Mryvle Privte Hospitl SOUTH South Gippslnd Hospitl South Gippslnd Pll Cre Serv WELLINGTON STATEWIDE SERVICES Wellington Pll Cre Serv Yrrm & Dist Hlth Serv Peter McCllum Cncer Inst Victorin Peditric Pll Cre Prog Motor Neurone DAV Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 121

9.3.6 CENTRE BASED CARE LGA BASS COAST BAW BAW / CARDINIA EAST LATROBE SERVICE Bss Cost Comm. Helth Serv OUTPATIENT SERVICES INPATIENT BEDS NO. OF FUNDED / ALLOCATED Bss Cost Regionl Hlth 1 Kooweerup Reg Hlth Serv Neerim District Hlth Serv West Gippslnd Hlthcre Grp Birnsdle Reg Hlth Serv 0.8 Buchn Bush Nursing Cnn Vlley Bush Nursing Gelntipy District Bush Nursing Gippslnd Lkes Comm Hlth Now Now Comm Hlth Serv Omeo District Hlth/Ensy Comm Hlth Orbost Reg Helth Swifts Creek Bush Nursing BEDS Ltrobe Comm Hlth Serv Ltrobe Reg Hospitl 11 / 68 Mryvle Privte Hospitl South Gippslnd Hospitl SOUTH South Gippslnd Pll Cre Serv 1 Wellington Pll Cre Serv 2 WELLINGTON Yrrm & Dist Hlth Serv STATEWIDE SERVICES Peter McCllum Cncer Inst Victorin Peditric Pll Cre Prog Motor Neurone DAV Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 122

9.3.7 OTHER SERVICES LGA SERVICE OTHER SERVICES BASS COAST BAW BAW / CARDINIA EAST LATROBE SOUTH WELLINGTON STATEWIDE SERVICES Bss Cost Comm. Helth Serv Bss Cost Regionl Hlth Kooweerup Reg Hlth Serv Neerim District Hlth Serv West Gippslnd Hlthcre Grp Birnsdle Reg Hlth Serv Buchn Bush Nursing Cnn Vlley Bush Nursing Gelntipy District Bush Nursing Gippslnd Lkes Comm Hlth Now Now Comm Hlth Serv Omeo District Hlth/Ensy Comm Hlth Orbost Reg Helth Swifts Creek Bush Nursing Ltrobe Comm Hlth Serv Ltrobe Reg Hospitl Mryvle Privte Hospitl South Gippslnd Hospitl South Gippslnd Pll Cre Serv Wellington Pll Cre Serv Yrrm & Dist Hlth Serv Peter McCllum Cncer Inst Victorin Peditric Pll Cre Prog Motor Neurone DAV Grief support Berevement support Grief Support Progrm Counselling/Socil Worker Services Use cute cre bed for pll cre if needed - non pll cre funded Berevement Flexible Funding Pckge Informtion; coordintion of volunteers; equipment; librry Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 123

9.4 SERVICE PROFILE 9.4.1 COMMUNITY SERVICES LGA SERVICE NO. OF CLIENTS [LAST 12 MONTHS] COMMENTS/DESCRIPTION BASS COAST BAW BAW / CARDINIA EAST LATROBE Bss Cost Comm. Helth Serv 130 Pllitive cre in home nd berevement support for ll, other services for some Bss Cost Regionl Hlth 41 District Nursing Service providing ll cre tht my be relted to pllitive cre Kooweerup Reg Hlth Serv Neerim District Hlth Serv West Gippslnd Hlthcre Grp 77 Hospitl bsed service Birnsdle Reg Hlth Serv 59 Pllitive Cre: Home Bsed Nursing provided to these clients Buchn Bush Nursing Nil Cnn Vlley Bush Nursing 6 CACPS; Home Cre; Centre/outptient cre; respite Gelntipy District Bush Nursing Nil in 2004 We re very smll service, only hve one or two PC clients every few yers. Gippslnd Lkes Comm Hlth 30 clients by nursing, 28 berevement, 8 volunteers. Home bsed nursing with 24 hour on cll s 66 required with pllitive cre trined nd or experienced nurses. Now Now Comm Hlth Serv 1 Nursing support t home Omeo District Hlth/Ensy Comm Hlth 5% Orbost Reg Helth 2 Swifts Creek Bush Nursing 1 Home visiting/cre 24 hr on-cll service Ltrobe Comm Hlth Serv 132 Home bsed pllitive cre 24/7 to ptient nd fmily: specilist nursing tem Ltrobe Reg Hospitl 65 Respite for fmilies cring for people who re pllitive nd symptom mngement Mryvle Privte Hospitl South Gippslnd Hospitl SOUTH 6 D.N.S. South Gippslnd Pll Cre Serv 61 registered clients Wellington Pll Cre Serv 24 hour on cll service, to support those people living with life thretening illness in the Shire of Wellington. Tem is vilble to nd works cross n integrted service, encompssing cute, ged WELLINGTON 101 nd community cre. Yrrm & Dist Hlth Serv 12 STATEWIDE SERVICES Peter McCllum Cncer Inst Victorin Peditric Pll Cre Prog 41 Referrl to Community bsed pllitive cre services through VPPCP consultncy Motor Neurone DAV Cse coordintion/cse mngement to link into services, provide counselling, informtion nd 344 other support Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 124

9.4.2 PALLIATIVE CARE BEDS LGA SERVICE BED DAYS [LAST 12 MONTHS] BASS COAST BAW BAW / CARDINIA EAST LATROBE SOUTH WELLINGTON Bss Cost Comm. Helth Serv Bss Cost Regionl Hlth Kooweerup Reg Hlth Serv 43 PALL. CARE FUNDED BEDS COMMENTS/DESCRIPTION One funded pll cre bed. There were 488 bed dys used in this period of time BED DAYS [LAST 12 MONTHS] NON-PALL. CARE FUNDED BEDS COMMENTS/DESCRIPTION Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 125 152 This for specific dmission for Pllitive Cre, we hve mny other dmissions but they re code to reflect dignosis tht my hve higher DRG weighting to mximise their WEIS $ s Neerim District Hlth Serv 2 Inptient hospitl dmissions 8 Not lwys specificlly dignosed s pllitive West Gippslnd Hlthcre Grp 56 72 Birnsdle Reg Hlth Serv 1 bed: i.e. 365 ed dys In ptient: Birnsdle Regionl Helth Service Buchn Bush Nursing Cnn Vlley Bush Nursing Gelntipy District Bush Nursing Gippslnd Lkes Comm Hlth Now Now Comm Hlth Serv Nil Omeo District Hlth/Ensy Comm Hlth 8% Orbost Reg Helth Swifts Creek Bush Nursing Ltrobe Comm Hlth Serv Ltrobe Reg Hospitl Mryvle Privte Hospitl 12 Terminl cre 4 South Gippslnd Hospitl 63 bed dys South Gippslnd Pll Cre Serv 491 non- Our LGA is currently funded for 1 designted DVA bed inptient bed t 80% cpcity = 292 bed dys; 103 dys per nnum [South Gippslnd Hospitl DVA bed dys Foster does not hve designted bed dy]. Wellington Pll Cre Serv Community clients needing respite, or who hve expressed wish to die in hospitl. A lot of these clients spent only few dys in 42 hospitl before dischrge or deth. Yrrm & Dist Hlth Serv 90-100 bed 0 dys CGHS hs lwys endevoured to keep within the llocted bed dys. There re other dmissions which could hve used Pllitive bed dys, but utilised WEIS. Access is to generl cute beds with cre being provided by GPs who re lso VMOs

STATEWIDE SERVICES Peter McCllum Cncer Inst On verge we would hve 3-4 high needs dmissions per nnum Victorin Peditric Pll Cre Prog 1 Referrls to Adult hospice 1 Referrl to Very Specil Kids Motor Neurone DAV 9.4.3 CONSULTANCY LGA BASS COAST BAW BAW / CARDINIA EAST LATROBE SERVICE Bss Cost Comm. Helth Serv Bss Cost Regionl Hlth Kooweerup Reg Hlth Serv Neerim District Hlth Serv NO. OF CLIENTS SEEN [LAST 12 MONTHS] IN-REACH CONSULTANCY COMMENTS/DESCRIPTION NO. OF CLIENTS [LAST 12 MONTHS] West Gippslnd Hlthcre Grp 40 11 Birnsdle Reg Hlth Serv 910 bed dys per nnum Buchn Bush Nursing Cnn Vlley Bush Nursing Gelntipy District Bush Nursing Gippslnd Lkes Comm Hlth Now Now Comm Hlth Serv Omeo District Hlth/Ensy Comm Hlth Orbost Reg Helth 0 0 Swifts Creek Bush Nursing Ltrobe Comm Hlth Serv Ltrobe Reg Hospitl Mryvle Privte Hospitl SOUTH South Gippslnd Hospitl South Gippslnd Pll Cre Serv 4 10 To locl hospitl L.R.H. - Aged cre wrd/acute wrds/pc unit; to locl privte Hospitl [Mryvle] Mny OUT-REACH CONSULTANCY Informl only COMMENTS/DESCRIPTION Offer peer support nd dvice over the phone to other service providers within our region To hostels nd nursing homes [cnnot trck numbers]; eduction to rurl helth, Division of G.P. Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 126

WELLINGTON STATEWIDE SERVICES Wellington Pll Cre Serv Yrrm & Dist Hlth Serv Peter McCllum Cncer Inst 600 new About 10-15% for end of life cre Victorin Peditric Pll Cre Prog Royl Children s Hospitl, Monsh 91 Medicl Centre 10 Motor Neurone DAV Community hospitls, fmily, disbility & community gencies 9.4.4 GRIEF AND BEREAVEMENT LGA BASS COAST BAW BAW / CARDINIA EAST LATROBE SERVICE Bss Cost Comm. Helth Serv NO. OF CLIENTS [LAST 12 MONTHS] Bss Cost Regionl Hlth 13 Kooweerup Reg Hlth Serv 16 in 2 month period Neerim District Hlth Serv West Gippslnd Hlthcre Grp 127 Birnsdle Reg Hlth Serv Buchn Bush Nursing Cnn Vlley Bush Nursing 6 Gelntipy District Bush Nursing Gippslnd Lkes Comm Hlth Now Now Comm Hlth Serv Omeo District Hlth/Ensy Comm Hlth Orbost Reg Helth 0 Swifts Creek Bush Nursing Ltrobe Comm Hlth Serv Ltrobe Reg Hospitl Mryvle Privte Hospitl All ptients nd fmilies SOUTH South Gippslnd Hospitl South Gippslnd Pll Cre Serv 49 WELLINGTON Wellington Pll Cre Serv COMMENTS/DESCRIPTION All Pll Cre clients' fmilies, within our District Nursing Service, receive minimum of 3 berevement visits post deth Hve developed brochure nd set up referrl system so tht should pt/resident pss wre referrl is generted to the Socil Worker nd she will follow up with the fmily nd stff if required. Provided by socil worker who lso provides counselling for whole of orgnistion Offer berevement support nd dvice to stff nd clients outside out side the locl re over the phone Do not hve berevement support worker, so t times it is very hrd to lwys follow-up: need more funding Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 127

Yrrm & Dist Hlth Serv Peter McCllum Cncer Inst STATEWIDE SERVICES Victorin Peditric Pll Cre Prog Difficult to scertin VPPCP hs communictions within hospitl setting nd community setting to ensure fmilies hve ccess to berevement support through locl services Motor Neurone DAV 9.4.5 TOTAL CLIENTS: ONE-TO-ONE SERVICES LGA SERVICE TOTAL CLIENTS [LAST 12 MONTHS] COMMENTS/DESCRIPTION BASS COAST BAW BAW / CARDINIA EAST LATROBE Bss Cost Comm. Helth Serv Bss Cost Regionl Hlth 97 Some of these will be the sme clients Kooweerup Reg Hlth Serv Neerim District Hlth Serv 10 West Gippslnd Hlthcre Grp Birnsdle Reg Hlth Serv Buchn Bush Nursing Cnn Vlley Bush Nursing 6 Gelntipy District Bush Nursing Gippslnd Lkes Comm Hlth 66 Now Now Comm Hlth Serv Omeo District Hlth/Ensy Comm Hlth Orbost Reg Helth Swifts Creek Bush Nursing Ltrobe Comm Hlth Serv Ltrobe Reg Hospitl Mryvle Privte Hospitl SOUTH South Gippslnd Hospitl South Gippslnd Pll Cre Serv 708 All pllitive stts go to Gippslnd Lkes CHC WELLINGTON STATEWIDE SERVICES Wellington Pll Cre Serv 143 Yrrm & Dist Hlth Serv Peter McCllum Cncer Inst Victorin Peditric Pll Cre Prog Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 128

Motor Neurone DAV 344 9.4.6 GROUP ACTIVITIES AND OTHER PROGRAMS LGA SERVICE FREQ / NO. GROUPS /PROGS SOCIAL, RECREATIONAL GROUPS CONTACTS COMMENTS BASS COAST BAW BAW / CARDINIA EAST Bss Cost Comm. Helth Serv Bss Cost Regionl Hlth Kooweerup Reg Hlth Serv Neerim District Hlth Serv West Gippslnd Hlthcre Grp Birnsdle Reg Hlth Serv Buchn Bush Nursing Cnn Vlley Bush Nursing Gelntipy District Bush Nursing Gippslnd Lkes Comm Hlth Now Now Comm Hlth Serv Omeo District Hlth/Ensy Comm Hlth PAGs 3x week Nil PAG fortnightly Ave. bout 6 per time LATROBE SOUTH Orbost Reg Helth 0 Swifts Creek Bush Nursing Ltrobe Comm Hlth Serv Ltrobe Reg Hospitl Mryvle Privte Hospitl South Gippslnd Hospitl South Gippslnd Pll Cre Serv Wellington Pll Cre Serv WELLINGTON Yrrm & Dist Hlth Serv 3 per week 8 Not specific to PC STATEWIDE SERVICES Peter McCllum Cncer Inst Victorin Peditric Pll Cre Prog 0 Motor Neurone DAV Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 129

LGA SERVICE FREQ / NO. GROUPS /PROGS CONTACTS CARER SUPPORTGROUPS / ACTIVITIES COMMENTS BASS COAST BAW BAW / CARDINIA EAST LATROBE SOUTH Bss Cost Comm. Helth Serv Monthly 30 Bss Cost Regionl Hlth Kooweerup Reg Hlth Serv Neerim District Hlth Serv West Gippslnd Hlthcre Grp Birnsdle Reg Hlth Serv Buchn Bush Nursing Cnn Vlley Bush Nursing Gelntipy District Bush Nursing One monthly [run by Socil Worker] 55 Nil Do number of ctivities nd hve vrious spekers on topic of groups choice primrily group provides support to ech other nd opportunity to shre experiences. Gippslnd Lkes Comm Hlth Twice yerly 8 Crer support group for bereved supported by pllitive volunteers Now Now Comm Hlth Serv Omeo District Hlth/Ensy Comm Hlth Orbost Reg Helth 0 Swifts Creek Bush Nursing Ltrobe Comm Hlth Serv Ltrobe Reg Hospitl Mryvle Privte Hospitl South Gippslnd Hospitl South Gippslnd Pll Cre Serv WELLINGTON Wellington Pll Cre Serv 4 15-20 Well ttended by fmilies Yrrm & Dist Hlth Serv 2 new contcts in the cncer support group per month. Combined support group 1 per month 5 meets 2nd monthly STATEWIDE SERVICES Peter McCllum Cncer Inst Victorin Peditric Pll Cre Prog 0 Motor Neurone DAV 16 groups: qurterly LGA SERVICE HEALTH PROMOTION, PREVENTION, EDUCATION PROGRAMS FREQ / NO. GROUPS /PROGS CONTACTS COMMENTS BASS COAST Bss Cost Comm. Helth Serv Assorted Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 130

BAW BAW / CARDINIA EAST LATROBE Bss Cost Regionl Hlth Kooweerup Reg Hlth Serv Neerim District Hlth Serv West Gippslnd Hlthcre Grp 10 150 Some groups exceed 23 Birnsdle Reg Hlth Serv Nil Buchn Bush Nursing Cnn Vlley Bush Nursing About 4 per yer Ave. bout 6 Gelntipy District Bush Nursing Gippslnd Lkes Comm Hlth Now Now Comm Hlth Serv Omeo District Hlth/Ensy Comm Hlth 1 2 Orbost Reg Helth 0 Swifts Creek Bush Nursing Ltrobe Comm Hlth Serv Ltrobe Reg Hospitl Mryvle Privte Hospitl SOUTH South Gippslnd Hospitl South Gippslnd Pll Cre Serv pprox 10 per nnum 271 Wellington Pll Cre Serv 6 10-20 WELLINGTON Yrrm & Dist Hlth Serv Active helth promotion nd eduction progrms- currently developing sorrow group, s with other progrm, this is generlist service. STATEWIDE SERVICES Peter McCllum Cncer Inst Victorin Peditric Pll Cre Prog 0 Motor Neurone DAV 33 sessions 9.4.7 OTHER SERVICES LGA SERVICE ANY OTHER SERVICES ACTIVITY FREQ / NO. CONTACTS COMMENTS BASS COAST Bss Cost Comm. Helth Serv Bss Cost Regionl Hlth Grief support Monthly nd ssocited ctivities s plnned by members Working on Memoril grden, fundrising ctivities e.g. dinners Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 131

BAW BAW / CARDINIA EAST LATROBE SOUTH WELLINGTON STATEWIDE SERVICES Kooweerup Reg Hlth Serv Neerim District Hlth Serv West Gippslnd Hlthcre Grp Birnsdle Reg Hlth Serv Buchn Bush Nursing Cnn Vlley Bush Nursing Gelntipy District Bush Nursing Gippslnd Lkes Comm Hlth Now Now Comm Hlth Serv Omeo District Hlth/Ensy Comm Hlth Orbost Reg Helth Swifts Creek Bush Nursing Ltrobe Comm Hlth Serv Ltrobe Reg Hospitl Mryvle Privte Hospitl South Gippslnd Hospitl South Gippslnd Pll Cre Serv Wellington Pll Cre Serv Yrrm & Dist Hlth Serv Peter McCllum Cncer Inst Victorin Peditric Pll Cre Prog Telephone specilist support to GPs Occsionl 5 We do not hve specilist in- house services but we do hve MOU with South Est Pllitive cre whereby they provide consulttion for GP s on Pin Mngement vi telephone nd for those difficult cse will visit nd review ptient with GP Coping with Christms Yerly 12 Positive feedbck from those ttending Memoril Service Yerly 63 Excellent positive feedbck Volunteer driving; Free bus to Birnsdle monthly; Free bus to Lkes Entrnce monthly - with block booking nd subsidised Physio ppointments. Eduction Ecumenicl service 1-2 50 fmilies Motor Neurone DAV 0 Equipment Librry 851 lons to 477 people 477 Motor Neurone DAV 1025 informtion Informtion contcts Hostels, nursing homes; student nurses, medicl students; community; Division of GP Usully coordinted s prt of hospice wreness week 34 meetings ttended, 820 items returned from lon 128 new resources developed; 20 seminrs, 6000 newsletters; 33 informtion sessions Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 132

9.4.8 24 HOUR SERVICE LGA BASS COAST BAW BAW / CARDINIA EAST SERVICE OFFER 24 HR SERVICE DESCRIPTION Bss Cost Comm. Helth Serv 24 hour district nurses on cll Bss Cost Regionl Hlth Kooweerup Reg Hlth Serv Neerim District Hlth Serv West Gippslnd Hlthcre Grp Birnsdle Reg Hlth Serv Buchn Bush Nursing Cnn Vlley Bush Nursing Gelntipy District Bush Nursing Gippslnd Lkes Comm Hlth Now Now Comm Hlth Serv Omeo District AFTER HRS CONTACTS Stnd up stff to 10p.m. Nurse on cll overnight 7 dys per week. Nurse will visit if necessry. 33 Nurses on cll 24hrs every dy On cll out of hours for emergencies nd essentil/necessry cre 96 hrs incl. trvel 475 contcts, 155 individul clients If someone needs end of life cre, we cn provide it Nil 2004 Nurse on-cll for both phone nd direct service provision s required 25 COMMENTS Clients re dvised of out-of-hours service. Contct phone number supervised by nursing coordintor who contcts nurse on cll. Coordintor knows which ptient the nurse is visiting nd when she returns [sfety fctor]. 33 clients: 11 visits, 22 phone contcts. We provide symptom mngement nd support to ptients nd fmily over 24 hours but could be improved with the services of n on-cll medicl consultnt. Difficult to replce those clled out in order to provide stff with entitled brek especilly on weekends. Currently investigting ll options. Improved ccess to specilist pllitive providers nd counsellors is required. Where possible pllitive cre clients nd crers re supported 24 hours dy but it is not lwys possible. Well worth while: necessry We re not officilly on-cll, but s members of smll community everyone knows where we live, nd they cll us if needed. We only hve one or two nurses in this remote re, which is why we cn't be officilly on-cll, but when we do hve pllitive clients, it's pretty hrd goring for the durtion, but worth it. Costly. Difficult to cover next dy shift due to limited stffing. Distnces between home nd clients Occsionlly this hs creted difficulties which we hve hd to ddress by employing nurse to visit out of clinic hours. This is smll community nd our service is generlly dequte. Omeo District Helth - not Ensy 24 Not funded. Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 133

Hlth/Ensy Comm Hlth Comm. Helth Clients in the Ensy & Omeo communities need to trvel either to the hospitl t Omeo or to lrger centres with services. LATROBE Orbost Reg Helth Swifts Creek Bush Nursing Ltrobe Comm Hlth Serv Ltrobe Reg Hospitl District Nursing with ssistnce from cute nursing stff who re prepred to go on cll 2 Avilbility of stff nd limited funding to support intensive pllitive cre Mon-Fri 9m-5pm; St-Sun 9m- 11m, then on cll. Clinicl service, home nursing, dministrtion of chemotherpy 1 Home bsed pllitive cre delivered by specilist nursing tem 610 home visits; 518 telephone consults The out-of-hours usully comprise weekend visits. Our centre is open 9-11m only t weekends, then on-cll 24 hours. When we hve client, it is usully very intense nd use ll of our resources given tht we re smll nursing prctice. Under funded: $1500 given monthly to L.C.H. Pllitive Cre from Pllitive Cre fundrising volunteers Mryvle Privte Hospitl SOUTH WELLINGTON STATEWIDE South Gippslnd Hospitl South Gippslnd Pll Cre Serv Wellington Pll Cre Serv Yrrm & Dist Hlth Serv Peter McCllum DNS: phone contct nd/or home visits. 2 We offer the 24 hr service on n 's required' bsis 95 contcts [telephone & fce-to-fce] Avilble 24 hours 7 dys per week. Stff on cll 2030 hours to 0830 hours. 17 cllouts Community nursing is predominntly used but ptients cn ccess limited respite. On only one occsion in the previous ten yers hve we hd to dmit ptient for respite becuse nursing stff were unble to provide the OOH cre. 12 Indequte finding. SGH pys on-cll s Pllitive Cre [Region] does not. Unfunded trvel time mens tht Pllitive Cre funding dies not cover the costs of service provided. We cover very lrge re. I refer to PCA "Stndrds for Providing Qulity pllitive Cre for ll Austrlins" Stndrd 10: "Ptients, cregiver/s nd fmilies hve ccess to specilist telephone ssessment nd dvice on 24-hour 7-dy bsis". Adequte funding to services is required for this stndrd to be met, prticulrly in community-bsed funding. We hve just commenced with our own nurses, which enble us to pre-empt much more nd should reduce number of cllouts. Yrrm nd District Helth Service provide on cll for people who re unstble or in their terminl phse. Our service is integrted cross community, cute nd ged cre, with cre coordintion continuing for most people in ny setting by the community tem. I.e. volunteers hve done night sit to relieve fmilies in the cute wrd. OOH is drwn from the existing community nursing roster, with bckfill for rostered shifts tight nd difficult if there is long term requirement for OOH. An integrted Helth Service Model tht provides for most community bsed services delivered to the ctchment. Gives degree of flexibility but cn restrict choice. Registrr nd consultnt on-cll every We would like to be funded for inptient pllitive cre beds Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln weekend 2005-2009 5-134

SERVICES Cncer Inst 24/7 10 dily Victorin Peditric Pll Cre Prog Motor Neurone DAV Currently not provided however we hve necdotl evidence tht fter hours vilbility would be helpful for community-bsed pllitive cre services. Unusul tht there re difficulties s the coordintion nd plnning through VPPCP is developed to ensure 24 ccess to support t home. When the referrl is very lte nd community-bsed service is not vilble the VPPCP my ssist in the prcticl spects of deth nd dying for peditricins nd fmilies. The ide of consulttion-liison service is to set up good links nd plns for fmilies tht includes plnning for out of business hours ccess. 9.5 SERVICE PROVIDER PROFILE 9.5.1 PALLIATIVE CARE PHYSICIANS: EMPLOYED LGA SERVICE NUMBER QUALIFIED: NUMBER EMPLOYED: COMMUNITY INPATIENT COMMUNITY INPATIENT FUNDING SOURCE OTHER COMMENTS WELLINGTON STATEWIDE SERVICES Wellington Pll Cre Service Peter McCllum Cncer Institute 3 1.8 WEIS Victorin Peditric Pll Cre Prog 0.4 0.4 DHS Motor Neurone DAV There used to be forml links with Monsh Medicl Centre (McCulloch House) through the consortium. We if needing further medicl guidnce tend to still cll the Pllitive cre physicins t Monsh or t Peter McCllum Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 135

9.5.2 PALLIATIVE CARE PHYSICIANS: PRIVATE LGA SERVICE NUMBER QUALIFIED: NUMBER EMPLOYED: COMMUNITY INPATIENT COMMUNITY INPATIENT FUNDING SOURCE OTHER COMMENTS Ltrobe Regionl Hospitl 0.1 Mryvle Privte Hospitl All ptients cred for by visiting medicl stff nd hospitl rostered RNs. 9.5.3 OTHER EMPLOYED MEDICAL LGA NUMBER QUALIFIED: NUMBER EMPLOYED: SERVICE COMMUNITY INPATIENT COMMUNITY INPATIENT WELLINGTON Wellington Pll Cre Service FUNDING SOURCE Pllitive cre; Medicre Funding OTHER COMMENTS Medicl dviser is vilble for dvice/consulttion cross ny setting 9.5.4 GENERAL PRACTITIONERS: BULK BILLING LGA SERVICE NUMBER QUALIFIED: NUMBER EMPLOYED: COMMUNITY INPATIENT COMMUNITY INPATIENT FUNDING SOURCE OTHER COMMENTS BASS COAST BAW BAW / CARDINIA Bss Cost Comm. Helth Serv 1.2 To commence mid June 2005 Bss Cost Regionl Hlth Kooweerup Reg Hlth Serv Neerim District Hlth Serv West Gippslnd Hlthcre Grp 12 On cll Birnsdle Reg Hlth Serv 2 Vries Buchn Bush Nursing Cnn Vlley Bush Nursing EAST Gelntipy District Bush Nursing Gippslnd Lkes Comm Hlth 4.5 Medicre Now Now Comm Hlth Serv Omeo District Hlth/Ensy Comm Hlth Orbost Reg Helth Swifts Creek Bush Nursing LATROBE Ltrobe Comm Hlth Serv 1 0.03 Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 136

Ltrobe Reg Hospitl Mryvle Privte Hospitl SOUTH WELLINGTON STATEWIDE SERVICES South Gippslnd Hospitl South Gippslnd Pll Cre Serv Wellington Pll Cre Serv Yrrm & Dist Hlth Serv Peter McCllum Cncer Inst Victorin Peditric Pll Cre Prog Motor Neurone DAV Medicre 5 Medicre Medicl Adviser s GP sees own pllitive cre ptients cross ll settings Bulk billing of pensioners, HCC holders nd children lso of high use ptients. GPs not with specific Pllitive cre interest, rther true generlists. 9.5.5 GENERAL PRACTITIONERS: FEE-FOR-SERVICE LGA BASS COAST BAW BAW / CARDINIA EAST LATROBE NUMBER QUALIFIED: NUMBER EMPLOYED: FUNDING SERVICE COMMUNITY INPATIENT COMMUNITY INPATIENT SOURCE Bss Cost Comm. Helth Serv Bss Cost Regionl Hlth Kooweerup Reg Hlth Serv Neerim District Hlth Serv West Gippslnd Hlthcre Grp 2 Medicre Birnsdle Reg Hlth Serv 2 Vries WEIS Buchn Bush Nursing Cnn Vlley Bush Nursing Gelntipy District Bush Nursing Gippslnd Lkes Comm Hlth Now Now Comm Hlth Serv Omeo District Hlth/Ensy Comm Hlth Orbost Reg Helth Swifts Creek Bush Nursing Ltrobe Comm Hlth Serv Ltrobe Reg Hospitl Mryvle Privte Hospitl OTHER COMMENTS GP visits town one dy per week. Does house clls on this dy if needed. Provides dvice per phone s needed. 1 GP visits twice week Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 137

SOUTH WELLINGTON STATEWIDE SERVICES South Gippslnd Hospitl 1 1 Unknown Unknown South Gippslnd Pll Cre Serv Wellington Pll Cre Serv yes WEIS? Yrrm & Dist Hlth Serv Peter McCllum Cncer Inst Victorin Peditric Pll Cre Prog Motor Neurone DAV 9.5.6 CLINICALNURSE CONSULTANTS LGA BASS COAST BAW BAW / CARDINIA EAST NUMBER QUALIFIED: NUMBER EMPLOYED: SERVICE COMMUNITY INPATIENT COMMUNITY INPATIENT Bss Cost Comm. Helth Serv Bss Cost Regionl Hlth Kooweerup Reg Hlth Serv Neerim District Hlth Serv West Gippslnd Hlthcre Grp 0 Birnsdle Reg Hlth Serv Buchn Bush Nursing Cnn Vlley Bush Nursing Gelntipy District Bush Nursing Gippslnd Lkes Comm Hlth Now Now Comm Hlth Serv Omeo District Hlth/Ensy Comm Hlth Orbost Reg Helth Swifts Creek Bush Nursing Ltrobe Comm Hlth Serv 1.58 FUNDING SOURCE LATROBE Ltrobe Reg Hospitl Mryvle Privte Hospitl SOUTH South Gippslnd Hospitl South Gippslnd Pll Cre Serv 1 0.7 DHS -Pllitive Cre Fund WELLINGTON Wellington Pll Cre Serv yes yes 1 Across both settings WEIS nd Pllitive Cre Medicl Funding Yrrm & Dist Hlth Serv Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 138

STATEWIDE SERVICES Peter McCllum Cncer Inst 2 0.4 Victorin Peditric Pll Cre Prog Motor Neurone DAV 9.5.7 CLINICALNURSE SPECIALISTS LGA BASS COAST BAW BAW / CARDINIA EAST LATROBE SERVICE NUMBER QUALIFIED: NUMBER EMPLOYED: COMMUNITY INPATIENT COMMUNITY INPATIENT Bss Cost Comm. Helth Serv 1.8 HACC Bss Cost Regionl Hlth Kooweerup Reg Hlth Serv Neerim District Hlth Serv West Gippslnd Hlthcre Grp 2 1.2 Birnsdle Reg Hlth Serv Buchn Bush Nursing Cnn Vlley Bush Nursing Gelntipy District Bush Nursing Gippslnd Lkes Comm Hlth Now Now Comm Hlth Serv Omeo District Hlth/Ensy Comm Hlth Orbost Reg Helth Swifts Creek Bush Nursing Ltrobe Comm Hlth Serv 8 2.06 Ltrobe Reg Hospitl 0.2 Mryvle Privte Hospitl SOUTH South Gippslnd Hospitl South Gippslnd Pll Cre Serv 1 0.4 DHS -Pllitive Cre Fund FUNDING SOURCE Funding to support fter hours pllitive cre in the community is through the unssigned bed fund controlled by Gippslnd Lkes Community Helth. Other pyments re through HACC funding. WELLINGTON STATEWIDE SERVICES Wellington Pll Cre Serv Yrrm & Dist Hlth Serv Peter McCllum Cncer Inst Victorin Peditric Pll Cre Prog Motor Neurone DAV Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 139

9.5.8 OTHER DIVISION 1 LGA BASS COAST BAW BAW / CARDINIA EAST LATROBE SERVICE NUMBER QUALIFIED: NUMBER EMPLOYED: COMMUNITY INPATIENT COMMUNITY INPATIENT Bss Cost Comm. Helth Serv 5 2.4 HACC Bss Cost Regionl Hlth 5 5 3.1 1.0 HACC/WEIS Kooweerup Reg Hlth Serv 15 9.4 WEIS FUNDING SOURCE Neerim District Hlth Serv 5 Privte Helth Funds; occsionl pllitive cre funding West Gippslnd Hlthcre Grp 8 1.52 Birnsdle Reg Hlth Serv 2 4.64 2 Buchn Bush Nursing 1 1.1 SRHS-HACC Cnn Vlley Bush Nursing 1 0.8 Smll rurl hetlh HACC & MPC Gelntipy District Bush Nursing.42 HACC Gippslnd Lkes Comm Hlth 7 Now Now Comm Hlth Serv 0 0 1.2 Omeo District Hlth/Ensy Comm Hlth Orbost Reg Helth Swifts Creek Bush Nursing 3 Ltrobe Comm Hlth Serv Ltrobe Reg Hospitl 0.8 7.5 Mryvle Privte Hospitl South Gippslnd Hospitl SOUTH 2.8 P.C. South Gippslnd Pll Cre Serv.57 Div 1&2 HACC - District Nursing Service WELLINGTON Wellington Pll Cre Serv 1 2 1.5? 0.5 Pllitive Cre Medicl funding; 1 HACC Yrrm & Dist Hlth Serv Funding is Smll Rurl Helth Services nd HACC funding 3 predominntly. All re through rnge of primry cre progrms STATEWIDE SERVICES Peter McCllum Cncer Inst Victorin Peditric Pll Cre Prog DHS Motor Neurone DAV Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 140

9.5.9 DIVISION 2 NURSES LGA BASS COAST BAW BAW / CARDINIA EAST LATROBE SOUTH SERVICE NUMBER QUALIFIED: NUMBER EMPLOYED: COMMUNITY INPATIENT COMMUNITY INPATIENT Bss Cost Comm. Helth Serv 1.58 HACC Bss Cost Regionl Hlth 2 1.0 HACC Kooweerup Reg Hlth Serv 5 2.6 WEIS Neerim District Hlth Serv 4 West Gippslnd Hlthcre Grp 2.5 Birnsdle Reg Hlth Serv 1.18 Buchn Bush Nursing Cnn Vlley Bush Nursing Gelntipy District Bush Nursing Gippslnd Lkes Comm Hlth Now Now Comm Hlth Serv Omeo District Hlth/Ensy Comm Hlth Orbost Reg Helth Swifts Creek Bush Nursing Ltrobe Comm Hlth Serv Ltrobe Reg Hospitl 0.5 Mryvle Privte Hospitl South Gippslnd Hospitl South Gippslnd Pll Cre Serv Wellington Pll Cre Serv WELLINGTON Yrrm & Dist Hlth Serv 1 STATEWIDE SERVICES Peter McCllum Cncer Inst Victorin Peditric Pll Cre Prog Motor Neurone DAV FUNDING SOURCE Funding is Smll Rurl Helth Services nd HACC funding predominntly. All re through rnge of primry cre progrms Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 141

9.5.10 PHYSIOTHERAPISTS LGA BASS COAST BAW BAW / CARDINIA EAST LATROBE SOUTH WELLINGTON STATEWIDE SERVICES SERVICE Bss Cost Comm. Helth Serv 2 Bss Cost Regionl Hlth NUMBER QUALIFIED: NUMBER EMPLOYED: COMMUNITY INPATIENT COMMUNITY INPATIENT Kooweerup Reg Hlth Serv 1 0.6 WEIS Neerim District Hlth Serv 1 West Gippslnd Hlthcre Grp.001 Birnsdle Reg Hlth Serv Buchn Bush Nursing Cnn Vlley Bush Nursing Gelntipy District Bush Nursing Gippslnd Lkes Comm Hlth Now Now Comm Hlth Serv Omeo District Hlth/Ensy Comm Hlth Orbost Reg Helth Swifts Creek Bush Nursing Ltrobe Comm Hlth Serv 1 When needed Ltrobe Reg Hospitl 0.1 Mryvle Privte Hospitl South Gippslnd Hospitl South Gippslnd Pll Cre Serv Wellington Pll Cre Serv Yrrm & Dist Hlth Serv Peter McCllum Cncer Inst Victorin Peditric Pll Cre Prog Motor Neurone DAV FUNDING SOURCE The pllitive cre service enlists the support nd service of llied helth workers on n 's required' bsis. Funding comes form HACC; outptient budget [nnon VAC]?? WEIS/ Pllitive cre Medicre Funding Funding is Smll Rurl Helth Services nd HACC funding predominntly. All re through 1 1 rnge of primry cre progrms OTHER COMMENTS Employed by LCHG PC tem: refer to when pproprite Well supported by ll Allied Helth disciplines nd cn ccess nytime Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 142

9.5.11 OCCUPATIONAL THERAPISTS LGA BASS COAST BAW BAW / CARDINIA EAST LATROBE SOUTH WELLINGTON STATEWIDE SERVICES SERVICE NUMBER QUALIFIED: NUMBER EMPLOYED: COMMUNITY INPATIENT COMMUNITY INPATIENT Bss Cost Comm. Helth Serv 1.5 Bss Cost Regionl Hlth Kooweerup Reg Hlth Serv Neerim District Hlth Serv West Gippslnd Hlthcre Grp.004 Birnsdle Reg Hlth Serv Buchn Bush Nursing Cnn Vlley Bush Nursing Gelntipy District Bush Nursing Gippslnd Lkes Comm Hlth Now Now Comm Hlth Serv Omeo District Hlth/Ensy Comm Hlth Orbost Reg Helth Swifts Creek Bush Nursing Ltrobe Comm Hlth Serv 1 When needed Ltrobe Reg Hospitl 0.1 Mryvle Privte Hospitl South Gippslnd Hospitl South Gippslnd Pll Cre Serv FUNDING SOURCE Wellington Pll Cre Serv?? WEIS/ Pllitive Cre Medicre Funding Yrrm & Dist Hlth Serv Funding is Smll Rurl Helth Services nd HACC funding predominntly. All re through 1 rnge of primry cre progrms Peter McCllum Cncer Inst Victorin Peditric Pll Cre Prog Motor Neurone DAV OTHER COMMENTS Employed by LCHG PC tem: refer to when pproprite Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 143

9.5.12 SPEECH PATHOLOGISTS LGA BASS COAST BAW BAW / CARDINIA EAST LATROBE SOUTH WELLINGTON STATEWIDE SERVICES SERVICE Bss Cost Comm. Helth Serv Bss Cost Regionl Hlth Kooweerup Reg Hlth Serv Neerim District Hlth Serv West Gippslnd Hlthcre Grp Birnsdle Reg Hlth Serv Buchn Bush Nursing Cnn Vlley Bush Nursing Gelntipy District Bush Nursing Gippslnd Lkes Comm Hlth Now Now Comm Hlth Serv Omeo District Hlth/Ensy Comm Hlth Orbost Reg Helth Swifts Creek Bush Nursing Ltrobe Comm Hlth Serv NUMBER QUALIFIED: NUMBER EMPLOYED: COMMUNITY INPATIENT COMMUNITY INPATIENT Ltrobe Reg Hospitl 0.1 Mryvle Privte Hospitl South Gippslnd Hospitl South Gippslnd Pll Cre Serv FUNDING SOURCE Wellington Pll Cre Serv?? WEIS/ Pllitive Cre Medicre Funding Yrrm & Dist Hlth Serv Funding is Smll Rurl Helth Services nd HACC funding predominntly. All re through 1 rnge of primry cre progrms Peter McCllum Cncer Inst Victorin Peditric Pll Cre Prog Motor Neurone DAV OTHER COMMENTS Visits bout once ech 2-3 months Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 144

9.5.13 COUNSELLORS LGA BASS COAST BAW BAW / CARDINIA EAST LATROBE SOUTH WELLINGTON STATEWIDE SERVICES SERVICE Bss Cost Comm. Helth Serv 2 Bss Cost Regionl Hlth NUMBER QUALIFIED: NUMBER EMPLOYED: COMMUNITY INPATIENT COMMUNITY INPATIENT Kooweerup Reg Hlth Serv 1 0.6 WEIS Neerim District Hlth Serv FUNDING SOURCE OTHER COMMENTS West Gippslnd Hlthcre Grp 2.05 Privte prctitioners Birnsdle Reg Hlth Serv Buchn Bush Nursing Cnn Vlley Bush Nursing Pid by nother service Visits twice week Gelntipy District Bush Nursing Gippslnd Lkes Comm Hlth 1.32 Pllitive Berevement Now Now Comm Hlth Serv Omeo District Hlth/Ensy Comm Hlth Orbost Reg Helth Swifts Creek Bush Nursing Ltrobe Comm Hlth Serv Ltrobe Reg Hospitl Mryvle Privte Hospitl South Gippslnd Hospitl South Gippslnd Pll Cre Serv Wellington Pll Cre Serv Yrrm & Dist Hlth Serv Peter McCllum Cncer Inst Victorin Peditric Pll Cre Prog Motor Neurone DAV 1 When needed yes 0.2 Pllitive Cre Medicre Funding Funding is Smll Rurl Helth Services nd HACC funding predominntly. All re 1 through rnge of primry cre progrms Weekly visit Employed by LCHG PC tem: refer to when pproprite Socil worker vilble in hospitl s required Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 145

9.5.14 SOCIAL WORKERS LGA BASS COAST BAW BAW / CARDINIA EAST LATROBE SOUTH WELLINGTON STATEWIDE SERVICES SERVICE Bss Cost Comm. Helth Serv Bss Cost Regionl Hlth Kooweerup Reg Hlth Serv Neerim District Hlth Serv NUMBER QUALIFIED: NUMBER EMPLOYED: COMMUNITY INPATIENT COMMUNITY INPATIENT 2 2.0 Globl budget West Gippslnd Hlthcre Grp 1.005 Birnsdle Reg Hlth Serv Buchn Bush Nursing FUNDING SOURCE OTHER COMMENTS Used for inptients nd community Cnn Vlley Bush Nursing 0.1 MPC 8 hours per fortnight Gelntipy District Bush Nursing Gippslnd Lkes Comm Hlth Now Now Comm Hlth Serv Omeo District Hlth/Ensy Comm Hlth Orbost Reg Helth Swifts Creek Bush Nursing Ltrobe Comm Hlth Serv Ltrobe Reg Hospitl 0.2 Mryvle Privte Hospitl South Gippslnd Hospitl 1 South Gippslnd Pll Cre Serv Wellington Pll Cre Serv?? WEIS/ Pllitive Cre Medicre Funding Yrrm & Dist Hlth Serv Funding is Smll Rurl Helth Services nd HACC funding predominntly. All re 0.4 through rnge of primry cre progrms Peter McCllum Cncer Inst Victorin Peditric Pll Cre Prog Motor Neurone DAV 1 DHS 1.0 EFT includes mngement time Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 146

9.5.15 DIVERSIONAL THERAPY LGA BASS COAST BAW BAW / CARDINIA EAST LATROBE SOUTH WELLINGTON STATEWIDE SERVICES SERVICE Bss Cost Comm. Helth Serv Bss Cost Regionl Hlth Kooweerup Reg Hlth Serv NUMBER QUALIFIED: NUMBER EMPLOYED: COMMUNITY INPATIENT COMMUNITY INPATIENT 5 0.1 WEIS Neerim District Hlth Serv 1 FUNDING SOURCE OTHER COMMENTS DT s primrily employed in Aged Cre but utilise some of their time for our Pllitive cre ptients. West Gippslnd Hlthcre Grp 2 1 0.03 Shred with inptient service Birnsdle Reg Hlth Serv Buchn Bush Nursing Cnn Vlley Bush Nursing Gelntipy District Bush Nursing Gippslnd Lkes Comm Hlth Now Now Comm Hlth Serv Omeo District Hlth/Ensy Comm Hlth Orbost Reg Helth Swifts Creek Bush Nursing Ltrobe Comm Hlth Serv Ltrobe Reg Hospitl Mryvle Privte Hospitl South Gippslnd Hospitl South Gippslnd Pll Cre Serv Wellington Pll Cre Serv Yrrm & Dist Hlth Serv Peter McCllum Cncer Inst Victorin Peditric Pll Cre Prog Motor Neurone DAV?? WEIS/ Pllitive Cre Medicre Funding One dy per fortnight: conducts Plnned Activity Group [provides respite nd socil ctivity] Yog weekly Use s required, sometimes clients use own nd py themselves. In lst yer hve used only 3 times Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 147

9.5.16 OTHER ALLIED HEALTH LGA SERVICE NUMBER QUALIFIED: NUMBER EMPLOYED: COMMUNITY INPATIENT COMMUNITY INPATIENT FUNDING SOURCE OTHER COMMENTS BASS COAST Bss Cost Comm Hlth Serv Plnned Activity group stff 4 STATEWIDE Motor Neurone DAV Regionl Advisors 4.3 Disbility/Pll Cre Significntly self funded 9.5.17 PASTORAL CARE LGA SERVICE NUMBER QUALIFIED: NUMBER EMPLOYED: COMMUNITY INPATIENT COMMUNITY INPATIENT FUNDING SOURCE OTHER COMMENTS BASS COAST Bss Cost Comm. Helth Serv Bss Cost Regionl Hlth BAW BAW / CARDINIA Kooweerup Reg Hlth Serv Neerim District Hlth Serv We hve rotting service with the Clergy from the Community, they visit ech week nd hold service in the Hostel, ny pts cn ttend nd they will visit pts on our request or the pts/fmily request s needed. West Gippslnd Hlthcre Grp 0.02 Contct suitble religious leder Birnsdle Reg Hlth Serv Buchn Bush Nursing Cnn Vlley Bush Nursing EAST LATROBE SOUTH WELLINGTON Gelntipy District Bush Nursing Gippslnd Lkes Comm Hlth Now Now Comm Hlth Serv Omeo District Hlth/Ensy Comm Hlth Orbost Reg Helth Swifts Creek Bush Nursing Ltrobe Comm Hlth Serv Ltrobe Reg Hospitl Mryvle Privte Hospitl South Gippslnd Hospitl South Gippslnd Pll Cre Serv Wellington Pll Cre Serv Yrrm & Dist Hlth Serv 1 Uniting Church minister, 1 R.C. priest vilble Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 148

STATEWIDE SERVICES Peter McCllum Cncer Inst Victorin Peditric Pll Cre Prog Motor Neurone DAV 9.5.18 EXECUTIVE LGA SERVICE NUMBER QUALIFIED: NUMBER EMPLOYED: COMMUNITY INPATIENT COMMUNITY INPATIENT FUNDING SOURCE OTHER COMMENTS BASS COAST BAW BAW / CARDINIA Bss Cost Comm. Helth Serv 1 1.0 Bss Cost Regionl Hlth Kooweerup Reg Hlth Serv Neerim District Hlth Serv 2 West Gippslnd Hlthcre Grp 1 EAST LATROBE SOUTH Birnsdle Reg Hlth Serv 1 0.2 HACC Buchn Bush Nursing Cnn Vlley Bush Nursing 1 HACC, RHS, MPC Given some teching in Pllitive Cre Gelntipy District Bush Nursing Gippslnd Lkes Comm Hlth.1 Community Helth Now Now Comm Hlth Serv Omeo District Hlth/Ensy Comm Hlth Orbost Reg Helth Swifts Creek Bush Nursing Ltrobe Comm Hlth Serv Ltrobe Reg Hospitl 0.1 Mryvle Privte Hospitl South Gippslnd Hospitl South Gippslnd Pll Cre Serv Wellington Pll Cre Serv WELLINGTON Yrrm & Dist Hlth Serv Being n integrted helth service the executive nd dmin stff cover ll res. STATEWIDE SERVICES Peter McCllum Cncer Inst Victorin Peditric Pll Cre Prog Hve Committee of Mngement 1 x CEO, 3 x directors nd 3 dmin Motor Neurone DAV 1 Disbility/Pll Cre Significntly self funded Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 149

9.5.19 SUPPORT STAFF LGA BASS COAST BAW BAW / CARDINIA EAST NUMBER QUALIFIED: NUMBER EMPLOYED: SERVICE FUNDING SOURCE OTHER COMMENTS COMMUNITY INPATIENT COMMUNITY INPATIENT Bss Cost Comm. Helth Serv Bss Cost Regionl Hlth Kooweerup Reg Hlth Serv Neerim District Hlth Serv 2 West Gippslnd Hlthcre Grp 1 0.1 Birnsdle Reg Hlth Serv 1 0.2 HACC Buchn Bush Nursing 0.8 SRHS-HACC Administrtive Mnger [Office] Cnn Vlley Bush Nursing Gelntipy District Bush Nursing Gippslnd Lkes Comm Hlth.2 Community Helth Now Now Comm Hlth Serv Omeo District Hlth/Ensy Comm Hlth Orbost Reg Helth Swifts Creek Bush Nursing Ltrobe Comm Hlth Serv 1 0.53 LATROBE SOUTH WELLINGTON STATEWIDE SERVICES Ltrobe Reg Hospitl 0.1 Mryvle Privte Hospitl South Gippslnd Hospitl South Gippslnd Pll Cre Serv Wellington Pll Cre Serv 0.3 Pllitive Cre Medicre Funding Yrrm & Dist Hlth Serv Peter McCllum Cncer Inst Victorin Peditric Pll Cre Prog.1 DHS Motor Neurone DAV 1 Disbility/Pll Cre Significntly self funded Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 150

9.5.20 VOLUNTEER COORDINATORS LGA SERVICE NUMBER QUALIFIED: NUMBER EMPLOYED: COMMUNITY INPATIENT COMMUNITY INPATIENT FUNDING SOURCE OTHER COMMENTS BASS COAST BAW BAW / CARDINIA EAST Bss Cost Comm. Helth Serv 1 Bss Cost Regionl Hlth 1 1.0 HACC Coordintor oversees ll volunteers Kooweerup Reg Hlth Serv Neerim District Hlth Serv West Gippslnd Hlthcre Grp 0.3 Prt of CNS role Birnsdle Reg Hlth Serv 1 0.2 HACC Buchn Bush Nursing Cnn Vlley Bush Nursing Gelntipy District Bush Nursing Gippslnd Lkes Comm Hlth 1.32 HACC Now Now Comm Hlth Serv 0 0 1 Omeo District Hlth/Ensy Comm Hlth Orbost Reg Helth Swifts Creek Bush Nursing Ltrobe Comm Hlth Serv 1 Not funded This is prt of Nurse Coordintor's role LATROBE SOUTH WELLINGTON STATEWIDE SERVICES Ltrobe Reg Hospitl 0.1 Mryvle Privte Hospitl South Gippslnd Hospitl South Gippslnd Pll Cre Serv Wellington Pll Cre Serv 0.3 Pllitive Cre Medicre Funding Yrrm & Dist Hlth Serv.5 HACC Responsible for ll volunteers Peter McCllum Cncer Inst Victorin Peditric Pll Cre Prog Motor Neurone DAV 0.8 Disbility/Pll Cre Significntly self funded Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 151

9.5.21 OTHER STAFF LGA SERVICE STAFF NUMBER QUALIFIED: NUMBER EMPLOYED: COMMUNITY INPATIENT COMMUNITY INPATIENT FUNDING SOURCE OTHER COMMENTS WELLINGTON Wellington Pll Cre Serv Phrmcist WEIS Provides support nd eductes tem s required STATEWIDE Motor Neurone DAV Informtion Officer 1 Disbility Significntly self funded SERVICES Equipment Lon Officer 1.6 Disbility Significntly self funded 9.5.22 TOTAL STAFFING LGA BASS COAST BAW BAW / CARDINIA EAST LATROBE SOUTH WELLINGTON SERVICE Bss Cost Comm. Helth Serv NUMBER QUALIFIED: NUMBER EMPLOYED: COMMUNITY INPATIENT COMMUNITY INPATIENT Bss Cost Regionl Hlth 10 1 7.1 Kooweerup Reg Hlth Serv Neerim District Hlth Serv 15 West Gippslnd Hlthcre Grp Birnsdle Reg Hlth Serv Buchn Bush Nursing Cnn Vlley Bush Nursing Gelntipy District Bush Nursing Gippslnd Lkes Comm Hlth Now Now Comm Hlth Serv Omeo District Hlth/Ensy Comm Hlth Orbost Reg Helth Swifts Creek Bush Nursing 3.37 Ltrobe Comm Hlth Serv 12 3.17 Ltrobe Reg Hospitl Mryvle Privte Hospitl South Gippslnd Hospitl South Gippslnd Pll Cre Serv Wellington Pll Cre Serv 3 3 3.3*? *+ 1 Medicl session per month Yrrm & Dist Hlth Serv OTHER COMMENTS Combintion of 3 funding sources: HACC, WEIS, Pll. Cre funding. Govt. funding does not cover ctivity Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 152

STATEWIDE SERVICES Peter McCllum Cncer Inst Victorin Peditric Pll Cre Prog Motor Neurone DAV 9.9 9.6 VOLUNTEER PROFILE LGA SERVICE NUMBER OF VOLUNTEERS VOLUNTEER HOURS PER WEEK COMMUNITY INPATIENT COMMUNITY INPATIENT BASS COAST BAW BAW / CARDINIA Bss Cost Comm. Helth Serv 8 Bss Cost Regionl Hlth 10 Kooweerup Reg Hlth Serv Neerim District Hlth Serv 15 15 West Gippslnd Hlthcre Grp 19 26 2 Birnsdle Reg Hlth Serv 9 0 12 0 Buchn Bush Nursing 0 0 0 0 Cnn Vlley Bush Nursing 3 EAST Gelntipy District Bush Nursing Gippslnd Lkes Comm Hlth 6 6 LATROBE Now Now Comm Hlth Serv 0 Omeo District Hlth/Ensy Comm Hlth 0 Orbost Reg Helth Swifts Creek Bush Nursing Ltrobe Comm Hlth Serv 8 1-2 Ltrobe Reg Hospitl 4 5 Mryvle Privte Hospitl SOUTH South Gippslnd Hospitl South Gippslnd Pll Cre Serv 12 5 Wellington Pll Cre Serv 32 12 1-2 WELLINGTON Yrrm & Dist Hlth Serv 22 12 7765 [ctul 6 month dt] 68 STATEWIDE SERVICES Peter McCllum Cncer Inst Nil Victorin Peditric Pll Cre Prog Motor Neurone DAV 260 15 Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 153

9.6.1 POLICIES, ORIENTATION AND TRAINING PROGRAMS LGA BASS COAST BAW BAW / CARDINIA EAST LATROBE SERVICE Bss Cost Comm. Hlth Serv Bss Cost Regionl Hlth DOCUMENTED POLICIES ORIENTATION PROGRAM TRAINING PROGRAM HAVE TOPICS HAVE COMMENTS HAVE COMMENTS Confidentility, consent, existing progrm, EEO, identifiction, incident reporting, grievnce, police check, reimbursement Sme progrm for stff nd volunteers clims, right of refusl, support nd trining Kooweerup Reg Hlth Serv Neerim District Hlth Serv Roles, responsibilities, rights West Gippslnd Hlthcre Grp Birnsdle Reg Hlth Serv Buchn Bush Nursing Cnn Vlley Bush Nursing Gelntipy District Bush Nursing Gippslnd Lkes Comm Hlth Now Now Comm Hlth Serv Omeo District Hlth/Ensy Comm Hlth Orbost Reg Helth Swifts Creek Bush Nursing Ltrobe Comm Hlth Serv WGHG hs written policies & protocols Occuptionl Helth nd Sfety, Hrssment & Discrimintion, Security Clernce, Grievnce procedure, Privcy nd Confidentility Currently developing them. Would like to see other volunteer protocols Position Description, Police Checks, Code of Conduct, Trining Progrm, Ongoing eduction, Privcy & Confidentility, Duty of Cre, Role, Rights & Responsibilities, Disciplinry Process, OH&S, Infection Control Prt of eduction progrm 8/52 Pllitive Volunteer Trining Course. (4hrs/week) Stringent ppliction & interview process prior to being ccepted into 8 week course. Post course interview with feedbck from both prties Specific pll cre trining every 2 yers PCV volunteer eduction pckge: regulr six weekly meetings, ongoing eduction, supervision nd nnul contrcts/review Monthly meeting with volunteers nd volunteer coordintor. Phone support s required. Ongoing trining nd workshops. Monthly meeting including ongoing eduction, involvement in debriefing with other service providers, support volunteers to ttend workshops etc. To be developed when progrm becomes estblished To be developed This is currently being developed Confidentility, vision, mission, vlues, for PC volunteers: At present in lst weeks of identifiction, dress code, complints, roles, interview with volunteer trining course. Present Gippslnd Regionl Pllitive Cre Consortium rights nd responsibilities Strtegic Pln 2005-2009 Coordintor; time volunteers meet monthly: 154 on-going spent with nursing eduction orgnised for these

SOUTH WELLINGTON STATEWIDE SERVICES Ltrobe Reg Hospitl Mryvle Privte Hospitl South Gippslnd Hospitl South Gippslnd Pll Cre Serv Wellington Pll Cre Serv Yrrm & Dist Hlth Serv Peter McCllum Cncer Inst Victorin Peditric Pll Cre Prog tem visiting ptients nd fmilies Communiction, complints, customer service, OH&S, emergency prctices, privcy, confidentility, police check, infection control, deling with ggression, grief, bsic CPR, sfe trnsporting, code of prctice, volunteer role, driving policy Security for volunteers, remunertion costs, rights nd responsibilities, peer support etc New volunteers ttend 10 week forml trining progrm Through centrl intke, police check, volunteer mnuls (generic) & core trining, then Pllitive cre specific mnul nd trining. Stndrd cross ll volunteers Motor Neurone DAV meetings. All bove mnged by South Gippslnd Pllitive Cre Services Monthly 2 hour meetings: 1 hour for eduction; 1 hour for reflective prctice. One-to-one support s required. See bove. We hve mentor system lso for peer support. Volunteers re lso given further trining to enble them to provide hnd nd foot mssge, nd Berevement follow ups. Stndrd cross ll volunteers 9.6.2 VOLUNTEERS: KEY ISSUES LGA SERVICE KEY ISSUES BASS COAST BAW BAW / CARDINIA EAST Bss Cost Comm. Helth Serv Bss Cost Regionl Hlth Kooweerup Reg Hlth Serv Neerim District Hlth Serv West Gippslnd Hlthcre Grp Birnsdle Reg Hlth Serv Buchn Bush Nursing Need more volunteers Pllitive Cre volunteers re lso utilised in our ged cre fcilities Recruitment: mny of our volunteers re now very elderly The time llocted to support nd supervise ech volunteer An extremely vluble resource. Use volunteers PRN if client nd crers hppy for sme Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 155

LATROBE Cnn Vlley Bush Nursing Gelntipy District Bush Nursing Gippslnd Lkes Comm Hlth Now Now Comm Hlth Serv Omeo District Hlth/Ensy Comm Hlth Orbost Reg Helth Swifts Creek Bush Nursing Ltrobe Comm Hlth Serv Ltrobe Reg Hospitl Mryvle Privte Hospitl When the crunch comes, everyone helps even though they wouldn't clssify themselves s 'volunteer'. Mintining the interest of volunteers during the quieter times hs been chieved by including them in crer support progrm nd support their inititives such s mking memory tokens to give to the bereved etc, or promotionl ctivities such s in pllitive cre week We re currently in the process of developing volunteer progrm nd eduction pckge for volunteers. Funding for support worker: coordinting volunteers nd ongoing trining/eduction. Keeping brest of relevnt chnges in pllitive cre. Recruiting effective volunteers. South Gippslnd Hospitl SOUTH South Gippslnd Pll Cre Serv As the Nurse Consultnt, I oversee nd mnge the volunteers. I m finding it incresingly difficult to do this in the llocted 0.7 EFT. It would be beneficil if designted EFT would be llocted to mnger of volunteers. Wellington Pll Cre Serv Recruitment in certin res nd filling gps. Strtegies hve been implemented like tking the trining to these res, nd lso hving popultion tht needs to work (economic climte) nd lso tht hs competing interests i.e. other volunteer WELLINGTON orgnistions needing them s well. Yrrm & Dist Hlth Serv Lck of specific skills to pllitive cre ptients. Support for Volunteers in this re is high nd requires more resource thn is often vilble in smll services. Peter McCllum Cncer Inst Victorin Peditric Pll Cre Prog Motor Neurone DAV 9.7 LINKS 9.7.1 ACUTE/SUB-ACUTE SERVICES LGA SERVICE LINKS WITH WHICH: NOT BASS COAST BAW BAW / Bss Cost Comm. Helth Serv Bss Cost Regionl Hlth Kooweerup Reg Hlth Serv Within our service provision INPATIENT PALLIATIVE CARE AVAILABLE STRENGTH OF LINK AVAILABLE NOT LINKED FAIR GOOD EXCELLENT HAVE PROTOCOLS COMMENTS Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 156

LGA SERVICE LINKS WITH WHICH: NOT CARDINIA EAST LATROBE INPATIENT PALLIATIVE CARE AVAILABLE STRENGTH OF LINK AVAILABLE NOT LINKED FAIR GOOD EXCELLENT HAVE PROTOCOLS Neerim District Hlth Serv Eduction/trining West Gippslnd Hlthcre Grp Vrious cute sector hospitls Birnsdle Reg Hlth Serv Buchn Bush Nursing Cnn Vlley Bush Nursing Gelntipy District Bush Nursing Gippslnd Lkes Comm Hlth Now Now Comm Hlth Serv BRHS Hospitls & specilists involved with specific ptients Birnsdle Hospitl Omeo District Hlth/Ensy Comm Hlth Omeo Orbost Reg Helth Swifts Creek Bush Nursing Ltrobe Comm Hlth Serv Ltrobe Reg Hospitl Mryvle Privte Hospitl SOUTH South Gippslnd Hospitl South Gippslnd Pll Cre Serv WELLINGTON Wellington Pll Cre Serv LRH: Tyers Wrd: PC unit Centrl Gippslnd Helth Service, Yrrm nd District Helth service, Heyfield Bush nursing hospitl COMMENTS Plese note - pllitive cllients re not common nd s such links re only fir. I hve been well supported by BRHS & LECHC As smll remote rurl gency it is not esy to hve 'joint ctivities'. We [nurses] ttend workshops t other plces when ble No current links s we hve no current clients needing pllitive cre locl hospitl: forml trnsfer to nd referrl to both services Links with medicl wrd CGHS excellent; good with the other services. Bed dys cn move to where client needs. Direct dmissions to CGHS medicl wrd. File notes to follow client from community to medicl. Resource support if needed for community. Working on joint cre pln. Wrd stff ttend our tem meeting. Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 157

LGA SERVICE LINKS WITH WHICH: NOT STATEWIDE SERVICES Yrrm & Dist Hlth Serv Peter McCllum Cncer Inst Victorin Peditric Pll Cre Prog Motor Neurone DAV Regionl Hospitl usully CGHS &LRH Peninsul, Very Specil Kids, Brodmedows INPATIENT PALLIATIVE CARE AVAILABLE STRENGTH OF LINK AVAILABLE NOT LINKED FAIR GOOD EXCELLENT HAVE PROTOCOLS COMMENTS VSK prt of the VPPCP llince; Prtnerships with other gencies s required LGA SERVICE LINKS WITH WHICH: NOT BASS COAST BAW BAW / CARDINIA EAST Bss Cost Comm. Helth Serv Bss Cost Regionl Hlth Kooweerup Reg Hlth Serv Neerim District Hlth Serv LRH, Southern Helth, Peter McCllum ONCOLOGY SERVICES AVAILABLE STRENGTH OF LINK AVAILABLE NOT LINKED FAIR GOOD EXCELLENT HAVE West Gippslnd Hlthcre Grp Dr Scrlett Birnsdle Reg Hlth Serv Buchn Bush Nursing BRHS Cnn Vlley Bush Nursing Gelntipy District Bush Nursing Gippslnd Lkes Comm Hlth Now Now Comm Hlth Serv Don't know PROTOCOLS Omeo District Hlth/Ensy Comm Hlth Orbost Reg Helth Swifts Creek Bush Nursing BRHS & Trrlgon LATROBE Ltrobe Comm Hlth Serv LRH: chemo unit nd Sr Scrlett COMMENTS Purchse eduction off BRHS for portcth ccessing. Oncology opertes only 1 dy per week Re-eduction: consultncy nd referrl Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 158

LGA SERVICE LINKS WITH WHICH: NOT Ltrobe Reg Hospitl Mryvle Privte Hospitl ONCOLOGY SERVICES AVAILABLE STRENGTH OF LINK AVAILABLE NOT LINKED SOUTH South Gippslnd Hospitl South Gippslnd Pll Cre Serv GSHS WELLINGTON STATEWIDE SERVICES Wellington Pll Cre Serv Centrl Gippslnd Helth Service Yrrm & Dist Hlth Serv CGHS/LRH Peter McCllum Cncer Inst Victorin Peditric Pll Cre Prog Motor Neurone DAV RCH, MMC FAIR GOOD EXCELLENT HAVE PROTOCOLS COMMENTS Developing protocols t present. Services provides by these services with our stff. Weekly discussion with Oncology, ttends tem meetings. Forml referrl process. Volunteers do hnd nd foot mssges whilst people re witing for tretments. Hospitls re prt of the VPPCP Allince OTHER ACUTE SERVICES LGA SERVICE LINKS WITH WHICH: NOT BASS COAST BAW BAW / CARDINIA EAST Bss Cost Comm. Helth Serv Bss Cost Regionl Hlth Kooweerup Reg Hlth Serv Neerim District Hlth Serv West Gippslnd Hlthcre Grp Birnsdle Reg Hlth Serv Buchn Bush Nursing Cnn Vlley Bush Nursing Gelntipy District Bush Nursing Within our service provision Don't know AVAILABLE STRENGTH OF LINK AVAILABLE NOT LINKED FAIR GOOD EXCELLENT HAVE PROTOCOLS COMMENTS Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 159

LATROBE OTHER ACUTE SERVICES LGA SERVICE LINKS WITH WHICH: NOT Gippslnd Lkes Comm Hlth Now Now Comm Hlth Serv AVAILABLE STRENGTH OF LINK AVAILABLE NOT LINKED Omeo District Hlth/Ensy Comm Hlth Birnsdle Orbost Reg Helth Swifts Creek Bush Nursing Ltrobe Comm Hlth Serv Ltrobe Reg Hospitl Mryvle Privte Hospitl SOUTH South Gippslnd Hospitl South Gippslnd Pll Cre Serv GSHS; SGH WELLINGTON STATEWIDE SERVICES Wellington Pll Cre Serv Phrmcy CGHS Yrrm & Dist Hlth Serv CGHS/LRH Peter McCllum Cncer Inst Victorin Peditric Pll Cre Prog All cute peditric settings Motor Neurone DAV FAIR GOOD EXCELLENT HAVE PROTOCOLS COMMENTS Attend tem meetings, provide eduction/support. Helping with setting up protocols etc, esy ccess to drugs especilly fter hours SURGICAL SERVICES LGA SERVICE LINKS WITH WHICH: NOT BASS COAST BAW BAW / CARDINIA Bss Cost Comm. Helth Serv Bss Cost Regionl Hlth Kooweerup Reg Hlth Serv Within our service provision AVAILABLE STRENGTH OF LINK AVAILABLE NOT LINKED FAIR GOOD EXCELLENT HAVE PROTOCOLS Neerim District Hlth Serv West Gippslnd Hlthcre Grp EAST Birnsdle Reg Hlth Serv COMMENTS Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 160

SURGICAL SERVICES LGA SERVICE LINKS WITH WHICH: NOT LATROBE AVAILABLE STRENGTH OF LINK AVAILABLE NOT LINKED Buchn Bush Nursing BRHS Cnn Vlley Bush Nursing Gelntipy District Bush Nursing Gippslnd Lkes Comm Hlth Now Now Comm Hlth Serv Omeo District Hlth/Ensy Comm Hlth Orbost Reg Helth Swifts Creek Bush Nursing Don't know Ltrobe Comm Hlth Serv LRH: Ltrobe Reg Hospitl Mryvle Privte Hospitl SOUTH South Gippslnd Hospitl South Gippslnd Pll Cre Serv Wellington Pll Cre Serv Centrl Gippslnd Helth Service FAIR GOOD EXCELLENT HAVE PROTOCOLS WELLINGTON Yrrm & Dist Hlth Serv Access to YDHS public hospitl bed Peter McCllum Cncer Inst STATEWIDE SERVICES Victorin Peditric Pll Cre Prog Motor Neurone DAV COMMENTS Hve very few Pllitive dmissions When they hve ptient with MND LOCALPALLIATIVECARECONSULTANCY SERVICE LGA SERVICE LINKS WITH WHICH: NOT BASS COAST BAW BAW / CARDINIA Bss Cost Comm. Helth Serv Bss Cost Regionl Hlth Kooweerup Reg Hlth Serv Neerim District Hlth Serv AVAILABLE STRENGTH OF LINK AVAILABLE NOT LINKED FAIR GOOD EXCELLENT HAVE PROTOCOLS COMMENTS Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 161

LOCALPALLIATIVECARECONSULTANCY SERVICE LGA SERVICE LINKS WITH WHICH: NOT EAST LATROBE AVAILABLE STRENGTH OF LINK AVAILABLE NOT LINKED FAIR GOOD EXCELLENT HAVE PROTOCOLS West Gippslnd Hlthcre Grp All regionl/metro Birnsdle Reg Hlth Serv Buchn Bush Nursing LECHC Cnn Vlley Bush Nursing Gelntipy District Bush Nursing Gippslnd Lkes Comm Hlth Now Now Comm Hlth Serv Don't know Omeo District Hlth/Ensy Comm Hlth Lkes Entrnce Orbost Reg Helth Swifts Creek Bush Nursing Lkes Entrnce Ltrobe Comm Hlth Serv Ltrobe Reg Hospitl Mryvle Privte Hospitl South Gippslnd Hospitl SOUTH South Gippslnd Pll Cre Serv GPCS Wellington Pll Cre Serv WELLINGTON Yrrm & Dist Hlth Serv CGHS COMMENTS STATEWIDE SERVICES Peter McCllum Cncer Inst Victorin Peditric Pll Cre Prog Motor Neurone DAV SUB-ACUTE SERVICES LGA SERVICE LINKS WITH WHICH: NOT BASS COAST BAW BAW / Bss Cost Comm. Helth Serv Bss Cost Regionl Hlth Kooweerup Reg Hlth Serv Within our service provision AVAILABLE STRENGTH OF LINK AVAILABLE NOT LINKED FAIR GOOD EXCELLENT HAVE PROTOCOLS COMMENTS Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 162

SUB-ACUTE SERVICES LGA SERVICE LINKS WITH WHICH: NOT CARDINIA EAST LATROBE Neerim District Hlth Serv West Gippslnd Hlthcre Grp Birnsdle Reg Hlth Serv Buchn Bush Nursing Cnn Vlley Bush Nursing Gelntipy District Bush Nursing Gippslnd Lkes Comm Hlth Now Now Comm Hlth Serv Omeo District Hlth/Ensy Comm Hlth Orbost Reg Helth Swifts Creek Bush Nursing Ltrobe Comm Hlth Serv Don't know AVAILABLE STRENGTH OF LINK AVAILABLE NOT LINKED FAIR GOOD EXCELLENT HAVE PROTOCOLS Ltrobe Reg Hospitl Mryvle Privte Hospitl SOUTH South Gippslnd Hospitl South Gippslnd Pll Cre Serv Wellington Pll Cre Serv Centrl Gippslnd Helth WELLINGTON Service Porters STATEWIDE SERVICES Yrrm & Dist Hlth Serv Integrted services Peter McCllum Cncer Inst Victorin Peditric Pll Cre Prog Motor Neurone DAV COMMENTS Deliver equipment to homes LGA SERVICE LINKS WITH WHICH: NOT BASS COAST Bss Cost Comm. Helth Serv Bss Cost Regionl Hlth OTHER ACUTE SERVICE AVAILABLE STRENGTH OF LINK AVAILABLE NOT LINKED FAIR GOOD EXCELLENT HAVE PROTOCOLS COMMENTS Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 163

LGA SERVICE LINKS WITH WHICH: NOT BAW BAW / CARDINIA EAST LATROBE SOUTH WELLINGTON STATEWIDE SERVICES Kooweerup Reg Hlth Serv Neerim District Hlth Serv South Est Pll. Cre refer bove OTHER ACUTE SERVICE AVAILABLE STRENGTH OF LINK AVAILABLE NOT LINKED FAIR GOOD EXCELLENT HAVE PROTOCOLS West Gippslnd Hlthcre Grp Allied helth Birnsdle Reg Hlth Serv Buchn Bush Nursing Cnn Vlley Bush Nursing Gelntipy District Bush Nursing Gippslnd Lkes Comm Hlth Now Now Comm Hlth Serv Omeo District Hlth/Ensy Comm Hlth Orbost Reg Helth Swifts Creek Bush Nursing Ltrobe Comm Hlth Serv Ltrobe Reg Hospitl Mryvle Privte Hospitl South Gippslnd Hospitl South Gippslnd Pll Cre Serv Wellington Pll Cre Serv Yrrm & Dist Hlth Serv Peter McCllum Cncer Inst Victorin Peditric Pll Cre Prog Motor Neurone DAV Mryvle Privte Hospitl Yrrm nd District Helth; Allied Helth: Centrl Gippslnd Helth Service Disbility gencies COMMENTS Forml trnsfer to nd referrl to both services; ccess to respite bed with no chrge to fmilies; 3 monthly meeting with NUM inptient PC We use these services lot. Hve worked together quite well especilly OT/Physio to mintin people in there homes Provide consultncy cross settings including disbility When they hve ptient with MND Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 164

9.7.2 COMMUNITY BASEDSERVICES LGA BASS COAST BAW BAW / CARDINIA EAST LATROBE SOUTH WELLINGTON STATEWIDE SERVICES SERVICE LINKS WITH WHICH: COMMUNITY PALLIATIVE CARE SERVICE NOT AVAILABLE STRENGTH OF LINK AVAILABLE NOT LINKED FAIR GOOD EXCELLENT HAVE PROTOCOLS COMMENTS Bss Cost Comm. Helth Serv Nursing tem for estern hlf of Shire Bss Cost Regionl Hlth Within our district nursing service Kooweerup Reg Hlth Serv Neerim District Hlth Serv West Gippslnd Hlthcre Grp Birnsdle Reg Hlth Serv Other regionl/metro Buchn Bush Nursing LECHC Cnn Vlley Bush Nursing Gelntipy District Bush Nursing Gipps Lkes CHC Gippslnd Lkes Comm Hlth Now Now Comm Hlth Serv Omeo District Hlth/Ensy Comm Hlth Lkes Entrnce Orbost Reg Helth Swifts Creek Bush Nursing Ltrobe Comm Hlth Serv Ltrobe Reg Hospitl Mryvle Privte Hospitl South Gippslnd Hospitl South Gippslnd Pll Cre Serv Lkes Entrnce CHC is our closest resource regrding dvice nd funding Wellington Pll Cre Serv As we re the community bsed Pllitive Cre tem I did not know how to nswer this. The tem is very committed nd united t chieving the best possible outcomes for the client. Yrrm & Dist Hlth Serv Onsite Peter McCllum Cncer Inst Victorin Peditric Pll Cre Prog All services Ptient focused links Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 165

LGA SERVICE LINKS WITH WHICH: COMMUNITY PALLIATIVE CARE SERVICE NOT AVAILABLE STRENGTH OF LINK AVAILABLE NOT LINKED FAIR GOOD EXCELLENT HAVE PROTOCOLS COMMENTS Motor Neurone DAV When they hve ptient with MND LGA BASS COAST BAW BAW / CARDINIA EAST LATROBE SOUTH SERVICE Bss Cost Comm. Helth Serv Bss Cost Regionl Hlth Kooweerup Reg Hlth Serv Neerim District Hlth Serv West Gippslnd Hlthcre Grp Birnsdle Reg Hlth Serv COMMUNITY PALLIATIVE CARE INREACH CONSULTANCY LINKS WITH WHICH: South Estern Penisnsul PC NOT AVAILABLE STRENGTH OF LINK AVAILABLE NOT LINKED Buchn Bush Nursing LECHC Cnn Vlley Bush Nursing Gelntipy District Bush Nursing Gippslnd Lkes Comm Hlth Now Now Comm Hlth Serv Omeo District Hlth/Ensy Comm Hlth Orbost Reg Helth Swifts Creek Bush Nursing Ltrobe Comm Hlth Serv Ltrobe Reg Hospitl Mryvle Privte Hospitl South Gippslnd Hospitl South Gippslnd Pll Cre Serv FAIR GOOD EXCELLENT HAVE PROTOCOLS Wellington Pll Cre Serv WELLINGTON Yrrm & Dist Hlth Serv NA COMMENTS STATEWIDE Peter McCllum Cncer Inst Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 166

SERVICES Victorin Peditric Pll Cre Prog Motor Neurone DAV COMMUNITY PALLIATIVE CARE INREACH CONSULTANCY Monsh Intermittent links for ptient specific cre LGA SERVICE LINKS WITH WHICH: NOT BASS COAST BAW BAW / CARDINIA EAST LATROBE SOUTH Bss Cost Comm. Helth Serv Bss Cost Regionl Hlth Kooweerup Reg Hlth Serv Neerim District Hlth Serv Within our service provision DISTRICT NURSING AVAILABLE STRENGTH OF LINK AVAILABLE NOT LINKED FAIR GOOD EXCELLENT HAVE West Gippslnd Hlthcre Grp Kooweerup DNS/RDNS Birnsdle Reg Hlth Serv Our service which provides pllitive cre Buchn Bush Nursing Cnn Vlley Bush Nursing Gelntipy District Bush Nursing Other Estern Vic Bush Nursing centres PROTOCOLS COMMENTS Gippslnd Lkes Comm Hlth Prt of the sme service Now Now Comm Hlth Serv Omeo District Hlth/Ensy Comm Hlth Orbost Reg Helth Swifts Creek Bush Nursing Ltrobe Comm Hlth Serv Ltrobe Reg Hospitl Mryvle Privte Hospitl South Gippslnd Hospitl Our service LCHG District Nurses South Gippslnd Pll Cre Serv GSHS; SGH Wellington Pll Cre Serv WELLINGTON Yrrm & Dist Hlth Serv Onsite Protocols for cre-shring for pllitive ptients STATEWIDE Peter McCllum Cncer Inst Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 167

LGA SERVICE LINKS WITH WHICH: NOT SERVICES DISTRICT NURSING AVAILABLE STRENGTH OF LINK AVAILABLE NOT LINKED FAIR GOOD EXCELLENT HAVE PROTOCOLS COMMENTS Victorin Peditric Pll Cre Prog Across Victori Through RDNS s required Motor Neurone DAV When they hve ptient with MND LGA SERVICE LINKS WITH WHICH: NOT BASS COAST BAW BAW / CARDINIA EAST LATROBE Bss Cost Comm. Helth Serv Bss Cost Regionl Hlth Kooweerup Reg Hlth Serv Neerim District Hlth Serv West Gippslnd Hlthcre Grp Birnsdle Reg Hlth Serv Buchn Bush Nursing Cnn Vlley Bush Nursing 4 locl prctices within our ctchment LOCAL GP PRACTICES AVAILABLE STRENGTH OF LINK AVAILABLE NOT LINKED FAIR GOOD EXCELLENT HAVE PROTOCOLS COMMENTS Gelntipy District Bush Nursing Birnsdle GPs very good Gippslnd Lkes Comm Hlth Now Now Comm Hlth Serv Omeo District Hlth/Ensy Comm Hlth Orbost Reg Helth Swifts Creek Bush Nursing GP very helpful nd will dmit client to Omeo Hospitl if it becomes necessry Ltrobe Comm Hlth Serv Ltrobe Reg Hospitl Mryvle Privte Hospitl SOUTH South Gippslnd Hospitl South Gippslnd Pll Cre Serv KMG, LMG, FMG Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 168

LGA SERVICE LINKS WITH WHICH: NOT LOCAL GP PRACTICES AVAILABLE STRENGTH OF LINK AVAILABLE NOT LINKED FAIR GOOD EXCELLENT HAVE Wellington Pll Cre Serv WELLINGTON Yrrm & Dist Hlth Serv Yrrm Medicl Centre onsite King Street STATEWIDE SERVICES Peter McCllum Cncer Inst PROTOCOLS COMMENTS Victorin Peditric Pll Cre Prog As required for specific children Motor Neurone DAV When they hve ptient with MND LGA SERVICE LINKS WITH WHICH: NOT BASS COAST BAW BAW / CARDINIA EAST LATROBE Bss Cost Comm. Helth Serv Bss Cost Regionl Hlth Kooweerup Reg Hlth Serv South Gippslnd Division GP DIVISIONS OF GENERAL PRACTICE AVAILABLE STRENGTH OF LINK AVAILABLE NOT LINKED Neerim District Hlth Serv West Gippslnd Hlthcre Grp Birnsdle Reg Hlth Serv Buchn Bush Nursing Cnn Vlley Bush Nursing Gelntipy District Bush Nursing Est Gippslnd Div GP Gippslnd Lkes Comm Hlth Now Now Comm Hlth Serv Omeo District Hlth/Ensy Comm Hlth Orbost Reg Helth Swifts Creek Bush Nursing Ltrobe Comm Hlth Serv Moe Ltrobe Reg Hospitl Mryvle Privte Hospitl FAIR GOOD EXCELLENT HAVE PROTOCOLS COMMENTS Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 169

LGA SERVICE LINKS WITH WHICH: NOT DIVISIONS OF GENERAL PRACTICE AVAILABLE STRENGTH OF LINK AVAILABLE NOT LINKED SOUTH South Gippslnd Hospitl South Gippslnd Pll Cre Serv FAIR GOOD EXCELLENT HAVE PROTOCOLS COMMENTS Wellington Pll Cre Serv WELLINGTON Yrrm & Dist Hlth Serv South Gippslnd STATEWIDE SERVICES Peter McCllum Cncer Inst Victorin Peditric Pll Cre Prog Motor Neurone DAV As required - some interest in future eduction LGA SERVICE LINKS WITH WHICH: NOT Bss Cost Comm. Helth Serv BASS COAST Bss Cost Regionl Hlth Bss Cost Shire, Home Help & within our service provision BAW BAW / CARDINIA EAST Kooweerup Reg Hlth Serv Neerim District Hlth Serv HOME AND COMMUNITY CARE SERVICES AVAILABLE STRENGTH OF LINK AVAILABLE NOT LINKED FAIR GOOD EXCELLENT HAVE PROTOCOLS West Gippslnd Hlthcre Grp Birnsdle Reg Hlth Serv Riverine House Birnsdle Buchn Bush Nursing Cnn Vlley Bush Nursing COMMENTS Gelntipy District Bush Nursing We re funded by HACC Gippslnd Lkes Comm Hlth Prt of the sme service Now Now Comm Hlth Serv Omeo District Hlth/Ensy Comm Hlth Orbost Reg Helth Swifts Creek Bush Nursing LATROBE Ltrobe Comm Hlth Serv Ltrobe City Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 170

LGA SERVICE LINKS WITH WHICH: NOT HOME AND COMMUNITY CARE SERVICES AVAILABLE STRENGTH OF LINK AVAILABLE NOT LINKED FAIR GOOD EXCELLENT HAVE PROTOCOLS COMMENTS Ltrobe Reg Hospitl Referrl forms in plce Mryvle Privte Hospitl South Gippslnd Hospitl SOUTH South Gippslnd Pll Cre Serv S.G. Shire Wellington Pll Cre Serv WELLINGTON Yrrm & Dist Hlth Serv Onsite YDHS STATEWIDE SERVICES Peter McCllum Cncer Inst Victorin Peditric Pll Cre Prog Motor Neurone DAV Dependent on eligibility criteri for trining of crers for children with medicl cre needs When they hve ptient with MND LGA SERVICE LINKS WITH WHICH: NOT BASS COAST BAW BAW / CARDINIA EAST Bss Cost Comm. Helth Serv Bss Cost Regionl Hlth Kooweerup Reg Hlth Serv Neerim District Hlth Serv COMMUNITY HEALTH SERVICES AVAILABLE STRENGTH OF LINK AVAILABLE NOT LINKED FAIR GOOD EXCELLENT HAVE PROTOCOLS West Gippslnd Hlthcre Grp WGHG Birnsdle Reg Hlth Serv Continence/ACAT Buchn Bush Nursing Cnn Vlley Bush Nursing Gelntipy District Bush Nursing Gippslnd Lkes Comm Hlth Now Now Comm Hlth Serv Omeo District Hlth/Ensy Comm Hlth Orbost Reg Helth COMMENTS Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 171

LATROBE SOUTH LGA SERVICE LINKS WITH WHICH: NOT Swifts Creek Bush Nursing COMMUNITY HEALTH SERVICES AVAILABLE STRENGTH OF LINK AVAILABLE NOT LINKED FAIR GOOD EXCELLENT HAVE PROTOCOLS Ltrobe Comm Hlth Serv LCHS COMMENTS Ltrobe Reg Hospitl Referrl forms in plce Mryvle Privte Hospitl South Gippslnd Hospitl South Gippslnd Pll Cre Serv Wellington Pll Cre Serv WELLINGTON Yrrm & Dist Hlth Serv Onsite YDHS STATEWIDE SERVICES Peter McCllum Cncer Inst Victorin Peditric Pll Cre Prog Motor Neurone DAV When they hve ptient with MND BEREAVEMENT SERVICES LGA SERVICE LINKS WITH WHICH: NOT BASS COAST BAW BAW / CARDINIA EAST Bss Cost Comm. Helth Serv Bss Cost Regionl Hlth Kooweerup Reg Hlth Serv Neerim District Hlth Serv Within our service provision AVAILABLE STRENGTH OF LINK AVAILABLE FAIR GOOD EXCELLENT NOT LINKED West Gippslnd Hlthcre Grp Professionl counsellors Birnsdle Reg Hlth Serv Socil worker @ BRHS Buchn Bush Nursing Cnn Vlley Bush Nursing Gelntipy District Bush Nursing HAVE PROTOCOLS COMMENTS Gippslnd Lkes Comm Hlth Prt of the sme service Now Now Comm Hlth Serv Omeo District Hlth/Ensy Comm Hlth Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 172

BEREAVEMENT SERVICES STRENGTH OF LINK COMMENTS HAVE LGA SERVICE LINKS WITH WHICH: NOT AVAILABLE FAIR GOOD EXCELLENT PROTOCOLS AVAILABLE NOT LINKED Orbost Reg Helth Swifts Creek Bush Nursing Ltrobe Comm Hlth Serv LATROBE Ltrobe Reg Hospitl Referrl forms in plce Mryvle Privte Hospitl SOUTH South Gippslnd Hospitl WELLINGTON South Gippslnd Pll Cre Serv Wellington Pll Cre Serv Yrrm & Dist Hlth Serv STATEWIDE SERVICES Peter McCllum Cncer Inst Victorin Peditric Pll Cre Prog Motor Neurone DAV Sttewide Well linked with service system When they hve ptient with MND RESIDENTIAL AGED CARE FACILITIES LGA SERVICE LINKS WITH WHICH: NOT BASS COAST BAW BAW / CARDINIA EAST Bss Cost Comm. Helth Serv Bss Cost Regionl Hlth Kooweerup Reg Hlth Serv Within our service provision AVAILABLE STRENGTH OF LINK AVAILABLE NOT LINKED FAIR GOOD EXCELLENT HAVE PROTOCOLS Neerim District Hlth Serv West Gippslnd Hlthcre Grp All Birnsdle Reg Hlth Serv Mddox Grdens Buchn Bush Nursing Cnn Vlley Bush Nursing Gelntipy District Bush Nursing Gippslnd Lkes Comm Hlth Now Now Comm Hlth Serv COMMENTS Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 173

LATROBE RESIDENTIAL AGED CARE FACILITIES LGA SERVICE LINKS WITH WHICH: NOT Omeo District Hlth/Ensy Comm Hlth Orbost Reg Helth AVAILABLE STRENGTH OF LINK AVAILABLE NOT LINKED FAIR GOOD EXCELLENT HAVE PROTOCOLS Swifts Creek Bush Nursing At Omeo Ltrobe Comm Hlth Serv Locl hostels/ nursing homes Ltrobe Reg Hospitl Mryvle Privte Hospitl SOUTH South Gippslnd Hospitl South Gippslnd Pll Cre Serv Severl in this LGA WELLINGTON STATEWIDE SERVICES COMMENTS Wellington Pll Cre Serv We do lot of trining in Aged Cre fcilities Yrrm & Dist Hlth Serv Onsite Peter McCllum Cncer Inst Victorin Peditric Pll Cre Prog Motor Neurone DAV N/A When they hve ptient with MND PRIMARY CARE PARTNERSHIPS LGA SERVICE LINKS WITH WHICH: NOT BASS COAST BAW BAW / CARDINIA EAST Bss Cost Comm. Helth Serv AVAILABLE STRENGTH OF LINK AVAILABLE NOT LINKED FAIR GOOD EXCELLENT HAVE PROTOCOLS Bss Cost Regionl Hlth Southcost Consortium Kooweerup Reg Hlth Serv Neerim District Hlth Serv COMMENTS West Gippslnd Hlthcre Grp SCoTT tool utilised Birnsdle Reg Hlth Serv Buchn Bush Nursing Cnn Vlley Bush Nursing Gelntipy District Bush Nursing Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 174

LATROBE PRIMARY CARE PARTNERSHIPS LGA SERVICE LINKS WITH WHICH: NOT AVAILABLE STRENGTH OF LINK AVAILABLE NOT LINKED FAIR GOOD EXCELLENT HAVE PROTOCOLS COMMENTS Gippslnd Lkes Comm Hlth Belong to Est Gippslnd PCP Now Now Comm Hlth Serv Omeo District Hlth/Ensy Comm Hlth Orbost Reg Helth Swifts Creek Bush Nursing Ltrobe Comm Hlth Serv Ltrobe Reg Hospitl Mryvle Privte Hospitl SOUTH South Gippslnd Hospitl South Gippslnd Pll Cre Serv STATEWIDE SERVICES Wellington Pll Cre Serv WELLINGTON Yrrm & Dist Hlth Serv South Cost excellent, Wellington good Peter McCllum Cncer Inst Victorin Peditric Pll Cre Prog Motor Neurone DAV Not currently SERVICE LINKS WITH WHICH: NOT OTHER COMMUNITY BASED AVAILABLE AVAILABLE NOT LINKED STRENGTH OF LINK FAIR GOOD EXCELLENT HAVE PROTOCOLS COMMENTS West Gippslnd Helthcre Group Post cute cre Very obliging 9.8 STATE-WIDE SERVICES DISEASE SPECIFIC SERVICES LGA SERVICE LINKS WITH WHICH: NOT AVAILABLE STRENGTH OF LINK AVAILABLE NOT LINKED FAIR GOOD EXCELLENT HAVE PROTOCOLS COMMENTS Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 175

DISEASE SPECIFIC SERVICES LGA SERVICE LINKS WITH WHICH: NOT BASS COAST BAW BAW / CARDINIA EAST LATROBE SOUTH WELLINGTON STATEWIDE SERVICES Bss Cost Comm. Helth Serv Bss Cost Regionl Hlth Kooweerup Reg Hlth Serv Neerim District Hlth Serv AVAILABLE STRENGTH OF LINK AVAILABLE NOT LINKED FAIR GOOD EXCELLENT HAVE West Gippslnd Hlthcre Grp Asbestos, MND, MS Birnsdle Reg Hlth Serv Phone support to mny support groups Buchn Bush Nursing Cnn Vlley Bush Nursing Gelntipy District Bush Nursing Gippslnd Lkes Comm Hlth Now Now Comm Hlth Serv Omeo District Hlth/Ensy Comm Hlth Orbost Reg Helth Swifts Creek Bush Nursing Ltrobe Comm Hlth Serv Ltrobe Reg Hospitl Mryvle Privte Hospitl South Gippslnd Hospitl South Gippslnd Pll Cre Serv Wellington Pll Cre Serv Yrrm & Dist Hlth Serv MND Peter McCllum Cncer Inst PROTOCOLS Victorin Peditric Pll Cre Prog Sttewide As required Motor Neurone DAV COMMENTS Used when needed, some specific res used for Volunteer trining Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 176

CLIENT SPECIFIC SERVICES LGA SERVICE LINKS WITH WHICH: NOT BASS COAST BAW BAW / CARDINIA EAST LATROBE SOUTH WELLINGTON STATEWIDE SERVICES Bss Cost Comm. Helth Serv Bss Cost Regionl Hlth Kooweerup Reg Hlth Serv Neerim District Hlth Serv AVAILABLE STRENGTH OF LINK AVAILABLE NOT LINKED FAIR GOOD EXCELLENT HAVE PROTOCOLS West Gippslnd Hlthcre Grp Commonwelth Crer Respite Birnsdle Reg Hlth Serv Phone Support or trvel to Melb Buchn Bush Nursing Cnn Vlley Bush Nursing Gelntipy District Bush Nursing Gippslnd Lkes Comm Hlth Now Now Comm Hlth Serv Omeo District Hlth/Ensy Comm Hlth Orbost Reg Helth Swifts Creek Bush Nursing Ltrobe Comm Hlth Serv Peter Mc; RCH; Alfred Hospitl Ltrobe Reg Hospitl Mryvle Privte Hospitl South Gippslnd Hospitl South Gippslnd Pll Cre Serv Wellington Pll Cre Serv Yrrm & Dist Hlth Serv Peter McCllum Cncer Inst Victorin Peditric Pll Cre Prog Motor Neurone DAV Ltrobe Community Helth Service Crer Respite, Kilmny Fmily Cre COMMENTS When needed hve very good support, nd meet with these providers on regulr bsis When they hve ptient with MND Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 177

SERVICE LINKS WITH WHICH: NOT Gippslnd Lkes Comm Hlth AVAILABLE OTHER STATE-WIDE SERVICES STRENGTH OF LINK AVAILABLE NOT LINKED FAIR GOOD EXCELLENT HAVE PROTOCOLS COMMENTS Ltrobe Regionl Hospitl McCulloch House; Monsh Ring Professor Asby/stff re tretment nd dvice Yrrm & District Hlth Serv Locl Clergy, Funerl Directors Usully involved before we re, but gret support to people. Funerl Directors help in our volunteer trining Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 178

10 APPENDIX 7: SUMMARY OF RESULTS: PRESS GANEY SURVEY 2004 10.1 BACKGROUND The Press Gney client survey ws conducted cross the Stte over five month period: Jnury 1 st to My 31 st. 2004. The number of responses from ech re in Gippslnd ws s follows: AREA RESPONSES AREA RESPONSES Birnsdle 4 South Gippslnd 7 Bss Cost 1 West Gippslnd 14 Centrl Gippslnd 16 Wonthggi 3 Ltrobe 26 Totl 71 10.2 SURVEY COVERAGE AND SUMMARY OF RESULTS Given the low response rte, cre needs to be exercised in interpreting the dt. Plese note there re hndful of sttisticlly significnt chnges from the previous survey for the region s whole but there is no consistent in direction in them. There re no sttisticlly significnt chnges for individul res nd no sttisticlly significnt differences between res. The following is n Executive summry by the reserchers. 55 Our impression from the two tbles below 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. PALLIATIVE CARE EXECUTIVE SUMMARY 4.0 Section Performnce Summry The following informtion is summry of results for the Gippslnd region. The informtion identifies the highest nd lowest performnces nd discusses the common issues tht rise. 4.1 Arrnging Pllitive Cre Services The key issues mong the questions tht mke up this index re: Ese of rrnging the initil visit; Avilbility of dys/times requested; Explntion nd informtion tht stff gve bout the service; nd Helpfulness of the stff mking the rrngements. 55 Press Gney Assocites. Preceptor, Gippslnd Region Pllitive Cre Gippslnd, Pllitive Cre System Report 1/1/2004 31/5/2004 Bundll Queenslnd, 2004 pp. iii - vii Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 179

Performnce t regionl level ws 91.5 compred to the Victorin Pllitive Cre Norm of 91.0. At n individul service level the top performer ws South Gippslnd (94.6) while the lowest performer ws West Gippslnd (86.7). 4.2 Deling with Pllitive Cre Office The key issues mong the questions tht mke up this index relte to the crer/client/ptient s experience with stff t the pllitive cre office during their service. In prticulr, whether the stff were friendly, ccommodting, responsive nd helpful. Performnce t regionl level ws 92.0 compred to the Victorin Pllitive Cre Norm of 90.7. At n individul service level the top performer ws Ltrobe (94.0) while the lowest performer ws South Gippslnd (86.7). 4.3 Pllitive Cre Tem This section ws divided into subsections to ssess the crer/client/ptient s stisfction with their experiences with the following key groups mking up the pllitive cre tem (nd in prticulr their vilbility, skills nd friendliness): Nurse/Cre Coordintor; Min Doctor/Medicl Prctitioner; Socil Worker/Counsellor; Volunteer/s; Attendnts/Aides; Other Workers (including Physiotherpists, Admin/Clericl Stff, Grief nd Loss Services, Mssge Therpists, Pstorl/ Spiritul Cre Services, Music nd Art Therpy Stff). The involvement of ech stffing group will vry between services nd between the crer/client/ptient s schedule of cre. All crers/clients/ptients receive services from Nurse/Cre Coordintor, however mny my only receive services from selection of other members of the pllitive cre tem. For this reson n ssessment of the pllitive cre tem s unit ws conducted. Performnce t regionl level ws 94.1 compred to the Victorin Pllitive Cre Norm of 93.2. At n individul service level the top performer ws Centrl Gippslnd (95.3) while the lowest performer ws South Gippslnd (91.7). 4.4 Personl Issues The key issues in this index relte to how well the pllitive cre service met the crer/client/ptient s nd fmily s needs with regrds to privcy, pin mngement, control of symptoms, wound cre/dressings, emotions, religion, spiritulity, culturl beliefs nd coping with grief nd loss. It lso ssesses the pllitive cre tem s bility to educte, inform nd involve the crer/client/ptient nd fmily/crer in spects relting to the crer/client/ptient s cre. Performnce t regionl level ws 90.4 compred to the Victorin Pllitive Cre Norm of 90.2. At n individul service level the top performer ws Ltrobe (92.3) while the lowest performer ws Centrl Gippslnd (86.2). 4.5 Overll Rtings of Pllitive Cre Services The key issues in this index relte to the overll experience of crer/client/ptient nd their fmily with the pllitive cre service. It focuses on overll coordintion, support nd qulity of the service s well s sking whether the person completing the survey would recommend the service to others. Performnce t regionl level ws 95.4 compred to the Victorin Pllitive Cre Norm of 93.6. 56 57 Gippslnd priority of issues bsed on correltion with overll stisfction Victorin priority issues bsed on correltion with overll stisfction Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 180

At n individul service level the top performer ws Ltrobe (97.1) while the lowest performer ws South Gippslnd (92.9).. 7.0 Priority Index (Internl) 56 8.1 Priority Index (Victorin Pllitive Cre) 57 Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 181

11 APPENDIX 8: PARTIES CONSULTED IN DEVELOPMENT OF THE PALLIATIVE CARE STRATEGIC PLAN 2005-2009 The following consulttions occurred during the development phse of this pln: Monthly meetings with the Gippslnd Regionl Pllitive Cre Consortium [Mrch to June 2005] Regulr meetings with the Strtegic Pln Working Prty of the Consortium [11 meetings Februry to June 2005] Two workshops: The first to explore the principles, vlues, strengths, weknesses, priorities nd preliminry strtegies; nd the second to develop strtegies nd ctivities. Mrch 16 th 2005 t Sle: Attendees June 7 th 2005 t Sle: Attendees Peter Crighed Centrl Gippslnd Helth Service Anne Curtin West Gippslnd Helthcre Group Anne Curtin West Gippslnd Helthcre Group S. Allen West Gippslnd Helthcre Group Helen Jckmn West Gippslnd Helthcre Group Helen Jckmn West Gippslnd Helthcre Group Cheryl Bush Gippslnd Lkes Community Helth Terron Rmsy Kooweerup Regionl Helth Service Penny Sers Gippslnd Lkes Community Helth Mry Ross-Hezlewood South Gippslnd Pllitive Cre Service Berndette Crstein Ltrobe Community Helth Service Kryn Crighed Yrrm nd District Helth Service Irene Renzenbrink Gippslnd Pllitive Cre Service Neil Lngstff Gippslnd Southern Helth Service Kylie Clrke Birnsdle district Nursng Nicole Steers Gippslnd Regionl Integrted Cncer Services Mry Ross-Hezlewood South Gippslnd Pllitive Cre Service Berndette Crstein Ltrobe Community Helth Service Neil Lngstff Gippslnd Southern Helth Service Cheryl Bush Gippslnd Lkes Community Helth Colleen Bog Yrrm nd District Helth Service Mndy Pusmucns Centrl Gippslnd Helth Service Lesley Murry Orbost Regionl Helth Drren Fitzptrick Omeo District Helth Peter Abrhm Omeo District Helth Shron Bover Centrl Gippslnd Helth Service Debr Cers Centrl Gippslnd Helth Service Dorothy Beck-McKy Bss Cost Community Helth Service Terron Rmsy Kooweerup Regionl Helth Service Ry Godbold Bss Cost Regionl Helth Vicki Frthing Birnsdle Regionl Helth Service Kye Beton Wonthggi Hospitl Ry Godbold Bss Cost Regionl Helth Jen Newling DHS Gippslnd Mpping Tool [which lso sought views on service system strengths, gps, opportunities, brriers to development, nd priorities. Respnses were provided by: Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 182

Birnsdle Regionl Helth Service Gelntipy District Bush Nursing Neerim District Helth Service Swifts Creek Bush Nursing Bss Cost Community Helth Service Gippslnd Lkes Community Helth Now Now Community Helth Service Victorin Peditric Pllitive Cre Progrm Bss Cost Regionl Helth Kooweerup RHS Omeo District Helth & Ensy Community Helth BRHS NH Jcrnd House Sutherlnd Lodge Wellington Pllitive Cre Service Ltrobe Community Helth Service Orbost Regionl Helth West Gippslnd Helthcre Group Buchn Bush Nursing Ltrobe Regionl Hospitl Peter McCllum Cncer Institute Yrrm nd District Helth Service Cnn Vlley Bush Nursing Mryvle Privte Hospitl South Gippslnd Hospitl Criny Lodge Hostel Motor Neurone DAV South Gippslnd Pllitive Cre Service [incorp GSDHS & SGH] Generl Prctitioner Survey: Responses were received from the following prctices: Foster, Wrrgul/Drouin, Trflgr Medicl Centre, Wrrgul, LCHS Churchill, Newborough, Morwell nd Leongth Medicl Group Survey of other gencies [e.g. Shire HACC services, disbility etc.]: Responses were received from Bss Cost Shire Council HACC services nd Ltrobe City Council Direct Cre. Gippslnd Regionl Pllitive Cre Consortium Strtegic Pln 2005-2009 183