Adelaide Hills (Mount Barker, Mount Pleasant, Gumeracha, Strathalbyn)

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Adelaide Hills (Mount Barker, Mount Pleasant, Gumeracha, Strathalbyn)
Adelaide Hills
(Mount Barker, Mount Pleasant, Gumeracha,
                                   Strathalbyn)

10 Year Local Health Service Plan

                           2011 – 2020

                Mount Pleasant District Hospital
 Gumeracha District Soldiers’ Memorial Hospital
Mount Barker District Soldiers’ Memorial Hospital
       Strathalbyn and Districts Health Services
       Adelaide Hills Community Health Service
       Country Health SA Local Health Network

                                             1
10 Year Local Health Service Plan

                                  Adelaide Hills Country Health Services

                                                             2011 - 2020

                                                          Table of Contents

1.   Executive Summary ....................................................................................................... 3
2.   Catchment summary...................................................................................................... 8
3.   Needs Analysis summary............................................................................................ 11
4.   Local implications of Statewide plans........................................................................ 15
5.   Planning Principles...................................................................................................... 16
6.   Service Delivery Plan ................................................................................................... 17
  6.1    Core Services to be Sustained ............................................................................... 17
  6.2    Strategies for new / expanded services .................................................................. 24
7. Key Requirements for Supporting Services............................................................... 33
  7.1    Safety and Quality .................................................................................................. 33
  7.2    Patient Journey ...................................................................................................... 34
  7.3    Cultural Respect..................................................................................................... 35
  7.4    Engaging with our community................................................................................. 36
  7.5    Local Clinical Networks .......................................................................................... 37
8. Resources Strategy ..................................................................................................... 38
  8.1    Workforce............................................................................................................... 38
  8.2    Infrastructure .......................................................................................................... 40
  8.3    Finance .................................................................................................................. 41
  8.4    Information Technology .......................................................................................... 42
  8.5    Risk Analysis .......................................................................................................... 43
9. Appendix ...................................................................................................................... 44
  9.1    Leadership Structure .............................................................................................. 44
  9.2    Methodology........................................................................................................... 44
  9.3    Review Process...................................................................................................... 45
  9.4    Glossary ................................................................................................................. 46

                                                                                                         Date: 8 August 2011

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1.    Executive Summary
“We acknowledge this land as the traditional lands for the Peramangk people and that we respect
their spiritual relationship with their country. We also acknowledge the Peramangk people as the
custodians of the Adelaide Hills region and that their cultural and heritage beliefs are still as important
to the living Peramangk people today.”

The Hills Area is east of the capital city of Adelaide in South Australia with Mount Barker 33
kilometres, Strathalbyn 56 kilometres, Mount Pleasant 54 kilometres and Gumeracha 36 kilometres
from Adelaide. There are four Hospitals and a Community Health Service in the Hills Area including
Mount Barker District Soldiers’ Memorial (DSM) Hospital, Strathalbyn and District Health Service,
Gumeracha District Soldiers’ Memorial (DSM) Hospital and Mount Pleasant District Hospital. Adelaide
Hills Community Health Service (AHCHS) is a multidisciplinary agency providing a diverse range of
community health preventative, early intervention, health promotion, better care in the community and
hospital avoidance / GP Plus health service programs.

The Hills catchment area extends to Kersbrook and Springton to the north, Lobethal and Stirling to the
west, Callington and Palmer to the east, and Ashbourne and Milang to the south. The resident
population for the Hills Area Hospitals is 60, 690 (DPLG, Population Projections 2011). The resident
population incorporating the total catchment for Adelaide Hills Community Health Service is 84,548.
People from Aboriginal and Torres Strait Islander backgrounds comprise 0.7% of the population
catchment, compared with 1.7% of the total South Australian (SA) population. There are 439 people
who have identified themselves as Aboriginal in the last ABS Census. The Peramangk people are the
original custodians of the land in the Hills Area.

Over the past 10 years the District Council of Mount Barker (DCMB) has been the fastest growing non
coastal Council within Australia, averaging 3% growth per annum1. The Hills Area is one of the
fastest growing populations in South Australia with the conservative projected population estimated to
increase to 81,639 by the year 2021. The Country Health SA Local Health Network (CHSALHN)
projected population for the broader Adelaide Hills Community Health Service catchment is estimated
to increase to 105,758 by the year 2021. However the SA Department of Planning and Local
Government2 sets a population growth target of 20,300 by 2024, for the combined population of the
townships of Mount Barker, Littlehampton and Nairne, leading to a population of approximately
40,000 people. This is a doubling of the existing population for that area3. This 10 Year Local Health
Service Plan recommends the same approach to planning health services for the Hills Area and the
Mount Barker and Strathalbyn districts in particular.

The Hills Area 10 year Health Service Plan reflects consultation between the Adelaide Hills Health
Advisory Council, the Adelaide Hills Division of General Practice and the existing Country Health SA
health units, namely Adelaide Hills Community Health Service, and Mt Pleasant, Gumeracha, Mt
Barker and Strathalbyn Hospitals. The plan is about providing services closer to home for the Hills
Area residents and providing better care in the community resulting in hospital avoidance. The overall
vision supported within the plan is that in 10 years time (2020) 80% of the hills area population have
access to services that meet 80% of their health care needs within the hills area. This will mean in
real terms a transition of primary and secondary services across the region. It will require Mt Barker
DSM Hospital to provide a new range of services aligned with statewide plans so that only patients
requiring highly specialised or complex care will need to access this type of care in Adelaide. These
services will be supported by rehabilitation services at Strathalbyn Health Services, integrated closely
with statewide rehabilitation directions and an Integrated Health Care Centre at Mt Barker built on the
Hospital Grounds and linked to services throughout the hills area. Existing services provided at Mt
Pleasant Hospital are to continue and an expanded role in bowel screening program to be
investigated. Existing services at Gumeracha Hospital are to continue. Adelaide Hills Community

1
  The District Council of Mount Barker (2009). Council Submission to the Draft 30 Year Plan for Greater Adelaide.
2
  SA Department of Planning and Local Government (2009). Planning the Adelaide we all want: Progressing the 30 Year
Plan for Greater Adelaide.
3
  SA Department of Planning and Local Government (2009). Planning the Adelaide we all want: Progressing the 30 Year
Plan for Greater Adelaide.
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Health Service is to have an expanded role in collaboration with all key stakeholders within the
Integrated Health Care Centre. A GP Plus Super Clinic has been supported by the federal Minister for
Health, the Hon. Nicola Roxon who has pledged up to $7 Million seeding funding to the Adelaide Hills
Division of General Practice. The Division and Hills Area Health Advisory council support the building
of the GP Plus Centre at Mt Barker on the Hospital Grounds.

Through this vision, priority needs identified through the needs analysis process which informed the
planning process will be addressed.

ENHANCED PRIMARY HEALTH CARE
  • Partnerships and collaboration across organisations such as those evidenced within the SA
     Inner Country Health Network will result in better health outcomes for the population
  • Increased flexible funding arrangements that support changing models of care and enable
     greater provision of outpatient, day patient and community based care is enabled through
     effective partnerships to maximise expertise and funding streams.
  • Strengthened primary and community based care and transition services to and from hospital
     via the Better Care in the Community initiative (incorporates self managed care for chronic
     disease).
  • Funded early intervention, illness (disease) prevention and health promotion initiatives.
  • Redesigned aged care support infrastructure to support GP Plus initiatives.

“A high quality and effective acute care system depends, in part on robust primary health care,
community care and post acute care services being in place” (SA Health Submission to the National
Health and Hospitals Reform Commission)

LINKED PUBLIC TRANSPORT SYSTEM FOR THE HILLS AREA
It is essential to the success of the above vision that an integrated public transport system connecting
townships between Mt Pleasant, Gumeracha and Strathalbyn to Mt Barker is developed.

INCREASED CAPACITY TO CARE FOR LOCAL POPULATION
Clinical Governance to support the local General Practitioners will be enhanced by the
implementation of the Integrated Health Care Centre. This will enable access to both residential and
visiting specialist care, recruitment and retention of a skilled health care workforce, training capacity in
the areas of obstetrics, anaesthetics and procedures for local GPs. It will also provide opportunity for
building links to tertiary health services and utilising e-health technology.

Increased AND redesigned disability support.

Increased access to timely mental health specialist care.

Utilisation of e-health technology.

Ensure that emergency department in each hospital is appropriate to the population health needs of
the immediate community

Importance of partnerships with General Practice and future developments in Commonwealth health
reform, such as Medical Local networks.

HEALTH PROMOTION
Support the provision of opportunities for exercise eg. sporting fields / clubs and healthy lifestyle
support.

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Key Recommendations:
PROVIDING SERVICES CLOSER TO HOME:
1. Liaise with Adelaide Health Service (formerly Central Northern Adelaide Health Service and
   Southern Adelaide Health Service) to address opportunities to provide local access to services
   instead of travelling to metropolitan services.
         a. Identify the services that are more appropriately accessed throughout the Adelaide Hills
             Service catchment based on the changing health needs of the population in the
             catchment and work to repatriate services into the Hills
         b. Identify the services that will continue to be accessed in metropolitan Adelaide as Mt
             Barker expands its role in line with statewide plans.
         c. Explore a medical link between Royal Adelaide Hospital Emergency Department (ED)
             and Mount Barker DSM Hospital ED in the first instance, building capacity for
             collaboration regarding more complex inpatient management in the future.
2. Implement an Integrated Health Care Centre at Mount Barker (IHCC). The IHCC will deliver:
         • Increased opportunities for provision of specialist services
         • Development of multidisciplinary care models
         • Enabled early intervention and prevention strategies
         • Enabled health promotion strategies
         • Increased mental health workforce
         • Integrated private and public allied health services
         • Enhanced midwifery and early childhood intervention services
         • Development of an aboriginal health strategy
         • Creation of an ideal environment for medical and allied health education at
             undergraduate and post graduate level
3. Develop an Orthopaedic Post Acute Rehabilitation service at Strathalbyn and District Health
   Service based on best practice and with metropolitan rehabilitation services as aligned with the
   Statewide Rehabilitation Plan.
4. Develop an Arthroplasty Clinic at Mt Barker
5. Resource surgical services across the Hills Area to meet population health demand.
6. Resource the maternity services at Mt Barker Hospital to meet population health demand in the
   redeveloped Maternity services (allocation announced at CHSALHN HAC in 2010 by Minister Hill.
7. Improve and enhance services to Aboriginal people by working with other service providers to
   improve accessibility
8. Recruitment and retention of a skilled workforce across disciplines and infrastructure to support
   best practice service delivery models to ensure future models of care are provided in a quality
   safety framework.

ENHANCED PRIMARY HEALTH CARE
    The area health service will work closely with strategic partners including the Adelaide hills
    Division of General Practice to enhance Primary Health Care.
9. Increase access to and services for early intervention for children and youth.
10. Develop an Early Childhood and Family Centre integrated closely with other service providers.
11. Increase hospital avoidance by greater integration with the aged care sector to ensure streamlined
    services, adequate provision of aged care beds, community care packages and health care
    services for older people at home.
12. Implement the Health Service Framework for Older People 2009 – 2016 as a priority. Establish a
    Level 4 Older People’s Health Services including inpatient Geriatric Evaluation and Management
    or ‘GEM’ teams and support across the Hills area.
13. Introduce a flexible suite of ambulatory community and hospital based services with multiple
    access points to be available to older people, and include day rehabilitation programs and
    rehabilitation in the home.
14. Consider mobile support teams for aged care and mental health needs.
15. Provide a Level 4 Palliative Care Service as described in the Palliative Care Services Plan 2009-1
16. Source physicians for the Hills, Southern Fleurieu, and Kangaroo Island (HSFKI) cluster; to
    increase access to specialist care locally. There would be a combination of resident and visiting
    services.
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17. Increase models that support changing models of care and enable greater provision of outpatient,
    day patient, and community based care regardless of age.
18. Ongoing cultural awareness program for all health service providers. Cultural respect will improve
    with the continuation of a dedicated education program for all staff and community as well as
    engagement and consultation with culturally and linguistically diverse (CALD) communities.
19. Ongoing engagement with the Aboriginal community and implement a local strategy for Improving
    Aboriginal health; including breaking down service delineation barriers
20. Implement a men’s health program.

LINKED PUBLIC TRANSPORT SYSTEM FOR THE HILLS AREA
21. The Hills Area Health Advisory Council and Country Health SA seek a review of the current public
    transport system with a view to increased access to rehabilitation, outpatient departments,
    ambulatory centres, community and acute services across the Hills Area.
22. Improve access to health care by innovation in transport including a ‘bee-line’ (free scheduled
    transport) concept for residents over 65 years or who need public transport to access health care.
    It is acknowledged that health services in Adelaide will continue to be an option for care,
    recognising personal networks, historic connections and individual choice, particularly for people
    residing in the North of the catchment.

INCREASED CAPACITY TO CARE FOR LOCAL POPULATION
23. Implement a formal local clinical governance structure that evidences links with the statewide
    clinical networks.
24. Increase access to diagnostic results.

INCREASED AND REDESIGNED DISABILITY SUPPORT.

INCREASED ACCESS TO TIMELY MENTAL HEALTH SPECIALIST CARE.
25. Establish, strengthen and continue collaborations that are currently happening across the Hills,
    Southern Fleurieu and Kangaroo Island Cluster.
26. Improve mental health services by clear links to tertiary visiting services, strong governance and
    implementation of a local 24/7 on call service response capability within the local service
    networks.
27. Work with DASSA and strengthen links with Divisions of General Practice (Adelaide Hills Division
    of General Practice (AHDGP)), general practitioners (GPs), and nurse practitioner programs.
    Implement training of health providers in the use of screening and brief intervention tools; training
    of GP prescribers; DASSA community pharmacy program links to local pharmacies; partnerships
    across health, alcohol, tobacco and other drugs (ATOD) and mental health services.
28. Explore local models of care to better manage people, who are affected by alcohol and other
    drugs, including those experiencing co-morbidity.
29. Implement a Youth Centre.

UTILISATION OF E-HEALTH TECHNOLOGY.
30. The patient journey will be improved by the Implementation of e-health.
31. ICT capacity is built in to all capital works redesign and care modelling:
         a. Access to e-health is essential to meet current and future models of care.
         b. ICT connectivity at outreach centres across the Hills Area.
         c. CHSALHN has equity of access to e-health with metropolitan health services and units
             within CHSALHN have equity of access.
         d. Education program for all staff relative to their role to support e-health, including visiting
             GPs and specialists.

ENSURE THAT EMERGENCY DEPARTMENT IN EACH HOSPITAL IS APPROPRIATE TO THE
POPULATION HEALTH NEEDS OF THE IMMEDIATE COMMUNITY
32. Build the Emergency Department capacity at Mount Barker and Strathalbyn – including capital
    works to redesign the Emergency Departments to meet current Australian Standards.

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HEALTH PROMOTION
33. Ensure that the community is engaged in the ongoing review and implementation of the 10 Year
    Health Service Plan.
34. Improve aged care with strong health promotion programs, providing opportunity to reduce social
    isolation, and a workforce development strategy that focuses on the development of aged care
    specific or blended nurse practitioner roles.
35. Continue effective community engagement to ensure that the Hills Area community is health
    literate and supports consumer / volunteer / carer programs
36. Advocate for increase funding for the public dental service to meet population demand.

   The Hills Area Health Advisory Council acknowledge the importance of reviewing the plans and
   progress annually as needs change in the future. The Plan provides a framework to move forward
   in a planned and forward thinking way. It sets out strategic directions over the next 10 years and
   implementation steps will need to be established annually to describe how they will be achieved –
   addressing the highest priorities first.

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2.   Catchment summary
Introduction

The Hills Area Health Services catchment has a population of approximately 53,200 residents living
within four local government areas including Adelaide Hills, Alexandrina, Barossa and Mount Barker.
The catchment area encompasses key townships including Gumeracha, Mount Barker, Mount
Pleasant, Strathalbyn, Birdwood, Echunga, Kersbrook, Lobethal, Macclesfield, Meadows, Milang,
Mount Torrens, Oakbank, Nairne, Springton and Woodside (refer map below). Four hospital and
health services provide services to the community situated in the Gumeracha, Mount Barker, Mount
Pleasant and Strathalbyn. The Mount Barker and Gumeracha Hospitals and Health Services are
located approximately 32-39 kilometres from Adelaide, and the Mount Pleasant and Strathalbyn
Hospitals are located approximately 54-56 kilometres from Adelaide.

                                      Source: www.atlas.sa.gov.au

Population

The resident population for the catchment is 60, 690 (DPLG, 2011). People from Aboriginal and
Torres Strait Islander backgrounds represent 0.7% of the catchment population compared with 3.1%
across country South Australia. The traditional owners of the land throughout the Hills catchment are
the Peramangk people. Approximately 2.9% of the population speak a language other than English at
home, compared with 3.9% across country South Australia.

The proportion of people aged 0-14 for the catchment area is 20.5%, compared with 18.5% across
total SA. The proportion of people aged 15-64 for the catchment area is 65.6% compared with 63.8%
across country SA and 66.1% across total SA. The proportion of people aged 65-84 for the
catchment area is 12.2% compared with 13.9% across country SA and 13.4% across total SA. The
proportion of people aged over 85 years for the catchment area is 1.8% compared with 2.0% across
total SA. It is estimated that the total population of the Hills Area Health Services catchment has
increased by approximately 7,000 persons in the five year period between 2006 and 2011.

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Based on Planning SA data (high stable projections), the population is expected to increase by
approximately 7% over the next 10 years. This prediction is below the growth identified by the Mount
Barker District Council and the Greater Adelaide Plan. It is also important to note that from 2004 to
2009, Statistical Local Areas such as Mount Barker Central, Strathalbyn district and the Adelaide Hills
North/Balance have grown by 19%, 11% and 3% respectively (2009 ABS Estimated Resident
Population). The fertility rate across the catchment ranges between 1.83 in the Adelaide Hills - North
Statistical Local Area (SLA) to 2.21 in the Barossa - Barossa SLA (encompassing the Mount Pleasant
catchment). This compares with 1.82 for South Australia. The average indirect standardised death
rate for the Hills Area Health Services catchment ranges from 4.8 in the Mount Barker - Balance SLA
to 7.3 in the Mount Barker – Central SLA. This compares with 6.1 for South Australia.

Information sourced from the South Australian Tourism Commission for 2007 indicates that for the
Adelaide Hills (which includes Mount Barker and Gumeracha but excludes Strathalbyn) and Fleurieu
Peninsula (which includes Strathalbyn, Yankalilla and Victor Harbor) there is a significantly high
number of overnight and same day visitors, most of which are aged between 45-64 years of age. The
Tour Down Under attracts more than 7,000 visitors to the area. Other major events include Classic
Adelaide and the Bay to Birdwood.

Table 1: Hills Area Health Services Population

                                                                                                       Country
                                                                        Cluster*        Cluster*                       SA total
                                            No.             %                                            SA
                                                                          No.              %                             %
                                                                                                         %
 Total Population                         60,690                         98,235

 Males                                    30,186          49.7%          48,662          49.5%           50.5%          49.4%
 Females                                  30,504          50.3%          49,573          50.5%           49.5%          50.6%

 0-14 years of age                        12,431          20.5%          18,403          18.7%           20.4%          18.5%
 15-24 years                              7,502           12.4%          10,908          11.1%           11.4%          13.3%
 25-44 years                              15,052          24.8%          22,183          22.6%           25.1%          26.7%
 45-64 years                              17,208          28.4%          27,997          28.5%           27.3%          26.1%
 65-84 years                              7,394           12.2%          16,236          16.5%           13.9%          13.4%
 85 years and over                        1,102           1.8%            2,507           2.6%            1.8%           2.0%

 ATSI**                                     379           0.7%             681            0.9%            3.1%           1.7%
 CALD (Speaks a language
                                          1,558           2.9%            2,360           2.8%            3.9%          12.2%
 other than English at home)**
                                              *Adelaide Hills, Fleurieu and KI Cluster total
  Source: Projected population by age and sex – SLAs in South Australia, 30 June 2011, Department of Planning and Local Government
                                                     **Source: 2006 ABS Census

Socioeconomic factors

On the basis of Australian Bureau of Statistics’ measures of remoteness, the Hills Area Health
Services catchment has been identified as inner regional which indicates reasonable proximity to
service centres including Adelaide when compared with other country locations. However transport for
health care consumers remains a barrier to better care in the community despite the existing public
infrastructure including regular bus services between major centres in the region and between the
region and Adelaide. Despite the close proximity to Adelaide, the public transport system across the
Hills Area is insufficient to meet the community needs, especially when needing to access health care
services.

The socioeconomic status for most of the catchment area is similar to or higher than country SA and
total SA averages. A relatively low socioeconomic status is observed in several collection districts
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within the Mount Pleasant catchment, and Strathalbyn. For most of the catchment area, the median
individual, family and household incomes are consistent or higher than the state average. Strathalbyn
and parts of the Mount Pleasant catchments are slightly lower than the state average. Aboriginal
people living in Strathalbyn have been identified as a special needs population since they have come
into the area from elsewhere with little family support.

Based on data which monitors the trends of diseases, health related problems, risk factors and other
issues across major regional areas, the Hills Mallee Southern region demonstrates similar levels of
risk factors for alcohol consumption, obesity, blood pressure, cholesterol, physical inactivity and
smoking when compared with country South Australia overall. The prevalence of chronic disease for
persons aged 16 years and over in the Hills Mallee Southern region demonstrates a slightly lower
prevalence of diabetes and a slightly higher prevalence of existing mental illness when compared to
country and total South Australia.

Health care and social assistance makes up 11.9% of total employment across the Hills Area Health
Services catchment, with manufacturing making up to 10.5%, retail trade 10.0%, education and
training 8.7%, and construction 8.5%. Located just 20 minutes drive east of Adelaide, the Hills Area
region offers easy road access to the eastern states and metropolitan Adelaide. The key industry
sectors in the Adelaide Hills region are wine production, beef and dairy cattle, vegetable growing, fruit
orchards and tourism. Significant extractive mineral operations contribute significantly to the economy
of the region and state. The region has the potential to be the site of new mining ventures, for
example the Angas Prospect near Strathalbyn has significant diamond, copper, lead and silver
deposits.

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3.       Needs Analysis summary
Methodology used to identify community needs

Community consultation is fostered through a number of formal and informal stand alone and ongoing
forums.

Previous formal community and network engagement in service planning for the Hills Area has
included:
    •  Northern Adelaide Hills Health Service (NAHHS) - survey to ascertain the Torrens Valley
       community’s knowledge, use and perception of the NAHHS sites and its services.
    •  Review of the pressures impacting on delivery of health services in the Mount Barker and
       surrounding areas.
    •  Gumeracha Community Association Public Survey.
    •  Alexandrina Council Feedback Report ‘Have Your Say’ consultation on the Draft Community
       Strategic Plan 2009-2013.
    •  Council submission to the draft 30 Year Plan for Greater Adelaide.
    •  Local Liaison Group (Mental Health Memorandum of Understanding).
    •  Local Councils - Population planning projections.
    •  Hills Area Health Advisory Council Annual General Meeting.
    •  Hills Area Positive Aging Taskforce.
    •  Hills Area Palliative Care Strategic Planning Group.
    •  Hills Area Aboriginal Services Forum.
    •  SA Inner Country Network Local Alliance.
    •  Hills Area Better Care in the Community Committee.
    •  Hills Area Pandemic Planning – Influenza (HAPPI).
    •  Mount Barker District Soldiers Memorial Hospital 2009-10 Business Planning Session.
    •  Strathalbyn and District Health Service Emergency Department questionnaire.

Ongoing community engagement and collaboration will occur with a diverse range of stakeholders in
the future.

From mid January 2010 a dedicated CHSALHN Planning Officer liaised and consulted with both
internal and external stakeholders including staff, clinicians, local government, statewide service
providers and other key groups. All information from community, staff and key stakeholder
consultations was reviewed and utilised to inform the 10 Year Local Health Service Plan. Leakage
data from the Hills Area to metropolitan health units and outpatient clinics was obtained and analysed.
The Hills Area Health Advisory Council (HAHAC) has considered the consultation outcomes.

The 10 Year Health Service Plan has been considered by the cluster Director HSFKI, cluster
Executives and the local HAHAC for review and endorsement.

Summary of Needs Analysis Key Issues

Community Health Promotion and Prevention Programs
  • A need to re-orientate care whenever possible to an ambulatory/hospital avoidance/GP Plus
    model of care.
  • South Australia’s Strategic Plan 2007–2016 informs the health reform agenda for South
    Australia and includes goals for the community to stay healthy, with a focus on preventing
    illness through improving lifestyle.

Community Health and GP Plus Services
  • The provision of an Integrated Health Care Centre (IHCC) (GP Plus Centre) has community,
    key stakeholder and health service staff support and would assist to deliver the integrated care
    required for the growing population in the Hills4 The Great Expectations report5 and recent

4
    Adelaide Hills Division of General Practice (2009). Mount Barker Integrated Health Care Centre (proposal)
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operational assessment of paediatrics in the Adelaide Hills6 identifies the IHCC as an integral
        part of a service delivery model for the future.
    •   Capital works to enable future models of care are needed at Mount Barker and Strathalbyn
        Hospital and AHCHS:
          o   5,857 community health episodes of treatment provided in the metropolitan area (an
              additional 11% to treatments provided locally). In the last three financial years leakage
              to metropolitan community health services has increased by 14%.
    •   The GP Plus Health Care Strategy 2007 is the overarching primary health care and out-of-
        hospital strategy for South Australia.
    •   Increase ambulatory care for chemotherapy, transfusions, orthopaedic follow up, post acute
        care and rehabilitation.
    •   Transport to and from the metropolitan area is problematic for the ageing and young
        populations.

Emergency Services
  •  There is a higher than national average rate of car accidents in the Hills Area.
  •  The close proximity to Adelaide, predicted population growth, high community priority on a 24
     hour emergency service at Mount Barker and across the Hills, and lack of access to local GPs
     impact on emergency service capacity at both Mount Barker and increasing demand at
     Strathalbyn. This highlights the need for strengthening emergency services.
  •  The Mount Barker DSM Hospital ED requires capital works to provide improve the
     environment for staff and in particular meet mental health care needs and GP after hours
     medical clinic needs
  •  There is a strong community desire to maintain the EDs at all Hospitals in the Hills area. The
     emergency departments provide a core service to both people residing in the catchment and
     also the many tourists who travel through the area.

Acute Inpatient Care
   •   42% of catchment area acute medical care is being provided locally.
   •   In the last three financial years leakage to metropolitan public hospitals has increased by 14%
       for medical episodes, 13% ‘other episodes, and 11% for surgical episodes.
   •   674 chemotherapy treatments are performed in the metropolitan area from catchment.
   •   468 renal dialysis admissions to metropolitan area from the catchment.
   •   There is a strong community desire to maintain the acute services at all Hospitals in the Hills
       area.

Elective Surgical
   •   22% of catchment area surgery is being performed locally.
   •   100% of local emergency surgery is being performed in the metropolitan area.
   •   There is a need to explore the existing theatre complex capacity at Mount Barker to meet
       increased elective surgery demand.

Maternal and Birthing Services
   •  37% of women in the Hills cluster birth at Mount Barker Hospital, which is a decrease from
      40% in 2001. The maternity ward was redeveloped in 1990 to accommodate 150 births per
      annum however the number of births has grown to 350 per annum. The maternity service at
      Mount Barker DSM Hospital requires capital works and the introduction of contemporary
      midwifery models of care to meet current and future population birthing and family
      needs7 8 9.Capital works funding was committed for this in the last election.
   •  More contemporary models of care (eg. Midwifery Led Care) may contribute to improving
      recruitment and retention of midwives.

5
  Hoorenman and O’Shea (2007). Great Expectations: A Review of the pressures impacting on delivery of health services to
Mount Barker and surrounding districts.
6
  Country Health SA (2009). Paediatrics in the Adelaide Hills: Operational assessment.
7
  Hoorenman and O’Shea (2007). Great Expectations: A Review of the pressures impacting on delivery of health services to
Mount Barker and surrounding districts.
8
  Wright, D. (2009). Midwife Models Project: Report to the Midwifery Models Project Steering Committee.
9
  HASSELL (2009). Mount Barker Maternity Ward Feasibility Update.
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Medical Specialist Services
  •   Staff and community identified specialist care needs locally, particularly access to respiratory
      physician, paediatrician, geriatrician, cardiology, chemotherapy, oncology, orthopaedic,
      general physician and allied health. Access to psychiatrist and other specialist support for
      mental health is required in the Northern Hills area. This lack of access to specialists limits the
      capacity to provide care in the local hospitals and contributes to a negative patient journey and
      increased leakage to metropolitan hospitals.

Mental Health
  •   Clinicians identified the need to explore the opportunity to provide a better environment to
      meet mental health and associated co-morbidity needs.
  •   Young people identified mental ill-health as a major issue including depression, stress, anxiety
      associated with bullying and issues at home.
  •   Clinicians and stakeholders recognised delays in transporting patients to approved treatment
      centres impacts on local health and police services and the need for support to manage
      violent patients.
  •   The community and clinicians identified the need for greater clarification about how to access
      the services.
  •   Aboriginal people are accessing mental health services in the cluster at less than optimal
      level.
  •   The Country Model of Care has been based on recognition of the need to reform the health
      care system concepts of ‘Right Care, Right Time, Right Place, Right Person/Team’.

Rehabilitation
   •  Clinicians have identified the opportunity for the provision Orthopaedic Post Acute
      Rehabilitation services at Strathalbyn and District Health Service, integrated with key
      directions identified in the Framework for Older People 2009-16 and the Statewide
      Rehabilitation Plan.

Respite Services
   •  There is a strong community desire to maintain respite at Mt Barker, Strathalbyn, Gumeracha
      and Mount Pleasant Hospitals.

Aged Care
   •  Statewide planning notes that health care, rehabilitation, primary health care providers and
      aged care residential services integration is essential for the Hospitals and AHCHS to meet
      the health care needs of the elderly into the future10.
   •  As the majority of health care for older people occurs in primary health care settings, the GP
      Plus Strategy is integral to the SA Health Service Framework for Older People, and provides
      the context for many of the strategies described in this Health Service Plan.
   •  The Model of Care to meet the needs of the aged is described in the Health Service
      Framework for Older People 2009-1611.
   •  Clinicians identified the need for a pro-active system that enables outreach into the aged care
      facilities to facilitate early intervention, health promotion, rehabilitation, palliative care, early
      discharge from acute care and hospital avoidance.
   •  Burden of disease statistics for the HSFKI cluster indicates that dementia is noticeably higher
      in the cluster than the national average.
   •  Based on current trends and policy it is likely that there will be a shift in demand away from
      low-level residential care and towards community care over the next 10 to 15 years — in
      addition to the projected growth resulting from population ageing12.
   •  As people live longer and with advances in medicine it is expected that individuals will live
      longer with disability and will be more likely to benefit from rehabilitation. Evidence indicates

10
   SA Health (2009). Health Service Framework for Older People 2009-16: Improving Health and Wellbeing Together
11
   SA Health (2009). Health Service Framework for Older People 2009-16: Improving Health and Wellbeing Together
12
   The Allen Consulting Group (2007). The Future of Community Care: Report to the Community Care Coalition, Melbourne.
                                                                                                                    13
that perhaps as much as half of the functional decline associated with ageing is the result of
        disuse and can be reversed by exercise aimed at increasing the fitness of older people.

Palliative Care
   •    299 palliative care treatments were performed in the metropolitan area (community health).
   •    The SA Palliative Care Services Plan13 projects a significant increase in demand for end of life
        care and outlines an expectation that a significant portion of this demand will be managed by
        GPs, community health, community and residential aged care providers.

Clinical Support Services
    •  Clinicians and stakeholders have identified the need for access to ultrasound equipment for
       maternity services and increase in hours to radiology services.
    • Key focus around the implementation of new health technology concepts in line with SA Health
       ICT direction including e- health, electronic decision support tool and electronic referral tools.

Youth Services
   •  The Youth Advisory Committee (YAC-RAP) has identified young people’s mental health as
      needing more of a focus by services, particularly in the areas of depression, anxiety, eating
      disorders, self-harm and suicide prevention. There are gaps in current services for children
      and youth as identified in AHCHS Child, Youth, and Families Services Development
      Proposal14
   •  Young people have identified mental health as a major issue including depression, stress,
      anxiety associated with bullying and issues at home.

Drug and Alcohol Services
   •  Clinicians and stakeholders have identified that there remains significant unmet demand for
      drug dependence treatment, particularly from those who are primarily heroin users, as well as
      the increasing number of people dependent on prescription opioids.
   •  ATOD and mental illness admissions comprise a significant proportion of hospital A&E or
      admission episodes and has been identified as an issue previously in needs assessments.
      People with ATOD and mental illness co-morbidity often have high and complex health issues
      and may be at high risk of mortality.
   •  Clinicians and stakeholders identified the opportunity for the use of screening tools such as
      ASSIST to help identify substance use as a cause of the presenting illness.
   •  Clinicians and stakeholders identified the need to increase the capacity of GPs who are
      permitted to prescribe Suboxone and dispensing pharmacies to meet demand, and for
      capacity building in the early identification and treatment intervention of ATOD problems
      among primary health care services15.

Early Childhood
   • Extract      from Operational Assessment of Paediatrics in the Adelaide Hills:
       ‘Given the growth, demographic make up of the population and perceived benefits from a local
       service, concentration of the population, future facility developments and ability to recruit
       specialists ….the location of the Adelaide Hills paediatric services is recommended to be at
       Mount Barker’.

13
   SA Health (2009). Palliative Care Services Plan 2009-2016.
14
   Adelaide Hills Community Health Service (2009). Child, Youth, and Families Service Development Proposal
15
   DASSA
                                                                                                             14
4.       Local implications of Statewide plans
Strategy for Planning Country Health Services in SA

The Strategy for Planning Country Health Services in South Australia, endorsed in December 2008,
builds on the vision in South Australia’s Health Care Plan 2007-2016, South Australia’s Strategic
Plan, and the SA Health Aboriginal Cultural Respect Framework and sets out how to achieve an
integrated country health care system so that a greater range of services are available in the country,
meaning fewer country residents will need to travel to Adelaide for health care.

The Strategy identifies the need for significant changes to achieve a sustainable health system that
addresses the contemporary challenges facing the health system. The main factors contributing to an
increasingly unsustainable health system include the ageing population, increasing prevalence of
chronic diseases, disability and injury, poorer health of Aboriginal people and people of lower
socioeconomic status, and increasing risks to society from communicable diseases, biological threats,
natural disasters and climate change.

Health services located in areas in close proximity to Adelaide (peri-urban sites) including Mount
Barker, Gawler and Victor Harbor are subject to urban growth and have a rural mode of service
delivery. These services’ catchment areas extend into designated country areas and services will be
jointly planned across both country and metropolitan areas. This approach aims to support the
services to expand as their rural catchment grows, with the advantages of being relatively close to
metropolitan services.

A number of Statewide Clinical Service Plans have been developed or are currently under
development providing specific clinical direction in the planning of services. Interpreting these plans
for country South Australia and specific health units is an important element of the planning process
for Country Health SA. The enabling factors which are demonstrated across the statewide clinical
plans include:

     •    Multi-disciplinary teams across and external to the public health system.
     •    Patient focused care.
     •    Care as close to home as possible.
     •    Teaching and research integrated in service models.
     •    Integrated service model across the continuum of care.
     •    Streamlining access to specialist consultations.
     •    Increasing use of telehealth.
     •    Improving Aboriginal health services.
     •    Focus on safety and quality.
     •    Recruiting and developing a workforce to meet future service models.
     •    Engaging closely with consumers and community.
     •    Developing the infrastructure to meet future service models.
     •    Clinical networking and leadership.
     •    Connect local patients with pathways to higher level care needs.
     •    Reduce progression to chronic disease for at risk populations.

Strategies within the Statewide Clinical Service Plans which support the achievement of local needs
have been integrated through the 10 Year Local Health Service Plans.

                                                                                                    15
5.   Planning Principles
The Strategy for Planning Country Health Services in South Australia set out important principles
which have been used to guide the local planning which include:

       1. Focusing on the needs of patients, carers and their families utilising a holistic care
       approach.

       2. Ensuring sustainability of country health service provision.

       3. Ensuring effective engagement with local communities and service providers.

       4. Improving Aboriginal health status.

       5. Contributing to equity in health outcomes.

       6. Strengthening the IT infrastructure.

       7. Providing a focus on safety and quality.

       8. Recognising that each health service is part of a total health care system.

       9. Maximising the best use of resources.

       10. Adapting to changing needs.

                                                                                                   16
6.    Service Delivery Plan

6.1    Core Services to be Sustained

Service Category   Service Description                      Target Group               Directions over next 10 years
Community Health   Local Area:                              • Over 45                  All Sites:
Promotion and      •   Access to chronic disease self       • Children and youth       •    Ongoing staff development in the delivery of services that respond to
Prevention             management programs,                 • People with diabetes          community demand including:
Programs               Domiciliary Care, Aboriginal         • Aboriginal people             o    Post acute management
                       health, community nursing and        • Carers                        o    Palliative care
                       midwifery services, drug and                                         o    Expansion of staffing capacity to address ageing workforce issues
                       alcohol services, community                                     •    Continue with qualified diabetes resource
                       mental health (adult and child),                                •    HAHAC to work with the community to resource an Aboriginal
                       counselling and allied health                                        Community House
                       services.                                                       •    HAHAC to source a bus for use by Aboriginal communities for events /
                   District:                                                                funerals, medical appointments
                   •   Specialised chronic disease                                     •    HAHAC to work with Local Council and Housing SA to address the lack
                       practitioners eg. diabetes                                           of public housing for Aboriginal people
                       educators, chemotherapy                                         •    Increase resources to meet increasing population demand for early
                   •   Diabetes management, women’s                                         intervention strategy implementation including allied health
                       health, Aboriginal health, early                                •    Continue to engage the community and key stakeholders to support
                       learning for families team, youth                                    carers:
                       program,                                                             o    SA Carers Support Model
                   Carers Support Program:                                                  o    HACC service agreements
                   •   Commonwealth Respite and                                             o    Positive Aging Taskforce 10 Year Plan
                       Carelink Centre South and East                                       o    Carers support groups
                       Country (Carers SA)
                   •   Hills Carer Wellness Centre which                               Mount Barker
                       is auspiced by Carers Link in the                               •  Work with partners to implement a Youth Centre to respond to youth
                       Barossa                                                            mental health needs and a large number of disengaged youth from
                                                                                          school, significant youth issues

                                                                                       •  See section 6.2 for new services
Outpatient Care    District:                                • People with cancer       Mount Barker
                   •   Chemotherapy                         • People with a clinical   •  Establishment of an Outpatient Department Cancer Oncology and
                   •   High level provision of post acute       need that does not        Chemotherapy clinic with specialists who would consult and supervise
                       and hospital avoidance services          require a hospital        the administration of the more toxic drugs that are not administered at a
                                                                admission                 local level currently
                                                                                       •  Implement a designated ambulatory care centre for chemotherapy,
                                                                                          transfusions, post acute assessment and rehabilitation assessment
                                                                                       •  Develop common approach to packages of care that are criteria driven
                                                                                                                                                                17
Strathalbyn, Mount Pleasant and Gumeracha Hospitals
                                                                                             •    Provide services to clients in the community using existing hospital staff.
                                                                                                  AHCHS and Hospitals collaborate to provide outreach services in the
                                                                                                  community using this model
Allied Health               •   Local access to broad range of     Clients  across     the   All Sites
                                allied health services (eg.        continuum of care         •    Development of allied health assistant roles eg. reorienting services to
                                physiotherapy, occupational                                       use professional skills appropriately
                                                                                                                                                                         16
                                therapy, social work, speech                                 •    Re-orienting services to promote independence and early intervention
                                pathology, podiatry, dietician)                              •    Partnerships - shared leadership of a broad range of health and human
                            •                                                                     services at the local level to deliver on specified impacts and outcomes
                                                                                             •    Practice standards - agreed minimum standard of service coordination
                                                                                                  practice
Emergency Services          •   Mount Barker, Strathalbyn,         All people                All Sites
                                Gumeracha and Mount Pleasant                                 •    Nurse led emergency care overnight
                                24 hour service 7 days a week                                •    Ensure ongoing education program and up skilling for nursing staff in
                            •                                                                     first line emergency management
                                                                                             •    Introduce aged care specialist nurses into the ED to facilitate hospital
                                                                                                  avoidance for the elderly

                                                                                             Mount Barker
                                                                                             •  Using current facilities, explore alternative models of care in provision of
                                                                                                emergency services notably at Mt Barker
                                                                                             •  Capital works business case to meet service demand, address deficits
                                                                                                and control risks at Mount Barker Hospital:
                                                                                                o   Establish separate space for agitated patients or grieving families
                                                                                                    Establish physical infrastructure to manage presenting patients and
                                                                                                    improve facilities for staff to safely manage agitated or violent clients
                                                                                             •  Work towards capacity for emergency surgery in Mount Barker

Acute Inpatient Care        •   Local area services at all         Hills Area community      All Sites:
                                hospitals                                                    •    Maintain access to acute inpatient care
                            •   District services for surgical,
                                birthing, chemotherapy at Mount                              Mount Barker DSM Hospital:
                                Barker                                                       •  Increase capacity to admit and treat more complex medical conditions,
                            •   Level one surgery at Strathalbyn                                to improve the patient journey
                            •   Day procedural surgery at Mount                              •  Increased capacity is linked to the IHCC initiative
                                Pleasant                                                     •  Paediatric Step Down Unit linked to increased maternity services and
                                                                                                IHCC

16
     Chronic Disease Action Plan for South Australia 2009-2018
17
     Stepping up Report, Social Inclusion Report
                                                                                                                                                                          18
•    Explore possibility of expanded service for youth and young adults with
                                                                                                                                                          17
                                                                                                        mental health / drug and alcohol co-morbidities
Elective Surgical           •   Local area services at Mount           Hills Area community        Mount Barker DSM Hospital:
                                Barker and Strathalbyn                                             •    Ensure that infrastructure and resourcing meet the elective surgery
                            •   District services including joint                                       demand for the Hills Area
                                replacement at Mount Barker                                        •    Explore the possibility of providing all inpatient surgery at Mount Barker,
                            •   Procedural and scope services at                                        appropriately funded by the elective surgery strategy; with Strathalbyn a
                                Mount Pleasant (linked to national                                      Centre for Orthopaedic Post Acute Rehabilitation, supporting the
                                bowel screening program)                                                increased surgical demand across the Hills Area
                                                                                                   •    Explore the feasibility of 23 hour day surgery clinic and stand alone day
                                                                                                        surgery suite into the future
                                                                                                   •    Explore the possibility of a team to support the national bowel screening
                                                                                                        program across the Hills supported by Mount Barker and Mount
                                                                                                        Pleasant District Hospitals (high prevalence of cancer in the Hills area)
                                                                                                   Mount Pleasant District Hospital:
                                                                                                   •    Continue and expand procedural day surgery only; particularly for
                                                                                                        screening and monitoring for bowel cancer (could service the Hills,
                                                                                                        some of the Barossa and the near Murray Mallee area eg. Mannum)
                                                                                                   Strathalbyn and District Health Service:
                                                                                                   •    Utilise existing theatre resources for up to level 1 day surgery until
                                                                                                        Mount Barker builds capacity to meet demand in the Hills Area
Maternal          and       Local Area Services:                       Pregnant        women,      All Sites
Birthing Services           •   Antenatal and postnatal care           foetus and infants in the   •    Resource community midwifery to meet demand – particularly the large
                            •   Shared Care Programs                   Hills Area                       proportion of women returning to the Hills Area after birthing in
                                                                                                                                   18
                            •   Access to community midwifery                                           metropolitan health units
                                services and parenting programs
                            District Services:                                                     Mount Barker DSM Hospital:
                            •   Low risk, single birth, theatre and                                •  Build birthing capacity to 600 births each year and enable a step down
                                staffing for caesarean sections 24                                    nursery for neonates who no longer need to be at the Women’s and
                                hours a day, 7 days a week                                            Children’s Hospital for ongoing care
                            •   Service is supported by one                                        •  Encourage the introduction of a Midwifery Led Model to compliment the
                                obstetric specialist, 5 GP                                            existing Shared Care Model as it taps into a sustainable workforce in the
                                obstetricians and 4 GP                                                recruitment/employment of direct entry midwives
                                anaesthetists
Medical Specialist          Local area services                        • People with cancer        All Sites:
Services                    •   District Services                      • People who need      Liaise with Adelaide Health Service (formerly Central Northern
                            •   There are no resident medical            palliation           Adelaide Health Service and Southern Adelaide Health Service) to
                                specialists                            • People with a mental address opportunities to provide local access to medical specialist
                                                                         health     issue  or services instead of travelling to metropolitan services
                                                                            illness

18
     Standards for Maternal and Neonatal Services in South Australia 2009
                                                                                                                                                                                19
• People over 65           Mount Barker
                                                            • People    with       a   •    Building and implementing an Integrated Health Care Centre at Mount
                                                              respiratory condition         Barker will increase access to medical and other specialists eg.
                                                            • Children                      o    Access to a visiting oncologist
                                                                                            o    Access to a visiting palliative care specialist
                                                                                            o    Increase access to visiting mental health specialists
                                                                                            o    Increase access to visiting geriatric specialists
                                                                                            o    Access to a visiting respiratory physician
                                                                                            o    Access to a visiting paediatrician
Mental Health    Local area services                        People of all ages and     All Sites
                 •  Community based care                    across the continuum of    •    Identify clear links to tertiary visiting services
                    Primary mental health care              care who have a mental     •    Inclusive leadership and governance
                 •  Shared care management with             health issue or illness    •    See section 6.2 for new services
                    local GP
                 •  Local admissions for mental
                    health 24 hour 7 day/week
                    emergency mental health service
                    by telehealth

                 District area services
                 •   Visiting psychiatrists in Mt Barker
                 •   Local private psychologist in Mt
                     Barker
                 Resident mental health nurses in Mt
                 Barker
Rehabilitation   •   Inpatient immediate post               • People    who have       Strathalbyn District Hospital
                     operative rehabilitation for joint       orthopaedic              •   Work in collaboration with the Hills area to develop a Orthopaedic Post
                     replacement and other                    procedures,                  Acute Rehabilitation service at Strathalbyn and District Health Service
                     orthopaedic surgery at Mount             including                    based on best practice and with metropolitan rehabilitation services as
                     Barker and Strathalbyn                   arthroplasty                 aligned with the Statewide Rehabilitation Plan
                 •   Transitional Care Packages are         • People over 65           •   See section 6.2 for new services
                     available
                 •   community and home based
                     rehabilitation support, centre
                     based day therapy, multi-
                     discipline outpatient rehabilitation
                     and aquarobics / tai chi classes

                                                                                                                                                               20
Respite Services           Local area services                     All people   requiring   All Sites
                           •  Access to domiciliary care           respite                  •    Strengthen partnerships with current providers of respite services
                           •  Access to residential care                                    •    Improved access to day centres to provide support for carers
                           •  Volunteer programs                                            •    Explore opportunities to increase respite options to avoid hospital
                           •  Organised in home respite                                          admission
                           •  No access to higher level acuity /                            •    Continue existing links to the community eg. respite in residential care
                              disability care
                           •  Strathalbyn Hospital to provide
                              programmed respite care, other
                              health units to provide emergency
                              respite only
Aged Care                  •  Mount Barker Hospital is a           Over 65                  All Sites
                              casemix funded Hospital for acute                             •    Explore infrastructure needs to meet consumer expectations
                              care only                                                     •    Implement minor capital works to meet the needs of in house
                           •  Strathalbyn, Gumeracha and                                         Transitional Care Packages (TCP)
                              Mount Pleasant District Hospitals                             •    Increase EACH and EACH-D packages to meet population health
                              have aged care beds with a mix                                     demand in the Hills Area
                              of commonwealth and state                                     •    Undertake more detailed analysis to clarify HACC accessibility and
                              funding                                                            priorities to build community confidence in the service
                           •  Local Area services for                                       •    Redesign care to meet the outcomes as specified in the Health Service
                                                                                                                                     19
                              community management,                                              Framework for Older People 2009
                              including aged care assessment                                •    Plan to build capacity for people with dementia to access dementia
                                                                                                                                20
                              is provided by Adelaide Hills                                      services across the Hills Area
                              Community Health Service                                      Mount Pleasant District Hospital
                           •  Regional services including                                   •    Develop space for day activities in line with current required standards
                              psycho-geriatric support are                                  •    See section 6.2 for new services
                              available
                           •  Day Care Dementia Service
                           •  Willow Fern Community Respite
                              House (Southern Cross)
                              overnight and day activities

19
     Health Services Framework for Older People 2009-2016
20
     South Australia’s Dementia Action Plan 2009-2010
                                                                                                                                                                      21
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