Dr Teresa Anderson AM - Chief Executive - Sydney Local Health District
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Overview Wrap up of 2017/18 Budget Principles 2018/19 Budget Allocation from 2017/18 Achievements MoH Overview of 2018/19 Service Agreement Hospital & Service Budgets Next steps 2018/19 Service Level Agreement Strategies and Priorities Service Level Agreement Key Performance Indicators
Wrap up of 2017/18 GENERAL FUND FOR YEAR TO 30 JUNE 2018 Actual $M Budget $M $ VAR % VAR STATUS TOTAL EXPENDITURE $1,721.58M $1,729.50M $7.92M (F) 0.46% (PERFORMING) (UNDER TOTAL REVENUE $1,664.23M $1,670.86M $6.63M (UF) -0.67% PERFORMING) NCoS before Doubtful $57.35M $58.64M $1.29M (F) 2.19% (PERFORMING) Debts (UNDER Doubtful Debts $7.53M $3.05M $4.48M (UF) -146.88% PERFORMING) (UNDER Total NCoS $64.88M $61.69M $3.19M (UF) -5.17% PERFORMING) Note: Total Revenue excludes one-off items provided by MoH at the end of the financial year 2
Wrap up of 2017/18 SPECIAL PURPOSE & TRUST FUND FOR YEAR TO 30 JUNE 2018 Actual $M Budget $M $ VAR % VAR STATUS TOTAL EXPENDITURE $36.429M $25.102M $11.33M (UF) -45.12% (UNDER PERFORMING) TOTAL REVENUE $44.425M $38.318M $6.108M (F) 15.93% (PERFORMING) (UNDER TOTAL NCoS $7.997M $13.216M $5.219M (UF) -39.49% PERFORMING) Note: Additional SP&T expenditure was used to invest in infrastructure and equipment (medical and ICT) across the District 3
Wrap up of 2017/18 Facility level financial performance 30 June 2018: HOSPITAL / SERVICE 2017/18 % 2016/17 % NCoS NCoS ($M) ($M) RPA $8.358M (U) -1.41% $7.222M (U) -1.33% CONCORD $3.562M (U) -1.19% $4.640M (U) -1.60% CANTERBURY $4.043M (U) -3.82% $3.037M (U) -3.09% BALMAIN $0.988M (U) -2.97% $0.037M (F) 0.12% IRO $0.823M (U) -4.50% $0.101M (F) 0.54% SYDNEY DENTAL $0.010M (U) -0.02% $4.575M (F) 10.09% MENTAL HEALTH $0.632M (U) -0.57% $0.154M (F) 0.15% THOMAS WALKER $0.482M (U) -7.88% $0.004M (F) 0.07% COMMUNITY HEALTH $0.239M (F) 0.66% $1.440M (F) 4.13% POPULATION HEALTH $0.617M (F) 5.33% $0.408M (U) -4.05% REPORTING ENTITY (including Direct $14.736 (F) 1.22% $9,178 (F) 0.84% Research & Capital Works) 4
Wrap up of 2017/18 FTE Growth in 2017/18: AWARD TYPE 1 July 2017 30 June 2018 Increase % Increase MEDICAL 1,287 1,335 48 3.74% NURSING 4,016 4,164 148 3.69% ALLIED HEALTH 838 888 50 5.95% PROFESSIONAL, TECHNICAL & ORAL HEALTH 753 763 10 1.32% CORPORATE SERVICES, HOSPITAL SUPPORT 2,162 2,227 65 3.01% & HOTEL SERVICES MAINTENANCE, TRADES & OTHER 122 124 2 1.64% TOTAL 9,178 9,501 323 3.52% 5
Wrap up of 2017/18 NWAU Activity delivered in 2017/18: ACTIVITY TYPE Actual Target Variance % Variance ACUTE 159,919 157,553 2,365 1.50% EMERGENCY DEPARTMENT 22,553 22,616 (63) -0.28% NON-ADMITTED 43,318 43,375 (56) -0.13% SUB-ACUTE 11,310 11,137 173 1.55% MENTAL HEALTH 28,808 28,219 589 2.09% DENTAL 10,518 8,234 2,284 27.74% TOTAL 276,426 271,134 5,292 1.95% 6
2017/18 Challenges These results and the following achievements were delivered in spite of a number of significant challenges during the year including: Significant demand for services, particularly during the winter period Pressures on ICU services The need for increased investment in facility infrastructure
2017/18 Achievements PROJECT EXPENDITURE RPA MULTI-STOREY CAR PARK (COMPLETED) $29.316M BIOBANK PROJECT AT PROF MARIE BASHIR CENTRE (COMPLETED) $10.922M RPA GYNAEOLOGY CAMERA STACK/TOWERS (COMPLETED) $0.284M K2 FETAL MONITORING SYSTEM (COMPLETED) $0.624M EMERGENCY DEPARTMENTS SECURITY AND DURESS ALARMS UPGRADE (COMPLETED) $7.298M RPA IRO BUILDING LEVEL 6 REFURBISHMENT (COMPLETED) $0.735M EEGP SLHD – EFFICIENCY UPGRADES AT CROYDON & MARRICKVILLE HEALTH CENTRES $0.177M (COMPLETED) EEGP SLHD – BALMAIN AND SYDNEY DENTAL HOSPITAL (NEAR COMPLETION) $0.615M RPA ENERGY EFFICIENCY GOVERNMENT PROGRAM (EEGP) (WORK COMMENCED) $6.992M SLHD AGED CARE/REHAB. NETWORK - WORK COMMENCED (NEAR COMPLETION) $6.400M 8
2017/18 Achievements WORK IN PROGRESS PROJECTS EXPENDITURE CONCORD HOSPITAL OPERATING THEATRE RENOVATION (WORK COMPLETED THEATRES 7&8) $2.736M CONCORD HOSPITAL X-RAY MACHINES (PROJECT UNDERWAY) $1.507M CONCORD HOSPITAL MAMMOGRAPHY UNIT REPLACEMENT (PROJECT UNDERWAY) $0.750M CANTERBURY HOSPITAL TSSU EQUIPMENT REPLACEMENT (PROJECT UNDERWAY) $0.800M CANTERBURY HOSPITAL X-RAY EQUIPMENT (PROJECT UNDERWAY) $0.435M CANTERBURY HOSPITAL CHILLED WATER SYSTEM (PROJECT UNDERWAY) $0.620M RPA STANDBY GENERATOR UPGRADE (PROJECT UNDERWAY) $0.654M CONCORD HOSPITAL LIFTS MODERNISATION (PROJECT UNDERWAY) $2.000M RPA FIRE DETECTION SYSTEM (PROJECT UNDERWAY) $0.600M 9
2017/18 Achievements 164,598 people attended emergency departments across SLHD (an increase of 2.7%) 42,606 operations were performed in our hospitals (an increase of 1.04%) 171,698 admissions and discharges across our hospitals (an increase 1.4%) 6,702 babies born at RPA and Canterbury Exceeded the SLHD NWAU target of 273,802 (1.4% YTD May exact figure being finalised due to coding) 3,833 additional NWAU at a cost of $4,588 = $17,585,804 in additional activity from contingency. 10
2017/18 Achievements Maintained Performance at level 0 for the full year – 90 months in a row Came in on budget (Net Cost of Service) Maintained Performance at level 0 for the full year – 90 months in a row Came in on budget (Net Cost of Service- excluding doubtful debts) Maintained surgical performance at 0,0,0 Significantly improved performance on most KPIs Balmain, RPA and Community Health all achieved successful accreditation with the Equip National standards 11
2017/18 Achievements Organisation achievements New District Strategic Plan and Research Strategic Plan completed New Aboriginal Health Strategic Plan, cultural gardens throughout District Outpatient Transformation Program – commencing at Canterbury Hospital Ongoing enhancement of STARS to enable real time monitoring of services, business processes, activity and outcomes. Multiple signature events to engage our staff and our community– Innovation Week, AGM, Yaralla Festival, Rivendell Flower Show, cultural events including Sorry Day, NAIDOC Week, Close the Gap, Think Tanks and Planning forums, EquityFest, Sydney Urban Health and Wellbeing Forum, commemorative services.
2017/18 Achievements Patient achievements A top performer in the State - timely care, transfer, flow, elective surgery wait times and ETP + on budget. Patient and Family Centred Care program continues – Launch of Partners in Care Policy and Pilot at Balmain Hospital with a view to rolling out across the District by December 2018 Canterbury Hospital launched the Cemplicity Survey tool to gain better knowledge of the patient experience Patient surveys show high levels of satisfaction Clinical Governance: maintained high quality and safety standards with systems and processes audited based on national standards. Continued implementation of Essentials of Care, Heart of Health, Productive ward, Canterbury Cares and Intentional Rounding. 13
2017/18 Achievements Community achievements Continued to strengthen community engagement through consumer advisory committees, community consultation and engagement in planning and service delivery Developed SydneyConnect – new digital communication platform for news and events of Sydney Local Health District www.slhd.nsw.gov.au/sydneyconnect Enhanced social media for community engagement, new Community and Events Facebook and Instagram Further opportunities to engage community in health services delivery through Yaralla Festival, Carols at Yaralla, Fair Day Stall (won best stall), inaugural March Arts events, inaugural Rivendell Flower Show fundraiser, commemorative events including Dawn Service to mark Centenary of ANZAC 14
2017/18 Achievements Community achievements Ongoing investment in community-based healthcare eg. Sustained Home Visiting, community mental health, Sydney District Nursing Mental Health launched Eurella House Enhancement of Integrated Care programs eg. CCChip, Healthy Homes and Neighbourhoods, Criteria–led Discharge, peer support workers, HeatheNet, NDIS, Residential Aged Care Outreach International interest in Healthy Homes and Neighbourhoods – preliminary data shows reduction in ED presentations among enrolled clients NGO engagement continues through Healthy Strong Communities, EquityFest, RPA HealthOne East consultations and through funding NGOs Continued Implementation of healthy children’s initiatives, 15 Go4Fun, Munch and Move, Live Life Well @ School.
2017/18 Achievements Staff achievements Continued implementation of the Workforce Strategic Plan People Matter 2017 survey results - achieved the highest culture index and highest engagement score in NSW Successfully implemented HealthRoster - an Information Technology system for rostering staff. Inaugural Women’s Leadership Breakfast held to acknowledge inspiring women throughout the District. Women make up 72% of the Sydney Local Health District workforce (in line with Premier’s Priorities). Aboriginal Workforce development (1.7%) strategies have been very actively pursued through AINs (nursing, Admin Assistants program). Respecting the Difference completed by 9,000 staff. 16
2017/18 Achievements Staff achievements Health Promotion initiatives implemented to improve health of our workforce including: ‘Making healthy choices easier’ campaign as part of the Healthy Food and Drinks Framework, Get Healthy at Work, Free Health Checks for staff. 17
2017/18 Achievements Staff achievements Officially opened new RPA Staff Car Park 18
2017/18 Achievements Staff achievements The Pitch Innovation Series reached major milestone in June with $1m invested in the ideas of our staff Performance Development and Review, Employee recognition programs, EAP services, BPTOK. Significantly reduced excessive annual leave balances 19
2017/18 Achievements Education achievements Expansion of education programs in CEWD and continued development of CEWD as a leading delivery site of the NSW Health RTO. Third annual Education and Training Forum at CEWD with more than 130 delegates Enhancement of Clinical Placement capacity Strong collaboration with University of Sydney and other tertiary partners Opening of the David Storey Surgical Skills and Simulation Centre at the IAS at RPA 20
2017/18 Achievements Research achievements Launched Research Strategic Plan Held the sixth Annual Sydney Innovation and Research Symposium – expanded program to ‘Innovation Week’ – 9 events hosted including: ‘Research Day’ with the Big Idea, Clinical Trials Showcase and Research Education Series, the Symposium and the Sydney Robotics Summit - more than 2500 Delegates and 150 presenters 21
2017/18 Achievements Research achievements Strengthening of Sydney Research – Appointment of Executive Director, hosted second ‘Big Idea’ with $45,000 awarded to help commercialise research. Launched the STRIVE Research Impact and Commercialisation Series. Sydney Research Awards and the first Sydney Local Health District Clinical Trials Awards. 550 clinical trials underway across five hospitals, giving our patients access to the latest in drug treatments. Major world breakthroughs in Gene Therapy leading to cures for Haemophilia and Thalassaemia. 22
2017/18 Achievements Research achievements Officially opened the NSW Health Statewide Biobank, a partnership of OHMR, NSW Health Pathology, Health Infrastructure and SLHD. Ongoing development of Sydney Health Partners, one of the first Advanced Health and Research Translation Centres in Australia designated by NHMRC - awarded $2.2m funding announced at 2017 Sydney Innovation and Research Symposium. Signed historic Partnership Agreement and IP Agreement with the University of Sydney affirming the commitment of both institutions to excellence in the pursuit of research, education, community engagement and health delivery. 23
2017/18 Achievements Research achievements Launched Australian first eating disorders research institute “InsideOut Institute” in partnership with the University of Sydney. Established Institute of Musculoskeletal Health in partnership with the University of Sydney. Ongoing development of the RPA Institute of Academic Surgery and RPA Surgical and Robotics Training Institute (only centre of its kind in Southern Hemisphere) – more than 120 clinicians trained last year. Further development of the Charles Perkins Centre RPA Clinic. Ongoing development of the SLHD Clinical Research Centre and ICT Health Informatics Unit. Strengthened Population Health, Community Health, Nursing and Allied Health research (annual research forums and 24 ongoing research).
2017/18 Achievements Service achievements Announcement: $341m redevelopment of Concord Hospital (Stage 1) – held planning and Community Consultation Sessions. Masterplanning for the development of Canterbury Hospital. Continued preparation for RPA HealthOne East, Green Square in collaboration with community, local providers, NGOs, four universities and staff.
2017/18 Achievements Service achievements Opening of the Emergency Short Stay Unit at Concord Hospital Completion of the Balmain capital works program Sydney Dental Hospital refurbishments including 17 specialist dental surgeries in Periodontics and Prosthodontics and the Prosthodontic Laboratory New concierge service at Sydney Dental Hospital
2017/18 Achievements Service achievements Digital transformation – The CARI Project: Move the delivery of the eMR service to the eHealth Government Data Centre – in partnership with eHealth and SWSLHD. Digital transformation - @health email migration: Over 10,000 SLHD emails (22,000 across SLHD and SSWAHS) converted to the statewide email service providing a single lifelong health email address for all health employees. Digital transformation RPA: roll-out of eMeds, SurgiNet and hTrak in JL Theatres, eMR2, VitalsLink, Oncology and Haematology Information Management System (OHMIS) introducing digital documentation and electronic prescribing within Cancer Services Digital transformation Concord: eMeds in Intensive Care, OHMIS for oncology and haematology. Digital transformation Canterbury: eMR enhancements, eMR2 in outpatient departments, clinical barcoding. Digital transformation Balmain: eMR2, first NSW Hospital to implement VitalsLink across an entire hospital.
2017/18 Achievements Service achievements Digital transformation: PABX KGV – over 700 new phones installed. Digital transformation: BYOD program. Strengthened discharge planning through Criteria-Led Discharge, Whole of Health, PathWays, electronic discharge. REACH: Concord Emergency Department implemented Reach in December – first application of the program in Emergency in NSW. HealthPathways Sydney became first Australian region to publish 600 locally relevant pathways. Published 84 new pathways and referral pages, reviewed 147 existing pathways. Launched SLHD/PRISM Electronic GP referral portal trial enabling patient referral to supported SLHD Ambulatory care services. 28
2017/18 Achievements Service achievements Launch of the new RPA Comprehensive Stroke Service including new ambulant services for stroke and neurovascular care. New ECRNOW service for acute stroke - multidisciplinary hyperacute 24/7 state-wide endovascular clot retrieval service supporting metro and regional hospitals across the state. 35% increase in admissions. New multi-disciplinary memory and cognition clinic at RPA – more than 270 patients in the first 12 months. The COMBAT-MS Study – world first program targeting both thinking skills and general psychological wellbeing in multiple sclerosis. Recruiting for IMPROVE-MS the largest longitudinal 29 MS Study ever conducted in Australia integrating
2017/18 Achievements Service achievements Commencement of the state’s second peritonectomy service at RPA – between April 2017 and June 2018 - 59 patients have had the procedure. Best performing metropolitan Local Health District in initiating Hepatitis C treatment to residents. Appointment of Director of TB Services for SLHD. Enhancement of Pulmonary Hypertension Service with the appointment of a dedicated CNC to the multidisciplinary team. Integrated Care Program for Aboriginal patients with chronic disease. Strong relationships with the AMS are reinforcing patient health plans and improving health outcomes. Chronic Care program - building innovative partnerships between the patient, health and social services including NGOs, primary care and FACS to ensure 30 patients receive holistic care addressing health issues and
2017/18 Achievements Service achievements Enhanced Healthy Lifestyle Services to prevent chronic disease in Sydney Local Health District Diabetes - Successful implementation of insulin eMeds processes across SLHD input facilities – now being adapted statewide SLHD ComPacks assisted 1397 inpatients with a 6-week post discharge package of care, finishing on 100% of 2017/18 package and financial targets 89% of people living with a disability in SLHD who were assisted by the SLHD NDIS Transition Team were deemed eligible for the Scheme 96% of SLHD Community Care Support Program clients (excluding clients receiving nursing) were successfully transitioned to NDIS or alternative care before the 30 June 2018 deadline RACF Outreach - Successful development and implementation of the ‘right care, right place, right time’ - enhanced model of care and multidisciplinary team supported by a geriatrician
2017/18 Achievements Service achievements New/upgraded service developments such as Peritonectomy, INR, Health Interpreter Service, HiTH, Xtend, Chronic Care, obesity clinics, hybrid labs, robotic surgery, genomics, imaging Continued to work with Chris O’Brien Lifehouse to provide selected cancer service for public patients under a service agreement Achievement of rates of Organ Donation at world best practice level. 77 liver transplants performed at RPA + 30 performed by the RPA team at the Children’s Hospital and 121 kidney transplants performed in 2017/18. Celebrated 50 years kidney transplants at RPA Completion of 679 pelvic exenterations (June 2018) and 75 exenterations in 2018 with the best 5 year survival of any centre in the world Established specialised clinic for thrombosis and haematological 32 disorders of pregnancy – Institute of Haematology
2017/18 Achievements Population Health Healthy Beginnings has been integrated into four sustained home visiting services, collaborated with four LHDs, NGOs and international organisations to implement the program. CHAT study (Communicating healthy beginnings by phone) close to completion. Healthy Beginnings app has been published. Public Health Meningococcal Vaccination provided to 9613 Year 11 and 12 students and 5108 Year 10 and 11 students in 2017 and first part of 2018 $48,000 won through The Pitch to develop ‘Flucare’ web based application to improve the quality and efficiency of notification of influenza 33 outbreaks in aged care facilities to PHU.
2017/18 Achievements Allied Health District implementation of best practice for Stroke Patients with aphasia at all stages of the stroke journey from acute to rehabilitation and home. “Memory Books” for relatives and carers of dying patients (RPA) CHESTY multi-centre trial measuring incidence of respiratory complications and sepsis following surgery (Concord) 34
2017/18 Achievements Community Health International interest in Healthy Homes and Neighbourhoods integrated care program. Redesign Child and Family Health Nursing care model, including expansion of Sustained Home Visiting Service Continued focus on Growing Healthy Families Healthy Children in Sydney Local Health District – Talking and Listening check ups offered to 4992 children at early childhood centres and family friendly locations across District 35
2017/18 Achievements First comprehensive domestic violence counselling service for the District – the new Community Domestic Violence Team provides a free, confidential, trauma- informed clinical service to women to support recovery Achieved ambitious HIV testing targets – increasing the number of Sexual Health Clinic patients by 155%. Enrolled over 900 high-risk patients into the NSW Pre Exposure Prophylaxis trial. Expanded specialist palliative care support to weekends and public holidays Introduced first Nurse Practitioner role in Sydney District Nursing (mental health/HIV) Celebration - 40 years of the NSW Health Care Interpreter Service and publication of history of the service. SHCIS Call Centre received 71,544 incoming calls in 2017/18 - a 6% increase in calls 36
2017/18 Achievements Clinical Governance and Risk Completion of the audit of 215 Cancer patients as directed by Ministry on time with no clinical issues identified. Continue to be the best performer for TMF (claims performance and deposit contribution). Winter preparation awareness – vaccination days for staff and pop up immunisation clinic at Redfern with more than 200 people in our community receiving free flu shots Implemented the Advance Care Planning program with the launch of a suite of standardised tools and resources, including a staff forum and the provision of education to 37 key staff
2017/18 Achievements Nursing and Midwifery Inaugural SLHD Transition to Professional Practice Programs and MidSTART open day held at CEWD with more than 500 students attending Medical Services Additional support for JMOs including website resources, notice boards, podcasts, BPT OK program, enhanced EAP involvement especially for debriefing, review of rostering practices, streamlining recruitment to replace staff who leave and working with senior staff to ensure JMOs take ADOs. Establishment of the monthly CE/DiT Steering Committees 38
2017/18 Achievements Awards Prime Minister’s Award: Employ-my-ability, Workforce Services Premier’s Award: Employ-my-ability, Workforce Services Premier’s Award: Dr Andrea Issler-Fisher - Improving Service Levels in Hospitals and Anthea Kerr Award NSW Health Finalist: Supporting our people - Employ-my-ability, Workforce Services NSW Health Finalist: Excellence in the provision of Mental Health Services - Living Well Living Longer, Clinical Services Integration and Mental Health Angela Manson - NSW Human Rights Award winner Alice Kang – Canada Bay Citizen of the Year
2017/18 Achievements Awards Australia Day Awards: Associate Professor Peter Haertsch AM, Professor Fiona Blyth AM and Professor David Handelsman AO Queens Birthday Honours List: Dr Teresa Anderson AM, Professor Andrew McLachlan AM, Clinical Associate Professor Michael Cooper OAM, Association Professor Paul McKenzie OAM. Pride of Concord Medal - Professor Lewis Chan RPA Research Medal - Professor Anthony Keech NSW Health Nursing and Midwifery Awards: Claudia Pollauszach for Excellence in Nursing and Amal Helou for the Judith Meppem Lifetime Achievement Award Sydney Gay and Lesbian Mardi Gras People’s Choice stall award – SLHD Fair Day
Overview of the Service Agreement
The objectives of the LHD Service Agreement To articulate responsibilities and accountabilities across all NSW Health entities for the delivery of the priorities of the NSW Government and NSW Health. To establish with Districts and Networks a performance management and accountability system for the delivery of high quality, effective health care services that promote, protect and maintain the health of the community, and provide care and treatment to sick and injured people, taking into account the particular needs of their diverse communities. To develop effective partnerships with Aboriginal Community Controlled Health Services and ensure the health needs of Aboriginal people are considered in all health plans and programs developed by Districts and Networks. To promote accountability to Government and the community for service delivery and funding. 42
National Agreement – Hospital funding and health reform The Council of Australian Governments (COAG) has reaffirmed that providing universal health care for all Australians is a shared priority and agreed a Heads of Agreement for public hospitals funding from 1 July 2017 to 30 June 2020. The Agreement preserves important parts of the existing system, including activity based funding and the national efficient price. There is a focus on actions to improve patient safety and the quality of services, and reduce unnecessary hospitalisations. The Commonwealth will continue its focus on reforms in primary care that are designed to improve patient outcomes and reduce avoidable hospital admissions. http://www.coag.gov.au/agreements 43
Governance Each Health Service and Support Organisation must ensure that all applicable duties, obligations and accountabilities are understood and complied with, and that services are provided in a manner consistent with all NSW Health policies, procedures plans, circulars, inter-agency agreements, Ministerial directives and other instruments, and statutory obligations. Districts and Networks are to ensure: - Timely implementation of Coroner’s findings and recommendations, as well as recommendations of Root Cause Analyses. - Active participation in state-wide reviews. 44
Clinical Governance NSW public health services are accredited against the National Safety and Quality Health Service Standards. See https://www.safetyandquality.gov.au/our-work/assessment-to-the-nsqhs- standards/nsqhs-standards-second-edition/ The Australian Safety and Quality Framework for Health Care provides a set of guiding principles that can assist Health Services with their clinical governance obligations. See http://www.safetyandquality.gov.au/wp-content/uploads/2012/04/Australian- SandQ-Framework1.pdf The NSW Patient Safety and Clinical Quality Program provides an important framework for improvements to clinical quality. See http://www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2005_608.pdf 45
Corporate Governance Each Health Service and Support Organisation must ensure services are delivered in a manner consistent with the NSW Health Corporate Governance and Accountability Compendium (the Compendium) seven corporate governance standards. See http://www.health.nsw.gov.au/policies/manuals/pages/corporate-governance- compendium.aspx In particular, where applicable, they are to: provide required reports in accordance with the timeframes advised by the Ministry; review and update Manual of Delegations (PD2012_059) to ensure currency; ensure NSW Auditor-General’s, the Public Accounts Committee and the NSW Ombudsman’s recommendations where accepted by NSW Health are actioned in a timely and effective manner, and that repeat audit issues are avoided. 46
Safety and Quality Accounts Standard 1, Clinical Governance, of the National Safety and Quality Health Service Standards describes the clinical governance, and safety and quality systems that are required to maintain and improve the reliability, safety and quality of health care, and improve health outcomes for patients. Standard 1 ensures that everyone – from frontline clinicians to managers and members of governing bodies, such as boards – are accountable to patients and the community for assuring the delivery of health services that are safe, effective, integrated, high quality and continuously improving. Districts and Networks complete Safety and Quality Accounts to document achievements, and affirm an ongoing commitment to improving and integrating safety and quality into their functions. The Account provides information about the safety and quality of care delivered by the Organisation, including key state-wide mandatory and locally selected high priority measures, patient safety priorities, service improvements and integration initiatives. The Account must also demonstrate how the Organisation meets Standard 1. 47
Safety and Quality Accounts Consistent with the National Agreement, Districts and Networks must continue to focus on reducing the incidence of Hospital Acquired Complications. Through the Purchasing Framework, NSW Health has incentivised Districts and Networks to locally invest in quality improvement initiatives to specifically target these complications. It is expected that the Safety and Quality account articulates the incentivised initiative/s, and provides details on the approach and outcomes. 48
Performance Framework Service Agreements are central components of the NSW Health Performance Framework, which documents how the Ministry monitors and assesses the performance of public sector health services to achieve the expected service levels, financial performance, governance and other requirements. The performance of a Health Service is assessed in terms of whether the organisation is meeting the strategic objectives for NSW Health and Government, the Premier’s priorities, the availability and implementation of governance structures and processes, performance against targets and whether there has been a significant critical incident or sentinel event. The Framework also sets out the performance improvement approaches, responses to performance concerns and management processes that support achievement of these outcomes in accordance with NSW Health and Government policy and priorities. Performance concerns will be raised with the Organisation for focused discussion at performance review meetings in line with the NSW Health Performance Framework available at: http://www.health.nsw.gov.au/Performance/Pages/frameworks.aspx
Service Agreement Schedules A. Strategies and Priorities B. Services and Networks C. Budget D. Purchased Volumes E. Performance against Strategies and Objectives 50
Schedule A: Strategies and Priorities NSW Health Strategies and Priorities are to be reflected in the strategic, operational and business plans of the Ministry and NSW Health Services and Support Organisations. Delivery of the Strategies and Priorities is the mutual responsibility of all entities. - NSW: Making it Happen outlines NSW Health’s State Priorities, including 12 Premier’s Priorities that together define the NSW Government’s vision for a stronger, healthier and safer NSW. As delivery of both Premier’s and State priorities is the responsibility of all NSW Government Agencies, all entities work together to ensure successful delivery, in both lead and partnering agency capacities. - Election Commitments: NSW Health is responsible for the delivery of 102 election commitments over the period to March 2019. The Ministry of Health will lead the delivery of these commitments with support from Health Services and Support Organisations – see also http://nswtreasury.prod.acquia-sites.com/sites/default/files/pdf/2015- 2016_Budget_Papers_-_Election_Commitments_2015-19.pdf 51
Schedule A: Strategies and Priorities Minister’s Priority: NSW Health will strive for engagement, empathy and excellence to promote a positive and compassionate culture that is shared by managers, front-line clinical and support staff alike. This culture will ensure the delivery of safe, appropriate, high quality care for our patients and communities. To do this, Health Services are to continue to effectively engage with the community, and ensure that managers at all levels are visible and working collaboratively with staff, patients and carers within their organisation, service or unit. These requirements will form a critical element of the Safety and Quality Account. 52
Schedule A: Strategies and Priorities NSW State Health Plan: Towards 2021 provides a strategic framework which brings together NSW Health’s existing plans, programs and policies and sets priorities across the system for the delivery of the right care, in the right place, at the right time. See http://www.health.nsw.gov.au/statehealthplan/Publications/NSW-state-health-plan-towards- 2021.pdf NSW Health Strategic Priorities 2018-19 builds on and complements the NSW State Health Plan: Towards 2021 and aligns with the NSW State and Premier’s Priorities. The approach outlined in the plan frames the Ministry’s role as system manager for NSW Health, strengthens system governance and establishes a strategic planning framework that: Embeds a new cross-functional approach to strategic planning and delivery in the Ministry including tighter direction and leadership; Allows a flexibility about how we go about achieving this in order to encourage innovation and continuous improvement; and Applies tight ownership around the deliverables which will enable transparency in monitoring results.
Sydney LHD local priorities Maintenance of overall performance of SLHD: SLHD will continue to achieve Performance Level 0 in accordance with the NSW Ministry of Health Performance Framework throughout 2018/19. Surgical Performance: the District will continue to be leaders in relation to surgery and ensure all patients are admitted within the clinically appropriate timeframe for their surgery. Quality and Safety: SLHD will continue to focus on and improve performance on all key safety and quality measures. Capital Works: the following major capital works projects are a priority for SLHD in 2018/19: - Fulfilment of the SLHD Asset Strategic Plan, including the redevelopment of RPA, Canterbury Hospital and Stage 2 of Concord Hospital Redevelopment - Commencement of main works for Stage 1 Concord Hospital Redevelopment - Expansion of RPA Emergency Department to increase the 56 number of resuscitation beds from 3 to 8
Sydney LHD local priorities Planning: the following plans will be developed/launched in 2018/19: - RPA Strategic and Clinical Services Plans - Concord Hospital Strategic Plan - Canterbury Hospital Strategic and Master Plans - Balmain Hospital Strategic Plan - SLHD Diabetes Strategy - SLHD Health Advancement Plan - SLHD Cardiothoracic Service Plan - SLHD Genomics Development Strategy - Inter-sectoral Inner West Youth Health and Wellbeing Plan 57
Sydney LHD local priorities Information and Communications Technology: Continue to improve and enhance our services, including: - Completion of the implementation of eMR2 across all facilities - Completion of the roll out of eMeds across all facilitates - Implementation of PowerChart Maternity, PowerChart Cardiovascular and PowerChart Oncology and Haematology Leading Better Value Care: committed to the further development, implementation and evaluation of the Leading Better Value Care initiatives. Investing in the Early Years: Continue to redesign child and family health services to better meet the needs of families with children 0-5 years, in particular those families requiring additional support. New service modalities will be explored, including telehealth and targeted outreach. Resources will continue to be reallocated to ensure sufficient capacity to provide two-year sustained health home visiting to those families requiring additional support. The most complex families will be offered care coordination for all family members, with health and social care needs in scope. 58
Sydney LHD local priorities Research: Continue leading collaborative research partnerships and research through both Sydney Research and Sydney Health Partners. SLHD will also continue conducting and implementing research through the Translational Research Grants Scheme and continue to implement the Research Ethics and Governance Information System (REGIS). Enhancement of the Surgical and Robotic Training Institute: RPA provides basic and advanced level robotic training to surgeons from NSW, Australia and overseas in an industry partnership with Intuitive Surgical and Device Technologies. The purpose-built facility commenced delivering training in March 2017 and SLHD will continue to build the profile of the Institute with industry partners and the broader surgical community. Enhancement of the Peritonectomy Program: The Peritonectomy Program delivered the projected activity in 2017/18 and will be enhanced in 2018/19 in line with MoH funding activity. The Model of Care is multidisciplinary in approach and the program will continue to develop within a translational research framework. 59
Sydney LHD local priorities Neuro-Intervention (NI) Services: As the neuro-interventional workforce is small across Australia, SLHD is committed to the continued growth and fostering of an increasing NI workforce at RPA. Stroke Service: RPA plans to continue increasing both inpatient and outpatient services including TIA, stroke and neurovascular treatments, within this includes a preoperative assessment following stroke, specific stroke consults within the inpatient population and a specific young stroke clinic. All clinics are multidisciplinary in nature including neurology, neurosurgery, interventional neuroradiology and nursing. All incorporating a comprehensive stroke service model. RPA aims to increase the capacity to treat patients with stroke, vascular disease, aneurysms, and other complex neurological and vascular conditions in an efficient, cost effective and clinically advanced manner. Establishment of Cardiology Service at Canterbury Hospital: SLHD is committed to the establishment of a Cardiology service at Canterbury Hospital, including: cardiac clinics, enhanced ECHO service and the implementation of strategies associated with the ACI Leading Better Value Care CHF initiative. 60
Sydney LHD local priorities Establishment of Endocrine Service at Canterbury Hospital: Committed to the establishment of an Endocrine Service at Canterbury Hospital, including diabetes clinics that will better serve our disadvantaged community, as well as implement strategies associated with the ACI Leading Better Value Care management of inpatient diabetes initiative. National Centre for Veterans’ Healthcare: Committed to the further development of a Model of Care and the establishment of a pilot NCVH service at CRGH. Continued implementation of the Outpatient Transformation Project: the project aims to revolutionise the District’s outpatient services by improving patients’ and families interactions with services and will be further rollout in 2018/19. 61
Key Performance Indicators (KPIs) 62
Strategic Deliverables Leading Better Value Care The Leading Better Value Care Program creates shared priorities across the NSW health system to improve health outcomes, improve the experience of care for patients, carers and clinicians and provide efficient and effective care. The main components of this approach include the following: - The Ministry of Health will continue as system administrator, purchaser and manager and will articulate the priorities for NSW Health. Performance against delivery of the priorities will be monitored in line with the NSW Health Performance Framework. - Districts and Networks will continue to provide services established through LBVC in 2017- 18 and determine local approaches to deliver new LBVC initiatives in 2018-19. - The Pillars, as required, will continue to support Districts and Networks in a flexible manner that can be customised to meet local needs and will support measurement as required. - Districts and Networks will participate with Pillars in evaluation, monitoring and regular reporting on the progress of the LBVC initiatives as specified in the Monitoring and Evaluation Plans.
Strategic Deliverables In 2018/19, Districts and Networks will: - Continue to provide clinical services in the most appropriate care setting for patients in LBVC Tranche One (T1) initiatives of Osteoporotic Refracture Prevention (ORP), Osteoarthritis Chronic Care Program (OACCP), Renal Supportive Care and High Risk Foot Services through designated HERO clinics. - Implement the LBVC solutions for Chronic Heart Failure, Chronic Obstructive Pulmonary Disease (COPD) and Diabetes. - Continue to undertake and report on the agreed solutions to reduce falls in hospital. - Participate in monitoring, evaluation and other studies (e.g. costing) of LBVC initiatives formative evaluations will occur throughout 2018-19 in consultation with the Districts and other stakeholders. - Undertake regular reviews of activity associated with all T1 initiatives. - Work with the Ministry of Health and lead Pillar agencies to participate in data gathering and other activities to support the development and implementation of LBVC Tranche 2 (T2) initiatives for: Bronchiolitis, Hip Fracture, Cancer care (optimal care pathways for colorectal cancer; hypofractionation), Wound Management.
Strategic Deliverables - Work with the Ministry of Health and lead Pillar agencies to participate in data gathering and other activities to support the development and implementation of LBVC Tranche 2 (T2) initiatives for: Bronchiolitis Hip Fracture Cancer care (optimal care pathways for colorectal cancer; hypofractionation) Wound Management. 68
2018-19 National Health Funding Body Service Agreement Period: 1 July 2018 – 30 June 2019 72
Capital Program 73
Budget principles As with previous years, the District is holding a contingency of $40M (to meet additional patient demands, unforeseen equipment replacement or other unexpected District costs) The District has established an allocation of $13.5M for enhancements which have been finalised with the Executive and Clinical Directors Lifehouse budget allocated as per their agreement with the NSW Ministry of Health To derive the contingency: – NWAU price adjusted for contribution to contingency – Block funding adjusted for contribution to contingency Facility budgets built using available ABF & Block Funding principles: – ABF funding pool developed using discounted 2019FY prices – Block funding allocated (e.g. Dental, AIDS, NGO grants) – Alignment of Entity budgets to 2018 FY actual and budget
2018/19 Budget from MoH SLHD Total Expenditure Budget for 2018-19 is: $1.772BILLION GENERAL FUND SP&T $1.746B $0.025B MoH presents budget escalation on prior year annualised budget – a 4.9% increase for SLHD 75
2018/19 Budget from MoH SLHD Total Revenue budget for 2018-19 is: $1.735BILLION Govt Contribution SP&T Own Source $1.447B $0.038B $0.250B Own Source Revenue represents a 3.82% increase on 2017/18 actual result
Activity NWAU Prices 2018/19 NWAU prices: – State Price = $4,713 – MoH determined SLHD Price = $4,521 – Mental Health Non Admitted = $4,636 77
2018/19 NWAU Activity SLHD NWAU activity targets Facility / Service 2018-19 NWAU18 RPA 130,225 Concord Hospital 67,068 Canterbury 27,965 Balmain 7,073 IRO 7,177 Lifehouse 8,684 Mental Health 24,992 78
2018/19 Budgets Expenditure Revenue NCoS Facility / Service $M $M $M RPA $680.630M $120.518M $560.112M Concord Hospital $363.539M $60.967M $302.572M Canterbury $116.528M $11.227M $105.301M Balmain $49.714M $18.652M $31.062M IRO $26.822M $4.175M $22.647M Lifehouse $41.292M - $41.292M Mental Health $113.716M $7.831M $105.885M Thomas Walker $6.261M $0.007M $6.254M Primary and Community Health $38.209M $6.168M $32.041M Population Health $12.959M $0.867M $12.092M Dental $47.318M $2.073M $45.245M Tresillian $12.101M - $12.101M 79
2018-19 Service Agreement Service Agreement for 2018-19 detailing activity and funding was issued to the Chief Executive on 19 June 2018 The signed Service Agreement was returned to the Secretary, NSW Health on 31 July 2018 The signed Service Agreement is displayed in a prominent and easily accessible location on the Sydney Local Health District website Service and facility-level budgets (including staffing and activity levels) were published on the District website following Board deliberations (31 July 2018) A summary of each facility and District-wide service total expense budget (all programs) is available in a prominent location on the SLHD internet site (31 July 2018) The value of roadmapping (Productivity, Expenses and Revenue) goals required to achieve on budget performance in 2018/19 confirmed on 31 July 2018. Roadmaps must be loaded by the 30 September 2018. Budgets and forecasts loaded into the Statewide Management Reporting Tool (SMRT) reporting system (31 July 2018).
Next steps Continue strong governance over financial performance: – Monthly distribution of modified monthly finance reports. – CE & DoF performance meetings with GMs and Clinical Directors. – Continued monthly performance reporting to FRAP. – Monitoring of Productivity, Expenses and Revenue Roadmaps. 81
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