Dr Teresa Anderson AM - Chief Executive - Sydney Local Health District

Dr Teresa Anderson AM - Chief Executive - Sydney Local Health District
Prepared by

      Dr Teresa Anderson AM
               Chief Executive
                John O’Connor
A/ Executive Director of Finance
Dr Teresa Anderson AM - Chief Executive - Sydney Local Health District
    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
Dr Teresa Anderson AM - Chief Executive - Sydney Local Health District
Wrap up of 2017/18

                               Actual $M        Budget $M               $ VAR    % VAR     STATUS

    TOTAL EXPENDITURE           $1,721.58M       $1,729.50M        $7.92M (F)     0.46% (PERFORMING)

    TOTAL REVENUE               $1,664.23M       $1,670.86M      $6.63M (UF)      -0.67%

    NCoS before Doubtful
                                  $57.35M          $58.64M         $1.29M (F)      2.19% (PERFORMING)

    Doubtful Debts                 $7.53M           $3.05M       $4.48M (UF)    -146.88%

    Total NCoS                    $64.88M          $61.69M       $3.19M (UF)      -5.17%

    Note: Total Revenue excludes one-off items provided by MoH at the
    end of the financial year
Dr Teresa Anderson AM - Chief Executive - Sydney Local Health District
Wrap up of 2017/18

                                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)

TOTAL NCoS                        $7.997M         $13.216M         $5.219M (UF)      -39.49%

Note: Additional SP&T expenditure was used to invest in infrastructure and equipment (medical and ICT) across the

Dr Teresa Anderson AM - Chief Executive - Sydney Local Health District
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)

Dr Teresa Anderson AM - Chief Executive - Sydney Local Health District
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%

                                             2,162           2,227        65        3.01%
MAINTENANCE, TRADES & OTHER                    122            124          2        1.64%
TOTAL                                        9,178           9,501       323        3.52%

Dr Teresa Anderson AM - Chief Executive - Sydney Local Health District
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%

Dr Teresa Anderson AM - Chief Executive - Sydney Local Health District
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
Dr Teresa Anderson AM - Chief Executive - Sydney Local Health District
2017/18 Achievements
     PROJECT                                                                    EXPENDITURE
    RPA MULTI-STOREY CAR PARK (COMPLETED)                                            $29.316M


    RPA GYNAEOLOGY CAMERA STACK/TOWERS (COMPLETED)                                    $0.284M

     K2 FETAL MONITORING SYSTEM (COMPLETED)                                          $0.624M


    RPA IRO BUILDING LEVEL 6 REFURBISHMENT (COMPLETED)                                $0.735M




Dr Teresa Anderson AM - Chief Executive - Sydney Local Health District
2017/18 Achievements
                        WORK IN PROGRESS PROJECTS                       EXPENDITURE
    THEATRES 7&8)                                                             $2.736M





    RPA STANDBY GENERATOR UPGRADE (PROJECT UNDERWAY)                          $0.654M


    RPA FIRE DETECTION SYSTEM (PROJECT UNDERWAY)                              $0.600M

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

        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.

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

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,
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.
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
        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

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.
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.

2017/18 Achievements
     Staff achievements

        Officially opened new RPA Staff Car Park

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

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
        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

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

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.

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.

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
         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
   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
   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
        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.
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

        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
   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
   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)

2017/18 Achievements
     Community Health

        International interest in Healthy Homes
         and Neighbourhoods integrated care

        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
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

        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
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

        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

2017/18 Achievements

   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

   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
   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
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

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

   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.

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-

   The Australian Safety and Quality Framework for Health Care provides a set of
    guiding principles that can assist Health Services with their clinical governance
    See http://www.safetyandquality.gov.au/wp-content/uploads/2012/04/Australian-

   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

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-

   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.

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.

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.

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:
Service Agreement Schedules
A.   Strategies and Priorities

B.   Services and Networks

C.   Budget

D.   Purchased Volumes

E.   Performance against Strategies and Objectives

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
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.

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

   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
    - 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

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.
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

   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.

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.
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

   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.

Key Performance Indicators

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.

2018-19 National Health
     Funding Body Service Agreement
       Period: 1 July 2018 – 30 June 2019

Capital Program

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
2018/19 Budget from MoH

    SLHD Total Expenditure Budget for 2018-19 is:
                     GENERAL FUND                     SP&T
                        $1.746B                      $0.025B

    MoH presents budget escalation on prior year annualised budget – a 4.9%
     increase for SLHD

2018/19 Budget from MoH
   SLHD Total Revenue budget for 2018-19 is:

        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

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

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

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.

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