EASTERN HEALTH 2022 THE STRATEGIC CLINICAL SERVICE PLAN 2012-2022
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Eastern health 2022 The Strategic Clinical SERVICE PLAN 2012–2022
This work is copyright. It may be reproduced in whole or in part to inform people about strategic directions for clinical services within Eastern Health and for study and training purposes, subject to an inclusion of the acknowledgement of the source. It may not be reproduced for commercial use or sale. Reproduction for purposes other than those above requires written permission from Eastern Health. For information, please contact: Eastern Health Quality, Planning and Innovation Directorate Phone: 9955 1289 Fax: 9955 1392 This document can be downloaded from the Eastern Health web site at: www.easternhealth.org.au May 2013 Acknowledgments Eastern Health 2022 has been developed after feedback and comments on a draft plan that was presented to and circulated amongst the staff of Eastern Health, healthcare partners and the broader community. All contributors are sincerely thanked for their input and feedback. In addition, the following people are acknowledged for their work in research, data collection, analysis and writing of this Plan: Karen Fox Director, Quality Planning & Innovation (Strategy, Planning & Risk Management), Eastern Health Lachlan MacBean Director, Decision Support and Health Information Services, Eastern Health
FOREWORD
It is with great pleasure that we present increasingly, outside our hospitals.
Eastern Health 2022 – the Strategic We have thought carefully about how
Clinical Service Plan for 2012 – 2022. we can do things differently to provide
We have developed Eastern Health the best possible patient outcomes
2022 consistent with our mission ‘to and value for our health system.
provide positive health experiences for Eastern Health 2022 outlines Eastern
people and communities in the east. Health’s aspirations to provide health
services in our communities over the
We acknowledge and thank the next decade. Furthermore, it describes the
hundreds of people who were involved important role that we play in achieving
in the development of Eastern Health substantial reforms within the broader
2022 Their experience, expertise and Victorian health system, as described
wisdom have been invaluable in the in the Victorian Government’s Victorian
identification of innovative strategies Health Priorities Framework 2012–22:
which will ensure that Eastern Health Metropolitan Health Plan.
continues to serve the health needs of
people in the east over the next decade. We are keen to begin the substantial
work which is now needed to implement
At Eastern Health, we are excited Eastern Health 2022 and look forward to
to articulate a comprehensive plan working with our people, our healthcare
that will ensure we can deliver on partners and the broader community in
our promise – our vision – of Great its implementation.
Health and Wellbeing by providing
a broad range of health services to our We commend Eastern Health 2022 to you
communities in conjunction with our as we begin this exciting journey.
healthcare partners.
Dr Joanna Flynn, AM
We are particularly proud that the Chair, Eastern Health
initiatives mapped out in Eastern Health
2022 focus not only on the bricks and Mr Alan Lilly
mortar of our health services but also, Chief Executive
what we do within our hospitals and
CONT EN T S 1 Introduction 7 2 Executive Summary 9 3 Background 12 4 The External Context 15 5 Policy Context 17 5.1 Victorian Health Priorities Framework 2012–2022: Metropolitan Health Plan 17 5.2 Melbourne 2030 and Melbourne @ 5 million 18 5.3 National Health and Hospitals Network Agreement 19 5.4 A Healthier Future for all Australians 19 6 Eastern Health organisational profile 21 7 The current Eastern Health Clinical Service Profile 23 8 Primary and secondary catchment profile 25 9 Demographic population analysis 28 9.1 Population forecasts for Eastern Health’s primary catchment area 28 9.2 Population forecasts for Eastern Health’s secondary catchment area 29 9.3 Our ageing population 30 9.4 Growth in demand for hospital admission across primary catchment area 30 9.5 Our community profile 34 9.5.1 Religion, culture, ethnicity and our indigenous population 34 9.5.2 Socio-economic status 34 9.5.3 Burden of disease 34 9.5.4 Disability 35 9.5.5 Travel 35 9.6 What are our patients telling us? 35 10 Meeting the demand for public services in the east 37 10.1 Clinical activity – Top 10 37 10.2 The Patient Care Delivery System and Streams of Care 39 10.3 Self-sufficiency 43 10.4 Patient ‘Outflows’ 46 10.5 Patient ‘Inflows’ 48 11 Prioritising clinical service areas 50 12 Eastern Health-wide priority initiatives 52
13 New and planned investment in our buildings 67
13.1 Box Hill Hospital Redevelopment 67
67
13.2 Maroondah Hospital Expansion Project (Stage 2B) 67
13.3 Healesville & District Hospital Site (incorporating Yarra Valley Community Health Service) 67
13.4 Wantirna Health 67
14 Configuration of Clinical Services by site 69
14.1 Current configuration of clinical services by site 69
14.2 Future configuration of clinical services by Directorate, Program and site 70
15 What does this mean for Eastern Health’s larger sites? 72
16 Key enablers 75
16.1 An Eastern Health workforce that supports the Plan 75
16.2 Information and Communications Technology (ICT) as a vehicle for excellence in clinical practice 76
16.3 Research, Education and Training that supports the Plan 76
17 Implementation, review and next steps 79
18 References 80
19 Appendices 82
Appendix 1 – Government Policy Frameworks 82
Appendix 2 – Data Analysis, Assumptions and Calculations 91
Appendix 3 – Glossary 92
S tr ateg i c p l a n 2015
EXCELLENCE
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STRATEGIC 1.A PROVIDER 2. A GREAT PATIENT 3. A GREAT PLACE TO 4. A GREAT PARTNER 5. A GREAT ACHIEVER
DIRECTIONS OF GREAT EXPERIENCE LEARN AND WORK WITH OUR IN SUSTAINABILITY
HEALTHCARE COMMUNITIES
STRATEGIC 1.1
Meeting or 2.1
Taking a person- 3.1
Ensuring flexible, 4.1
Delivering models 5.1
Ensuring optimal
GOALS exceeding all centred approach highly-skilled and of care with our utilisation of
required standards which actively capable workforce community partners resources across the
of service and care. involves patients in and volunteer that provide a organisation.
decision-making. networks. seamless patient
journey and deliver
the right service in
the right place.
1.2
Delivering models 2.2
Aligning our 3.2
Communicating and 4.2
Partnering with 5.2
Building flexible,
of care and services and consulting with our other hospitals and sustainable
treatment that are resources to meet staff and providing community partners environments and
based on evidence. the changing needs feedback, reward to provide a technologies.
of our communities. and recognition. comprehensive and
integrated range of
services.
1.3
Monitoring, 2.3
Ensuring services 3.3
Identifying 4.3
Embracing 5.3
Measuring the
repairing and are easy to access leaders and technologies things that matter.
continuously and navigate. providing learning that enhance our
improving the opportunities for partnerships.
quality and safety of our staff.
clinical care.
1.4
Tailoring services 2.4
Ensuring access 3.4
Partnering 4.4
Being socially 5.4
Living within our
around the needs to health services with education responsible and means minimising
of a diverse for the most and training active in our waste.
population. disadvantaged organisations to community.
within our drive research and
community. education.
Strategic Clinical Service Plan 2012–2022 | 5
1 IN TRODU C T ION
Good health will always be valued ensures that Eastern Health can deliver its Ms Claire Grieveson
by Australian society. Doctors, services in a way that makes a substantial Health Service Lead, Service Performance
nurses, midwives, allied health contribution to the broader direction for & Governance, Department of Health
professionals, clinical support staff health services in Victoria. (from February 2013)
and other care givers will always
play a pivotal role in caring for people The Plan was developed over 18 months
Mr Craig Guscott
in need. However, the way we deliver following extensive consultation within
and outside Eastern Health. Figure 1a Manager, South East Metropolitan Service
the healthcare of tomorrow will be
overleaf illustrates the various mechanisms and Capital Planning, Department of Health
different to that of today.
used by Eastern Health to develop an
The health system faces enormous evidence-based Strategic Clinical Service Ms Neth Hinton
challenges. Community expectations Plan 2012–22 – Eastern Health 2022. Executive Director, Continuing Care,
are increasing, the burden of chronic Community and Mental Health,
disease is increasing and the population The project to develop the Plan was Eastern Health
is growing and ageing. Public health overseen by a Strategic Clinical Service
services will need to respond to these Plan Steering Committee with the Ms Jackie Kearney
challenges. Hospitals will always have an following members:
Acting Manager, Continuing Care,
important role to play in the management Mr Alan Lilly Department of Health
of illness and injury, acute exacerbation
Chief Executive, Eastern Health (Chair)
of chronic illness and surgical intervention Mr Lachlan MacBean
of disease, however, their role in the
Ms Narelle Campbell Director, Performance Analysis and Health
continuum of health will shift. Rather than
Project Manager, South East Metropolitan Information Services, Eastern Health
being the ‘starting point’ in a patient’s
journey, the hospital admission will be Service and Capital Planning, Department
of Health (from September 2011) Mr Tony McNamara
but one option for health services to be
provided. Where possible and appropriate, Senior Health Service Lead, Service
services will be provided in the home Mr Kevin Carter Performance & Governance, Department
and community. An important role of Manager, Capital Planning, Service of Health (to February 2013)
health services will be to ensure people Improvement, Mental Health Drugs and
have the services and support they need Regions Division, Department of Health Mr David Plunkett
to remain at home – receiving care that Executive Director, Nursing, Access
is increasingly becoming their choice. Ms Janet Compton and Patient Support Services and Chief
Executive Director, Acute Health, Nursing Officer, Eastern Health
Eastern Health 2022 (the Plan) responds to
Eastern Health
these issues by considering the service, Ms Chelsea Simpson
activity and physical profile that will be
Ms Zoe Ding Project Manager, South East
required to ensure equity of access to Metropolitan Service and Capital
health services for people in Melbourne’s Project Assistant, Strategic Clinical Service
Plan, Eastern Health (to May 2011) Planning Department of Health
east by providing clinical services to our (from March 2011 to September 2011)
community at the appropriate level and
at the appropriate place. Dr Colin Feekery
Ms Gayle Smith
Executive Director, Medical Services
In May 2011, during the development and Research and Chief Medical Officer, Executive Director, Quality, Planning
of the Plan, the Victorian Government Eastern Health & Innovation, Eastern Health
released the Victorian Health Priorities
Framework 2012–22: Metropolitan Health Ms Karen Fox Ms Gill Smith
Plan which articulated the principles and Project Manager, South East Metropolitan
Director, Quality, Planning & Innovation
priorities that will guide health service Service and Capital Planning, Department
(Strategy, Planning & Risk Management),
and capital planning over the next ten of Health (to March 2011)
Eastern Health (Project Manager, Eastern
years within a broader, statewide context.
Health 2022)
Eastern Health 2022 is well-aligned with
this statewide framework and, importantly,
Strategic Clinical Service Plan 2012–2022 | 7
1 | Int ro d uction
Figure 1a – Consultation and evidence
used to develop Eastern Health 2022
Past and
Forum with the Forecast Data 40 Workshops
Secretary and Analysis including almost 500
Executive Directors clinical services staff
of the Department across Eastern
of Health Health
Externally Consultation
reviewed by with the Eastern
communications Health Board of
experts Directors
Strategic Clinical
Service Plan Steering Government
Committee input Policy Review
and reviews
E a st ern
H e a lt h 2022
Consultation
Discussions with An evidence-Based with the Eastern
public health services
and hospitals in the strategic clinical Health Community
Advisory
east and beyond
service plan 2012-22 Commitee
Multiple
incremental reviews
General by members of the
Practitioner Forum Eastern Health
and Survey Executive Commitee
and Clinical Executive
Commitee
Consultation
with the Eastern
Community Health Primary
Consultation Care and Population
Forum Health Advisory
Forum with Eastern Forum with Commitee
Health Program Department of
Directors and Health Program
Clinical Executive representatives
Directors
8 | Strategic Clinical Service Plan 2012–20222 Exe c ut i v e sum m ary
Eastern Health is one of the largest and our work, we make a substantial and the burden of chronic disease within the
public health services in Australia. significant contribution to the health and community and advances being made
wellbeing of communities in Melbourne’s through evidence-based practice.
We provide a comprehensive range of east and we embrace this role with
high quality acute, sub-acute, palliative enthusiasm, skill and expertise. The Plan is based around nine principles
care, mental health, drug and alcohol, that articulate what Eastern Health aims
residential care and community health The configuration of health services to achieve through its clinical service
services to people and communities that at Eastern Health has served the development in the ten years to 2022.
are diverse in culture, age, socio-economic community and the people of Eastern These principles are well-aligned with
status, population and healthcare needs. Health well for many years. But times the principles as outlined by the Victorian
Our role is to provide positive health are changing and the services at Eastern Government in the Metropolitan Health
experiences for people and communities Health must also change to keep up Plan. They are:
in Melbourne’s east. Through our efforts with rising community expectations,
Principles for Eastern Health 2022 – Alignment with the guiding principles
The Strategic Clinical Service Plan 2012–22 within the Victorian Health Priorities
Framework 2012–22: Metropolitan Health Plan
1 Clinical services will be provided to ensure that patients have Universal access and a focus on those most in need
equity of access to the full range and standard of clinical services Equitable outcomes across the full continuum of health
across Eastern Health
2 Clinical services will be patient-centred Person and family-centred
3 Changes in clinical services will be based upon evidence Evidence-based decision-making
Continuous improvement and innovation.
4 Clinical Services profile will be orientated to meet population- Universal access and a focus on those most in need
health demand and improve Eastern Health-wide ‘self-sufficiency’ Local and responsive governance
5 Configuration of services will ensure that there is adequate critical Capable and engaged workforce
mass and appropriate clinical profiles in the interests of quality
and safety, teaching and research
6 Clinical services will be configured to enhance timely patient flow
Sustainable use of resources through efficiency and effectiveness
7 Clinical services that are encountered frequently by patients will be Person and family-centred
located close to where patients live
8 Services that can safely be provided in the home or in the Responsibility for care spans the continuum
community will be provided in the home or the community by
Sustainable use of resources through
the most appropriate health service provider efficiency and effectiveness
9 Clinical services will be configured in such a way that they Capable and engaged workforce
are sustainable and optimise utilisation of capacity across EH Maximum returns on health system investments
(financial, environmental, workforce, infrastructure, technology)
Sustainable use of resources through efficiency
and effectiveness
Strategic Clinical Service Plan 2012–2022 | 92 | Ex e c ut i v e S um m ary
Figure 2b – Clinical Service
Priority Initiatives 2012-22
Clinical Service Priority Initiatives 2012–22
1 Re-orientate inpatient (bed-based) services to be provided 11 Establish and enhance coordinated, multi-disciplinary
in ambulatory settings, including home, where appropriate specialty and ambulatory clinics, providing patients
to do so. with a ‘one-stop-service’.
2 Maximise utilisation of all Eastern Health infrastructure and 12 Expand and promote Advance Care Planning protocols
align future service expansion with forecast geographical and procedures across all Eastern Health sites.
demand for public health services in the mid-section of
Eastern Health’s primary catchment area – specifically Yarra
Ranges (Lilydale), Maroondah (Croydon) and Knox
(North-East).
3 Implement rapid assessment and early intervention 13 Invest in partnerships with general practitioners,
models of care. community providers and Medicare Locals.
4 Adopt and implement the Eastern Health Streams of Care as 14 Achieve Eastern Health-wide orientation of all clinical
a basis for Eastern Health’s patient care delivery system services and access points.
and ensure capacity is geared to these streams appropriately.
5 Expand Eastern Health clinical services and progress 15 Develop specific strategies for targeted groups on the
planning for facilities to meet the current and future elective surgical waiting list to enhance preparedness
needs of the community and ensure a minimum 70 per for admission, improve communication, reduce functional
cent self-sufficiency rate in the areas required. decline and enhance quality of life while they are
waiting for admission.
6 Establish models of care that are tailored to the 16 Orientate Eastern Health care delivery systems around the
requirements of older people within all services. time of day and days of week that the community
demonstrates it needs healthcare.
7 Consider new models for the delivery of patient-focused 17 Develop an active research program whereby research is
maternity and paediatric services that are translated into clinical practice at Eastern Health and
safe and consistent across Eastern Health. clinical practice is used to inform research.
8 Consider capacity and infrastructure options for planned, 18 Achieve the appropriate blend of generalist and sub-
short cycle streams of care and chronic disease specialist clinical staff to improve self-sufficiency in
(ambulatory) streams of care where it is not possible to particular areas of clinical practice and ensure Eastern
deliver these services in the home or community. Health provides a level of service equal to or better than
other services in Melbourne.
9 Explore opportunities with St Vincent’s Health and other 19 Respect and value diverse communities through tailored
health services to ensure timely access for Eastern models of care.
Health patients to tertiary services that are not within the
Eastern Health service profile.
10 Enable our health professionals to work to their full and 20 Align Clinical Support services with the clinical service
extended scope of practice. profile of each hospital.
10 | Strategic Clinical Service Plan 2012–2022Eastern Health 2022 provides a
framework that guides Eastern Health’s
future decision-making. Eastern Health
2022 is fundamentally focused around
20 Clinical Service priority initiatives
which are outlined below. The priority
initiatives represent major pieces of work
that apply right across Eastern Health
Clinical Services and are primarily about
continuous improvement and driving
change that will ensure Eastern Health
can execute its strategy and achieve
tangible outcomes based upon the
principles. The priority initiatives are:
According to Eastern Health clinicians, In October 2011, Eastern Health
In addition to these 20 priority initiatives, the most significant advances in implemented new and streamlined
Eastern Health 2022 outlines over 400 healthcare over the next decade will processes for Ambulatory and Community
specific and targeted improvements that not be through advances in technology Services. Wherever possible, patients
relate to specific clinical service groups or breakthrough research, but rather are cared for in their own homes which
across the organisation. These are explored in streaming of healthcare delivery reduces the risk of injury due to falls in
in greater detail in Part B of Eastern Health systems to focus around the needs of the an unfamiliar environment or acquiring
2022. These improvements represent the patient and ensuring smooth interfaces a hospital infection. Research shows
specific ways in which our clinical services between services (or ‘flow’). Redesigning that outcomes for patients cared for at
will be working to achieve the overall the systems, processes, structure and home are similar to those for hospitalised
strategic objectives of Eastern Health 2022. infrastructure to make these advances patients but without the inherent risks of
possible will be critical. being in hospital and with a much higher
Orientating Eastern Health’s services to level of patient satisfaction. This is an
address the high level of growth in service Healthcare provided by Eastern Health important direction for Eastern Health as
demand in the middle sections of our will address the biomedical aspects it cares for an increasing number of older
primary catchment area is critical for of care (dealing with abnormalities of people in its catchment area.
ensuring equity of access – particularly body function and structure and activity
for disadvantaged members of the limitations) and the bio-psychosocial People living in the east who are
community whose options are more aspects of care (dealing with personal care over 70 years of age will be the most
limited than others. At the time of writing participation restrictions, environmental frequent users of our service by 2022. In
this Plan, there are exciting and substantial factors and personal factors that 2009–10, Eastern Health admitted almost
capital developments underway at collectively influence quality of life). 30,000 people over the age of 70 years
Eastern Health – the Box Hill Hospital (excluding dialysis) and each patient
Redevelopment, the Maroondah Hospital Historically, the predominant need stayed, on average, over 3 days longer
Inpatient Ward Expansion Project and the in health care has been for the in hospital than those aged under 70
sub-acute redevelopment at Maroondah treatment of acute disease, but nearly years of age. Whilst the number of patients
Hospital. Even with this terrific capital ten percent of hospital admissions are over 70 years of age represented 27 per
expansion, Eastern Health 2022 identifies avoidable. (5). Most health care today cent of all patients, they represented 45
that there will still be additional inpatient and in the foreseeable future concerns per cent of all inpatient ‘bed days’ or days
bed capacity required across Eastern the management of chronic health spent in hospital. It is imperative that
Health to manage the forecast increase in conditions, which have intermittent elder-friendly services and environments
activity to 2022. A high level ‘map’ of the exacerbations. Health services that permeate throughout the breadth and
future configuration of clinical services at are now typically provided in hospital depth of Eastern Health.
Eastern Health is provided in section 14.2. will be provided by Eastern Health in
the home and community. Hospital
admissions at Eastern Health will
increasingly becoming ‘planned’
episodes of disease management.
Strategic Clinical Service Plan 2012–2022 | 113 BACKGRO UND
Eastern Health provides a any metropolitan health service in Victoria. progressive, responsive and innovative
comprehensive range of high quality We employ over 8300 people, deliver health service, we demonstrate our
acute, sub-acute, palliative care, mental more than 800,000 episodes of patient commitment to excellence through
health, drug and alcohol, residential care each year and manage a budget external accreditation with the Australian
care and community health services to approaching $760m per year. We aspire to Council on Healthcare Standards.
people and communities that are diverse be GREAT in everything that we do.
in culture, age, socioeconomic status, The primary objective of Eastern Health
population and healthcare needs. We focus extensively on continuously 2022 is to recommend the future service
building a high quality health care system profile of Eastern Health Programs and
We deliver clinical services to more than for the people we serve and through Clinical Services, at site and Eastern
750,000 people through seven clinical which we can also attract and retain the Health-wide levels, to best meet the
programs from more than 29 different best staff. We have an active education needs of Eastern Health’s communities
locations. Our services are located across and research focus and strong affiliations over the next ten years and improve
2800 square kilometres in the east – the with some of Australia’s top universities equity of access to Eastern Health services.
largest geographical catchment area of and educational institutions. As a
Figure 3a – Eastern Health
Performance Excellence Framework
Phase 1
Performance Standards
What is the Eastern Health Standard?
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Phase 3 Ann ent Phase 2
Perfomance Improvement ua l P a gem
lanning and Risk Ma n Performance Monitoring
& Innovation
What is actually happening?
What to do when performance
doesn’t meet the EH standard or
there is an opportunity for innovation
12 | Strategic Clinical Service Plan 2012–2022The scoping and development of the planning and capital investment, Eastern
Plan was identified as a priority for Health 2022 was developed with a ten-
the organisation in 2010–12 and goes year horizon for the period 2012–2022.
directly to Eastern Health’s Strategic
goal of ‘aligning our services and Figures 3a and 3b illustrate where
resources to meet the changing needs Eastern Health 2022 fits within Eastern
of our communities’. Health’s overall Performance Excellence
Framework and Planning Framework.
Eastern Health 2022 will inform the Eastern Eastern Health 2022 is a major statement
Health Workforce Plan and a series of of the ‘standards’ Eastern Health expects
Master Planning projects that will be and significantly influences and informs
undertaken at the larger Eastern Health Eastern Health direction.
sites. To enable a comprehensive, longer
term perspective on clinical service
planning that will inform site master
Figure 3b – Eastern Health
Planning Framework
Performance against scorecard
& Statement of Priorities (SoP)
Eastern Health 2022 –
Incident management system The Strategic Clinical Corporate Function Plans
Service Plan 2012-22
Capital Equipment
Policy and funding
requirements and opportunities
Master Plans
Legislative requirements
Organisation Development
Strategic Plan (5 year) and Workforce Plan
Benchmarking data and
stakeholder consultations
Information Communication
Technology Long Term Plan
Internal and external
recommendations and standards
Engaging with our Community
Annual Operations and – Consumer Participation Plan
Risk profile and risk register Improvement Plan (OIP) – Patient Experience of Care
3 year improvement plan review
Economic Sustainability Strategies
Annual evaluation of operations
Budget Plan
and improvement plan outcomes
Annual Statement of Priorities (SoP)
Patient experience of
care data and feedback
Strategic Clinical Service Plan 2012–2022 | 134 T h e Ext e r na l Co nte xt
Eastern Health 2022 has been developed Persistent health gaps Workforce
within the context of a number of ‘big Inequities in health are evident in the Finding new, innovative ways of learning
picture’ challenges that we face now eastern metropolitan region. The outer and working to ensure we can attract
and in the future. east areas of Eastern Health’s primary and retain highly skilled, capable staff in
catchment areas have high numbers of an environment where there is a national
These challenges were identified through
aboriginal people and socioeconomically healthcare workforce shortage, our
research, consultation with our clinical
disadvantaged groups which are the most workforce is ageing and there is increased
staff and a review of clinical service
severely affected and are most likely to globalisation (and mobilisation) of the
plans and strategic plans at other health
be overweight, smoke, develop chronic health workforce. Role substitution will
services in Victoria and Australia. The
illness and disability, be hospitalised for become increasingly important and there
challenges include:
avoidable conditions and die prematurely. will be emergence of roles that haven’t
Population even been ‘invented’ yet.
Meeting the needs of an ageing population Changes in the way health is delivered
in the east, where the number of those There is a shift from hospital-based to Environment
who are over 70 years of age is growing more ambulatory and community-based Climate change and environmental
more quickly than the rest of Melbourne. health care. People are better informed, consequences of this such as bushfire,
Forecast population changes in other expect more access to services locally and flood and water scarcity also impact
parts of Melbourne will also have an affect increasingly want to participate in their health directly and indirectly. There is
on Eastern Health which manages some own chronic care and that of their families. mounting evidence and support for all
aspects of demand by referring patients The role of Emergency Departments industries to use ‘clean’ energy, reduce
to other health services. has changed in line with community energy consumption, be environmentally
expectations. Rather than continuing to sustainable and be good corporate
Distribution of demand operate the same way, a challenge exists citizens.
Demand for public health services are to redesign people’s experience with this
not distributed equally throughout the ‘first point of call’. Cost Escalation
2800 square kilometres of Eastern Health’s Health care spending in Australia is
primary catchment area. The challenge is Advancing technology growing in excess of the economy
to align services and resources to manage Operating within our means in an generally with most of this attributable
a projected increased demand for public industry where change and technological to population, the burden of chronic
health services – particularly in the areas advancement is rapid, essential and disease and technology.
of Yarra Ranges, Maroondah and Knox – expected. There are challenges in acquiring
to improve self-sufficiency and ensure that costly equipment and drugs to ensure that Government policy
health services are positioned where they Eastern Health remains a leading health Uncertainty around the further
are needed most. service and complacency in this area can establishment and level of Government
quickly impact referral patterns. involvement in national health reforms,
Changes in disease patterns including Medicare Locals, Local
Chronic conditions such as diabetes, Healthcare Networks, National Health
heart disease, respiratory disease, obesity, Performance Authority, other initiatives of
dementia and mental illness are rising the National Health and Hospitals Reform
and now account for over two-thirds of Agenda and changes associated with the
avoidable hospitalisations. The incidence national Private Health Insurance Rebate.
of chronic disease also increases as the
population ages – a major challenge in
the eastern metropolitan region.
Strategic Clinical Service Plan 2012–2022 | 155 P oli cY Co nt ext
Eastern Health 2022 has been developed These are also aligned with ten In terms of the particular focus on
to ensure consistency with the state and guiding principles: communities in the east, the following
national Government policy frameworks. 1 .
Universal access and a focus on those are extracts from the Metropolitan Health
most in need Plan – Technical Paper (2011) relating to the
The following four government policy Inner and Outer East regions of Melbourne.
frameworks provide the primary 2.
Equitable outcomes across the full
reference points for the Plan, however continuum of health
I nner E as t
there are numerous other policies that 3 .
Person and family-centred
have also influenced Eastern Health’s “It is noted that the Inner East planning
4.
Evidence-based decision-making area is well served with health services and
direction for particular clinical services.
Details of these other government Capable and engaged workforce
5. facilities. It comprises relatively advantaged
areas, with good health outcomes, generally
policies are contained in Appendix 1. 6.
Responsibility for care spans the
above Victorian levels on health indicators
continuum
measured in VPHS. While well served with
7.
Maximum returns on health system health services, residents of the Inner East are
5.1 Victorian Health
investments relatively mobile and receive 43 per cent of
Priorities Framework
8 .
Sustainable use of resources through their health care from areas outside the Inner
2012 – 2022: Metropolitan East planning area. The projected population
efficiency and effectiveness
Health Plan growth to 2022 is the second lowest of all the
9.
Continuous improvement and
The Victorian Health Priorities Framework planning areas.”
innovation
2012 – 2022: Metropolitan Health Plan
10. Local and responsive governance O u ter E as t
was released by the Department of Health
in May 2011. A companion Metropolitan By 2022, Victoria’s health system should be: “Self-sufficiency is relatively high despite
Health Plan – Technical Paper provides the lack of a major hospital within the
A .
Responsive to people’s needs (People- planning area. This may have to do with the
the essential data and analysis to inform
focused) with the following outcomes: distance and the time it takes to travel to
implementation of these planning
priorities in metropolitan Melbourne.
People are as healthy as they can large hospitals outside the planning area.
be (optimal health status). In percentage terms, the Outer East area
The seven priority areas for metropolitan, has the smallest growth to 2022. Given the
People are managing their own
rural and regional and health capital current service availability and fair health
planning into the future are: health better.
status of residents, current facilities are likely
1.
Developing a system that is
People enjoy the best possible to be suitable into the future.”
responsive to people’s needs health care service outcomes.
Eastern Health must consider the
2 .
Improving every Victorian’s health B .
Rigorously informed and informative
challenges that exist to manage very
status and experiences (knowledge-focused) with the
high increases in forecast population and
following outcomes:
3.
Expanding service, workforce and health service demand in the broader
system capacity
Care is clinically effective and Victorian context and design its Plan to
cost-effective and delivered in consider this broader environmental
4.
Increasing the system’s financial
the most clinically effective and context over the ten years to 2022.
sustainability and productivity
cost-effective service settings.
5.
Implementing continuous
The health system is highly
improvements and innovation
productive and health services
6.
Increasing accountability and are cost-effective and affordable.
transparency
7.
Utilising e-health and
communications technology
Strategic Clinical Service Plan 2012–2022 | 175 | Po l i cy Context 5.2 Melbourne 2030 and Melbourne @ 5 million Released in 2002, Melbourne 2030 provides a long-term plan for Melbourne and the surrounding region. Melbourne @ 5 million provides policy initiatives that are complementary to the directions of Melbourne 2030 and the two documents should be considered together. Melbourne @ 5 million outlines the implications of the Victoria in Future 2008 growth projections for Melbourne, which indicate that the city’s population is likely to reach 5 million before 2030. Actively managing this growth and change is an important part of Melbourne’s future liveability. The Melbourne 2030 policy identifies a number of “Principal Activity Centres” and as such, outlines planning guidelines to develop these centres into major hubs of community services, transport, retail, commercial and government services. The Principal Activity Centres are major Victorian Government initiatives being delivered by the Victorian Department of Sustainability and Environment and are designed to create safe, vibrant and accessible communities. They will help link people to services, to opportunities and to each other by locating activities and development around public transport. 18 | Strategic Clinical Service Plan 2012–2022
5.3 National Health Elective surgery: National Access 5.4 A Healthier Future
and Hospitals Network Guarantee and Targets for all Australians
Agreement Under the Agreement, the Government
will improve access to elective surgery in The Final Report of the National Health
On 13 February 2011, the Council of public hospitals by fast-tracking elective and Hospitals Reform Commission,
Australian Governments (COAG) agreed surgery for patients who have waited A Healthier Future for all Australians
to sign the National Health and Hospitals longer than clinically-recommended times was released in July 2009 by the
Network Agreement with the Federal under a new National Access Guarantee Commonwealth Government. The
Government. The objective of the and establishing new access targets for objective was to report on long term
Agreement is to improve health outcomes elective surgery. States and territories reform of the Australian Health Care
and the sustainability of the Australian will work with patients, clinicians and System. This report emphasises four
health system. Local Hospital Networks to offer surgery strategic reform themes:
to patients, either within Local Hospitals
Taking responsibility – Individual and
The Agreement sets out the architecture Networks, through another Local Hospital collective action to build good health
and foundations of the National Health Network, or at a private hospital, at the and well-being – by people, families,
and Hospitals Network, which will deliver state’s expense. communities, health professionals,
five major structural reforms to establish employers, health funders and
the foundations of Australia’s future health The Government will improve access to governments
system in the areas listed below: elective surgery in public hospitals by:
Connecting care – Comprehensive
1.
Public hospitals and Local Hospital
Fast-tracking elective surgery for care for people over their lifetime
Networks (LHNs) patients who have waited longer
Facing Inequities – Recognise and
2.
Primary health care and Primary than clinically recommended
tackle the causes and impacts of
Health Care Organisations times under a new National Access
health inequities
Guarantee, started in 2012
3.
Financing
Driving quality performance –
Establishing new access targets for
Performance and Accountability
4. Leadership and systems to achieve
elective surgery. By December 2014,
Framework best use of people, resources and
95 per cent of patients waiting for
5. National governance evolving knowledge.
surgery in Category 1 or Category
2 will be treated within clinically
The reform of Australia’s health and
recommended times. The 95 per cent
hospital system includes:
target will be extended to patients
Improving our hospitals waiting for elective surgery in
A greater focus on primary health care Category 3 by December 2015
Training more doctors, nurses and
Providing hospitals with financial
allied health professionals rewards, including $650 million
to meet these new demands. The
Supporting aged care
funding will provide the equivalent
Investing in prevention of 90,000 extra elective surgeries
Helping those with mental illness across Australia.
Modernising our health system
Strategic Clinical Service Plan 2012–2022 | 196 East er n H e a lth
org a ni s at i o na l profi le
Eastern Health is organised into eight The structure was implemented in Eastern Health 2022 identified that the
directorates which are defined by clinical February 2010 and later modified in full range of clinical services which are
programs and corporate functions April 2011 and August 2012 to integrate required over the next decade can be
that run across the health service as ambulatory and community health managed within Eastern Health’s existing
illustrated in Figure 6a below. and establish a Statewide Services organisational profile.
Program respectively. The structure
supports the integration of clinical
programs and corporate functions Figure 6a – Eastern Health
across all Eastern Health facilities. Organisational Profile
Figure 6a
Cl inical Direc to r at e P ro gr a m Larger Sites Corporate and Clinical
Support Directorates
Acute Health Emergency and General Angliss Hospital Corporate Projects &
Medicine Sustainability
Box Hill Hospital
Women & Children’s Finance, Procurement and
Healesville & District Hospital Information Services
Specialty Medicine
Maroondah Hospital Quality, Planning and
Surgery Innovation
Peter James Centre
Continuing Care, Continuing Care Human Resources, Fundraising
Community and Wantirna Health
and Community Relations
Mental Health Mental Health
Yarra Ranges Health
Nursing, Access and Patient
State-wide Services Support Services
Yarra Valley Community Health
Ambulatory and Community Medical Services and Research
Services
Strategic Clinical Service Plan 2012–2022 | 217 T h e c u r r e nt Ea ste rn
Hea lt h C li ni c al S e rvi c e P rofi le
In 2012, within the two Eastern Health
Clinical Directorates, there are eight Clinical
Programs and 42 Clinical Service Groups.
Directo r ate C l i ni ca l Clinical Clinical
P ro gr a m Service Group Support
Acute Health Emergency and General 1. General Medicine
Medicine 2. Emergency Services
3. Intensive Care Services
Women & Children’s 4. Gynaecology
5. Maternity Services
6. Neonatology
7.
Paediatric Services (includes Paediatric Medicine, Paediatric Surgery)
Specialty Medicine 8. Cardiology (includes invasive cardiology)
9. Dermatology
(Including, but not limited to Pathology, Medical Imaging, Pharmacy, Allied Health,
10. Endocrinology
11. Endoscopy services
Anaesthetics, Biomedical Engineering, Health Information Services, etc.)
12. Gastroenterology
13. Haematology
14. Infectious Diseases
15.
Neurology (includes Acute Stroke and Multiple Sclerosis Services)
16. Oncology, Chemotherapy and Radiotherapy
17. Renal Medicine and Dialysis
18. Respiratory Medicine
19. Rheumatology
Clinical Support Services
Surgery 20. Breast & Endocrine Surgery
21. Colorectal Surgery
22. Ear, Nose & Throat Surgery
23. General Surgery
24. Ophthalmology
25. Orthopaedic Surgery
26. Plastic Surgery
27. Thoracic Surgery
28. Upper Gastro-Intestinal Surgery (includes Bariatric Surgery)
29. Urology
30. Vascular Surgery
Continuing care, Mental Health 31. Adult Mental Health
community and 32. Acute Aged Persons’ Mental Health
mental health 33. Child and Youth Mental Health Service (CYMHS)
Continuing Care 34. Geriatric evaluation and management
35. Residential Aged Care
36. Palliative Care
37. Rehabilitation
Ambulatory & Community 38. Ambulatory Services
Services 39. Transition Care Program (TCP)
40. Community Health
State-wide Services 41. Turning Point, Alcohol and Other Drugs
42.
Spectrum (state wide service for people who have personality
disorders)
Strategic Clinical Service Plan 2012–2022 | 238 Pr im a ry a nd s e co nda ry
catc hm ent p ro fi le
Eastern Health’s primary catchment The secondary catchment area is defined catchment, as defined here. For the
area is defined as the group of Statistical as the group of SLAs for which Eastern purposes of this Plan, unless otherwise
Local Areas (SLAs) for which Eastern Health treats the second greatest number specified, the primary and secondary
Health treats the greatest number of of public admitted patients of any public catchments as defined here will be
public admitted patients of any public health service. There are slight differences applied. Eastern Health’s primary and
health service. in the catchments of Eastern Health’s secondary catchments include Melbourne
Mental Health Programs. These relate SLAs as detailed in Figure 8a below.
to the outer margins of our primary
Figure 8a – Eastern Health’s
primary and secondary catchments
Source – Department of Health
Victoria 2012
Primary Catchment Area Km² Secondary Catchment Area Km²
Boroondara (C) – Camberwell N. 17.4 Boroondara (C) – Hawthorn 9.9
Boroondara (C) – Camberwell S. 18.2 Boroondara (C) – Kew 14.5
Knox (C) – North-East 40.4 Cardinia (S) – North 713.9
Knox (C) – North-West 31.2 Knox (C) – South 42.2
Manningham (C) – East 58.0 Monash (C) – Waverley East 27.9
Manningham (C) – West 55.5 Monash (C) – Waverley West 32.1
Maroondah (C) – Croydon 37.9 Murrindindi (S) – East 2,222.1
Maroondah (C) – Ringwood 23.5 Murrindindi (S) – West 1,650.6
Whitehorse (C) – Box Hill 21.6 Nillumbik (S) – South 65.8
Whitehorse (C) – Nunawading E. 21.4
Whitehorse (C) – Nunawading W. 21.2
Yarra Ranges (S) – Central 421.8
Yarra Ranges (S) – North 386.9
Yarra Ranges – Dandenongs 147.2
Yarra Ranges – Lilydale 102.8
Yarra Ranges – Seville 273.6
Yarra Ranges (S) – Pt B 1,137.5
Total(s) 2,816.1 4,779.0
Strategic Clinical Service Plan 2012–2022 | 258 | Pri ma ry and secondary catchment profile
In 2008-09, 82 per cent of Eastern Health’s communities in the east’ and confirms that Figure 8b – Melbourne Metropolitan
admissions to hospital related to patients it is a health service which predominantly Primary Catchment Areas
who lived within Eastern Health’s primary serves communities in Melbourne’s east. Source – Department of Health
catchment area and a further ten per cent Victoria 2008
related to patients who lived within its Figure 8b illustrates that Eastern
secondary catchment area. This supports Health’s primary catchment area
Eastern Health’s mission ‘to provide is geographically the largest of any
positive health experiences for people and public health service in Melbourne.
Figure 8b
Eastern Health
Austin
Melbourne Health
Peninsula Health
St Vincent’s Health
Alfred Health
Mercy Health & Aged Care
Southern Health
Western Health
Eastern Health
Northern Health
26 | Strategic Clinical Service Plan 2012–2022Eastern Health’s main facilities and the Eastern metropolitan area, consisting Figure 8c – Eastern Health’s
primary and secondary catchment areas of community-based mental health main facilities, primary and
are illustrated in figure 8c. The primary services, community health services and secondary catchment area
catchment stretches from Glen Iris residential care. These services are detailed Source – Department of
in the inner east to the outer eastern in the Eastern Health Sites and Services Health Victoria 2010
township of Matlock. In addition to Profile within Appendix 1.
its seven larger sites, Eastern Health
occupies over 60 locations across the
Figure 8c
dah
Buxton
Melba
Glenburn
oon
M ar Woods Point
Kinglake Marysville
Cambarville Matlock
Narbethong
Steel Creek
Chum Creek
Healesville &
Yarra Glen District Hospital
Reefton
Kangaroo Ground
Eltham Warrandyte Yarra
Ranges Toorongo
Templestowe Health
Warburton Warburton
e
ors
Eastern iteh Wandin
Kew Wh Maroondah Woori Wallock
box hill Hospital
Eastlink
HOSPITAL Mountain Hoddles Creek
Glen Iris WANTIRNA Olinda
PETer HEALTH Powelltown
James
Monash centre ANGLISS Emerald
HOSPITAL
Stud
Mulgrave Rowville Gembrook
Lysterfield
Upper Beaconsfield
Garfield
Eastern Health Campuses Primary Catchment Secondary Catchment
Arterial Roads Highways
Strategic Clinical Service Plan 2012–2022 | 279 Dem o gr a p hi c popu l ati o n a na lysi s
9.1 Population forecasts Figure 9.1a – Eastern Health primary
for Eastern Health’s catchment area forecast population
primary catchment area growth to 2021
Source – Department of Planning &
Figure 9.1a illustrates that the population
Community Development, Victoria in
in Eastern Health’s primary catchment area
Future (VIF) 2012
is expected to grow at a lower rate (5.8%)
than that of Victoria (15.6%) in the period
2011 – 2021.
Figure 9.1a
Statistical Local Area Population Forecast Forecast Forecast
2011 Population 2021 Population Population
change 2011 to change 2011 to
2021 (no.) 2021 (%)
Boroondara (C) - Camberwell N. 47,104 48,863 1,759 3.7%
Boroondara (C) - Camberwell S. 53,993 55,379 1,386 2.6%
Knox (C) - North-East 66,871 70,097 3,226 4.8%
Knox (C) - North-West 47,259 50,714 3,455 7.3%
Manningham (C) - East 16,254 16,803 549 3.4%
Manningham (C) - West 103,185 111,089 7,904 7.7%
Maroondah (C) - Croydon 62,516 68,073 5,557 8.9%
Maroondah (C) - Ringwood 44,793 49,005 4,212 9.4%
Whitehorse (C) - Box Hill 56,168 61,181 5,013 8.9%
Whitehorse (C) - Nunawading E. 47,528 48,992 1,464 3.1%
Whitehorse (C) - Nunawading W. 53,731 54,855 1,124 2.1%
Yarra Ranges (S) - Central 15,697 16,086 389 2.5%
Yarra Ranges (S) - Dandenongs 30,746 32,003 1,257 4.1%
Yarra Ranges (S) - Lilydale 73,527 77,863 4,336 5.9%
Yarra Ranges (S) - North 13,695 14,713 1,018 7.4%
Yarra Ranges (S) - Seville 16,319 16,795 476 2.9%
Yarra Ranges (S) - Pt B 618 630 12 1.9%
TOTAL 750,005 793,140 43,137 5.8%
(13% of all Victoria) (12% of all Victoria) (5% of all Victoria)
Victoria 5,621,210 6,500,653 879,443 15.6%
28 | Strategic Clinical Service Plan 2012–20229.2 Population forecasts Figure 9.2a – Eastern Health’s
for Eastern Health’s secondary catchment area forecast
secondary catchment area population growth to 2021
Source – Department of Planning &
Figure 9.2a illustrates that the population
Community Development, Victoria in
in Eastern Health’s secondary catchment
Future (VIF) 2012
area is also expected to grow at a lower rate
(6.5%) than that of Victoria (15.6%) to 2021.
Figure 9.2a
Statistical Local Area Population Forecast Forecast Forecast
2011 Population 2021 Population Population
change 2011 to change 2006 to
2021 (no.) 2021 (%)
Boroondara (C) - Hawthorn 37,656 42,856 568 2.0%
Boroondara (C) - Kew 31,686 33,274 5,200 13.8%
Cardinia (S) - North 25,969 27,218 1,588 5.0%
Knox (C) - South 42,958 44,846 2,581 4.3%
Monash (C) – Waverley East 60,717 63,298 3,757 5.4%
Monash (C) – Waverley West 69,465 73,222 1,888 4.4%
Murrindindi (S) – East 6,292 7,236 1,749 6.7%
Murrindindi (S) – West 7,349 9,262 944 15.0%
Nillumbik (S) - South 28,693 29,261 1,913 26.0%
TOTAL 310,785 330,974 20,189 6.5%
Victoria 5,621,210 6,500,653 879,443 15.6%
Strategic Clinical Service Plan 2012–2022 | 299 | De mo gr a phic popu l ation analysis
9.3 Our ageing population expected to experience a higher growth
in older persons than metropolitan
Australia’s ageing population affects us
Melbourne and Victoria. (2).
all. The median age of the population
has been rising for 40 years owing to a As illustrated in Figure 9.3a below, the
long-term decrease in fertility. The leading changes associated with the ageing
edge of the “baby boomers”, born in 1946, population are more pronounced in
reached the age of 66 in 2012 and are Eastern Health’s primary catchment area
either already retired or will retire soon. At than the rest of Victoria. While the rest of
the same time, our population aged 65-84 the state will experience a fairly normal
is increasing as is the number of people distribution in growth across all age groups,
aged 85 and over who have an increased all of Eastern Heath’s growth will be aged
reliance on care and support services. (1). over 50. While Eastern Health’s primary Figure 9.3a – Current and forecast age
catchment will always have young people, distribution, Eastern Health primary
Most areas within Eastern Health’s primary
the forecast demographic changes to 2021 catchment area and Victoria
catchment experience a higher median
will see a net decrease in the number of Source – Department of Planning &
age than the national average. The outer
people aged less than 50 and a substantial Community Development, Victoria in
eastern catchment, which includes
rise in the number of people over 50. Future (VIF) 2012
Maroondah, Yarra Ranges and Knox, is
Figure 9.3a
Age Eastern Health Primary Catchment Victoria
Group
Population Population Forecast Forecast Forecast Proportion Population Forecast Forecast Forecast Proportion
2011 within age population population population of 2011 population population population of
group 2011 2021 change change population 2021 change change population
(%) 2011 to 2011 to change 2011 to 2011 to change
2021 2021 (%) within age 2021 2021 (%) within age
group by group by
2021 (%) 2021
0-9 88,043 11% 85,506 -2,537 -3% -6% 691,582 783,433 91,851 13% 10%
10-19 95,085 12% 97,066 1,981 2% 5% 698,087 758,884 60,797 9% 7%
20-29 103,969 13% 103,021 -948 -1% -2% 854,373 903,465 49,092 6% 6%
30-39 96,627 12% 104,519 7,892 8% 18% 802,865 982,541 179,676 22% 20%
40-49 108,534 14% 101,654 -6,880 -6% -16% 790,731 843,610 52,879 7% 6%
50-59 99,649 12% 101,489 1,840 2% 4% 697,598 782,693 85,095 12% 10%
60-69 78,793 10% 87,681 8,888 11% 21% 537,065 671,944 134,879 25% 15%
70-79 46,379 6% 69,079 22,700 49% 53% 326,720 486,193 159,473 49% 18%
>80 32,925 4% 43,125 10,200 31% 24% 222,189 287,889 65,700 30% 7%
30 | Strategic Clinical Service Plan 2012–2022Older people generally need more health Figure 9.3b – Eastern Health rate of
services than younger people. Figure inpatient admission by age grouping,
9.3b illustrates that, in 2007, members actual and forecast
of Eastern Health’s community aged 70 Source – Department of Health Inpatient
and older required almost four times Forecast model (2010) & Australian Bureau
the number of hospital admissions as of Statistics Census (2001, 2006 & 2011)
those aged 69 and younger. The demand
for hospital admission increases as the
population ages. Also, the overall demand Figure 9.3b 0-44 45-69 70-84 85+
for Eastern Health hospital admission,
2003
within every age group, increased in the Eastern Health admitted patients (‘000) 38.2 30.4 21.9 6.6
four years to 2007 and this trend is forecast Primary catchment population (‘000) 437.3 206.3 56.6 12.0
to continue up to 2022. Ratio (EH admissions per 1,000 residents) 87.4 147.4 386.9 553.4
2007
9.4 Growth in demand for Eastern Health admitted Patients (‘000) 42.1 36.0 26.4 7.9
hospital admission across Primary catchment population (‘000) 433.4 216.3 58.3 13.3
Ratio (EH admissions per 1,000 residents) 97.0 166.0 453.0 589.0
primary catchment area
The projected increase in population, 2022 (Forecast)
Eastern Health admitted Patients (‘000) 45.7 42.8 41.3 14.3
together with the marked ageing of the
Primary catchment population (‘000) 439.4 241.5 89.8 22.4
population in Eastern Health’s primary Ratio (EH admissions per 1,000 residents) 104.0 177.2 460.0 638.4
catchment area, means that Eastern
Health is expected to experience a
42 per cent increase in hospital admissions
between 2008-09 and 2021-22. As Figure
9.4a illustrates, this growth will primarily Figure 9.4a – Eastern Health
relate to patients older than 70 years. Projected Hospital Admissions by
Age Group 2005-06 to 2021-22 (
Excluding Dialysis)
Adapted from – Department of Human
Services Inpatient Forecast Model (2010)
Figure 9.4a
45,000
40,000
35,000
30,000
25,000
20,000
15,000
10,000
5,000
0
17
19
22
06
07
08
09
10
14
-20
-20
-20
-20
-20
-20
-20
-20
-20
16
18
21
05
06
07
08
09
13
20
20
20
20
20
20
20
20
20
0-14
15-44
45-69
70-84
85+
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