Kangaroo Island 2011 2020 - 10 Year Local Health Service Plan

 
Kangaroo Island
10 Year Local Health Service Plan

                   2011 – 2020

Kangaroo Island Health Advisory Council
       Kangaroo Island Health Services
Country Health SA Local Health Network

                                     1
10 Year Local Health Service Plan

                                    Kangaroo Island Health Services

                                                         2011 - 2020

                                                      Table of Contents

1.     Executive Summary ....................................................................................................... 3
2.     Catchment summary...................................................................................................... 5
3.     Needs Analysis summary.............................................................................................. 7
4.     Local implications of Statewide plans.......................................................................... 9
5.     Planning Principles...................................................................................................... 10
6.     Service Delivery Plan ................................................................................................... 11
     6.1      Core Services to be Sustained ............................................................................... 11
     6.2      Strategies for the Future......................................................................................... 15
7.     Key Enablers for Supporting Services ....................................................................... 20
     7.1      Safety & Quality...................................................................................................... 20
     7.2      Patient Journey ...................................................................................................... 21
     7.3      Cultural Respect..................................................................................................... 22
     7.4      Engaging with our community................................................................................. 22
     7.5      Local Clinical Networks .......................................................................................... 23
8.     Resources Strategy ..................................................................................................... 24
     8.1      Workforce............................................................................................................... 24
     8.2      Infrastructure .......................................................................................................... 25
     8.3      Finance .................................................................................................................. 25
     8.4      Information Technology .......................................................................................... 26
     8.5      Risk Analysis .......................................................................................................... 26
9.     Appendix ...................................................................................................................... 27
     9.1      Leadership Structure .............................................................................................. 27
     9.2      Methodology........................................................................................................... 27
     9.3      Review Process...................................................................................................... 28
     9.4      Glossary ................................................................................................................. 28

                                                                                                               Date: 07 July 2011

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1.   Executive Summary
Kangaroo Island Health Services (KIHS) are delivered in the Multipurpose (MPS) Model.
Multipurpose Services are integrated health and aged care services. They receive Australian
Government funding for flexible aged care places and State funding for a range of health services.
A strength of the MPS model is its capacity to adapt to the circumstances of diverse rural
communities and to flexibly accommodate organisational arrangements that may change and develop
over time.

The resident population for Kangaroo Island has grown from 4,261 in 2006 (ABS 2006 Census) to
4,622 in 2011 (DPLG, Population Projections 2011). People from Aboriginal and Torres Strait Islander
backgrounds comprise 0.7% of the Kangaroo Island population compared with 3.1% of the total
country South Australian population. There is also a significant Maori and Phillipino population. When
compared with the overall population structure of country South Australia, Kangaroo Island has a
lower proportion of the population in the 15-24 age group, and a higher proportion of the population in
the 45-64 year age group. The projected population for Kangaroo Island is estimated to increase to
approximately 5,400 by the year 2021.

It is important to acknowledge that during peak holiday times such as Christmas and Easter the local
population of Kangaroo Island doubles. The latest Tourism Optimisation Management Model
(TOMM) statistics evidence that 180,000 people visit the Island annually. Kangaroo Island is a major
tourist destination which can mean that the actual number of people on Kangaroo Island is at least
6,000 with up to 25,000 at peak times.

Kangaroo Island lies to the South of Adelaide, 24 kms from the South Australian Coastline and just
124 kms from Adelaide CBD and is economically and socially disadvantaged by its 16 km ‘watergap’
separation from the mainland. Travel to all other service centres requires either road/ferry or air
transport with associated costs. There is a negative Impact on the social determinants of health; and
recruitment & retention of a skilled health service work force due to the 24 km ‘watergap’ separation
from the mainland. “There is general agreement that prevention is about dealing with risk factors, that
is the causes of disease; but, equally importantly, it is about dealing with the causes of the causes,
that is the determinants of health and illness – be they economic, social or environmental in origin”.i

The Kangaroo Island 10 Year Local Health Service Plan was developed by the Hills, Southern
Fleurieu, Kangaroo Island Cluster Executive Team in collaboration with the Kangaroo Island Health
Advisory Council. This plan has been based on consultation undertaken by the Health Advisory
Council with the local community, including key stakeholders, statewide health initiatives, trends in the
local Health Services Profile, health improvement plans and the directions identified to improve
population health by the SA Inner Country Health Network Alliance.

Priority needs identified through the needs analysis process include:
    • Recruitment and retention of a skilled health care workforce.
    • Creating effective partnerships to maximise expertise and funding streams.
    • Redesigning aged care infrastructure.
    • Increasing/redesigning disability support.
    • Increase access to timely mental health specialist care.
    • Continue the Early Intervention service for young children
    • Address domestic violence issues
    • Increase the awareness of Better Care in the Community (incorporating self managed care for
         chronic disease).
    • Reduce transport cost to the community and health care staff due to the water gap between
         Kangaroo Island and the mainland.
    • Utilise e-health technology.
    • Identify clear links to tertiary support.
    • Clarify clinical governance for medical support.
    • Provision of opportunity to exercise eg. sporting fields / clubs and healthy lifestyle support.
    • Prioritise the concept of health promotion to men, including the moderation of alcohol intake.
    • Ensure that emergency response keeps pace with tourism demand.
                                                                                                       3
This 10 year Plan sets out to sustain and strengthen its existing core services including 24 hour, 7
day/week emergency and acute care, medical services, maternal services, community and allied
health, aged care and other core services. This works closely with Kangaroo Island’s role as a MPS
and its 2009-2012 MPS Service Delivery Plan. Key recommendations to be incorporated into the
future proposed model include:
    • Contribute solutions to the transport barrier and the impact of the water gap between
        Kangaroo Island and the mainland.
    • Ensure equity of access to services to enable the elderly to stay in their own homes regardless
        of where they reside on the Island or appropriate residential aged care.
    • Ensure equity in health outcomes for people who live on Kangaroo Island.
    • Work towards integration of care (eg. a co-morbidity approach) so that every door is the right
        door (improve the patient journey).
    • Provision of respite services across the age spectrum.
    • Build early intervention capacity for children and youth – especially in regard to mental health.
    • Introduce a simple communicated and understood referral system.
    • Build consumer, carer and community participation.
    • Transition from crisis management to early intervention for Aboriginal and culturally and
        linguistically diverse populations.
    • Utilisation of the outreach centre for health promotion and early intervention at Penneshaw,
        American River and Parndana.
    • Utilise information and communications technology (ICT) capabilities and e-health.
    • Increase accessibility of emergency services

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

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2.   Catchment summary

Introduction

The Kangaroo Island Health Service is located within the Kangaroo Island Statistical Local Area
(SLA). The Health Service has been a recognised Multipurpose Service (MPS) since 1997. Kangaroo
Island is Australia’s third largest island situated 110 kilometres south-west of Adelaide and covers an
area of approximately 4,400 square kilometres. Kangaroo Island has approximately 1,600 kilometres
of sealed and unsealed roads; 509 kilometres of coastline; and is 155 kilometres from east to west.
Townships on Kangaroo Island include Kingscote, Penneshaw, American River, Vivonne Bay and
Parndana (see map below). The distance from Kingscote to Adelaide is approximately 180 kilometres
with road and ferry travel time of up to 6 hours.

                                     Reference: http://www.atlas.sa.gov.au/

Population

The resident population for Kangaroo Island has grown from 4,261 (ABS 2006 Census) to 4,622 in
2011 (DPLG, Population Projections 2011). People from Aboriginal and Torres Strait Islander
backgrounds comprise 0.7% of the Kangaroo Island population compared with 3.1% of the total
country South Australian population. Approximately 2.2% of the population speak a language other
than English at home, compared with 3.9% across country South Australia.

The total population of Kangaroo Island has remained relatively consistent in the five year period
between 2001 and 2006 Census counts. When compared with the overall population structure of
country South Australia, Kangaroo Island has a lower proportion of the population in the 15-24 age
group, and a higher proportion of the population in the 45-64 year age group. The projected
population for Kangaroo Island is estimated to increase to approximately 5,400 by the year 2021. The
fertility rate for the Island is 2.44 which is higher than both the replacement level and the South
Australian average rate (1.82). The indirect standardised death rate is 5.4, with a total of 30 deaths in
2008.

Kangaroo Island is an international tourist destination which attracts an average of 180,000 visitors
per annum. At peak periods between September to April, the tourist population quadruples the
resident population and in January is reported to rise to six times the resident population. This can
mean that the actual number of people on Kangaroo Island is at least 6,000 with up to 25,000 at peak
times.

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Table 1: Kangaroo Island population

                                                                                                       Country
                                                                      Cluster*         Cluster*                        SA total
                                         No.              %                                              SA
                                                                        No.               %                              %
                                                                                                         %
Total Population                        4,622                          98,235

Males                                   2,387          51.6%           48,662           49.5%           50.2%           49.2%
Females                                 2,235          48.4%           49,573           50.5%           49.8%           50.8%

0-14 years of age                        867           18.8%           18,403           18.7%           20.4%           18.5%
15-24 years                              439           9.5%            10,908           11.1%           11.4%           13.3%
25-44 years                             1,041          22.5%           22,183           22.6%           25.1%           26.7%
45-64 years                             1,523          33.0%           27,997           28.5%           27.3%           26.1%
65-84 years                              648           14.0%           16,236           16.5%           13.9%           13.4%
85 years and over                        104           2.3%            2,507            2.6%            1.8%            2.0%

ATSI**                                   30             0.7%             681             0.9%            3.1%            1.7%
CALD (Speaks a language
other than English at                    95             2.2%            2,360            2.8%            3.9%           12.2%
home)**
                                   *Adelaide Hills, Southern Fleurieu and Kangaroo Island Cluster total
  Source: Projected population by age and sex – SLAs in South Australia, 30 June 2011, Department of Planning and Local Government
                                                       **Source: 2006 ABS Census

Socioeconomic factors

On the basis of Australian Bureau of Statistics’ measures of remoteness, Kangaroo Island has been
identified as ‘remote’ which indicates a relatively high level of geographical isolation and distance to
service centres including Adelaide and other health services in the cluster area. Travel to all other
service centres requires either road/ferry or air transport with associated costs. No public transport
exists either on the Island or to other areas of the State. The Kangaroo Island catchment reflects a
relatively high level of socioeconomic disadvantage when assessed across a range of measures
including income, education and employment.

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

The economy of Kangaroo Island is primarily derived from wool, prime lamb, mutton and beef,
horticulture, viticulture, tourism, aquaculture, fishing, forestry, plantation, eggs and poultry and mining
industries. The raising of sheep has traditionally provided about 60% of the Island’s economic base.
However intensive animal keeping activities are limited. Honey is produced and Ligurian bees
exported. Agriculture accounts for 23% of employment in the Kangaroo Island catchment, followed by
accommodation and food services (12%); and retail trade (11%).

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3.    Needs Analysis summary
From mid January 2010 the dedicated Planning Officer along with senior staff from the Kangaroo
Island Health Service and key stakeholders undertook a SWOT (strengths, weaknesses, opportunities
and threats) analysis. This process considered the results of the community survey undertaken by
the Kangaroo Island Health Advisory Council (HAC) and other existing consultation information,
analysis of data regarding services accessed in Adelaide and diverse others sources of information.
This approach contributed to identifying priority service needs for the local community over the next
10 years.

Summary of findings

Aboriginal Health Services
    • Upfront gap payments can be a barrier to accessing timely health care.
    • There is a transport barrier for those who do not reside near Kingscote.
Culturally and Linguistically Diverse Background
   • Upfront gap payments can be a barrier to accessing timely health care.
Disability Services
   • There is a need for enhanced disability services. There is a 13% level of disability within the
        school population reported by participants in consultations.
Aged Care Services
   • Community care may not meet future demand.
   • Consideration should be given to a replacement or an upgrade of the existing aged care hostel
        ‘Carnarvon’ to support higher resident care needs.
   • Need for access to geriatric and psycho geriatric consults and dental care for residents who
        are bed or chair bound is limited.
    • Recent aged care forums identified a strong desire to stay home, rather than enter residential
        aged care. There is a community need for independent living unit type accommodation such
        as a retirement village. A desire for aging in place and available choice of accommodation for
        older people on the Island is also evidenced. Many community members discussed the
        possibility of a more flexible approach to in home care including the ability to have more
        control over the services offered. There were several comments in regard to having access to
        general cleaning, gardening and window cleaning1.
    • Access to low and high level aged care beds is anticipated to rise in the future.
Mental Health
   • Need for promotion, prevention and early intervention approaches adopted on Kangaroo
        Island. There is an understanding of the importance of community engagement to improve
        health outcomes for people who have a mental health issue, particularly within the confines of
        an Island.
Better Care in the Community
   • Strong demand for early intervention, prevention and self management programs integrated
        between health service providers, which aligns well with the Statewide direction for the GP
        Plus strategy services and packages of care.
   • Chronic disease management to maximise health is needed and is outlined in the Chronic
        Disease Action Plan for South Australia 2009-2018.
   • Provision for e-learning and audio-visual learning - very important for isolated workers on
        Kangaroo Island.
Acute Services
   • Local clinicians from the health services identified an opportunity in the stakeholders
        workshops that an alternative medical model of care for on-call, obstetrics and Emergency
        Department services could be explored through meaningful engagement with all local
        clinicians.
   • The Health Advisory Council acknowledged the impact of tourists on the needs for emergency
        acute triage and care.

1
 Lisa Sparrow. Southern Fleurieu and Kangaroo Island Positive Aging Taskforce. Care-Full Ageing Forums, Kingscote,
Parndana, Pennshaw (July – October 2009).
                                                                                                                     7
•   Gap payments for non-admitted emergency department attendances can be a barrier to
       accessing services.
Maternity Services
   • Consideration of current and future demand along with the isolation from accessible transport
       options due to the water gap between Kangaroo Island and the mainland. The maternity
       service provision may need to be analysed to determine sustainable service requirements. In
       2008 there were 65 births registered to residents of Kangaroo Island. Between thirty to fifty
       percent of women electively choose to birth off the Island (non-medical reasons) for a variety
       of reasons such as being closer to family and access to private services and also for valid
       medical reasons such as twins or complications.
   • The community and local GP’s value and support access to safe birthing services on
       Kangaroo Island.
Transport
   • There is a transport barrier for those who do not reside near Kingscote, particularly the
       Western end of the Island.
   • There is a negative Impact on the social determinants of health; and recruitment & retention of
       a skilled health service work force due to the 24 km ‘watergap’ separation from the mainland.
Youth Services
   • The YWCA of Adelaide Southern Services gathered information regarding youth needs
       through their services, activities and community consultations. The information supports the
       perception amongst young people, that they are excluded from their local communities, and a
       need for access to youth services, facilities and transport. Substance abuse and mental
       wellbeing were identified as key issues.

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

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

A number of Statewide Clinical Service Plans have been developed or are currently under
development providing specific clinical direction in the planning of services. Interpreting these plans
for country South Australia and specific health units is an important element of the planning process
for Country Health SA. The enabling factors which are demonstrated across the statewide clinical
plans include:
        • Multi-disciplinary teams across and external to the public health system.
       •   Patient focused care.
       •   Care as close to home as possible.
       •   Teaching and research integrated in service models.
       •   Integrated service model across the continuum of care.
       •   Streamlining access to specialist consultations.
       •   Increasing use of tele-medicine.
       •   Improving Aboriginal health services.
       •   Focus on safety and quality.
       •   Recruiting and developing a workforce to meet future service models.
       •   Engaging closely with consumers and community.
       •   Developing the infrastructure to meet future service models.
       •   Clinical networking and leadership.
       •   Connect local patients with pathways to higher level care needs.
       •   Reduce progression to chronic disease for at risk populations.
Strategies within the Statewide Clinical Service Plans which support the achievement of local needs
have been integrated through the 10 Year Health Service Plans. The Health Advisory Council
acknowledges the important principle of integrating with Statewide directions but also reiterates the
importance of applying this to local needs such as:
       • Ageing population
       •   Increasing prevalence of chronic disease
       •   Disability and injury
       •   Poorer health of Aboriginal people and people of lower socio-economic status
       •   Increasing risks to society from communicable diseases
       •   Biological threats
       •   Natural disasters and climate change
                                                                                                     9
5.   Planning Principles
The Strategy for Planning Country Health Services in South Australia set out important principles
which have been used to guide the local planning which include:

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

       2. Ensuring sustainability of country health service provision.

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

       4. Improving Aboriginal health status.

       5. Contributing to equity in health outcomes.

       6. Strengthening the IT infrastructure.

       7. Providing a focus on safety and quality.

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

       9. Maximising the best use of resources.

       10. Adapting to changing needs.

In addition, the Health Advisory Council acknowledges important local planning principles that have
been set out in past planning, including those identified in the “Shared Vision for Kangaroo Island
Health Service”

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6.       Service Delivery Plan

6.1 Core Services to be Sustained

Service Category                          Service Description                           Target Group            Directions over the next 10 Years
Community Health Promotion,               • Local area access to Aboriginal health,     • Older adults - over   • Implement programs for older adults:
Prevention and Early Intervention             community nursing and midwifery             65 years                  o    Falls prevention
Programs                                      services, children and youth health       • Children                  o    Weights training
                                              services, drug and alcohol services,      • Men, Women and            o    Walking groups
                                              mental health (adult and child)             Youth                     o    Orthotics / podiatry
                                              counselling and allied health services                                o    Dental care
                                                                                                                    o    Increase Extended Aged Care in Home (EACH)
                                                                                                                         packages
                                                                                                                    o    Pharmacy review (home medication review)
                                                                                                                    o    Provide alternative accommodation to residential care
                                                                                                                         (also see aged care directions)
                                                                                                                •   Implement programs for children:
                                                                                                                    o    Affordable access to specialist review
                                                                                                                    o    Timely access to speech pathology
                                                                                                                    o    Early intervention services
                                                                                                                •   See section 6.2 for expanded services
                                                                                                                                                        2
Community Health and GP Plus              • Local area access to community care,        Kangaroo Island         •   Chronic disease self management
Strategy Services                           Aboriginal health, community nursing and    community and           •   Build collaborative working systems with acute care,
                                            midwifery services, children and youth      visitors                    community care and local GPs
                                            health services, drug and alcohol                                   •   Increase access to specialist counselling
                                            services, mental health (adult and child)                           •   Provision of IT connectivity to outreach centres on the
                                            counselling and allied health services                                  Island and regular clinics in the outreach centres at
                                          • Low risk chemotherapy                                                   Penneshaw, American River and Parndana
                                                                                                                •   Explore opportunities to support enhanced access to
                                                                                                                    government agencies that are not on the Island eg.
                                                                                                                    Anglicare, Eldercare, Salvation Army, Second Story
                                                                                                                    Youth Health Service, SHINE-SA, Housing SA, Centrelink
                                                                                                                •   Explore other opportunities to access transport on the
                                                                                                                    Island such as school bus, local council cars
                                                                                                                •   Implement programs to support womens health,
                                                                                                                    particularly with regard to the remoteness of living on the
                                                                                                                    island.

2
    Chronic Disease Action Plan for South Australia 2009-2018
                                                                                                                                                                         11
Allied Health                              • Large range of allied health services          Kangaroo Island      • Ensure timely response to referrals
                                               provided                                     community            • Increased access to speech pathology, dietician, podiatry
                                                                                                                 • Review service delivery models and work collaboratively
                                                                                                                     with other community health facilities to provide services
                                                                                                                 • Work with Country Health SA Local Health Network
                                                                                                                     (CHSALHN) to review recruitment and retention
                                                                                                                     strategies for remote areas
                                                                                                                 •   Support multi-skilling of allied health staff
Emergency Service                          • 24 hour service 7 days a week,                 Kangaroo Island      •   Ongoing emergency response capacity review
                                           • Videoconferencing link with SA Retrieval       community and        •   Review the quality and safety impact of utilising the ED
                                               Service in place                             visitors                 treatment area to recover theatre patients
                                                                                                                 •   Support nurses to continue to expand emergency skills
                                                                                                                     such as wound assessment and suturing, removal of
                                                                                                                     foreign bodies and plasters of fractures
Acute Inpatient Care                       • Acute services including step down             Kangaroo Island      •   Maintain current services
                                               services from tertiary hospitals for local   community and        •   Implement the planned Stage III upgrade of facilities
                                               community                                    visitors
Elective Surgical                          •   Low complexity elective surgery              Kangaroo Island      • Review potential to provide elective surgery strategy
                                               undertaken in areas such as general          community              initiative to Island community and decrease need for
                                               surgery, orthopaedics, urology,                                     transport to other facilities, including attracting and
                                               gynaecology, obstetrics and other                                   retaining an appropriate medical and clinical workforce to
                                               appropriate emergency procedures                                    support this service
Maternal and Birthing Services             •   Local Area Services. Midwifery Led Care:     Pregnant women,      • Review the maternity service model in line with available
                                                                                                                                                               3
                                               o    Antenatal and postnatal care            foetus and infants     resources and contemporary standards
                                               o    Shared Care Programs                                         • Provide access to safe birthing and maternal services
                                               o    Access to community midwifery                                • Explore opportunities for antenatal and postnatal
                                                    services and parenting programs                                extended care on the Island
                                           •   District Services:
                                               o    Low risk, single birth, theatre and
                                                    staffing for caesarean sections 24
                                                    hours a day, 7 days a week
Medical Specialist Services                •   Local area visiting specialists for scope    Kangaroo Island      • Improve access to specialist services, including exploring
                                               services                                     community and          potential for ophthalmology, rheumatology, palliative care
                                           •   Visiting specialists including:              visitors               and sports medicine
                                               o    General surgery                                              • Consider establishing consulting space at time of Stage
                                               o    Orthopaedic surgery                                            III redevelopment to enable visiting specialists to consult
                                               o    Urology                                                        from KIHS
                                               o    Paediatric
                                               o    Gastroenterology

3
    Standards for Maternal and Neonatal Services in South Australia 2009
                                                                                                                                                                           12
o   ENT
                                             o   Cardiology
                                             o   Endocrinology
                                             o   Dermatology
                                             o   General Physician (includes cardiac,
                                                 geriatric conditions)
                                             o   Psychiatry
Mental Health                            •   Local and district services available        Kangaroo Island   • Work closely with GP’s as the primary carer for patients
                                         •   Partnerships with the community, GPs,        community and         with a mental health condition
                                             health service, SA Police                    visitors          • Explore opportunities for research and new programs
                                         •   Community health 24/7 primary care                             • Implement a geriatric psychotherapy service
                                         •   Early intervention, shared care with local                     • See section 6.2 for expanded services
                                             GPs
                                         •   Individual psychosocial rehabilitation
                                             support
                                         •   Counselling
                                         •   Local voluntary acute and respite
                                             admissions to local hospital
                                         •   Specialist mental health services
Disability Support                                                                        Kangaroo Island   • Increase services for intellectual disability especially for
                                                                                          community             children/youth
Rehabilitation                           • Local area service for recuperative and        Kangaroo Island   • Explore access to geriatric rehabilitation service (Geriatric
                                                                                                                                                      4
                                             maintenance care, community home             community and         Evaluation and Management (GEM))
                                             based rehabilitation support, centre         visitors          •   Increase rehabilitation capacity, recognising Kangaroo
                                             based day therapy, outpatient                                      Islands unique needs and aligning with the Statewide
                                             rehabilitation                                                     Rehabilitation Plan
                                                                                                            •   Increase capacity to provide Rapid Intensive Brokerage
                                                                                                                Support (RIBS), Transitional Care Packages (TCPs)
Respite Services                         • Local area access to residential and           Kangaroo Island   •   Ensure the sustainability for the Kangaroo Island carers
                                             hospital care                                community             program
                                                                                                            •   See section 6.2 for expanded services
Aged Care                                • Domiciliary care in home and the               Kangaroo Island   •   Increase community care – in particular EACH and
                                                                                                                                            5
                                             community                                    community             Dementia EACH packages
                                         • Inpatient admissions for elderly, including                      •   Consideration should be given to a replacement or an
                                           respite care                                                         upgrade of the existing aged care hostel ‘Carnarvon’
                                         • Low high care and respite residential                            •   Explore access to psycho-geriatric consults and dental
                                           aged care                                                            care for residents who are bed or chair bound
                                         • Access to aged care assessment                                   •   Increase access to home care help
                                                                                                            •   Explore independent living unit type accommodation such

4
    Statewide Rehabilitation Service Plan 2009-2017
5
    Health Services Framework for Older People 2009-2016
                                                                                                                                                                       13
as a retirement village
                                                                                              • Advocate with the Commonwealth to grow residential low
                                                                                                  and high care beds to meet local needs
                                                                                              • See section 6.2 for expanded services
Palliative Care             • Patients admitted for palliative care and     Kangaroo Island   • See section 6.2 for expanded services
                                some in home support                        community
Clinical Support Services   •   Point of care testing                       Kangaroo Island   •   Extended point of care testing
                            •   Access to pharmacy services including       community and     •   Access to e-health
                                starter packs of medication availability    visitors          •   Specialist support for GPs interpreting x-ray
                                after hours                                                   •   Maintain access to existing services
                            •   Access to general x-ray capabilities
                            •   Access to visiting Audiology,
                                ultrasonography and radiology
Oral Health                 •   There is no public oral health system       Kangaroo Island   • See section 6.2 for expanded services
                                provided through KIHS                       community and
                            •   KIHS supports a local dentist through the   visitors
                                provision of consulting space (and recent
                                redevelopment) to the rear of Carnarvon.
                            •   The hospital provides rooms for a private
                                practice

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6.2 Strategies for the Future

Service objective: Mental Health:
Target group: All age groups
Critical milestones: Identify clear links to tertiary visiting services; Inclusive leadership and governance

Outcomes                                                            Strategies                                                                          Time Frames
• Equity of access to specialist care                               • Identify opportunities for and implement e-health:                                TBD
• Equity of outcomes with metropolitan / state services                 o   Facilities to support Telehealth consultations / assessment
• Contribute to reduction in suicide rate                               o   Good e-clinical records management
• Promotion of optimum quality of life for people with mental           o   Integration of services via shared medical records
  disorders and / or mental health problems                             o   Electronic Decision Support (eg. high level electronics tool for decision
                                                                            making for risk assessment and early intervention)
                                                                        o   Electronic referral tools that embed the assessment tools
                                                                        o   Shared / integrated separation summaries

Service objective: Disability Services: Explore opportunities for research and development of new programs
Target group: Initially children with intellectual / learning disability; progress to youth, young adults as priorities
Critical milestones: Scope the extent of the need in the population; Identify clear links with Disability SA to meet service demand

Outcomes                                                            Strategies                                                                          Time Frames
• Equity of access to disability services for children, youth and   •  Continual engagement with the community                                          TBD
  young adults in the community                                     •  Maintain/strengthen essential partnerships
• Equity in health outcomes for children, youth and young           •  Implement the new Mental Health Service Delivery Model of Care
  adults with an intellectual disability when compared to state     •  Introduce a mental health nurse practitioner role
  averages

                                                                                                                                                                15
Service objective: Mental Health Emergency Response
Target group: All people who are having an acute mental health episode and present to the Emergency Department or their local GP
Critical milestones: Emergency care – provided in conjunction with the Rural and Remote 24/7 Mental Health Emergency Triage and Liaison Service
and over time to implement a local 24/7 on call service response capability within the local service networks

Outcomes                                                      Strategies                                                                          Time Frames
• Enhance the mental health emergency response in line with   • Work with Inner Country Mental Health Team to implement a streamlined             TBD
  the strengthened cardiac networks                             response to acute mental health need
                                                              • Introduce a mental health nurse practitioner role

Service objective: Aged Care - Health Promotion Programs
Target group: Older adults over 65 years
Critical milestones: Program definition; Retirement Village / Independent Living Units / Respite options

Outcomes                                                      Strategies                                                                          Time Frames
• People who reside on Kangaroo Island who are older have     • Implement programs:                                                               TBD
  optimum bone density, strength, agility, medication           o   Falls prevention
  management and oral health                                    o   Weights training
• People who reside on Kangaroo Island who are older have       o   Walking groups
  the opportunity to remain in their own home for longer        o   Orthotics / podiatry
  periods of time, and the option of aging in place             o   Dental care
                                                                o   Increase EACH packages
                                                                o   Pharmacy review (home medication review)
                                                                o   Provide alternative accommodation to residential care, including advocating
                                                                    with the Commonwealth to grow residential low and high care beds to meet
                                                                    local needs

                                                                                                                                                          16
Service objective: Disability Services
Target group: Children with a disability
Critical milestones: Access to respite on the Island; Effective link to specialist support

Outcomes                                                      Strategies                                                                         Time Frames
• Equity of access to specialist review and treatment         • Increase access to:                                                              TBD
• Equity of access to respite for carers                         o Community day respite centres
                                                                 o Residential / hospital beds
                                                                 o Transitional Care Packages
                                                                 o Volunteer programs
                                                                 o Organised in home respite
                                                                 o Respite for higher level acuity / disability care

Service objective: Men’s Health
Target group: Men and Youth
Critical milestones: Resources to implement a men’s health program

Outcomes                                                      Strategies                                                                         Time Frames
• Reduction in chronic medical conditions such as heart       • Implement Programs:                                                              TBD
  disease, diabetes and stroke due to risk factors such as       o Alcohol awareness, impact on health and social structure
  obesity, diet, exercise, smoking and alcohol intake            o Domestic violence awareness, link to alcohol and impact on social structure
• Reduction in violence                                          o Men’s health promotion programs
• Reduction in motor traffic accidents
• Increased health and wellbeing for youth and men
• Increased health and wellbeing for women and children
• Increased screening

                                                                                                                                                         17
Service objective: GP Plus Service Strategies
Target group: All people, particularly adults over 45 years
Critical milestones: Introduce a multi-disciplinary, multi-agency Better Care in the Community Committee

Outcomes                                                         Strategies                                                                          Time Frames
• People with chronic illness will be better managed in the      • Implement Programs:                                                               TBD
  community, reducing the need for hospital admission and           o Chronic disease self management
  improving the patient journey                                     o Build collaborative working systems with acute care, community care and
                                                                        local GPs
                                                                    o Increased access to specialist counselling
                                                                    o Provision of IT connectivity to outreach centres on the Island and regular
                                                                        clinics in the outreach centres
                                                                 • Explore opportunities to support access to government agencies on the Island
                                                                     eg. Anglicare, Eldercare, Salvation Army, Second Story Youth Health Services,
                                                                     SHINE-SA, Housing SA, Centrelink
                                                                 • Engage local GPs
                                                                 • Explore other opportunities to access transport on the Island

Service objective: Palliative Care
Target group: All people in need of palliation
Critical milestones: Formal links with level 6 palliative care at RGH / other cluster resources6

Outcomes                                                         Strategies                                                                          Time Frames
• Equity of access to effective palliative care for people who   • Implement programs for:                                                           Work within the
  reside on Kangaroo Island                                           o Multi-disciplinary teams                                                     timeframes as
                                                                      o Specialist nurse input                                                       set out in the
                                                                      o Specialist GP input                                                          Palliative Care
                                                                      o Formal links with level 6 palliative care at RGH                             Services Plan
                                                                      o Support existing clinicians providing ongoing care such as GP’s and          2009-16
                                                                       community health nurses

6
    Palliative Care Services Plan 2009-2016
                                                                                                                                                               18
Service objective: Oral Health
Target group: People in residential care
Critical milestones: Public dental service

Outcomes                                                       Strategies                                                             Time Frames
• Improved oral health for older people, leading to improved   • Implement programs for:                                              TBD
  general health                                                    o Dental early intervention and preventative care for residents
                                                                    o Emergency dental extractions in the hospital

                                                                                                                                              19
7.    Key Enablers for Supporting Services

7.1 Safety & Quality

Objective: Continue to improve the quality and safety of care in a sustainable manner
Critical milestones: NA

Outcomes                                            Existing Strategies Sustained                             Strategies for the Future
Sustainable skilled employment models in place to   •   Continue to support and credential qualified          •   Develop staffing models to meet times of increased
deliver the local service profile                       medical staff – able to provide a 24hr on call            activity
                                                        service                                               •   Enhance clinician involvement in clinical
                                                    •   Continue staff up skilling and development, such as       governance leadership
                                                        the Advanced Life Support, triage skills,
                                                        assessment and minor procedure training for all
                                                        registered nurses
Integrated access across the health system          •   Access the iCC network for clinical support and       •   Further expansion of statewide and Country Health
                                                        guidance                                                  SA clinical networks
                                                    •   24 hr access to consultant/specialist medical staff   •   Expand relationships and combine resources within
                                                    •   Access to perinatal practice guidelines which             the cluster
                                                        ensure the provision of evidence based care           •   Improve the use of knowledge, information
                                                    •   Access to statewide obstetric / neonatal retrieval        management and technology to increase quality
                                                        service                                                   and safety
Continual improvement and patient-centred           •   Maintain ACHS Accreditation                           •   Contribute to a country-wide accreditation
approach underpinning service delivery              •   Adherence to the Aged Care Act                            framework
                                                    •   Audit the full range of programs in place to ensure   •   Integrate acute, community health and aged care in
                                                        client satisfaction                                       accreditation
                                                    •   Implement the Australian Charter of Health Care
                                                        Rights
                                                    •   Implement strategies to improve the State and
                                                        National Patient Safety priority areas

                                                                                                                                                               20
7.2 Patient Journey

Objective: Increase the accessibility of the health system to reduce the impact on the patient journey
Critical milestones: NA

Outcomes                                             Existing Strategies Sustained                              Strategies for the Future
Local access to specialists and clinical             •   Enhance access to Rural and Remote Mental              •   Increase access to telehealth facilities
consultations through telehealth services                Health Services through existing telehealth facility   •   Integrate with statewide planning to coordinate
                                                                                                                    access to specialists and clinicians across South
                                                                                                                    Australia
Accessible public transport service between          •   Seek to enhance current patient transfer scheme        •   In partnership with other key stakeholders facilitate
Kangaroo Island and health services on the                                                                          the development of a transportation system for
mainland for increased access to health services                                                                    patients needing to travel to access specialist
                                                                                                                    services, allied health consultations outside of
                                                                                                                    regular visit schedule and any other health services
                                                                                                                •   In partnership with other stakeholders contribute to
                                                                                                                    address the challenges of distance, leading to low
                                                                                                                    economic status, lack of affordable housing and
                                                                                                                    transport
                                                                                                                •   Partnerships between Australian and State
                                                                                                                    Government departments to bring about a State
                                                                                                                    Government Passenger Vehicle Equalisation
                                                                                                                    Scheme
                                                                                                                •   Kangaroo Island HAC to lobby for the
                                                                                                                    implementation of the Regional Development
                                                                                                                    Board Water gap Project
                                                                                                                •   Kangaroo Island HAC to lobby for a daily flight
                                                                                                                    schedule that permits patients to travel and return
                                                                                                                    in the same day
Fast and efficient patient transport and retrieval   •   Work with SA Ambulance Service (SAAS) and the
                                                         Royal Flying Doctor Service (RFDS) to explore
                                                         opportunities to reduce delays in patient transport

                                                                                                                                                                    21
7.3 Cultural Respect

Objective: Increase capacity to contribute to the priority of closing the gap in Aboriginal health life expectancy
Critical milestones: NA

Outcomes                                            Existing Strategies Sustained                             Strategies for the Future
Kangaroo Island Health Service is culturally safe   •   All staff have attended Aboriginal cultural           •   Expand opportunities for Aboriginal people to be
and accessible                                          awareness training                                        employed at all areas of the health service
                                                    •   Aboriginal nursing placements                         •   Implement recommendations identified in the
                                                    •   Aboriginal employees who are encouraged to                Aboriginal Health Impact Statement for the 10 year
                                                        complete further education                                Health Service Plan
Targeted Aboriginal health improvement strategies   •   Close working relationship with cluster Aboriginal    •   Build connections with the Aboriginal health
                                                        health workers                                            workers within cluster
                                                    •   Aboriginal specific chronic disease management        •   Increase working towards wellness group
                                                        program                                                   opportunities

7.4 Engaging with our community

Objective: Increase the capacity for the community to contribute to the planning, implementation and evaluation of services
Critical milestones: NA

Outcomes                                            Existing Strategies Sustained                             Strategies for the Future
Health service needs of the community are           •   Support the Kangaroo Island Health Advisory           •   Explore opportunities for ongoing and meaningful
understood                                              Council to implement their ongoing role of engaging       discussion with the community and targeted
                                                        with the community and local stakeholders                 population groups
                                                    •   Regular community information through local
                                                        channels in partnership with the Health Advisory
                                                        Council

                                                                                                                                                                 22
7.5 Local Clinical Networks

Objective: Enhance relationships with other services locally, regionally and statewide
Critical milestones: NA

Outcomes                                               Existing Strategies Sustained                               Strategies for the Future
Formal ties with health service organisations in the   •   Build on linkages within the cluster for mental         •   Explore formal pathways with Repatriation General
region                                                     health and other health service programs                    Hospital for palliative care and specialist geriatric
                                                       •   Continue to expand relationships, access to                 management
                                                           specialised staff and combine resources within          •   Explore how state networks can link to services on
                                                                                                                       the Island
                                                                                                                   •   Engage with other agencies and service providers
                                                                                                                       on the Island to improve patient journey and health
                                                                                                                       outcomes eg. Kangaroo Island Local Council,
                                                                                                                       Finding Workable Solutions, DASSA, CAMHS,
                                                                                                                       Disability SA, Regional Development Board
Formal ties with statewide and Country Health SA       •   Strengthen networks with metropolitan and               •   Expand collaborative relationships with visiting
clinical networks                                          statewide services to sustain outpatient                    specialists throughout the region
                                                           chemotherapy services, access to Rural and              •   Further expansion of statewide and Country Health
                                                           Remote Mental Health Service, mental health                 SA clinical networks
                                                           services for older people and other clinical services

                                                                                                                                                                       23
8.    Resources Strategy

8.1 Workforce

Objective: Improve ability to recruit, develop and retain a skilled health workforce
Critical milestones: NA

Outcomes                                              Existing Strategies Sustained                             Strategies for the Future
Highly skilled and qualified workforce                •   Continue to develop the skills of clinical staff       •   Expand training opportunities for nursing staff,
                                                      •   Rotate staff from other outlying units to assist in        particularly in palliative care, x-ray capabilities,
                                                          staff development throughout the cluster                   midwifery, personal care and aged care nursing
                                                      •   Staff skilled in providing both high and low level     •   Up skilling / support of local persons to obtain allied
                                                          residential care services                                  health qualifications given difficultly faced in
                                                                                                                     recruiting allied health staff to rural and remote
                                                                                                                     locations
Recruitment and retention of the workforce to         •   Support to retain qualified medical staff             •    Explore options to strengthen the retention of all
support the service profile                           •   Recruitment of qualified nursing staff via graduate        personnel in the health service
                                                          nurse and cadetship programs                          •    Support the training of new registered midwifes and
                                                                                                                     ongoing professional development of current
                                                                                                                     midwives, building on strong staff interest in gaining
                                                                                                                     and/or maintaining midwifery qualifications
                                                                                                                •    Plan for implications of an ageing workforce
                                                                                                                •    Explore a sustainable model to recruit and retain
                                                                                                                     specialist medical staff within the region
Increased accessibility for Aboriginal people to be   •   Continue to encourage Aboriginal employees to         •    Encourage and recruit Aboriginal employees
employed in the Health Service                            complete further education                                 across all levels of the health service
                                                      •   Maintain Aboriginal nursing placements
                                                      •   Continue to seek all staff to undertake Aboriginal
                                                          cultural awareness training

                                                                                                                                                                       24
8.2 Infrastructure

Objective: Increase the capability of the infrastructure to support the planned service levels are provided and maintained within local communities
Critical milestones: NA

Outcomes                                              Existing Strategies Sustained                              Strategies for the Future
•   Physical building meets the needs of the          •   Plan for Health Service redevelopment including         •   Seek capital works upgrade funding
    service delivery for acute, aged, respite care        consideration of:                                       •   Advocate with the Commonwealth to grow
    and community health programs                         •   Emergency waiting room                                  residential low and high care beds to meet local
•   Improved patient journey                              •   Consulting rooms for visiting medical                   needs
•   Better Care in the Community                              specialists, counselling
•   Improved health outcomes for people who live          •   Clinicians work space
    on the Island                                         •   Recovery
•   Improved staff satisfaction leading to improved       •   Community health program space
    retention of skilled staff
•   Potential to attract more visiting specialists

8.3 Finance

Objective: Increase the efficiency and effectiveness of resources, and balanced with the provision of services as close to home as possible
Critical milestones: NA

Outcomes                                              Existing Strategies Sustained                              Strategies for the Future
Sustainable funding to achieve the planned service    •   Maintain funding to support the existing services to    •   Develop business cases to seek funding to
profile                                                   be sustained                                                implement new services or ease demand pressures
                                                                                                                      on existing services

                                                                                                                                                                     25
8.4 Information Technology

Objective: Increase access to communication and information technology systems to strengthen health care
Critical milestones: NA

Outcomes                                           Existing Strategies Sustained                                Strategies for the Future
Reduced need for patients to travel away for       •   Establish effective and efficient clinical networks to    •   Explore options for enhanced telehealth equipment
specialised services                                   support emergency advice and support including            •   Advocate for flexible funding to enable clinicians in
                                                       access to retrieval teams / consultant advice                 other areas to effectively utilise telehealth services
                                                   •   Explore options to increase use of digital x-ray          •   Support enhanced IT access between service
                                                       capacity to reduce the need for patients to travel to         providers
                                                       the mainland

8.5 Risk Analysis

Objective: Increase ability to plan for and manage risks
Critical milestones: NA

Outcomes                                           Existing Strategies Sustained                                Strategies for the Future
Key risks are understood and have plans in place   •   Recruitment and retention of qualified clinicians for     •   Explore options for enhanced telehealth equipment
to mitigate                                            specialised areas such as resident GP                     •   Explore Australian Government funding options to
                                                       practitioners, visiting medical specialist, allied            ensure aged care bed / service availability meets
                                                       health and other clinicians                                   local needs
                                                                                                                 •   Work collaboratively with local clinicians to explore
                                                                                                                     models for periods of remote call by medical officer
                                                                                                                     within safe standards
                                                                                                                 •   Enhancing diagnostic pathology services, overnight
                                                                                                                     and weekends

                                                                                                                                                                      26
9.   Appendix

9.1 Leadership Structure

The Kangaroo Island 10 Year Local Health Service Plan was developed by the Hills, Southern
Fleurieu, Kangaroo Island Cluster Executive Team in collaboration with the Kangaroo Island Health
Advisory Council. The Plan considered the statewide health initiatives, trends in the Local Services
Profile, health improvement plans and the directions identified to improve population health by the SA
Inner Country Health Network Alliance.

9.2 Methodology

The Kangaroo Island 10 Year Local Health Service Plan has been developed following consultation
with the local community, including key stakeholders. The Plan addresses community health needs
considering services already in place, existing infrastructure, capacity to attract workforce to provide
services, the demographic, geography, burden of disease, health service utilisation, statewide SA
Health initiatives, expected population growth and expected tourism development in the next 10
years.

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

Methodology used to identify community needs:
   • 1998-2000 - comprehensive consultation with community to develop the MPS model.
   • 2005-2006 - major community consultation to develop the Vision for Kangaroo Island Health
      Service.
   • 2007 - Mental Health Action Plan consultation.
   • 2009 - Continuous Improvement Plan included key strategies to engage with the local
      community.
   • 2009 – during the development of the MPS Service Delivery Plan a discussion group and
      planning forum was conducted with the Kangaroo Island HAC to review previous needs
      assessments from community consultations, to consider emerging needs of the community
      and to provide feedback in relation to the priority areas for the 10 year service plans.
   • 2009 - HACC program consultation on the needs of carers living on Kangaroo Island.
   • Advertisements in local newspaper seeking community feedback.
   • Regular meetings with service clubs.
   • Collaborative relationship with Southern Fleurieu and Kangaroo Island Positive Aging
      Taskforce.
   • Collaborative relationship with Community Living and Support Services (CLASS) and Disability
      SA.

Specific methodology for the development of the 10 Year Local Health Service Plan included:
   • Provision of questionnaires to the local community (20 respondents, 16 of which were from
        residents under 21 years of age).
   • Questionnaires provided to all KIHS staff and health service providers (23 respondents across
        all disciplines).
   • HAC members canvassed the community and received feedback from 27 members of the
        community ranging in age from 25 to 65.
   • Presentation to Kangaroo Island Local Council and Kangaroo Island Development Board.
   • Consideration of key local planning and development documents.
   • From mid January 2010 the dedicated Planning Officer along with senior staff from the
        Kangaroo Island Health Service and key stakeholders undertook a SWOT analysis. This
        process considered the results of the community survey undertaken by the HAC and other
        existing consultation information, analysis of data regarding services accessed in Adelaide
        and diverse others sources of information.
   • Consultation interviews undertaken with key stakeholders.

                                                                                                     27
•   Release of a draft plan for all community and stakeholder to contribute feedback

The Kangaroo Island Health Advisory Council undertook a genuine consultation strategy and
acknowledge that it has an ongoing role to represent the views of the community to the Minister for
Health and local health services. The Kangaroo Island Health Advisory Council acknowledges the
importance of reviewing the plans and progress annually as needs change in the future and further
community engagement occurs.

9.3 Review Process

A monitoring and evaluation strategy will be developed to support the implementation of this Plan in
collaboration between the Kangaroo Island Health Advisory Council and the local health service.

9.4 Glossary

            24/7                 24 hours / 7 days a week
            ABS                  Australian Bureau of Statistics
            ACHS                 Australian Council on Healthcare Standards
            CALD                 Culturally and linguistically diverse
            CAMHS                Child and Adolescent Mental Health Service (Statewide Service)
            CHSALHN              Country Health SA Local Health Network
            DASSA                Drug and Alcohol Services SA (Statewide Service)
            EACH                 Extended Aged Care at Home packages
            ED                   Emergency Department
            GEM                  Geriatric Evaluation and Management
            GP                   General Practitioner
            GP Plus              GP Plus Services provide early intervention, prevention and self
            Services             management programs provided by building partnerships and
                                 relationships with key health service providers to improve health
                                 outcomes for the population through service integration and
                                 coordination
            HAC                  Health Advisory Council
            IT                   Information Technology
            KIHS                 Kangaroo Island Health Service
            MPS                  Multipurpose Service
            RFDS                 Royal Flying Doctor Service
            RGH                  Repatriation General Hospital
            SA                   South Australia
            SAAS                 SA Ambulance Service
            SHINE-SA             Sexual Health Information Networking Education - SA
            SLA                  Statistical Local Area

            SWOT analysis        Strategy development tool which                 identifies   strengths,
                                 weaknesses, opportunities, threats

i   SA Health, Public Health Bulletin SA - Prevention, Vol 6, No 1, March 2009

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