City of Ballarat Health Sector Capability and Gap Analysis Report July 2010
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City of Ballarat Health Sector Analysis Report
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Contents DISCLAIMER ......................................................................................................................................... 7 EXECUTIVE SUMMARY ........................................................................................................................ 8 Key issues ...........................................................................................................................................................................8 Advocacy and leadership....................................................................................................................................................8 Investment and development..............................................................................................................................................9 Workforce ...............................................................................................................................................................................9
The role of governments ............................................................................................................................................. 10 Recommendations ...................................................................................................................................................... 10 Advocacy and leadership..................................................................................................................................................10 Investment and development............................................................................................................................................11 Workforce .............................................................................................................................................................................11
Conclusion ..................................................................................................................................................................... 12
BACKGROUND ................................................................................................................................... 13 DEFINITION ......................................................................................................................................... 13 Sub-sectors..................................................................................................................................................................... 13
METHODOLOGY ................................................................................................................................. 13 OVERVIEW OF HEALTH SECTOR IN BALLARAT ............................................................................ 14 Key health service providers ...................................................................................................................................... 14 Ballarat Health Services .......................................................................................................................................................14 St John of God Health Care ...............................................................................................................................................14 Ballarat Community Health Centre ....................................................................................................................................15 Central Highlands Primary Care Partnership .....................................................................................................................15 UFS Dispensaries ...................................................................................................................................................................16 Ballarat and District Division of General Practice .............................................................................................................16 Private Practitioners .............................................................................................................................................................16 Ballarat and District Nursing and Health Care ..................................................................................................................16 Ambulance Victoria ............................................................................................................................................................17 Department of Human Services .........................................................................................................................................17 Department of Health .........................................................................................................................................................17
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University of Ballarat .............................................................................................................................................................17 Australian Catholic University..............................................................................................................................................17 Other Universities ..................................................................................................................................................................17 City of Ballarat ......................................................................................................................................................................17
LITERATURE REVIEW ........................................................................................................................ 18 Sector overview and literature review summary ................................................................................................... 20 Recommendations ...................................................................................................................................................... 21
ECONOMIC ANALYSIS ....................................................................................................................... 21 Local expenditure and domestic imports ............................................................................................................... 23 Value of the sector ...................................................................................................................................................... 25 Economic analysis summary ...................................................................................................................................... 26 Recommendations ...................................................................................................................................................... 27
HEALTH SECTOR WORKFORCE....................................................................................................... 27 Capacity and sustainability ....................................................................................................................................... 27 Age profile ............................................................................................................................................................................28 Education and skills..............................................................................................................................................................30 Occupations.........................................................................................................................................................................32
Health sector workforce summary ............................................................................................................................ 36 Recommendations ...................................................................................................................................................... 36
CONSULTATIONS ............................................................................................................................... 37 Consultation process ................................................................................................................................................... 38
CONSULTATION FINDINGS ............................................................................................................... 39 Healthcare and accessibility ..................................................................................................................................... 39 Strengths ...............................................................................................................................................................................39 Weaknesses ..........................................................................................................................................................................40 Opportunities ........................................................................................................................................................................41 Threats ...................................................................................................................................................................................41 Enablers .................................................................................................................................................................................41 Commentary ........................................................................................................................................................................41 Recommendation ...............................................................................................................................................................42
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Providers and practitioners ......................................................................................................................................... 42 Strengths ...............................................................................................................................................................................42 Weaknesses ..........................................................................................................................................................................42 Opportunities ........................................................................................................................................................................42 Threats ...................................................................................................................................................................................43 Enablers .................................................................................................................................................................................43 Commentary ........................................................................................................................................................................43 Recommendation ...............................................................................................................................................................44
Workforce and development .................................................................................................................................... 44 Strengths ...............................................................................................................................................................................44 Weaknesses ..........................................................................................................................................................................44 Opportunities ........................................................................................................................................................................45 Threats ...................................................................................................................................................................................45 Enablers .................................................................................................................................................................................45 Commentary ........................................................................................................................................................................45 Recommendation ...............................................................................................................................................................45
Business and organisation ........................................................................................................................................... 46 Strengths ...............................................................................................................................................................................46 Weaknesses ..........................................................................................................................................................................46 Opportunities ........................................................................................................................................................................46 Threats ...................................................................................................................................................................................47 Enablers .................................................................................................................................................................................47 Commentary ........................................................................................................................................................................47 Recommendation ...............................................................................................................................................................47
Infrastructure and logistics .......................................................................................................................................... 47 Strengths ...............................................................................................................................................................................47 Weaknesses ..........................................................................................................................................................................47 Opportunities ........................................................................................................................................................................48 Threats ...................................................................................................................................................................................48 Enablers .................................................................................................................................................................................48 Commentary ........................................................................................................................................................................48 Recommendation ...............................................................................................................................................................48
Wellness and lifestyle ................................................................................................................................................... 49 Strengths ...............................................................................................................................................................................49 Weaknesses ..........................................................................................................................................................................49 Opportunities ........................................................................................................................................................................49 Threats ...................................................................................................................................................................................49
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Enablers .................................................................................................................................................................................49 Commentary ........................................................................................................................................................................49 Recommendation ...............................................................................................................................................................49
Consultations summary ............................................................................................................................................... 50
THE ROLE OF GOVERNMENTS ......................................................................................................... 51 RECOMMENDATIONS SUMMARY ..................................................................................................... 52 Advocacy and leadership ......................................................................................................................................... 52 Investment and development................................................................................................................................... 52 Workforce ...................................................................................................................................................................... 53
CONCLUSION ..................................................................................................................................... 53 APPENDIX 1: CONSULTATIONS....................................................................................................... 54 APPENDIX 2: KEY HEALTH SERVICE PROVIDERS IN THE BALLARAT REGION......................... 63 APPENDIX 3: LITERATURE REVIEW ................................................................................................ 66 APPENDIX 4: ECONOMIC DATA ....................................................................................................... 84 APPENDIX 5: HEALTH SECTOR WORKFORCE DATA .................................................................... 92
Tables Table 1: Table 2: Table 3: Table 4: Table 5: Table 6: Table 7: Table 8: Table 9:
Learnings and implications from sector overview and literature review ....................................................20 Economic performance of health and community services 2007-2010 .....................................................22 Local health sector expenditure trends......................................................................................................23 Key imported domestic products and services ..........................................................................................25 Job creation impacts ..................................................................................................................................25 Economic analysis summary .....................................................................................................................26 Workforce analysis summary ....................................................................................................................36 Consultation list .........................................................................................................................................37 Consultation analysis summary .................................................................................................................51
Figures Figure 1: Figure 2: Figure 3: Figure 4: Figure 5:
Output - all sectors - 2007-2010 ...............................................................................................................21 Health sector economic indicators 2007-2010 .........................................................................................22 Local expenditure by sector by health ......................................................................................................23 Domestic imports by the health and community services sector .............................................................24 Local expenditure versus domestic imports by sector .............................................................................24
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Figure 6: Employment - all sectors -2001 2006 .......................................................................................................27 Figure 7: Age profile comparison of the Ballarat workforce .....................................................................................28 Figure 8: Age profile comparison of the health sector workforce ............................................................................29 Figure 9: Age profile of all Ballarat industry sectors ................................................................................................29 Figure 10: Mature age workforce profile comparison ..............................................................................................30 Figure 11: Younger workforce profile for Ballarat ....................................................................................................30 Figure 12: Education profile comparison .................................................................................................................31 Figure 13: Education and qualifications across Ballarat industry sectors ...............................................................31 Figure 14: Occupation comparison ..........................................................................................................................32 Figure 15: Occupations across all Ballarat industry sectors....................................................................................33 Figure 16: Gender comparison of the Balarat workforce .........................................................................................33 Figure 17: Health sector male to female by age groups ..........................................................................................34 Figure 18: Health sector male to female by education / qualification ......................................................................34 Figure 19: Health sector male to female by occupation ..........................................................................................35 Figure 20: Male to female incomes in the health sector ..........................................................................................35
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Disclaimer The Ballarat Health Sector Analysis Report has been prepared specifically for the City of Ballarat the client. The Ballarat Health Sector Analysis Report and its contents are not to be referred to, quoted or used by any party in any statement or application, other than the City of Ballarat, without written approval from SED Consulting. The information contained in this document has been gained from anecdotal evidence and research. It has been prepared in good faith and in conjunction with the City of Ballarat. Neither SED Consulting, nor its servants, consultants, agents or staff shall be responsible in any way whatsoever to any person in respect to the Report, including errors or omission therein, however caused. SED Consulting - Central and Western
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Executive summary The City of Ballarat has commissioned this review to ascertain the capabilities and capacity of the health sector to meet the health and well-being needs of a growing population in and around Ballarat. The conduct of the review recognises the importance and value of the health sector and its associated interests and the important contribution that it makes to the socio-economic development of the community. The review has included an overview of key health service providers and support services in the Ballarat region; consideration of health policy and strategies at local, state and national levels; analysis of economic and workforce data relating to the Ballarat community and the health and community services sector; and a qualitative analysis based on a series of consultations with key health sector stakeholders in Ballarat. In broad terms, this review has shown that the sector is strongly positioned to provide high quality health and community care services which meet the diverse needs of the Ballarat community. The review has not highlighted significant, current gaps in service provision or key sector capabilities. Notwithstanding this statement, the review has revealed some emerging and potentially important issues and opportunities for the sector and community leaders to consider in relation advocacy and leadership, investment and development, workforce development and planning and associated promotion of the expertise and capabilities within the health and community services sector.
Key issues Advocacy and leadership Structural changes in the funding of health services by governments are anticipated to address a range of current and future health service provision issues. The progress and outcome of these new structures will not be known for some time, and with imminent elections, the health reform and policy may be subject to further revision and reform which cannot be anticipated at this time.
However, the
recognition that these issues are of critical importance is accepted across governments and we can therefore expect that programs and policy will be developed to address and mitigate them. Effective and responsive strategic planning that recognises the importance of corporate, clinical, academic, information and personal governance in healthcare is critical to the success of all healthcare organisations and practices in Ballarat.
Ultimately, the health, safety and wellbeing of
individuals and the community of Ballarat will depend on the alignment and achievement of these strategic goals. The City of Ballarat, Ballarat community, healthcare providers and educators can work together to improve healthcare delivery, outcomes and lifestyle in Ballarat. The City of Ballarat has a role in providing leadership to support the role of Ballarat, its community and region in the development, implementation and evaluation of the outcomes of new models of healthcare tailored to the needs and expectations of our community.
The City of Ballarat must
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City of Ballarat Health Sector Analysis Report
recognise and accept its important leadership and advocacy role in planning, developing, coordinating and enhancing healthcare in Ballarat. Investment and development The development and advancement of healthcare in Ballarat will depend on the adoption of new, best practice models of healthcare delivery and ensuring that Ballarat has access to and benefits from the latest and most advanced diagnostic, therapeutic, interventional and surgical technologies. Information and communications technology (ICT) is a strong sector in the Ballarat economy and offers significant opportunities to better integrate healthcare across Ballarat. Indeed, effective healthcare ICT can render the concept of a ‘health precinct’ redundant by linking patients, practitioners, and healthcare providers electronically and facilitating the delivery of quality healthcare services in the home, community or workplace. In order to support the potential of these flexible, ongoing investments, future sector opportunities will not only be focussed on ‘bricks and mortar’ developments, but also increasingly on technology based delivery, shared services programs for organisations and providers, and delivery of more home-based services. Import replacement opportunities (and associated investment attraction) may exist for the key products and services currently imported by the health sector.
Specialised manufacturing may need to be
supported by an investment business case due to potential high level of capital investment that would be required. The City of Ballarat can encourage healthcare providers, universities, local industries and government to foster translational research and development in quality improvement, service delivery, information technology, needs assessment, social health and clinical practice throughout Ballarat. Workforce Like nearly all sectors in Ballarat, the health and community services sector has shown good economic performance of the past few years. This has been driven by increased service demand, workforce growth and associated increases in funding and revenue streams. This continued growth, mainly demand driven, will impose pressures on the existing workforce and the overall capacity of the sector to meet demand. In addition, funding of public sector health services will undoubtedly become more competitive. Innovative solutions to workforce attraction and investment will need to be identified and implemented by the sector. Ballarat will increasingly become a location of choice for people seeking the health care they require and desire. It is also likely that the need to provide health services into the wider catchment region will also increase as neighbouring communities increase their populations.
A key issue will be how this
increased demand will be met especially as the population ages. In addition, with an ageing workforce profile and increased competition for workers in an increasingly tightening labour market, a further key
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issue for the sector is where it will source its required workforce. The development of required skills and qualifications by the sector within the sector may present opportunities for accessing an appropriately skilled workforce and assist with workforce attraction and retention activities How the sector manages its ageing workforce will become of increasing strategic importance. This will include workforce and employment structures to retain skills within the workforce for as long as possible. In addition, the potential loss of employers may exacerbate / negate workforce attraction efforts. Career path development for female workers and attracting highly qualified female professionals may be avenues for the sector to consider with the profile of the sector’s workforce presenting a growing proportion of female workers. This process may also need to be supported by innovative and flexible employment structures. The City of Ballarat, along with other healthcare organisations and agencies in Ballarat, should also consider specifically targeting young health professionals who have grown up or trained in Ballarat and the Grampians Region to encourage them to stay on or return to Ballarat on completion of their training.
The role of governments The Federal and State Government have the lead roles in setting policy and strategy for the provision of health and community services. This is undertaken through close liaison and co-operation with the sector and through assessments of current and future needs of communities. These processes of health service provision and the structures under which this occurs has been subject to significant review by Federal and State governments over recent months. At the time of this report, the final outcomes of these reforms to health service provision were subject to the results of the upcoming Federal election, to be held in August 2010. In addition, the State Victoria was also due to hold state election later in 2010. Therefore, it was felt that to provide stated positions on the roles of Federal and State government in relation to health care provision would not be appropriate at this time. For local government, the role can be more easily articulated, although it should be noted that the range and level of heath and community service by individual local councils will vary. In essence, local government’s role is to provide broad advocacy and leadership on the health and well-being needs of its community, based on an understanding of the structures and strategic thinking of its health service providers. This involves co-operative planning, vision setting, investment and development facilitation and identify where it can support the sector in terms of workforce attraction and retention.
Recommendations Advocacy and leadership The City of Ballarat should work with the health and education sectors to advocate for the attraction of ongoing and additional medical training dollars to the region.
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The City of Ballarat has a role in providing leadership to support the role of Ballarat, its community and region in relation to new models of healthcare, tailored to the needs and expectations of the community.
Consideration should be given to the establishment of timely briefings with targeted health sector decision makers to support health related strategic planning, vision setting, and dialogue between healthcare organisations in Ballarat and surrounding districts. The City of Ballarat must recognise and accept its important leadership and advocacy role in planning, developing, coordinating and enhancing healthcare in Ballarat. Investment and development The City of Ballarat should work with the regional health sector to identify opportunities for integrating primary health care services through the utilisation of the region’s strengths and capacities in eHealth and ICT. Where gaps in support ICT infrastructure and/or service solutions exist, opportunities to attract investment and leverage and build regional expertise should be explored.
In partnership with the sector, the City of Ballarat should identify tangible import replacement avenues and for increasing local spend. These opportunities should focus on existing or the development of potential supply / expertise within the region whilst also identifying opportunities for attracting new investment.
The City of Ballarat can encourage healthcare providers, universities, local industries and government to foster translational research and development in quality improvement, service delivery, information technology, needs assessment, social health and clinical practice throughout Ballarat.
To support health sector investment and development, the City should consider providing a health sector facilitation contact within the organisation. A major role of this position will be to assist and guide business and investment enquiries through Council processes. Workforce Opportunities exist for the City of Ballarat to work in partnership with health and community services providers to provide integrated marketing for workforce attraction and retention. In particular, the City can provide motivational materials and welcome packages for use by the sector as part of their recruitment campaigns.
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The importance of workforce planning based around the current and future demographic of the sector workforce should be advocated and supported by the City of Ballarat.
The City of Ballarat, along with other healthcare organisations and agencies in Ballarat, needs to specifically target young health professionals who have grown up or trained in Ballarat and the Grampians Region to encourage them to stay on or return to Ballarat on completion of their training.
Conclusion The City of Ballarat must recognise and accept its important leadership and advocacy role in planning, developing and enhancing healthcare in Ballarat. There is the potential to have Ballarat recognised as a leading centre of healthcare practice, eHealth, learning, research, health promotion and wellness and to build an evidence-base for healthcare improvements and outcomes that can support health reform locally, state-wide and nationally. This positioning may also provide the City, the sector and wider economy with opportunities to attract investment and provide for innovative product and service development opportunities within local and regional businesses.
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Background The City of Ballarat commissioned this review of the health sector in the immediate Ballarat region in order to ascertain the capabilities and capacity of the sector to meet the health and well-being needs of a growing population. The City recognises the importance and value of the health sector and its associated interests and the important contribution it make to the socio-economic development of the community. Ballarat’s health, well-being and community services sectors are growing rapidly and are the region’s second largest employer, employing over 15% of the workforce or nearly 6,000 people. Many health services are located in Ballarat but also provide care to a large regional catchment. The principal purpose of this report is to provide an overview of the health sector including relevant community services, and to present recommendations and guidance to further the development of the sector by exploring current capabilities, identifying current gaps and a review of current policy and strategic direction.
Definition The Australian Bureau of Statistics (ABS) defines the health and community services sector as being ‘units mainly engaged in providing human health care and social assistance. Units engaged in providing these services apply common processes, where the labour inputs of practitioners with the requisite expertise and qualifications are integral to production or service delivery’. There are six industry subdivisions for health under the Australian and New Zealand Standard Industrial Classification (ANZSIC) 2006 coding system.
Sub-sectors Hospitals and Nursing Homes
Veterinary Services
Medical and Dental Services
Child Care Services
Other Health Services
Community Care Services
To the meet the requirements of this project and following discussions with the project managers, the key sub-sectors of hospitals, medical and other health services were the focus of this review.
Methodology The core methodology employed to develop this report included: Interviews with key health service providers; A desktop review of key health service providers and support services in the Ballarat region; A desktop review of health policy and strategies at local, state and national levels; and
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Analysis of economic and workforce data relating to the wider Ballarat economy and the health and community services sector in particular.
Overview of health sector in Ballarat Ballarat plays an important regional role in the provision of health and community services. The Ballarat community has access to a range of healthcare facilities, including two major hospitals, a day procedure complex, over 100 general medical practitioners and more than 1,000 public and private, hospital, nursing and hostel beds. Ballarat Health Services (public hospital) and St John of God Health Care (private hospital) are located in central Ballarat. Both hospitals serve regional catchments and are leaders in research and development in areas of psychiatry, nursing, allied health, eHealth, and clinical medicine.
Key health service providers A high level review of key providers in Ballarat was undertaken. Although the listing does not include all health and community service providers in Ballarat, the following provides a summary of the main providers of health care and allied services in our community. A more detailed profile can be found in Appendix 2: Key health service providers in the Ballarat region. Annual reports and strategic plans for most of these organisations are available through their respective web-sites. Ballarat Health Services Ballarat Health Services (BHS) is the largest regional hospital and the principal referral hospital in the Grampians regions. BHS provides a comprehensive range of general and specialist care including: Acute care;
Residential care;
Sub-acute care;
Emergency services;
o Aged Care
Community care;
o Rehabilitation
Psychiatric services;
o Palliative Care
Outpatients and ambulatory services.
BHS also provide community-based psychiatric services in Horsham, Stawell, Ararat and Bacchus Marsh. St John of God Health Care The national St John of God Health Care organisation operates 14 hospitals in Australia and New Zealand, including St John of God Ballarat which recently underwent a $65m redevelopment. A new ward block, Emergency Department, cardiac and vascular catheter laboratory and outpatient rehabilitation facility were commissioned as part of the redevelopment. As St John of God’s largest Victorian hospital, and the state’s largest regional private hospital, it plays an important role in improving access to health services for communities across its wide geographic catchment.
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Ballarat Community Health Centre Ballarat Community Health provides services across four sites in Ballarat: Sebastopol, the City centre, East Ballarat and Wendouree. Outreach services and clinics are also provided at a range of locations throughout the Central Highlands. The organisation’s mission is to create opportunities and supportive environments which empower people to develop healthy lifestyles and prevent or manage illness. Ballarat Community Health Services include the following: •
Alcohol & Drug Services
•
Chronic disease management
•
Mental Health Services
•
Community Health Nursing
•
Counselling Services
Central Highlands Primary Care Partnership The Central Highlands Primary Care Partnership (CHPCP) encompasses four local government municipalities, including the City of Ballarat, Golden Plains Shire, Hepburn Shire and Moorabool Shire in the Central Highlands region. The CHPCP is a voluntary alliance of 36 health, local government, welfare and human service agencies working collaboratively with the community and other agencies to improve the health and well-being of the Central Highlands community: • Ballan and District Health and Care
• Golden Plains Shire Council
• Ballarat and District Aboriginal Co-Op
• Grampians Integrated Cancer Service
• Ballarat & District Division of General Practice
• Hepburn Health Service
• Ballarat Community Health Centre
• Hepburn Shire Council
• Ballarat and District Nursing and Healthcare
• Hesse Rural Health Service
• Ballarat Health Services
• Karden Disability Support Foundation
• Ballarat Hospice Care Inc
• McCallum Disability Service
• Bluearth
• Moorabool Shire Council
• Centacare
• PINARC
• Central Highlands General Practice Network
• Salvation Army Karinya
• Central Highlands Sports Assembly
• Southern Cross Care (Vic)
• Child and Family Services Ballarat
• St John of God Health Care
• City of Ballarat
• United Way Ballarat
• Department of Human Services Ballarat
• Uniting Care
• Department of Veteran’s Affairs Ballarat
• University of Ballarat
• Djerriwarrh Health Services
• Vision Australia Foundation
• Glastonbury Child and Family Services
• Women’s Health Grampians
UFS Dispensaries UFS Dispensaries is a not-for-profit, community based organisation running thirteen pharmacies, two pharmacy depots, a Medical Centre, a gift shop and a well-being centre throughout Western Victoria. Services include, Baby Club, Maternal & Child Health Nurse, Home Medication Reviews, Methadone Program, Healthcare Equipment Sales & Hire, Weight Management Programs, and NDSS. Ballarat and District Division of General Practice Ballarat and District Division of General Practice Inc. (BDDGP) is one of 100 divisions of general practice across Australia - currently 29 in Victoria. Ballarat and District Division of General Practice represents 118 GPs in the local area. BDDGP covers a geographic area of 7,300 square kilometres and a catchment population of approximately 122,000 people.
The catchment includes the city of Ballarat and the
outlying towns of Daylesford, Creswick, Clunes, Skipton and Ballan. BDDGP currently employs approximately 12.6 EFT staff working across a range of programs. Projects and programs run by BDDGP in 2008/2009 included, GP Well Being Program; Mental Health Program; Mental Health Support for Drought Affected Communities initiative; Aged Care Access Initiative; Continuing Professional Development; Nursing in General Practice and Immunisation Program; GP Training; Rural Palliative Care Project; and Primary Care Integration. Private Practitioners General practitioners, specialist doctors, nurses, allied health professionals, dentists and a wide range of other practitioners operate private practice businesses in and around Ballarat.
These include solo
practitioners, group practice and corporatised practices. The BDDGP is the peak representative body for the region’s general practitioners. Specialist medical practitioners are represented by their College specialty societies and associations. Ballarat and District Nursing and Health Care Ballarat and District Nursing and Health Care (BDNH) is the largest home nursing agency in the Grampians region and is one of only two independent HACC funded home nursing providers in Victoria. The core services offered by BDNH include: Nursing & Home Support Services; BDNH Podiatry; Footsteps to Fitness: building community awareness of the health benefits of walking, access to walking groups and walking options in the Ballarat and surrounding areas; and Grampians HACC Training: BDNH play a coordinating role in organising training and professional development for the full range of health and community services professionals working within the Home and Community Care (HACC) Program.
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Ambulance Victoria Ambulance Victoria is responsible for pre-hospital emergency medical care and patient transport and the majority of non-emergency patient transport (NEPT) services for the Victorian population. Ambulance Victoria currently has 250 ambulance branches strategically located throughout Victoria. Ambulance Service Victoria (ASV), based in Ballarat, manages ambulance services throughout regional and rural Victoria. On July 1st, 2008, ASV was integrated with the Metropolitan Ambulance Service to form Ambulance Victoria. Department of Human Services The Victorian Government Department of Human Services, through its Grampians regional office in Ballarat, oversees the delivery of disability, child protection, youth justice, housing, health and community services for 216,000 people who live in the region. Department of Health The Victorian Governments Department of Health works with the community to provide better access to health, aged care and mental health and drug services. This is done through managing the public hospital system, developing health infrastructure in rural and metropolitan Victoria, pursuing opportunities for partnership with the primary care sector and other governments, public health interventions, and implementing major health initiatives such as the Victorian Cancer Action Plan. University of Ballarat The University of Ballarat’s School of Nursing works in partnership with health care providers in Ballarat to offer innovative programs for nurses, midwives, aged care practitioners and other health professionals. Australian Catholic University The Ballarat Campus (Aquinas) offers Bachelor of Nursing / Bachelor of Paramedicine courses as well as graduate and postgraduate courses in midwifery and nursing research. Other Universities Deakin University, the University of Melbourne, the University of Notre Dame and Latrobe University all provide health professional training and clinical placements in Ballarat. City of Ballarat The City of Ballarat provides a range of health and community services to the Ballarat community. These include maternal and child health, immunisation, meals on wheels, family support programs, child care and play groups and aged in house support programs.
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Literature review A review of key health strategy and policy was completed with a more detailed analysis of this review contained in Appendix 3: Literature Review. The review aimed to highlight the key drivers of health sector development and the issues supporting or constraining this growth and development particularly within Ballarat. Whilst many health service providers are located within the Ballarat region, according to the Ballarat Health Services Strategic Service Plan and Model of Care (2006) their catchment area spreads across 12 local government areas and covers 20% of the State. The Ballarat Health Sector therefore acts as a central point for regional services spanning a wide area of the Victorian population. Ballarat’s health and community services sector is the second highest employing industry in Ballarat (behind retail trade) employing 5,829 people, or 15.4% of Ballarat’s workforce (Economic Strategy 20102014). Ballarat is served by a skilled and committed group of medical practitioners representing most medical specialties including general practice, internal medicine (physicians), aged care and rehabilitation, anaesthetics, surgery, obstetrics and gynaecology, paediatrics, psychiatry and emergency medicine. The Ballarat Health and Community services industry is progressive, adding value through the use of technology in remote health care and imaging, and is closely linked with the education sector through medical and clinical schools.
The industry also utilises Ballarat’s information and communications
technology capabilities, with many health providers and ICT firms forming partnerships in order to aid, for example, the management of health information systems. The City of Ballarat eHealth Capability Study (2009) highlights these developments and opportunities. Along with highlighting the key strength and capabilities of the Ballarat Health Sector, the literature also emphasises a number of current and emerging challenges presented to the industry.
These main
challenges include the growing and aging of the population, and skill shortages. According to the Ballarat Health Services Strategic Service Plan and Model of Care (2006), the population within Ballarat’s catchment is projected to increase to 239,856 persons by 2016, which represents an increase of 0.7% per annum, over this time period. Ballarat’s own population is expected to grow by 15, 716 person over the same time period, an annual increase of 1.1% per year1. In addition, the proportion of people over 70 years of age in the region is expected to increase significantly over the next 20 years. These trends, along with a steady national increase in the demand for elective surgeries, will present significant and ongoing growth in the demand for primary and allied health services. However it appears that problems with capacity are beginning to emerge with the Economic Strategy 2010-2014 highlighting the capacity issues faced by the Ballarat Austin Radiology Oncology Centre.
1
Source: id population forecasts - http://forecast.id.com.au/Default.aspx?id=210&gid=10&pg=30011
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The literature proposes a number of strategies to combat these issues. For example, Rural Directions for a Stronger, Healthier Victoria (2009), suggests that the region needs to continue to transform service provision and develop flexible service models to meet community needs. Consolidating health and community services, according to the Economic Strategy 2010-2014, as a strategic service sector for Ballarat and surrounding regions is the key to meeting growing demands generated by population growth.
The Central Highlands Regional Strategy (2010) advises that in order to meet this growing
demand, particularly for aged persons, more home-based health services will be required to alleviate strain on the hospitals. Another major challenge presented to Ballarat Health Services is the ability to attract and retain appropriately qualified health professionals including senior and junior medical staff, general and specialised nurses and allied health professionals.
According to the Grampians Region Nurse
Recruitment Five-year Plan (2006), there were approximately 4,300 nurses (3,350 FTE) living and working in the Grampians region in 2005. This report also cites that nurse numbers are expected to decline as health services located in larger rural towns or near major regional cities experience difficulties in attracting and retaining nurses. Furthermore, the supply of nurses is also expected to decrease due to an ageing workforce. The literature suggests that there is a lack of graduate and experienced nurses interested in working in rural areas. Similarly, it appears that practicing in rural areas is also not attractive to many doctors. These trends have prompted the development and implementation of strategies aimed at attracting Division 1 and 2 nurses, and qualified general practitioners and their families to the Ballarat region (See the Grampians Region Nurse Recruitment Five-year Plan and the GP Recruitment Kit). These strategies aim to promote Ballarat and build its reputation in order to become a preferred location for medical, nursing and allied health clinicians as well as clinical placements for medical students (Economic Strategy 2010-2014 pg 19). In the May 2009 budget, the Federal Government announced incentive schemes to encourage doctors to relocate to regional and rural areas. Direct incentives range from $15,000 for relocation to regional areas up to $120,000 for very remote areas. The Ballarat health sector provides an array of services for the health and wellbeing of its community. But in the face of emerging challenges, it is the consolidation of existing services, continual innovation, and the ability to attract qualified medical professionals to the region that will sustain the level of capabilities required to meet the health service demands brought upon by the growing, ageing population.
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Sector overview and literature review summary Learnings
Implications
Ballarat has access to a high
Ballarat will increasingly become a location of choice for people
range of public and private
seeking the health care they require and desire. It is also likely that
medical services supported by
the need to provide health services into the wider catchment
extensive expertise, technology
region will also increase as neighbouring communities increase their
and support care services.
populations. A key issue will be how this increased demand will be met especially as the population ages.
Many of the key health service
The importance of delivering investment in health services is
providers (St John of God, BHS,
recognised by the public and private sector. In order to support
UFS) have attracted or
the potential of flexible, ongoing investments will not only be
undertaken investment to
focussed on ‘bricks and mortar’ developments, but also
increase health service
increasingly on technology based delivery, shared services
provision.
programs for organisations and providers, and delivery of more home-based services.
Certain occupations and in
Direct intervention by governments through initiatives such as
particular nursing, appear to be
relocation incentive schemes, and broader promotion opportunities
reaching a level of criticality of
aimed a medical professionals may address some shortages in
supply. The drain of medical
some areas. However, relocation decisions made by professionals,
staff from rural areas into larger,
particularly those with partners and / or families are also influenced
regional centres and the ageing
by supporting lifestyle, liveability, partner careers and other
of the workforce are expected
considerations associated with relocation which may not be
to further impact on service
directly or adequately addressed by some of these intervention
capacity, particularly in rural
initiatives.
areas. In summary, the literature
Structural changes in the funding of health services by governments
particularly highlights issues
are anticipated to address some of these health service provision
around the consolidation of
issues. The progress and outcome of these new structures will not
existing services, continual
be known for some time, and with imminent elections, the health
innovation and staff attraction
reform and policy may be subject to further revision and reform
and retention. This last issue is
which cannot be anticipated at this time. However, the
being impacted by an ageing
recognition that these issues are of critical importance is accepted
workforce and a growing and
across governments and we can therefore expect that programs
ageing population.
and policy will be developed to address and mitigate them. Table 1: Learnings and implications from sector overview and literature review
City of Ballarat Health Sector Analysis Report
Page 21 of 94
Recommendations The City of Ballarat should work with the regional health sector to identify identify opportunities for integrating primary health care services through the utilisation of the region’s strengths and capacities in eHealth and ICT. Where gaps in support ICT infrastructure and/or service solutions exist, opportunities to attract investment tment and leverage and build regional expertise should be explored.
Opportunities may exist for the City of Ballarat to work in partnership with health and community services providers to provide integrated marketing for workforce attraction and retention. In particular, the City can provide motivational materials and welcome packages for use by the sector as part of their recruitment campaigns.
Economic analysis An analysis of the economic performance of the health sector was completed using REM REMPlan economic modelling data for the City of Ballarat. The following provides an analysis summary with full data provided in Appendix 4: Economic data. data
Figure 1: Output - all sectors - 2007-2010
The health and community services sector is the fifth most important sector in terms of output (total revenues) and demonstrates a 50.2% .2% growth in output from $455.6m $455.6m in 2007 to $684.2 in 2010. All sectors except agriculture show output growth over the same period of time. Within the two sub sub-sectors of health services and community services, health services account for 87.5% of total output ($598.1m in 2010). Health services has grown slightly more than community services at a rate of 53.3% over the 2007 to 2010 period.
City of Ballarat Health Sector Analysis Report
Page 22 of 94
Although output is a measure of a sector’s performance, due to the service nature of the sector and the significant government funding it receives and high level sector policy structures, it is somewhat problematic to make commentary in relation to the economic performance for this sector. The health and community services sector is a growth industry in terms of both outputs and employment and this may increase competition within in the sector for funding and difficulties in attracting and retaining health sector workers in an increasingly tightening labour market. The following table and figure shows the performance of the health sector and the wider Ballarat economy between 2007 and 2010 using key REMPlan indicators. It shows that the health sector has performed on par with the wider Ballarat economy against the key indicators. $
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Table 2: Economic conomic performance of health and community services 2007-2010 2007
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Figure 2:: Health sector economic indicators 2007-2010 2007
The health has shown positive performance across the key indicators. There has been significant growth in local expenditure by the sector (that is ‘spend’ by the sector within the Ballarat municipality) and good growth in wages and salaries and value add. Whilst acknowledging that there will be some significant variances in wages within the sector, average wages and salaries within the sector has grown from $59,000 per person employed to $75,160 per person, an increase of 27.4%.
City of Ballarat Health Sector Analysis Report
Page 23 of 94
Local expenditure and domestic mestic imports The health sector purchases just over $87m of local products and services within the Ballarat economy. Figure 3 shows that the key sectors ors purchased from are property and business services and manufacturing. The main services purchased from property and business services are legal, accounting, marketing and business management services and scientific research, technical and computer services. serv From manufacturing, the health sector chiefly purchase purchasess other machinery and equipment and chemical and chemical products. %
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Figure 3: Local expenditure by sector by health
Further analysis of the local expenditure trends shows that health and community services buys good and services at the following level from the following key sub sectors ($ spend +$5m in 2010). Sector
2007 ($m)
2010 ($m)
Property & business services
$9.6
$22.2
$12.6
132%
Communication services
$3.2
$9.2
$5.9
185%
Wholesale trade
$2.3
$7.9
$5.6
238%
Finance & insurance
$2.5
$7.1
$4.6
181%
Other machinery & equipment
$2.2
$6.3
$4.1
187%
Personal & other services
$2.9
$5.9
$3
104%
Total
$22.7
$58.6
$35.8
158%
Table 3: Local health sector expenditure trends
$ ($m)
%
City of Ballarat Health Sector Analysis Report
Page 24 of 94
The health and community services sectors imports a total of $59.4m of product and services, and of this, $53.6m is imported from within Australia. Figure 4 shows that manufactured products comprise the th majority of domestic imports followed by property and business services. *
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Figure 4:: Domestic imports by the health and community services sector
A comparison was also made of local expenditure versus domestic imports by sector by the health sector. This was undertaken in order to ascertain where the greatest opportunity may exist for import replacement and associated ociated investment attraction. %
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Figure 5:: Local expenditure versus domestic imports by sector
Page 25 of 94
City of Ballarat Health Sector Analysis Report
Figure 5 shows that manufacturing is the only sector where imported products are greater in value than products purchased locally by the health sector. Table 4 provides an analysis of the key sub-sectors within manufacturing and property and business services and shows that the health and community services sectors imports the following products and services. Product / sector
Value
Photographic and scientific equipment
$10.7m
Medicinal and pharmaceutical products
$6.2m
Legal, accounting, marketing and business management services
$4m
Other business services
$3.4m
Paper containers and products
$3m
Table 4: Key imported domestic products and services
The two main manufactured products would appear to be highly health sector specific and specialised. Investment attraction within these supply chains would need to a very robust business case due to the potentially high level of development investment required. The property and business services imported would appear to be areas which local Ballarat companies could increase supply to the health sector.
Value of the sector Research and analysis undertaken by the Council as part of the ED2014 shows that property and business services, health and community, manufacturing and ICT are among the economic drivers of the local economy. Table 3 would appear to further support this thinking with key support sectors of health including those identified sectoral economic drivers. It would also appear to support the premise that growth sectors within the local economy both support and derive benefit from each other. Another indicator of the value of the sector is analysing the impacts on job creation within the sector on the wider economy. As noted, the health workforce has grown by 16.5% over a five-year period. If this trends continues, we can estimate that the workforce will grow by at least a further 1,000 employees over the next 5 years. Using impact modelling, Table 5 shows the multiplier of this employment growth. Direct Effect
Industrial Flow On Effect
Consumption Flow On Effect
Total
Type 1 Multiplier
Type 2 Multiplier
Output ($M)
$117.4
$21.7
$76.2
$215.3
1.185
1.834
Employment (Jobs)
+1,000
71
338
1,409
1.071
1.409
Wages and Salaries ($M)
$75.2
$5.7
$21.6
$102.5
1.076
1.363
Value Added ($M)
$92.2
$9.7
$35.3
$137.2
1.105
1.487
Table 5: Job creation impacts
City of Ballarat Health Sector Analysis Report
Page 26 of 94
The table shows that 1,000 jobs created within the health and community services sector leads to a further 71 jobs created within the sector and 338 in other industry sectors. These would be mainly in retail (125), property and business services (38), manufacturing and education (29 each). In addition, the economic flow-ons include an increase in overall output within the economy of $215.3m, additional wages and salaries of $102.5m and a further $137.2m in value-add within the economy. These multiplier effects would be similar to like job creation within education, retail and personal and other services sectors. When compared to multiplier effects within other sectors such as manufacturing, professional and business services, and communication services, the health and community services sector impacts are relatively low. This is in part due to the lower levels of local intra-sector linkages of the health sector and its public service delivery rather than ‘commercial product’ profile.
Economic analysis summary Learnings
Implications
Like nearly all sectors in Ballarat,
This continued growth, mainly demand driven will impose
the health and community services
pressures on the existing workforce and the overall capacity of the
sector has shown good economic
sector to meet demand. In addition, funding of public sector
performance of the past few years.
health services will undoubtedly become more competitive.
This has been driven by increased
Innovative solutions to workforce attraction and investment will
service demand, workforce growth
need to be identified and implemented by the sector.
and associated increases in funding and revenue streams. Growth in the health sector has
Although an important driver within the local economy, these flow
important economic flow on
on benefits are not as high as similar growth impacts from within
benefits to the wider Ballarat
other sectors. In addition, local expenditure by the sector within
economy.
Ballarat is relatively low apart from property and business services and manufacturing. This may present opportunities for increasing expenditure by health within other sectors.
Key imports by the health sector
Import replacement opportunities (and associated investment
appear to be within specialised
attraction) may exist for the key products and services currently
manufacturing and property and
imported by the health sector. Specialised manufacturing may
business services.
need to be supported by an investment business case due to potential high level of capital investment that would be required.
This high wage sector provides
Provides a competitive advantage for the sector in relation to
significant ‘value’ to the local
workforce attraction and retention and employment generation
economy.
in other sectors. Table 6: Economic analysis summary
City of Ballarat Health Sector Analysis Report
Page 27 of 94
Recommendations In partnership with the sector, the City of B Ballarat allarat should identify tangible import replacement avenues and for increasing local spend. These opportunities should focus on existing or the development of potential supply / expertise within the region whilst also identifying opportunities for attract attracting new investment.
Health sector workforce Capacity and sustainability Helath and community services is the second most important employment sector after retail trade and accounts for 15.5% of workforce, employing 5,829 people. The workforce has grown by 16.5% between 2001 an 2006 (ABS Census data periods), an increase of 824 824 employees. Should this employment trend continue at the same rate, it can be estimated that there will be approximately 6,790 employed in the sector in 2011. The City of Ballarat Economic Strategy 2010-2014 2010 2014 (ED2014) estimates that by 2026, there will be e 10,941 people working in the sector. Within the two subsub sectors, health services employ 4,543 people which represents 13.5% of the total Ballarat workforce and 80% of the total sector workforce. The REMPlan workforce modelling system uses ABS Census data data from 2006 which shows that the total workforce is Ballarat at that time was 37,708 people working in Ballarat.
Sector workforce figures
presented are based on this figure. +
. /"
. /"
Figure 6: Employment - all sectors -2001 2006
The following provides a summary of the key workforce characteristics and profiling of the workforce. More in-depth depth workforce data is provided in Appendix 5: Health sector workforce data data.
City of Ballarat Health Sector Analysis Report
Page 28 of 94
Age profile Using REMPlan data sets, Figure 7 presents the overall age profile of the Ballarat workforce compared to state and national profiles. ,
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Figure 7:: Age profile comparison of the Ballarat workforce
There e are some differentials between the age profile of the Ballarat workforce and state and national profiles. Ballarat has a slightly higher proportion of workers aged under 24 years, but this profile then declines between the years of 25 and 44 years. This This may indicate a loss of workers from the region in this age group. Workers aged between 45 and 54 years is slightly higher in Ballarat than elsewhere and slightly lower in the 55 to 74 years age groups.
The data shows that 47% of the workforce in Ballarat Balla is
aged between 35 and 54 years. However, when we look at the age profile comparisons within the health and community services sector, we see a different profile as presented in Figure 8.
City of Ballarat Health Sector Analysis Report
,
-
Page 29 of 94
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Figure 8:: Age profile comparison of the health sector workforce
The 15 to 34 age groups are lower in the Ballarat health sector workforce than elsewhere. The age profile then increases with nearly 32% of the health sector workforce in Ballarat aged between 45 and 54 years compared to 28.7% for Victoria and 29.1% for Australia as a whole.
The workforce then
becomes slightly younger than elsewhere from 55 years years of age and over. Finally, a comparison was made of the age profile of the workforce across all industry sectors in Ballarat as shown in Figure 9. $
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Figure 9: 9 Age profile of all Ballarat industry sectors
The data shows that the health sector has the second highest proportion of workers in the 45 to 54 age groups, and the fourth oldest workforce across all industry sectors in Ballarat. This his profile is more clearly defined in Figure 10.
City of Ballarat Health Sector Analysis Report
.
-
Page 30 of 94
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Figure 10: 10 Mature age workforce profile comparison
It can be anticipated that this older workforce profile will create capacity issues for the sector as service demand increases and the need to additional staff and professionals also grows. The capacity of the sector to ‘back-fill’ fill’ occupations also appears appear to be somewhat constrained due to the lower proportion of current workers aged under 45 years. This younger age workforce profile is presented in Figure 11. 1
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Figure 11: Younger workforce profile for Ballarat
Education and skills Figure 12:: Education profile comparison presents the level of education / qualification of the total Ballarat workforce compared to Victoria and nationally. The data shows show that generally the Ballarat workforce has comparable levelss of qualifications to the rest of the Australia population and in some cases higher education attainment.
City of Ballarat Health Sector Analysis Report
Page 31 of 94
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Figure 12: Education profile comparison
Figure 13 presents in a comparison of education and qualification achievement of the Ballarat workforce across all industry sectors. The The health and community services sector has the second highest number of people with an education and qualification of any industry industry, after the education sector sector. Within its workforce of 5,830 people, 4,027 hold a stated state qualification of some kind, (69% of the health workforce).
This compares to the education sector where 80% of the workforce has attained a
qualification. In effect, this provides the health sector with an existing pool of over 1,800 workers where a qualification has not been attained or was not stated or described adequately within Census responses. ponses. This pool may provide the sector with some opportunities to develop skills and capabilities from within its existing workforce. 2
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Figure 13:: Education and qualifications across Ballarat industry sectors
City of Ballarat Health Sector Analysis Report
Page 32 of 94
Occupations Analysis ysis was made of the occupations within the wider Ballarat workforce and the health sector workforce as shown in Figure 14 and Figure 15.. Ballarat has a lower representation of managers and professionals within the wider workforce but higher levels of trades and technicians, labourers and community and community and personal service workers. This reflects the manufacturing base of the Ballarat economy and the cityâ&#x20AC;&#x2122;s role as a regional service service provider. When we compare occupations across Ballarat industry sectors, it is not surprising that we see a high level of professionals within the health.
Professionals and managers comprise 47.8% of the health workforce compared to 69% within
the education sector.
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City of Ballarat Health Sector Analysis Report
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Page 33 of 94
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Figure 15:: Occupations across all Ballarat industry sectors
Finally, an analysis was made of the gender profile of the workforce. workforce. The number of females employed in the Ballarat workforce is 49.5% of the total workforce. The health sector has a high level of female participation in the workforce at 77.7%. This is comparable to the male profile of the manufacturing sector at 75.9%. When compared to state stat and national figures, the female profile of the health sector workforce in Ballarat shows a higher number of female employees within the 35-54 54 age groups. .
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Figure 16:: Gender comparison of the Ballarat workforce
City of Ballarat Health Sector Analysis Report
.
-
Page 34 of 94
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Figure 17:: Health sector male to female by age groups
The following three graphs show the qualification, occupation and income profiles of the health sector by gender. Female qualifications and occupations generally parallel the percentage percentage of females within the workforce. However differentials begin to emerge in the weekly income levels of females most notably in the higher income brackets form $1,000 - $1,299 and more particularly above $1,600. .
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Figure 18: Health sector male to female by education / qualification
City of Ballarat Health Sector Analysis Report
Page 35 of 94
.
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.
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Figure 20:: Male to female incomes in the health sector
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Page 36 of 94
City of Ballarat Health Sector Analysis Report Health sector workforce summary Learnings The
Implications
sector
workforce
has
experienced
With
an
ageing
workforce
profile
and
increased
growth of 16% over a five year period which
competition for workers in an increasingly tightening
will equate to over 10,500 people being
labour market, a key issue for the sector is where it will
employed in the sector in 2026.
source its required workforce.
The age profiling shows that the sector has
How the sector manages its ageing workforce will
a
become of increasing strategic importance.
generally
older
workforce
when
This will
compared to state and national figures and
include workforce and employment structures to retain
the fourth oldest workforce of any sector in
skills within the workforce for as long as possible.
Ballarat.
addition, the potential loss of employers may exacerbate
As the workforce ages, we can
expect this age differential within the sector
In
/ negate workforce attraction efforts.
to increase. Even though the health sector has the
The development of required skills and qualifications by
highest level of qualification attainment
the sector within the sector may present opportunities for
when compared to other sectors in Ballarat,
accessing an appropriately skilled workforce and assist
there are just over 30% of the health sector
with workforce attraction and retention activities.
workforce who do not have a clearly stated qualification. Females represent a significant part of the
Career path development for female workers and
health sector workforce at 77.7%. Although
attracting highly qualified female professionals may be
their qualifications and occupations mirror
avenues for the sector to consider. This process may also
this percentage when compared to males,
need to be supported by innovative and flexible
income parity begins to decline within the
employment structures.
higher wage brackets. Table 7: Workforce analysis summary
Recommendations The City of Ballarat should work with the health and education sectors to advocate for the attraction of ongoing and additional medical training dollars to the region.
The importance of workforce planning based around the current and future demographic of the sector workforce should be advocated and supported by the City of Ballarat.
Page 37 of 94
City of Ballarat Health Sector Analysis Report
Consultations The following representatives of key Ballarat health sector organisations were interviewed during June and July 2010: Person
Position
Organisation
Mr Andrew Rowe
Chief Executive Officer
Ballarat Health Services
Ms Lynne McLennan
Chief Executive Officer
UFS Dispensaries, Ballarat
Dr Lynette Stockhausen
Professor and Head, School of Nursing
University of Ballarat Ballarat and District Division of
Mr Andrew McPhearson
Chief Executive Officer
Ms Betty McGuinness
Head, School of Nursing
Australian Catholic University
Mr John Fogarty
Chief Executive Officer
St John of God Health Care, Ballarat
Ms Joanne Gell
Chief Executive Officer
General Practice
Ballarat District Nursing and Healthcare
Ms Bronwyn Herbert (with Sean Cameron, Manager
Coordinator Community Planning
City of Ballarat
Economic Development) Victorian Department of Health,
Mr Tom Niederle
Director, Health & Aged Care
Ms Robyn Reeves
Chief Executive Officer
Ballarat Community Health Centre
Chief Executive Officer
Ambulance Service Victoria
Mr Greg Sassella (with Greg Lynch) Ms Helen Wade
Prof. Mark Yates
Executive Officer Director of Internal Medicine and Director of Clinical Studies Table 8: Consultation list
Grampians Regional Office
Central Highlands Primary Care Partnership Ballarat Deakin Clinical School
City of Ballarat Health Sector Analysis Report
Page 38 of 94
Consultation process One to one interviews were conducted using templates developed with the MindManager c computer mapping tool (MindManager Pro 7, Mindjet Corporation, San Francisco, Calif, USA) to guide and document discussions. The templates were displayed in front of interviewees on an Apple iPad which wirelessly emulated the screen in front of the intervi interviewer. ewer. A sample template is shown below: The notes taken during the interviews appeared on the screen and were able to be reviewed an validated by the interviewee before the interview concluded. The notes were extracted from MindManager, loaded into a spreadsheet, preadsheet, broken down into individual statements, classified and sorted before being used as a basis for the detailed reports that follow. The verbatim comments are reproduced in Appendix 1 â&#x20AC;&#x201C; Consultation List. The health governance model outlined below provided a broad structure for the consultations. It looks at health from a number of key perspectives and identifies important enablers that might enhance health and healthcare in Ballarat.
Enablers: Education & Research
Enabler: Strategic Planning
Workforce & Development
Enabler:: Evidence-based Best Practice
Business & organisation
Healthcare & Accessibility
Providers & Practitioners
Wellness & Lifestyle
Infrastructure & Logistics
Enablers: Recruitment & Retention
Enablers:: City of Ballarat & Community Enabler: Information & Communication Technology
City of Ballarat Health Sector Analysis Report
Page 39 of 94
Consultation findings Healthcare and accessibility Strengths All healthcare providers reported high levels of activity and a determination to serve the Ballarat community as well as a wider regional role as a hub for specialist and referral services. The major public hospital service provider, Ballarat Health Services, continues to develop and expand its services, including: Cancer services (Ballarat Regional Integrated Cancer Centre, Breastscreen); Emergency Medicine; Acute Medicine including cardiology, endocrinology and renal medicine; Surgical Services across a range of surgical specialties in response to elective surgery waiting list priorities and emergency workload; Mental Health services (inpatient, community-based and regional); and Aged care and subacute services including rehabilitation and palliative care. St John of God Hospital, Ballarat has undergone a major redevelopment including: Five wards; Emergency Medicine service; Hydrotherapy Pool; Day Procedure Centre; Pharmacy; Chapel; Cardiac and vascular angiography suite; and Refurbishment of five operating rooms. St John of God Hospital continues to provide a wide range of private acute medical services with a particular emphasis on interventional angiography services including the provision of public angiography services in association with Ballarat Health Services. St John of God Health Care has also recently expanded its home nursing division, St John of God Health Choices, through the acquisition of a Melbourne-based home nursing provider. The Ballarat Austin Radiation Oncology Centre (BAROC) represents an important example of effective cooperation between Ballarat Health Services, St John of God Hospital and a major metropolitan teaching hospital (Austin Health) which has directly benefited the community of Ballarat and the wider Grampians Region.
City of Ballarat Health Sector Analysis Report
Page 40 of 94
Ambulance Service Victoria plays a critical role in emergency and, in association with other transport providers, non-emergency patient transport in Ballarat and the Grampians Region.
Quality and
performance indicators demonstrate significant improvements in patient outcomes in emergency transport situations. The Ballarat Community Health Centre promotes health and well-being in the community and provides quality and affordable health care. Services include: alcohol and other drug services; early intervention in chronic disease management; mental health services; community health nursing; general practitioner services; allied health services; sexual health and specialised clinics. Ballarat District Nursing and Healthcare (BDNH) provides a wide range of home-based nursing services, working in close cooperation with the City of Ballarat (Home and Community Care), the Primary Care Partnership and other healthcare providers in Ballarat and surrounding districts. BDNH has a reputation for excellence in its service provision and innovation in the use of mobile health information technology. General and specialist medical practitioners provide medical services through private medical practices, health services and clinics in the Ballarat area. Many also travel outside Ballarat to provide medical services across the Grampians Region. Despite major workforce challenges, the quality and accessibility of medical services has been sustained and improved in recent years. The Ballarat and District Division of General Practice has worked in close cooperation with hospitals and health services to improve integration and communication in the best interests of patients, carers and families. The Ballarat Health Services Perinatal Support Unit is a practical and successful example of this cooperative effort. The City of Ballarat is also a major provider of health related services through its Home and Community Care aged care programs, Wellness Programs, legislated responsibilities under the Health Act and through the Municipal Public Health Plan, indigenous and other programs. Weaknesses Social disadvantage, lower life expectancy and greater burden of disease as compared with other areas of Victoria are placing growing demands on acute, subacute, community and other healthcare services in Ballarat.
Variability in demand (e.g. influenza pandemics), the complexity of modern
healthcare, inequities in funding, difficulties in integration and communication and the influence of power and politics also all impact on healthcare delivery in Ballarat and elsewhere in regional Australia. As in most regional areas of Australia, Ballarat is facing the challenges of developing and maintaining a sustainable health workforce.
Demand continues to increase as residents of Ballarat and the
Grampians Region rightly demand a level and quality of healthcare services comparable to those available to metropolitan communities, national and international best practice. It is difficult to identify significant gaps in the range of health services that are available in Ballarat. Growing demand for services and workforce issues span all sectors, organisations and service providers.
City of Ballarat Health Sector Analysis Report
Page 41 of 94
Opportunities There are enormous opportunities to further develop and improve healthcare in Ballarat. The development and implementation of the Grampians Integrated Cancer Service provides an opportunity to better integrate all aspects of cancer diagnosis and treatment and to develop new evidence-based models of cancer prevention, treatment, care and support. The planning and approval of funding for the Ballarat Regional Integrated Cancer Centre will provide state of the art facilities, allowing Ballarat to build on the success of BAROC, medical oncology services, surgical oncology and the excellent palliative care services available in the region. The ageing population presents challenges but also enormous opportunities for health services and the City of Ballarat.
The development and improvement of primary care, acute hospital, subacute,
residential and other aged care services will benefit the Ballarat community and also contribute to employment, workforce development and economic growth across Ballarat. The national focus on the improvement of mental health services will offer the opportunity to develop new and improved models of mental health care in Ballarat. A redevelopment of the acute psychiatric facilities of Grampians Psychiatric Services is underway.
There are opportunities to further develop
outpatient and community services. Ballarat and District Division of General Practice has a particular interest in the development of adolescent mental health programs. Primary health services should be strengthened and improved through the implementation of Primary Health Care Organisations and Medicare Locals. The â&#x20AC;&#x2DC;superclinicâ&#x20AC;&#x2122; model may provide opportunities for Ballarat, particularly in the growing western corridor. New group general practices, specialist centres, primary health, risk screening and preventative healthcare services (including the possibility of a University of Ballarat multidisciplinary teaching clinic at the SMB Campus) are all under consideration. Threats Imminent State and Federal elections, health reforms and the complexity of healthcare can all threaten the rational development of health services in regional centres such as Ballarat. Enablers The development and advancement of healthcare in Ballarat will depend on the adoption of new, best practice models of healthcare delivery and ensuring that Ballarat has access to and benefits from the latest and most advanced diagnostic, therapeutic, interventional and surgical technologies. Commentary Ballarat is ideally structured and positioned to build an evidence-base for healthcare improvements and outcomes that can support health reform locally, state-wide and nationally.
Page 42 of 94
City of Ballarat Health Sector Analysis Report Recommendation
The City of Ballarat has a role in providing leadership to support the role of Ballarat, its community and region in relation to new models of healthcare, tailored to the needs and expectations of our community.
Providers and practitioners Strengths Health care providers and health professionals form the backbone of healthcare provision in Ballarat. Ballarat offers a unique healthcare practice and employment environment, cherished by the majority of those within it and eminently marketable to trainees, graduates and established practitioners elsewhere. Medical practitioners, nurses, allied health professionals, scientific and technical staff have the opportunity to practice in a comprehensive healthcare system offering primary, secondary and tertiary healthcare services in all but a few highly specialised areas.
Undergraduates, new graduates,
vocational and specialist trainees, senior and management staff in both the public and private sectors have the opportunity to develop a wide breadth and depth of practice and to see the results of their practice reflected in the health and wellbeing of their community and region. Weaknesses The growing demand for health services and the delayed recognition nationally that there is a severe shortage and misdistribution of health professionals across all disciplines and services has meant that practicing clinicians have had to deal with a growing workload and increased requirements for teaching and supervision of both undergraduate and early graduate health professionals. Overworked health professionals can easily become disillusioned and dissatisfied. It may be difficult for them to rise above the day-to-day workload and become actively engaged in the development and implementation of new practices and models of care. Ballarat and other regional centres must also deal with common perceptions that practice in country areas is less challenging, fulfilling and interesting that practice in metropolitan areas. It is important to keep stressing the lifestyle, family and personal benefits of regional and rural practice. Opportunities Ballarat can and does demonstrate the attractions and benefits of regional and rural health professional practice. Smaller and more responsive healthcare providers and businesses can provide practice environments and demonstrate career pathways that allow new graduates and vocational trainees to consolidate their knowledge and skills and build a satisfying and rewarding patient-base and clientele.
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City of Ballarat Health Sector Analysis Report
New employment models for trainee midwives (combining training and part-time employment), combined paramedic/nurse roles and the development of specialist nursing and nurse practitioner roles are examples of new models of practice that are being developed in Ballarat and the Grampians Region. Ballarat offers outstanding employment and lifestyle opportunities, given its proximity to Melbourne (allowing commuting in either direction), arts, sporting and residential options (including in urban, semirural and rural settings). Threats Disillusioned and dissatisfied health professionals, if not properly supported, may leave Ballarat and move to metropolitan Melbourne or elsewhere. An ageing workforce also means that many senior and experienced health professionals are approaching retirement.
Some are electing to retire early
because of the pressure of work. All of these developments impact on the workload, satisfaction and work-life balance of those who remain. Enablers Effective recruitment and retention strategies are crucial to the sustainability of providers and practitioners in Ballarat. These may include: Recruitment websites e.g. My Ballarat My Community; organisations (BHS, St John of God etc.); New resident Welcome Booklet and New Resident Functions; Voucher and discount programs for new residents; Area of need recruitment / skilled immigration where applicable; Existing dedicated senior staff in the Department of Health, Grampians Regional Office, dealing with nursing and allied health recruitment and retention; Specific health sector initiatives (e.g. UFS Dispensaries â&#x20AC;&#x201C; pharmacist recruitment; Ballarat and District Division of General Practice â&#x20AC;&#x201C; general practitioner recruitment); and Marketing in Melbourne, nationally and overseas. Commentary In association with other organisations and agencies, the City of Ballarat must ensure the relevance, currency and impact of its recruitment strategies, targeting heath professionals who might come to Ballarat.
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Recommendation The City of Ballarat, along with other healthcare organisations and agencies in Ballarat, needs to specifically target young health professionals who have grown up or trained in Ballarat and the Grampians Region to encourage them to stay on or return to Ballarat on completion of their training.
Workforce and development Strengths The development and expansion of health professional tertiary training places in medicine, nursing, allied health and other disciplines has strengthened health professional training in Ballarat and offer great promise for the future expansion of the Ballarat health workforce. There are now five tertiary institutions based in or having schools or departments located in Ballarat: University of Ballarat (Nursing, Psychology, Paramedicine, Exercise Rehabilitation, First Aid - TAFE); Australian Catholic University (Nursing, Midwifery, Allied Health, Paramedicine, Psychology); Deakin University Faculty of Health, Medicine, Nursing & Behavioural Sciences (Medicine); University of Melbourne Faculty of Medicine, Dentistry & Health Sciences (Medicine); and University of Notre Dame (Medicine). Clinical placements are being developed and expanded in Ballarat and throughout the Grampians Region. New programs have been created in Ballarat Health Services, St John of God Hospital, regional and rural health services and practices. New alliances have also formed including the University of Ballarat / Australian Catholic University alliance and linkages between universities and healthcare providers for example, the joint appointment of a Foundation Professor of Aged Care Nursing between the University of Ballarat and Ballarat Health Services. These initiatives will provide pathways for local students to enter tertiary health professional training in the region and, hopefully, to remain in or return to Ballarat and surrounding districts after graduation and postgraduate training. The rural clinical schools also provide an opportunity for city-based students to experience life and work in the country and some of them may also return or be retained in the country. Weaknesses As undergraduates progress through their training and begin to undertaken clinical placements, new placements must be developed, supervisors must be identified and facilities (tutorial rooms, simulation facilities, study areas, ward workstations etc.) must be built, equipped and staffed. Funding for these initiatives has been opportunistic and slow to be delivered. As a result, the facilities themselves have only just begun to become available.
City of Ballarat Health Sector Analysis Report
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Opportunities The Ballarat teaching, learning and clinical environment offers enormous opportunities to develop new clinical education and practice models, vertically integrate training and promote interdisciplinary care. The University of Ballarat and Australian Catholic University initiatives to develop multiple entry pathways for nursing and other health professions will offer new opportunities for residents of Ballarat and the Grampians Region to enter the health workforce. The newly formed Health Workforce Australia (HWA), an initiative of the Council of Australian Governments, has been established to meet the future challenges of providing a health workforce that meets the healthcare needs of the Australian Community. Ballarat and the Grampians Region offer ideal settings for the development, piloting and roll-out of HWA funded initiatives. Proposals from the Ballarat region are already under consideration by HWA. Threats As indicated above, pressures of workload and workforce challenges impact directly on health professionals throughout Ballarat. These pressures and challenges also limit the capacity and motivation of senior staff to take on additional responsibilities for teaching and supervision of students and trainees. Failure to engage health professionals throughout the city and region will threaten the success of new programs for health professional education and training. Enablers The establishment of new health professional education and training programs in Ballarat and the Grampians Region depends on the development of curricula, education programs, assessment strategies and evaluation tools that ensure a rigorous, educationally sound approach to health professional training in the clinical workplace. It is also vitally important that a culture of learning and discovery is fostered and encouraged in healthcare organisations, services and practices throughout the region. Commentary Health professional education, training and practice must be underpinned by educational and clinical research and development, needs assessment and evaluation. Recommendation The City of Ballarat can encourage healthcare providers, universities, local industries and government to foster translational research and development in quality improvement, service delivery, information technology, needs assessment, social health and clinical practice throughout Ballarat.
City of Ballarat Health Sector Analysis Report
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Business and organisation Strengths Organisations throughout Ballarat, ranging from the largest hospital providers (Ballarat Health Services; St John of God Hospital Ballarat), community service providers (Ballarat and District Nursing and Healthcare; Primary Care Partnerships; Ambulance Service Victoria), small healthcare providers, practices and clinics, all speak well of their relationship with the City of Ballarat and the level of service and support provided by the City of Ballarat, particularly in recent years. The larger organisations have been particularly pleased with the support that they have received in their master-planning, redevelopment and new building programs that they have recently undertaken. New collaborations and linkages between organisations throughout Ballarat are being developed at existing links are being strengthened and improved. Examples include: University of Ballarat / Australian Catholic University Alliance; Ballarat Health Services / St John of God Ballarat Joint Liaison Committee; Ballarat Health Services / Ballarat and District Division of General Practice liaison; St John of God Ballarat and Australian Catholic University / University of Notre Dame alliance; and Ballarat Health Services and the University of Melbourne relationship (existing) and the Deakin University relationship (new) for undergraduate medical training. Business units of both the health and education providers in Ballarat provide internal services (e.g. maintenance); services to each other (e.g. meal preparation and laundry); and external / direct patient and community services (e.g. Safety Link). New industries and businesses are also being fostered to support innovation and growth in the Ballarat healthcare sector. Weaknesses Large healthcare organisations and, indeed, the City of Ballarat itself, are very complex and dynamic organisations. It can be very difficult for large organisations and bureaucracies to form and engage in effective partnerships. Opportunities There are enormous opportunities for the City of Ballarat to support, coordinate and facilitate the interactions of organisations and businesses involved in the delivery of healthcare services in Ballarat and surrounding districts. The City of Ballarat can advocate on behalf of all members of the Ballarat community and can help organisations in Ballarat to advance the regional self-sufficiency agenda with State and Federal governments.
City of Ballarat Health Sector Analysis Report
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Threats At times, different sectors and organisations in Ballarat and across the Grampians Region will compete for the same limited resources. This may threaten existing relationships and power-bases. Similarly, reforms or policy changes at either State or Federal level may work to the advantage of some organisations and to the detriment of others Enablers Effective and responsive strategic planning that recognises the importance of corporate, clinical, academic, information and personal governance in healthcare is critical to the success of all healthcare organisations and practices in Ballarat.
Ultimately, the health, safety and wellbeing of
individuals and the community of Ballarat will depend on the alignment and achievement of these strategic goals. Commentary The City of Ballarat can facilitate communication and joint strategic planning of healthcare providers, educators and businesses across Ballarat. Recommendation Consideration should be given to the establishment of timely briefings with targeted health sector decision makers to support health related strategic planning, vision setting, and dialogue between healthcare organisations in Ballarat and surrounding districts.
Infrastructure and logistics Strengths The City of Ballarat has important responsibilities with regard to regulation and approval of development in the built environment of Ballarat. Given that considerable development is occurring in the health sector, it is important that the approval process is streamlined, effective, fair and transparent. Interviewees representing the larger organisations all reported that they had been impressed with the approach of the City of Ballarat and, whilst inevitably there have been occasional issues or delays, the approval processes have generally worked very well. Weaknesses Smaller organisations were more sensitive to the effect of individual planning decisions, each of which have the potential to significantly impact on their businesses and clinical practice. Car-parking remains a contentious issue, especially in the â&#x20AC;&#x2DC;health precinctâ&#x20AC;&#x2122;. The development of a multistorey car-parking facility near the major hospitals would be desirable but is unlikely to be achievable if a Ballarat specific business case cannot be sustained.
City of Ballarat Health Sector Analysis Report
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Helicopter access to the acute hospital facilities remains a contentious and challenging issue that requires the attention and consideration of a wide range of stakeholders rather just being a left as a lingering issue for Ballarat Health Services. Opportunities The City of Ballarat could facilitate consideration of building permit applications from all levels of healthcare in Ballarat, irrespective of the size of the applicant organisation.
In doing so it could
transparently apply whole of health sector development principles as well as building and environmental regulations and planning guidelines. There is an opportunity to consider radical options to reshape the delivery of healthcare services across the region e.g. by considering the establishment of an Ambulance Service Victoria helicopter and fixed wing aircraft base at a redeveloped Ballarat Airport in association with a helipad at Ballarat Health Services. This model could support flying in of patients and flying out of healthcare teams to the region. Threats No significant threats were identified by interviewees. Enablers Information and communications technology (ICT) is a strong sector in the Ballarat economy and offers significant opportunities to better integrate healthcare across Ballarat. Indeed, effective healthcare ICT can render the concept of a â&#x20AC;&#x2DC;health precinctâ&#x20AC;&#x2122; redundant by linking patients, practitioners, and healthcare providers electronically and facilitating the delivery of quality healthcare services in the home, community or workplace. Clinical information technology can also support the collection and analysis of outcomes data to build an evidence base to support healthcare evaluation, research and quality improvement. Commentary The City of Ballarat can facilitate the planning, development and associated investment attraction of physical infrastructure, transport facilities and ICT to support healthcare needs assessment, delivery and evaluation across Ballarat and the Grampians Region. Recommendation To support health sector investment and development, the City should consider providing a health sector facilitation contact within the organisation. A major role of this position will be to assist and guide business and investment enquiries through Council processes.
City of Ballarat Health Sector Analysis Report
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Wellness and lifestyle Strengths The City of Ballarat has a Health and Wellbeing Plan, Positive Ageing Strategy, Maternal and Child Health Program, dedicated Indigenous programs and Environmental Health Plan. All of these directly inform the delivery of City of Ballarat services but also impact on the delivery of services in these areas by other healthcare providers in Ballarat. Weaknesses The ageing population and consequent increased demand for healthcare services remains the major issue being faced by healthcare providers and the City of Ballarat. Opportunities The City of Ballarat is well positioned to support health promotion, wellness and the lifestyle benefits of living in and around Ballarat. Threats Wellness and lifestyle improvement, particularly for elder residents, is highly dependent on volunteerism. Enablers The City of Ballarat, Ballarat community, healthcare providers and educators can work together to improve healthcare delivery, outcomes and lifestyle in Ballarat. Commentary There is the potential to have Ballarat recognised as a leading centre of healthcare practice, learning, research, health promotion and wellness. Recommendation The City of Ballarat must recognise and accept its important leadership and advocacy role in planning, developing, coordinating and enhancing healthcare in Ballarat.
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City of Ballarat Health Sector Analysis Report Consultations summary Learnings
Implications
Ballarat is ideally structured and positioned
The City of Ballarat has a critical role in providing
to build an evidence-base for healthcare
leadership to support the role of Ballarat, its community
improvements and outcomes that can
and region in the development, implementation and
support health reform locally, state-wide
evaluation of the outcomes of new models of healthcare
and nationally.
tailored
to
the
needs
and
expectations
of
our
community. In association with other organisations and
The City of Ballarat, along with other healthcare
agencies, the City of Ballarat must ensure
organisations
the relevance, currency and impact of its
specifically target young health professionals who have
recruitment
grown up or trained in Ballarat and the Grampians
strategies,
targeting
heath
professionals who might come to Ballarat.
and
agencies
in
Ballarat,
needs
to
Region to encourage them to stay on or return to Ballarat on completion of their training.
Health professional education, training and
The City of Ballarat can encourage healthcare providers,
practice
universities, local industries and government to foster
must
be
underpinned
by
educational and clinical research
and
translational
development,
and
improvement, service delivery, information technology,
needs
assessment
evaluation.
research
and
development
in
quality
needs assessment, social health and clinical practice throughout Ballarat.
The
City
of
Ballarat
can
facilitate
Consideration should be given to the establishment of a
communication and joint strategic planning
health business and organisational forum, sponsored and
of healthcare providers, educators and
facilitated by the City of Ballarat, to support health
businesses across Ballarat.
related between
strategic
planning
healthcare
activities
organisations
in
and
dialogue
Ballarat
and
surrounding districts. The City of Ballarat is well positioned to articulate a longterm, shared vision for healthcare in Ballarat and this may be done through the development of a health master plan driven by a population health approach within an agreed health framework.
City of Ballarat Health Sector Analysis Report
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Learnings
Implications
The City of Ballarat can facilitate the
The City should consider the appointment of a health
planning,
sector development facilitator to assist health businesses
development
investment
and associated
attraction
of
physical
through council processes.
infrastructure, transport facilities and ICT to support
healthcare
needs
assessment,
delivery and evaluation across Ballarat and the Grampians Region. The City of Ballarat, Ballarat community,
The City of Ballarat must recognise and accept its
healthcare providers and educators can
important leadership and advocacy role in planning,
work
developing, coordinating and enhancing healthcare in
together
to
improve
healthcare
delivery, outcomes and lifestyle in Ballarat.
Ballarat.
There is the potential to have Ballarat recognised
as
a
leading
centre
of
healthcare practice, learning, research, health promotion and wellness. Table 9: Consultation analysis summary
The role of governments The Federal and State Government have the lead roles in setting policy and strategy for the provision of health and community services.
This is undertaken through close liaison and co-operation with the
sector and through assessments of current and future needs of communities. These processes of health service provision and the structures under which this occurs has been subject to significant review by Federal and State governments over recent months.
At the time of this report, the final outcomes of
these reforms to health service provision were subject to both to final agreement and the results of the upcoming Federal election, to be held in August 2010. In addition, the State Victoria was also due to hold state election later in 2010. Therefore, it was felt that to provide stated positions on the roles of Federal and State government in relation to health care provision would not be appropriate at this time. For local government, the role can be more easily articulated, although it should be noted that the range and level of heath and community service by individual local councils will vary. In essence, local governmentâ&#x20AC;&#x2122;s role is to provide broad advocacy and leadership on the health and well-being needs of its community, based on an understanding of the structures and strategic thinking of its health service providers. This involves co-operative planning, vision setting, investment and development facilitation and identify where it can support the sector in terms of workforce attraction and retention.
City of Ballarat Health Sector Analysis Report
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Recommendations summary Advocacy and leadership The City of Ballarat should work with the health and education sectors to advocate for the attraction of ongoing and additional medical training dollars to the region.
The City of Ballarat has a role in providing leadership to support the role of Ballarat, its community and region in relation to new models of healthcare, tailored to the needs and expectations of the community.
Consideration should be given to the establishment of timely briefings with targeted health sector decision makers to support health related strategic planning, vision setting, and dialogue between healthcare organisations in Ballarat and surrounding districts.
The City of Ballarat must recognise and accept its important leadership and advocacy role in planning, developing, coordinating and enhancing healthcare in Ballarat.
Investment and development The City of Ballarat should work with the regional health sector to identify opportunities for integrating primary health care services through the utilisation of the regionâ&#x20AC;&#x2122;s strengths and capacities in eHealth and ICT. Where gaps in support ICT infrastructure and/or service solutions exist, opportunities to attract investment and leverage and build regional expertise should be explored.
In partnership with the sector, the City of Ballarat should identify tangible import replacement avenues and for increasing local spend. These opportunities should focus on existing or the development of potential supply / expertise within the region whilst also identifying opportunities for attracting new investment.
The City of Ballarat can encourage healthcare providers, universities, local industries and government to foster translational research and development in quality improvement, service delivery, information technology, needs assessment, social health and clinical practice throughout Ballarat.
To support health sector investment and development, the City should consider providing a health sector facilitation contact within the organisation. A major role of this position will be to assist and guide business and investment enquiries through Council processes.
City of Ballarat Health Sector Analysis Report
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Workforce Opportunities may exist for the City of Ballarat to work in partnership with health and community services providers to provide integrated marketing for workforce attraction and retention. In particular, the City can provide motivational materials and welcome packages for use by the sector as part of their recruitment campaigns.
The importance of workforce planning based around the current and future demographic of the sector workforce should be advocated and supported by the City of Ballarat.
The City of Ballarat, along with other healthcare organisations and agencies in Ballarat, needs to specifically target young health professionals who have grown up or trained in Ballarat and the Grampians Region to encourage them to stay on or return to Ballarat on completion of their training.
Conclusion The City of Ballarat must recognise and accept its important leadership and advocacy role in planning, developing and enhancing healthcare in Ballarat. There is the potential to have Ballarat recognised as a leading centre of healthcare practice, eHealth, learning, research, health promotion and wellness and to build an evidence-base for healthcare improvements and outcomes that can support health reform locally, state-wide and nationally. This positioning may also provide the City, the sector and wider economy with opportunities to attract investment and provide for innovative product and service development opportunities within local and regional businesses.
Page 54 of 94
City of Ballarat Health Sector Analysis Report
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City of Ballarat Health Sector Analysis Report
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City of Ballarat Health Sector Analysis Report
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City of Ballarat Health Sector Analysis Report
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Page 63 of 94
Appendix 2: Key health service providers in the Ballarat region Service provider
Summary
Ballarat Health Services www.bhs.org.au
Ballarat Health Services (BHS) is the largest regional hospital and the principal referral hospital in the Grampians regions. BHS provides a comprehensive range of general and specialist care including: • • • • • •
Acute care; Sub-acute care; Residential care; Community care; Psychiatric services; and Rehabilitation services.
BHS also provide community-based psychiatric services in Horsham, Stawell, Ararat and Bacchus Marsh.
St John of God Health Care www.stjohnofgod.org.au
Their 2008-2009 Annual report shows that revenue has increased by 34% between 2005 and 2009 to $241.9m. The national St John of God Health Care organisation operates 14 hospitals in Australia and New Zealand, including St John of God Ballarat which recently underwent a $65m redevelopment. A new ward block, Emergency Department, cardiac and vascular catheter laboratory and outpatient rehabilitation facility were commissioned as part of the redevelopment. As St John of God’s largest Victorian hospital, and the state’s largest regional private hospital, it plays an important role in improving access to health services for communities across its wide geographic catchment. St John of God Ballarat currently features: • Beds: 194 • Theatres and Procedure Rooms: 5 theatres, 1 endoscopy suite, 1 cardiac catheterisation laboratory • Staff: 754 / 494.3 FTE • Accredited Doctors: 329 • Services: Medicine, surgery, obstetrics, emergency, day surgery, intensive care, coronary care, rehabilitation, oncology, sleep studies, home nursing, interventional cardiac, community mental health.
UFS Dispensaries www.ufs.com.au
UFS Dispensaries is a not-for-profit, community based organisation running thirteen pharmacies, two pharmacy depots, a Medical Centre, a gift shop and a well-being centre throughout Western Victoria, Australia. UFS Dispensaries currently have stores located in, Bacchus Marsh, Ballan, Ballarat (Bridge Mall, Sturt St, Victoria St), Beaufort, Buninyong, Delacombe, Golden Point, Melton, Melton South, Mount Clear, Sebastopol, Skipton, Wendouree, and Willaura. Services include, Baby Club, Maternal & Child Health Nurse, Home Medication Reviews, Methadone Program, Healthcare Equipment Sales & Hire, Weight Management Programs, and NDSS. According to the 2008-2009 Annual report, UFS Dispensaries generated revenue of almost $54 million.
City of Ballarat Health Sector Analysis Report
Page 64 of 94
Service provider
Summary
Ballarat and District Division of General Practice www.bddgp.org.au
Ballarat and District Division of General Practice Inc. (BDDGP) is one of 100 divisions of general practice across Australia - currently 29 in Victoria. The aim of the program is to reinforce the central role of GPs in the health system with a particular focus on the Primary Health Care sector and systems. This is achieved by enabling GPs to work in ways that have hitherto been impossible because of the structure of the health system. The Divisions allow GPs to develop a common and united approach to local health issues; to become involved in population health activity; to participate in health planning and policy; to liaise and co-operate with state and regional health authorities and agencies; and to develop and manage local programs to achieve specified outcomes. Ballarat and District Division of General Practice represents 118 GPs in the local area. BDDGP covers a geographic area of 7,300 square kilometres and a catchment population of approximately 122,000 people. The catchment includes the city of Ballarat and the outlying towns of Daylesford, Creswick, Clunes, Skipton and Ballan. BDDGP currently employs approximately 12.6 EFT staff working across a range of programs. Projects and programs run by BDDGP in 2008/2009 included, GP Well Being Program; Mental Health Program; Mental Health Support for Drought Affected Communities initiative; Aged Care Access Initiative; Continuing Professional Development; Nursing in General Practice and Immunisation Program; GP Training; Rural Palliative Care Project; and Primary Care Integration.
Ballarat District Nursing and Health Care www.bdnh.com.au
Ballarat District Nursing and Healthcare Incorporated (BDNH) has been serving the communities of Ballarat and District for over ninety years. Over 60 staff are now employed providing 5,000 home visits to 1,400 people annually. BDNH is the largest home nursing agency in the Grampians region and is one of only two independent HACC funded home nursing providers in Victoria. The core services offered by BDNH include: • • • •
Ambulance Victoria www.ambulance.vic.gov.au
Nursing & Home Support Services; BDNH Podiatry; Footsteps to Fitness: building community awareness of the health benefits of walking, access to walking groups and walking options in the Ballarat and surrounding areas; and Grampians HACC Training: BDNH play a coordinating role in organising training and professional development for the full range of health and community services professionals working within the Home and Community Care (HACC) Program.
Ambulance Victoria is responsible for pre-hospital emergency medical care and patient transport and the majority of non-emergency patient transport (NEPT) services for the Victorian population. Ambulance Victoria currently has 250 ambulance branches strategically located throughout Victoria. Ambulance Service Victoria (ASV), based in Ballarat, manages ambulance services throughout regional and rural Victoria. On July 1st, 2008, ASV was integrated with the Metropolitan Ambulance Service to form Ambulance Victoria.
Department of Human Services www.dhs.vic.gov.au
The Victorian Government Department of Human Services, through its Grampians regional office in Ballarat, oversees the delivery of disability, child protection, youth justice, housing, health and community services for 216,000 people who live in the region.
Department of Health www.health.vic.gov.au
The Victorian Governments Department of Health works with the community to provide better access to health, aged care and mental health and drug services. This is done through managing the public hospital system, developing health infrastructure in rural and metropolitan Victoria, pursuing opportunities for partnership with the primary care sector and other governments, public health interventions, and implementing major health initiatives such as the Victorian Cancer Action Plan.
City of Ballarat www.ballarat.vic.gov.au
The City of Ballarat oversees city marketing, business development, finance and shared services, organisational development, infrastructure, sustainability, health and wellbeing. The City has responsibility for a broad range of Public Health services. According to their 2008-2009 Annual Report, The City of Ballarat’s operating surplus for the 08-09 financial year was $27.756 million, significantly higher than the forecast position of $15.079 million.
City of Ballarat Health Sector Analysis Report
Service provider University of Ballarat www.ballarat.edu.au
Page 65 of 94
Summary The University of Ballarat (UB) is Australia’s only regional multi-sector university. UB is the third oldest site of higher learning in Australia, and offer secondary schooling, technical and further education (TAFE), higher education, and research opportunities. We have six campuses, located at the Mt Helen, SMB and Camp Street campuses in Ballarat and at Horsham, Stawell and Ararat. UB currently has around 25,000 international and domestic students. The University of Ballarat School of Nursing works in partnership with health care providers in Ballarat to offer innovative programs for nurses, midwives, aged care practitioners and other health professionals.
Australian Catholic University www.acu.edu.au
Australian Catholic University educates approximately 17,000 students across a variety of disciplines. It is Australia’s only university with a national dimension, with campuses in three state capitals – Sydney, Melbourne and Brisbane – as well as in Canberra, and a regional campus in Ballarat. By Australian standards, it is a medium-sized university, but with six relatively small campuses it is able to offer a personalised education to its students. The Ballarat Campus (Aquinas) hosts 700 students including 9 international students, offering Bachelor of Nursing / Bachelor of Paramedicine courses as well as graduate and postgraduate courses in midwifery and nursing research.
Ballarat Community Health www.bchc.org.au
Ballarat Community Health provides services across four sites in Ballarat: Sebastopol, the City centre, East Ballarat and Wendouree. Outreach services and clinics are also provided at a range of locations throughout the Central Highlands. The organisation’s mission is to create opportunities and supportive environments which empower people to develop healthy lifestyles and prevent or manage illness.
Appendix 3: Literature Review Economic Strategy 2010-2014 Objective Key Elements
The City of Ballarat Economic Strategy sets out a 20 year vision for the Ballarat economy whilst also providing practical guidance for Council and local stakeholders for economic development in the City of Ballarat. Health and Community Services • Ballarat has several major health institutional and small business assets which together make this sector a competitive advantage. Ballarat is also a hub for regional services into the Central Highlands. This industry is already adding value through the use of technology in remote health care and imaging, and is closely linked with the education sector through medical and clinical schools. This sector will consolidate its position as a strategic export sector for Ballarat with jobs expected to increase by 4,700 (+2.9% p.a.) between 2006 and 2026. •
Ballarat’s health and community services sector is the second highest employing industry in the City behind (Retail Trade), employing 5,829 (15.4%) in 2006. Jobs (2006) 5,829 (15.4%)
• •
Total Output $636.8m (6.1%)
Value-Added $494.4m (11.8%)
The share of employment in health and community services in Ballarat is significantly higher than in Victoria as a whole (10.9%). Ballarat plays a regional role in health and community service provision. Ballarat Health Services (public hospital) and St John of God Health Care (private hospital) are located within the City, both serve regional catchments and are leaders in research and development in areas of psychiatry, nursing, eHealth, and general medical.
Ballarat’s Strategic Policy Context • The Clever Health Project, funded through the Department of Broadband, Communication and Digital Economy, will link emergency / urgent care and maternity patients in the Central Highlands region through wireless and video conference technology and specialist equipment. • The Health Smart initiative will be implemented in the Grampians region through Grampians Health based in Ballarat and will modernise and replace healthcare ICT systems to ensure Grampians Health remains consistent with other facilities in the state. Issues/Challenges • Future institutional development could be affected by land availability. • Skills shortages, in for example general and specialist nursing and medical specialists in orthopaedics, obstetrics and gynaecology, oncologists, rehabilitation, as well as general practitioners. • Significant and ongoing growth in demand. • Capacity issues with Ballarat Austin Radiology Oncology Centre. Goals • Consolidate health and community services as a strategic service sector for Ballarat, the Grampians Region and Western Victoria. • To meet growing demands generated by population growth, service expansion, service diminution in regional health services and burden of disease. • Grow Ballarat as a preferred location for medical, nursing and allied health clinicians as well as clinical placements for medical students. Implementation Actions • Action 1: Explore the feasibility of establishing a Ballarat Health Cluster to grow and assist industry development comprising all major stakeholders in Ballarat including the Ballarat Health Services, St. John of God Hospital Ballarat, as well as other key health and community services, clinical schools, University of Ballarat and ACU and private industry. • Action 2: Leverage major regional health assets to promote and build Ballarat’s reputation as a leader in regional health innovation and service delivery. • Action 3: Prepare a Health Industry Plan which examines the current service and facilities on offer and which explores industry development opportunities particularly in research and development and allied health. • Action 4: Facilitate through CH21 a regional demand and supply study for health services also identifying community based services, health promotion and illness prevention strategies as well as seeking to identify new investment and service opportunities for Ballarat.
City of Ballarat Health Sector Analysis Report ! 4 Objective Key Elements
Page 67 of 94
# & 5 The Central Highlands Regional Strategy Plan (CHRSP) identifies a regional scale vision, and a series of strategic directions and priority actions to be undertaken to best position the Central Highlands region to 2030 and beyond to provide a productive, sustainable and liveable region for its population. Central Highlands Region Issues / Weaknesses • There is an increasing need to link and integrate primary health care with general practitioners and hospital care – opportunities to do this are particularly important to serve the needs of people in rural areas and the smaller towns and cities that service them. • Meeting the growing need for the provision of health services, particularly for aged persons will require that more people are able to be supported in their own homes for longer. Ballarat’s Comparative Advantages and the Key Drivers of Change • Convenient access to the network of existing health services across the region is critical for the region’s residents particularly those in smaller centres and rural areas. • Models of provision of co-locating and integrating all primary care services and general practitioners to increase the capacity for early diagnosis and intervention are emerging and they are a critical structure to be implemented so as to reduce death rates and the amount of time people spend in hospital. • The region is well placed to roll out such a model and to integrate that and better service the region’s residents using the existing strength and capacity of the region in IT and computing. • Existing models for the delivery of education and potentially health services using IT can be relatively easily replicated across much of the region with the model and the region used as a case study for regional Victoria. Strategic Directions and Actions • Roll out a model across the region’s cities and towns based on the collocated and integrated primary health care facility established at Stawell. • Integrate such services with general practitioners and the application of additional services utilizing the region’s strengths and capacities in IT and computing and national broadband network provision to provide services such as patient monitoring in home. - Trial the service in a suitable local community – Avoca has been suggested as appropriate.
July 2010
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City of Ballarat Health Sector Analysis Report ! 6 Objective Key Elements
7
Page 68 of 94
8 The Ballarat City Council Plan presents a strategic framework that outlines the Council’s strategic objectives for the next four years. • The Council seeks to improve the health and wellbeing of the community, prioritising the promotion, revision and implementation of Council’s Health and Wellbeing Plan • Ballarat has two major hospitals, a day procedure complex, more than 100 general medical practitioners and more than 1,000 public and private, hospital, nursing and hostel beds cater for the health needs of the community. • The city’s major industry sector employers include retail trade (18%), manufacturing (14.9%), health and community services (15.3%), education (9.9%) and property and business services (8%). The Ballarat Council Plan 2009 to 2013 provides the following three focus areas and goals: Growth and Development: A sustainable mix of residential, commercial and industrial development and infrastructure that provides for a high quality of life along with sound financial management and accountable Government. People and Communities: A safe, healthy, environmentally sustainable, innovative and well serviced community that has equal access to opportunities, is proud of its unique heritage, optimistic about its future, is welcoming of diversity and respected by others. Part of the strategic goals for People and Communities includes: • Providing support and services that meet the care, health, education and early childhood needs of children and young families • Planning for and providing services that meet the care and health needs of an ageing population • These will be done by (1) reviewing the Health and Wellbeing Plan 2007-2009 to meet the requirements of the Public Health and Wellbeing Act 2009, and (2) implementing the Positive Ageing Strategy Destination and Connections: A respected regional leader with a strong profile that facilitates tourism, residential and business attraction by shaping people’s perceptions around the unique lifestyle benefits of Ballarat.
July 2010
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City of Ballarat Health Sector Analysis Report ! Objective Key Elements
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Page 69 of 94
5 5 The Municipal Strategic Statement has been developed as the overall land use strategy for the Ballarat City Council. The key planning issues facing Ballarat health care issues include: promoting the importance of the health care sector to the local and regional economy; ensuring the two main hospitals are able to grow and develop; and maintaining the residential integrity of the Mair Street Medical Precinct whilst providing opportunities for appropriately sited specialist medical practices and facilities. Health Care: The provision of a quality healthcare system is essential to the physical and mental wellbeing of Ballarat’s and the wider region’s population. Ballarat has a thriving health services industry focused on the Ballarat Base and St John of God hospitals. The industry is Ballarat’s largest employer as well as being a significant regional provider of a range of quality health and medical facilities, with the majority of these medical and health services, including the two hospitals, located to the north west of the Ballarat CBD. Demand for medical services in Ballarat’s catchment is expected to increase due to population growth and ageing, and improvements in medical technology. Therefore, it is essential that planning issues do not compromise the long-term growth of the health care sector. Objectives and Strategies Objective 1 To facilitate the continued development of the health care sector. Strategy 1.1 Encourage medical centres and allied health professionals that provide a local or general service to locate within the community they serve, preferably within a non residential zone. Strategy 1.2 Provide for other medical centre uses in the community either in neighbourhood centres or on corner sites in residential areas with access to a road in a Road Zone. Strategy 1.3 Promote the Mair Street Medical Precinct as the preferred location for specialist medical centre uses and other allied health professionals. Mair Street Medical Precinct - Ballarat is a significant regional provider of health and medical facilities. The majority of medical and health services are located in the Mair Street Medical Precinct to the north west of the Ballarat CBD, including the Ballarat Base Hospital and the St. John of God Hospital. Over many years a significant number of smaller medical centres and allied health professionals have established in these areas which have historically been zoned residential. Dwellings in this area are highly desirable due to their close proximity to the Ballarat CBD, schools and Lake Wendouree, as well as the relatively intact stock of heritage dwellings and streetscapes. The increasing number of non residential uses in the area has lead to a number of conflicts between local residents and these non residential uses, such as, car parking difficulties for residents and patients. To balance these competing issues Council completed the Ballarat Health Precinct Study 2006. The Mair Street Medical Precinct is identified in Mair Street Medical Precinct Plan included in this clause. Implementation Strategies Land use Strategy 1 Encourage the location of medical centres within the Precinct. Strategy 2 Give a priority to medical centre uses that provide regionally significant specialist services as identified by the Ballarat Health Precinct Study 2006. Strategy 3 Strongly discourage office, retail or industrial uses that do not require collocation with the hospital uses. Strategy 4 Discourage medical centre uses from locating in the residential areas surrounding the Mair Street Medical Precinct.
July 2010
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City of Ballarat Health Sector Analysis Report 4 Objective Key Elements
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( 7 Present the current capabilities and successes of the eHealth sector in the Ballarat region. eHealth Partnerships: Many health providers and ICT firms are forming partnerships with a common goal of achieving a mutually desired outcome which benefits, not only the companies involved, but more importantly the end user. This includes capabilities in the management of health information systems. Ballarat’s Information & Communications Technology: Increasingly businesses are choosing Ballarat as a destination for establishing themselves. The University of Ballarat Technology Park and ICT Cluster is moving towards critical mass. There are now over 100 ICT businesses located in Ballarat, including IBM Australia. Current Environment for Patients and Providers • Patients, families & carers: The City of Ballarat has a population of approximately 90,000. Ballarat’s population is ageing with the number of people over the age of 65 projected to grow by 60% over the next 20 years. • Medical practitioners: Ballarat is served by a skilled and committed group of medical practitioners representing most medical specialties including general practice, internal medicine (physicians), aged care and rehabilitation, anaesthetics, surgery, obstetrics and gynaecology, paediatrics, psychiatry and emergency medicine. • Registered and enrolled nurses: Registered Nurses, Division 1 and 2, enrolled nurses and community care workers (Personal Care Workers) provide acute, subacute, residential, mental health, community and domiciliary nursing services in Ballarat. Undergraduate and graduate nurse training programs integrate university and hospital nursing practice. • Allied health professionals: Physiotherapists, occupational therapists, podiatrists, dieticians, speech pathologists, psychologists, social workers, exercise therapists and prosthetists work in the public, private and community sectors in Ballarat. • Pharmacists: Pharmacists work in retail and hospital pharmacy settings throughout Ballarat and the Grampians region. • Medical scientists: Medical scientists provide pathology and diagnostic services for the Ballarat community. • Ambulance paramedics: Ambulance paramedics work on general and mobile intensive care vehicles throughout Ballarat and the Grampians region. • BHS – Information Technology: The Ballarat Health Services IT Department operates within the Finance Division and provides a technical and consultative service to departments, services and individuals throughout Ballarat Health Services. • Safety Link: Safety Link, a division of Ballarat Health Services, provides an Australia-wide personal response service. • Uniti: Uniti is an advanced client management system designed primarily for use in the delivery of community nursing services • ExpressRx: Express Rx is an innovative company focused on developing, marketing and servicing a portfolio of integrated system solutions to the pharmacy and healthcare industries. Care Delivery Providers • Ballarat Health Services: Ballarat Health Services is the largest hospital and principal referral centre in the Grampians region. • Ballarat Health Services – Medical Imaging: Provides state of the art imaging services in the public hospital and private sectors. • Dorevitch Pathology: Leading provider of pathology and medical diagnostic services throughout Victoria. • Lake Imaging: A joint venture between highly qualified radiologists, skilled radiographers and business managers providing diagnostic imaging and patient care. • Grampians Integrated Cancer Services: GICS provides an integrated approach to cancer service delivery in Ballarat and the Grampians region. Radiotherapy services in Ballarat are provided by BAROC in conjunction with Ballarat Health Services and the Austin Repatriation Medical Centre. Palliative care services are provided through Gandarra Palliative Care Unit and Ballarat Hospice Care. • St John of God Health Care – Ballarat: St John of God Hospital, Ballarat is the largest private hospital in regional Victoria. It provides a full range of medical, surgical, maternity, diagnostic, emergency and intensive care services to Ballarat and Victoria’s Western region. St John of God Pathology delivers high quality diagnostic pathology services to medical practitioners, hospitals and industry throughout Victoria. • Ballarat District Nursing & Healthcare Inc: BDNH is the largest home nursing agency within the Grampians region. Services include wound care, stomal therapy, continence care, diabetes care, aged care, hospital liaison, assessment, home care services, HACC education and podiatry. Health Information Management • Central Highlands Primary Care Partnership: Central Highlands Primary Care Partnership (CHPCP) is a voluntary alliance of 31 health, education and human
July 2010
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City of Ballarat Health Sector Analysis Report • • • • • • • •
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service agencies working to improve the health and wellbeing of communities in the municipal areas of Ballarat, Moorabool, Hepburn and Golden Plains Shire. Ambulance Victoria: Based in Ballarat, ASV manages ambulance services throughout regional and rural Victoria. Ballarat & District Division of General Practice: B&DDGP is one of 119 divisions of general practice across Australia. The division represents 102 GPs and 12 GP Registrars across Ballarat, Daylesford, Creswick, Clunes, Skipton and Ballan. Ballarat Health Services – Health Information Services: The Ballarat Health Services Health Information Services department of BHS ensures that clinical records are created, collated, stored and accessed appropriately throughout the health service. The records have been predominantly paper-based but are increasingly being stored as scanned images or on electronic databases. Ballarat Health Services – Pharmacy: The BHS Pharmacy Department aims to ensure that inpatient, discharge and outpatient drug therapy is optimum, safe and cost-effective at all times. UFS Dispensaries: A not-for profit organisation which supplies subsidised prescriptions and other pharmacy requirements to its members. The organisation consists of 12 pharmacies which embrace and utilise technological advancements to improve customer service and organisational efficiency while increasing employee job satisfaction. Grampians Regional Health Alliance: One of five alliances of Victorian rural health agencies that are responsible for the delivery of the Victorian Department of Human Services HealthSMART strategy and ICT strategic planning and development within each rural health region.
Education and Development • University of Ballarat: The University of Ballarat School of Nursing works in partnership with health care providers in Ballarat to offer innovative programs for nurses, midwives, aged care practitioners and other health professionals. • Australian Catholic University: Australian Catholic University (ACU) Ballarat offers Bachelor of Nursing courses as well as graduate and postgraduate courses in midwifery and nursing research. • Notre Dame Medical School: The Notre Dame Medical School offers a new, innovative model of medical training through St. John of God Health Care, Ballarat. • Ballarat Health Services Centre for Nursing & Health Education: The Centre operates two clinical skills centres: an acute care facility at the Base Hospital; and a geriatric simulation facility at Queen Elizabeth Centre. Business and Strategy: With strong collaborative links between organisations, Ballarat continues to be the city of choice for the development of best practice clinical care and optimal population health for the community. Supporting organisations include: Ballarat Health Services, St. John of God Health Care, Department of Health Services, City of Ballarat, SED Health Consulting, and the Collaborative Centre for eHealth. Challenges to the development of eHealth in Ballarat • Workforce shortages across the healthcare disciplines limit the advancement of research, development, and innovation in eHealth. • There is a lack of strategic alignment across major healthcare and educational institutions with regard to eHealth and the need to develop a shared vision for the advancement of eHealth. • The high cost and complexity of advanced eHealth applications often precludes the development of innovative local initiatives. Future direction for the development of eHealth in Ballarat • The Ballarat ICT Cluster eHealth Forum provides the opportunity for the development of a region-wide eHealth strategy. • Ballarat would offer an ideal setting for the trial of a region-wide, web-based, individualised electronic healthcare record. • The development of innovative and effective user interfaces for both patients and healthcare providers will be the key to the successful implementation of eHealth applications.
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6 4 #$ ( 6 79 8 The purpose of the Municipal Public Health & Wellbeing Plan is to protect, improve and promote public health and wellbeing within the municipality of Ballarat. In doing this, the Plan identifies priority issues and needs of the Ballarat community and outlines a plan of action for the next four years in response to these needs and actions to improve health and wellbeing. The development of the City of Ballarat’s Health & Wellbeing Plan has used an evidence-based framework underpinned by a sound understanding of the social and environmental determinants of health. The methodology used to develop this Plan included the identification of community aspirations and needs through recent community engagement processes including: the Community Summit 2009, Positive Ageing Strategy, Youth Strategy, the Child & Family Friendly City Consultation, the Community Safety Action Plan and Cultural Diversity Strategy. Analysis was also drawn from a broad range of interviews, meetings and workshops with key stakeholders and community groups. The data and evidence was reviewed under five domains of wellbeing and presented in a series of Fact Sheets. Community groups, key stakeholders, partner organisations and Council staff provided input into sourcing the evidence presented and setting priorities as part of the planning and consultation process. Through this process, 18 priority areas have been identified under five broad domains: • Healthy, Safe and Inclusive Communities (Personal Health & Wellbeing, Community Connectedness & Strength, Early Childhood, Personal & Community Safety, Lifelong Learning, Service Availability) • Sustainable Built and Natural Environments (Urban Planning & Development, Transport Accessibility, Environmental Sustainability & Health) • Dynamic, Resilient Local Economies (Economic Activity & Employment, Skills, Income & Wealth, Work-life Balance) • Culturally Rich and Vibrant Communities (Cultural Diversity, Indigenous Community & Reconciliation, Participation in Arts & Cultural Activities, Participation in Recreational & Leisure Activities) • Democratic and Engaged Communities (Citizen Engagement) The action plan summarises 48 actions for these 18 priority areas which will be progressed by Council’s business units over the next four years to help create environments in which communities prosper and enjoy improved health and wellbeing. Salient actions relating to community-based health include; the promotion and education of Alcohol Harm, Food and Nutrition, Physical Activity, and Tobacco related harm, the identification of Health Care Services Gaps, and improving the effectiveness of the health care referral & support network.
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6 : The MEYP brings together the range of services provided for children aged 0 to 11 years and their families, and outlines the priorities for action by the City of Ballarat for the next five years. Ballarat’s early childhood services include Childcare, Kindergarten, Maternal & Child Health, and Recreation. The City of Ballarat Maternal & Child Health Service (M&CH) aims to engage with all families with children from birth to school age in order to improve their health, development and wellbeing. Services include: Generic Services M&CH provides support, guidance and information to parents of young children regarding their parenting role. M&CH also provides health screening of mothers and their children between the ages of 0 and 6 years. The service is provided from seven centres located throughout the municipality. A total of 3,965 children were seen by the generic M&CH service during the 2002/03 financial year for an average of 3 visits each (total 13,745 visits). Family Wellbeing Clinic Provides a counselling service for families experiencing Post Natal Depression (PND), domestic violence and substance abuse. All clients are referred by other agencies with 57% of referrals being from M&CH Nurses. Indigenous Maternal and Child Health Service This home-based service provides M&CH Services to Indigenous families in Ballarat one day a week. In the 2002/03 financial year: • 12 notifications of births to Indigenous mothers in Ballarat were made; and • 112 visits by 36 clients were made to the Indigenous M&CH nurse. Teenage Parents’ Program This program provides a home-based M&CH Program for teenage mothers and their partners. In the 2002/03 financial year: • 57 notifications of births to young mothers residing in Ballarat were made; and • 1,002 visits by 140 child clients were made to the M&CH nurse coordinating this program, averaging 7 visits per client. Enhanced Home Visiting Program This program targets families with young children requiring extra support for up to 5 days per week. Clients are referred to the service if they meet one or more criteria which include: parent with physical disability or chronic illness; parent with an intellectual disability; domestic violence; substance abuse; psychiatric disorders; PND; Koori; and major parenting issues. Bassinet Loans/Capsule Hire This service provides safe, accessible car restraint capsules for children up to the age of six months. The service is based at the Mair St Centre and operates two half days a week. Evidence of Need A City of Ballarat review (2004) identified key areas for improvement of the M&CH Service including: 1. Inappropriateness and poor maintenance of the physical environment; 2. The geographic isolation and/or small size of some of the M&CH Centres; and 3. Recruitment of appropriately trained nursing staff (projected). Actions indicated that appropriate investment in the Maternal & Child Health Services was required by Council to ensure its ongoing development as an efficient and modern service, and for training and promotional purposes to relieve the shortage of skilled medical personnel.
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1 ; # Objective
7 Provide a list of Ballarat services designed to assist and guide families with children up to twelve years of age.
Key Elements
Health related services available for children in Ballarat include: Breastfeeding Support • Ballarat Health Services Breastfeeding Support Service • Australian Breastfeeding Association (ABA) Ballarat group • St John of God Hospital Ballarat Primary School Nursing Program • Aims to provide specific health surveillance activities for children at school entry as part of a network of health and support services available to families within a local community. Maternal & Child Health (MCH) • MCH is a free service for families with infants and children aged from birth to four years. • Locations in Ballarat Central, Ballarat North, Ballarat East, Buninyong, Mouth Clear, Sebastopol, Wendouree Cooinda Centre, UFS Dispensary Specialist Maternal & Child Health Services • Enhanced Parenting: A referral service for families requiring extra parenting support. • Family Wellbeing: provides a counselling service for families experiencing Postnatal Depression (PND). • Indigenous Maternal & Child Health Service • Young Parents Maternal & Child Health Service: A service for parents under 20 years Health Services • Community Health: Ballarat Community Health Centre offers a variety of services and programs that aim to enhance and promote health and wellbeing of individuals, families and the community, while preventing illness, disease and injury. Community Health in Ballarat is provided across multiple sites including Sebastopol, Sturt Street, APROTCH and Wendouree. Outreach services and clinics are also provided within the Ballarat region. • Continence Services: Ballarat has a number of continence services, including: Grampians Regional Continence Service, Ballarat Urology Clinic, Bedwetting Clinic, and the Continence Clinic. • Dental Health: Ballarat Health Services Dental Clinic. • General Practitioners: Ballarat and District Division of General Practice. • Health Information & Support Groups: Ballarat Autism Network, Ballarat Cystic Fibrosis Support Group, Ballarat & District Multiple Birth Association, Ballarat Parents’ Support Group • Hearing Services: Vicdeaf • Hospitals: Ballarat Health Services, St John of God • Sexual Health & Family Planning: Family Planning & Sexual Health Clinic • Women’s Health: Billings Ovulation Method, Women’s Health Grampians Mental Health Services & Support Groups - Ballarat has a number of services which are able to provide a range of mental health services. • APROTCH: APROTCH provides psychosocial rehabilitation, including vocational, educational, recreational and individual support to meet the complex needs of consumers. • Ballarat Community Health Centre: Community health provides a range of counselling services using various therapeutic models including: individual, family, art and play, trauma, psychodynamic counselling, solution based, and competency based therapy, cognitive behavioural therapy and narrative therapy. • Ballarat Family & Friends: Mental health support group for carers, families and friends of people with a mental illness. • Ballarat Health Services; Psychiatric Services • Child & Adolescent Mental Health Services (CAMHS): CAMHS is a free service which helps children, adolescents (aged 0-18 years) and their families where the
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child has an emotional, social, behavioural or developmental problem. Adult Community Mental Health Services: Adult Community Mental Health Services provide assessment and treatment to residents of the Grampians Region who are aged between 16 - 65 years and who may be developing (or have) a mental health problem. CENTACARE Mental Health Services: A rehab and support service for people with mental health issues. Lifeline Ballarat: Lifeline Ballarat is the major provider of accessible and affordable telephone counselling in the greater Ballarat and Grampians regions. Pomegranate House: Pomegranate House provides psychological interventions in relation to mental health issues for adults, young adults, children and/or their families. Uniting Care Ballarat Family Counselling Program: Provides Counselling to families or members of families who are experiencing difficulties with a family based issue.
Pregnancy & Birth • Domiciliary Midwifery: Postnatal support at home is provided by both hospitals. • Maternal and Child Health - Family Wellbeing: The Family Wellbeing Clinic provides a counselling service for families experiencing postnatal depression. •
Objective Key Elements
Services also available relating to the protection of women and children, relationships, and for young parents.
! *5 The Ballarat CBD Strategy is a long-term plan to guide growth and change in the CBD over the next 20-25 years. The Draft Strategy draws together the outcomes of extensive community consultation and the directions of a number of current projects taking place within the CBD. The health and community services sector in Ballarat is a major employer and fundamental to the economic and social well-being of Ballarat. The Ballarat Health Services Base Hospital and the surrounding medical services precinct are located immediately to the west of the designated CBA and Study Area for this project. Its continued existence and growth is assumed in preparing the Strategy and is taken into account in considering future growth of the office and commercial sectors, and ways to increase benefits from this proximity. CBD building space: Space for smaller professional services, medical related consultants and clinics, owner-operator businesses and personal services should be available throughout the upper levels of existing buildings, many of which are underutilised at present.
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5 <4 7 Rural directions––for a stronger healthier Victoria builds upon the Victorian Government’s vision for the ongoing support and development of the health system in rural Victoria previously outlined in Rural directions for a better state of health, released in November 2005. This updated document reports on what has already been achieved, and outlines the next phase of continuing service development. This document provides three broad directions, each containing a number of strategies and specific projects: =
Improving the health of rural Victorians: Aboriginal health, Alcohol and drug services, Aged care, Cancer services, Cardiac services, Critical care, Emergency care, Environmental health, Health promotion, Hospital Admission Risk Program, Maternity services, Mental health, Neonatal services, Oral health, Paediatric services, Palliative care, Primary health care, Procedural services, Renal dialysis, Stroke services, Sub-acute services, Vulnerable children.
=
Supporting a contemporary health system • Regional health services. • Sub-regional health services. • Local health services: Acute inpatient care, Community care - emphasising the need for Training and Education, and developing a coordinated rural health system based around collaborative arrangements and relationships. • Emergency ambulance and patient transport services: Ambulance Victoria, Non-emergency patient transport, Non-clinical patient transport, Patient travel.
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Strengthening and sustaining rural health services • Continuing service enhancement: Planning for geographic areas, Enhancing regional and sub-regional service capacity, Supporting local health services, Enhancing regional partnerships, Redesigning services and systems, Investing in infrastructure and facilities, Developing information and communication technology. • Growing workforce capacity: Improving recruitment and retention in rural and regional areas, Redesigning the workforce to meet changing local needs, Preparing for future workforce growth. • Improving governance and performance: Enabling robust governance structures and processes, Improving clinical governance, Strengthening accountability and performance, Improving funding models.
Ballarat Health Services is the regional health service and the sub-regional health service is Wimmera Health Care Group (Horsham) for the Grampians region. There are 16 local health services, including two independent community health centres and four BNCs. The region has three PCPs and 11 LGAs: Ararat City, Ballarat City, Golden Plains Shire, Hepburn Shire, Hindmarsh Shire, Horsham Rural City, Moorabool Shire, Northern Grampians Shire, Pyrenees Shire, West Wimmera Shire and Yarriambiack Shire. # 6
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A major challenge for Grampians region is the ability to provide services over such a large area to an ageing population while retaining clinical staff and services. The region needs to continue to transform service provision and develop flexible service models to meet community needs.
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5 ) 5 5 ) 6 #. # ! + This report outlines the strategic services plan and model of care for Ballarat Health Services (BHS) over the five year period to 2011. • Ballarat Health Services (BHS) has a catchment area spreading across 12 local government areas and covers 20% of the State. • In 2005/06, BHS delivered a wide range of acute, sub-acute, mental health, residential aged care, and community based health services to the residents of the Grampians region. Changing Population: The population of the total catchment in 2006 is estimated to be 224,010, which is approximately 4.4% of the State’s population. The population is projected to increase to 239,856 persons by 2016, which represents an increase of 7%, or 0.7% per annum, over the next 10 years. Key characteristics of this catchment population include: a declining number of children, a ‘dip’ in population of young adults (as they move for tertiary studies), decline in 25 – 20 year olds in the past 5 years, increase in all age groups over 40 years, proportion of the population 65 years and over has increased to 15.9% in 2006 (from 14.8% in 2001). Overall, the population is ageing consistent with the ageing of the population across rural Victoria. This is an expected factor in the increase demand for health services. The BHS strategic services plan has identified four key themes that serve as a focus for BHS over the next five years: 1. BHS’ tertiary referral role 2. BHS’ regional leadership role 3. BHS’ role in teaching, training and research 4. Improved service quality through effective processes and systems Models of care have been developed for BHS’ seven clinical streams in order to deliver more efficient and effective services. These clinical streams are: 1. Acute emergency services 2. Acute elective services 3. Non-acute ambulatory services 4. Psychiatric services 5. Sub-acute services 6. Residential aged care services 7. Women’s and children’s services Priority strategic developments The strategic services plan and model of care has identified issues and proposed actions that BHS proposes to undertake over the five-year planning period in order to address service gaps, to positively shape the nature of the organisation, or address potential weaknesses. These include: 1. Cancer services: As the second major cause of death and in recognition of the shortage of public medical oncology services at BHS the development of cancer services is a high priority. = Cardiovascular service ? 6! ! %2! %+ % !$ !2! =' $% "! 2%'! 2%"% # 9 * #$ ! %2! : %%" % # !" ' + !$ : % 6 ,%' % !#! ' $% "! 2%'!" : % #!!$ $!2! " % % 5 # ! < @ & ? ' %2! !" / %"6@!) !#$ 6! + !$%' "'6 9 * 6%" %#' $!" $!2! %# %# ' #A #' % # : % 6 6! ==%% !$ 8= ! #%2! "% B2! %' %# ! % #C+ !$%' %#%# " ' ! # ) ?; % % %!" ! /! %2!# ' ! ' ! = 6! ! $! '!"" %+ 2!+ !# != + 0= . # ) ?D %" "!$ !) #$ %# %!# % %2! ' ! ' '% %# $! 3!! : %6 : %# $!+ #$ := 6 ) ? #" %$ ! 6! + !# 6! 6 != + " $ ! #$ = 6! !#6 #'! ' %!# ' + !" += 6 # = & # # ? 9 * %" # / ! $! %2! 6! 6 ' ! "! 2%'!" 6! != ! % #'!" #$ #! "6% " ! /! $!2! !$ !#" ! 6 ' + !+ !# "! 2%'!" ! >= 5 $! %2! !$ ; !# % "6 !" %# 3! ' %#%' "3% " ! # %+ # %"" ! = 9 * D %" "!$ %+ !+ !# " ! %!" !' % #$ ! %# 3! + !$%' " !'% %" " #$ 7= $ " " !'% %"!$ # "!" + !! ' ! "! 2%'! !> % !+ !# " 1 6! 3! " ! %' %"" !" %#' $!E ' ! "! 2%'! $!2! + !# ' ! "! 2%'! $!2! + !# %#%' ' ! < !#! + !$%'%#! < !#! " ! 1 6 6 + 1 6 !$%'" ;! %0 ! %2! "! 2%'!" (!# "! 2%'!" F +/ "! 2%'!" %#%' " "! 2%'!" !$%' %+ %# ; 6 ;6 + ' %!$ 6! 6 * /0 ' ! "! 2%'!" " /0 ' ! %# %!# /!$" + !#C" #$ '6%$ !#C" "! 2%'!" 3= '! $!2! + !# G % #$ ' " + ! "! 2%'! D#= + % # + # !+ !# D#= " ' ! ; #! "6% " #$ % #'!" #$ * ! %' + # !+ !# ' %'!
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5 <4 7 Rural directions––for a stronger healthier Victoria builds upon the Victorian Government’s vision for the ongoing support and development of the health system in rural Victoria previously outlined in Rural directions for a better state of health, released in November 2005. This updated document reports on what has already been achieved, and outlines the next phase of continuing service development. This document provides three broad directions, each containing a number of strategies and specific projects: 0=
Improving the health of rural Victorians: Aboriginal health, Alcohol and drug services, Aged care, Cancer services, Cardiac services, Critical care, Emergency care, Environmental health, Health promotion, Hospital Admission Risk Program, Maternity services, Mental health, Neonatal services, Oral health, Paediatric services, Palliative care, Primary health care, Procedural services, Renal dialysis, Stroke services, Sub-acute services, Vulnerable children.
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Supporting a contemporary health system • Regional health services. • Sub-regional health services. • Local health services: Acute inpatient care, Community care - emphasising the need for Training and Education, and developing a coordinated rural health system based around collaborative arrangements and relationships. • Emergency ambulance and patient transport services: Ambulance Victoria, Non-emergency patient transport, Non-clinical patient transport, Patient travel.
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Strengthening and sustaining rural health services • Continuing service enhancement: Planning for geographic areas, Enhancing regional and sub-regional service capacity, Supporting local health services, Enhancing regional partnerships, Redesigning services and systems, Investing in infrastructure and facilities, Developing information and communication technology. • Growing workforce capacity: Improving recruitment and retention in rural and regional areas, Redesigning the workforce to meet changing local needs, Preparing for future workforce growth. • Improving governance and performance: Enabling robust governance structures and processes, Improving clinical governance, Strengthening accountability and performance, Improving funding models.
Ballarat Health Services is the regional health service and the sub-regional health service is Wimmera Health Care Group (Horsham) for the Grampians region. There are 16 local health services, including two independent community health centres and four BNCs. The region has three PCPs and 11 LGAs: Ararat City, Ballarat City, Golden Plains Shire, Hepburn Shire, Hindmarsh Shire, Horsham Rural City, Moorabool Shire, Northern Grampians Shire, Pyrenees Shire, West Wimmera Shire and Yarriambiack Shire. # # , 5 > 6 ! 6 > > !# 9% 6 #$" < + % #" ; !#!!" %+ + ! (! % # ,
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City of Ballarat Health Sector Analysis Report Objective Key Elements
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Identifies the challenges faced regarding nurse recruitment and retention in the Grampians region and identifies opportunities to move forward and proactively make a difference. Overview of the Grampians Region • In 2004 the population of the Grampians Region was 213,316, consisting of 107,804 females and 105,512 males. • The proportion of people over 70 years is expected to increase significantly over the next 20 years. • For the Grampians Region, cardiovascular disease, cancer and mental disorders are the leading causes of death and disease. Grampians Region public health service network • There are 12 public health services located in the Grampians Region. • The services provided include acute care, aged and disability services, hostel accommodation, general practitioner services, mental health services, clinical services (such as pathology), specialist services, primary health and support services, maternal and child health services, transport services and hospital-in-the home. • There are two major hospitals in the region: Ballarat Health Services (Ballarat) and Wimmera Health Care Group (Horsham). Characteristics of the Grampians nurse workforce • There are approximately 4,300 nurses (3,350 FTE) who live and work in the region (2005). • The majority of these nurses (76.2 per cent, or approximately 3,300) work in the public health sector. • 63.7 per cent of nurses in the Grampians regions are Division 1. • 28.7 per cent of nurses in the region work in aged care, surgical nursing (14.8 per cent), medical nursing (12.2 per cent), community care (7.5 per cent), critical care (5.7 per cent) and midwifery/obstetrics (6.2 per cent). Nurse recruitment and retention issues in the Grampians Region • Health services in smaller rural towns have experienced ongoing problems in filling generalist, aged care and midwifery positions. • Health services located in larger rural towns or near major regional cities are starting to experience difficulties in attracting and retaining nurses. • The supply of nurses is expected to decrease because the nurse workforce is ageing. • There is generally a lack of graduate and experienced nurses interested in working in rural areas. The Grampians nurse recruitment and retention plan lists actionable strategies aimed at addressing these needs and trends. The strategies are listed under three sections: Section A Workforce planning issues Section B Nurse workforce recruitment issues • Marketing campaign/strategies promoting the benefits of living and working in rural/regional areas • Recruitment of and support for nurses who have commitments to local area • Provide additional incentives to attract nurses into regional and rural areas • Investigate feasibility of re-establishing re-entry/refresher course in the region • Promote rural nursing practice in Certificate IV/undergraduate nursing courses • Build career paths that enable rural nurses to advance their practice in rural health • Recruit and support overseas nurses interested in working the Grampians Region Section C Nurse workforce retention issues • Lack of access to affordable flexibly-delivered childcare • Lack of availability of affordable and/or appropriate housing/accommodation • Lack of employment opportunities for nurses’ spouses/partners • Rural nurses report that lack of suitable secondary school deters nurses from working in rural areas.
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- # A Objective
4 6 ! 5 # > This paper is designed to encourage consideration of future changes required to address existing shortfalls in the Australian health system.
Key Elements
This Discussion Paper proposes 10 key elements which could underpin a future Australian primary health care system: All Australians should have access to primary health care services which keep people well and manage ill-health by being: 1. Accessible, clinically and culturally appropriate, timely and affordable; 2. Patient-centred and supportive of health literacy, self-management and individual preference; 3. More focussed on preventive care, including support of healthy lifestyles; 4. Well-integrated, coordinated, and providing continuity of care, particularly for those with multiple, ongoing, and complex conditions Service delivery arrangements should support: 5. Safe, high quality care which is continually improving through relevant research and innovation; 6. Better management of health information, underpinned by efficient and effective use of eHealth; 7. Flexibility to best respond to local community needs and circumstances through sustainable and efficient operational models. Supporting the primary health care workforce are: 8. Working environments and conditions which attract, support and retain workforce; 9. High quality education and training arrangements for both new and existing workforce. Primary health care is: 10. Fiscally sustainable, efficient and cost effective.
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#4 A - " , CB This document sets out the architecture and foundations of the Government’s historic National Health Reform Plan, which will deliver major structural reforms to establish the foundations of Australia’s future health system. These major structural reforms will mean that the Commonwealth Government: • Becomes the majority funder of public hospitals; • Takes over all funding and policy responsibility for GP and primary health care services; • Dedicates around one third of annual Goods and Services Tax (GST) allocations currently directed to state and territory governments (referred to throughout this document as ‘states’) to fund this change in responsibilities for the health system; • Changes the way hospitals are run, taking control from central bureaucracies and handing it to Local Hospital Networks; and • Changes the way hospitals are funded, by paying Local Hospital Networks directly for each hospital service they provide, rather than by a block grant from the Commonwealth to the states. The key elements outlined in this document include: 1. • • • • • • • 2. •
Problems with our health system today A system that isn’t prepared for future challenges: Aging population, population is projected to grow, chronic disease, costs have increased sharply, workforce shortages. Too much blame and fragmentation between governments Gaps and poor coordination in health services that people need Too much pressure on public hospitals and health professionals An unsustainable funding model Too much inefficiency and waste Not enough local or clinical engagement
• • • • • • • •
Building on major reform Increased funding for health and hospitals o $1.1 billion to train more doctors, nurses and allied health workers o $750 million to take pressure off emergency departments o $500 million for sub acute care facilities o $600 million in an elective surgery waiting list reduction plan More doctors, nurses and allied health professionals — and making smarter use of our health workforce Comprehensive health care that is close to home through GP Super Clinics Focusing on prevention rather than cure Closing the life expectancy gap between Indigenous and non Indigenous Australians Addressing workforce shortages in regional and rural Australia Investing in hospitals, medical research and clinical training infrastructure Sustainable, high quality aged care A more financially sustainable health system
3.
Listening to the community and experts
4. • • •
Reforms to establish the foundation of a new health system Taking majority funding responsibility for public hospitals Taking full funding and policy responsibility for GP and primary health care Rebalancing financial responsibility in the federation
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Key Elements
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• • •
National standards for a unified health system Local Hospital Networks to drive accountability and performance Paying Local Hospital Networks directly for the services they provide
5. •
A comprehensive reform plan Building on existing investments and structural reforms made across; public hospitals, GP and primary health care, the health workforce, and allied health professionals, and e health.
6.
Taking a reform plan to the states
5 # + This review is the most recent attempt to reconcile: • The economic development and social imperative of providing quality, accessible health and allied health services to the Ballarat and regional communities; • The desire to protect high quality residential environments; and • The achievement of greater planning certainty. Following is a summary regarding future health service provision and locational needs of the Ballarat Health Precinct: • • • • • • • • •
The Ballarat and Ballarat region population will continue to grow with an overall ageing of the population. Over the next 20 years health service needs will increase due to population growth, an ageing population and increasing opportunity for elective procedures. There is a large number of medical practices and medical practitioners within the historic residential/hospital precinct, and specifically within sub-zones 2 and 3 of the residential/medical conflict zone to the east of the hospitals (pp.16-29). Although there is a trend to decentralised health service provision, supported living environments and home based care specialist hospital procedures, services and care will continue as a fundamental part of the health service provision. In assessing location dependency and nexus close to the hospitals the most highly dependent health service sector appears to be medical specialists followed by general practitioners. Future development of the St John of God site may provide location options within the historic residential/hospital precinct for new medical specialists. Recent facility development away from the historic residential/hospital precinct points to competitive benefits in locating away from the hospitals and the historic residential/hospital precinct, for some heath providers. Because of parking constraints and traffic congestion close to the hospitals, the issue of patient convenience associated with medical centre location close to the hospitals is becoming increasingly problematic and the parking issues need to be dealt with. In the future there may be medical services and facilities that need to be located close to the hospitals and this contingency needs to be catered for.
July 2010
H:\ECONOMIC\HEALTH\2010\Final Report\100628_City of Ballarat_1937_Health Sector_Report_Final v3.docx
City of Ballarat Health Sector Analysis Report ;6 & Objective Key Elements
Page 83 of 94
D Provide information and tools to assist the local recruitment team to recruit and retain general practitioners in our rural communities. • • • •
The development of this kit was prompted by difficulties in recruiting and retaining trained GPs to Western Victoria, as “practicing in rural areas is not attractive to most doctors” Recruiting an overseas trained doctor is a complex, time consuming process. The current GP workforce in Western Victoria consists of 75 General Practitioners, 29 of whom are overseas trained. There are 26 steps to recruiting and retaining GPs and their families, discussed under four headings: 1. Partners in recruiting and retention: RWAV, West Vic Division of General Practice, Small Rural Health Services, Rural Medical Family Network, Local Government 2. Promoting the vacancy: selling the professional position and also the rural lifestyle to the GP and their family. 3. Practice visit: organising a well prepared visit for the GP and his/her family, providing a practice visit information kit, and providing a post visit follow-up. 4. Settling of the new candidate and their family: Orientation and assistance through the RWAV Recruitment Support Package (i.e., provides contract advice, practice orientation, immigration assistance, and other assistance).
July 2010
H:\ECONOMIC\HEALTH\2010\Final Report\100628_City of Ballarat_1937_Health Sector_Report_Final v3.docx
Appendix 4: Economic data
# "
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+ ,+
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All industry sectors in Ballarat (C) ranked by Output Ballarat (C) (Apr 2007) Ballarat (C) (May 2010) Industry Sector
$M
%
$M
%
Manufacturing
$3,073.951
39.12 %
$3,898.676
34.30 %
Property & business services
$719.424
9.15 %
$1,106.918
9.74 %
Retail trade
$619.545
7.88 %
$823.264
7.24 %
Construction
$549.579
6.99 %
$1,026.611
9.03 %
Health & community services
$455.594
5.80 %
$684.205
6.02 %
Wholesale trade
$340.018
4.33 %
$535.087
4.71 %
Education
$310.970
3.96 %
$463.474
4.08 %
Finance & insurance
$269.553
3.43 %
$420.455
3.70 %
Communication services
$244.405
3.11 %
$406.075
3.57 %
Transport & storage
$240.016
3.05 %
$334.152
2.94 %
Accommodation, cafes & restaurants
$227.503
2.89 %
$338.454
2.98 %
Cultural & recreational services
$209.880
2.67 %
$282.190
2.48 %
Government administration & defence
$204.389
2.60 %
$364.812
3.21 %
Electricity, gas & water supply
$147.099
1.87 %
$252.605
2.22 %
Agriculture Forestry Fishing
$118.369
1.51 %
$91.606
0.81 %
Personal & other services
$107.637
1.37 %
$136.572
1.20 %
$20.672
0.26 %
$200.861
1.77 %
Mining Total
$7,858.604
$11,366.019
Page 85 of 94
City of Ballarat Health Sector Analysis Report
"
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/$$$
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All industry sectors in Ballarat (C) ranked by Employment Ballarat (C) (Apr 2007) Ballarat (C) (May 2010) Industry Sector
Jobs
%
Jobs
%
Retail trade
6,081
18.12 %
6,833
18.12 %
Manufacturing
5,903
17.59 %
5,615
14.89 %
Health & community services
5,005
14.91 %
5,829
15.46 %
Education
3,215
9.58 %
3,719
9.86 %
Property & business services
2,375
7.08 %
2,998
7.95 %
Accommodation, cafes & restaurants
1,700
5.06 %
1,799
4.77 %
Construction
1,621
4.83 %
2,112
5.60 %
Wholesale trade
1,321
3.94 %
1,370
3.63 %
Personal & other services
1,145
3.41 %
1,152
3.06 %
Government administration & defence
1,049
3.13 %
1,731
4.59 %
Cultural & recreational services
1,033
3.08 %
1,071
2.84 %
Transport & storage
875
2.61 %
959
2.54 %
Finance & insurance
785
2.34 %
856
2.27 %
Communication services
632
1.88 %
798
2.12 %
Agriculture Forestry Fishing
559
1.67 %
390
1.03 %
Electricity, gas & water supply
236
0.70 %
303
0.80 %
32
0.09 %
173
0.46 %
Mining Total
33,567
37,708
Page 86 of 94
City of Ballarat Health Sector Analysis Report
!
" #
$
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'$$
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)$$
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.$$
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All industry sectors in Ballarat (C) ranked by Wages and Salaries Ballarat (C) (Apr 2007) Ballarat (C) (May 2010) Industry Sector
$M
%
$M
%
Manufacturing
$391.965
20.32 %
$525.437
18.51 %
Health & community services
$295.283
15.30 %
$438.292
15.44 %
Education
$207.957
10.78 %
$317.493
11.18 %
Retail trade
$196.183
10.17 %
$271.338
9.56 %
Property & business services
$186.488
9.67 %
$309.283
10.90 %
Wholesale trade
$92.658
4.80 %
$135.253
4.76 %
Government administration & defence
$89.232
4.62 %
$175.789
6.19 %
Finance & insurance
$88.573
4.59 %
$128.301
4.52 %
Construction
$79.238
4.11 %
$122.015
4.30 %
Accommodation, cafes & restaurants
$60.785
3.15 %
$73.291
2.58 %
Personal & other services
$56.440
2.93 %
$71.004
2.50 %
Transport & storage
$53.571
2.78 %
$74.552
2.63 %
Cultural & recreational services
$49.057
2.54 %
$57.318
2.02 %
Communication services
$41.497
2.15 %
$63.254
2.23 %
Electricity, gas & water supply
$22.687
1.18 %
$40.127
1.41 %
Agriculture Forestry Fishing
$14.069
0.73 %
$11.366
0.40 %
$3.730
0.19 %
$24.537
0.86 %
Mining Total
$1,929.413
$2,838.650
Page 87 of 94
City of Ballarat Health Sector Analysis Report
#
"
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)$$
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All industry sectors in Ballarat (C) ranked by Local Sales Ballarat (C) (Apr 2007) Ballarat (C) (May 2010) Industry Sector
$M
%
$M
%
Manufacturing
$737.797
33.63 %
$962.350
27.19 %
Property & business services
$498.761
22.73 %
$902.090
25.49 %
Construction
$161.560
7.36 %
$291.286
8.23 %
Finance & insurance
$131.559
6.00 %
$214.600
6.06 %
Wholesale trade
$118.955
5.42 %
$226.117
6.39 %
Communication services
$105.005
4.79 %
$190.293
5.38 %
Retail trade
$95.611
4.36 %
$108.669
3.07 %
Transport & storage
$94.954
4.33 %
$178.421
5.04 %
Cultural & recreational services
$59.691
2.72 %
$99.662
2.82 %
Electricity, gas & water supply
$56.214
2.56 %
$109.577
3.10 %
Agriculture Forestry Fishing
$41.235
1.88 %
$37.894
1.07 %
Accommodation, cafes & restaurants
$29.662
1.35 %
$71.069
2.01 %
Government administration & defence
$20.611
0.94 %
$42.980
1.21 %
Education
$18.654
0.85 %
$33.017
0.93 %
Personal & other services
$9.624
0.44 %
$14.469
0.41 %
Mining
$8.081
0.37 %
$46.311
1.31 %
Health & community services
$5.924
0.27 %
$10.002
0.28 %
Total
$2,193.898
$3,538.808
Page 88 of 94
City of Ballarat Health Sector Analysis Report
! " #
$
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($$$
All industry sectors in Ballarat (C) ranked by Regional Exports Ballarat (C) (Apr 2007) Ballarat (C) (May 2010) Industry Sector
$M
%
$M
%
Manufacturing
$2,001.225
63.73 %
$2,389.462
60.14 %
Health & community services
$159.112
5.07 %
$228.271
5.75 %
Retail trade
$152.984
4.87 %
$210.858
5.31 %
Property & business services
$139.320
4.44 %
$67.353
1.70 %
Wholesale trade
$94.394
3.01 %
$109.542
2.76 %
Education
$93.051
2.96 %
$137.465
3.46 %
Transport & storage
$85.791
2.73 %
$59.540
1.50 %
Communication services
$64.318
2.05 %
$105.037
2.64 %
Accommodation, cafes & restaurants
$61.064
1.94 %
$86.827
2.19 %
Agriculture Forestry Fishing
$60.782
1.94 %
$39.599
1.00 %
Finance & insurance
$53.438
1.70 %
$72.370
1.82 %
Cultural & recreational services
$51.079
1.63 %
$54.022
1.36 %
Construction
$39.794
1.27 %
$131.850
3.32 %
Electricity, gas & water supply
$38.973
1.24 %
$58.821
1.48 %
Government administration & defence
$27.698
0.88 %
$66.196
1.67 %
Mining
$12.359
0.39 %
$150.829
3.80 %
$4.960
0.16 %
$5.168
0.13 %
Personal & other services Total
$3,140.341
$3,973.210
Page 89 of 94
City of Ballarat Health Sector Analysis Report
All industry sectors in Ballarat (C) ranked by Local Expenditure Ballarat (C) (Apr 2007) Ballarat (C) (May 2010) Industry Sector
$M
%
$M
%
Manufacturing
$623.528
28.42 %
$1,075.283
30.39 %
Property & business services
$310.470
14.15 %
$428.914
12.12 %
Construction
$287.784
13.12 %
$540.555
15.28 %
Retail trade
$187.239
8.53 %
$262.804
7.43 %
Wholesale trade
$140.254
6.39 %
$179.527
5.07 %
Transport & storage
$100.921
4.60 %
$116.123
3.28 %
Finance & insurance
$88.156
4.02 %
$116.525
3.29 %
Cultural & recreational services
$81.380
3.71 %
$120.268
3.40 %
Communication services
$72.273
3.29 %
$141.349
3.99 %
Accommodation, cafes & restaurants
$63.577
2.90 %
$110.728
3.13 %
Government administration & defence
$60.076
2.74 %
$115.029
3.25 %
Education
$39.520
1.80 %
$73.527
2.08 %
Health & community services
$38.785
1.77 %
$87.076
2.46 %
Electricity, gas & water supply
$34.062
1.55 %
$64.829
1.83 %
Agriculture Forestry Fishing
$32.791
1.49 %
$19.662
0.56 %
Personal & other services
$25.255
1.15 %
$35.030
0.99 %
$7.829
0.36 %
$51.580
1.46 %
Mining Total
$2,193.898
$3,538.808
Page 90 of 94
City of Ballarat Health Sector Analysis Report
All industry sectors in Ballarat (C) ranked by Regional Imports Ballarat (C) (Apr 2007) Ballarat (C) (May 2010) Industry Sector
$M
%
$M
%
Manufacturing
$1,790.916
69.52 %
$1,959.629
60.54 %
Retail trade
$131.667
5.11 %
$139.928
4.32 %
Construction
$91.796
3.56 %
$193.159
5.97 %
Property & business services
$85.145
3.31 %
$174.494
5.39 %
Accommodation, cafes & restaurants
$65.409
2.54 %
$95.533
2.95 %
Cultural & recreational services
$61.501
2.39 %
$63.565
1.96 %
Wholesale trade
$53.883
2.09 %
$127.189
3.93 %
Health & community services
$53.490
2.08 %
$59.454
1.84 %
Communication services
$50.998
1.98 %
$81.520
2.52 %
Government administration & defence
$38.848
1.51 %
$47.731
1.47 %
Education
$35.831
1.39 %
$38.906
1.20 %
Transport & storage
$34.688
1.35 %
$76.309
2.36 %
Electricity, gas & water supply
$31.346
1.22 %
$49.749
1.54 %
Agriculture Forestry Fishing
$19.346
0.75 %
$20.068
0.62 %
Personal & other services
$13.815
0.54 %
$16.441
0.51 %
Finance & insurance
$12.917
0.50 %
$45.033
1.39 %
$4.630
0.18 %
$48.005
1.48 %
Mining Total
$2,576.227
$3,236.715
Page 91 of 94
City of Ballarat Health Sector Analysis Report
All industry sectors in Ballarat (C) ranked by Value-Added Ballarat (C) (Apr 2007) Ballarat (C) (May 2010) Industry Sector
$M
%
$M
%
Manufacturing
$659.507
21.35 %
$863.764
18.82 %
Health & community services
$363.319
11.76 %
$537.675
11.71 %
Property & business services
$323.810
10.48 %
$503.510
10.97 %
Retail trade
$300.639
9.73 %
$420.532
9.16 %
Education
$235.620
7.63 %
$351.041
7.65 %
Construction
$169.999
5.50 %
$292.897
6.38 %
Finance & insurance
$168.480
5.46 %
$258.898
5.64 %
Wholesale trade
$145.881
4.72 %
$228.371
4.97 %
Communication services
$121.134
3.92 %
$183.206
3.99 %
Government administration & defence
$105.465
3.41 %
$202.052
4.40 %
Transport & storage
$104.407
3.38 %
$141.720
3.09 %
Accommodation, cafes & restaurants
$98.518
3.19 %
$132.194
2.88 %
Electricity, gas & water supply
$81.690
2.64 %
$138.027
3.01 %
Personal & other services
$68.566
2.22 %
$85.100
1.85 %
Cultural & recreational services
$66.998
2.17 %
$98.357
2.14 %
Agriculture Forestry Fishing
$66.232
2.14 %
$51.876
1.13 %
$8.214
0.27 %
$101.276
2.21 %
Mining Total
$3,088.479
$4,590.496
Page 92 of 94
City of Ballarat Health Sector Analysis Report
Appendix 5: Health sector workforce data
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City of Ballarat Health Sector Analysis Report
Page 93 of 94
City of Ballarat Health Sector Analysis Report
Page 94 of 94