Health Needs Assessment 2022-2025

MPHN Health Needs Assessment 2022-2025

Murrumbidgee Primary Health Network acknowledges the Traditional Custodians of the land in the Murrumbidgee region. We pay respect to past and present Elders of this land: the Wiradjuri, Yorta Yorta, Baraba Baraba, Wemba Wemba and Nari Nari peoples.

Murrumbidgee Primary Health Network gratefully acknowledges the financial and other support from the Australian Government Department of Health. The Primary Health Networks Program is an Australian Government Initiative.

Murrumbidgee Primary Health Network (MPHN) Health Needs Assessment .................................................... 4 Underlying Principles and Governance ........................................................................................................... 5 HNA process .................................................................................................................................................... 6 Data and information issues and opportunities ............................................................................................ 10 Key issues for 2023-25 ................................................................................................................................... 10 What does the Murrumbidgee region look like ................................................................................................ 11 Summary demography .................................................................................................................................. 11 Summary health determinants...................................................................................................................... 16 Summary risk factors ..................................................................................................................................... 17 Summary health conditions........................................................................................................................... 19 Summary community consultation ............................................................................................................... 25 Summary services and workforce ................................................................................................................. 30 Opportunities and Priorities .......................................................................................................................... 37 What do we know about the nation’s health.................................................................................................... 50 What do we know about Aboriginal and Torres Strait Islander health............................................................. 51 What do we know about patient experiences in Australia ............................................................................... 53 Data Sources .................................................................................................................................................. 55 Checklist......................................................................................................................................................... 57

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Murrumbidgee Primary Health Network (MPHN) Health Needs Assessment Murrumbidgee Primary Health Network (MPHN) is a not-for-profit organisation with a vision of “Well People.

Resilient Communities”. MPHN achieves this vision by understanding the region’s health needs to inform:   

funding services to meet population health needs; integrating local services and systems and improve coordination of care; and supporting the development of a local sustainable health care workforce through quality improvement and professional development.

This Needs Assessment will be for a three year period and cover 1 July 2022 to 30 June 2025. It will be reviewed and updated as needed during this period.

MPHN’s Health Needs Assessment (HNA) provides an understanding of the Murrumbidgee region, taking a detailed and systematic approach to reviewing the population’s health needs and health services to identify and prioritise service gaps and key issues and interventions to address these.

MPHN places an emphasis on listening to the local communities that make up the region. Understanding the evidence of the health conditions and risks is complemented by talking with and listening to our local communities. Our community’s involvement in shaping the decisions about services is key to uptake of those services resulting in better health outcomes.

MPHN takes a person centred approach looking at community through a lens of groups within the population such as; mother’s children and youth, older people, Aboriginal and Torres Strait Islander people and the general population.

MPHN uses both quantitative and qualitative data gathered through data analysis and through stakeholder and community consultation to triangulate information that provides evidence of gaps.

Once MPHN identify key issues for local communities, identified gaps are then prioritised for activity through relevant Department of Health funding schedules and in line with key priorities.

PHNs have seven key priority areas guiding their work including:       

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mental health; Aboriginal and Torres Strait Islander health; population health; health workforce; digital heath; aged care; and alcohol and other drugs

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Underlying Principles and Governance MPHN has underpinning principles for commissioning, social disadvantage and planning that guide the needs assessment and these include ensuring an approach that includes both equality and equity for communities across the Murrumbidgee region.

The Needs Assessment and Annual Planning Guide (links available at the end of this document) supports MPHN to identify priority health needs and conduct annual planning across the Murrumbidgee region through commissioning of services, integration and collaboration activity. This guide is updated regularly to ensure that the most up-to-date methods are captured and available as evidence of the robust process undertaken.

Needs assessment is an ongoing activity for MPHN but the significant analysis of data that occurs at the commencement of the needs assessment cycle is detailed in the planning guide.

We work with partner service providers including the Murrumbidgee Local Health District (MLHD), Aboriginal Medical Service (AMS), and other local providers to implement integrated/coordinated models of care, including the development of Murrumbidgee HealthPathways.

To assist in the identification of opportunities to improve primary healthcare across the Murrumbidgee we have established Clinical Councils and a Community Advisory Committee (CAC). These committees are an important part of MPHN’s governance infrastructure and play a significant role in supporting the delivery of best practice healthcare. They also provide advice about population health planning and the commissioning of services. The clinical councils and CAC are Board endorsed and make recommendations to MPHNs Board for final approval.

MPHN has a team consisting of data programming and management and activity planning and monitoring and Aboriginal and Torres Strait Islander engagement led by an experienced Senior Manager however all MPHN staff contribute to the HNA process through gathering information and providing information that adds to the understanding of the health status and service delivery across the region.

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HNA process MPHN uses a supply and demand approach to determine gaps in service which results in identification, prioritisation and planning of strategies or programs to address the gaps identified. Planned commissioned services and programs in response to the identified health needs provide service utilisation data which informs effectiveness and efficiency of services and programs and which feeds back into the continuous review of health needs and gaps in service provision.

Understanding the quantity of the gap is one element, measured by supply and demand. Understanding the reason for the gap is another, MPHN take a consultative approach with community members, key stakeholders and health service providers to understand reasons why gaps exist and to co-design where applicable, solutions that address the root causes.

MPHN take a stepped approach, identifying demand by developing population profiles analysing demographic and health data which are then prioritised for the region and within local government areas. Prioritisation assists in identifying the most significant issues and where geographically they occur in higher prevalence.

MPHN constantly looks for robust data sources to include in its HNA data review. MPHN preferences gold standard sources of information such as the Australian Institute of Health and Welfare (AIHW), Australian Bureau of Statistics (ABS), Public Health Information Development Unit (PHIDU) and New South Wales (NSW) Health data.

An exciting improvement to MPHN’s data analysis in relation to prioritisation of health issues and risk factors includes the development of automation through the Population Health Analytics (PHA) tool which ingests templates, in excess of 500 data points currently, of MPHN related health data and automatically calculates priority status based on a defined algorithm of benchmarking throughout the nation and variance to national averages. Within its LGA structure prioritisation of areas to concentrate on included taking into account magnitude of the difference compared with MPHN or state averages. This provides a transparent and robust methodology to data analysis.

Using service data as a measure of supply, MPHN maps where services are currently provided. Service supply can also include patient use of services data such as general practice data, Medicare Benefits Scheme (MBS) items and hospital usage rates. Workforce data is a critical piece of information that informs service gaps.

Service mapping is undertaken in general practice and the community through MPHN staff regularly and at census points through the year. MPHN additionally use their commissioned service data to inform supply.

Service use data is also prioritised using the MPHN automated Population Health Analytics tool.

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Confirmation of potential gaps and why the gap exists are achieved by consultation with communities through several mechanisms. MPHN conducts a “Conversations on the Couch” tour of several places in the region annually to talk openly with communities about their issues. There is no defined agenda which is deliberate to ensure we are not influencing the issues that communities face. A minor change to the Conversations tour for this HNA includes changing from a week-long tour at one time point to a designated tour to areas at the end of each month for a period of six to eight months. This results in the same coverage but allows for additional conversations to occur in specific naturally occurring groups such as youth groups, men’s sheds, Country Women’s Association and local councils, broadening the scope of consultation in each of the chosen areas.

This HNA process will include a specific “Yarns on the Couch” conversation with Aboriginal and Torres Strait Islander people in four areas of the Murrumbidgee region. Held at local land councils or significant places where local people gather, this informal process built on the conversations on the couch will ensure a culturally safe and respectful mechanism for engagement to hear Aboriginal and Torres Strait Islander people’s voices.

HNA Live, now HNA mini, allows consumers and healthcare professionals of the region to let MPHN know in real time their concerns about emerging health issues. Information on issues, challenges or positive feedback for specific populations is sought by promotion of a month long activity of feedback. Twitter, Facebook and MPHN newsletters are used to promote the feature of the month to encourage the community to provide feedback

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MPHN has added a community survey for this HNA. The survey seeks to gather information from communities about how they view their community. It also gathers information on self-reported health status and health challenges and capacity to access services. It is available with a cultural lens for Aboriginal and Torres Strait Islander people.

It is acknowledged that MPHN whilst capturing a broad range of stakeholders will need to continue to find solutions to engaging with people who normally don’t engage with health services, this includes but is not limited to people who are homeless, from culturally linguistic backgrounds and the prison population.

Targeted in depth projects are also undertaken, for example Community Led Planning projects are undertaken with two dedicated communities annually to work with community members to identify their needs and develop strategies led by the community to address them. This has been impacted by COVID-19 but remains an important strategy in working with regional communities and is partnered work with the MLHD to ensure that duplication of effort does not occur.

In addition promotion of the feedback mechanisms occurs through the Local Health Advisory Committees (LHACs). Consultation with various groups include the Murrumbidgee Aboriginal Health Consortium, the Youth Reference Group, the Shared Care Antenatal Group, the Murrumbidgee Mental Health Drug and Alcohol Alliance and the Murrumbidgee Aged Care Consortium also occur regularly to gather information on these groups specific needs. The insights of these groups are useful for identifying efficiency and effectiveness of current service delivery models and provide opportunities for improvement and identification of barriers to service access.

Clinical Councils are consulted to connect with healthcare providers, as a key stakeholder group it is important to understand the constraints and limitations of providers for health service delivery and to take into account their views related to health needs of their communities. MPHN consults with its current providers of commissioned services regularly and each have an opportunity to express issues with healthcare through regular contact with their portfolio manager. Primary care providers are regularly supported by primary care engagement officers in each of the four MPHN sectors. Information and issues gathered during support visits are captured and fed back to MPHNs HNA through MPHN’s customer relationship management system.

Consideration of both qualitative and quantitative analysis of health issues provides strong evidence for service and navigation investment to best meet what matters to communities.

MPHN analyses a range of sources related to geography, demography, health determinants and health status including risk factors. MPHN analyses the data at a Primary Health Network (PHN) level and 8|Page

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benchmarks to other PHNs across the nation. To determine locally where these domains are more relevant, MPHN uses LGA data. MPHN analysis of Statistical Area 3 (SA3) level information does not provide a good distribution within its boundaries and in particular is less able to be matched to MLHD service delivery and is rarely used. Local Health Advisory Committees additionally look to support their local communities within the LGA boundaries.

MPHN has developed a Population Health Analytics (PHA) tool to ingest publically available data. Data is ingested into the tool and is ranked comparing all 31 PHNs data. Data is ordered by PHN dependent on whether a lower or higher score is relevant. For example having less infant deaths is desirable so the ascending order would be by lower values, the higher the MPHN value is the worse the issue. Having more people exercising is desirable so this variable would be sorted by higher values. Ranking remains static in that a rank of one is always considered better than a ranking of 31 considered to be worse. In the MPHN view in the tool in addition to the rank score the variance to the national average and the NSW average is displayed if available.

The tool preferentially sorts indicators by most significant variance to national data. This identifies which indicators we should be considering for activities to improve health. Where indicators fall in the bottom third of the nation, indicating worse standing they are considered for activity. Other indicators may be considered for continuing activity to maintain or improve their standings. Rank order is not the only consideration though, indicators are preferentially sorted by their variance to the National average.

To determine where MPHN activity should be focused, the PHA tool reports each indicator across all LGAs where information is available and displays the difference between the MPHN average or the NSW average.

The final action in the needs assessment is to incorporate all data and qualitative information collected in a triangulation methodology that brings together demand and supply to identify gaps, reasons for gaps, existing planned activities to determine where maintenance of existing service supply is required or where new activity would be required to address an unmet need.

MPHN has a community and person first philosophy, to support this MPHN organises its health needs assessment and activity workplans by population groups. The following groupings are used:    

Aboriginal and Torres Strait Islander people; mothers, children and youth; older persons and population health including vulnerable populations who experience socio economic disadvantage.

Using these groupings allows synthesis of profiles, geographic, demographic and health to be analysed in conjunction with information from feedback and consultations to give an accurate representation of the entire MPHN and the 21 LGAs. Prior to submission to the Commonwealth the last important actions for the compiled priority list is to validate the results with key stakeholders. Key stakeholders include identified staff from the MLHD as a major partner in the process and MPHN community. Refinement of priorities occurs based on validation feedback. Once this validation has been completed the HNA is provided to the Clinical Councils and the Community Advisory Committee of MPHN for their input into validation and endorsement for progression to the MPHN Board.

Once endorsed MPHN’s Board considers the recommendations and approves submission to the Commonwealth.

This formal approach to reviewing the HNA is undertaken annually, however it is reviewed and updated continuously. MPHN take a reflective approach to reviewing its processes for HNA regularly to ensure they are fit for purpose and take opportunities to refine and improve and mature its implementation of the HNA.

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Data and information issues and opportunities There are some issues that impact on MPHN’s HNA, one relates to its geography being close to a state border (Victoria). MPHN has issues in particular for breast screening with cross-border utilisation in its Border sector.

Where healthcare is delivered in another state it is not always possible to retrieve that information. There are other minor issues where MPHN borders another PHN such as in the community of Lake Cargelligo which is located in Lachlan LGA which crosses into the Western PHN. Service mapping is problematic with a lack of resources or systems that adequately keep up to date information on services. There are a plethora of service directories but the reliability of the information in them is questionable. This makes understanding the service offerings in an LGA or across the region difficult to track and report against. It is also not possible to assess the quality, efficiency and effectiveness of services delivered in anything but a rudimentary way by measuring accreditation in the case of general practice.

Data issues are also noted in relation to accessibility of data, ability to publish and use data outside of internal planning and timeliness of the data. Where data exists sometimes the last refresh of the data is more than five to ten years previous. This can result in an artificial issue that may have recently changed, although population health is less likely to see significant impacts given the large scale of data and therefore less likely to see large data variations.

Key issues for 2023-25 Many of the needs for the Murrumbidgee remain the same in this HNA period as the previous HNA period. Issues that did not arise in this HNA identified previously include childhood obesity, reproductive issues, homelessness, refugee health, drought, grief and bereavement issues, breast cancer screening and vaccine preventable disease in two year old Aboriginal and Torres Strait Islander people.

Lack of identification of these issues specifically does not mean they don’t exist, it may be that they don’t rank in the bottom third of the nation but still are higher in rate or proportion than NSW and Australia.

This year’s HNA focusses on data where the rate or proportion is in the bottom third of the available NSW or national data and has a negative difference indicating room for improvement. Additionally issues that are relevant and discovered through past community consultation may not be identified in current consultations, not because they are not important, it may be they were not a key focus at the time of consultation for community members.

The following section outlines the needs and issues identified in the Murrumbidgee region and finishes by identifying priorities and relevant activities to address them. The document includes an appendix that presents data in comparison to either NSW or nation or both and demonstrates the variability through the 21 LGAs of the region. The appendix also includes results of community surveys and community consultations and commissioned service data. MPHNs philosophy of people first and providing and using evidence to drive the identification of needs and supply of services is the basis of the 2022-25 Health Needs Assessment.

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What does the Murrumbidgee region look like

Summary demography MPHN is situated in southern New South Wales with communities bordering on NSW and Victoria to the south, Lake Cargelligo in the north, Young and the Snowy Valleys in the east and Barham in the west. Historically the Murrumbidgee district was land between the Murrumbidgee River and the Murray River and was pastoral and grazing land, it is most commonly known as the Riverina region.

The majority of MPHN is located on Wiradjuri land and also includes lands of the Wemba Wemba, Baraba Baraba Nari Nari and Yorta Yorta people. The AIATSIS Indigenous Australia map shown below in figure 1 (not exact or with fixed boundaries) attempts to represent the language, social or nation groups of Aboriginal Australia using larger groupings of people which may include clans, dialects or individual languages. The nations included here are within but not restricted to the MPHN footprint.

FIGURE 1: MAP OF INDIGENOUS AUSTRALIA FOCUSSING ON MPHN REGION

Source: https://aiatsis.gov.au/explore/map-indigenous-australia

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Wiradjuri people, skilled hunter-fisher gatherers are scattered throughout central New South Wales, united by common descent through kinship and shared traditions. Wiradjuri is derived from wirraay, meaning "no" or "not", with dhuurray or –juuray meaning "having". The people of Wiradjuri country are known as “people of three Rivers” being the Macquarie River (Wambool), Lachlan River (Kalari) and the Murrumbidgee River (Murrumbidjeri) which border their lands.

The majority of the region is classified as outer regional Australia (RA3) with remote areas (RA4) and inner regional areas (RA2). The major city of the region is Wagga Wagga. This is depicted in figure 2 below.

FIGURE 2: AUSTRALIAN STANDARD GEOGRAPHICAL CLASSIFICATION (ASGC) MAP OF MPHN REGION

Source: https://www1.health.gov.au/internet/main/publishing.nsf/Content/PHN-Murrumbidgee

MPHN has sector divisions for purposes of planning and organisation of service delivery, the Border sector to the south, the Western sector to the north west, Riverina sector to the east and Wagga Wagga centrally located in the largest city.

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FIGURE 3: SECTOR MAP OF MPHN REGION

MPHN has a population of approximately a quarter of a million people. A significant majority of these people live in Wagga Wagga or Griffith, the two major cities in the region. On average for every square kilometre of land there are three people. The population remains stable with a net neutral change between 2019 and 2020.

MPHN has a large Aboriginal and Torres Strait Islander population, nearly double that of the NSW and national average. The majority of Aboriginal and Torres Strait Islander people are located in the Western sector, in particular in the Lachlan LGA. MPHN has an ageing population with higher proportions of people over the age of 65 years compared with NSW and Australia. The region has a moderately lower socioeconomic score compared with NSW and Australia. The regions socioeconomic status is important to the provision of equitable fee based services with a propensity towards requiring low fee services in the more disadvantaged areas. The Indigenous relative socioeconomic index score for Murrumbidgee is similar in the Aboriginal and Torres Strait Islander population.

This is further supported by the regions higher proportions of low income households and proportions of weekly households with nil or negative incomes or incomes less than $799 per week.

Whilst unemployment is only slightly higher than the NSW average it is lower than the national average for non-Aboriginal people. For Aboriginal and Torres Strait Islander people the unemployment rate is better than both NSW and national averages, however is, alarmingly, three times higher than non-Aboriginal unemployment rates. Unemployment is not evenly distributed through the region with Western sector having more LGAs with the issue compared with the other regions. Lower unemployment is reported in both Griffith and Wagga Wagga.

Youth unemployment is slightly higher in MPHN compared with NSW and Australia. There is an uneven distribution for youth unemployment with areas of the Western sector having much higher proportions

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compared with other sectors. There is a higher rate of people relying on government support in MPHN compared with NSW and Australia. This too may contribute to ability to pay for fee based health services.

Single parent families with young children may have increased difficulty accessing services due to childcare issues and cost for fee based health services where the family is dependent on government assistance. MPHN has higher proportions of female sole parent pensioners compared with NSW and Australia, mainly in the Western sector. The proportion of single parent Aboriginal and Torres Strait Islander families is nearly double that of non-Aboriginal single parent families and compared with NSW and Australia is higher in MPHN. MPHN has slightly higher proportions for low income, welfare dependent families, children in low income, welfare dependent families and jobless families with young children compared with NSW and Australia. Aboriginal and Torres Strait Islander jobless families are nearly three times higher compared with non-Aboriginal jobless families with a slightly higher proportion compared with both NSW and Australia. Low income and jobless families may experience difficulty accessing fee based health services.

MPHN has some of the lowest rankings across Australia for low educational attainment, measured by lower participation in secondary school education at age 16, in Year 10 or below and Year 11 or below. Similarly Aboriginal and Torres Strait Islander people who left school at Year 10 or below or did not go to school was ranked 31st with higher rates compared with both NSW and Australia. This is confirmed with less people participating in higher education in MPHN compared with NSW and Australia. For Aboriginal and Torres Strait Islander people this is higher compared with Australia but lower compared with NSW. MPHN has a higher rate of people per 100 that participate in vocational education and training compared with NSW and Australia.

Level of educational attainment can be used to reflect levels of health literacy and require an effort to ensure that people have access to clear and concise health information tailored for lower education.

Health literacy consideration is particularly important for the higher proportions of mothers with low educational attainment in the region compared with NSW and Australia. For Aboriginal and Torres Strait Islander women this rate is nearly double that of non-Aboriginal mothers. Fewer than one percent of people born overseas report poor proficiency in English compared with NSW and Australia. There are four LGAs within the Murrumbidgee region where consideration to interpretation of resources may be required for a small subset of the population.

Added to the issues of health literacy due to educational attainment, MPHN has higher proportions of dwellings without internet access for both non-Aboriginal and Aboriginal and Torres Strait Islander households. Dwellings without internet access are throughout the region with the exception of Wagga Wagga sector. Access to the internet for children across the Murrumbidgee is more than double that in Aboriginal and Torres Strait Islander households compared with non-Aboriginal households. The rates for both are higher compared with NSW and Australia. Relying on internet as a sole mechanism for contact with these households will potentially result in a lack of service use linked to telehealth services at the very least.

People in the Murrumbidgee region reported feeling safer walking alone after dark in their communities, with discrimination and a lack of acceptance of other cultures comparing similarly to NSW and Australian rates.

In summary for the demographic characteristics of MPHN, there are three key areas which require consideration when planning and delivering primary care health care services. Table 1 describes the priority areas and the population groups affected by identification of issues in MPHN’s population. Table 2 provides a description of evidence where MPHN ranks 25th or more indicating that MPHN is in the lowest third of the nation.

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Table 1: Priority areas for action for population groups from demography

Need for specific age related services Increase access to services due to limitations for fee based healthcare services Improve health literacy due to less education or lack of internet access

Aboriginal and Torres Strait Islander people

Maternal, Child and Youth









Older persons



Population

 

Table 2: Summary of evidence for priority areas demography Outcomes of the health needs analysis Identified Need Need for specific age related services Increase access to services due to limitations for fee based healthcare services

Improve health literacy due to less education or lack of internet access

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Key Issue Higher proportion of people aged over 65 years 4.5% higher than Australia, 4.1% higher than NSW Higher proportion of weekly household income $1 - $799 (rank 29/31, variance to Aust -30%) Higher proportion of weekly household income – nil or negative (rank 28/31, variance to Aust -42%) Higher proportion of low income households (rank 27/31, variance to Aust -20%) Higher proportion of Aboriginal and Torres Strait Islander single parent families with young children (rank 25/31, variance to Aust -6%) Higher rate of people who left school at year 10 or below or did not go to school (rank 29/31, variance to Aust -38%) Higher rate of Aboriginal and Torres Strait Islander people who left school at year 10 or below, or did not go to school (rank 29/31, variance to Aust -15%) Lower proportion of full time participation in secondary school education at age 16 (rank 25/31, variance to Aust -6%) Lower proportion of highest level of education – Bachelor’s degree or higher (rank 30/31, variance to Aust -50%) Lower proportion of school leaver participation in higher education (rank 23/25, variance to Aust -68%): Aboriginal and Torres Strait Islander (rank 23/25, variance to Aust -70%) Higher proportion of children in families where the mother has low educational attainment (rank 26/31, variance to Aust 47%) Higher proportion of Aboriginal and Torres Strait Islander children in families where the mother has low educational attainment (rank 29/31, variance to Aust -19%) Higher proportion of dwellings without internet access (rank 29/31, variance to Aust -61%) Higher proportion of dwellings with Aboriginal and Torres Strait Islander households without internet access (rank 25/31, variance to Aust -19%) Higher proportion of children living in dwellings without internet access (rank 25/31, variance to Aust -19%) Higher proportion of Aboriginal and Torres Strait Islander children living in dwellings without internet access compared with NSW (rank 25/31, variance to Aust -19%)

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Description of Evidence PHIDU 2019; Table 16 age groups AIHW 2016; Table 18: Household income PHIDU 2016; Table 18: Household income PHIDU 2016; Table 30: Single parent families PHIDU 2016; Table 40: Nonparticipation in education

PHIDU 2019; Table 41: Participation in education AIHW 2016; Table 42: Participation in higher education

PHIDU 2016; Table 44: Families education

PHIDU 2020, 2016; Table 38: Dwellings - Internet

PHIDU 2020, 2016; Table 39: Dwellings – Children without Internet access

Summary health determinants MPHN has a higher fertility rate compared with both NSW and Australia. For teenage mothers the birth rate is double that of the nation. MPHN has a lower proportion of babies born with a low birthweight compared with Australia for non-Aboriginal babies and similar for Aboriginal and Torres Strait Islander babies. Although the proportion of Aboriginal and Torres Strait Islander babies is double that of the non-Aboriginal babies. For babies that are fully breastfed by six months of age the MPHN has lower proportions compared with NSW and Australia. This is the case at three months as well although not ranked quite as low as six months.

Across all ages and all vaccine types, MPHN children are higher in proportion compared with Australia, for both non-Aboriginal and Aboriginal and Torres Strait Islander children. For vaccine types such as Diphtheria, Pertussis and Tetanus, Hepatitis B, Polio, Haemophilus influenza B, Pneumococcal, Meningococcal, Measles Mumps and Rubella, Varicella, across all relevant ages MPHN rates are higher compared with Australia.

MPHN has similar proportions for children who are on track, who are vulnerable and at risk in five developmental domains of language and cognitive skills; social competence; emotional maturity; physical health and wellbeing; communication and general knowledge.

Both males and females have a slightly lower life expectancy than their counterparts in Australia. People with profound and severe disability are similar in proportion in the MPHN compared with NSW and Australia. This is also the case for disability in those over the age of 65 years.

For MPHN higher rates of domestic violence related assault but lower rates of non-domestic violence related assault are noted. The opposite is reported for alcohol related domestic violence related assault with lower proportions in MPHN compared with NSW but higher proportions of alcohol related non-domestic violence related assault. MPHN has higher rates of both sexual and indecent assault compared with NSW. MPHN adults who report having a long term health condition are higher in proportion compared with Australia and less people report having excellent, very good or good health compared with Australia in MPHN. In summary for the health determinants of MPHN, there are five key areas which require consideration when planning and delivering primary care healthcare services. Table 3 describes the priority areas and the population groups affected by identification of issues in MPHN’s population. Table 4 provides a description of evidence where MPHN ranks 25th or more indicating that MPHN is in the lowest third of the nation.

Table 3: Priority areas for action for population groups from health determinants

Need to increase life expectancy due to lower life expectancy experienced Increased need for ante-natal support due to higher teenage mother birth rate Increased need for ante-natal support due to less fully breastfeed babies at six months Need for support related to domestic violence related assault Need for support for victims of sexual or indecent assault

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Aboriginal and Torres Strait Islander people

Maternal, Child and Youth

Older persons

Population

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    HNA 2022-25

Table4: Summary of evidence for priority areas health determinants Outcomes of the health needs analysis Identified Need Need to increase life expectancy due to lower life expectancy experienced

Key Issue Life expectancy for persons, males and females all lower compared with Australia (males; rank 25/31, variance to Aust -2%)

Description of Evidence AIHW 2016; Table 53 Life expectancy

Increased need for ante-natal support due to higher teenage mother birth rate

Higher proportion teenage mother birth rates (rank 25/31, variance to Aust -89%)

PHIDU 2018; Table 52 teenage mothers

Increased need for ante-natal support due to less fully breastfeed babies at six months

Lower proportion of fully breastfed babies at six months of age (rank 28/31, variance to Aust -15%)

PHIDU 2014; Table 56 Breastfeeding and early nutrition

Need for support related to domestic violence related assault

Higher rate of domestic violence related assault

Boscar 2020; Table 82 Violence related assault Boscar 2020; Table 83 Alcohol related violence related assault Boscar 2020; Table 84 Sexual and indecent assault Boscar 2020; Table 84 Sexual and indecent assault

Need for support for victims of sexual or indecent assault

Higher proportion of alcohol related non-domestic violence related assault Higher rates of sexual assault Higher rates of indecent assault

Summary risk factors MPHN has higher rates of people, both males and females that consume alcohol at harmful levels compared with both NSW and Australia. These rates are across all sectors with the exception of Wagga Wagga. Both short and long term risk associated with alcohol drinking is higher in the Murrumbidgee compared with NSW. Drinking daily is higher in the Murrumbidgee region compared with NSW. There is a lower proportion of drinking within the recommended levels in the Murrumbidgee compared with NSW. MPHN has higher rates of possession and or use of amphetamines, cannabis compared with NSW but lower rates of cocaine and ecstasy use compared with NSW. MPHN has higher rates of people with low or very low or no exercise are higher compared with both NSW and Australia. People with adequate fruit intake are similar in the MPHN to both NSW and Australia. Conversely MPHN has higher proportions of vegetable intake compared with NSW. MPHN has higher rates of people with high blood pressure and higher proportions of people with a long term condition of high blood pressure or hypertension compared with Australia.

Proportions of people who are overweight and obese are higher in MPHN compared with Australia. Obesity is higher in three sectors, Riverina, Border and Western. MPHN has the highest rates of overweight males and females for young people compared with NSW and Australia. This rate of overweight young people is reflected in all four sectors. Obesity is the same for MPHN young people, although this is not reported in the Wagga Wagga sector however is evident in the other three sectors.

MPHN residents do not have higher rates of people with high or very high psychological distress compared with NSW and Australia.

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Higher rates of male smokers are reported in MPHN compared with NSW and Australia, in all sectors except Wagga Wagga. In MPHN proportions of women that smoke during pregnancy are higher for both nonAboriginal and Aboriginal and Torres Strait Islander mothers and smoking throughout the pregnancy. For Aboriginal and Torres Strait Islander mothers the proportion is more than double that of non-Aboriginal mothers. In the first 20 weeks of pregnancy the MPHN proportion is approximately double NSW and Australia.

Exposure to the sun in the Murrumbidgee is similar to NSW. In summary for risk factors there are six key areas which require consideration when planning and delivering primary care healthcare services. Table 5 describes the priority areas and the population groups affected by identification of issues in MPHN’s population. Table 6 provides a description of evidence where MPHN ranks 25th or more indicating that MPHN is in the lowest third of the nation.

Table 5: Priority areas for action for population groups from risk factors

Reduction of alcohol at harmful levels

Aboriginal and Torres Strait Islander people

Maternal, Youth

Child

and

Older persons

    

Reduction of use of amphetamines and cannabis Increased exercise due to current low rates Reduction in risk related to high blood pressure Reduction in overweight and obesity Increase smoking pregnancy

cessation

during



Population

 

Table 6: Summary of evidence for priority areas risk factors Outcomes of the health needs analysis Identified Need Reduction of alcohol at harmful levels

Reduction of use of amphetamines and cannabis

Key Issue Higher rate of people who consume alcohol at harmful levels (people, rank 26/31, variance to Aust -27%; males, rank 26/31, variance to Aust -25%; females, rank 26/31, variance to Aust -27%) Higher proportion of levels of risky alcohol consumption (rank 31/31, variance to Aust -191%) Higher rate of possession and or use of amphetamines Higher rate of possession and or use of cannabis

Increased exercise due to current low rates

Higher rates of people with low or very low or no exercise (rank 26/31, variance to Aust -6%)

Reduction in risk related to high blood pressure

Higher rate of people with high blood pressure (rank 25/31, variance to Aust -3%) and high blood pressure or hypertension as a long term health condition (rank 25/31, variance to Aust -9%)

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Description of Evidence PHIDU 2017; Table 88 consume alcohol at harmful levels AIHW 2017; Table 89 levels of risky alcohol consumption BOSCAR 2020; Table 90 Possession and or use of amphetamines BOSCAR 2020; Table 91 Possession and or use of cannabis PHIDU 2017; Table 94 Diet and exercise PHIDU 2017; table 95 high blood pressure

Reduction in overweight and obesity

Increase cessation pregnancy

smoking during

Higher proportion of overweight and obesity (rank 28/31, variance to Aust -11%), in particular for young people (overweight people, rank 30/30, variance to Aust -9%; males, rank 29/30, variance to Aust -8%; females, rank 30/30, variance to Aust -8%) (obese people, rank 28/30, variance to Aust -33%; males, rank 28/30, variance to Aust -31%; females, rank 28/30, variance to Aust -36%) Higher proportion smoking during pregnancy (rank 26/31, variance to Aust -73%) Aboriginal and Torres Strait Islander mothers (rank 26/31, variance to Aust -10%) Higher proportion smoking in first 20 weeks of pregnancy (rank 28/31, variance to Aust -80%) Higher proportions of smoking after 20 weeks of pregnancy (rank 29/31, variance to Aust -16%)

AIHW 2017; Table 96 overweight and obesity PHIDU 2017; Table 99 Overweight young people PHIDU 2017; Table 100 Obese young people PHIDU 2018, PHIDU 2016, AIHW 2018; Table 103 Smoking in pregnancy

Summary health conditions The leading causes of death in the Murrumbidgee region for the top three are the same as Australia, these include coronary heart disease, Alzheimer’s disease or dementia and cerebrovascular disease.

Long term health conditions, particularly more than three and those that report being limited a lot by condition are higher in MPHN this suggests that in general the health of MPHN residents is likely to be poorer and not easily resolved as acute conditions may be. This will have an impost on need to use services in the Murrumbidgee region.

Infant deaths 0 – 48 months are higher in the MPHN, details on causes of death are not known, however, this may have an impact for support related to grief and bereavement that need to be considered. Infant mortality in the first 0-12 months is similar in MPHN compared with NSW and Australia.

The median age at death for Murrumbidgee residents is similar to NSW and Australia with males having a median age at death of 78 years and females having a median age of 84 years. For Aboriginal and Torres Strait Islander people in MPHN the median age at death for males is 58 years and for females a decade older at 68 years. This is significantly lower than non-Aboriginal people.

MPHN has higher mortality from all causes for females and males compared with Australia. Premature mortality, potentially avoidable deaths and avoidable deaths in males are higher in MPHN compared with NSW and Australia. For premature mortality, rates are higher in females in MPHN compared with Australia, avoidable deaths and potentially avoidable deaths are not however significantly higher. For Aboriginal and Torres Strait Islander people premature mortality and avoidable deaths are similar in MPHN compares to NSW. Morbidity measured by potential years of life lost is higher in MPHN compared with Australia, in particular for males but also for females. For Aboriginal and Torres Strait Islander people rates of years of life lost are similar to NSW and Australia. Potential years of life lost by age groupings demonstrate that those aged 25-44 years do not have significantly higher years of life lost in MPHN compared with Australia. This is the case though for those 0-14 years, 15-24 years, 45-64 years and 65-74 years. In particular for males these age groupings have much higher potential years of life lost compared with Australia in MPHN region however for females, those 15-24 years, 45-64 years and 65-74 years have higher potential years of life lost compared with Australia but not for those 0-14 years or 25-44 years.

Mortality related to alcohol attributable deaths is higher in MPHN compared with NSW for both males and females. Deaths attributed to smoking are slightly higher in MPHN compared with NSW. 19 | P a g e

HNA 2022-25

MPHN has higher proportions of people with long term health conditions for both heart disease and effects of stroke. Heart, stroke and vascular disease rates are higher in MPHN compared with both NSW and Australia.

Mortality associated with cardiovascular disease is higher for males for circulatory disease deaths, this is not the case of females or in general. Deaths due to atrial fibrillation are also only marginally higher in MPHN compared with Australia. Premature mortality and avoidable deaths are higher in MPHN for circulatory disease in non-Aboriginal people, is only slightly higher in Aboriginal and Torres Strait Islander people and marginally higher for ischaemic heart disease. Premature deaths due to cerebrovascular disease and avoidable deaths are lower in MPHN compared with NSW and marginally higher than Australia. Potential years of life lost due to circulatory system disease in Aboriginal and Torres Strait Islander people and non-Aboriginal people are similar in MPHN compared with NSW and Australia. Potential years of life lost due to ischaemic heart disease and cerebrovascular disease are also not significantly higher in MPHN compared with NSW and Australia.

The prevalence of diabetes is slightly higher in MPHN compared with NSW and as a long term health condition compared with Australia. The incidence of diabetes in MPHN is lower compared with both NSW and Australia.

Mortality due to endocrine and nutritional and metabolic disease is higher in MPHN compared with Australia.

Premature mortality due to diabetes was similar in MPHN compared with NSW and Australia. Potential years of life lost attributed to diabetes was similar in MPHN compared with NSW and Australia.

Prevalence of arthritis as a long term health condition is higher in proportion compared with Australia and as a rate compared with both NSW and Australia. Osteoporosis is similar in MPHN compared with NSW and Australia. There is a higher rate of mortality due to musculoskeletal system and connective tissues disease in females in MPHN compared with Australia.

Mortality due to external causes is higher in MPHN compared with Australia for males and females. Premature mortality and avoidable deaths are also higher in MPHN compared with NSW and Australia for non-Aboriginal people. Premature deaths and avoidable deaths for Aboriginal and Torres Strait Islander people are similar in MPHN compared with NSW. Potential years of life lost due to mortality from external causes is much higher in MPHN compared with NSW and Australia.

Mortality due to chronic kidney disease is higher in MPHN compared with NSW. Kidney failure is also the 18th leading cause of death in the Murrumbidgee region.

Mortality due to pregnancy, childbirth and the puerperium are slightly higher compared with Australia as is mortality due to certain conditions originating in the perinatal period. Mortality due to disease of the genitourinary system are similar in MPHN compared with Australia for females but are higher in males.

Infectious disease prevalence for chlamydia and Hepatitis C are higher in MPHN compared with NSW. Gonorrhoea infections are lower in MPHN compared with NSW. The current COVID-19 prevalence and vaccine administration rates are variable given it is an active pandemic. Mortality due to certain infectious and parasitic disease is higher in MPHN compared with Australia particularly in males. Influenza and pneumonia is the 15th leading cause of death in MPHN. Long term mental health conditions in MPHN are slightly higher but do not rank lower than 25th across the nation. There is no difference in the rate of mental and behavioural problems for males and females compared with NSW and Australia. This is not consistent for age though where people aged 5-11 years and 65 plus years proportions of total mental health conditions are significantly higher in MPHN compared with Australia. These age cohorts have significantly higher mental health conditions for early intervention, mild, moderate or severe mental health conditions in the MPHN compared with Australia. Mortality due to mental and behavioural disorders was similar in MPHN compared with Australia. Specifically mortality due to suicide in males are much higher in MPHN compared with Australia. Both premature mortality, avoidable deaths and potential years of life lost due to suicide and self-inflicted injuries are higher in MPHN compared with Australia.

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Cancer as a long term health condition is higher proportionately compared with Australia. The cancer incidence rate is higher in MPHN compared with NSW and Australia, specifically for males. For cancers detected through screening for breast, cervical and bowel cancer rates were similar in MPHN compared with NSW. Mortality due to neoplasms is higher in MPHN compared with Australia for both males and females. Premature deaths due to cancer and specifically breast cancer is higher in MPHN compared with NSW and Australia and ranks lower than 25th across the nation. Premature deaths due to lung cancer are slightly higher compared with NSW and Australia in MPHN, however, do not rank lower than 25th across the nation. Premature deaths from colorectal cancer and in Aboriginal and Torres Strait Islander people are lower in MPHN compared with NSW and Australia. Avoidable deaths due to cancer, specifically breast and colorectal cancer are higher in MPHN compared with NSW and Australia. Whilst avoidable deaths due to cancer in Aboriginal and Torres Strait Islander people are higher in MPHN compared with Australia, they do not rank lower than 25th across the nation. Morbidity measured by potential years of life lost is higher in MPHN compared with NSW and Australia for all cancers and for breast cancer. Colorectal cancer and Aboriginal and Torres Strait Islander peoples potential for year’s life lost is lower in MPHN compared with NSW and Australia.

As a long term health condition, chronic lung disease is similar in MPHN compared with Australia. Asthma is higher in proportion in MPHN as a long term health condition compared with Australia. Rates of asthma in MPHN are also higher compared with NSW and Australia. Chronic obstructive pulmonary disease is higher as a condition compared with NSW but similar to Australia in MPHN. Mortality due to respiratory disease is higher in MPHN compared with Australia, specifically in males, mortality is higher in females but does not rank lower than 25th across the nation. Premature mortality due to respiratory disease and chronic obstructive pulmonary disease is higher in MPHN compared with NSW and Australia. Premature mortality in Aboriginal and Torres Strait Islander people is also higher in MPHN compared with NSW but does not rank lower than 25th in the nation. Avoidable deaths are higher in MPHN compared with NSW and Australia for respiratory disease and for chronic obstructive pulmonary disease. Avoidable deaths are similar to NSW in the MPHN for Aboriginal and Torres Strait Islander people. Potential for years of life lost is higher in MPHN for respiratory system disease compared with NSW and Australia. Morbidity is slightly higher for chronic obstructive pulmonary disease in MPHN compared with NSW and Australia but does not rank lower than 15th across the nation.

Morbidity is lower for Aboriginal and Torres Strait Islander people for respiratory system disease in MPHN compared with NSW. MPHN has higher rates of both premature mortality and potential years of life lost due to road traffic injuries and avoidable deaths from transport accidents compared with NSW and Australia. Prevalence of Alzheimer’s disease or dementia as a long term health condition is similar in MPHN compared with Australia, chronic pain is slightly higher in MPHN compared with Australia.

Mortality due to skin disease is lower in MPHN compared with Australia for males and females. Other conditions where mortality is higher in MPHN compared with Australia include symptoms‚ signs and abnormal clinical and laboratory findings‚ not elsewhere classified, congenital malformations, deformations and chromosomal abnormalities, nervous system disease and digestive disease. Liver disease is ranked 19th in MPHN as a leading cause of death. Deaths due to hypertensive disease rank 11th in the MPHN. There are 25 health conditions in MPHN which rank in the lowest third of the nation and require some level of intervention to reduce the burden on incidence/prevalence, mortality and morbidity that they place on the region. Table 7 describes the priority areas and the population groups affected relating to specific health conditions. Table 8 provides a description of evidence for health conditions where MPHN ranks 25th or more indicating that the MPHN is in the lowest third of the nation.

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HNA 2022-25

Table 7: Priority areas for action for population groups from health conditions

Reduce coronary heart disease and CHD mortality Reduce mortality related to Alzheimer’s disease or dementia Reduce cerebrovascular mortality

Aboriginal and Torres Strait Islander people

Reduce number of long term health conditions Reduce limitations of long term health conditions Reduce Infant deaths 0-48 months

Maternal, Child and Youth

Older persons

      



Reduce all-cause mortality; premature mortality; avoidable deaths; potentially avoidable deaths Reduce morbidity through reduction in potential years of life lost Reduce mortality attributable to alcohol and smoking Reduce mortality due to diabetes

    

Reduce prevalence of arthritis Reduce mortality and morbidity due to external causes; premature mortality; avoidable deaths, external causes, other external causes Reduce mortality due to chronic kidney disease or kidney failure Reduce mortality due to genitourinary system disease Reduce mortality due to infectious and parasitic disease Reduce mental health conditions for specific age groups Reduce mortality and morbidity, premature mortality, avoidable deaths due to suicide Reduce incidence of cancer (specific types)

   

   

Reduce mortality, premature deaths, avoidable deaths and morbidity due to cancer Reduce prevalence of asthma

   

Reduce premature mortality due to respiratory system disease Reduce premature mortality due to chronic obstructive pulmonary disease Reduce premature mortality, avoidable deaths and morbidity due to road traffic injuries or transport accidents Reduce mortality due to digestive disease, specifically liver disease Reduce deaths due to hypertensive disease

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Population

  HNA 2022-25

Table 8: Summary of evidence for priority areas health conditions Outcomes of the health needs analysis Identified Need Reduce coronary heart disease and CHD mortality

Key Issue Leading cause of death 8th cause of death for heart failure and complications and ill-defined heart disease 17th cause of death for cardiac arrhythmias Higher proportion (rank 31/31, variance to Aust -32%) and rate of (rank 28/30, variance to Aust -10%) long term health condition – heart disease Second leading cause of death

Description of Evidence AIHW 2015-19; Table 104 20 top leading causes of death in Australia and MPHN

Reduce cerebrovascular mortality

Third leading cause of death

AIHW 2015-19; Table 104 20 top leading causes of death in Australia and MPHN

Reduce number of long term health conditions

AIHW 2016; Table 105 long term health conditions

Reduce limitations of long term health conditions

Higher proportion of people with more than three long term health conditions (rank 25/31, variance to Aust 14%) Higher proportion of people with a long term health condition which is limited a lot by condition (rank 27/31, variance to Aust -20%)

Reduce Infant deaths 048 months

Higher rate of infant deaths 0-48 months (rank 28/31, variance to Aust -26%)

PHIDU 2014; Table 106 Infant mortality

Reduce all-cause mortality; premature mortality; avoidable deaths; potentially avoidable deaths

Higher rate of all-cause mortality (rank 25/31, variance to Aust -13%), males (rank 25/31, variance to Aust 14%) Higher rate of premature mortality (rank 28/31, variance to Aust -22%), males (rank 28/31, variance to Aust -24%) Higher rate of avoidable deaths (rank 26/31, variance to Aust -24%), males (rank 26/31, variance to Aust 26%) Higher rate of potentially avoidable deaths males (rank 26/31, variance to Aust -34%) Higher rate of potential years of life lost (rank 26/31, variance to Aust -27%), males (rank 26/31, variance to Aust -30%) Persons and males 0-14 (rank 26/31, variance to Aust 19%) males (rank 27/31, variance to Aust -35%), 15-24 (rank 28/31, variance to Aust -77%) males (rank 28/31, variance to Aust -84%), 45-64 (rank 25/31, variance to Aust -21%) males (rank 25/31, variance to Aust -22%), 65-74 (rank 28/31, variance to Aust -21%) males (rank 28/31, variance to Aust -24%) Females 15-24 (rank 27/31, variance to Aust -60%), 4564 (rank 25/31, variance to Aust -19%), 65-74 (rank 25/31, variance to Aust -15%) Higher rate of deaths attributable to alcohol, males and females Higher rate of deaths attributed to smoking

AIHW 2018; Table 109 mortality all causes

7th leading cause of death

AIHW 2015-19; Table 104 20 top leading causes of death in Australia and MPHN

Reduce mortality related to Alzheimer’s disease or dementia

Reduce morbidity through reduction in potential years of life lost

Reduce mortality attributable to alcohol and smoking Reduce mortality due to diabetes

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HNA 2022-25

AIHW 2016, PHIDU 2017; Table 120 Cardiovascular and cerebrovascular disease AIHW 2015-19; Table 104 20 top leading causes of death in Australia and MPHN

AIHW 2016; Table 105 long term health conditions

PHIDU 2014; Table 110 Premature mortality PHIDU 2014; Table 112 Avoidable deaths PHIDU 2014; Table 114 Potentially avoidable deaths PHIDU 2014; Table 115 Potential years of life lost

HealthStatsNSW, 2018-19, 2019

Reduce prevalence of arthritis

Higher proportion as a long term health condition – arthritis (rank 29/31, variance to Aust -17%) Higher rate of arthritis (rank 30/30, variance to Aust 27%) Higher rate of mortality due to external causes (rank 27/31, variance to Aust -28%), females (rank 29/31, variance to Aust -28%) Higher rate of premature deaths due to external causes (rank 27/31, variance to Aust -39%) Higher rate of avoidable deaths due to external causes (rank 26/31, variance to Aust -30%) and other external causes (rank 27/31, variance to Aust -47%) Higher rate of potential years of life lost external causes (rank 28/31, variance to Aust -59%) 12th leading cause of death other ill define causes 20th leading cause of death accidental falls Higher rate of mortality due to chronic kidney disease 18th leading cause of death – kidney failure

AIHW 2016; Table 133 Arthritis

Reduce mortality due to genitourinary system disease

Higher rate of mortality due to genitourinary system disease (rank 25/31, variance to Aust -13%)

AIHW 2018; Table 140 Mortality due to disease of the genitourinary system

Reduce mortality due to infectious and parasitic disease

Higher rate of mortality due to infectious and parasitic disease males (rank 25/31, variance to Aust -17%) 15th leading cause of death Influenza and pneumonia

Reduce mental health conditions for specific age groups

Higher total mental health conditions 5-11 years (rank 25/31, variance to Aust -8%), 65 plus years (rank 31/31, variance to Aust -33%); early intervention 5-11 years (rank 25/31, variance to Aust -8%) 65 plus years (rank 26/31, variance to Aust -6%); mild 5-11 years (rank 25/31, variance to Aust -8%) 65 plus years (rank 31/31, variance to Aust -44%); moderate 5-11 years (rank 25/31, variance to Aust -8%) 65 plus years (rank 31/31, variance to Aust -47%); severe mental health conditions 5-11 years (rank 25/31, variance to Aust 6%) 65 plus years (rank 31/31, variance to Aust -44%) Higher premature mortality from suicide and selfinflicted injuries (rank 26/31, variance to Aust -37%) Higher avoidable deaths from suicide and self-inflicted injuries (rank 26/31, variance to Aust -37%) Higher rate of potential years of life lost due to suicide and self-inflicted injuries (rank 26/31, variance to Aust -50%) 16th leading cause of death suicide

AIHW 2018; Table 141 Mortality due to certain infectious and parasitic disease AIHW 2015-19; Table 104 20 top leading causes of death in Australia and MPHN NMHSPF, PHIDU 2019; Table 143: Mental health conditions - Total mental health conditions

Reduce mortality and morbidity due to external causes; premature mortality; avoidable deaths, external causes, other external causes

Reduce mortality due to chronic kidney disease or kidney failure

Reduce morbidity, premature mortality, avoidable deaths due to suicide

Reduce incidence of cancer (specific types)

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Higher proportion as a long term condition (rank 29/31, variance to Aust -19%) Higher rate of cancer incidence specifically males (rank 29/31, variance to Aust -9%) Higher incidence colorectal cancer (rank 26/31, variance to Aust -9%); males (rank 29/31, variance to Aust -12%) Higher incidence pancreatic cancer (rank 27/31, variance to Aust -9%), females (rank 27/31, variance to Aust -10%) Higher incidence prostate cancer (rank 31/31, variance to Aust -27%)

HNA 2022-25

PHIDU 2017; Table 133 Arthritis AIHW 2018; Table 135 Mortality due to external causes PHIDU 2014; Table 136 Premature mortality due to external causes PHIDU 2014; Table 136 Premature mortality due to external causes PHIDU 2014; Table 138 Potential years of life lost, external causes AIHW 2015-19; Table 104 20 top leading causes of death in Australia and MPHN HelathStatsNSW, 2016-18 AIHW 2015-19; Table 104 20 top leading causes of death in Australia and MPHN

PHIDU 2014; Table 150 Suicide premature deaths PHIDU 2014; Table 151 Avoidable deaths due to suicide and self-inflicted injuries PHIDU 2014; Table 152 Suicide potential years of life lost AIHW 2015-19; Table 104 20 top leading causes of death in Australia and MPHN AIHW 2016; Table 153 Long term health condition - cancer PHIDU 2010-14; Table 154 Cancer incidence by gender PHIDU 2010-14; Table 155 Colorectal cancer incidence PHIDU 2010-14; Table 156 Pancreatic cancer incidence PHIDU 2010-14; Table 157 Prostate cancer incidence

Reduce mortality, premature deaths, avoidable deaths and morbidity due to cancer

Higher mortality rate due to neoplasms males (rank 25/31, variance to Aust -13%) and females (rank 25/31, variance to Aust -12%) Higher rate of premature deaths due to cancer (rank 28/31, variance to Aust -16%); breast cancer (rank 29/31, variance to Aust -16%) Higher rate of avoidable deaths due to cancer (rank 31/31, variance to Aust -24%); breast (rank 29/31, variance to Aust -17%) 5th leading cause of death – lung cancer 6th leading cause of death – colorectal cancer 9th leading cause of death – prostate cancer 10th leading cause of cancer – unknown or ill-defined primary site 13th leading cause of death - pancreatic cancer 14th leading cause of death – breast cancer Higher rate of potential years of life lost for all cancers (rank 25/31, variance to Aust -16%); breast cancer (rank 28/31, variance to Aust -12%) Higher proportion as a long term health condition – asthma (rank 29/31, variance to Aust -24%)

AIHW 2018; Table 166 Mortality due to cancer

Reduce premature mortality due to respiratory system disease

Higher rate of premature mortality due to respiratory system disease (rank 27/31, variance to Aust -37%)

PHIDU 2014; Table 176 Premature mortality due to respiratory system disease

Reduce premature mortality due to chronic obstructive pulmonary disease

4th leading cause of death – chronic obstructive pulmonary disease

AIHW 2015-19; Table 104 20 top leading causes of death in Australia and MPHN

Reduce premature mortality, avoidable deaths and morbidity due to road traffic injuries or transport accidents

Higher rate premature mortality due to road traffic injuries (rank 26/31, variance to Aust -98%) Higher potential years of life lost – road traffic injuries (rank 28/31, variance to Aust -122%) Higher rate of avoidable deaths from transport accidents (rank 27/31, variance to Aust -103%)

PHIDU 2014; Table 179 Premature mortality due to road traffic injuries PHIDU 2014; Table 181 Potential years of life lost – road traffic injuries PHIDU 2014; Table 180 avoidable deaths from transport accidents

Reduce mortality due to digestive disease, specifically liver disease

Higher rate of mortality due to digestive disease 19th leading cause of death – liver disease

AIHW 2018 AIHW 2015-19; Table 104 20 top leading causes of death in Australia and MPHN

Reduce deaths due to hypertensive disease

11th leading cause of death – hypertensive disease

AIHW 2015-19; Table 104 20 top leading causes of death in Australia and MPHN

Reduce prevalence of asthma

PHIDU 2014; Table 167 Premature mortality due to cancer PHIDU 2014; Table 169 Avoidable deaths due to cancer AIHW 2015-19; Table 104 20 top leading causes of death in Australia and MPHN

PHIDU 2014; Table 171 potential years of life lost AIHW 2016; Table 173 Long term respiratory disease

Summary community consultation Generally, in the Aboriginal and Torres Strait Islander survey, the 39 respondents reported community spirit and friendly people were the best things about living in their towns. Respondents were generally proud, thought their communities coped with challenges, had access to non-health related services and sporting facilities, could get involved and that their communities were safe. These results were similarly reported in the non-Aboriginal community survey of 751 respondents who in addition to community spirit and friendly people thought the best things were the lifestyle and natural environment of their towns. Similarly, slightly higher proportions of people reported pride, community resilience, community involvement, access to no health related facilities and safety in the community survey.

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Differences between the Aboriginal and Torres Strait Islander cohort and the non-Aboriginal cohort were reported for being treated with respect, this was as low as a third in the Aboriginal and Torres Strait Islander cohort (33%) and as high as 60% in the non-Aboriginal cohort. For whether a person thought that racism was a problem in their community in the Aboriginal and Torres Strait Islander survey 67% reported this compared with the 38% in the non-Aboriginal survey. The cost of living was also different between both cohorts with 56% in the Aboriginal and Torres Strait Islander cohort reporting that living costs were affordable compared with 40% in the non-Aboriginal cohort.

People’s experience in their community was high in both cohorts for feeling part of the community, participating in community activities, getting help from family friends or neighbours, accessing community support groups and getting involved in local decision making processes. In the non-Aboriginal cohort less than a third (28.5%) have experienced racism in the Aboriginal and Torres Strait Islander cohort this was nearly three times that (79%).

Self-report of health and overall life satisfaction was different between the cohorts with far greater ratings of health (75% non-Aboriginal, 54% Aboriginal and Torres Strait Islander) and overall life satisfaction (82% nonAboriginal, 62% Aboriginal and Torres Strait Islander).

In the non-Aboriginal cohort people reported an average of 1.5 health conditions, in the Aboriginal and Torres Strait Islander cohort that quadrupled to 4.5 health conditions. Both cohorts reported weight and nutrition issues (36.9% non-Aboriginal, 48.7% Aboriginal and Torres Strait Islander), mental health issues (28.1% nonAboriginal, 46.2% Aboriginal and Torres Strait Islander), arthritis (34.1% non-Aboriginal, 30.8% Aboriginal and Torres Strait Islander), high blood pressure (26% non-Aboriginal, 23.1% Aboriginal and Torres Strait Islander), chronic pain (22.2% non-Aboriginal, 28.2% Aboriginal and Torres Strait Islander) more frequently than other conditions. In the Aboriginal and Torres Strait Islander cohort they also reported lung disease (25.6%) as a significant health issue.

The five top issues that people thought affected their whole community were similar between the two cohorts in terms of order but different in magnitude. The top five issues in order included mental health issues; drug and alcohol misuse; housing affordability; ageing issues; poor access to health care; family violence; and cancer. Other significant issues included cost of living; social isolation; child abuse/neglect; family violence; diabetes; suicide; and transport issues.

In the Aboriginal and Torres Strait Islander cohort and the non-Aboriginal cohort difficulty accessing services was higher than 50% with the exception of childcare and education and training. Access difficulty for both cohorts was noted for GPs, specialist doctors, allied health, alcohol and other drug services and mental health services.

Asked what could happen to improve health and wellbeing, most Aboriginal and Torres Strait Islander people responses indicated a lack of access to quality health services, including accountability of those health services.

Suggestions to improve health and wellbeing included hubs to meet and yarn up, mentoring programs, early intervention, adequate housing, respect and understanding, youth activities, support groups and affordable services. Access to mental health services featured prominently in the types of services to make available.

Ensuring cultural safety was also suggested. Access to quality workforce, access to allied health, access to specialists, mental health services, AOD services, health literacy and holistic services were also consistently noted.

In the non-Aboriginal cohort the response followed the same themes, access to specialists, mental health and AOD services, GPs, allied health, aged care, maternal, child and youth services and hospital services were all raised as issues. Access and awareness of where and how to access services was a major recurring theme in both the community survey and the mini feedback received.

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Eighteen themes were identified from the Aboriginal and Torres Strait Islander and non-Aboriginal community consultations through survey and feedback. Table 9 describes the priority areas and the population groups affected relating to community feedback. Table 10 provides a description of evidence where there is difference between cohorts and evidence of need expressed by communities.

Table 9: Priority areas for action for population groups from community consultations

Increase respect and reduce racism and discrimination Respond to issues relating to family violence Respond to issues relating to social isolation Respond to issues relating to child abuse/neglect Respond to issues relating to housing affordability, transport and cost of living Improve health literacy including education relating to access and awareness of services available Respond to issues relating to poor access to healthcare including GPs, specialists and allied health Respond to issues relating to weight and nutrition Respond to issues relating to diabetes Respond to issues relating to mental health including access to services Respond to issues relating to arthritis Respond to issues relating to high blood pressure Respond to issues relating to chronic pain Respond to issues relating to lung disease Respond to issues relating to cancer Respond to issues relating to suicide Respond to issues relating to drug and alcohol misuse including access to services Respond to issues relating to ageing issues

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Aboriginal and Torres Strait Islander people

     

Maternal, Child and Youth

Older persons

Population

    





      



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HNA 2022-25

   



   

Table 10: Summary of evidence for priority areas health conditions Outcomes of the health needs analysis Identified Need Increase respect and reduce racism and discrimination

Key Issue Treated with respect (disagree, 37% non-Aboriginal, 64% Aboriginal and Torres Strait Islander) Racism is a problem in our community (agree,39% nonAboriginal, 67% Aboriginal and Torres Strait Islander) Experienced racism (agree, 28% non-Aboriginal, 79% Aboriginal and Torres Strait Islander)

Description of Evidence MPHN 2021: Table 189: Aboriginal and Torres Strait Islander about your community…

MPHN 2021: Table 190: Aboriginal and Torres Strait Islander about your experience…

MPHN 2021: Table 202: About your community…

MPHN 2021: Table 203: About your experience…

Respond relating violence

to to

issues family

26.9% non-Aboriginal, 51.3% Aboriginal and Torres Strait Islander

MPHN 2021: Table 193: Aboriginal and Torres Strait Islander five most serious health and wellbeing concerns for your community as a whole MPHN 2021: Table 206: Five most serious health and wellbeing concerns for your community as a whole

Respond relating isolation

to to

issues social

24.6% non-Aboriginal, 38.5% Aboriginal and Torres Strait Islander

MPHN 2021: Table 193 Aboriginal and Torres Strait Islander five most serious health and wellbeing concerns for your community as a whole MPHN 2021: Table 206: Five most serious health and wellbeing concerns for your community as a whole

Respond to relating to abuse/neglect

issues child

Respond to issues relating to housing affordability, transport and cost of living

33.3% Aboriginal and Torres Strait Islander

MPHN 2021: Table 193: Aboriginal and Torres Strait Islander five most serious health and wellbeing concerns for your community as a whole

Housing affordability 36% non-Aboriginal, 59% Aboriginal and Torres Strait Islander Cost of living 30.5% non-Aboriginal, 59% Aboriginal and Torres Strait Islander Transport 27.7% non-Aboriginal, 30.8% Aboriginal and Torres Strait Islander

MPHN 2021: Table 193: Aboriginal and Torres Strait Islander five most serious health and wellbeing concerns for your community as a whole

Improve health literacy including education relating to access and awareness of services available Respond to issues relating to poor access

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MPHN 2021: Table 206: Five most serious health and wellbeing concerns for your community as a whole Aboriginal community and mini feedback survey qualitative responses Page 157 Community and mini feedback survey qualitative responses Page 166

Poor access to healthcare 43.6% non-Aboriginal, 59% Aboriginal and Torres Strait Islander

HNA 2022-25

MPHN 2021: Table 193: Aboriginal and Torres Strait Islander five most serious

to healthcare including GPs, specialists and allied health

Respond to issues relating to weight and nutrition

health and wellbeing concerns for your community as a whole MPHN 2021: Table 206: Five most serious health and wellbeing concerns for your community as a whole Difficulty accessing GP 51% non-Aboriginal, 77% Aboriginal and Torres Strait Islander Difficulty accessing specialist 77% non-Aboriginal, 92% Aboriginal and Torres Strait Islander Difficulty accessing allied health 73% non-Aboriginal, 82% Aboriginal and Torres Strait Islander 36.9% non-Aboriginal, 48.7% Aboriginal and Torres Strait Islander

MPHN 2021: Table 194: Aboriginal and Torres Strait Islander service access MPHN 2021: Table 207: Service access

MPHN 2021: Table 192: Aboriginal and Torres Strait Islander health challenges MPHN 2021: Table 205: Health challenges

Respond to issues relating to diabetes

30.8% Aboriginal and Torres Strait Islander

MPHN 2021: Table 193: Aboriginal and Torres Strait Islander five most serious health and wellbeing concerns for your community as a whole

Respond to issues relating to mental health including access to services

28.1% non-Aboriginal, 46.2% Aboriginal and Torres Strait Islander

MPHN 2021: Table 192: Aboriginal and Torres Strait Islander health challenges MPHN 2021: Table 205: Health challenges

57.5% non-Aboriginal, 82.1% Aboriginal and Torres Strait Islander

MPHN 2021: Table 193: Aboriginal and Torres Strait Islander five most serious health and wellbeing concerns for your community as a whole MPHN 2021: Table 206: Five most serious health and wellbeing concerns for your community as a whole

73% non-Aboriginal, 90% Aboriginal and Torres Strait Islander

MPHN 2021: Table 194: Aboriginal and Torres Strait Islander service access MPHN 2021: Table 207: Service access

Respond to issues relating to arthritis

34.1% non-Aboriginal, 30.8% Aboriginal and Torres Strait Islander

MPHN 2021: Table 192: Aboriginal and Torres Strait Islander health challenges MPHN 2021: Table 205: Health challenges

Respond to issues relating to high blood pressure

26% non-Aboriginal, 23.1% Aboriginal and Torres Strait Islander

Respond to issues relating to chronic pain

22.2% non-Aboriginal, 28.2% Aboriginal and Torres Strait Islander

MPHN 2021: Table 192: Aboriginal and Torres Strait Islander health challenges MPHN 2021: Table 205: Health challenges MPHN 2021: Table 192: Aboriginal and Torres Strait Islander health challenges MPHN 2021: Table 205: Health challenges

Respond to issues relating to lung disease

25.6% Aboriginal and Torres Strait Islander

MPHN 2021: Table 192: Aboriginal and Torres Strait Islander health challenges

Respond to issues relating to cancer

32.4% non-Aboriginal

MPHN 2021: Table 206: Five most serious health and wellbeing concerns for your community as a whole

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HNA 2022-25

Respond to issues relating to suicide

26% non-Aboriginal, 30.8% Aboriginal and Torres Strait Islander

MPHN 2021: Table 193: Aboriginal and Torres Strait Islander five most serious health and wellbeing concerns for your community as a whole MPHN 2021: Table 206: Five most serious health and wellbeing concerns for your community as a whole

Respond to issues relating to drug and alcohol misuse including access to services

52.9% non-Aboriginal, 71.8% Aboriginal and Torres Strait Islander

MPHN 2021: Table 193: Aboriginal and Torres Strait Islander five most serious health and wellbeing concerns for your community as a whole MPHN 2021: Table 206: Five most serious health and wellbeing concerns for your community as a whole

58% non-Aboriginal, 72% Aboriginal and Torres Strait Islander

MPHN 2021: Table 194: Aboriginal and Torres Strait Islander service access MPHN 2021: Table 207: Service access

Respond to issues relating to ageing issues

Difficulty accessing 54% non-Aboriginal, 56% Aboriginal and Torres Strait Islander

MPHN 2021: Table 194: Aboriginal and Torres Strait Islander service access

Ageing issues 58.5% non-Aboriginal

MPHN 2021: Table 206: Five most serious health and wellbeing concerns for your community as a whole

Summary services and workforce General practice attendances in MPHN are lower than Australia. MPHN has a lower proportion of adults who have had a usual GP for more than five years compared with Australia. MPHN residents report waiting longer than acceptable to get an appointment with their GP and are less likely to report that explanations of their test results are given in a way that’s easy to understand. MPHN residents are less likely to report quality of healthcare received from their usual place of care being excellent.

In the after-hours period attendances at GPs are much lower in MPHN compared with NSW and Australia and availability of a GP weekdays after 6pm or on the weekends is significantly lower than Australia and NSW. GP attendance in residential aged care facilities are also lower in MPHN compared with Australia and NSW. Less adults reported speaking to their health professional about emotional or psychological health, or saw a health professional when they needed to, mostly due to embarrassment.

Reduced attendance in general practice in hours and after hours highlights the potential for workforce shortages that exist through most rural and regional areas, this is the case in the Murrumbidgee region.

Additionally results suggest that health literacy could be impacted by MPHN results.

Of the general practices in the Murrumbidgee region in 2020-21, the main areas of interest are women’s health, dermatology, mental health and paediatrics. The majority of practices completed cultural training more than two years ago. Several programs such as GoShare (health literacy), Lumos (data linkage), emergency response planning tool and winter strategy are delivered in general practice often with engaged practices participating in all programs on offer. Continuous professional development was attended mainly by practice nurses and medical personnel.

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HNA 2022-25

General practice patients span all age groups with a quarter being under the age of 24 years and a further quarter approximately being over 65 years of age. Less than 5% identify as Aboriginal and Torres Strait Islander however nearly a quarter inadequately describe their Aboriginal status. Approximately half the population are married, more than a third are pensioners. Slightly more than half of the population are female.

For both incidence and prevalence respiratory disease is the highest health condition managed in general practice followed by mental health issues and cancer. In relation to Medicare Benefits Scheme (MBS) items unsurprisingly in this financial year COVID GP telephone items were the highest reported MBS billing item. The prevalence of GP management plans either in preparation or in team care arrangements billed second highest.

For specialist use, potentially there is less access to specialists as is the case in rural and regional Australia with lower specialist attendances compared with Australia. There is a higher proportion of patient with out of pocket costs associated with specialist care in the MPHN compared with Australia.

Community health centres are reported higher as usual place of care settings compared with Australia. Allied health attendances are lower in MPHN compared with Australia. In MPHN people report a lower selfassessment on the quality of the healthcare received from their usual practice in relation to excellence. More patients report an out of pocket cost for non-hospital Medicare services compared with Australia and in particular for imaging. Lower allied health attendances are confirmed with lower rates of MBS allied health service claims compared with Australia, ranking in the bottom third of the nation. In particular for physiotherapy, speech pathology, occupational therapy, physical healthcare and other medical practitioners.

Allied health mental health, psychiatry, clinical psychology and other psychologist services are all lower for MBS claims in MPHN compared with Australia.

There is a significantly lower proportion of cervical screening participation in MPHN compared with Australia and NSW. For alcohol and other drug (AOD) services, there is a lower rate of clients in MPHN compared with Australia.

More referrals come from self or family or health services in MPHN compared with Australia. Less referrals in MPHN come from corrections, diversion or other compared with Australia. Support and case management is higher in MPHN compared with Australia as is assessment only as a service type. The most common setting for AOD services in MPHN was non-residential. The most common principal drugs of concern are alcohol, amphetamines and cannabis.

MPHN has a higher proportion of Indigenous health checks compared with Australia, particularly face to face and for follow up checks.

MPHN has a lower proportion of five or more antenatal visits compared with Australia.

Emergency Department (ED) presentations for low urgency care across all hours is higher in MPHN indicating that there is a higher reliance on hospital ED service for lower acuity care. Reasons for using the ED included waiting times for general practice. More people thought their care could have been provided by a GP in the MPHN compared with Australia.

Types of health conditions where MPHN has higher rates and ranks in the lowest third of the nation include circulatory diseases; digestive diseases; genitourinary diseases; injury; poisoning and other external causes; infectious and parasitic diseases; musculoskeletal and connective tissue issues; respiratory issues; other conditions; and mental and behavioural disorders.

MPHN has 33 hospitals and Multi Purpose Services (MPS) across the region with a higher total admission rate compared with NSW, in particular to public hospitals. This is supported by a higher proportion of adults reporting they were admitted to any hospital in the previous 12 months. Admissions for total chronic 31 | P a g e

HNA 2022-25

conditions (potentially preventable hospitalisations) and all potentially preventable conditions are higher in MPHN compared with Australia. Admissions for Aboriginal and Torres Strait Islander are not in the lower third of the nation although generally are higher than Australia and NSW. Admissions for health conditions which are higher in MPHN include chronic congestive cardiac failure; chronic diabetes complications; type 1 and 2 diabetes; injury; poisoning and other external causes; genitourinary issues; kidney disease; infectious and parasitic diseases; respiratory issues; chronic asthma; chronic obstructive pulmonary disease; influenza, particular over 65 years of age; digestive diseases; and congenital malformations. For Aboriginal and Torres Strait Islander people higher admissions are reported for genitourinary diseases; acute urinary tract infections; kidney disease; intentional self-harm; respiratory issues; chronic asthma; chronic obstructive pulmonary disease; digestive diseases; chronic iron deficiency anaemia; and acute convulsions and epilepsy.

MPHN commissions a number of different services to address high rates of PPH including allied health services (WARATAH); integrated care coordination; health navigation for chronic diseases; family violence; Murrumbidgee HealthPathways; integrated team care (Aboriginal and Torres Strait Islander chronic disease); mental health (including Gidget and headspace); alcohol and other drugs; vitality program (aged people in community and RACF); and after hours general practice. Commissioned services are in line with the seven priority areas of the Commonwealth and are captured in MPHN’s Activity Work Plans (AWPs).

There are 13 identified needs from the service information in this report where MPHN rank in the bottom third of the nation indicating issues with access to and availability of services. Table 11 describes the priority areas and the population groups affected relating to service use. Table 12 provides a description of evidence that indicate an issue related to service use in MPHN. Table 11: Priority areas for action for population groups from service use

Lower general practice attendances

Aboriginal and Torres Strait Islander people

Maternal, Child and Youth

Lower GP attendances after hours Lower GP attendances residential aged care facilities Lower GP attendance about emotional health Lower specialist attendances Lower allied health attendances Lower cervical cancer screening participation Lower proportion of antenatal visits



Higher out of pocket costs Lower MBS mental health services Higher use of Emergency Department for low urgency presentations Higher total admissions to hospital Lack of dentists

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HNA 2022-25

Older persons

Population

            

Table 12: Summary of evidence for priority areas service use Outcomes of the health needs analysis Identified Need Lower general practice attendances

Key Issue Lower GP attendances – potentially indicating less access to GPs both males and females (MPHN 546.9 per 100, Aust 604.9 per 100) Less time associated with usual GP – potentially indicating transient GP workforce (rank 29/31, variance to Aust -14%) Waited longer than acceptable to get an appointment with GP (rank 28/30, variance to Aust -37%) Lower health literacy - explanations of test results easy for patient to understand (rank 25/31, variance to Aust -5%)

Description of Evidence AIHW 2018: Table 208: General practice attendances

Lower GP attendances after hours – potentially indicating less access to GPs both males and females (MPHN 18.7 per 100, Aust 48.6 per 100)

AIHW 2018: Table 231: General practice after hours

Less access - Usual place of care has a GP available to visit or talk with on weekdays after 6pm (rank 31/31, variance to Aust -51%) Less access - Usual place of care has a GP available to visit or talk with on Saturdays after midday (rank 30/31, variance to Aust -50%) Less access - Usual place of care has a GP available to visit or talk with on Sundays (rank 31/31, variance to Aust -61%) Lower MBS GP after hours services delivered (level 3) (rank 28/28, variance to Aust -60%)

AIHW 2016: Table 232: Usual place of care after hours

Lower GP attendances residential aged care facilities

Lower GP attendances RACF – potentially indicating less access to GPs (MPHN 13.0 per 100, Aust 17.8 per 100)

AIHW 2016: Table 218: GP attendance residential aged care facilities

Lower GP attendance about emotional health

Less adults who spoke to a GP about their own emotional or psychological health (rank 26/31, variance to Aust -5%) More people who needed to see a health professional for psychological health but didn't (rank 28/31, variance to Aust -16%) Reason for not seeing a health professional for psychological health – embarrassment (rank 21/25, variance to Aust -22%) Lower specialist attendances – potentially indicating less access to specialists (specifically females) (MPHN 78.9 per 100, Aust 88.5 per 100) More patients with out-of-pocket costs for nonhospital Medicare services – Specialists (rank 28/31, variance to Aust -9%) Lower allied health attendances – potentially indicating less access to allied health (MPHN 70.7 per 100, Aust 91.2 per 100) Lower self-assessed quality of health care received from usual place of care is excellent (rank 25/31, variance to Aust -9%) Lower allied health services (rank 26/28, variance to Aust -24%)

AIHW 2016: Table 229: GP consulted for emotional health

Lower GP attendances after hours

Lower attendances

Lower allied attendances

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specialist

health

HNA 2022-25

AIHW 2016: Table 213: Length of time with usual GP AIHW 2016: Table 220: GP usage AIHW 2016: Table 224: Patient experience

AIHW 2017-18: Table 233: MBS GP attendances after hours

AIHW 2016: Table 230: Psychological health – reasons for not using AIHW 2018: Table 235: Specialist attendances AIHW 2016: Table 237: Specialist cost implications AIHW 2018: Table 241: Allied health attendances AIHW 2016: Table 246: Self assessed care AIHW 2017-18: Table 251: MBS Allied health services

Lower MBS Allied Health – Physiotherapy (rank 25/28, variance to Aust -32%)

AIHW 2017-18: Table 252: MBS Allied health provider services Level 3

Lower MBS Allied Health – Speech pathology (rank 20/26, variance to Aust -29%)

Lower cervical cancer screening participation

Lower MBS Allied Health – Occupational therapy (rank 17/22, variance to Aust -15%) Lower MBS Allied Health – Other non-referred medical practitioner (rank 25/28, variance to Aust -53%) Lower MBS Allied Health – Physical health care (rank 24/28, variance to Aust -28%) Lower cervical cancer screening participation (rank 30/31, variance to Aust -14%)

Lower proportion antenatal visits

Lower than five or more antenatal visits (rank 28/31, variance to Aust -3%)

AIHW 2019: Table 272: Antenatal visits

More patients with out-of-pocket costs for nonhospital Medicare services (rank 27/31, variance to Aust -17%) More patients with out-of-pocket costs for nonhospital Medicare services – Imaging (rank 28/31, variance to Aust -51%) Lower MBS allied health mental health (rank 27/28, variance to Aust -44%) Lower MBS psychiatry (rank 25/28, variance to Aust 33%) Lower MBS clinical psychologist (rank 27/28, variance to Aust -78%) Lower MBS other psychologist (rank 25/28, variance to Aust -42%) High use of ED for low urgency presentation all hours (rank 26/28, variance to Aust -120%) High use of ED for low urgency presentation after hours (rank 26/28, variance to Aust -116%) High use of ED for low urgency presentation in hours (rank 26/28, variance to Aust -124%)

AIHW 2016: Table 249: Out of pocket expenses

of

Higher out of pocket costs

Lower MBS mental health services

Higher use of Emergency Department for low urgency presentations

Across all age groups and both genders for all hours, after hours and in hours

AIHW 2018: Table 259: Cancer screening

AIHW 2017-18: Table 254: MBS mental health services

AIHW 2018: Table 275: Low urgency ED presentations AIHW 2018: Table 276: ED low urgency presentations all hours by age AIHW 2018: Table 278: ED low urgency presentations after hours by age AIHW 2018: Table 277: ED low urgency presentations in hours by age AIHW 2018: Table 279 : ED low urgency presentations by gender

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Main reason for most recent ED visit – Waiting time too long (rank 22/26, variance to Aust -124%)

AIHW 2016: Table 286: Reasons for ED visits

More patients who thought care could have been provided by a GP for most recent visit to ED (rank 28/31, variance to Aust -49%) Higher use of ED for non-urgent disease:

AIHW 2016: Table 287: General practice ED visits

Circulatory system (rank 27/28, variance to Aust 588%)

AIHW 2018-19: Table 288: ED presentations circulatory system

Digestive system (rank 27/28, variance to Aust -367%)

Table 289: ED presentations digestive system

Genitourinary system (rank 27/28, variance to Aust 311%)

Table 290: ED presentations genitourinary system

HNA 2022-25

Higher total admissions to hospital

Injury, poisoning and other external causes (rank 27/28, variance to Aust -393%)

Table 291: ED presentations injury, poisoning and other external causes

Infectious and parasitic disease (rank 27/28, variance to Aust -491%)

Table 292: ED presentations infectious and parasitic diseases

Musculoskeletal system and connective tissue (rank 27/28, variance to Aust -348%)

Table 293: ED presentations musculoskeletal system and connective tissue

Respiratory system (rank 27/28, variance to Aust 531%)

Table 294: ED presentations respiratory system

Other conditions (rank 27/28, variance to Aust -393%)

Table 295: ED presentations other conditions

Mental and behavioural disorders (rank 28/28, variance to Aust -2848%)

Table 296: ED presentations mental and behavioural disorders

Higher total admissions to hospital (rank 18/21, variance to NSW -14%) Higher admissions to public hospitals (rank 27/31, variance to Aust -21%) More adults who were admitted to any hospital in the preceding 12 months (rank 29/30, variance to Aust 30%) Higher admissions for total chronic conditions (PPH) (rank 30/31, variance to Aust -40%)

PHIDU 2017: Table 298: Total admissions

Higher admissions for all potentially preventable conditions (rank 28/31, variance to Aust -30%)

PHIDU 2017: Table 301: Admissions for potentially preventable conditions

Higher admissions for total acute preventable conditions (rank 20/21, variance to Aust -35%)

PHIDU 2017: Table 303: Admissions for acute conditions

Higher admissions for chronic congestive cardiac failure (PPH) (rank 28/31, variance to Aust -29%)

PHIDU 2017: Table 307: Admissions for chronic congestive cardiac failure

Higher admissions for chronic diabetes complications (PPH) (rank 28/31, variance to Aust -33%)

PHIDU 2017: Table 312: Admissions for chronic diabetes complications

Higher Type 1 diabetes hospitalisations (rank 9/10, variance to NSW -71%)

NSW Health 2018-19: Table 313: Admissions for diabetes by type

AIHW 2018: Table 299: Total admissions 12 months PHIDU 2017: Table 300: Admissions for total chronic conditions (potentially preventable)

Higher Type 2 diabetes hospitalisations (rank 10/10, variance to NSW -50%) Higher admissions for injury, poisoning and other external causes (rank 26/31, variance to Aust -21%)

PHIDU 2017: Table 315: Admissions for injury, poisoning and other external causes

Higher admissions for genitourinary system disease (rank 29/31, variance to Aust -30%)

PHIDU 2017: Table 316: Admissions for genitourinary system disease

Higher Aboriginal admissions for genitourinary system disease (rank 27/31, variance to Aust -17%) Higher Aboriginal admissions for acute urinary tract infections, including pyelonephritis (PPH) (rank 26/31, variance to Aust -8%) Higher admissions for kidney disease, all (rank 8/10, variance to NSW -1%)

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PHIDU 2016: Table 317: Admissions for urinary tract infections NSW Health 2018-19: Table 318: Admissions for kidney disease

Higher admissions for infectious and parasitic diseases (Public Hospitals) (rank 29/31, variance to Aust -26%)

PHIDU 2017: Table 321: Admissions for infectious and parasitic diseases

Aboriginal admissions for kidney disease (rank 8/10, variance to NSW -10%)

NSW Health 2018-19: Table 319: Admissions for same day admission for dialysis for kidney disease

Higher Aboriginal admissions for intentional self-harm (rank 29/31, variance to Aust -33%)

PHIDU 2015: Table 322: Admissions for intentional self-harm

Higher Aboriginal admissions for respiratory system disease (rank 24/28, variance to Aust -8%)

PHIDU 2017: Table 328: Admissions for respiratory system disease

Higher admissions for chronic asthma (PPH) (rank 28/31, variance to Aust -32%)

PHIDU 2017: Table 329: Admissions for chronic asthma

Higher Aboriginal admissions for chronic asthma (PPH) (rank 25/31, variance to Aust -22%) Higher admissions for chronic obstructive pulmonary disease (PPH) (rank 30/31, variance to Aust -60%)

PHIDU 2017: Table 330: Admissions for chronic obstructive pulmonary disease

Higher Aboriginal admissions for chronic obstructive pulmonary disease (PPH) (rank 27/31, variance to Aust16%) Higher admissions for influenza (rank 10/10, variance to NSW -40%)

NSW Health 2018-19: Table 332: Admissions for influenza and pneumonia all ages

Higher admissions for influenza over 65 years (rank 10/10, variance to NSW -29%)

NSW Health 2018-19: Table 333: Admissions for influenza and pneumonia over 65 years

Higher admissions for digestive system disease (rank 26/31, variance to Aust -35%)

PHIDU 2017: Table 336: Admissions for digestive system disease

Higher Aboriginal admissions for digestive system disease (rank 25/31, variance to Aust -9%)

Lack of Dentists

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Higher admissions for congenital malformations, deformations and chromosomal abnormalities (rank 31/31, variance to Aust -32%) Higher admissions for Admissions for chronic iron deficiency anaemia (PPH) (rank 27/31, variance to Aust -55%) Higher Aboriginal admissions for admissions for chronic iron deficiency anaemia (PPH) (rank 25/31, variance to Aust -36%) Higher Aboriginal admissions for acute convulsions and epilepsy (PPH) (rank 26/31, variance to Aust -23%)

PHIDU 2017: Table 337: Admissions for congenital malformations

Lower rank for dentists per 100,000 population (rank 26/30, variance to Aust -33%)

PHIDU 2018: Table 367: Dentists

HNA 2022-25

PHIDU 2017: Table 340: Admissions for chronic iron deficiency anaemia

PHIDU 2016: Table 344: Aboriginal admissions for acute convulsions and epilepsy (PPH)

Opportunities and Priorities To determine the priority areas for MPHN it is important to triangulate and synthesize all of the issues identified through the health needs assessment process. Table 13 below themes major issues identified and denotes where it was identified by either health or service need analysis and/or community feedback. The number of times that an issue was identified as a priority gives an indication of the strength of the issue. Higher numbers should be addressed as a priority. This table includes all of the priorities identified in the HNA process.

Table 14 presents the opportunities and priorities of the MPHN summarising the activities planned to address the identified needs that translate to these priorities. Activities are expanded upon in the AWPs submitted to the Department of Health.

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Table 13: Summary of evidence for all domains Outcomes of the health needs analysis Identified Need response

Demography

Health determinant

Risk factor

Health condition

Community consultation

Service and workforce

Aboriginal and Torres Strait Islander Increase respect and reduce racism and discrimination

1



Reduce admissions for Aboriginal and Torres Strait Islander people for chronic PPH including genitourinary, acute UTIs, kidney disease, digestive disease, chronic iron deficiency anaemia, acute convulsions and epilepsy, intentional self-harm and respiratory disease (asthma, COPD)

Number times issue is priority



1



2

Maternal, Child and Youth Increased need for ante-natal support for all women, teenage mothers and including breastfeeding



Increase smoking cessation during pregnancy

1



Increase specific age related services increasing life expectancy - Youth





Reduce Infant deaths 0-48 months

3



1



Older persons Increase specific age related services increasing life expectancy





3



Reduce Influenza admissions over 65 years



1

Increase GP attendances RACF



1

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HNA 2022-25

Identified Need response

Demography

Health determinant

Risk factor

Health condition

Community consultation

Service and workforce

Number times issue is priority



2

Population Increase access to services due to limitations for fee based healthcare services



Improve health literacy due to less education or lack of internet access





2

Respond to issues relating to housing affordability, transport and cost of living



1

Respond to issues relating to poor access to healthcare including GPs, specialists and allied health





2

Reduce ED presentations and admissions for PPH



1

Increase care delivery in general practice, specialists in community and allied health, improve number of dentists available



1

Increase GP attendances after hours



1

Increase support related to domestic violence related assault and victims of sexual or indecent assault





2

Reduction of alcohol at harmful levels and drug use specifically amphetamines and cannabis







3

Reduction of risk factors including low exercise, high blood pressure, overweight and obesity







3

Reduction of long term health conditions, prevalence, incidence, mortality and or morbidity for; • • •

alzheimer’s disease or dementia cerebrovascular disease road traffic injuries or transport accidents

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

1

Identified Need response

Demography

Health determinant

Risk factor

Health condition

Community consultation

Service and workforce

Number times issue is priority



2



3

Population Reduction of prevalence, incidence, mortality and or morbidity and high use of services in ED or hospital for; • • • • •

coronary heart disease and CHD including congestive cardiac failure genitourinary system disease including chronic kidney disease or kidney failure infectious and parasitic disease, including influenza digestive disease, specifically liver disease Injury, poisoning and other external causes

Reduction of prevalence, incidence, mortality and or morbidity and high use of services in ED or hospital and identified by community consultations for; • • • •









2



1

diabetes respiratory system disease, including asthma and chronic obstructive pulmonary disease mental health conditions including social isolation musculoskeletal system and connective tissue including arthritis

Reduction of prevalence, incidence, mortality and or morbidity and identified by community consultations for; • •



suicide cancer

Respond to issues relating to chronic pain Increase cervical cancer screening participation



Respond to emerging issues related to disasters (drought, bushfires, floods, pandemic)

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1 3

Table 14: Opportunities and priorities Opportunities and priorities Priority area Priority

Priority subcategory

Expected Outcome

Aboriginal and Torres Strait Islander Increase respect reduce racism discrimination

and and

Reduce admissions for Ab original and Torres Strait Islander people for chronic PPH including genitourinary, acute UTIs, kidney disease, digestive disease, chronic iron deficiency anaemia, acute convulsions and epilepsy, intentional self-harm and disease respiratory (asthma, COPD)

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Aboriginal and Torres Strait Islander Health

Appropriate care (including cultural safety)

HSI230.1 Collaboration with the Aboriginal population The purpose of the Murrumbidgee Aboriginal Health Consortium is to work together and with the community to coordinate action that improves the wellbeing of Aboriginal and Torres Strait Islander people living in the Murrumbidgee region.

AOD407 Aboriginal and Torres Strait Islander employment initiative Support Aboriginal and Torres Strait Islander people whose substance use is impacting their ability to gain or maintain employment or participate in education.

CF310 Activities relating to the Aboriginal population Provide Aboriginal and Torres Strait Islander people with complex chronic conditions, one-onone assistance from a care coordinator to enable effective management of their condition through access to necessary services, care pathways and service linkages.

Aboriginal and Torres Strait Islander Health

Aboriginal and Torres Strait Islander Health

ITC 1 Care coordination and supplementary services Provide Aboriginal and Torres Strait Islander people with complex chronic conditions, one-onone assistance from a care coordinator to enable effective management of their condition through access to necessary services, care pathways and service linkages.

ITC 2 Culturally competent mainstream services Foster collaboration and support between mainstream primary care and the Aboriginal health sector, to improve capacity of mainstream primary care services to deliver culturally appropriate services to Aboriginal and Torres Strait Islander people.

AOD411 Aboriginal and Torres Strait Islander outreach services Work with Aboriginal Community Controlled Health Organisations to support Aboriginal and Torres Strait Islander people who experience issues with drug and alcohol use to extend outreach services across the Murrumbidgee region.

HNA 2022-25

Potential lead agency and/or collaboration and partnership

Opportunities and priorities

Maternal, Child and Youth Increased need for antenatal support for all women, teenage mothers and including breastfeeding

Increase cessation pregnancy

smoking during

Increase specific age related services increasing life expectancy - Youth

Reduce Infant deaths 0-48 months

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Population Health

Population Health

Early intervention and prevention

CF315 Activities relating to maternal and child health The Maternal and Child Health Strategy and the programs that are implemented aim to improve outcomes for children (including the first 2000 days), families and expectant women.

AOD406 Targeted services for pregnant women and new mothers who have Alcohol and Other Drug (AOD) issues including specific services for Aboriginal and Torres Strait Islander women Provides medium-high intensity, assertive specialist AOD treatment and midwifery services for pregnant women and/or women with young children, who are experiencing problems with alcohol and/or other drugs.

Early intervention and prevention

CF315 Activities relating to maternal and child health The Maternal and Child Health Strategy and the programs that are implemented aim to improve outcomes for children (including the first 2000 days), families and expectant women.

Access Mental Health

Population Health

Early intervention and prevention

HNA 2022-25

MH435 Child and youth mental health services – Youth Severe Early intervention mental health services for young people with, or at risk of, severe mental illness, who experience considerable disadvantage when accessing (or attempting to access) services.

MH438 Child and youth mental health services – headspace headspace offers access to holistic youth friendly mental health supports for people aged 12 to 25 including early intervention strategies resulting in an improvement in their mental health and wellbeing.

MH436 Headspace Demand Management and Enhancement Program Increase access and reduce wait times at headspace centres and enhancing the quality of experience for young people accessing care through the centres.

AOD403 Alcohol and Other Drug (AOD) support in headspace Facilitate and support evidence-based tailored treatment for young people who use alcohol and other drugs and build capacity of headspace staff to work with these young people.

CF315 Activities relating to maternal and child health The Maternal and Child Health Strategy and the programs that are implemented aim to improve outcomes for children (including the first 2000 days), families and expectant women.

Older persons Increase specific age related services increasing life expectancy

Aged Care

MH465 More choices for longer life Delivery of in-reach mental health services to residents of residential aged care facilities.

CF340 Activities relating to Murrumbidgee Wellness and Resilience activity Provide an integrated wellness and resilience activity enabling older people, those with or at risk of chronic disease, vulnerable or high risk group’s timely access to appropriate primary care services.

Access

Reduce Influenza admissions over 65 years

Aged Care

Increase GP attendances RACF

Aged Care

Potentially preventable hospitalisations

HSI220.2 General practice capacity development and support – immunisation Work with stakeholders and support general practices to deliver quality vaccination services with the overall aim of improving immunisation rates. Provide on-site general practice support with recall and reminder systems, data cleaning, Australian Immunisation Register report utilisation and cold chain management.

AH373 Winter Strategy The Winter Strategy is a collaborative initiative with the Murrumbidgee Local Health District to manage the increased demand for health care services during the winter period and improve outcomes for people at risk.

AH378 Decision guidelines in Residential Aged Care Facility (RACF) in after hours The aim of this activity is to increase the use of the acute care decision guidelines in RACFs to support access to care in the after-hours period and appropriate care within hours to prevent after hours escalation.

After hours

Population Increase access to services impacted by limitations for fee-based healthcare services

Improve poor health literacy due to less education or lack of internet access

Population Health

HealthPathways

CF360 Integrated system of primary healthcare – decision support tool (HealthPathways) Continue to engage with Streamliners to support the implementation and uptake of HealthPathways across the region.

HSI220.3 General practice capacity development and support – health literacy Health Literacy activities are focused on empowering people to take control of their own health and wellbeing.

Digital Health

Appropriate (including safety)

care cultural

HSI230.4 General practice capacity development and support – digital health Raise awareness of digital health and support practices to adopt digital solutions and provide them with ongoing assistance and training.

CF360 Integrated system of primary healthcare – decision support tool (HealthPathways) Continue to engage with Streamliners to support the implementation and uptake of HealthPathways across the region.

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HNA 2022-25

HSI240 Integrated system of primary health care – decision support tool (HealthPathways) Engage local clinicians and health professionals in the acute and primary care sectors to support the implementation and uptake of HealthPathways across the region.

Respond to issues relating to housing affordability, transport and cost of living

Develop general practice capacity to use evidence and data driven quality improvement to improve patient outcomes

Reduce ED presentations and admissions for PPH

Increase care delivery in general practice, specialists in community and allied health, improve number of dentists available Increase GP attendances after hours

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AH370 Access marketing The after-hours access marketing campaign aims to improve health literacy in the community to understand available after-hours options.

Population Health

Social determinants HSI230.2 Provision of quality improvement in general practice Support general practice to enable delivery of best practice outcomes through continuous quality improvement and data driven processes.

Population Health

Safety and quality of care

HSI230.3 General practice capacity development and support – CPD Continuing professional development facilitates and promotes networking, education and inter-professional learning opportunities for primary healthcare clinicians.

AOD401 GP Liaison MPHN engages an alcohol and other drugs GP Liaison to work collaboratively with key partners and support providers to increase their confidence working with people experiencing issues with alcohol and other drugs.

Population Health

Health Workforce

Population Health

After hours

Workforce

AH375 Frequent flyers vulnerable population initiative Improving access for vulnerable people to in hours health care through care coordination, navigation and referral pathways to reduce the frequency of unplanned presentations to emergency departments in the after-hours period.

HSI220.6 General practice capacity development and support – workforce support Work with all relevant stakeholders to recruit, retain and strengthen a strong local primary care workforce.

AH374 Regional approach to after-hours access Activities will be identified and implemented to provide innovative and localised solutions to improve access and coordination and minimise presentations to after-hours services.

After hours

HNA 2022-25

AH377 Wagga GP After Hours Service Wagga Wagga GP After Hours Service provides urgent non-life threatening primary care in the after-hours period.

Increase support related to domestic violence related assault and victims of sexual or indecent assault Reduction of alcohol at harmful levels and drug use specifically amphetamines and cannabis Reduction of risk factors including low exercise, high blood pressure, overweight and obesity Reduction of prevalence, incidence, mortality and or morbidity for;  alzheimer’s disease or dementia  cerebrovascular disease  road traffic injuries or transport accidents Reduction of prevalence, incidence, mortality and or morbidity and high use of services in ED or hospital for; coronary heart disease and CHD including congestive cardiac failure Reduction of prevalence, incidence, mortality and or morbidity and high use of services in ED or hospital for genitourinary

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Population Health

Vulnerable population

AH372 Family violence Initiative This activity provides face to face telehealth counselling and crisis support during the afterhours period when other support services are likely to be closed.

AOD400 Community Managed Organisations (CMO) enhancement Proactive and targeted drug and alcohol support for individuals waiting to access residential rehabilitation, and appropriate and sustained support on discharge from residential rehabilitation.

Alcohol and Other Drugs

Access

Population Health

Early intervention and prevention

CF340 Activities relating to Murrumbidgee Wellness and Resilience activity Provide an integrated wellness and resilience activity enabling older people, those with or at risk of chronic disease, vulnerable or high risk group’s timely access to appropriate primary care services.

Population Health

Access

HSI220.3 General practice capacity development and support – health literacy Health Literacy activities are focused on empowering people to take control of their own health and wellbeing

Care coordination

CF320 Activities relating to Integrated Care Coordination Integrated Care Coordination supports people with complex chronic disease and their families to navigate the health system and to achieve better health outcomes. Parkinson Support Nurse Service provides care coordination specialised for people diagnosed with Parkinson’s disease.

Population Health

CF340 Activities relating to Murrumbidgee Wellness and Resilience activity Provide an integrated wellness and resilience activity enabling older people, those with or at risk of chronic disease, vulnerable or high risk group’s timely access to appropriate primary care services.

Care coordination

Population Health

HNA 2022-25

CF320 Activities relating to Integrated Care Coordination Integrated Care Coordination supports people with complex chronic disease and their families to navigate the health system and to achieve better health outcomes. Parkinson Support Nurse Service provides care coordination specialised for people diagnosed with Parkinson’s disease.

system disease including chronic kidney disease or kidney failure

Reduction of prevalence, incidence, mortality and or morbidity and high use of services in ED or hospital for infectious and parasitic disease, including influenza

Reduction of prevalence, incidence, mortality and or morbidity and high use of services in ED or hospital for digestive disease, specifically liver disease

Reduction of prevalence, incidence, mortality and or morbidity and high use of services in ED or hospital for Injury, poisoning and other external causes

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CF340 Activities relating to Murrumbidgee Wellness and Resilience activity Provide an integrated wellness and resilience activity enabling older people, those with or at risk of chronic disease, vulnerable or high risk group’s timely access to appropriate primary care services.

Population Health

Population Health

Population Health

Care coordination

HSI220.2 General practice capacity development and support – immunisation Work with stakeholders and support general practices to deliver quality vaccination services with the overall aim of improving immunisation rates. Provide on-site general practice support with recall and reminder systems, data cleaning, Australian Immunisation Register report utilisation and cold chain management.

AH373 Winter Strategy The Winter Strategy is a collaborative initiative with the Murrumbidgee Local Health District to manage the increased demand for health care services during the winter period and improve outcomes for people at risk.

Care coordination

CF320 Activities relating to Integrated Care Coordination Integrated Care Coordination supports people with complex chronic disease and their families to navigate the health system and to achieve better health outcomes. Parkinson Support Nurse Service provides care coordination specialised for people diagnosed with Parkinson’s disease.

CF340 Activities relating to Murrumbidgee Wellness and Resilience activity Provide an integrated wellness and resilience activity enabling older people, those with or at risk of chronic disease, vulnerable or high risk group’s timely access to appropriate primary care services.

Care coordination

CF320 Activities relating to Integrated Care Coordination Integrated Care Coordination supports people with complex chronic disease and their families to navigate the health system and to achieve better health outcomes. Parkinson Support Nurse Service provides care coordination specialised for people diagnosed with Parkinson’s disease.

CF340 Activities relating to Murrumbidgee Wellness and Resilience activity Provide an integrated wellness and resilience activity enabling older people, those with or at risk of chronic disease, vulnerable or high risk group’s timely access to appropriate primary care services.

HNA 2022-25

Reduction of prevalence, incidence, mortality and or morbidity and high use of services in ED or hospital and identified by community consultations for diabetes

Reduction of prevalence, incidence, mortality and or morbidity and high use of services in ED or hospital and identified by community consultations for respiratory system disease, including asthma and chronic obstructive pulmonary disease Reduction of prevalence, incidence, mortality and or morbidity and high use of services in ED or hospital and identified by community consultations for musculoskeletal system and connective tissue including arthritis

Reduction of prevalence, incidence, mortality and or morbidity and high use of services in ED or hospital and identified by community consultations for; mental health conditions including social isolation

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Population Health

Care coordination

CF320 Activities relating to Integrated Care Coordination Integrated Care Coordination supports people with complex chronic disease and their families to navigate the health system and to achieve better health outcomes. Parkinson Support Nurse Service provides care coordination specialised for people diagnosed with Parkinson’s disease.

CF340 Activities relating to Murrumbidgee Wellness and Resilience activity Provide an integrated wellness and resilience activity enabling older people, those with or at risk of chronic disease, vulnerable or high risk group’s timely access to appropriate primary care services.

Population Health

Care coordination

CF320 Activities relating to Integrated Care Coordination Integrated Care Coordination supports people with complex chronic disease and their families to navigate the health system and to achieve better health outcomes. Parkinson Support Nurse Service provides care coordination specialised for people diagnosed with Parkinson’s disease.

CF340 Activities relating to Murrumbidgee Wellness and Resilience activity Provide an integrated wellness and resilience activity enabling older people, those with or at risk of chronic disease, vulnerable or high risk group’s timely access to appropriate primary care services.

Population Health

Care coordination

CF320 Activities relating to Integrated Care Coordination Integrated Care Coordination supports people with complex chronic disease and their families to navigate the health system and to achieve better health outcomes. Parkinson Support Nurse Service provides care coordination specialised for people diagnosed with Parkinson’s disease.

CF340 Activities relating to Murrumbidgee Wellness and Resilience activity Provide an integrated wellness and resilience activity enabling older people, those with or at risk of chronic disease, vulnerable or high risk group’s timely access to appropriate primary care services.

MH431 MyStep to Mental Wellbeing The provision of mental health services in a stepped care approach where supports change for people as their needs change.

Mental Health

Access

MH445 Services for severe and complex mental illness Provides intensive psychological intervention and care coordination by appropriately qualified mental health nurses for people with severe and persistent mental illness.

MH455 Aboriginal and Torres Strait Islander mental health services The provision of culturally appropriate mental health services and supports for Aboriginal and Torres Strait Islander people in the Murrumbidgee region.

HNA 2022-25

MH460 Regional assessment service Supporting general practitioners and connecting people requiring mental health supports with a suitable service provider in a timely manner.

NPS485 Commissioned non-clinical, mental health psychosocial support service To deliver non-clinical mental health psychosocial support to people living with a severe mental illness and are not engaged in the NDIS and who are not receiving psychosocial services through Continuity of Support (CoS), with Aboriginal and Torres Strait Islander people and people over 65 years of age given priority.

NPS487 National psychosocial support transition funding Continued support for existing clients to test eligibility for the NDIS and be transitioned either to the NDIS or to CoS, if found ineligible for the NDIS. NPS490 Continuity of Support initiative Continuity of Support provides continued access to psychosocial supports to people who are ineligible for NDIS supports.

Reduction of prevalence, incidence, mortality and or morbidity and identified by community consultations for; suicide and intentional self-harm

Reduction of prevalence, incidence, mortality and or morbidity and identified by community consultations for cancer Respond to issues relating to chronic pain

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NPS491 NPS Service Navigator The service navigator role aims to improve the integration of local health services and make the health system more accessible for people with severe mental illness and associated psychosocial disorders.

MH450 Community based suicide prevention – The Way Back Support Service The delivery of The Way Back Support Service provides non-clinical intensive, assertive, and practical support to an individual following a suicide attempt or suicidal crisis.

Mental Health

Access

MH451 After suicide support program The provision of support to bereaved individuals, families and communities following a death by suicide.

MH452 Gatekeeper suicide prevention training Provision of gatekeeper suicide prevention training will upskill community members to identify when someone is experiencing a suicide crisis and respond appropriately.

Population Health

Population Health

Multi-disciplinary care

After hours

HNA 2022-25

AH371 Activities relating to palliative end of life care Work with general practice, residential aged care facilities and pharmacies to improve access to palliative care medications in the after-hours period resulting in good symptom management for palliative care patients.

AH379 Improving after hours pain management This activity will explore the feasibility of community based biopsychosocial multidisciplinary pain management programs in reducing the need for acute after hours care.

Increase cervical cancer screening participation

Population Health

Early intervention and prevention

HSI230.2 Provision of quality improvement in general practice Support general practice to enable delivery of best practice outcomes through continuous quality improvement and data driven processes.

COVID366 GP Led Respiratory Clinics funding Support GP Led Respiratory Clinics throughout the Murrumbidgee region.

Respond to emerging issues related to disasters (drought, bushfires, floods, pandemic)

COVID368 COVID Primary Care Support Support the delivery of education packages to the primary healthcare sector.

BF470 Community wellbeing and participation activity Enhancing non-clinical supports which promote community wellbeing and participation in line with local need, in consultation with local government, National Bushfire Recovery Agency and National Mental Health Commission.

Population Health

Emergency response

BF472 Bushfire trauma response coordinators The Bushfire Trauma Response Coordinator supports access to mental health services for people impacted by bushfires at a systems and service level.

BF473 Expansion of mental health services This activity provides the delivery of evidence-based mental health services to support the needs of people experiencing low to medium levels of distress as a result of the bushfires.

MH444 COVID Initial Assessment and Referral Murrumbidgee residents who call the Head to Health pop up clinic 1800 number and are determined to need mental health supports, receive an assessment utilising the Initial Assessment and Referral (IAR) and is connected to local mental health supports.

CF363 Activities relating to innovation grant funding Innovation funding is an initiative where locally based organisations can pitch innovative ideas for funding to help address the health needs of their local communities.

Improve coordination of care and to allow palliative patients to receive appropriate care and to pass away in their place of choice

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Population Health

Palliative care

AH371 Activities relating to palliative end of life care Work with general practice, residential aged care facilities and pharmacies to improve access to palliative care medications in the after-hours period resulting in good symptom management for palliative care patients.

GCAHPC365 Greater Choice for At Home Palliative Care This activity is to improve quality of care and to ensure patients receive the right care in the right place at the right time including allowing those who wish to be cared for and dying at home.

HNA 2022-25

What do we know about the nation’s health

Mental and behavioural conditions  Mental or behavioural condition - 4.8 million (20.1%)  Anxiety-related condition - 3.2 million (13.1%)  Depression or feelings of depression (10.4%)

The 2017-18 National Health Survey is the most recent in a series of Australia-wide health surveys conducted by the Australian Bureau of Statistics. The survey was designed to collect a range of information about the health of Australians, including: prevalence of long-term health conditions; health risk factors such as smoking, overweight and obesity, alcohol consumption and physical activity; and  demographic and socioeconomic characteristics.

The survey was conducted in all states and territories and across urban, rural and remote areas of Australia (excluding very remote areas) from July 2017 to June 2018. The survey included around 21,000 people in over 16,000 private dwellings.  

General health  Excellent or very good health 15 years and over (56.4%)  Fair or poor health (14.7%)  Adults experienced high or very high levels of psychological distress - 2.4 million (13.0%)

High blood pressure  Australians aged 18 years and over had a measured high blood pressure reading - 4.3 million people (22.8%)

Overweight and obesity  Adults overweight or obese - 12.5 million (67.0%)  Males overweight or obese (74.5%)  Females overweight or obese (59.7%)  Children aged 5-17 years overweight or obese (24.9%; 17% overweight, 8.1% obese)

Fruit and vegetable consumption  Met guidelines for recommended daily serves of fruit (2 or more serves; 51.3%)  Met guidelines for serves of vegetables (5-6 or more serves for men depending on age, and 5 or more for women; 7.5%)  Adults met both fruit and vegetable recommendations (5.4%)  Children aged 2-17 years met guidelines for recommended number of serves of both fruit and vegetables (6.0%)  Children ate recommended serves of fruit (73.0%)

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Chronic conditions One or more chronic conditions (47.3%) Chronic health conditions experienced in Australia were:     

    

Mental and behavioural conditions - 4.8 million people (20.1%) Back problems - 4.0 million people (16.4%) Arthritis - 3.6 million people (15.0%) Asthma - 2.7 million people (11.2%) Diabetes mellitus- 1.2 million people (4.9%) Type 1 Diabetes - 144,800 people (0.6%) Type 2 Diabetes - 998,100 people (4.1%) Heart, stroke and vascular disease - 1.2 million people (4.8%) Osteoporosis - 924,000 people (3.8%) Chronic obstructive pulmonary disease - 598,800 people (2.5%) Cancer - 432,400 people (1.8%) Kidney disease - 237,800 people (1.0%)

Alcohol consumption  Consumed more than two standard drinks per day on average (16.1%)  Males exceeded the lifetime risk guideline (23.7%)  Females exceeded the lifetime risk guideline (8.8%)  Consumed more than four standard drinks on one occasion in the past year (42.1%)  Males consumed more than four standard drinks on one occasion in the past year (54.3%)  Females consumed more than four standard drinks on one occasion in the past year (30.5%)

Sugar sweetened and diet drink consumption  Consume sugar sweetened drinks daily adults (9.1%)  Consume sugar sweetened drinks daily (children aged 2-17 years; 7.1%)  Males usually consume sugar sweetened drinks daily (11.8%)  Females usually consume sugar sweetened drinks daily (6.4%)  Consume diet drinks daily adults (4.8%)  Consume diet drinks daily children (1.3%)  Did not consume any sugar sweetened or diet drinks adult (52.0%)  Did not consume any sugar sweetened or diet drinks children (55.2%)

HNA 2022-25

Smoking  Adult daily smokers (13.8%)  Adults never smoked (55.7%)  Young adults (18-24 year olds) never smoked (75.3%)  Men smoke daily (16.5) Women smoke daily (11.1%)  Current daily smokers smoked average 12.3 cigarettes per day

Physical activity  15 years and over exercised 42 minutes per day on average,  Walking for transport and walking for exercise (24.6 minutes)  Met physical activity guidelines; 15-17 year olds (1.9%), 18-64 year olds (15.0%) 65 year olds (17.2%)  15-17 year olds engaged in 60 minutes of exercise (excluding workplace) every day (10.3%)  15-17 year olds engaged in strength or toning activities on three or more days in last week (15.8%)  18-64 years olds undertook 150 minutes or more of exercise in the last week, excluding workplace physical activity (55.4%)  18-64 year olds undertook strength or toning activities on two or more days in the last week (24.9%)  Older adults (65 years and over) engaged in 30 minutes of exercise on 5 or more days in last week (26.1%)  Adults aged 18-64 years described their day at work as mostly sitting (43.7%); mostly walking (22.8%); mostly standing (19.5%); mostly heavy labour or physically demanding work (13.6%)

Source: https://www.abs.gov.au/statistics/health/health-conditions-and-risks/national-health-survey-first-results/latest-release Accessed 13th August 2021

What do we know about Aboriginal and Torres Strait Islander health The 2018–19 National Aboriginal and Torres Strait Islander Health Survey (NATSIHS) was conducted between July 2018 and April 2019.

It collected information from Aboriginal and Torres Strait Islander people of all ages in non-remote and remote areas of Australia, including discrete Indigenous communities.

It collected information on a number of topics for the first time, including mental health conditions, medications, consumption of sugar sweetened and diet drinks, experiences of harm and a hearing test.

Health  At least one chronic condition posed a significant health problem (46%)  Anxiety (17%) or depression (13%)  Rated own health as excellent or very good (45%)

Chronic conditions  One or more selected chronic conditions (46%)  Males one or more selected chronic conditions (44%)  Females one or more selected chronic conditions (47%)

Within each identified Aboriginal and Torres Strait Islander household in both the community and non-community sample:  up to two adults (aged 18 years and over) and two children (aged 0–17 years) were randomly selected in non-remote areas, and  up to one adult (aged 18 years and over) and one child (aged 0–17 years) were randomly selected in remote areas.

Heart disease  Heart disease (5%); males (6%), females (5%)

Diabetes  Diabetes (8%); 55 years and over (35%)

Kidney disease  Kidney disease (1.8%); females (2.3%), males (1.2%), over 55 year (8%)

Risk factors  Smoked every day (37%) Children aged 2–14 years overweight or obese (37%)  Sugar sweetened drinks consumed every day over 15 years of age (24%)

Asthma and chronic obstructive pulmonary disease  Asthma (16%); females (18%), males (13%) Chronic obstructive pulmonary disease (3.4%); females (4.3%) males (2.5%); higher 55 years and over (13%)

Ear disease and hearing problems  Ear disease or hearing problems (14%); aged 25–34 years (12%), 35–44 years (15%), over 55 years (34%)  Partial or complete deafness in one or both ears (10%)  Children aged 0–14 years deaf in one or both ears (4%); long-term otitis media (3%)

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HNA 2022-25

Disability  Disability (38%); males (39%), females (37%)  Profound or severe disability (8%); males (9%), females (8%)

Mental health  Mental or behavioural condition (24%); males (23%), females (25%); aged 2–14 years (15%), 15–24 years (24%)  Anxiety (17%); females (21%), males (12%)  Depression (13%); females (16%), males (10%)  Behavioural or emotional problems aged 2–14 years (11%)

High blood pressure  Hypertension 8%; aged 25–34 years (3.0%), aged 55 years and over (38%)  High blood pressure reading at the time of interview (23%); males (25%), females (21%)

Psychological distress  Experienced high or very high levels of psychological distress (31%); females (35%) males (26%)

Self-assessed health status  Rated own health excellent or very good improved (45%); rated health good (32%)

Smoking  Current smokers (41%); smoked every day (37%), smoked but not every day (3%), males (39%), females (36%); ,aged 15–17 years (10%), smoked every day averaged 12 cigarettes per day  Ex-smokers (22%); males (21%), females (23%)  Never smoked (37%); males (36%), females (39%)  Young people never smoked 15–17 years (85%), 18–24 years (50%)

Alcohol consumption  Exceeded single occasion risk guideline (> four standard drinks one occasion last 12 months, 54%); males (65%), females (43%), 55 years and over males (47%), females (23%), 15–17 years (18%)  Exceeded lifetime risk guideline (consumed more than two standard drinks per day on average (20%); males (30%), females (10%); aged 18–24 year, males (33%), females (8%)  Not consumed alcohol in last 12 months or never consumed alcohol (26%); females (31%), males (19%)

Substance use  Used substances non-medical purposes previous year (28%); males (37%), females (21%); 15–29 years (33%), 30–44 years (31%), 45 years + (21%)  Marijuana use in previous year (24%); males (31%), females (18%), 15–29 years (29%), 30–44 years (25%)  Amphetamines (7%)

Diet and weight (children)  Children aged 2–14 years met guidelines for recommended number of serves of fruit each day (69%)  Children met guidelines for recommended number of serves of vegetables per day (7.0%)  Children aged 2–14 years usually consumed sugar sweetened drinks or diet drinks at least once a week (63%)  Children usually consumed sugar sweetened drinks at least once a week (59%); consumed diet drinks at least once a week (9%); children usually consumed sugar sweetened drinks daily (20%), children consumed diet drinks daily (2.0%)  Children aged 2–14 years normal weight range (54%); children were overweight (24%), obese (13%); underweight (9.0%)

Diet, weight and exercise (adult)  Met guidelines for recommended number serves fruit per day (39%); females (44%), males (35%)  Met guidelines for recommended number of serves of vegetables per day (4.0%); females (6%), males (2%)  Usually consumed sugar sweetened drinks or diet drinks at least once a week (71%); males (75%), females (67%); < 45 years (80%), 45–54 years (63%), 55 years + (49%)  Usually consumed sugar sweetened drinks daily (24%), consumed diet drinks daily (6%)  Overweight or obese (71%); overweight (29%), obese (43%); normal weight range (25%); underweight (4.0%), obese females (45%), males (40%)  Measured waist circumference that put them at increased risk of developing chronic disease (71%); females (81%), males (60%), aged 55 years + (86%)  Did not meet physical activity guidelines for their age (89%); no physical activity at all in the last week (22%); males (20%), females (23%)

Physical harm  Experienced physical harm or threatened physical harm at least once in 12 months prior (16%); males (17%), females (14%), identified an intimate partner/family member as at least one of the offenders females (74%), males (56%)  Physically injured in their most recent experience of physical harm (72%); males (75%), females (72%)  Reported most recent experience of physical harm to the police (44%); females (59%), males (28%)  Experienced at least one threat face-to-face (9%), non-face-to-face (6%); experienced at least one of those threats from someone they knew, females (96%), males (84%), experienced at least one of those threats from a stranger (18%); received at least one non-face-to-face threat had received at least one of those threats via text message, phone, email or writing (61%)

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HNA 2022-25

Use of health services  Seen a general practitioner (GP) or specialist in last 12 months (86%); people with one or more selected chronic conditions (93%), people with none (79%); disability or restrictive long-term health condition (94%), no disability (83%); with a non-school qualification (90%), no non-school qualification (82%)  Needed to see a GP in last 12 months but had not gone to one on at least one occasion (13%); most common reasons for not going too busy (33%), decided to not seek care (28%)  Living in remote area usually saw GP part of an Aboriginal Medical Service (68%), in non-remote areas (29%)  Seen a dentist or dental professional in last 12 months (44%); children (57%), adults (36%); with a non-school qualification (41%), none (34%)  Admitted to hospital in last 12 months (17%); one or more selected chronic conditions (24%), none (11%); disability or restrictive long-term health condition (27%), no disability (13%)

Source: https://www.abs.gov.au/statistics/people/aboriginal-and-torres-strait-islander-peoples/national-aboriginal-and-torres-strait-islander-health-survey/latest-release Accessed 13th August 2021

What do we know about patient experiences in Australia Patient Experience Survey, is a topic on the Multipurpose Household Survey (MPHS) conducted throughout Australia from July 2019 to June 2020. Survey collected information from people about their experiences with selected aspects of the health system in the 12 months before their interview, including access and barriers to a range of health care services. Respondents were asked about their experiences with medical professionals, the frequency of their visits, waiting times, and barriers to accessing care, as well as their self-assessed health status, long term health conditions and private insurance. Data was also collected on aspects of communication between patients and health professionals.

Response rate for the 2019-20 survey was 76.4%.

Potential impacts of COVID-19 The 2019-20 Patient Experience Survey did not explicitly ask about the impacts of COVID-19. However, it is possible that COVID-19 may have contributed to an increase in the proportion of people who delayed or did not use health services when needed compared to 2018-19: dental professionals (30.4% vs 28.2%); GPs (25.7% vs 22.8%); medical specialists (19.9% vs 17.4%)

Health service use in 2019-20

Females were more likely than males to:

 saw a GP (83.2%)  had a pathology test (58.1%)  saw a dental professional (49.5%)  had an imaging test (38.3%)  saw a medical specialist (36.0%)  visited a hospital (ED) (14.4%)  were admitted to hospital (12.5%)  saw a GP for urgent medical care (8.3%)  saw an after hours GP (7.1%)

 see a GP (87.7% vs 78.6%)  have a pathology test (64.9% vs 51.2%)  see a dental professional (52.9% vs 46.0%)  have an imaging test (44.0% vs 32.5%)  see a medical specialist (39.0% vs 33.0%)  visit a hospital ED (15.3% vs 13.4%)  be admitted to hospital (14.1% vs 10.7%)  see a GP for urgent medical care (9.2% vs 7.3%)  see an after hours GP (8.2% vs 6.0%)

People aged 85 years and over were more likely than those aged 15-24 years to:  see a GP (98.3% vs 70.9%)  have a pathology test (80.1% vs 33.9%)  see a medical specialist (58.9% vs 20.3%)  have an imaging test (51.9% vs 26.0%)  be admitted to hospital (27.5% vs 6.8%)  visit a hospital ED (24.3% vs 14.6%)  see a GP for urgent medical care (10.6% vs 7.1%)

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Living in outer regional, remote or very remote areas more positive experiences with hospital ED doctors and specialists than major cities: always listened to carefully (75.0% vs 68.0%), always shown respect (79.4% vs 73.2%), always had enough time spent with them (73.5% vs 65.6%)

People with a long-term health condition were more likely than those without a long-term health condition to:  see a GP (94.5% vs 71.5%)  have a pathology test (75.3% vs 40.3%)  see a medical specialist (53.0% vs 18.4%)  see a dental professional (52.4% vs 46.5%)  have an imaging test (51.5% vs 24.6%)  visit a hospital ED (19.5% vs 9.1%)  be admitted to hospital (18.4% vs 6.3%)  see a GP for urgent medical care (12.2% vs 4.3%)  see an after hours GP (9.0% vs 5.1%)

HNA 2022-25

Waiting times  Waiting longer than they felt acceptable for a medical specialist appointment (22.7%), waiting for a GP appointment (18.7%)  People living in areas of most socio-economic disadvantage waiting longer than they felt acceptable for an appointment than those living in areas of least disadvantage; medical specialist appointment (26.3% vs 20.6%), GP appointment (22.2% vs 15.2%)

Barriers to health service use Cost reason for delaying or not using a health service when needed: dental professionals (18.7%), medical specialists (8.0%), GPs (3.7%) People with a long-term health condition were more likely to delay or not use the following health services when needed due to cost than those without a long-term health condition: dental professionals (22.0%), medical specialists (8.9%), GPs (4.4%) People with a long-term health condition were also more likely to delay getting or go without prescription medication when needed due to cost than those without a long-term health condition (8.0% vs 3.8%)

Coordination of care  Three or more health professionals for the same condition (16.6%), Of these people; at least one health professional helped coordinate their care (71.9%), issues caused by a lack of communication between health professionals (14.3%)  GPs were most likely to help coordinate their care (57.4%)  Long-term health condition were more likely than those without a long-term health condition to; see three or more health professionals (26.8% vs 6.1%), receive coordination of care (74.3% vs 60.8%), report issues caused by a lack of communication between health professionals (15.0% vs 10.3%)

Health professionals who always listened carefully:

Health professionals who always showed respect:

Health professionals who always spent enough time with people:

 dental professionals (86.0%)  medical specialists (80.6%)  hospital nurses (78.6%)  hospital doctors and specialists (76.0%)  GPs (75.5%)  hospital ED nurses (75.0%)  hospital ED doctors and specialists (69.4%)

 dental professionals (89.2%)  medical specialists (83.8%)  GPs (82.0%)  hospital nurses (80.9%)  hospital doctors and specialists (79.6%)  hospital ED nurses (77.5%)  hospital ED doctors and specialists (74.2%)

 dental professionals (89.0%)  medical specialists (80.4%)  hospital nurses (76.3%)  GPs (76.2%)  hospital doctors and specialists (74.5%)  hospital ED nurses (71.7%)  hospital ED doctors and specialists (67.1%)

Other health professionals Saw at least one type of other health professional (excluding GPs, dental professionals or medical specialists) (63.9%) Other health professionals; Radiographers or Sonographers (38.3%), Chemists or Pharmacists for advice only (19.7%), Physiotherapists or Hydro therapists (17.7%). Of those who saw at least one type of other health professional; had a long-term health condition (79.5%), without a long-term health condition (47.7%)

Source: https://www.abs.gov.au/statistics/health/health-services/patient-experiences-australia-summary-findings/2019-20 Accessed 13th August 2021

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Data Sources National Health Survey 2017-18 https://www.abs.gov.au/statistics/health/health-conditions-and-risks/national-health-surveyfirst-results/latest-release National Aboriginal and Torres Strait Islander Health Survey 2018-19 https://www.abs.gov.au/statistics/people/aboriginal-and-torres-strait-islander-peoples/nationalaboriginal-and-torres-strait-islander-health-survey/latest-release National Patient Experiences in Australia 2019-20 https://www.abs.gov.au/statistics/health/health-services/patient-experiences-australia-summaryfindings/2019-20 Australian Bureau of Statistics (ABS) https://www.abs.gov.au/websitedbs/D3310114.nsf/Home/2016%20QuickStats Australian Institute of Health and Welfare (AIHW) including Medicare Benefits Schedule (MBS) https://www.aihw.gov.au/reports-data/health-welfare-services/primary-healthcare/data-sources https://www.aihw.gov.au/about-our-data/aihw-data-by-geography Public Health Information Development Unit (PHIDU), Torrens University Australia, Social Health Atlas of Australia including AEDC data https://phidu.torrens.edu.au/social-health-atlases/data#social-health-atlas-ofaustralia-primary-health-networks NSW Cancer Institute Cancer Institute NSW, RBCO 2020 https://www.cancer.nsw.gov.au/research-and-data/cancer-data-and-statistics/request-unlinked-unitrecord-data-for-research/nsw-cancer-registry Australian Childhood Immunisation Register https://www.health.gov.au/health-topics/immunisation/childhood-immunisation-coverage NSW Health HealthStatsNSW, 2020 https://www.health.nsw.gov.au/hsnsw/Pages/default.aspx Department of Veterans Affairs (DVA) https://www.dva.gov.au/about-us/overview/research/statistics-about-veteran-population#localgovernment-area-lga-profile Boscar 2020 (Crime statistics) 55 | P a g e

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https://www.bocsar.nsw.gov.au/Pages/bocsar_crime_stats/bocsar_lgaexceltables.aspx National Mental Health Service Planning Framework database (currently under review) http://www.nmhspf.org.au/ HeaDSUPP health workforce data (Restricted site, must have clearance and log in) https://dataportal.health.gov.au/wps/portal/register/ GEN aged care data https://www.gen-agedcaredata.gov.au/ MPHN Commissioned service data including General Practice (PENCS data) (SharePoint site only available to internal staff and restrictions on access apply) https://murrumbidgeephn.sharepoint.com/sitepages/Data%20Analytics.aspx PHN Resources PHN website https://www.health.gov.au/initiatives-and-programs/phn PHN Publications https://www.health.gov.au/resources/publications/primary-health-networks-phn-performance-and-qualityframework https://www.health.gov.au/resources/publications/primary-health-networks-phns-needs-assessmentpolicy-guide https://www.health.gov.au/resources/publications/primary-health-networks-phns-planning-in-acommissioning-environment-a-guide MPHN Resources MPHN Health Needs Assessment and Planning Guide MPHN Commissioning Framework

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Checklist This self-assessment checklist confirms that the key elements of the NA process have been undertaken.

Requirement

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Provide a brief description of the PHN’s Needs Assessment development process and the key issues discovered.

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Outline the process for utilising techniques for service mapping, triangulation and prioritisation.

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Provide specific details on stakeholder consultation processes.

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Provide an outline of the mechanisms used for evaluating the Needs Assessment process.

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Provide a summary of the PHN region’s health needs.

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Provide a summary of the PHN region’s service needs.

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Summarise the priorities arising from Needs Assessment analysis and opportunities for how they will be addressed.

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Appropriately cite all statistics and claims using the Australian Government Style Manual author-date system.

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Include a comprehensive reference list using the Australian Government Style Manual.

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Use terminology that is clearly defined and consistent with broader use.

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Ensure that development of the Needs Assessment aligns with information included in the PHN Needs Assessment Policy Guide.

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mphn.org.au Tel 02 6923 3100 Fax 02 6931 7822 1/185 Morgan Street, Wagga Wagga NSW 2650