A.7 Statement of Performance

Health Directorate Report of Factual Findings

Health Directorate Report of Factual Findings

Health Directorate Statement of Responsibility

Health Directorate Statement of Responsibility

Output Class 1: Health and Community Care

Output 1.1 Acute Services

Description

The Canberra Hospital provides a comprehensive range of acute care, including inpatient, outpatient and emergency department services. The key strategic priority for acute services is to deliver timely access to effective and safe hospital care services.

This means focussing on:

  • implementing work arising from the National Health Reform Agreement which the Commonwealth Government has put into place through a number of national partnerships and agreements with the aim of improving services to the Australian community;
  • strategies to improve access to emergency services;
  • meeting the demand for elective surgery in the Territory and reducing the number of people waiting longer than recommended standard waiting times;
  • strategies to meet performance targets for the emergency department and elective and emergency surgery; and
  • continuing to increase the capacity of acute care services in the ACT and surrounding region.

 

  Original Target
2012‑13
Actual
Result
2012‑13
% Variance
from Original Target
Explanation of Material Variances Notes
Total cost ($000’s) 659,657 682,977 4% The higher than expected total cost
relates mostly to accelerated depreciation for the old Women’s and Children’s
Hospital and tower block level 5 at
Canberra Hospital. These facilities are undergoing significant redevelopment.
 
Government payment for outputs
(GPO) ($000’s)
137,678 134,615 (2%)    
           
Accountability Indicators
Patient activity
   
a. Cost weighted patient separations 63,541 66,184 4% The growth in acute cost weighted separations in 2012‑13 was largely due
to increased levels of elective surgery and maternity services. The increase in
maternity was due to high birth rates experienced in 2012‑13.
1

 

Notes

1. Cost weighted separations for all Canberra Hospital episodes, excluding those reported elsewhere (Mental Health, Cancer Services and Aged Care and Rehabilitation Service) and unqualified neonates (well babies, who are counted as part of their mother’s admission). Cost weighted separations differ from reporting raw separations, as they account for the relative complexity of each separation, thereby giving a more accurate picture of the activity performed.

 

  Original Target
2012‑13
Actual
Result
2012‑13
% Variance
from Original Target
Explanation of Material Variances Notes
b. Non-admitted occasions of service 268,434 282,192 5% There has been a higher than expected demand for outpatient services at the Canberra Hospital. Growth has occurred in all areas, although it is most notable in Medical Imaging and Pathology. 2
c. Percentage of category one elective surgery patients who receive surgery within 30 days of listing 97% 99% 2%   3
d. Number of allied health care services provided for acute care patients in ACT public hospitals 101,400 107,485 6% There has been a higher than expected demand for these services. 4
e. Mean waiting time for clients on the dental services waiting list 12 Months 12 Months   5
f. Percentage of the Women’s Health Service Intake Officer’s clients who receive an intake and assessment service within 14 working days of their initial referral 100% 100%   6

 

Notes

2. Non-admitted patient services provided at the Canberra Hospital, excluding those services provided by Mental Health, Cancer Services and the Aged Care and Rehabilitation Service.

3. Category one patients are those assessed by the treating medical officer as the highest priority for elective surgery requiring surgery within 30 days of being listed on the elective surgery waiting list. In line with national definitions, the 30-day recommended waiting time for category one patients commences from when the hospital accepts the patient’s ‘request for admission’ from the treating medical officer and is placed on the hospital’s elective surgery waiting list. The time does not start from the date a patient is initially assessed by the treating medical officer as the Directorate cannot control the time taken by the treating medical officer to submit complete documentation to the hospital to place them on the elective surgery waiting list.

4. The number of allied health services to inpatients within the Canberra Hospital.

5. Client mean waiting time is defined as the mean waiting period between when a client is placed on the adult dental central waiting list and the receipt of treatment provided by a public dentist.

6. This accountibility indicator provides an indication of the availability of services.

Output 1.2 Mental Health, Justice Health and Alcohol and Drug Services

Description

Mental Health, Justice Health and Alcohol and Drug Services provide a range of services in hospitals, community health centres, adult and youth correctional facilities and private homes. This service works with its community partners to provide integrated and responsive care to a range of services including hospital based specialist services, supported accommodation services and community based service responses.

The key strategic priorities for Mental Health, Justice Health and Alcohol and Drug Services are ensuring that clients’ needs are met in a timely fashion and that care is integrated across hospital, community, and residential support services.

This means focussing on:

ensuring timely access to emergency mental health care by reducing waiting times for urgent admissions to acute psychiatric units;

ensuring that public mental health services in the ACT provide consumers with appropriate assessment, treatment and care that result in improved mental health outcomes; and

providing hospital and community based alcohol and drug services and health care assessments for people detained in corrective facilities.

 

  Original Target
2012‑13
Actual
Result
2012‑13
% Variance
from Original Target
Explanation of Material Variances Notes
Total cost ($000’s) 117,504 114,338 (3%) The variance relates to staff vacancies and a delayed opening of a planned older persons step-up step-down sub-acute service. The underspend was offset by increased expenditure for accelerated depreciation of the old Psychiatric Services Unit that will be converted to accommodate other services.  
Government payment for outputs (GPO) ($000’s) 54,432 54,432    
Accountability Indicators
a.
Cost weighted separations
3,004 3,098 3%   7
b.
Admitted patient separations
830 950 14% The variance is due to increased demand for services at the Adult Mental Health Unit (AMHU). 8
c.
Adult services
(18 – 64 years)
185,000 203,689 10% The variance is attributable to continued growth in demand for adult services. 9
d.
Children and youth services (0 – 17 years)
52,000 48,455 (7%) Staff vacancies early in the reporting period impacted on the level of activity. 10
e.
Older persons’ services (65+ years)
17,000 14,974 (12%) The variance is mainly due to the unavailability
of staff.
11

 

Notes

7. Cost weighted separations for mental health relate to the Adult Mental Health Unit at Canberra Hospital and Health Services and Alcohol and Drug Services. Cost weighted separations differ from reporting raw separations, as they account for the relative complexity of each separation, thereby giving a more accurate picture of activity performed.

8. Raw separations from the Adult Mental Health Unit. Raw separations count the number of inpatient hospital episodes discharged in the reference period.

9. Mental Health ACT Adult community occasions of service (Age group 18 – 64).

10. Mental Health ACT Children and Adolescents community occasions of service (Age group 0 – 17).

11. Mental Health ACT older person’s community occasions of service (Age group 65+).

 

  Original Target
2012‑13
Actual
Result
2012‑13
% Variance
from Original Target
Explanation of
Material Variances
Notes
f. Older persons’ services bed days 4,928 5,174 5% The variance is due to increased demand for this service. 12
g. Supported accommodation
bed occupancy rate
95% 97% 2%   13
h. Proportion of clients contacted by a Health Directorate community facility during the 7 days post discharge from the inpatient services 75% 90% 20% Follow-up contact post discharge was above target and this was due to the work undertaken by mental health workers who assist in the transition of patients from inpatient units back into the community. 14
i. Percentage of clients with outcome measures completed 65% 58% (11%) The target was based on a different method of calculation. By applying the method of calculation used in setting the target, the result would have been 65% 15
j. Proportion of offenders and detainees at the Alexander Maconochie Centre with a completed health assessment within 24 hours of detention 100% 100%   16
k. Proportion of offenders and detainees in Bimberi Youth Detention Centre with a completed health assessment within
24 hours of detention
100% 93% (7%) A total of 7 young people were not assessed within 24 hours of detention.
Six young people were still assessed however due to attending court
breached the 24 hour target by less
than two hours. One young person
refused a health assessment.
16
l. Percentage of current clients on opioid treatment with management plans 98% 99% 1%   17

 

Notes

12. The actual number of Occupied Bed Days at the Calvary Public Hospital older persons’ mental health inpatient unit.

13. Actual occupancy expressed as a percentage of the total supported accommodation places provided by the following Community Service providers: Richmond Fellowship, Centacare, ACT Mental Health Foundation and Inanna.

14. The proportion of clients admitted to a mental health inpatient unit and contacted by Mental Health ACT Community Services during the 7 days post discharge from the mental health inpatient unit (not all inpatients are referred to Mental Health ACT community mental health but may be seen by their general practitioner or private psychiatrist).

15. Percentage of Mental Health ACT registered clients with mandatory outcome measures completed each three months and for each inpatient episode. The purpose of measuring clinical outcomes is to see whether consumers of public mental health services are getting better as a result of the services they receive.

16. Percentage of detainees inducted into Bimberi and Alexander Maconochie Centre who are assessed within 24 hours of arrival at the facility. In respect of Bimberi, young detainees who are detained for a period of less than 24 hours will be excluded from this indicator.

17. On presentation for opioid replacement treatment, a management plan is developed. This indicator represents the percentage of clients with management plans.

Output 1.3 Public Health Services

Description

Public Health Services provides high quality health and community services to the ACT and surrounding region. The key strategic priorities for Public Health Services include monitoring the health of the ACT Population, promoting health, preventing disease, improving health equity, protecting the health of the public, and supporting workforce excellence (Population Health Division).

 

  Original Target
2012‑13
Actual
Result
2012‑13
% Variance
from Original Target
Explanation of
Material Variances
Notes
Total cost ($000’s) 40,952 41,338 1%    
Government payment for outputs (GPO) ($000’s) 37,417 37,417    
Accountability Indicators
a. Samples analysed 7,600 8,322 10% The variance is due to an increase in samples received to test for asbestos. 18
b. Compliance of licensable, registrable and
non licensable activities at the
time of inspection
85% 76% (11%) The compliance rates recorded primarily relate to regulated food business. The non-compliance is a continuation of previous trends in food safety compliance, which is attributed to routine inspections, complaint based inspections and re-inspections of non compliant premises. 19
c. Response time to environmental health hazards, communicable disease hazards relating to measles and meningococcal infections and food poisoning outbreaks
is less than 24 hours
100% 100%   20

 

Notes

18. Number of samples analysed during the period by the ACT Government Analytical Laboratory.

19. Percentage of inspected premises found to be in compliance with relevant legislation, licence, or registration. The data is drawn from records of inspection carried out under provisions of all ACT Health administered legislation. The relevant Acts are: Food Act 2001, Public Health Act 1997, Radiation Protection Act 2006 and Medicines, Poisons and Therapeutic Goods Act 2008.

20. Response time is defined as the elapsed time between notification and commencement of investigation. The reported percentage is derived from the combined data sets across the three classes of quick response categories: environmental health hazards, communicable disease control hazards and food poisoning outbreaks.

Output 1.4 Cancer Services

Description

Capital Region Cancer Service provides a comprehensive range of screening, assessment, diagnostic, treatment and palliative care services. Services are provided in inpatient, outpatient and community settings.

The key strategic priorities for cancer care services are early detection and timely access to diagnostic and treatment services. These include ensuring that population screening rates for breast cancer meet targets, waiting times for access to essential services such as radiotherapy are consistent with agreed benchmarks, and increasing the proportion of women screened through the BreastScreen Australia program for the target population (aged 50 to 69 years) to 70 per cent over time.

 

  Original Target
2012‑13
Actual
Result
2012‑13
% Variance
from Original Target
Explanation of Material Variances Notes
Total cost ($000’s) 64,866 66,698 3%    
Government
payment for outputs (GPO) ($000’s)
15,205 15,252    
Accountability Indicators
Patient activity
a. Cost weighted admitted patient separations 4,142 4,154   21
b. Non-admitted occasions of service 59,260 65,462 10% Demand remains high for outpatient cancer services. Significant growth has occured in all areas although it is most notable in Medical Oncology and Immunology. The increased activity was managed by permanent appointments during the financial year in both these areas. 22

 

Notes:

21. Inpatient cost weighted activity for patients of the Capital Region Cancer Service at Canberra Hospital. Cost weighted separations differ from reporting raw separations, as they account for the relative complexity of each separation, thereby giving a more accurate picture of activity performed.

22. Medical oncology (including chemotherapy), radiation oncology, immunology and haematology outpatient services at Canberra Hospital.

 

  Original Target
2012‑13
Actual
Result
2012‑13
% Variance
from Original Target
Explanation of Material Variances Notes
Breast Screening
c. Total breast screens 14,907 14,017 (6%) Appointments at BreastScreen ACT are readily available, however the service is experiencing difficulty in filling them. There are a number of initiatives underway to encourage ACT women to participate in the BreastScreen ACT program including contacting lapsed attendees and advising General Practitioners that there are appointments available. Use of electoral roll data for direct invitation for women in the target age group to participate in the program is currently being established. 23
d. Number of breast screens for women aged 50 to 69 12,552 11,385 (9%) Appointments at BreastScreens ACT are readily available, however the service is experiencing difficulty in filling them. There are a number of initiatives underway to encourage ACT women aged 50–69 to participate in the BreastScreen ACT program including contacting lapsed attendees and advising General Practitioners that there are appointments available. Use of electoral roll data for direct invitation for women in this target group to participate in the program is currently being established. 24
e. Percentage of women who receive results of screen within 28 days 100% 100%   25
f. Percentage of screened who are assessed within
28 days
90% 94% 4% The wait time to assessment has improved significantly, primarily as a result of modified work practices resulting from a redesign project and also due to increased capacity. In addition, a reduction in time taken to read images by radiologists has enabled women to be recalled for assessment sooner. 26

 

Notes:

23. Total number of women screened in the period.

24. Number of women aged between 50 to 69 years screened in the period. This age group is the target population for the breast screen program.

25. The percentage of women with a ‘normal’ result who receive notice of this outcome within 28 days of their screening appointment. Consistent with national methods, the end date is the date the results are produced, as it is not possible to ascertain the date a client receives a mailed document.

26. The percentage of women requiring assessment who wait 28 days or less from their breast screen appointment to their

assessment appointment.

Output 1.5 Rehabilitation, Aged and Community Care

Description

The provision of an integrated, effective and timely response to rehabilitation, aged care and community care services in inpatient, outpatient, emergency department, sub-acute and community-based settings.

The key strategic priorities for Rehabilitation, Aged and Community Care are:

  • ensuring that older persons in hospital wait the least possible time for access to comprehensive assessment by the Aged Care Assessment Team. This will assist in their safe return home with appropriate support, or access to appropriately supported residential accommodation;
  • improving discharge planning to minimise the likelihood of readmission or inadequate support for independent living, following completion of hospital care; and
  • ensuring that access, consistent with clinical need, is timely for community based nursing and allied health services and that community based services are in place to better provide for the acute and post acute health care needs of the community.

 

  Original Target
2012‑13
Actual
Result
2012‑13
% Variance
from Original Target
Explanation of Material Variances Notes
Total cost ($000’s) 101,815 100,891 (1%)    
Government payment for outputs (GPO) ($000’s) 69,160 69,020    
Accountability Indicators
Patient activity
a. Cost weighted admitted patient separations 3,541 3,511 (1%)   27
b. Non-admitted occasions of service 2,230 1,485 (33%) The below target result is due to a change which now excludes Geriatrics home visit activity (undertaken by the RADAR Team), which is now counted as community health service rather than as a non-admitted occasions of service. The below target result is also due to one registrar position being vacant in Rehabilitation Medicine for the larger part of the third quarter of 2012‑13 due to an unexpected resignation. 28

 

Notes

27. Inpatient cost weighted activity for patients of the Aged Care and Rehabilitation Service at Canberra Hospital. Cost weighted separations differ from reporting raw separations, as they account for the relative complexity of each separation, thereby giving a more accurate picture of activity performed.

28. Geriatric and rehabilitation outpatient services.

 

  Original Target
2012‑13
Actual
Result
2012‑13
% Variance
from Original Target
Explanation of Material Variances Notes
c. Sub‑acute service— episodes of care 1,384 1,289 (7%) The variance is due to a large number of nursing home type patients waiting for an aged care placement, which has reduced
the unit’s capacity to manage additional
sub-acute services. The unit has also experienced a delay in the recruitment of
an additional medical specialist in rehabilitation medicine.
29
d. Sub‑acute service— occupied bed days 13,349 11,572 (13%) The variance is due to a large number of nursing home type patients waiting for an aged care placement, which has reduced
the unit’s capacity to manage additional sub-acute services. The unit has also experienced a delay in the recruitment of an additional medical specialist in rehabilitation medicine.
30
e. Number of
people assessed
in falls clinics
420 448 7% The variance is a result of the increased use of awareness and promotional materials. These include representation at the Seniors Week Expo, April Falls month, engagement with the Healthcare Consumers Group and ACT Medicare Local, media advertisements and monthly newsletters. 31
f. Number of nursing (domiciliary and clinic based) occasions of service 80,000 83,962 5% The variance is due to increased complexity and acuity of patients. 32
g. Number of allied health regional services (occasions of service) 22,000 21,740 (1%)   33

 

Notes

29. The total number of persons separated from the sub-acute service at Canberra Hospital.

30. Total number of occupied bed days used for persons separated from the sub-acute service at Canberra Hospital.

31. Data for the Falls Clinic is taken from ‘Integrated Health Care Partnership Central Regional Team‘. The ‘Integrated Health Care Partnership Assessors’ contacts have been excluded as this relates to ‘non-clinic time’ intervention by staff member.

32. All occasions of service provided to community patients by Continuing Care Nurses in the following settings: home visits; ambulatory care clinics; foot care clinics; continence clinics; wound clinics; and stoma clinics.

33. All occasions of service provided to community patients by Continuing Care Allied Health Professionals and Technical Officers for Physiotherapy, Occupational Therapy, Social Work, Podiatry and Nutrition.

Output 1.6 Early Intervention and Prevention

Description

Increasing the focus on initiatives that provide early intervention to, or prevent, health care conditions that result in major acute or chronic health care burdens on the community.

The key strategic priorities for intervention and prevention are reducing the level of youth smoking in the ACT and maintaining immunisation rates for children above 90 per cent.

 

  Original Target
2012‑13
Actual
Result
2012‑13
% Variance
from Original Target
Explanation of Material Variances Notes
Total cost ($000’s) 78,493 77,546 (1%)    
Government payment for outputs (GPO) ($000’s) 51,968 53,520 3%    
Accountability Indicators
a. Immunisation coverage for the primary immunisation schedule measured at 1 year of age, in accordance with the Australian Childhood Immunisation Register 92% 93% 1%   34
b. Proportion of clients attending ‘Well Women’s Check’ within the Women’s Health Service that are from culturally and linguistically diverse communities 30% 40% 33% The favourable outcome is due to targeted promotion of services in culturally and linguistically diverse communities and services offered in outreach locations. 35
c. Proportion of children aged 0–14 who are entering substitute and kinship care within the ACT who attend to the Child at Risk Health Unit for a health and wellbeing screen 80% 96% 20% The positive variance reflects improved referral rates from Office of Child, Youth and Family Services. 36

 

Notes

34. Percentage of 12 month old children who have been fully immunised in accordance with the Australian Childhood Immunisation Register.

35. This indicator measures the percentage of women who are from culturally and linguistically diverse communities accessing a ’Well Women’s Check’.

36. This indicator measures the percentage of children aged 0–14 placed in out of home care (substitute or kinship care) who have received a health and wellbeing screen. The Health Directorate is reliant on referrals from the Community Services Directorate in order to provide these services.