B.1 - Organisational Overview

Vision, mission and values

ACT Health’s vision is ‘Your Health—Our Priority’.

Our values are:

  • Care
  • Excellence
  • Collaboration
  • Integrity.

Our vision, and these values developed by ACT Health staff, represent what we believe is important and worthwhile. Our values underpin the way we work and how we treat others.

We often see people in our community at their most vulnerable. The way we interact with them is extremely important and directly influences their experience of care. Both compliments and complaints from our consumers are largely to do with our commitment to our values, as evidenced by our behaviour, which can be summarised as:

  • Care: Go the extra distance in delivering services to our patients, clients and consumers. Be diligent, compassionate and conscientious in providing a safe and supportive environment for everyone. Be sensitive in managing information and ensuring an individual's privacy. Be attentive to the needs of others when listening and responding to feedback from staff, clinicians and consumers.
  • Excellence: Be prepared for change and strive for continuous learning and quality improvements. Acknowledge and reward innovation in practice and outcomes. Develop and contribute to an environment where every member of the team is the right person for their job, and is empowered to perform to the highest possible standard.
  • Collaboration: Actively communicate to achieve the best results by giving time, attention and effort to others. Respect and acknowledge everyone's input, skills and experience by working together and contributing to solutions. Share knowledge and resources willingly with your colleagues.
  • Integrity: Be open, honest and trustworthy when communicating with others, and ensure correct information is provided in a timely way. Be accountable, reflective and open to feedback. Be true to yourself, your profession, consumers, colleagues and the government.

Role, functions and services

ACT Health aims to deliver better service:

  • to our community on behalf of our Government.
  • to our Government to meet the needs of our community

We aim for sustainability and improved efficiency in the use of resources, by designing sustainable services to deliver outcomes efficiently, and embedding a culture of research and innovation.

ACT Health aims to support our people and strengthen teams, by helping staff to reach their potential, promoting a learning culture and providing high-level leadership.

The ACT Health Corporate Plan addresses the following challenges:

  • meeting increasing demand for health services
  • improving the health of vulnerable people
  • improving the patient journey
  • building and nurturing a sustainable health system
  • ensuring that service planning and delivery is underpinned by ACT Health’s Safety and Quality Framework.

ACT Health has already established the foundations to meet the challenges facing the health system by:

  • redesigning the organisation and services
  • redeveloping capital infrastructure under the umbrella of the Health Infrastructure Program (HIP).

Clients and stakeholders

ACT Health partners with the community and consumers for better health outcomes by:

  • delivering patient- and family-centred care
  • strengthening partnerships
  • promoting good health and wellbeing
  • improving access to appropriate health care
  • having robust safety and quality systems.

ACT Health works closely with other ACT Government agencies such as the:

  • Community Services Directorate (CSD)
  • Justice and Community Safety Directorate
  • Chief Minister, Treasury and Economic Development Directorate.

This also includes emergency services providers, such as the ACT Ambulance Service and ACT Policing.

Formalised consultative arrangements exist with a range of agencies, such as:

  • the Health Care Consumers Association (ACT)
  • Medicare Local
  • mental health, alcohol and drug, and other community service providers.

The tertiary and training sectors remain key partners in planning, developing and delivering healthcare services. Partnership arrangements with the Australian National University (ANU) Medical School, University of Canberra, Australian Catholic University (ACU) and Canberra Institute of Technology (CIT) are well established and serve to assure the future supply of skilled health professionals.

Organisational structure

The ACT Health Director-General leads the organisation in delivering its vision of ‘Your Health—Our Priority’.

ACT Health comprises four groups, each led by a Deputy Director-General reporting to the Director-General.

Canberra Hospital and Health Services (CHHS) is led by the Deputy Director-General, Canberra Hospital and Health Services and provides acute, subacute, primary and community-based health services to the ACT and surrounding region through its key service divisions. The Little Company of Mary also provides public hospital services through Calvary Public Hospital, under a contractual agreement with ACT Health.

The Strategy and Corporate Group is led by the Deputy Director-General, Strategy and Corporate. The role of the Strategy and Corporate Group is to provide corporate and strategic support to clinical service areas. The group:

  • supports national health reforms and National Partnership Agreements
  • develops strategies for attracting and retaining the health workforce
  • maintains critical physical and technological infrastructure for the ACT's public hospitals and health services.

Health Planning and Infrastructure (HPI) Program is led by the Deputy Director-General, HPI, which is the single largest capital works project undertaken in the history of the ACT. This includes:

  • leading and facilitating the development of whole-of-government plans (as they relate to the Health Directorate and health services), the Health Directorate Corporate Plan, territory-wide strategic plans and clinical service plans that have a territory-wide impact
  • directing and managing the directorate’s Health Infrastructure Program (HIP), including health planning, coordination, management and implementation
  • strategic accommodation
  • the Capital Upgrades Program (CUP)
  • the Arts in Health Program.

ACT Health’s Population Health Group is led by the ACT Chief Health Officer/Deputy Director-General and provides a range of public and environmental health services, health protection services and health promotion services including:

  • undertaking the core functions of prevention, assessment, policy development and assurance
  • contributing to local and national policy, program delivery and protocols on population health issues.

The Chief Health Officer fulfils a range of statutory responsibilities and delegations as required by public health legislation.

Other operational areas also report directly to the Director-General and provide a range of corporate support and organisation-wide services, such as financial management and audit and risk management.

During 2014–15, resources from the Quality and Safety Branch, excluding the Workplace Safety Unit, were realigned to Canberra Hospital and Health Services within the HealthCARE Improvement Unit. The Workplace Safety Unit continues to sit within the Strategy and Corporate Group. This was to ensure the effective oversight of progress to meet the requirements for patient safety and accreditation.

Organisational chart

ACT Health Organisational Chart

Environment and the planning framework

To contribute to the broader ACT Government vision, ACT Health’s vision is ‘Your Health—Our Priority’. This vision is supported by a range of strategic plans that identify objectives for the organisation. There is recognition that the demand for health services is increasing every year. Expanding health technologies, consumer expectation and an increasing and ageing population all contribute to this demand.

The Corporate Plan articulates:

  • key focus areas
  • priorities for improvement
  • key strategies for achieving the priorities
  • achievements planned for the long term (five years).

In 2014–15, ACT Health continued to measure its performance against these areas through:

  • key performance measures identified in the ACT Public Health Service’s quarterly performance report
  • ACT Health’s strategic and accountability indicator sets in the ACT Budget Papers.

The target achievements for each year are contained in ACT Health’s Business Plan.

Summary of performance

ACT Health performed well against a range of strategic objectives and priorities over the reporting period.

The ACT continues to enjoy the highest life expectancy of any jurisdiction in Australia.

Life expectancy at birth is:

  • 85.0 years for females in the ACT, against a national average of 84.3 years
  • 81.7 years for males, against a national average of 80.1 years.

This indicates the general health of the population and reflects on a range of issues other than providing health services, such as economic and environmental factors.

More information: For more information, see Strategic Objective 9: Management of Chronic Disease: Maintenance of the Highest Life Expectancy at Birth in Australia.

ACT Health saw 100 per cent of emergency dental clients within 24 hours and achieved lower than the national rate in the Decayed, Missing, or Filled Teeth (DMFT) index at ages six years and 12 years. The DMFT index at six years in the ACT rate was 1.03, compared to the national rate of 2.13. At 12 years the ACT rate was 0.70, compared to the national rate of 1.05. This is the lowest of all jurisdictions.

More information: For more information, see:

  • Strategic Objective 2: No Waiting for Access to Emergency Dental Health Services.

  • Strategic Objective 16: Achieve Lower than the Australian Average in the Decayed, Missing, or Filled Teeth (DMFT) Index.

Preliminary results show that 11,875 people were removed from the ACT elective surgery waiting list in 2014–15.

More information: For more information, see Strategic Objective 1: Removals from Waiting List for Elective Surgery.

100 per cent of urgent, 95 per cent of semi-urgent and 99 per cent of non-urgent radiotherapy patients commenced treatment within standard timeframes. All three urgency categories reported better than target results in 2014–15.

More information: For more information, see Strategic Objective 3: Improving Timeliness of Access to Radiotherapy Services.

55 per cent of women in the target age group (50 to 69 years) had a breast screen in the 24 months before each counting period. This is slightly below the 2014–15 target of 60 per cent.

More information: For more information, see Strategic Objective 4: Improving the Breast Screen Participation Rate for Women aged 50 to 69 years.

The ACT comfortably exceeded the national rate of expenditure on infrastructure. The Australian Institute of Health and Welfare (AIHW) reported that in 2010–11, the ACT recorded an investment rate of 3.84 per cent (against a national rate of 2.15 per cent) in capital expenditure on healthcare infrastructure.

More information: For more information, see Strategic Objective 12: Government capital expenditure on healthcare infrastructure.

Reflecting ACT Health's priority of reducing the long-term chronic disease burden, the AIHW also reported that in 2010–11 the ACT recorded a rate of 2.6 per cent (against a national average of 2.1 per cent) for total government expenditure on public health activities as a proportion of total current health expenditure.

More information: For more information, see Strategic Objective 13: Higher proportion of Government recurrent health funding expenditure on public health activities than the national average.

For the two-year participation rate in the Cervical Screening Program, the ACT achieved 57.9 per cent, which is a slight increase on the national average of 57.8 per cent and demonstrates the effectiveness of early intervention health messages.

More information: For more information, see Strategic Objective 15: Higher Participation Rate in the Cervical Screening Program than the National Average.

ACT Health met its responsiveness target for the Aged Care Assessment Team (ACAT) of two days to assess the needs of clients for patients in public hospitals.

More information: For more information, see Strategic Objective 5: Maintaining the waiting times for in hospital assessments by the Aged Care Assessment Team.

Public mental health services were effective in providing care to mental health clients, with only 6 per cent of clients returning to hospital within 28 days of discharge from an ACT public acute psychiatric unit following an acute episode of care. This is 4 per cent below the target of 10 per cent.

More information: For more information, see Strategic Objective 7: Maintaining Reduced Rates of Patient Return to an ACT Public Acute Psychiatric Inpatient Unit.

ACT public hospitals achieved an average bed occupancy rate of 85 per cent in 2014–15, an improvement on the 90 per cent reported for 2013–14.

More information: For more information, see the Strategic Objective 8: Reaching the Optimum Occupancy Rate for all Overnight Hospital Beds section.

In 2013–14, the ACT rate of admissions in persons aged 75 years and over with a fractured neck of femur was 6.7 per 1,000 persons in the ACT population. This is slightly above the long-term target and follows a generally decreasing trend over the 10-year period from 2001–02.

More information: For more information, see Strategic Objective 17: Reducing the Risk of Fractured Femurs in ACT Residents Aged Over 75 years.

The prevalence of diabetes in the ACT, of 3.8 per cent, was similar to the national rate of 3.7 per cent.

More information: For more information, see Strategic Objective 11: Lower Prevalence of Diabetes than the National Average.

Overall, the ACT Aboriginal and Torres Strait Islander immunisation rate of 90.5 per cent indicates a high level of investment in public health services to minimise the incidence of vaccine preventable diseases among the ACT’s Aboriginal and Torres Strait Islander population.

More information: For more information, see Strategic Objective 14: Addressing Gaps in Aboriginal and Torres Strait Islander Immunisation Status.

Results from the 2011 Australian Secondary School Alcohol and Drug Survey (ASSAD) show that 5.8 per cent of students were current smokers in that year, well below the national average. This demonstrates a continued decline in smoking, from 15.3 per cent in 2001 to 5.8 per cent in 2011.

More information: For more information, see Strategic Objective 18: Reduction in the Youth Smoking Rate.

Our public hospitals continue to exceed national and local benchmarks for:

  • hand hygiene rates
  • hospital-acquired infection rates
  • unplanned return to hospital within 28 days
  • unplanned return to the operating theatre.

More information: For detailed information, see the ACT Local Hospital Network strategic objectives and indicators.

Outlook for 2015–16

Although there are many challenges in the year ahead, 2015–16 promises to be another year of growth and achievement for ACT Health.

The ACT Government continues to invest heavily in public healthcare to meet both present and future challenges. Health continues to be one of the ACT Government’s biggest areas of investment, with a commitment of $1.42 billion in recurrent spending for health services for the people of the ACT and surrounding NSW in 2015–16.

More general inpatient beds and intensive care beds will be opened. This will be complemented by additional Hospital in the Home (HITH) places.

Outpatient services in cancer, women, youth and children and other outpatient clinics will continue to be expanded.

In addition, more support will be for available for:

  • people affected by suicide
  • mental health
  • suicide prevention awareness and research.

The 2015–16, the ACT Budget provides $6.2 million (and $8.4 million in a full year) to significantly enhance mental health services. This funding is allocated to increase current services and provide new interventions to better meet client needs. All of the funding is directed at community-based service responses and is in line with the ACT Government’s aim of ensuring that care is provided in the least invasive environment possible for any condition.

Along with this investment in mental health services, we will be continuing the work to transform other aspects of our services, through innovation and redesign, to deliver the most care in the most cost-efficient and effective way. Working collaboratively with healthcare consumers and the primary care sector will be central to achieving this objective.

This approach will complement the work done on models of care through the HIP. The continued investment in new e-health services will also support service delivery transformation.

Under the HIP, work will commence on:

  • the University of Canberra Public Hospital (UCPH) and the Secure Mental Health Unit (SMHU)
  • the expansion of the Emergency Department at Canberra Hospital
  • a range of staging and decanting projects.

The Healthy Weight Initiative will also remain a key focus for ACT Health as part of the whole-of-government initiative to reduce the incidence of obesity in our population.

Internal accountability

Executives in the ACT Public Service are engaged under contract for periods not exceeding five years. Their remuneration is determined by the Australian Capital Territory Remuneration Tribunal.

Table 1 identifies the Senior Executives across the organisation.

Table 1: Senior Executives

Senior Executive Position

Dr Peggy Brown

Director-General 1 July 2014 – 30 May 2015

Nicole Feely

Director-General from 1 June 2015

Ian Thompson

Deputy Director-General, Canberra Hospital and Health Services

Dr Paul Kelly

Chief Health Officer, Population Health Division

Paul Carmody

Deputy Director-General, Health Infrastructure and Planning

Stephen Goggs

Deputy Director-General, Strategy & Corporate

Ron Foster

Chief Finance Officer

Dr Frank Van Haren

Director, DonateLife ACT

Liz Sharpe

Director, Strategic Projects

Dr Andrew Mitchell

Director, Territory-Wide Surgical Services

Judy Redmond

Chief Information Officer, E-health and Clinical Records Branch

Phil Ghirardello

Executive Director, Performance Information Branch

Jodie Skriveris

Executive Director, Canberra Region Medical Education Council

Rosemary Kennedy

Executive Director, Business and Infrastructure Branch

Ross O’Donoughue

Executive Director, Policy and Government Relations Branch

Judi Childs

Executive Director, People Strategy and Services Branch

Veronica Croome

ACT Chief Nurse

Prof Frank Bowden

Chief Medical Administrator

Karen Murphy

Chief Allied Health Officer

Prof Kirsty Douglas

Director, Academic Unit of General Practice and Professor of General Practice, ANU Medical School

Dr Marianne Bookallil

GP Advisor

Professor Nicholas Glasgow

Dean ANU Medical School

A/Prof Deborah Browne

Executive Director, HealthCARE Improvement Unit

Rosemary O’Donnell

Executive Director, Medicine

Katrina Bracher

Executive Director, Mental Health, Justice Health and Alcohol and Drug Services

Prof Peter Collignon

Executive Director, Pathology

Linda Kohlhagen

Executive Director, Rehabilitation, Aged and Community Care

Barbara Reid

Executive Director, Surgery, Oral Health and Medical Imaging

Elizabeth Chatham

Executive Director, Women Youth and Children

Mark Dykgraaf

Executive Director, Critical Care

Adrian Scott

Executive Director, Acute Support Services

Denise Lamb

Executive Director, Cancer, Ambulatory and Community Health Support

Senior management committees and roles

ACT Health committees are established at the following levels:

  • Tier 1: directorate level
  • Tier 2: division/branch level and Tier 1 subcommittees
  • Tier 3: unit/team level.

Information within the organisation cascades down from Tier 1 committees. Similarly, information and issues can be raised at the Tier 3 level and reported and managed up through the higher committee tiers.

Figure 2 shows the relationship between the Executive Council and other councils and committees.

shows the relationship between the Executive Council and other councils and committees.

Figure 2: Relationship between the Executive Council and other councils and committees

Executive Council

The overarching governance committee for ACT Health is the Executive Council. Its role is to:

  • support the Director-General to meet responsibilities outlined in the Health Act 1993 and other relevant legislation
  • make recommendations on the strategic direction, priorities and objectives of the organisation and endorse plans and actions to achieve the objectives
  • oversee finance, performance and human resources
  • set an example for the corporate culture throughout the organisation.

The Executive Council is chaired by the Director-General and meets twice monthly, where:

  • one meeting focuses on finance, performance and other matters
  • one meeting focuses on other business.

A number of subcommittees report to the Executive Council, each dealing with different areas of accountability across the directorate.

Executive Directors’ Council

The Executive Directors’ Council provides an opportunity for all executive members to communicate and collaboratively work in partnership with other areas of ACT Health to deliver patient-focused, high-quality care by:

  • influencing policy and strategic direction
  • managing policy governance and risk
  • maximising operational effectiveness.

Executive Directors’ Quality and Safety Committee

The Executive Directors’ Quality and Safety Committee provides high-level advice to the Executive Council on all matters regarding quality and safety and ensures impacts on patient safety are considered in decision-making. The committee:

  • sets the strategic direction, priorities and objectives for safety and quality across the organisation
  • oversees clinical practice improvement, quality improvement, accreditation, clinical governance matters (including sentinel events), consumer engagement and clinical policy.

Work Health and Safety Committee

The Work Health and Safety Committee:

  • facilitates cooperation between ACT Health and staff to instigate, develop and carry out measures designed to ensure the health and safety of staff
  • assists in developing standards, rules and procedures relating to health and safety that are to be complied with in the workplace
  • provides work health and safety advice and recommendations on strategies, resource allocation and legislative arrangements
  • addresses whole-of-agency work health and safety issues unable to be resolved at the division or branch level.

Information Communication and Technology Committee

The Information Communication and Technology Committee:

  • oversees the development of Health Directorate information management and information and communications technology (IM&ICT) plans, policies and frameworks, as required, ensuring whole-of-government issues are considered
  • monitors lifecycle information and communications technology (ICT) asset management frameworks, strategies and policies and ensures these are consistent with best practice
  • monitors portfolio IM&ICT risks
  • monitors, reviews and manages ICT assets, services and delivery and financial performance and infrastructure risk across the Health Directorate
  • ensures whole-of-ACT Government and Health Directorate IM&ICT policies and standards are implemented across the organisation
  • prioritises IM&ICT initiatives
  • evaluates proposed IM&ICT initiatives and submits business cases for all major IM&ICT projects to the Executive Council, for endorsement
  • reviews and reports the status of ICT projects under development and, if required, recommends strategies to rectify significant variances of these.

Health Infrastructure Program Strategic Committee

The Health Infrastructure Program Strategic Committee is the chief decision-making body for the ACT Health Infrastructure Program (HIP). It is responsible for:

  • providing advice
  • monitoring progress
  • monitoring risk in the HIP.

Audit and Risk Management Committee

The Audit and Risk Management Committee provides independent assurance, assistance and advice to the Director-General regarding:

  • audit
  • risk control and its framework
  • external accountabilities and responsibilities
  • appropriate internal controls.

Canberra Hospital and Health Services Overview

Canberra Hospital and Health Services is led by the Deputy Director-General. It provides acute, subacute, primary and community-based health services to the ACT and surrounding region through its key service divisions, which are:

  • Division of Surgery, Oral Health and Imaging
  • Division of Women, Youth and Children
  • Division of Critical Care
  • Division of Cancer, Ambulatory and Community Health Support
  • Division of Rehabilitation, Aged and Community Care
  • Division of Mental Health, Justice Health, Alcohol and Drug Services
  • Division of Pathology
  • Division of Medicine
  • Division of Clinical Support Services
  • The Office of the Chief Nurse
  • The Office of the Chief Medical Administrator
  • The Office of the Chief Allied Health Officer
  • HealthCARE Improvement Division.

Achievements

The Acute Surgical Unit (ASU) commenced in April 2015 and is staffed and run by consultants at Canberra Hospital. The ASU admits patients who have been assessed as likely to require a surgical procedure and aims to maximise access to emergency theatre time for suitable patients. The ASU has access to a dedicated theatre list from Monday to Friday.

The Mobile Dental Clinic was launched in January 2015. The purpose-built truck is improving access to dental health services for Canberrans residing in aged care facilities. In the first six months it visited seven facilities, providing a range of preventative, restorative and denture services.

A new Cardiac Catheter Diagnostic Suite (CCDS) was installed in the Cardiology Department at Canberra Hospital in 2014. This has provided enhanced clinical services for our patients. The CCDS brings a new imaging performance, enabling the clinician to ultimately treat the patient faster, with more precision and with added confidence for enhanced patient outcomes. The CCDS is the first of its kind in the ACT.

An Adult Community Mental Health Model of Care redesign project delivered a preliminary Model of Care and high-level implementation plan. It is anticipated that this redesign will support community mental healthcare that is evidence-based, contemporary and better meets the needs of the expanding Canberra community.

The Community Nursing and Allied Health performance exceeded the 2014–15 targets for:

  • number of nursing occasions of service, which was set at 82,000
  • number of allied health regional services, which was set at 22,600.

This was achieved by:

  • recruiting additional allied health and nursing positions, which expanded community-based services
  • implementing changed models of care.

ACT Health undertook an extensive transformational policy redesign project, which reviewed over 1,800 policies across Canberra Hospital and Health Services. The project significantly reduced the number of policies housed on the ACT Health Policy Register and improved our evidence base to ensure clinical reliability.

The Respecting Patient Choices Program signed a two-year agreement with the Health Care Consumers Association (HCCA) to assist in increasing awareness of Advance Care Planning. It particularly focuses on:

  • disadvantaged groups
  • Aboriginal and Torres Strait Islander people
  • Culturally and Linguistically Diverse (CALD) groups.

Extended visiting hours at Canberra Hospital were implemented after a successful trial. Visiting hours are now 6.00 am to 9.00 pm.

Outlook for 2015–16

The Mental Health (Treatment and Care) Amendment Act 2014 will be implemented in March 2016. A training program is being developed to ensure that all staff are familiar with their responsibilities under the new Act.

A community mental health team will be established for the Gungahlin region. Currently, services are provided to this area as an extension from the Belconnen Mental Health Team.

The current community Adult Model of Care will be redesigned to ensure an improved integrated flow of patients from both inpatient and community settings—crisis, assertive outreach, clinic- and home-based care.

Enhancements to the Model of Care for both the Discharge Lounge and Medi-Hotel are planned. The aim is to improve access to the services and improve patient flow for patients being discharged from the hospital.

A breast screening clinic will open at the Belconnen Community Health Centre (BCHC) in the latter half of 2015. This will increase accessibility and ensure an increased capacity to accommodate the expansion of the target age group to target women aged 70–74 years.

ACT Pathology will introduce a pilot electronic ward ordering system that will improve the accuracy and timeliness of pathology orders.

The Dementia Care in Hospitals Program will be implemented. The program aims to raise awareness and support for more dementia-friendly and supportive environments in Canberra Hospital.

Canberra Hospital will also enhance patient care by developing an Acute Stroke Pathway. It is developing, in collaboration with the ACT Ambulance Service and Calvary Public Hospital, an evidence-based, widely-endorsed pathway for caring for acute stroke patients across the territory.

Strategy and Corporate Overview

The Strategy and Corporate Group:

  • supports national health reforms and National Partnership Agreements
  • develops strategies for attracting and retaining the health workforce
  • maintains critical physical and technological infrastructure for the ACT's public hospitals and health services.

The Strategy and Corporate Division consists of seven branches:

  • Policy and Government Relations
  • Business and Infrastructure
  • People, Strategy and Services
  • Performance Information
  • eHealth and Clinical Records
  • Academic Unit of General Practice
  • Canberra Region Medical Education Council (CRMEC).

Quality and Safety transferred to the Canberra Hospital and Health Services Division in 2013–14.

Strategy and Corporate administers ACT Health's contract for the provision of public hospital services by Calvary Health Care ACT at Bruce and at Clare Holland House, and supports these close working relationships.

Calvary Health Care ACT's report on its achievements in 2014–15 is provided in an annexed report.

More information: Attachments, Annexed and subsumed public authority reports, Calvary Health Care Ltd Annual Report 2014–15.

Much of the work supported by Strategy and Corporate is discussed elsewhere in this report; however, other highlights for the division during this reporting period are discussed in this section.

National Disability Insurance Scheme

The National Disability Insurance Scheme (NDIS) was launched on 1 July 2014 and its implementation continues across ACT Health. Strategy and Corporate's work in this area includes:

  • financial planning
  • service configuration
  • community sector contracting
  • assisting with its phasing in for clients of ACT Health services
  • workforce issues.

During 2014–15, ACT Health and contracted providers began transitioning clients and funding into the NDIS. ACT Health is working closely with the ACT Government NDIS Taskforce and the National Disability Insurance Agency (NDIA) to support clients and services through the transition period.

The commencement of the NDIS and the associated planning and implementation requirements are significant for the Division of Mental Health, Justice Health and Alcohol and Drug Services. An implementation plan has been developed to ensure:

  • appropriate services are available for eligible people for the transition of care arrangements to the NDIS
  • support those people who may not be eligible or who may have difficulties accessing these services.

Rehabilitation, Aged and Community Care (RACC) is a registered service provider to the NDIS. Procedures have been implemented to:

  • identify NDIS clients at intake
  • capture service delivery activity in the ACT Patient Administration System (ACTPAS)
  • raise notional or actual claims to the NDIS for services delivered.

ACT Equipment Scheme (ACTES) is providing funding assistance to clients who are involved in the initial NDIS planning process. The funding aims to meet a client’s ongoing needs until their planning process is completed.

The ACT NDIS trial will conclude with all eligible residents to be phased in by 2016. Nationally, preparation continues for the implementation of the full scheme.

ACTES will still be required to operate to provide funding assistance to NDIS ineligible clients, who are clients who:

  • need items not covered by the NDIS
  • are over the age of 65 years with lower incomes.

RACC will continue to strengthen systems for identifying potentially eligible clients, ascertaining whether they have an NDIS plan, and encouraging them to register with the NDIS.

RACC will continue to work collaboratively with:

  • the NDIA to promote timely, appropriate and seamless service delivery to clients with disabilities
  • the NDIA and other ACT Government directorates to contribute lessons learnt from the trial, promote inter-sectoral resolution of issues, and work towards the development of a full scheme.

In April 2014, the ACT Government announced that, due to the implementation of the NDIS, it would withdraw from providing:

  • early intervention services in 2014
  • therapy services by December 2016.

To provide continuity of service during the NDIS trial, a collaborative approach to service provision was undertaken from January 2015 as Stage 1 of the Child Development Service (CDS). This provided:

  • therapy intervention for children not eligible or not yet phased for the NDIS, which continues to be provided by Therapy ACT
  • early development groups for children not eligible for early intervention services funded by NDIS, which were run through child and family centres by Early Childhood Teachers funded by the Education and Training Directorate (ETD)
  • co-locating at Therapy ACT Holder of Community Paediatricians (Health) and Early Intervention Psychologists (ETD) to provide developmental and health assessment.

The CDS proposes that current services be redesigned to achieve:

  • streamlined access to allied health and medical assessment for children who are ACT residents and at risk of developmental delay
  • referral to appropriate services including the NDIS
  • a model of intervention and supports for those children not eligible for the NDIS, including group programs and parent supports.

Depending on the assessed need, this may include time limited, episodic interventions and/or referral to mainstream services, such as playgroups or parenting programs for children at risk of developmental delay and their parents.

ACT Health is working closely with the Community Services Directorate to progress this work.

Real-time reporting

For the first time, ACT Health is using real-time reporting to help clients make decisions about the best treatment options available to them. These initiatives improve the patient journey and contribute to the sustainability of the health service.

A web-based report named ED Live was developed during the reporting period and released to the public in July 2014. The website, the first for the territory, reports on the current status of the two public hospital Emergency Departments. Clients can use this information to decide which service to access, and consider alternative services for less urgent medical needs. ED Live was developed in line with the Government’s Open Data Strategy.

The Performance Information Portal (PIP) allows ACT Health users to:

  • view real-time activity in many areas of the organisation
  • access historical trends and activities in particular areas of its operations.

Further developments have been rolled out during 2014–15, including a theatre utilisation module and a bed management tool.

Centralised Waitlist Service

Performance Information Branch will build an improved elective surgery site for public viewing in 2016. The site intends to provide users with information on surgical waiting lists for differing specialist groups and the surgeons within each group. The site will allow users of public hospital elective surgery facilities to become more informed about potential waiting times, and assists them in making informed decisions about the doctors undertaking their care.

The site is being built in response to the Auditor-General’s Report No. 1 of 2011: Waiting Lists for Elective Surgery and Medical Treatment report, which recommended establishing a single waiting list across the territory.

While the Centralised Waitlist Service (CWLS) is not a single wait list, it is the first stage in progressing to this concept. This continues to be progressed in 2015.

The main features of the CWLS are:

  • All Request for Admission forms (RFAs) are received into the CWLS and patients are added to the elective surgery waiting list. All RFAs have previously been managed at individual hospital sites.
  • Clinicians can specify a surgery location, or indicate if the procedure can be undertaken at either site.
  • Patients will be added to the waitlist within the shortest waiting time possible.

Policy adherence is also more easily enforced with this model.

The CWLS is located at Gungahlin Community Health Centre. It is managed by the Territory-Wide Surgical Services Team and is staffed by administrative and nursing staff.

Additionally, work is underway to realign the delivery of surgical services in the territory. This will include:

  • identifying ways to improve theatre utilisation
  • managing the allocation of theatre sessions based on demand for particular specialty groups.

Implementing this strategy will greatly assist in more timely access to surgical services in the future.

Systems, technology and clinical records

ACT Health now trades electronically with 22 of its major suppliers, which represents about half of spending on medical and related consumables. Electronic catalogue synchronisation has reduced the number of price and payment variations from suppliers by more than 60 per cent. Electronic trading provides early shipping status from suppliers. Supply Services (in the Business and Infrastructure Branch) uses the information to advise internal customers of when goods can be expected to be delivered, thus enhancing the customer service experience.

The eHealth and Clinical Records Branch has overseen improvements to a range of existing ICT, including the following:

  • enhancing the Clinical Portal to provide greater flexibility when viewing pathology results
  • upgrading the Cardiobase system used within the Canberra Hospital Cardiology Unit
  • expanding the renal information system to the Tuggeranong and Belconnen Dialysis clinics.

A pilot of an Electronic Medication Reconciliation solution has additionally been undertaken within the Canberra Hospital Geriatric Specialty.

The BreastScreen Information System was implemented in December 2014. This purpose-built system has been designed to:

  • streamline administrative and clinical workflows
  • support BreastScreen management and reporting processes.

An electronic task management system, known as the Medical Officer Notice board, was introduced in 2015 to assist nursing, midwifery and medical staff to manage tasks for inpatient wards. This has reduced reliance on the paging system and supports clearer, more consistent communication of tasks.

An improved clinical record search and registration solution, known as Active Search, has been developed and is being progressively rolled out across ACT Health. Active Search leverages the patient master index (PMI) to provide advanced searching tools that support fast, effective patient record searches and reduce duplicate record creation rates.

eHealth and Clinical Records has overseen a successful trial of a rapid access technology solution, which enables staff to log into shared computers within 4–6 seconds. This technology is available within Canberra Hospital Emergency Department and is being progressively rolled out to other clinical areas of Canberra Hospital.

The Data Warehouse core framework implemented in 2013–14 uses widely available technology to integrate, manage and share information via a web portal.

E-learning continued to be used to strengthen staff skills and professionalism, including for the Workplace Induction Pathway and training on writing, aseptic techniques and neonatal care. New e-learning programs were rolled out across the directorate, and others were updated.

More information: For detailed information on further initiatives, see B.8 Human resources management, Learning and development programs.

The Clinical Record Service undertook a number of back-scanning and record archiving projects to digitise or track and file a range of decentralised paper records, including a range of Respiratory and Sleep Medicine, Psychology and Pain Management records. In total, 65,000 records or 250,000 pages were scanned and a further 16,000 inactive records were tracked and filed. A team of 11 temporary staff members were employed to carry out this work.

During the last six months the Clinical Coding Team has exceeded the coding Key Performance Indicator (KPI) of 90 per cent of records, averaging a 95 per cent completion rate without the assistance of external contract coders.

Future directions

eHealth and Clinical Records Branch is working towards implementing a range of initiatives, which support staff in delivering high-quality care to ACT Health consumers. The initiatives build on the solid e-health foundation that has been established over the past few years. The objectives that guide the initiatives include:

  • improving availability and timeliness of information designed to support clinical decision-making at the point of care
  • facilitating better collaboration
  • supporting improved efficiencies across hospital and community-based health services.

Reviews and planning

A significant review of the Mental Health (Treatment and Care) Act 1994 was completed during the year. As a result, an extensive amendment bill was debated and passed by the ACT Legislative Assembly on 30 October 2014. An additional Mental Health Transition and Minor Amendments Bill was tabled in the Legislative Assembly on 4 June 2015. The combined amendments from these two bills will mean that the new ACT Mental Health Act 2015 will become operational from March 2016.

In 2014–15, ACT Health chaired an inter-directorate committee to lead the development of a 10-year whole-of-government Mental Health and Wellbeing (MH&W) Framework. This framework will contribute to the ACT Government’s strategic priorities for improving the community’s mental health and wellbeing and protecting vulnerable groups.

The framework will explicitly address self-harm and suicide prevention. The ACT Government acknowledges that many of the social determinants affecting mental health, wellbeing and suicide prevention lie outside the health domain and, therefore, require a whole-of-government, whole-of-community approach. The framework will be developed by December 2015.

A replacement for the ACT Mental Health Services Plan 2009–2014 will be developed by December 2015, in parallel to the whole-of-government MH&W framework. The replacement will be specific to ACT Health and will sit within the Health Directorate’s Corporate Plan 2012–17. The plan will contribute to ACT Health’s strategic priorities of continuing to meet the growth in demand for mental health services.

A new Aboriginal and Torres Strait Islander Reconciliation Action Plan (RAP) is planned for release in August 2015.

Workforce planning

ACT Health continues to grow as an organisation that provides health services to support the growing community of the ACT. Workforce planning is essential to guide the recruitment, retention and development of a very diverse clinical and non-clinical workforce. This approach helps to ensure that the right person, with the right skills is in the right place at the right time to provide the right services within budget.

Workforce planning, as a key pillar within the organisation, is needed to support the largest recurrent expense of the organisation, with approximately 80 per cent of recurrent funds being spent on workforce.

The ACT Health Workforce Plan 2013–2018 identified five focus areas:

  • Health Workforce Reform
  • Health Workforce Development
  • Health Workforce Leadership
  • Health Workforce Planning
  • Health Workforce Policy.

To date, the organisation is tracking well against all focus areas.

Recruitment and retention strategies are being explored and implemented to ensure that we have a workforce into the future that has the skills and capability of providing health services of the highest standard.

The Australian Government funds the ACT Region Integrated Clinical Training Network (ICTN). The network is made up of the region’s health and education sectors. The ICTN and its two programs—Simulated Learning Environment (SLE) and Clinical Supervision and Support Program (CSSP)—continue to be used in the region, and staff are:

  • working towards a sustainable coordinated jurisdictional simulation learning program
  • increasing capacity for all levels of clinical and student supervision in all health settings.

More information: For detailed information about human resources activities, see B.8 Human resources management.

Academic Unit of General Practice

The Academic Unit of General Practice (AUGP) is co-founded by the ACT Health Directorate and the ANU Medical School. Since its establishment in 1997, the AUGP has made extensive contributions to delivering:

  • the ANU Medical School Program
  • medical educational programs for junior medical officers, General Practitioner (GP) vocational trainees and practicing doctors.

The AUGP has developed research activities that encompass:

  • child health
  • integrated service development
  • clinical research
  • individual routes to health and healing
  • social determinants of medical care
  • scholarship in teaching and learning.

The AUGP has led research, building from information gathered during the ACT Health Kindergarten Health Check.

In addition, the AUGP has contributed to policy development within the Australian Capital Territory (ACT) and wider Australian health service:

  • through the work of the GP Advisor
  • through the work of ICTN and Health Workforce Australia (HWA)
  • through committee work
  • by liaising with the ACT Medicare Local
  • by communicating its research findings.

The AUGP and academics provide clinical services to:

  • Winnunga Nimmityjah Aboriginal Health Service
  • Companion House Refugee health service
  • mainstream general practice in the ACT.

Senior members of the AUGP have pivotal roles with the:

  • Royal College of General Practitioners (RACGP)
  • ACT Medicare Local
  • Australian Association of Academic Primary Care
  • Confederation of Postgraduate Medical Education Councils.

Achievements

During 2014–15, AUGP’s achievements included the following:

  • ANU Medical School Program
  • Healer’s Art
  • Prevocational GP Placement Program (PGPPP)
  • Supervisor and Registrar Teaching
  • GP Workforce Infrastructure Program
  • Peter Sharp Scholarship
  • Kindergarten Health Check Research
  • Treating Adult Obesity in General Practice Research
  • Refugee Health Research
  • Integration in Primary Health Care Research
  • Vertical Integration of GP Education Research.

Strategic partnerships are being developed with the Research School of Population Health at the ANU and ACT Medicare Local. Future research will build on primary healthcare health services research, with a particular focus on developing more systematic and reliable ways to articulate, measure and value the complex nature of primary care consultation. Research effort will continue in the areas of primary care in vulnerable populations, medical education and child health.

Canberra Region Medical Education Council (CRMEC)

The Canberra Region Medical Education Council (CRMEC) was established in December 2014 by the Minister for Health and took over the functions of the Canberra Region Prevocational Management Committee (CRPMC). The CRMEC has been accredited by the Australian Medical Council as an intern training accreditation authority for the next three years to March 2018. The CRMEC has a strong collaborative relationship with South Australian Medical Education and Training, the equivalent body in South Australia, and has strong consumer engagement and representation.

The CRMEC performs accreditation functions for the intern training and education program within the ACT and region for Canberra Hospital and Health Services, Calvary Hospital, Goulburn Hospital and Bega District Hospital. Additionally, the CRMEC oversees the development and management of medical education standards, policies, processes and functions of the ACT and Region Prevocational Network.

Additionally, the CRMEC oversees the development and management of medical education standards, policies, processes and functions of the ACT and Region Prevocational Network.

In March 2015, the CRMEC, with the assistance of the South Australian Medical Education Training Unit, facilitated training of 13 accreditation surveyors, including members from the CRMEC and the Accreditation Committee:

  • A/Prof Katrina Anderson
  • Dr Rob Griffin
  • Dr Diana Tracy
  • Ms Fiona Tito Wheatland
  • Ms Miffany Trenery
  • Dr David Banfield
  • Dr Estella Janz-Robinson
  • Dr Cameron Maxwell
  • Dr Yinan Zhang
  • Dr Helmut Yu
  • Dr Russell Thomas
  • Dr Suhaila Fatima Kamrani
  • Dr Glenn Verheul

An accreditation of the Bega District Hospital was undertaken on 22 July 2015 in conjunction with Health Education and Training Institute (HETI). Future accreditation of the Calvary Hospital and Goulburn hospital intern training programs are planned to be undertaken over the next 12 months.

The CRMEC is committed to identifying, evaluating, monitoring and promoting medical education and training programs for junior medical officers and their educators, in conjunction with key stakeholders. The council’s goal is to continue to develop partnerships nationally and locally with other Postgraduate Medical Councils and professional networks to ensure familiarity with the work of other jurisdictions and maintain collaborative working relationships.

Canberra Hospital Smoke-free Environment Implementation

In 2014–15, a comprehensive smoke-free implementation plan was developed, and included:

  • an education campaign
  • providing an increased range of Nicotine Replacement Therapy (NRT) for inpatients and staff
  • removing the Designated Outdoor Smoking Areas on the campuses
  • increasing staff training in smoking care
  • increasing enforcement of the smoke-free environment.

Business and Infrastructure

Business and Infrastructure Branch is responsible for providing a range of infrastructure and strategic support services to all ACT Health acute and non-acute sites across the ACT. The value of assets under management was $886.129 million as at 30 June 2015, with property assets totalling 274,480 square metres. Activities span across several campuses including:

  • the Canberra Hospital campus
  • Calvary Hospital
  • Civic offices
  • Community Health Centres
  • Curtin
  • Holder
  • Mitchell

More information: For detailed information about asset management, see C.4 Asset management.

Achievements

ACT Health Business and Infrastructure undertook a Food Service ‘Meal Service Quality Improvement Project’ based on feedback from patients, consumer representatives and relatives following their hospital experience.

As part of the menu item review aspect of the project, Food Services coordinated input from a variety of stakeholders, to deliver a replacement menu, based on items and packaging with:

  • ease of opening
  • improved flavour
  • the correct portion size
  • improved presentation.

Stakeholders included the:

  • ACT Rheumatoid Arthritis and Sjogrens Support Group
  • ACT Health Aged Care Unit, Nutrition department and Speech Pathology department.

As a result Food Services introduced easy-opening breakfast cereal packs as part of the breakfast patient meal service and a range of easy-opening packaged items.

Other initiatives undertaken included an Improving Patient Meal Consumption Project to provide greater ‘access’ to meals. This project included introducing coloured tray mats to communicate to clinical staff that:

  • a patient requires full assistance with their meal (red tray mat) or
  • a patient requires their meal to be set up for self-feeding, i.e. inserting straws and opening packaging (green tray mat).

Following the trial of coloured tray mats within ward 11A, there has been a 22.9 per cent increase in lunch main meals consumed and a 19 per cent increase in the main dinner meals consumed. The tray mats have since been implemented into wards 11A, 11B, 5A and 5B.

Issues and challenges

ACT Health is one of the highest consumers of energy in the ACT Government due to the type of services delivered. Canberra Hospital delivers a critical 24-hour service to our community and is the ACT Government’s largest user of energy, with 25 per cent of the territory’s electricity being consumed at that site alone.

As an organisation, ACT Health faces increasing environmental challenges, some of which are yet to be experienced. These challenges include increased stakeholder pressure for a robust position on sustainability.

The organisation is required to achieve certain targets and meet numerous regulatory and policy measures, such as the:

  • ACT Climate Change Strategy 2007–25
  • Building Code of Australia
  • ACT Government’s target of zero net emissions by 2020.

Future directions

ACT Health is committed to whole-of-government sustainability initiatives that work towards achieving carbon neutrality by 2060. As a part of this commitment, a feasibility study was undertaken to support an application to the Carbon Neutral Government Loan Fund. The application to the fund was for the installation of 500kW solar photovoltaic (PV) system on the roof of the southern (multi-storey) car park at Canberra Hospital. This is estimated to reduce the hospital’s energy consumption by about 721,000kW each year. The project also includes the rollout of LED lighting for many of the older buildings on the hospital campus. The application was submitted in May 2015.

More information: For detailed information about utilities usage and sustainability initiatives, see B.9 Ecologically sustainable development.

Workplace safety

Safety training remains a priority and continues to be provided for Health and Safety Representatives (HSRs), managers and new staff. The Work Health and Safety Managers and Investigation course assists managers to:

  • implement relevant preventive and corrective safety controls
  • continuously improve safety in the workplace.

ACT Health received accreditation in 2015 from WorkSafe ACT as a Registered Training Organisation (RTO) to provide tailored HSR training for our staff.

Population Health

The Population Health Division (PHD) has primary responsibility for managing population health issues within ACT Health. The division:

  • undertakes the core functions of prevention, assessment, policy development and assurance
  • contributes to local and national policy, program delivery and protocols on population health issues.

The PHD is headed by the Chief Health Officer, who is appointed under the Public Health Act 1997 and reports to the Director-General of ACT Health. The Chief Health Officer is also required to report biennially on the health of the ACT population on specific health-related topics, through the Chief Health Officer’s Report.

The Health Improvement Branch has carriage of policy and program delivery in the areas of health promotion and preventive health. Current programs include:

  • Kids at Play Active Play
  • Good Habits for Life
  • Fresh Tastes
  • Ride or Walk to School (RWTS)
  • Active Streets.

The Health Improvement Branch also collects, analyses and disseminates information on the health status and health-related behaviours of the ACT population. This information can be used to monitor, evaluate and guide health planning and policy.

The Health Protection Service manages risks and implements strategies for the prevention of, and timely response to, public health incidents. This is achieved through a range of regulatory and policy activities relating to areas such as:

  • food safety
  • communicable disease control
  • environmental health
  • emergency management
  • pharmaceutical products
  • tobacco control
  • analytical services

The Office of the Chief Health Officer (OCHO) is responsible for:

  • providing public health advice—both internally and externally to the division
  • conducting high-level project and policy work on behalf of the Chief Health Officer.

Key policy priority areas for the OCHO include:

  • obesity and injury prevention and reduction
  • medicinal cannabis
  • loose-fill asbestos
  • organ and tissue donation
  • gene technology
  • the health effects of climate change.

Achievements

In February 2015, a team of 11 public health officers conducted food inspections during the three-day National Multicultural Festival, as part of a strategy to minimise public health risk from serious breaches of the Food Act 2001. Public health officers routinely look for issues that would give rise to unacceptable food safety risks including:

  • inadequate temperature control
  • poor hand washing facilities
  • inappropriate food storage.

Over 290 inspections were conducted during the event. A number of food safety breaches were identified, resulting in five incidents of voluntary disposal of food.

The Good Habits for Life Program is a locally-developed behaviour change campaign, which targets families with young children, and encourages physical activity and healthy eating. Good Habits for Life was launched on 11 November 2014. Phase 2 was rolled out in May and June 2015 using innovative social media streams. The campaign website has received over 30,000 visits since its launch.

On 7 April 2015, ACT Health announced an Antenatal Pertussis Vaccination Program. Vaccinating pregnant women in the third trimester has been shown to be effective in preventing pertussis disease in newborn infants because protection is transferred from the mother to the unborn child. The ACT Government is funding the vaccine, which is to be administered at 28 weeks gestation or as soon as possible afterwards. The vaccine is available at general practices and hospital maternity units.

The ACT continued to achieve high childhood immunisation coverage in the general population. Coverage rates for children in all cohorts were consistently above the national average. In 2014–15, ACT childhood immunisation coverage rates remained above 90 per cent for 12-month-old children. ACT Health’s target of 92 per cent of one-year-old children being fully immunised was exceeded in all quarters (92.5 per cent, 93.1 per cent, 92.9 per cent and 92.9 per cent).

On 17 November 2014, the ACT Health Air Quality Monitoring website, which included an Air Quality Index (AQI) value to indicate the cleanliness of ACT air, was launched at the Health Protection Service. The AQI provides a number that allows easy comparison of different pollutants, locations and time periods. The website provides real-time air quality data from the three air quality monitoring stations operated by ACT Health.

Outlook for 2015–2016

The cessation of the National Partnership Agreement on Population Health (NPAPH) in the 2014–15 Federal Budget created significant funding shortfalls for health improvement services and programs. However, the ACT Government continued to support the majority of NPAPH-related programs for 2014–15 and provided additional support in the 2015–16 budget through its Healthier Lifestyles initiative.

PHD continues to progress work on improving controlled medicines regulation in the ACT. Consultation was undertaken in 2013 on a proposed model to remove the current Chief Health Officer approval requirement for prescribing controlled medicines. This was to be coupled with improved prescription monitoring by PHD using pharmacy data.

While the majority of stakeholders supported the proposal, some stakeholders have raised concerns that removing the current safeguards will put patients at risk. PHD is currently considering an alternative model to retain the approvals system for consideration by the Minister in 2015–16.

Health Improvement Branch will lead implementation of the Healthier Lifestyles initiative, focusing on:

  • delivering health promotion services for children in schools
  • reducing smoking in pregnancy
  • continuing implementation of Good Habits for Life.

The Health Improvement Branch is developing a new web platform to report on national and local health indicators and other population health priorities. The project aims to increase the availability of population health information for use in health policy and planning, research and by other stakeholders.

PHD will continue to progress work to address the potential public health issues associated with the sale and use of electronic cigarettes.

Health Planning and Infrastructure Overview

Health Planning and Infrastructure (HPI) has corporate responsibility for:

  • leading and facilitating the development of whole-of-government plans (as they relate to the Health Directorate and health services), the Health Directorate Corporate Plan, territory-wide strategic plans and clinical service plans that have a territory-wide impact
  • directing and managing the directorate’s Health Infrastructure Program (HIP), including health planning, coordination, management and implementation
  • strategic accommodation
  • the Capital Upgrades Program (CUP)
  • the Arts in Health Program.

Achievements

Implementing the HIP was a strategic priority for 2014–15.

More information: For detailed information about the HIP, see B.1 Organisational overview, 2014–15 strategic priorities, Implementing the Health Infrastructure Program.

Following a review of the governance of the HIP undertaken in 2013–14, a revised HPI Group organisation structure was implemented in September 2014. This structure delineates roles and functions within Health Planning and Infrastructure and the HIP.

During 2014–15, HPI aligned planning activity for:

  • the Corporate Plan 2012–2017
  • the ACT Health Business Plan 2014–15
  • the draft ACT and Southern NSW Local Health District Cancer Services Plan 2015–2020
  • the ACT Lymphoedema Services Background Paper and Implementation Plan 2015–2018
  • associated Lymphoedema Services Plan 2015–2018
  • capital and facility planning in support of the HIP.

A review of the Calvary Master Plan Stage 1 commenced in March 2015, and was completed on 30 June 2015 for consideration by ACT Health, the Little Company of Mary and the ACT Government.

The Calvary Master Plan review will inform decisions about the future development of the Calvary Public Hospital campus. If the ACT Government agrees to progress to undertaking a full Master Plan study for the Calvary Public Hospital, Calvary staff and consumers will be involved in providing input to the process.

Projects delivered by HPI as part of the HIP in 2014–15 included:

  • the Canberra Region Cancer Centre (CRCC)
  • refurbishing Building 1 Level 5, Canberra Hospital
  • providing 15 additional beds at Calvary Hospital
  • upgrading external signage at Canberra Hospital.

The CRCC was a strategic priority for 2014–15.

More information: For detailed information about the CRCC, see B.1 Organisational overview, 2014–15 strategic priorities, Canberra Region Cancer Centre.

The Arts in Health Program includes developing and implementing briefs for art in new HIP projects. In 2014–15, this included procuring works for the:

  • CRCC
  • Centenary Hospital for Women and Children (CHWC)
  • Isolation Ward, Intensive Care Unit
  • Belconnen Community Health Centre (BCHC).

Planning is underway to procure art works for the Secure Mental Health Unit (SMHU) and the University of Canberra Public Hospital (UCPH).

The Arts in Health Program is supported by the Canberra Hospital Foundation.

Outlook for 2015–16

During 2015–16, the following plans are programmed to be released and implemented:

  • the ACT and Southern NSW Local Health District Cancer Services Plan 2015-2020
  • the ACT Lymphoedema Services Background Paper and Implementation Plan 2015–2018, and the associated Lymphoedema Services Plan 2015–2018.

A number of specialty-level clinical services plans are scheduled to be completed/reviewed in 2015–16, in collaboration with clinical networks, staff and consumers. These include:

  • reviewing the Ambulatory Care Framework, Critical Care Plan and Mental Health Services Plan
  • developing new plans for Child Health Services, Chronic Conditions, Cardiology and Surgical Services
  • developing an ACT Child and Youth Health Services Plan that is supported by the National Child and Youth Health Strategic Framework, which is due for finalisation in 2015.

The Canberra Hospital Master Plan Study is scheduled to be completed in early 2016. The Canberra Hospital Master Plan Study will guide future planning and inform long-term investment in health infrastructure development on the Canberra Hospital campus.

Corporate and Operations Plans

ACT Health's efforts over the reporting year have been guided by:

  • frameworks and strategies
  • a range of whole-of-government strategic documents, including the Canberra Social Plan and the ACT Children’s Plan.

This section discusses the ACT Health-specific frameworks and strategies.

ACT Aboriginal and Torres Strait Islander Health Workforce Action Plan 2013–2018

The Aboriginal and Torres Strait Islander Health Workforce Action Plan 2013–2018 seeks to increase the number of Aboriginal and Torres Strait Islander people employed in the health workforce.

Employing, recruiting and retaining Aboriginal and Torres Strait Islander people in the health workforce strengthens our ability to provide an effective, responsive and culturally safe health system, which is of mutual benefit to the community and our organisation.

ACT Health Workforce Plan 2013–2018

The ACT Health Workforce Plan 2013–2018 aligns with national health workforce reform, including the research and evidence provided by the Health Workforce Australia (HWA) National Health Workforce Innovation and Reform Strategic Framework for Action 2011–2015.

The plan provides strategies under focus areas for direction, action, accountabilities and measures of success, which are able to be applied for operational workforce planning in all areas of ACT Health.

ACT Alcohol, Tobacco and Other Drug Strategy 2010–2014

The ACT Alcohol, Tobacco and Other Drug Strategy 2010–2014 aims to:

  • improve the health and social wellbeing of individuals, consumers, families and carers, and the community in the ACT
  • minimise the harm in our community from alcohol, tobacco and other drugs while recognising the individual needs of all citizens in the ACT
  • develop evidence-informed policies and initiatives to ensure that issues associated with harmful alcohol, tobacco and other drug use are addressed in an effective way
  • implement the Strategy Action Plan in a manner that respects, protects and promotes human rights.

In 2014, the Minister for Health approved the commencement of work on the ACT Alcohol, Tobacco and Other Drug Strategy 2015–2019.

ACT Breastfeeding Strategic Framework 2010–2015

The ACT Breastfeeding Strategic Framework 2010–2015 sets the context for protecting, promoting and supporting breastfeeding in the ACT. The framework is consistent with, and supports the implementation of, the action areas in the Australian National Breastfeeding Strategy 2010–2015.

ACT Chronic Conditions Strategy 2013–2018

The ACT Chronic Conditions Strategy 2013–2018 provides overarching direction for chronic condition care and support in the ACT and outlines the requirement for a coordinated approach across the government and non-government sector. It concentrates on improving care and support services for every person living with a chronic condition.

ACT Health Corporate Governance Statement, 2015

The ACT Health Corporate Governance Statement provides an overview of the organisation. It is a starting point for gaining further detailed information on organisational:

  • structures
  • roles and relationships
  • policies and procedures
  • accountability mechanisms.

ACT Health Corporate Plan 2012–2017

The Corporate Plan articulates:

  • key focus areas
  • priorities for improvement
  • key strategies for achieving the priorities
  • achievements planned for the long term (five years).

In 2014–15, ACT Health continued to measure its performance against these areas through key performance measures identified in:

  • the ACT Public Health Service's quarterly performance reports
  • ACT Health's strategic and accountability indicator sets in the ACT Budget Papers.

The target achievements for each year are contained in ACT Health's Business Plan.

ACT Health Food and Nutrition Strategic Framework 2012–2018

The ACT Health Food and Nutrition Strategic Framework: 2012–2018 has been developed to assist ACT Health staff to understand the key food and nutrition issues facing the population of the ACT and to take action to address these issues. The framework identifies:

  • key food and nutrition issues affecting the ACT population
  • strategic areas for action by ACT Health
  • guiding principles to underpin the ACT Health’s roles in food and nutrition.

The framework has a high-level strategic focus on issues and areas for action that affect the whole ACT population and vulnerable subgroups of the population. It focuses on promoting healthy eating in accordance with Australian Dietary Guidelines among the general population. The framework is also used to inform stakeholders and the community about ACT Health’s roles in food and nutrition.

The framework is not intended to guide clinical practice in managing an individual’s health conditions where specific dietary advice and intervention is required.

ACT Health Quality and Clinical Governance Framework 2015–2018

The ACT Health Quality and Clinical Governance Framework 2015–2018 articulates the clinical governance systems within ACT Health that support delivering high-quality safe services. In practice, good clinical governance focuses on creating an environment in which there is transparent responsibility and accountability for maintaining standards, allowing excellence in clinical care to flourish.

ACT Health Safety and Quality Framework 2010–2015

The Safety and Quality Framework 2010–2015 describes a vision and direction to improve safety and quality in ACT Health. It sets out organisational activities that will improve the safety and quality of ACT Health services.

ACT Health Sustainability Strategy 2010–2015

The Sustainability Strategy is designed to meet the challenges that climate change will have on the ACT. It provides a roadmap for collaborative action between:

  • ACT Health and all stakeholders
  • clients and staff, including other government departments.

The roadmap ensures that business and clinical services (including planning for the future) are linked with the strategy and incorporate actions and achievements to deliver the objective of a sustainable health system for the future.

ACT Health Physical Activity Strategic Framework 2010–2015

The ACT Health Physical Activity Strategic Framework seeks to address the growing need for a strategic approach to:

  • improve physical activity outcomes at a population level
  • guide the activities of ACT Health in this regard.

It proposes that promoting physical activity should be core business for the Health Directorate, given the strong evidence base demonstrating downstream health system benefits to be gained from improving physical activity levels.

ACT Mental Health Services Plan 2009–2014

The ACT Mental Health Services Plan 2009–2014 is a strategic-level document giving broad direction for the future development of public mental health services in the ACT. It was developed in consultation with stakeholders over a two-year period. The plan covers the years 2009 to 2014, but conveys a vision for how mental health services will be delivered in the ACT in 20 years.

The guiding vision for mental health services in the ACT is that by 2020 the mental health needs of the community will be met by a comprehensive network of complementary and integrated mental health services that:

  • enhance knowledge and understanding
  • intervene and provide support early and for as long as is necessary
  • address, as far as possible, mental health issues in community settings, working with and developing natural systems of support.

ACT Health Palliative Care Services Plan 2013–2017

The ACT Health Palliative Care Services Plan 2013–17 was released on 28 October 2013 by the then Chief Minister and Minister for Health, Ms Katy Gallagher, MLA. An ACT Palliative Care Clinical Network has been established to:

  • implement the plan
  • streamline and improve access to coordinated palliative care services
  • facilitate communication and collaboration between specialist palliative care services, acute services, and community service providers. 

The network has been designed to work flexibly across the various service delivery settings in the ACT and surrounding NSW region to provide a cohesive palliative care service.

People with a life-threatening illness in the ACT and their families and carers need timely access to quality palliative care that:

  • is consumer and carer focused
  • respects their choices
  • is appropriate to their needs.

The ACT Palliative Care Services Plan 2013–2017 provides strategic direction for developing palliative care in the ACT to best meet current and projected population needs.

ACT Primary Health Care Strategy 2011–2014

The ACT Primary Health Care Strategy 2011–2014 aims to improve integration between general practice and the wider primary healthcare sector in providing primary healthcare. Six-monthly reports outlining progress against the annual implementation plan are provided to the ACT Health Executive Council and primary health care stakeholders.

Improving Women’s Access to Healthcare Services and Information: A Strategic Framework 2010–2015

The Strategic Framework: Improving Women’s Access to Healthcare Services and Information is an overarching planning document. It outlines the long-term strategic directions and objectives and initiatives to be adopted by ACT Health for:

  • enabling and enhancing women’s access to and satisfaction with health care services
  • providing clear information about health services.

The target group for this framework is females aged 12 years and over.

Managing the Risk of Suicide: A Suicide Prevention Strategy for the ACT 2009–2014

This strategy provides a service development framework to guide an integrated, whole-of-community approach to suicide prevention across the lifespan of ACT residents. It aims to:

  • reduce rates of suicide and self-harm in the ACT
  • increase resilience, coping skills and connectedness
  • improve awareness of, and access to, suicide prevention training, education and information
  • increase collaboration among organisations providing suicide prevention and postvention services in the ACT.

Towards Culturally Appropriate and Inclusive Services ­- A Coordinating Framework for ACT Health 2014–18

A new Multicultural Health Policy Unit (MCHPU) within Policy and Government Relations was established and commenced on 1 July 2013. Its role is to facilitate an organisation-wide approach to multicultural health issues so that culturally and linguistically appropriate services and information are a focus not only in clinical areas but across the organisation, including in preventive health, health promotion and public health services.

After extensive consultation, the MCHPU developed a strategic document to improve responsiveness to cultural and linguistic diversity across the organisation.

2014–15 strategic priorities

Strategic and operational initiatives pursued in 2014–15 included:

  • continuing to meet the growth in demand for acute care, Emergency Department, critical care, cancer treatment, mental health, women’s and children’s services, outpatient services and community health centres through extra capacity and by redesigning care delivery systems
  • continuing implementation of a comprehensive HIP to build a sustainable and modern health system to ensure safety, availability and viability of quality healthcare in the ACT for now and into the future
  • continuing work to improve health and wellbeing within the Aboriginal and Torres Strait Islander community
  • opening the CRCC
  • opening the new Walk-in Centre (WiC) at Belconnen
  • maintaining accreditation with international standards and other appropriate national bodies.

Meeting growth in demand

Overview

In 2014–15, ACT public hospitals had increased demand levels for:

  • Emergency Department presentations
  • inpatient admissions
  • elective surgery
  • births.

The Australian Institute of Health and Welfare (AIHW) reported that in 2013–14, ACT public hospitals provided an average of 1,030 beds. In 2014–15, ACT Health further boosted the bed capacity to a total of 1,068 available beds in ACT public hospitals. This is a 59 per cent increase on the 670 beds available in 2002–03.

As shown in Figure 3, in 2013–14, ACT public hospitals reported an average of 2.7 available beds per 1,000 populations, which is above the national average of 2.5. Furthermore, the ACT was the only jurisdiction to report continued growth from 2009–10 up to 2013–14. Average available beds per 1,000 population is reported as a crude rate based on the estimated resident population as at 30 June of the relevant year.

graph showing Available beds per 1,000 population, ACT and national comparison

Figure 3: Available beds per 1,000 population, ACT and national comparison

The 2015–16 ACT Budget provides for an additional 18 beds to be opened across ACT public hospitals to meet the growing demand for our hospital services. The increase in bed capacity has been funded by increases to ACT Government health funding. As shown in Figure 4, the estimated budget for this financial year (2014–15) was $1.4 billion, which was 171 per cent more than the $512 million provided for health services in 2002–03.

Expenditure by year

Figure 4: Expenditure by year

Births

In 2014–15, there were a total of 5,184 births at ACT public hospitals, an increase of 4 per cent when compared with the 4,999 births reported in 2013–14. As shown in Figure 5, the result for 2014–15:

  • is the highest number of births within a single year for ACT Health
  • represents a 26 per cent increase (over 1,060 additional births) in the number of ACT public hospital births since 2009–10.

In 2014–15, the number of births born by caesarean section equated to 29 per cent of all births, consistent with the result reported for 2013-14.

graph showing Birthing instances versus caesarean

Figure 5: Birthing instances versus caesarean

Emergency Department presentations

As shown in Figure 6, in 2014–15, ACT public hospital Emergency Departments had 129,963 presentations, a 3 per cent increase when compared with 2013–14. This was the highest number of presentations recorded in a single year. The 129,963 result represents a 22 per cent increase in the number of presentations when compared with the figure reported in 2009–10 and a 6 per cent increase when compared to 2012–13 to 2013–14.

Admissions to hospital via the Emergency Department have increased, with 35,583 admissions (4 per cent increase) reported in 2014–15 compared to 34,221 recorded in 2013–14.

Despite the increase, ACT Health is committed to improving waiting times in the Emergency Departments.

More information: For detailed information on improving Emergency Department timeliness, see B.2 Performance analysis, ACT Local Hospital Network strategic objectives and indicators, Strategic Objective 2: Improved Emergency Department Timeliness.

graph Presentation to the Emergency Department versus admissions for hospital; via the Emergency Department

Figure 6: Presentation to the Emergency Department versus admissions for hospital; via the Emergency Department

Elective surgery

The demand for elective surgery and the number of additions to the elective surgery waiting list continues to increase. In 2014–15, 824 more people were added to the elective surgery waiting list than in 2013–14 (a 6 per cent increase). Despite the increase in demand, ACT public hospitals have ensured that patients can access elective surgery as quickly as possible, according to their urgency category

More information: For detailed information on elective surgery, see:

B.2 Performance analysis, Health Directorate strategic indicators, Strategic Objective 1: Removals from Waiting List for Elective Surgery.

B.2 Performance analysis, ACT Local Hospital Network strategic objectives and indicators, Strategic Objective 1: Percentage of Elective Surgery Cases Admitted on Time by Clinical Urgency.

Implementing the Health Infrastructure Program

2014–15 marked the seventh year of the Health Infrastructure Program (HIP). The HIP continues to plan and construct new or refurbished infrastructure to provide enhanced services.

A range of projects within the HIP have been completed, others are ongoing and a number recently commenced. Aligned with planning, designing and constructing facilities is concurrent activity relating to:

  • the workforce
  • models of care
  • service delivery
  • technology.

This will ensure that the built environment assists clinicians to provide the best possible care.

The continued management and delivery of the HIP on time and on budget is a priority to ensure the following are not negatively impacted:

  • quality of care and health outcomes
  • access
  • cost/efficiency
  • workforce sustainability.

The following HIP projects are programmed to be completed in 2015–16:

  • Calvary Car Park
  • Building 15 demountable
  • Building 1 Level 4 refurbishment
  • Emergency Department Paediatric Stream
  • internal signage and wayfinding at Canberra Hospital.

The following HIP projects are programmed to commence construction in 2015–16:

  • the UCPH
  • the Ngunnawal Bush Healing Farm (NBHF)
  • the SMHU
  • works under the Continuity Of Services – Essential Infrastructure project that support engineering and infrastructure at Canberra Hospital.

More information: For a detailed description of the progress of HIP works, and works undertaken as part of the Capital Upgrades Program (CUP), see C.3 Capital works.

Improving health and wellbeing within the Aboriginal and Torres Strait Islander community

Detailed information is provided in:

  • B.2 Performance analysis, Strategic Objective 14: Addressing Gaps in Aboriginal and Torres Strait Islander Immunisation Status.
  • B.2 Performance analysis, Output 1.6: Early Intervention and Prevention.

Canberra Region Cancer Centre

Services commenced in the Canberra Region Cancer Centre (CRCC) on 18 August 2014. The centre is designed to improve the integration and standard of care to people with cancer in the ACT and surrounding region by:

  • being patient-centred
  • bring together services and supports within a cohesive environment.

The new facility provides capacity for additional outpatient cancer services with increases in resources for:

  • medical oncology
  • haematology
  • immunology

Multidisciplinary clinics are also being provided.

The following clinics have been established within the CRCC:

  • A Shared Care Model of Care for Early Breast Cancer, which provides a new nurse-led clinic and preparation of End of Treatment Summaries to assist in follow-up care.
  • A Melanoma Clinic to assist in the multidisciplinary care of patients with this condition. This is especially important because many new treatment options, including immune therapies and targeted agents, are now available.
  • A Palliative Care Outpatient Clinic, which is run by the Nurse Practitioner. This clinic has assisted in timely care and support for patients of the service.

A Volunteer Program was also established for the CRCC to extend engagement and support people accessing the centre and cancer wards. Volunteers are engaged to:

  • assist with patient comfort measures
  • provide support and company
  • assist with way finding.

With the move into the CRCC, implementing a Rapid Assessment Clinic has been further developed in a dedicated area on level 4 of the building. This enables patients who are having current treatment or within three months of completing treatment to be reviewed, assessed and if required treated by an oncology nurse and doctor.

An initial review of the Rapid Assessment Clinic model has found that total time for review, rate of hospital admission and length of stay after admission were significantly shorter than when patients were required to present to the Emergency Department.

The Rapid Assessment Clinic has been complemented by the availability of a 24-hour dedicated Telephone Triage number for current and recent patients of the CRCC.

Walk-in Centres

The Walk-in Centre (WiC) is designed to help people get  free, one-off treatment for minor illnesses and injuries. Presenting patients are able to see a specialist nurse for advice, assessment and treatment for conditions such as:

  • cuts and bruises
  • minor infections
  • strains
  • sprains
  • skin complaints
  • coughs and colds.

Australia’s first public, nurse-led WiC was opened in May 2010 on the Canberra Hospital campus. From its opening in May 2010, until it relocated on 25 June 2014, 73,392 clients presented to the WiC, as shown in Figure 7.

The WiC relocated to two sites during 2014:

  • the Tuggeranong WiC opened on 26 June 2014
  • the Belconnen WiC opened on 1 July 2014.

The WiCs continue to provide free access to health advice and treatment for minor injury and illness on a one-off basis.

As shown in Figure 8, in 2014–15, the Tuggeranong WiC had 18,669 presentations and Belconnen recorded 14,311 people presenting for treatment.

In 2014–15, the combined total presentations to the two WiCs increased by 47 per cent, when compared to the 2013–14 presentations to Canberra Hospital WiC.

Figure 9 shows the top 10 presenting conditions for treatment. The top 10 conditions treated have not changed significantly since last year. The common cold remains the main reason for presentations at the WiCs.

As shown in Table 2, in 2014–15, the median wait time to treatment in the WiCs was 13 minutes, where:

  • Belconnen reported a median wait time of seven minutes
  • Tuggeranong reported a median wait time of 19 minutes.

Table 2: Median wait times for WiCs

Location

Median wait time

Belconnen

7 minutes

Tuggeranong

19 minutes

Combined WiCs

13 minutes

Source: ACT Health Walk-In-Centre Database

As shown in Table 3, in 2014–15, Belconnen and Tuggeranong WiCs reported a combined rate of 1.1 per cent of patients not waiting for treatment. Belconnen WiC reported the lowest Did Not Wait (DNW) and Tuggeranong was 1.5 per cent.

Table 3: Percentage of patients who DNW for treatment at the Walk-In-Centres in 2014–15

Location

% of patients who DNW for treatment

Belconnen

0.6%

Tuggeranong

1.5%

Combined WiCs

1.1%

Source: ACT Health Walk-In-Centre Database

The WiC does not:

  • provide ongoing care for patients
  • treat people with chronic conditions
  • treat children less than two years of age.

These patients are encouraged to seek treatment and advice from their GP or the Emergency Department.

The WiC does not provide the range of services that a GP can provide, including:

  • comprehensive medical management
  • referral to specialist services
  • general health checks.

However, the nurses who work in the WiC have all completed additional training. The care they provide is guided by established clinical protocols that have been endorsed by the appropriate clinical approvals processes.

A visit report is sent to the patient’s GP with consent. People in the ACT community now have access to a wide range of primary health services, including:

  • their GPs
  • community health services
  • pharmacists
  • the WiCs.

New WiC software is currently under development. It will deliver an electronic client record that is integrated with other ACT Health applications. The introduction of the new software is progressing with an expected rollout in late 2015.

Graph Total presentations to the Woden WIC

Figure 7: Total presentations to the Woden WIC

graph Total presentations to the new WiC campuses

Figure 8: Total presentations to the new WiC campuses

graph showing Top 10 conditions treated at the WiCs

Figure 9: Top 10 conditions treated at the WiCs

Accreditation

In May 2015, ACT Health underwent a successful organisation-wide accreditation against the National Safety and Quality Health Service Standards. The Australian Commission on Safety and Quality in Health Care has awarded ACT Health full accreditation for the next three years.

Significant changes to the National Safety and Quality Health Service Standards in the next accreditation cycle will require ACT Health to review its current accreditation processes to meet the requirements of the revised standards.

ACT Pathology undergoes accreditation inspections by the National Association of Testing Authorities (NATA) and Royal College of Pathologists of Australasia (RCPA). The latest accreditation reassessment occurred in February and March 2015. This involved five NATA staffers and 16 technical assessors consisting of scientist and pathology specialists from other institutions. The result of this reassessment was the renewed accreditation of all of ACT Pathology laboratories.

The current three-year accreditation process will change to a four-yearly cycle with:

  • a surveillance mid-term reassessment conducted during the second year (2017)
  • online assessments conducted during the first and third years (2016 and 2018).

ACT Pathology also supports Canberra Hospital in their Australian Council on Healthcare Standards (ACHS) accreditation to the National Safety and Quality Health Service Standards.

In 2014, Rehabilitation, Aged and Community Care’s (RACC’s) Geriatric Medicine Training programme was successfully accredited for a period of five years, until 2019.

ACT Health is accredited with the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) for the provision of for obstetrics and gynaecology training until October 2015.