B.2 Performance analysis

Overview

ACT Health continually strives to provide a safe and high-quality health care system, and is continually implementing service improvements to increase safety for all patients. This section discusses our performance against the strategic objectives/indicators specified in the ACT Budget Papers. Due to the differing type and nature of services provided at each public hospital campus the targets for some indicators are different.

Table 2 provides an overview of ACT Health’s performance against the specified strategic objectives/indicators.

Table 2: Performance analysis overview
Strategic objective/indicator 2015–16 performance comment More information
Health Directorate
Strategic Objective 1: Removals from Waiting List for Elective Surgery ACT public hospitals performed 13,396 elective surgery procedures, a 13% increase on the 11,875 reported for 2014–15. Strategic Objective 1: Removals from Waiting List for Elective Surgery
Strategic Objective 2: No Waiting for Access to Emergency Dental Health Services ACT public hospitals achieved the target throughout 2015–16. Strategic Objective 2: No Waiting for Access to Emergency Dental Health Services
Strategic Objective 3: Improving Timeliness of Access to Radiotherapy Services ACT public hospitals achieved the set targets for Emergency radiotherapy services, however were not able to achieve the 90% required for Palliative and Radical categorised patients. Strategic Objective 3: Improving Timeliness of Access to Radiotherapy Service
Strategic Objective 4: Improving the Breast Screen Participation Rate for Women aged 50 to 69 years The participation rate for women aged 50–69 years was 58%, which is below the target of 60%. Strategic Objective 4: Improving the Breast Screen Participation Rate for Women aged 50 to 69 years
Strategic Objective 5: Reducing the Usage of Seclusion in Mental Health Episodes ACT public hospitals reported a seclusion result of 3%, an improvement on last year’s seclusion rate of 5%. Strategic Objective 5: Reducing the Usage of Seclusion in Mental Health Episodes
Strategic Objective 6: Maintaining Reduced Rates of Patient Return to an ACT Public Acute Psychiatric Inpatient Unit ACT public hospitals achieved a result of 9%, in line with the <10% target. Strategic Objective 6: Maintaining Reduced Rates of Patient Return to an ACT Public Acute Psychiatric Inpatient Unit
Strategic Objective 7: Reaching the Optimum Occupancy Rate for all Overnight Hospital Beds ACT public hospitals reported a combined occupancy rate of 86%, which is 4% less than the 2015–16 target of 90%. Strategic Objective 7: Reaching the Optimum Occupancy Rate for all Overnight Hospital Beds
Strategic Objective 8: Management of Chronic Disease: Maintenance of the Highest Life Expectancy at Birth in Australia The ACT continues to enjoy the highest life expectancy of any jurisdiction in Australia. Strategic Objective 8: Management of Chronic Disease: Maintenance of the Highest Life Expectancy at Birth in Australia
Strategic Objective 9: Lower Prevalence of Circulatory Disease than the National Average The proportion of the ACT population with some form of circulatory disease was 19.8%, above the national rate of 18.3%. Strategic Objective 9: Lower Prevalence of Circulatory Disease than the National Average
Strategic Objective 10: Lower Prevalence of Diabetes than the National Average The prevalence of diabetes in the ACT is 4.3%, similar to the national rate of 4.7%. Strategic Objective 10: Lower Prevalence of Diabetes than the National Average
Strategic Objective 11: Addressing Gaps in Aboriginal and Torres Strait Islander Immunisation Status The overall immunisation rate for ACT Aboriginal and Torres Strait Islander population was 90%. Strategic Objective 11: Addressing Gaps in Aboriginal and Torres Strait Islander Immunisation Status
Strategic Objective 12: Higher Participation Rate in the Cervical Screening Program than the National Average The ACT’s two-year participation rate for the target population is on par with the National average of 58%. Strategic Objective 12: Higher Participation Rate in the Cervical Screening Program than the National Average
Strategic Objective 13: Achieve Lower than the Australian Average in the Decayed, Missing, or Filled Teeth Index The ACT DMFT index result was lower than the national average for the DMFT index. Strategic Objective 13: Achieve Lower than the Australian Average in the Decayed, Missing, or Filled Teeth (DMFT) Index
Strategic Objective 14: Reducing the Risk of Fractured Femurs in ACT Residents Aged Over 75 years In 2014–15, the ACT rate of admissions in persons aged 75 years and over with a fractured neck of femur was 5.5 per 1,000 persons in the ACT population. Strategic Objective 14: Reducing the Risk of Fractured Femurs in ACT Residents Aged Over 75 years
Strategic Objective 15: Reduction in the Youth Smoking Rate The proportion of ACT students reporting to be smokers in 2014 was 5.2%, slightly higher than the national average of 5.1%. Strategic Objective 15: Reduction in the Youth Smoking Rate
ACT Local Hospital Network
Strategic Objective 1: Percentage of Elective Surgery Cases Admitted on Time by Clinical Urgency The demand for elective surgery continued to increase in 2015–16, which has impacted the ability to meet the targets. Strategic Objective 1: Percentage of Elective Surgery Cases Admitted on Time by Clinical Urgency
Strategic Objective 2: Improved Emergency Department Timeliness See below Strategic Objective 2: Improved Emergency Department Timeliness
  • Strategic Indicator 2.1: The proportion of Emergency Department presentations that are treated within clinically appropriate timeframes
ACT Emergency Departments achieved targets for seen on time for both category one and category five patients. The ACT’s Emergency Departments are reviewing their processes, and working with their colleagues throughout the hospitals to eliminate barriers that delay access to required services and to improve patient flow through the hospitals. Strategic Indicator 2.1: The proportion of Emergency Department presentations treated within clinically appropriate timeframes, by triage category, 2015–16
  • Strategic Indicator 2.2: The proportion of Emergency Department presentations whose length of stay in the Emergency Department is four hours or less
ACT public hospital Emergency Departments continued to improve the proportion of patients who presented to Emergency Departments who stayed less than four hours from arrival to either admission or departure.  The full year result of 66% is a 3% improvement on the previous year. Strategic Indicator 2.2: The proportion of Emergency Department presentations whose length of stay in the Emergency Department is four hours or less, 2015–16
Strategic Objective 3: Maximising the Quality of Hospital Services See below Strategic Objective 3: Maximising the Quality of Hospital Services
  • Strategic Indicator 3.1: The Proportion of People who Undergo a Surgical Operation Requiring an Unplanned Return to the Operating Theatre within a Single Episode of Care due to Complications of their Primary Condition
Both Canberra Hospital and Calvary Public Hospital performed better than 2015–16 targets. Strategic Indicator 3.1: The proportion of people who undergo a surgical operation requiring an unplanned return to the operating theatre within a single episode of care due to complications of their primary condition
  • Strategic Indicator 3.2: The Proportion of People Separated from ACT Public Hospitals who are re-admitted to Hospital within 28 Days of their Separation due to Complications of their Condition (where the re-admission was unforeseen at the time of separation)
Canberra and Calvary Public Hospitals performed better than the 2015–16 target. Strategic Indicator 3.2: The proportion of people separated from ACT public hospitals who are re‑admitted to hospital within 28 days of their separation due to complications of their condition (where the re-admission was unforeseen at the time of separation)
  • Strategic Indicator 3.3: The Number of People Admitted to Hospitals per 10,000 Occupied Bed Days who Acquire a Staphylococcus Aureus Bacteraemia Infection (SAB infection) During their Stay
Performance for both Canberra and Calvary Public Hospitals was better than the national benchmark Strategic Indicator 3.3: The number of people admitted to hospitals per 10,000 occupied bed days who acquire a Staphylococcus aureus bacteraemia infection (SAB infection) during their stay
  • Strategic Indicator 3.4: The Estimated Hand Hygiene Rate
Canberra and Calvary Public Hospitals continued to perform better than the national benchmark of 70% during the most recent audit. Strategic Indicator 3.4: The Estimated Hand Hygiene Rate

Health Directorate strategic indicators

Strategic Objective 1: Removals from Waiting List for Elective Surgery

The ACT Government provided additional funding in the 2015–16 financial year for a long wait reduction strategy (also known as ‘the blitz’) to boost access to elective surgery and to reduce the number of people waiting for elective surgery for longer than clinically recommended. During this time ACT Health significantly reduced the number of people waiting beyond recommended timeframes. ACT Health is developing a Whole-of-Territory elective surgery plan to ensure we manage demand into the future.

Strategic Indicator 1: The number of people removed from the ACT elective surgery waiting lists (this may include public patients treated in private hospitals), 2015–16
  2015–16 target 2015–16 result
People removed from the ACT elective surgery waiting list for surgery 12,500* 13,396**
*In November 2015 a long wait reduction strategy was announced which provided additional surgeries over 2015–16.
**Preliminary figure – subject to change
Source: Draft ACT Health Elective Surgery data set

 

In 2015–16, ACT public hospitals performed 13,396 elective surgeries, a 13 per cent increase on 2014–15 (see Figure 4).

 
Figure 4: Number of elective surgery operations performed
Source: ACT Health Elective Surgery Waiting List Published Dataset

ACT Health implemented a number of initiatives to address increasing public elective surgery demand including:

  • providing surgery to some patients at private hospitals
  • increasing the number of surgeries in public hospitals
  • improving partnerships with Southern NSW to enable NSW patients to have surgery closer to home.

ACT Health is undertaking an in-depth analysis of elective surgery in the Territory, with a focus on improving theatre utilisation and session allocation to meet demand for specialty groups.

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

Strategic Indicator 2: The percentage of assessed emergency clients offered an appointment within 24 hours, 2015–16
  2015–16 target 2015–16 result
Percentage of assessed emergency clients offered an appointment within 24 hours 100% 100%
Source: ACT Health Dental published data

ACT Health’s target is to see all emergency dental clients within 24 hours of being assessed as an emergency client. The ACT Dental Health Program has continued to achieve this target throughout 2015–16.

Strategic Objective 3: Improving Timeliness of Access to Radiotherapy Services

Strategic Indicator 3: The percentage of cancer patients who commence radiotherapy treatment within standard time frames, by category, 2015–16
Category 2015–16 target 2015–16 result
Emergency — treatment started within 48 hours 100% 100%
Palliative — treatment started within 2 weeks 90% 81%
Radical — treatment started within 4 weeks 90% 82%
Source: ACT Health Radiation Oncology published data (CAS)

ACT Health is committed to commencing treatment for radiation therapy patients within the waiting time guidelines specified in Radiation Oncology Practice Standards. In 2015–16, the department achieved the following:

  • 81 per cent of palliative patients received radiation therapy treatment within two weeks.
  • 82 per cent of radical patients received radiation therapy treatment within four weeks.

Table 3 provides comparative figures since 2011–12.

Table 3: Comparative timeframes for percentage of cancer patients who commence radiotherapy treatment within standard time frames, by category, 2011–12 to 2015–16
July to June 2011–12 2012–13 2013–14 2014–15 2015–16
Emergency: within 48 hours 100% 100% 100% 100% 100%
Palliative: with 2 weeks 100% 100% 100% 95% 81%
Radical: within 4 weeks 94% 98% 100% 99% 82%
Source: ACT Health Radiation Therapy Dataset

Strategic Objective 4: Improving the Breast Screen Participation Rate for Women aged 50 to 69 years

Strategic Indicator 4: The proportion of women aged 50 to 69 years who had a breast screen in the 24 months prior to each counting period, 2015–16
  2015–16 target 2015–16 result
Proportion of women aged 50 to 69 years who have a breast screen 60% 58%
Source: ACT Health BreastScreen published data (BIS)

In 2015–16, ACT Health focussed on initiatives to encourage GPs to refer women to the Breast Screen program. A total of 17,869 breast screens were performed for ACT residents in 2015–16, compared with the 15,566 screening procedures reported for the same period in 2014–15.

Strategic Objective 5: Reducing the Usage of Seclusion in Mental Health Episodes

Strategic Indicator 5: The proportion of mental health clients who are subject to a seclusion episode while being an admitted patient in an ACT public mental health inpatient unit, 2015–16
  2015–16 target 2015–16 result
The proportion of mental health clients who are subject to a seclusion episode while being an admitted patient in an ACT public mental health inpatient unit <3% 3%
Source: ACT Health Mental Health published data (MHAGIC)

As shown in Table 4, in 2015–16, the ACT seclusion result was in line with our local target of less than three per cent and an improvement when compared to the previous year’s result of 5 per cent.

Table 4: Change to the proportion of mental health clients who are subject to a seclusion episode while being an admitted patient in an ACT public mental health inpatient unit, 2015–16
ACT public hospitals – Mental Health Seclusion Rates
2013–14 2014–15 2015–16
2% 5% 3%
Source: ACT Health Admitted Patient Care Published Dataset and MHAGIC Databases

Nationally, the highest rates of seclusion occur in adult mental health units. Reducing seclusion remains a high priority for the staff in the Adult Mental Health Unit and strategies were successfully implemented in 2015–16 to reduce the ACT’s seclusion rates.

Strategic Objective 6: Maintaining Reduced Rates of Patient Return to an ACT Public Acute Psychiatric Inpatient Unit

Strategic Indicator 6: The proportion of clients who return to hospital within 28 days of discharge from an ACT public acute psychiatric unit following an acute episode of care, 2015–16
  2015–16 target 2015–16 result
Proportion of clients who return to hospital within 28 days of discharge from an ACT acute psychiatric mental health inpatient unit <10% 9%
Source: ACT Health Mental Health published data (MHAGIC)

Strategic Objective 7: Reaching the Optimum Occupancy Rate for all Overnight Hospital Beds

Strategic Indicator 7: The mean percentage of overnight hospital beds in use, by hospital and total, 2015–16
Mean percentage of overnight hospital beds in use 2015–16 target 2015–16 result
ACT Public Hospitals 90% 86%
Canberra Hospital 90% 91%
Calvary Public Hospital 90% 75%
Source: ACT Health Admitted Patient Care published

In 2015–16, ACT public hospitals reported a combined occupancy rate of 86 per cent, seeing performance being better than target.

In 2015–16, ACT public hospitals provided 302,602 overnight hospital bed days of care, which is a four per cent increase on 2014–15. 

Figure 5 shows the number of overnight bed days and overnight separations.

 
Figure 5: Overnight bed days of care versus overnight separations, 2010–11 to 2015–16
Source: ACT Health Admitted Patient Care Dataset

As shown in Table 5, the average length of stay for overnight patients in ACT public hospitals in 2015–16 was just under 6 days. ACT Health has been working on reducing unnecessary hospital lengths of stay to bring performance in line with the national average.

Table 5: Average length of stay in hospital for overnight patients, by hospital and total, 2012–13 to 2015–16
Year Canberra Hospital Calvary Public Hospital ACT public hospitals National average
2012–13 6.2 days 6.3 days 6.3 days 5.8 days
2013–14 6.3 days 6.3 days 6.3 days 5.7 days
2014–15 6.4 days 5.7 days 6.2 days 5.7 days
2015–16 6.1 days 5.6 days 5.9 days n/a
Source: ACT Health Admitted Patient Care Dataset and Australian Institute of Health & Welfare

Strategic Objective 8: Management of Chronic Disease: Maintenance of the Highest Life Expectancy at Birth in Australia

Strategic Indicator 8: Life expectancy at birth in the ACT and Australia, by sex, 2014
  ACT rate (years) National rate (years)
Females 85.2 84.4
Males 81.4 80.3
Source: ABS 2015, Deaths, Australia, 2014, cat. no. 33030, ABS, Canberra.

Australians are living longer and gains in life expectancy are continuing. Potentially avoidable deaths refer to deaths from certain conditions that are considered avoidable given timely and effective health care. Nationally, potentially avoidable deaths have continued to fall to 107 per 100,000 in 2013, from 125 per 100,000 in 2007. A similar trend was observed in the ACT with potentially avoidable deaths falling from 103 per 100,000 in 2007 to 99 per 100,000 in 2013.

Source: Australian Government Productivity Commission. Report on Government Services 2016, Overview E attachment tables, . Canberra: AGPC; 2016.

Life expectancy at birth provides an indication of the general health of the population and is a reflection of a range of issues other than the provision of health services, such as economic and environmental factors. The ACT continues to enjoy the highest life expectancy of any jurisdiction in Australia and the Government aims to maintain this result.

Strategic Objective 9: Lower Prevalence of Circulatory Disease than the National Average

Strategic Indicator 9: The Proportion of the ACT Population with Some Form of Cardiovascular Disease
  ACT Rate National Rate
Proportion of the population diagnosed with any form of circulatory disease 19.8%(c) 18.3%(b)
Proportion of the population with some form of heart, stroke or vascular disease 3.7%(a) 5.2%(a)
Proportion with hypertension 12.1%(a) 11.3%(a)
Source: (a) Australian Health Survey: First Results, 2014–15. Australian Bureau of Statistics Cat. No: 4364.0.55.001 Data cube DO002 table 2.3 published December 2015 Non-age standardised proportions.
(b) Australian Health Survey: First Results, 2014–15. Australian Bureau of Statistics Cat. No: 4364.0.55.001 Data cube DO003 table 3.3 published December 2015. Non-age standardised proportions.
(c) Australian Health Survey: First Results, 2014–15. Australian Bureau of Statistics Cat. No: 4364.0.55.001 Data cube DO027 table 3.3 published March 2016. Non-age standardised proportions.
Footnote: ACT specific tables for 2014-15 Australian Health Survey results were not available at the time data was collected for the 2016-17 Budget Statements C; so proportions for heart, stoke and vascular disease, ACT and national, were used for this indicator.

The prevalence of circulatory disease is an important indicator of general population health as it is a major cause of mortality and morbidity. The main risk factor for circulatory disease is age. Population projections suggest that the ACT population is ageing faster than other jurisdictions, however the population is still younger than the national average having a median age of 35 years in 2015 compared with national median age of 37 years. While people of all ages can present with a chronic disease, the ageing of the population and longer life spans mean that chronic diseases will place major demands on the health system for workforce and financial resources.

Other risk factors for circulatory disease are high blood pressure, overweight and obesity, high cholesterol, poor diet, insufficient physical activity and smoking. With increasing prevalence of some of these risk factors in younger cohorts, such as high obesity rates, it is likely that chronic diseases will occur at younger ages.

Strategic Objective 10: Lower Prevalence of Diabetes than the National Average

Strategic Indicator 10: The Proportion of the ACT Population Diagnosed with Some Form of Diabetes
  ACT Rate National Rate1
Prevalence of diabetes in the ACT 4.3% 4.7%
Source: Australian Health Survey: First Results, 2014-15. Australian Bureau of Statistics Catalogue No: 4364.0.55.001, Data cube D002 Table 2.3 age standardised proportions.

This indicator provides a marker of the success of prevention and early intervention initiatives. The self-reported prevalence of diabetes in Australia has more than doubled over the past 25 years.

A number of factors may have contributed to this, such as changed criteria for the diagnosis of diabetes, increased public awareness and an increase in the prevalence of risk factors such as obesity and sedentary behaviour. These risk factors are traditionally associated with increasing age but are now being seen more frequently in younger cohorts. Prevalence rates may also increase in the short-term as a result of early intervention and detection campaigns. This would be a positive result as undiagnosed diabetes can have significant impacts on long-term health. The prevalence of diabetes in the ACT is similar to the national rate.

Source: National indicators for monitoring diabetes” (2007), Australian Institute of Health and Welfare Canberra, AIHW cat. no. CVD 38 (http://www.aihw.gov.au/diabetes/indicators/).

Strategic Objective 11: Addressing Gaps in Aboriginal and Torres Strait Islander Immunisation Status

Strategic Indicator 11: Immunisation Rates – ACT Aboriginal and Torres Strait Islander Population, by age and total, 2015–16
Immunisation rates for vaccines in the national schedule for the ACT indigenous population: 2015–16 target 2015–16 result
12 to 15 months ≥90% 94%
24 to 27 months1 ≥90% 84%
60 to 63 months ≥90% 91%
All ≥90% 90%

Notes:

1 The coverage rates above are annualised rates calculated from quarterly reports on childhood immunisation coverage for the June 2015, September 2015, December 2015, March 2016 and June 2016 quarters. Data is from the Australian Childhood Immunisation Register (ACIR). The data show the proportion of children fully immunised at age 12 -15 months, 24-27 months and 60-63 months according to the National Immunisation Program Schedule.

From December 2014, meningococcal C (given at 12 months), and dose 2 measles, mumps, rubella and dose 1 varicella (given as MMRV at 18 months) were included in the definition of fully immunised for the 24-27 month cohort. The more vaccines included in the assessment, the higher likelihood of reduced coverage rates. Reduced immunisation coverage rates have been experienced in all Australian jurisdictions and for all children as well as Aboriginal and Torres Strait Islander children. Coverage rates in this cohort are expected to increase over time as the changes become more routine.

The immunisation rate provides an indication of the level of investment in public health services to minimise the incidence of vaccine preventable diseases. The ACT’s Aboriginal and Torres Strait Islander population has a lower rate of immunisation than the general population in all three cohorts. The coverage rates of Aboriginal and Torres Strait Islander children in the ACT at 24–27 months is the lowest of all Australian States or Territories and is nearly 3.5 per cent below the national average.

ACT Health strives to increase the immunisation coverage rates for Aboriginal and Torres Strait Islander children through a suite of activities. Postcards are sent to the parents of all Aboriginal and Torres Strait Islander children to remind them when vaccinations are due. Promotional materials to raise the awareness of immunisation have been produced and a pack that will be given to mothers soon after birth is in development. The ACT aims to increase immunisation coverage rates for all Aboriginal and Torres Strait Islander children through a targeted immunisation strategy.

It should be noted that due to the very low numbers of Aboriginal and Torres Strait Islander children in the ACT, significant rate fluctuations can occur between reporting periods.

Strategic Objective 12: Higher Participation Rate in the Cervical Screening Program than the National Average

Strategic Indicator 12: Two Year Participation Rate in the Cervical Screening Program, 2013–14
  ACT rate National rate
Two year participation rate 58% 58%
Source: Cervical Screening in Australia 2013–14 (Published: Australian Institute of Health and Welfare May 2015).

The Cervical Screening Program captures and reports data over a two year period as recommended by the National Cervical Screening Program. The Australian Institute of Health and Welfare (AIHW) report, Cervical Screening in Australia 2013–2014, shows the ACT as one of the four best performing jurisdictions in Australia for participation in cervical screening and as the best perfuming jurisdiction for the five-year participation rate.

Strategic Objective 13: Achieve Lower than the Australian Average in the Decayed, Missing, or Filled Teeth Index

Strategic Indicator 13: The Mean Number of Teeth with Dental Decay, Missing or Filled Teeth at Ages 6 and 12 years, 2009
  ACT rate National rate
DMFT index at 6 years 1.03 2.13
DMFT Index at 12 years 0.70 1.05
Source: The dental health of Australia’s children by remoteness: Child Dental Health Survey, 2009 (Published: Australian Institute of Health and Welfare, 2013).

Strategic Objective 14: Reducing the Risk of Fractured Femurs in ACT Residents Aged Over 75 years

Strategic Indicator 14: Rate of Broken Hips (Fractured Neck of Femur) for those aged over 75 years, 2014–15
  2014–15 result Long-term target
Rate per 1,000 people in the ACT population 5.5 5.3
Source: ACT Health Admitted Patient Care data, 2014–15

This indicator provides an indication of the success of public and community health initiatives to prevent hip fractures. In 2014-15, the ACT rate of admissions in persons aged 75 years and over with a fractured neck of femur was 5.5 per 1,000 persons in the ACT population.

Strategic Objective 15: Reduction in the Youth Smoking Rate

Strategic Indicator 15: Percentage of Persons Aged 12 to 17 Years Who Smoke Regularly, 2014
  2014 outcome National rate
Percentage of persons aged 12 to17 who are current smokers 5.2% 5.1%
Source: ASSAD confidentialised unit record files 2014, ACT Health. Australian secondary students’ use of tobacco in 2014 report, The Cancer Council Victoria, October 2015

Results from the 2014 Australian Secondary School Alcohol and Drug Survey (ASSAD) show that 5.2 per cent of students were current smokers in that year. This represents a significant decline in current smoking from 20.5 per cent of students in 1999.

The proportion of ACT students reporting to be current smokers in 2014 is similar to the national average of 5.1 per cent.

ACT Local Hospital Network strategic objectives and indicators

Strategic Objectives and Indicators

The ACT Local Hospital Network (ACT LHN) consists of a networked system that includes the Canberra Hospital and Health Services, Calvary Public Hospital, Clare Holland House and Queen Elizabeth II Family Centre. The ACT LHN has a yearly Service Level Agreement (SLA) which sets out the delivery of public hospital services and is agreed between the ACT Minister for Health and the Director General of the ACT LHN. This SLA identifies the funding and activity to be delivered by the ACT LHN and key performance priority targets. The ACT Government manages system-wide public hospital service delivery, planning and performance, including the purchasing of public hospital services and capital planning, and is responsible for the management of the ACT LHN.

The following strategic indicators include some of the major performance indicators implemented under the requirements of the National Health Reform Agreement.

Strategic Objective 1: Percentage of Elective Surgery Cases Admitted on Time by Clinical Urgency

Strategic Indicator 1: Percentage of Elective Surgery Cases Admitted on Time by Clinical Urgency, 2015–16
Clinically recommended time by urgency category 2015–16 target 2015–16 result
Urgent – admission within 30 days is desirable for a condition that has the potential to deteriorate quickly to the point that it may become an emergency 100% 86%
Semi-urgent – admission within 90 days is desirable for a condition causing some pain, dysfunction or disability which is not likely to deteriorate quickly or become an emergency 78% 57%
Non-urgent – admission at some time in the future acceptable for a condition causing minimal or no pain, dysfunction or disability, which is not likely to deteriorate quickly and which does not have the potential to become an emergency 91% 71%
Source: ACT Health Elective Surgery published

Strategic Objective 2: Improved Emergency Department Timeliness

Strategic Indicator 2.1: The proportion of Emergency Department presentations treated within clinically appropriate timeframes, by triage category, 2015–16
Triage category 2015–16 target 2015–16 result
One (resuscitation seen immediately) 100% 100%
Two (emergency seen within 10 minutes) 80% 78%
Three (urgent seen within 30 minutes) 75% 47%
Four (semi-urgent seen within 60 minutes) 70% 56%
Five (non-urgent seen within 120 minutes) 70% 89%
All Presentations 70% 59%

 

Source: ACT Health Emergency Department published data

Emergency Department timeliness measures how long patients wait to receive their care. In 2015–16, ACT public hospital Emergency Departments reported an overall result of 59 per cent, the same as the result for 2014–15. The four per cent increase in presentations experienced in 2015–16 (5,344 additional presentations) has impacted on the ability to treat all patients within recommended timeframes. The ACT met the target for triage categories one and five.

Table 6 shows the breakdown by hospital for the percentage of patients treated within clinically appropriate timeframes by triage category in 2015–16

Table 6: The proportion of Emergency Department presentations treated within clinically appropriate timeframes, by hospital, by triage category, 2015–16
Triage category 2015–16 target ACT Public Hospitals combined 2015–16 results Canberra Hospital 2015–16 results Calvary Public Hospital 2015–16 results National average 2014–15 results
Category 1 (resuscitation – seen immediately) 100% 100% 100% 100% 100%
Category 2 (emergency – seen within 10 minutes) 80% 78% 77% 78% 79%
Category 3 (urgent – seen within 30 minutes) 75% 47% 38% 57% 68%
Category 4 (semi-urgent – seen within 60 minutes) 70% 56% 46% 70% 74%
Category 5 (non-urgent – seen within 120 minutes) 70% 89% 85% 94% 92%
All presentations 70% 59% 52% 69% 74%
Source: ACT Health Emergency Department Published Dataset and Australian Institute of Health & Welfare
Strategic Indicator 2.2: The proportion of Emergency Department presentations whose length of stay in the Emergency Department is four hours or less, 2015–16
  2015–16 target 2015–16 result
The proportion of Emergency Department presentations who either physically leave the Emergency Department for admission to hospital, are referred for treatment or are discharged, whose total time in the Emergency Department is within four hours. 69% 66%
Source: ACT Health Emergency Department published data

Revised target agreed by Cabinet, November 2015

As shown in Table 7, in 2015–16, ACT public hospital Emergency Departments continued to improve the proportion of patients who presented to Emergency Departments who stayed less than four hours from arrival to either admission or departure. In 2015–16 there was a three per cent improvement compared to 2014–15.

Table 7: Four hour rule ACT vs. Australia, 2011–12 to 2015–16
Financial year ACT performance National average
2011–12 58% 64%
2012–13 57% 67%
2013–14 62% 73%
2014–15 63% 73%
2015–16 66% n/a
Source: ACT Health Emergency Department Published Dataset and Australian Institute of Health & Welfare

As shown in Figure 6, in 2015–16, the proportion of patients who did not wait (DNW) for treatment was 5 per cent. This is consistent with the result for 2014–15.

 
Figure 6: Did Not Wait for treatment rates
Source: ACT Health Emergency Department Published Dataset

Strategic Objective 3: Maximising the Quality of Hospital Services

The following four indicators are a selection of the patient safety and service quality indicators that are used to monitor ACT public hospital services. Given the nature of these indicators, small changes in numbers can skew results and trends in performance over time are more meaningful. Canberra Hospital is a major teaching and referral hospital that manages more complex patients and higher levels of complications so has higher targets than Calvary for strategic indicators 3.1 and 3.2.

Strategic Indicator 3.1: The proportion of people who undergo a surgical operation requiring an unplanned return to the operating theatre within a single episode of care due to complications of their primary condition
  2015–16 target 2015–16 result
Canberra Hospital <1.0% 0.67%
Calvary Public Hospital <0.5% 0.24%
Source: Data obtained by screening individual medical records of patients from ACTPAS reports against the ACHS definitions for these indicators.

Both Canberra and Calvary Public Hospitals have consistently performed better than target (see Figure 7).

 
Figure 7: Unplanned return to the operating theatre within an episode of care
Source: ACT Health Admitted Patient Care Dataset and ACTPAS
Strategic Indicator 3.2: The proportion of people separated from ACT public hospitals who are re admitted to hospital within 28 days of their separation due to complications of their condition (where the re-admission was unforeseen at the time of separation)
  2015–16 target 2015–16 result
Canberra Hospital <2.0% 1.25%
Calvary Public Hospital <1.0% 0.46%
Source: Data obtained by screening individual medical records of patients from ACTPAS reports against the ACHS definitions for these indicators.
 
Figure 8: Rate of unplanned hospital admissions within 28 days of discharge
Source: ACT Health Admitted Patient Care Dataset and ACTPAS
Strategic Indicator 3.3: The number of people admitted to hospitals per 10,000 occupied bed days who acquire a Staphylococcus aureus bacteraemia infection (SAB infection) during their stay
  2015–16 target 2015–16 result
Canberra Hospital <2 per 10,000 1.45 per 10,000
Calvary Public Hospital <2 per 10,000 0.21 per 10,000
Source: ACT Health Infection Control database

The measurement methodology for this indicator was altered to meet the national quality and safety standards definition. It now measures the number of people admitted to hospitals who acquire a SAB infection during their hospital stay per 10,000 occupied bed days.

ACT Health infection control officers continue to develop and implement programs to limit the transfer of infections within public hospitals. This includes education programs for clinicians, patients, general staff and visitors. Table 8 provides SAB rates for from 2013.

Table 8: Canberra and Calvary Hospitals SAB rates, 2012–13 to 2015–16
Financial year Canberra Hospital Calvary Public Hospital Target
2012–13 1.55 0.32 2.00
2013–14 1.05 0.33 2.00
2014–15 1.00 0.32 2.00
2015–16 1.45 0.21 2.00
Source: ACT Health Admitted Patient Care Dataset, ACTPAS

Strategic Indicator 3.4: The Estimated Hand Hygiene Rate

The estimated hand hygiene rate for a hospital is calculated by dividing the number of observed hand hygiene 'moments' where proper hand hygiene was practiced during an audit period, by the total number of observed hand hygiene 'moments' (where had hygiene should be practiced) in the same audit period.

Hospital 2015–16 target March 2016 audit result
Canberra Hospital 70% 83%
Calvary Public Hospital 70% 87%
Source: Hand Hygiene Australia online database

Health Directorate Outputs

Output 1.1: Acute Services

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 focusing on:

  • strategies to meet performance targets for the Emergency Department, elective and emergency surgery
  • continuing to increase the capacity of acute care services.

Overview

Acute services are provided by the Divisions of:

  • Critical Care
  • Medicine
  • Pathology
  • Surgery and Oral Health
  • Women, Youth and Children
  • Director of Operations.

Division of Critical Care

The Division of Critical Care is responsible for delivering acute and critical care and providing retrieval services. These are provided as inpatient and outpatient services at Canberra Hospital, with a strong emphasis on accessible and timely care, delivered to a high standard of safety and quality. This is underpinned by the division’s commitment to research and training. The division includes the:

  • Retrieval Service (road and air)
  • Emergency Department
  • Intensive Care Unit
  • Acute Surgical Unit
  • Discharge Lounge and Medi-Hotel
  • ​Medical Assessment and Planning Unit
  • Acute Clinical Services Unit, comprising the Acute Surgical Unit, the Medical Emergency Team and the Early Recognition of the Deteriorating Patient Team.

Division of Medicine

The Division of Medicine provides adult medicine services to the Canberra community in inpatient, outpatient and outreach settings. An emphasis is placed on accessible, timely and integrated care, which is delivered to a high standard of safety and quality.

The Division of Medicine comprises:

  • Renal services
  • Cardiology
  • Academic Unit of Internal Medicine
  • Sexual Health Centre
  • Neurology
  • Gastroenterology and Hepatology
  • ​Dermatology
  • Diabetes Service
  • Endocrinology
  • Forensic and Medical Sexual Assault Services
  • Infectious Diseases
  • Inpatient ward services, ambulatory clinics and clinical measurement services across many specialties
  • Respiratory and Sleep Services
  • Rheumatology
  • Allied Health – Acute Support
  • General Medicine.

The division has a strong commitment to teaching and research. Health students from several universities undertake practical placements within the division. Most of the division’s senior medical staff have academic appointments at the Australian National University (ANU) Medical School and many research programs are operating. Many members of the division’s staff participate in developing national professional guidelines and quality initiatives.

Division of Pathology

Pathology is a medical specialty that examines disease processes and their causes. Services are provided in the acute setting at Canberra Hospital, Calvary Hospital and the National Capital Private Hospital and in the community through collection centres across the ACT. A home collection service for patients who are frail or unwell and who cannot attend these collection centres is also provided.

Pathology is a demand-driven service that plays a critical role in more than 70 per cent of clinical diagnoses and many of the decisions around optimal treatment for patients.

Division of Surgery and Oral Health

The Division of Surgery and Oral Health is responsible for delivering dental health programs for children, target youth and adults in the ACT and surrounding region. These programs provide:

  • inpatient and outpatient surgical services
  • prevention and treatment services.

The division includes:

  • Surgical Bookings and Pre-Admission Clinic
  • Anaesthesia
  • Pain Management Unit
  • Operating Theatres
  • ​Post-Anaesthetic Care Unit
  • Day Surgery Unit and Admissions/Extended Day Surgery Unit
  • Specialist surgical ward areas
  • Surgical and nursing outpatient services
  • Trauma Service
  • Trauma and Orthopaedic Research Unit
  • The ACT Dental Health Program.

Division of Women, Youth and Children

The Division of Women, Youth and Children provides a broad range of primary, secondary and tertiary healthcare services. Service provision is based on a family-centred, multidisciplinary approach to care, in partnership with the consumer and other service providers. Services are provided:

  • at Canberra Hospital
  • in community health centres
  • in community-based settings, including clients’ homes, schools, and child and family centres.

The Division of Women, Youth and Children comprises:

  • maternity services, including:
    • the Continuity at the Canberra Hospital (CatCH) Program
    • the Canberra Midwifery Program (CMP)
    • the Maternity Assessment Unit (MAU)
    • the Early Pregnancy Assessment Unit (EPAU)
    • the Fetal Medicine Unit (FMU)
  • women’s health, including:
    • screening, gynaecology
    • the Women’s Health Service, which prioritises women who experience barriers to accessing mainstream services
  • neonatology, including:
    • the Neonatal Intensive Care Unit (NICU)
    • Special Care Nursery (SCN)
    • specialist clinics
    • newborn hearing screening
    • the ACT Newborn Retrieval Service
  • paediatrics, including:
    • inpatient care
    • specialist clinics
    • community paediatricians
  • ​genetics service
  • school-based nursing services, including:
    • immunisation
    • kindergarten health checks
    • school youth health checks
  • nurse audiometry, which provides hearing assessments to children and adults
  • the Maternal and Child Health (MACH) nursing service, including:
    • a universal home visit following birth
    • support for breastfeeding and parenting
    • immunisation
    • referral services.
  • Services that support children and their families with complex care needs, including:
    • the MACH Parenting Enhancement Program
    • the Asthma Nurse Educator Service
    • the Child at Risk Health Unit (care for children affected by violence and abuse)
    • the Integrated Multi-agencies for Parents and Children Together service, which coordinates care for woman with complex care needs who are pregnant and/or have young children
    • child protection training for clinicians
    • the Healthcare Access At Schools (HAAS) Program.

Director of Operations

In 2015, a new executive position, the Director of Operations, was established to provide a single point of accountability for patient flow. The position also has responsibility for implementing the reform projects being undertaken across Canberra Hospital and Health Services (CHHS). The Director of Operations has line management responsibility for:

  • Medical Imaging
  • Patient Flow (formerly the Access Unit).

Performance against accountability indicators

Emergency Department

A $23 million expansion of the Emergency Department commenced in 2015, delivering an extra 1,000 square metres of floor space, including 21 additional treatment spaces and three additional ambulance bays. Added to this is $29 million in additional funding to provide 54 new Emergency Department staff over the four years to financial year 2019–20. This will ensure that as demand continues to grow for emergency health care, patients will receive timely access to emergency care.

The Emergency Department now has an additional 21 treatment spaces and three additional ambulance bays. Additional funding will also provide 54 new Emergency Department staff.

In May 2016, a new Paediatric Streaming model opened, providing:

  • six new paediatric emergency beds
  • two consultation rooms
  • a private sub-waiting area, which is separate to the Emergency Department’s main waiting area.

Paediatric patients are now seen in a private and family-friendly setting, which includes:

  • a play area
  • a beverage bay for refreshments
  • toilet facilities with change tables.

In June 2016, the third phase of the rebuilding program opened. This includes the new fast track area, which now has 10 bed spaces and three procedure rooms. This area is immediately behind the main reception and has its own dedicated waiting area. It will treat patients with less acute conditions and be instrumental in continuing to improve the timeliness of care through the Emergency Department.

The Emergency Medicine Unit (EMU) also opened in late June 2016. The EMU is a 12-bed, purpose-built unit that provides care to patients who require care for less than 24 hours. This represents an increase of an additional three beds to this important service.

In September 2015, a review of Canberra Hospital’s Emergency Department identified a suite of opportunities to improve patient flow through the Emergency Department and the hospital. The review recommended a whole-of-hospital approach to improving patient flow by examining the performance of the Emergency Department against national benchmarks, i.e. National Emergency Access Target (NEAT), and patient flow through the hospital more broadly. A number of projects were designed to improve CHHS performance in these areas.

Key initiatives to improve patient flow within the Emergency Department included:

  • Creating and staffing an Emergency Department Navigator role. This role is operational 24 hours a day, seven days a week and promotes patient flow through the Emergency Department by working collaboratively with:
    • senior Emergency Department staff
    • the Patient Flow Unit
    • after-hours hospital management
    • hospital-wide multidisciplinary teams.
  • Implementing Emergency Department Team-based Care, which provides an early assessment of patients by pre-determined teams of senior and junior doctors. The assessment is conducted as soon as possible after triage and makes high-level treatment plans. It is expected this will lead to earlier disposition planning and bed bookings for admitted patients. The model also supports improved supervision of junior doctors and clarifies responsibility lines.

These measures were put in place in early 2016, and have assisted in achieving significant improvements in the number of patients with a stay in Emergency Department of less than four hours. For example, for June 2016 the result was 72.7 per cent of patients stayed in the Emergency Department for less than four hours, compared with 58.2 per cent for the same period in 2015.

Broader reforms focused on supporting whole-of-hospital patient flow and access to assist Emergency Department efficiency and improve the patient journey. The key objectives of improved flow are:

  • improved clinical outcomes
  • reduced inpatient length of stay
  • optimal bed utilisation
  • improved performance against the NEAT and the National Elective Surgery Target (NEST).

Projects that focused on supporting whole-of-hospital patient flow and access include:

  • strengthening the Patient Flow Unit with responsibility for all bed decisions, allocations and escalations with a real-time information management system
  • developing and implementing a Medical Engagement Strategy to maintain and enhance the performance of the organisation by improving the active and positive contribution of medical staff within their normal working roles
  • establishing a Long Length of Stay Committee to identify barriers for discharge especially for patients with maintenance care type
  • developing and implementing a Key Performance Indicator Dashboard to measure and track performance across all divisions and departments
  • introducing the Early Discharge Program, which focused on:
    • removing identified delays from the discharge process by empowering patients to engage in the discharge process
    • ensuring all patients have an estimated date for discharge (EDD)
    • prioritising pathology and pharmacy services for patients identified for discharge.

Elective and emergency surgery

Canberra Hospital is the major tertiary and trauma referral centre for the ACT and surrounding NSW, and is equipped and able to manage high volumes of trauma and emergency cases that cannot be provided by neighbouring facilities.

The increasing demand for elective and emergency surgery has continued into the 2015–16 period. ACT Health continues to review where and how surgery is delivered in the ACT, to ensure that patients are receiving their surgery in the right facility at the right time.

ACT public hospitals have made significant improvements in how quickly patients access their elective surgery, within clinically recommended timeframes. These improvements have continued in 2015–16.

In November 2015, ACT Health commenced a comprehensive strategy to reduce the number of patients waiting longer than clinically recommended for elective surgery. This resulted in the removal of over 1,000 additional patients from the Elective Surgery Waiting List in 2015–16 when compared to the previous year. In addition, theatre utilisation rates across the ACT have steadily increased. The ACT Health System Innovation Program (SIP) has targeted theatre efficiency as one of its top 10 items for review and change.

For more information, see B.1 Organisational overview—System Innovation Group, page 63.

In partnership with the private hospital sector, the Elective Joint Replacement Program continued and provided approximately 320 joint replacements in 2015–16. This is an increase of nearly 90 per cent since the program commenced in 2014, and is achieving a dramatic decrease in the orthopaedic joint waitlist. This program will continue through 2016–17, with the aim of further reducing patients’ waiting time for joint replacements.

Acute Care services

An additional bed in the Intensive Care Unit has provided additional intensive care capacity.

The Capital Region Retrieval Service (CRRS) continued to see an increase in annual total activity (missions and consults) from 786 in 2014–2015 to 820 in 2015–2016. The CRSS was successful in recruiting staff to support the service, however additional recruitment continues. Despite this, the Service was still able to deliver a higher number of missions and consults compared to 2014-15.

The ACT Government launched Canberra’s first Mobile Dental Clinic (MDC) in 2015, improving access to dental health services for Canberrans residing in aged care facilities. In 2015–16, the MDC visited 16 aged care facilities and provided dental care to 532 clients and 2,232 services, ranging from preventive to restorative and denture services.

Trauma activity in the ACT is growing significantly and parallels the activity of ACT Hospital Emergency Departments. In 2016–17, ACT Health will commence:

  • An expanded Trauma Service to improve the service provided to trauma patients by:
    • reducing the time taken to access the operating theatre
    • ensuring fewer returns to theatre due to complications
    • reducing the length of Intensive Care Unit stay
    • reducing the overall length of inpatient stay
    • providing earlier access to rehabilitation medicine.

ACT Health is engaged in networking with Southern NSW Local Health District (SNSWLHD) through a series of critical care initiatives, which focus on:

  • building collaborative relationships between Critical Care services throughout the region
  • improving coordination and transfer processes for between services, such as the cross-border agreement for ST Segment Elevation Myocardial Infarction (STEMI) ECG Reading Service.

In a collaborative approach, CHHS, SNSWLHD and the Ambulance Service of NSW (ASNSW) have developed a regional STEMI pathway, which provides patients in the region with access to timely, best practice treatment, and facilitates SNSWLHD patients to be returned to facilities in their region as soon as clinically appropriate.

Other achievements

Dental Health

The Dental Health Program has continued to achieve the mean waiting time target of six months for clients on the dental services waiting list. The Dental Health Program has achieved the target with clients on the waiting list having a year-to-date (YTD) mean waiting time of 5.93 months at the end of June 2016. In June 2015, the YTD mean waiting time was reported at 4.15 months and in June 2014 YTD it was reported at 5.01 months.

The National Partnership Agreement on Adult Public Dental Services has been extended by the Commonwealth until 31 December 2016. This initiative has enabled the ACT Restorative Waiting List:

  • to be reduced
  • achieve a lower than six month mean waiting time
  • meet appointment timeframes for those clients triaged as emergency or priority patients.

During 2015, a new dental service was introduced for children and adolescents with special needs. This outreach service involves collaboration with ACT Special Schools and includes health education, dental assessments and treatment and family support. Since the service commenced, 175 children received oral health assessments and treatment and 32 groups received oral health education.

Medical Imaging

In December 2016, a review of the Medical Imaging Department identified opportunities for increased productivity and capacity. As a result a project was implemented with the objectives of:

  • improving daily productivity
  • providing additional capacity to meet increasing demands for medical imaging services
  • reducing the length of the outpatient waitlist for CT scans and MRI scans.

At 20 June 2016 the project had:

  • extended MRI outpatients’ operating hours, leading to a reduction in the MRI outpatient waitlist by 30 per cent
  • increased MRI outpatient studies per day by 50 per cent, an increase of 20 per day
  • increased CT outpatient studies to a minimum of 15 per day, leading to a reduction in the CT outpatient waitlist and providing patients requiring a CT scan with an appointment within five days
  • provided quarantined MRI/CT and US spots for the Emergency Department, leading to improved response times for Emergency Department patients requiring medical imaging
  • provided additional capacity for inpatients requiring medical imaging, contributing to reductions in the length of stay for patients

Since November 2015, the waiting lists for scans have reduced, as follows:

  • the MRI waiting list scan has reduced from more than 1,000 to approximately 300
  • the waiting list for CT scans has reduced from 550 to zero
  • the waiting list for ultrasounds has reduced from more than 1,100 to approximately 500.

Cardiology

The Canberra Hospital Cardiology department, the ACT Ambulance Service and Canberra Hospital Emergency Department have improved the management of STEMI patients at Canberra Hospital by:

  • streamlining the processes that activate the Cardiac Catheter Lab
  • transmitting Electrocardiographs (ECGs) directly from the Ambulance to the Cardiology Department.

Hospital in the Home Program

In 2015–16, the Hospital in the Home (HITH) Program at Canberra Hospital expanded the physical treatment space by up to three spaces. HITH has increased activity by 13 per cent compared to the same period last year. This equates to 20–22 patients a day receiving acute medical care in their homes.

Relocated Northside Dialysis Unit

At the beginning of 2015–16, the Northside Dialysis Unit relocated from Calvary Hospital to the Belconnen Community Health Centre. The move offers a number of advantages to clients accessing the service, including providing:

  • easy access to co-located allied health services
  • access to dieticians and podiatry
  • longer opening hours.

The unit plans to offer nocturnal dialysis. In addition, a self-care dialysis facility has been set up at Weston. This allows patients who cannot dialyse at home to manage their own care at their convenience in a community facility.

Hepatitis C treatment

The Gastroenterology and Hepatology Unit implemented a dedicated General Practitioner (GP) treatment referral program that allows GPs to prescribe a new Hepatitis C treatment to patients. This program was implemented with collaboration from the:

  • Pharmacy Department
  • Liver Clinic
  • GP Liaison Unit.

This new process means that GPs can care for these patients in the primary care sector, in consultation with consultants from the Liver Clinic. This creates efficiencies in outpatient clinics and an improved patient experience. Since the launch of this service in March 2016, 180 GP referrals have been processed.

Pathology

ACT Pathology undergoes accreditation inspections by the National Association of Testing Authorities and Royal College of Pathologists of Australasia. The new system of accreditation practices came into effect beginning January 2016. ACT Pathology underwent the first surveillance reassessment in March 2016 and achieved continued accreditation for all laboratories. In March 2017, the mid-term reassessment will be conducted for ACT Pathology, as part of the new four-yearly cycles.

Figure 9 shows the total number of ‘grouped’ pathology tests performed for 2014–15 compared with those for 2015–16. Grouping some of the pathology tests provides a more accurate representation of work load because some tests are performed simultaneously on the one analyser. The tests are, therefore, recorded together as one ‘group’ test, rather than separate tests.

 
Figure 9: Total number of ‘grouped’ pathology tests

The total patient referrals include both inpatients and outpatients. As shown in Figure 10, total referrals during 2015–16 increased by 3 per cent when compared to 2014–15.

 
Figure 10: Total patient referrals

The Australian Council on Healthcare Standards (ACHS) Clinical Indicators demonstrate timeliness of reporting of results for selected Canberra Hospital Emergency Department tests. As shown in Table 9:

  • The potassium result is regularly above target. However, the result is slightly lower than reported in 2014–15, because for three months the department had issues with an essential piece of equipment, which had a marginal impact on the overall turnaround times for this result.
  • The haemoglobin result is below target. Analysis of the cause found that the data included specimens where a blood film was required for analysis, due to one or more parameters being flagged as abnormal. These specimens caused an increase to the average turnaround time for haemoglobin. Having identified this, data for July 2016 shows the turnaround time to have been met in 90.3 per cent of cases.
  • The coagulation result is below target, which reflects a definition issue that does not take into account the centrifugation time required in sample preparation.
Table 9: ACHS Clinical Indicators
Test 2015–16 Canberra Hospital ACHS target
Potassium (% results in <60 mins) 83.7% 81.5%
Haemoglobin (% results in <40 mins) 86.3% 89.5%
Coagulation Testing (% results in <40 mins) 64.4% 70%

Child Development Service

In response to the National Disability Insurance Scheme (NDIS), a collaborative approach to child development service provision commenced from January 2015, as Stage 1 of the Child Development Service (CDS). The CDS provides:

  • 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.

Integrating the Community Paediatric and Child Health Service (CPCHS) and CDS services has resulted in:

  • multidisciplinary health assessments, involving CDS allied health staff and Child Health Medical Officers from CPCHS, to be conducted for children with complex developmental concerns
  • early development groups for children not eligible for early intervention services funded by NDIS, to be run through Child and Family Centres by Early Childhood Teachers and funded by the Education and Training Directorate
  • Community Paediatricians (Health) and Early Intervention Psychologists (Education and Training Directorate) to be relocated to Holder to provide developmental and health assessments.

ACT Health continues to work closely with the Community Services Directorate and Education and Training Directorate to further progress this work.

Child Youth Health Services Network for the ACT and Region

The Child Youth Health Service Network for the ACT and region has been established to provide strategic leadership and collaboration across services providing care to children. This will improve the health outcomes for all children and young people in the ACT and region. This Clinical Network aims to enhance the patient journey and the child and youth friendliness of healthcare services in the ACT.

Early intervention and prevention

Recurrent funding has been identified to enable the Trauma Service to continue to provide the Prevent Alcohol and Risk-related Trauma in Youth (PARTY) Program. This is in response to the success of this program in 2015–16 and the continued trend in alcohol-associated harm and hospitalisation in the ACT. PARTY is targeted at high school students and provides:

  • talks from ambulance workers and trauma surgeons
  • tours of the hospital
  • interaction with rehabilitation equipment
  • meetings with young trauma survivors.

The Healthcare Access at School (HAAS) Program provides nurse-led care to students with additional health care needs while they attend ACT Government schools. The model includes a HAAS Registered Nurse (RN) who works with the family and others involved to develop a care plan for the student. The RN then trains the school Learning Support Assistant in the specific healthcare tasks required to support that particular student. These are often the same tasks that are undertaken by family members or carers when the child is not at school.

Due to some concerns from the community, ACT Health in collaboration with the Education and Training Directorate, reviewed the needs of children in specialist schools and undertook a consultation process involving:

  • ACT Health
  • the Education and Training Directorate
  • teachers
  • unions
  • parents.

A revised HAAS model was developed to address the health needs of the entire specialist school community and meet the concerns that have been raised through the consultation process. The revised HAAS model uses a combination of Level 2 RNs, First Aid Officers and school staff in a tiered approach to health care.

Implementation of the revised HAAS Model of Care commenced in the ACT public specialist schools in April 2016.

Awards and presentations

In October 2015, the ACT Health Diabetes Service was designated a Diabetes Centre of Excellence by the National Association of Diabetes Centres. This award is a four-year award and is valid until 2019.

Future directions

Acute care admissions

An emphasis will be placed on the care of acute admissions to CHHS. This will include:

  • developing models of prevention of admission
  • streamlining the flow between patient to inpatient services
  • modifying the patient discharge process to streamline how patients are directed to appropriate services in the community.

Director of Operations

The Director of Operations will continue to develop processes to improve patient flow across CHHS. Patient flow will be improved by establishing projects, including:

  • expanding the capability of the transit lounge for patients leaving the hospital
  • improving capacity for transporting patients at the time of discharge
  • consolidating services that improve patient flow.

Medical Imaging

Medical Imaging will continue to develop access and service improvements, including:

  • creating additional capacity in ultrasound services to reduce outpatient waitlists
  • developing further strategies to reduce the MRI scan outpatient waitlist.

Division of Medicine

The Division of Medicine will:

  • implement the Acute Medicine Unit (AMU) model, incorporating the Medical Assessment and Planning Unit to:
    • create a more streamlined process from presentation to admission
    • improve the clinical care provided to our patients, including reducing the length of stay
  • progress more team-based models appropriate to care across the division
  • provide more community-based services in the new community health centres in Gastroenterology, Liver and Renal Services.

Gastroenterology and Hepatology Unit

Work is underway to improve access to and management of endoscopy services provided by the Gastroenterology and Hepatology Unit (GEHU) at Canberra Hospital. Demand for these services continues to increase year on year.

ACT Health and SNSWLHD have been working closely together to arrange for patients to gain more timely access to surgery and/or procedures, closer to their home. This work aims to improve wait times for those patients requiring a procedure. Work has commenced to develop processes to better manage the demand and flow of patients within the GEHU.

Back Pain redesign

Back pain is a relatively common problem in the Australian community with implications for:

  • work productivity
  • mental health
  • interpersonal relationships
  • the overall health budget.

Early initial intervention using a multidisciplinary approach is effective in reducing long-term disability.

2016–17 ACT Government budget funding has been committed to achieve a more integrated and resourced patient-centred intervention for both community and hospital presentations. Ideally, the solution will be community based. The proposed pathway will:

  • streamline the flow of patients who present with back pain through the Emergency Department to the community-based solution
  • ensure that these patients receive the best possible care through an efficient use of CHHS and community resources.

Acute Medical Unit

The Acute Medical Unit (AMU) will be a physician-led medical admissions short-stay unit structured to promote the inter-specialty and interdisciplinary care of patients who require unplanned admission to an internal medicine unit at Canberra Hospital.

Patients will be assessed and managed in this unit with the intention of adhering to evidence-based pathways of care when appropriate. This will:

  • create a more streamlined process from presentation to admission
  • improve the clinical care provided to our patients, including reducing the length of stay.

In collaboration with all physician-based units at Canberra Hospital and Acute Support allied health services, the AMU is being designed and established, with implementation due in November 2016.

Acute Stroke Pathway

Stroke incidence is increasing rapidly in the ACT as the population grows and the proportion of older people increases. The total number of admissions to Canberra Hospital stroke unit has risen from approximately 450 per year in 2004 to 650 per year in 2014 and is likely to continue to rise. Of these, approximately half are acute ischaemic strokes.

The 2016–17 ACT Government budget allocated $5 million for better acute stroke services and access to treatment in the ACT .This will be delivered through a coordinated network comprising Canberra and Calvary Public Hospitals. This enhancement will ensure:

  • timely assessment of clot breakdown at both Canberra Hospital and Calvary Public Hospital, Bruce
  • that evidence-based care is adopted for a smaller proportion of patients who would benefit from clot retrieval using existing advanced technology at Canberra Hospital.

ACT Renal Service

The Belconnen Community Health Centre will be one of the first public nocturnal dialysis providers in Australia, with rollout to commence in 2017. Nocturnal dialysis is undertaken throughout the night for approximately 8–10 hours for patients suitable for this option.

The service has deployed a comprehensive Renal Electronic Medical Record (REMR). The REMR provides access to information on dialysis treatment episodes and access to relevant patient pathology records and clinical records, irrespective of how that patient moves through the system, as part of the Renal Services Network across ACT and NSW.

Cardiac Imaging Medicine

In conjunction with the work being undertaken to improve care for patients with Acute Coronary Syndrome, Cardiology is working to establish a specific Coronary Angiography Computed Tomography Service. This service will:

  • build on existing cardiology services, such as the Chest Pain Evaluation Unit
  • contribute to identifying a patient’s underlying cardiac conditions.

Rapid Access Clinics

The Division of Medicine is exploring the development of Rapid Access Clinics for all subspecialties within the division. The service aims to provide patients with direct timely access to expert assessment and investigation, focusing on early intervention and prevention and negating the need for an admission to hospital in some cases. Rapid Access Clinics will have strong ties to the AMU.

Pathology

Pathology will continue to work collaboratively with Health IT to introduce an electronic ward ordering system that will:

  • improve completion rates of mandatory information required for pathology testing
  • improve legibility and thus accuracy of requested information
  • provide decision-making support information to the requesting doctor.

Pathology works closely with clinicians at Canberra Hospital to ensure accurate patient identification in specimen collection for pathology testing. To support this, the electronic ordering system will include a positive patient identification (PPID) component, which will reduce misidentification and mislabelling of specimens.

The pilot of the electronic ward ordering system went live in June 2016 in two wards within Canberra Hospital. The success of the pilot will result in this program being rolled out throughout Canberra Hospital, which will improve patient safety and reduce double ordering of tests.

Privately Practising Eligible Midwives at the Centenary Hospital for Women and Children

ACT Health has completed the framework that will introduce a model of patient care that allows privately practising, eligible midwives to admit their private patients to the Centenary Hospital for Women and Children (CHWC) or birthing services. This Model of Care is about to be introduced by the Division of Women, Youth and Children. The first two eligible midwives have been appointed. This is scheduled to commence at the beginning of 2017.

Publically Funded Homebirth Service

ACT Health has received Government approval to commence a trial of publicly funded homebirths. The trial will be conducted over three years up to a total number of 24 births per year. A framework document for the service has been written and endorsed. Expressions of interest for the homebirth trial will be taken from 4 October 2016. The first babies born as part of the trial are expected from 30 January 2017.

Consumer Survey for Parents and Children

In addition to the Patient Experience inpatient survey, which began in March 2016, a patient experience survey for parents of children in CHWC is currently in development. The information from this will provide the parent’s perspective and will be used to:

  • identify and focus on areas where we need to improve our services
  • generate additional ideas for service improvements
  • identify service areas where we met or exceeded our patients’ expectations.

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

The Health Directorate provides a range of Mental Health, Justice Health and Alcohol and Drug Services through:

  • the public and community sectors in hospitals
  • community health centres and other community settings
  • adult and youth correctional facilities
  • peoples’ homes across the territory.

These services work to provide integrated and responsive care to a range of services, including:

  • hospital-based specialist services
  • therapeutic rehabilitation
  • counselling
  • supported accommodation services
  • other community-based services.

The key priorities for Mental Health, Justice Health and Alcohol and Drug Services are ensuring that:

  • people’s health needs are met in a timely fashion
  • care is integrated across hospital, community, and residential support services.

This means focusing on:

  • ensuring timely access to emergency mental health care
  • ensuring that public and community mental health services in the ACT provide people with appropriate assessment, treatment and care that result in improved mental health outcomes
  • providing community- and hospital-based alcohol and drug services
  • providing health assessments and care for people detained in corrective facilities
  • engaging and liaising with community sector services, primary care and other government agencies that provide support and shared care arrangements.

Overview

The health services provided by Mental Health, Justice Health and Alcohol and Drug Services directly and through its partnerships with community organisations range from prevention and treatment to recovery and maintenance and harm minimisation. Consumer and carer participation is encouraged in all aspects of service planning and delivery.

The division delivers services at a number of locations, including:

  • hospital inpatient and outpatient settings
  • community health centres
  • ​detention centres
  • other community settings, including people’s homes.

These services include:

Adult Acute Mental Health Services
Adult Mental Health Unit (AMHU)
Mental Health Short Stay Unit
Mental Health Consultation Liaison—Canberra Hospital
Adult Community Mental Health Services
Belconnen Mental Health Team
City Mental Health Team
Gungahlin Mental Health Team
Tuggeranong Mental Health Team
Woden Mental Health Team
Crisis Assessment and Treatment Team
Mobile Intensive Treatment Team- North
Rehabilitation and Specialty Mental Health Services
Aboriginal and Torres Strait Islander Mental Health Services
Adult Mental Health Day Service
Brian Hennessy Rehabilitation Centre
Mental Health Comorbidity Clinician
Mental Health Service for People with Intellectual Disabilities
Neuropsychology
Older Persons Mental Health Team
Justice Health Services
Forensic Mental Health Services
Justice Health Primary Health
Secure Mental Health Unit (in development)
Child and Adolescent Mental Health Services (CAMHS)
CAMHS North Community Team
CAMHS South Community Team
Childhood Early Intervention Program
Early Intervention Team
Dialectical Behaviour Therapy Program (DBT)
Perinatal Infant Mental Health Consultation Service (PMHCS)
Eating Disorders Program
The Cottage
Alcohol and Drug Program
Consultation and Liaison Service
Counselling and Treatment Services
Police and Court Drug Diversion Services
Opioid Treatment Service
Withdrawal Services

Performance against accountability indicators

Against the accountability indicators, Mental Health, Justice Health and Alcohol and Drug Services:

  • Exceeded the target of 120,000 occasions of service within the Adult Mental Health Services Program. This achievement is the result of an adult mental health team being established for the people of Gungahlin, through the Gungahlin Community Health Centre.
  • Exceeded the target of 65,000 occasions of services within the Children and Adolescent Mental Health Services (CAMHS) Program by 10 per cent. This is due to the Choice and Partnership Model being implemented within the CAMHS community teams and an increase in referrals to perinatal consultation services.
  • Exceeded the target of 106, 000 occasions of service within the ACT-wide Mental Health Services Program by 1 per cent. This higher than expected level of activity was predominately achieved due to:
    • the high levels of contact with the Crisis Assessment and Treatment Team
    • additional ACT Budget 2015–16 funding for the Older Person’s Mental Health Community Team, the Crisis Assessment and Treatment Team and the Mobile Intensive Treatment Team.
  • Achieved the target of 98 per cent of all new clients who are on pharmacotherapy treatment for opioid dependency having a completed management plan.
  • Exceeded the target of 108,000 occasions of service within Justice Health Services Program by 40 per cent. This achievement can be attributed to the increased number of detainees at the Alexander Maconochie Centre (AMC).
  • Achieved 100 per cent of all detainees admitted to the AMC having a completed health assessment within 24 hours of detention.
  • Achieved 100 per cent of all young people admitted to Bimberi Youth Justice Centre having a completed health assessment within 24 hours of detention.

Emergency mental health care

ACT Health is a national leader in reducing seclusion and restraint in mental health inpatient settings. Reducing seclusion remains a high priority for the staff and this is reflected in a reduction of seclusion rates during the 2015–16 reporting period when compared with the previous financial year. Seclusion review meetings continue on a monthly basis to continue to monitor seclusion episodes and implement ongoing strategies for the reduction of seclusion and restraint episodes.

The Mental Health Short Stay Unit was commissioned on 27 January 2016 and is a six-bed standalone unit adjacent to Canberra Hospital Emergency Department. It is staffed with appropriately trained mental health medical and nursing staff. The unit is operational 24 hours a day, 365 days a year. It provides people presenting to the Emergency Department with the opportunity for:

  • extended clinical observation
  • crisis stabilisation
  • mental health assessment and intervention.

These services are available for up to 48 hours.

Mental health services

The Mental Health Act 2015 commenced on 1 March 2016. The Act gives people in the ACT living with a mental illness, or their carers and family members, greater opportunity to contribute to decisions on their treatment, care and support. The Act was developed over several years with extensive stakeholder engagement. The Act’s objectives and principles uphold the human rights of people with a mental illness and acknowledge the importance of carers. The Act empowers people with mental illnesses and mental disorders to make critical decisions about their treatment, care and support to the best of their ability, and with the involvement of carers, close family and friends.

The community Adult Model of Care was redesigned to ensure an improved integrated flow of patients from both inpatient and community settings, including crisis, assertive outreach, clinic and home-based care. The Crisis Assessment and Treatment Team expanded to provide additional intensive in-home support for people experiencing acute mental health problems.

In October 2015, a community mental health team began providing services to the Gungahlin region, at the Gungahlin Community Health Centre. Before October 2015, services were provided to this area as an extension from the Belconnen Mental Health Team.

Staff have been recruited to develop the therapeutic program, provide training, and develop policy and standards for the new 25-bed Secure Mental Health Unit, which is due to open in November 2016.

In April 2016, the Supported Accommodation Team became operational and began accepting referrals. This service provides intensive in-reach clinical services for a number of people who have significant chronic and severe mental health issues and are living in the community in supported accommodation.

The Older Person’s Community Mental Health Team expanded to provide intensive support for people with psychogeriatric conditions who are:

  • living in residential care or
  • transitioning from an acute inpatient unit to residential care.

The Consultation and Liaison service expanded to provide after-hours support seven days a week. The service assists people who have mental health-related issues when they are admitted to the general wards of Canberra Hospital.

Alcohol and Drug Services

Specialist Drug Treatment Services expanded the outreach specialist medical, counselling and case management services provided at community health centres to complement the existing services provided at Canberra Hospital. This service is now offering clinics one day a week at both at Belconnen Community Health Centre and Tuggeranong Community Health Centre.

In May 2016, the Police Drug Diversion Service, in collaboration with ACT Policing began a trial of voluntary diversions for adults taken into custody for intoxication. The aim is to offer assessment and referral following release from the City watch house, to assist people to access health services and support.

In October 2015, the Youth Drug and Alcohol Program expanded to include an in-reach service provision at Gugan Gulwan Youth Aboriginal Cooperation. The in-reach provides individual counselling, consultation and a collaborative small group initiative.

In March 2016, the Alcohol and Drug Service Consultation and Liaison services at Canberra Hospital expanded to provide seven day per week service.

Justice Health Services

In January 2016, the primary health team within Justice Health Services expanded their services to more effectively deliver health services to the AMC. Between 2015 and 2016, an additional 110 beds will be available at the:

  • Bimberi Youth Justice Centre
  • Periodic Detention Centre
  • Symonston Correctional Centre.

Engaging and liaising with other support and shared care organisations

​In January 2016, the CAMHS, partnered with the Education and Training Directorate, began a new program that provides early identification and treatment of children with emerging mental illnesses/disorders.

The Adult Mental Health Unit (AMHU) continued to experience challenges in the timely discharge of some patients. Primarily this is related to accessing appropriate housing options. Work is progressing to improve inter-agency relationships, particularly with ACT Housing, Disability ACT and the National Disability Insurance Agency (NDIA) to:

  • ensure the needs of these people are appropriately met in the community
  • reduce the impact on acute mental health inpatient beds.

Aggression and Violence Divisional Framework

An Aggression and Violence Divisional Framework has been adopted and is supported by clinical guidelines, which are being implemented throughout the adult inpatient mental health units. These guiding documents:

  • provide further clinical guidance and support to staff in the early identification and management of aggression and violence
  • contribute to the ongoing strategy to reduce seclusion and restraint episodes.

Future directions

The Mental Health, Justice Health and Alcohol and Drug Services workforce continues to be challenged by the increase in growth across the service. A workforce committee has been established to oversee the development of a Workforce Strategy, Planning and Development Framework.

The planning and implementation requirements for the commencement of the NDIS have been significant. An implementation plan has been developed to ensure appropriate services are available for eligible people for the transition of care arrangements to the NDIA and to support those people who may not be eligible or who may have difficulties accessing these services.

Mental health services

The Secure Mental Health Unit is planned to open in November 2016. The Secure Mental Health Unit will form part of an integrated care pathway for those people who need care and treatment as a result of their mental illness and associated comorbidity. The unit will contribute to the care continuum of mental health services provided through ACT Health.

The Secure Mental Health Unit is a newly-constructed and purpose-built facility providing inpatient services and operating 24 hours a day, seven days a week. It will support a person’s treatment, care and recovery by responding to the needs of:

  • people with moderate to severe mental illness who are or are likely to become involved with the criminal justice system (forensic)
  • civil people who cannot be treated in a less restrictive environment.

In the first phase, the Secure Mental Health Unit will open with 10 beds available. A dedicated Model of Care has been produced for the unit outlining:

The Model of Care also outlines the connections between the Secure Mental Health Unit and Forensic Mental Health Services within the AMC.

A workforce development and recruitment plan has been developed for the Secure Mental Health Unit, which includes the staging of the recruitment of staff in line with the commissioning/staging of beds. Training opportunities, such as scholarships, will be offered to staff to facilitate their development in the area of Forensic Mental Health.

The 2016–17 ACT Budget provided funding for the following:

  • The CAMHS Mental Health Follow-up for Young People and Intensive Clinical Rehabilitation Service. This service will provide an assertive outreach program focused on providing intensive interventions to young people:
    • with a history of severe, and/or disruptive mental illness
    • who struggle to sustain engagement with mental health services
    • who have limited supports, reduced social functioning and/or secondary psychosocial issues.

This service will significantly enhance access to continued comprehensive mental health treatment for young people who have difficulties attending office-based treatment.

  • Expanding the Mental Health Detention Exit Community Outreach (DECO) Program. This will allow the community sector DECO provider to work with the Forensic Mental Health Service to provide the treatment and short-term support services required to assist people leaving the Secure Mental Health Unit to re-establish themselves in the community. The community sector will also work with ACT Health to co-design the Mental Health Recovery College, supporting innovative practices with the Adult Mental Health Day Service of the University of Canberra Public Hospital. Funding is also available to provide additional intensive and specialised support services for older people by expanding the existing Older Person’s Mental Health Community Team.
  • For the AMHU to increase the number of commissioned mental health inpatient beds from 35 to 37. The additional beds will be accommodated within the existing AMHU Model of Care Framework and improve:
    • access to acute mental health services
    • patient flow through Canberra Hospital Emergency Department.

Justice Health Services

The number of staff in the Forensic Mental Health Services Team will increase. The team is located at the AMC. This increase will:

  • assist in meeting the demand created by increased detainee numbers
  • enhance the existing service
  • strengthen the capacity to provide early intervention and treatment
  • expand access to services
  • improve continuity of care in the prison population.

Output 1.3: Public Health Services

The aim of Output 1.3 is to improve the health status of the ACT population through interventions which:

  • promote behaviour changes to reduce susceptibility to illness
  • alter the ACT environment to promote the health of the population
  • promote interventions that remove or mitigate population health hazards.

This includes programs that:

  • evaluate and report on the health status of the ACT population
  • assist in identifying particular health hazards and measures to reduce the risk to the health of the public from communicable diseases, environmental hazards and the supply of medicines and poisons.

The aim of Output 1.3 is to improve the health status of the ACT population through interventions which:

  • promote behaviour changes to reduce susceptibility to illness
  • alter the ACT environment to promote the health of the population
  • promote interventions that remove or mitigate population health hazards.

This includes programs that:

  • evaluate and report on the health status of the ACT population
  • assist in identifying particular health hazards and measures to reduce the risk to the health of the public from communicable diseases, environmental hazards and the supply of medicines and poisons.

Performance against accountability indicators

The 2014–15 target of 8,500 samples analysed per annum was not increased for the 2015–16 financial year and effectively gives an estimated 45 per cent increase for the two years 2013–14 to 2015–16.

As shown in Table 10, the number of samples analysed significantly exceeded the 2015–16 target. The Output is based on samples having completed their analyses. The target for compliance of licensable, registrable and non licensable activities at time of inspection was not met due to an increase in noncompliant premises identified through:

  • routine inspections
  • complaint-based inspections
  • re-inspections of noncompliant premises.
Table 10: Output 1.3: Public Health Services
Output 1.3: Public Health Services 2015–16 targets 2015–16 outcome 2016-17 targets
Samples analysed 8,500 12,693 11,500
Compliance of licensable, registrable and non licensable activities at time of inspection 85% 69%1 85%
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% 100%
Percentage of Health Protection Service’s regulated business/activities who have access to Multi-year licenses/registrations. 75% 100% n/a

Note: Due to an increase in noncompliant premises identified through routine inspections, complaint-based inspections and re-inspections of noncompliant premises.

An increase in Samples Analysed occurred for the following categories in 2015–16 compared with 2014–15:

  • Illicit Drugs: 35.4 per cent
  • Food samples: 19.3 per cent.

A decrease in Samples Analysed occurred for the following categories in 2015–16 compared with 2014–15:

  • Oral Fluid samples: 23.6 per cent
  • Asbestos samples: 17.6 per cent.

Promote smoke-free areas

The Health Protection Service successfully implemented major tobacco control and smoke-free policy reforms in the ACT with the concurrent passage of two smoke-free amendment Bills through the ACT Legislative Assembly in March and April of 2016.

The Smoke-Free Public Places Amendment Bill 2016 was passed into legislation on 10 March 2016. The Bill allows for new smoke-free public places and events to be established by Ministerial declaration under the Smoke-Free Public Places Act 2003. Previously, new smoke-free areas could only be declared by primary legislation, making it a complex and time consuming process. This contributed to the ACT falling behind other jurisdictions in terms of legislated smoke-free areas. The new legislation streamlines the process for establishing new smoke-free areas, while setting up a framework to ensure a robust assessment of the costs and benefits associated with making a specific public place or event smoke-free.

Smoke-free areas are a vital tool to reduce tobacco-related harms in the community. They help to de-normalise smoking, which helps to prevent children and young people from taking up the habit. They also support smokers who are trying to quit by reducing social cues to smoke. This initiative will help enhance the health of the ACT community and ensure all Canberrans can enjoy more public amenities without exposure to second-hand smoke.

On 5 April 2016 the ACT Legislative Assembly passed the Smoke-Free Legislation Amendment Bill 2016 to restrict the sale, promotion and use of personal vaporisers, also referred to as e-cigarettes. The Bill applies the same restrictions to personal vaporisers that currently apply to tobacco. It:

  • prohibits the sale of personal vaporisers to children
  • bans the use of personal vaporisers in smoke-free areas
  • places restrictions on personal vaporiser advertisements, displays and marketing.

In doing so, it minimises potential health harms to the community from personal vaporiser usage and protects against the renormalisation of smoking behaviour. The new legislation is effective from 1 August 2016.

The primary aim of the new legislation is to protect the progress made in the ACT over the last few decades to discourage people from smoking, in particular to prevent the uptake of personal vaporisers by non-smokers, including children and young people. The new legislation was specifically drafted to protect public health, without constraining access to personal vaporisers for adults, including adult smokers wanting to quit traditional tobacco products.

The new legislation saw the ACT become the third Australian jurisdiction to directly regulate personal vaporisers behind Queensland and NSW and the second jurisdiction behind Queensland to ban their use in existing smoke-free areas.

The community benefits of the passage of these two smoke-free Bills are tangibly broad in scope. These positive outcomes are a direct result of the many months of evidenced-based, detailed and innovative policy analysis and development by the Health Protection Service staff.

Altering the ACT environment

In December 2015, an extensive clean-up was conducted under the Public Health Act 1997 due to an insanitary condition. The property had an accumulation of food and other material in and around the house. The food was decaying and odorous, providing harbourage for vermin and impacting upon neighbours. Ongoing monitoring of the property has continued since the clean-up to monitor recurrence.

Due to tendency for relapses to occur and difficulties in managing hoarding cases the Health Protection Service has initiated the development of a multi-agency model for handling hoarding cases. It is facilitated by the Hoarding Case Management Group, which is an intergovernmental advisory group that:

  • discusses the management of issues caused by hoarding-like behaviours in the ACT
  • provides operational advice on the best practice management of hoarding issues

This group has representation from relevant government areas, including:

  • ACT Mental Health
  • ACT Housing
  • ACT Fire and Rescue
  • Access Canberra
  • select non-government organisations, such as the Canberra Living Conditions Network and the RSPCA.

Interventions and mitigations

In February 2016, a team of three public health officers conducted inspections on stall holders serving kava during the three-day National Multicultural Festival. Over 300 food stall inspections were made over the three-day event. The Health Protection Service provided food safety education to stallholders at the National Multicultural Festival in the form of information sessions and printed materials. Food safety information sheets and checklists have been translated into 11 non-English languages.

The National Multicultural Festival has been declared as a public event in recognition of the cultural importance of kava customs to Pacific Islander people and an exemption granted under the Medicines, Poisons and Therapeutic Goods Act 2008 to serve kava. Kava is listed as a prescription only medicine under the Standard for the Uniform Scheduling of Medicines and Poisons (Poisons Standard). The Act adopts the Poisons Standard by reference. The Act also contains provisions to grant a public event exemption to allow the possession and supply of kava at public events. This means that kava may not be supplied in the ACT without either a prescription or a declared public event exemption. Organisers of public events may apply for an exemption to serve kava at a public event.

On 18 March 2016, amendments to the Transplantation and Anatomy Act 1978 came into effect to allow suitably trained officers to remove whole organs to:

  • support tissue transplantation outcomes
  • enable a coroner to direct (before the death of an intended organ donor) that coroner consent is not required to release the body for organ or tissue donation.

These changes will support the best transplant outcomes for the recipient.

On behalf of Access Canberra, the Health Protection Service:

  • registers food businesses
  • conducts routine food safety inspections of registered premises
  • processes food business registration renewals
  • provides food safety advice
  • undertakes inspections at Declared Events.

The Health Protection Service also communicates regularly with other arms of Access Canberra to ensure food business registrations are consistent with broader regulatory requirements, including liquor licensing, construction and safety. This engagement across Access Canberra reduces the regulatory burden on food business proprietors and ensures consistent advice is provided.

From 1 January 2015, the Food Act 2001 was amended to omit certain food businesses from the requirements of the Act, to minimise the regulatory burdens placed on volunteer non-profit community organisations. However, any business that conducts food services at a declared regulated event is subject to the requirements of the Act. The Minister for Health has declared the following to be regulated events:

  • National Multicultural Festival
  • National Folk Festival
  • Curry Festival in the City
  • Enlighten Night Noodle Markets.

In line with the ACT Government’s commitment to transparency, the Health Protection Service has published an online Food Business Inspection Manual to assist in delivering a consistent and open approach to food safety regulation. The Health Protection Service has also developed an online Food Business Self-Assessment Checklist to support food businesses:

  • identify potential areas for improvement
  • achieve compliance with food safety standards.

In February 2016, a team of 13 public health officers conducted food inspections during the three-day National Multicultural Festival as a strategy to minimise public health risks from serious breaches of the Food Act 2001. In total, over 320 inspections were conducted over the duration of the event. During inspections of food stalls, public health officers routinely look for issues (breaches) that would lead to unacceptable food safety risks, including:

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

A number of food safety breaches were identified, resulting in three food seizures and eight incidents of voluntary disposal of food.

In line with ACT Government regulatory reforms and reducing red tape, the Health Protection Service began implementing multi-year licences and registrations for businesses and individuals. The aim was 75% of all licences and registrations by the end of the financial year. The Health Protection Service achieved 100% compliance in this area.

In May 2016, the Health Protection Service’s ACT Government Analytical Laboratory (ACTGAL) completed a long-term project (identified as a gap in 2007) to develop and routinely deliver training courses to the Australian Federal Police (AFP) and ACT Fire and Rescue on the ACTGAL’s involvement, responsibility and capability in relation to clandestine laboratory investigation. The first training was delivered on 4 May 2016 as part of the ACT Fire and Rescue Hazmat Level II Technicians course, and approximately 15 staff from forensic chemistry and ACT Fire and Rescue attended. The training comprised a:

  • presentation on clandestine laboratories
  • practical session organised by forensic chemistry for both attendees of the ACT Fire and Rescue course and ACTGAL chemists.

Following consultation that occurred in 2015 and in line with ACT Government regulatory reforms and reducing red tape, the Health Protection Service is progressing with amendments to the Medicines, Poisons and Therapeutic Goods Regulation provisions for controlled medicines. These changes will allow prescribers to apply for a category of approval rather than having to apply each time that they need to increase a dose for a patient or change the drug.

These changes will allow the Health Protection Service to allocate resources to focus on identifying risk-based activities and reducing the harms inherently associated with controlled medicines. This will be achieved by increasing:

  • monitoring
  • inspections
  • subsequent regulatory compliance activity.

The Medicines, Poisons and Therapeutic Goods Regulation 2008 was amended on 1 March 2016 to allow pharmacists to administer influenza vaccinations to adults in the ACT without a prescription and in accordance with directions as established by the ACT Chief Health Officer.

Health status evaluations and reports

Population Health Division undertook or published the following population health surveys and data collections in 2015–16:

  • The ACT General Health Survey, which is a telephone computer-assisted technology household survey that collects information on a range of factors influencing health status.
  • The ACT Physical Activity and Nutrition Survey, which is a classroom-based tablet questionnaire collecting information on the physical activity and nutrition behaviour and the measured weight status of a sample of year 6 children.

The division produced a range of reports, information products and resources including:

  • The biennial ACT Chief Health Officer Report 2016, Healthy Canberra, which outlines the health status of ACT residents from July 2012 to June 2014.
  •  HealthStats ACT, an interactive web-based data platform with dynamic and static health statistics on a broad range of ACT population health topics. HealthStats ACT will be regularly updated and is accessible at any time.
  • The Health and Wellbeing of Older Persons in the ACT report, which provides an overview of the health and wellbeing of the ACT’s population aged 65 years and over, including:
    • a demographic profile
    • social indicators relevant to health
    • health status and quality of life
    • mortality
    • health service use.

The division also:

  • improved the completeness and timeliness of maternal and perinatal data and continued to report nationally against key indicators
  • through the NSW Cancer Institute, improved the quality and efficiency of ACT Cancer Registry data collection
  • increased availability of public hospital data for data-linkage purposes
  • continued to link different data sets with the Centre for Health Record Linkage in NSW
  • commenced a review of the Epidemiology section survey program.

Population Health Division contributed data to a range of reports, evaluations and research projects including:

The Health Protection Service’s ACTGAL published the Road Transport (Alcohol and Drugs) Act 1977 Report on Analytical Findings February 2015 report. The report is based on the toxicological analyses of blood taken from drivers involved in motor vehicle accidents as required by the Road Transport (Alcohol and Drugs) Act 1977 (http://www.legislation.act.gov.au/a/1977-17/default.asp), which specifies offences relating to driving while having ingested drugs and/or alcohol. The report includes the confirmed results of oral fluid samples taken under Section 20 of the Act when police conduct a random oral fluid testing program using a presumptive immunoassay-based screening technology. Since November 2011, the laboratory has provided the confirmatory testing of the three prescribed drugs:

  • delta-9-tetrahydrocannabinol (THC)
  • methylamphetamine
  • ​3,4-methylenedioxymethylamphetamine (MDMA).

The ANU’s National Centre for Epidemiology and Population Health has been contracted by ACT Health to conduct a ground-breaking and unique study to provide additional information of the risk of developing mesothelioma from living in a house containing loose-fill asbestos (a ‘Mr Fluffy’ house). The study will be conducted in four parts and is expected to take two years to complete. Parts one and two were completed in 2015–16. More information can be found on the study webpage.

Health hazards and countermeasures

The Population Health Division successfully conducted Exercise Kanthos on 26 August 2015 at Exhibition Park in Canberra.

Exercise Kanthos was a multi-agency, mixed mode health emergency exercise using the Emergo Train System (ETS) to simulate a coordinated response to an industrial accident at a healthcare facility. The exercise involved 65 participants from:

  • three ACT hospitals
  • ACT Ambulance Service
  • ACT Fire and Rescue
  • ACT Policing
  • NSW Health.

The exercise scenario involved five severe burn injuries to construction workers and the requirement for the coordinated evacuation and redistribution of 82 Hospital patients throughout the ACT Health sector. The response to the scenario was managed in real time using the ETS to simulate burns management and hospital surge capacity measures.

During Exercise Kanthos, hospital emergency operation centres were simulated, practicing major incident command, control and coordination of the ACT health sector. Cross-border liaison with NSW Health for extra jurisdictional assistance was also practiced during the exercise.

Population Health Division’s Health Emergency Management Unit (HEMU) also conducted Exercise Alimentaria on 3 June 2016 at Exhibition Park in Canberra. This discussion exercise involved 47 participants from across ACT Government and the health sector. The scenario involved a deliberate contamination of food that:

  • resulted in multiple sick persons
  • affected more than one food business
  • involved multiple facets of ACT Government.

The main objective of the exercise was to test the public health response and coordination of the ACT health sector in the event of a large scale deliberate food contamination event.

Future directions

Promote smoke-free areas

The Health Protection Service is prioritising establishing new smoke-free public places and events in and around Canberra. This is in accordance with the findings of a community consultation on Outdoor Smoke-free Areas undertaken in late 2015. Priority will be given to exploring smoke-free options at places frequently used by children and their families, or at places where people congregate in close proximity, such as playgrounds and bus waiting areas.

Interventions and mitigations

The Population Health Division has and will continue to lead (with colleagues from across Government) the development and implementation of a Medicinal Cannabis Scheme in the ACT.

Two expert advisory groups will be appointed with representation from across the spectrum of government agencies, non-government agencies, medical specialists and law enforcement to inform the development of the scheme.

The scheme will give people safe and legal access to high-quality medicinal cannabis products in appropriate clinical circumstances, and is expected to be in place in 2017.

The ACT Government is committed to ensuring that available medicines are safe and effective.

Health hazards and countermeasures

The Health Protection Service continues to progress work on improvements to controlled medicines regulation in the ACT, including:

  • enhancing the Drugs and Poisons Information System (DAPIS)
  • educating prescribers on the new controlled medicines framework.

On August 9 2016, the Public Health Amendment Bill 2016 was passed by the Legislative Assembly. The Bill will allow improved public health management of insanitary conditions resulting from hoarding and domestic squalor in the ACT.

Output 1.4: Cancer Services

Overview

The Division of Cancer, Ambulatory and Community Health Support (CACHS) provides:

  • a comprehensive range of cancer screening, assessment, diagnostic and treatment services
  • palliative care services
  • administration support to Ambulatory and Community Health sites
  • nursing and allied health support to central outpatients and the Ophthalmology service.

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 and cervical cancers meet targets
  • ensuring that the waiting time for access to essential services, such as radiotherapy, are consistent with agreed benchmarks
  • 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

During 2015–16, a project was undertaken to strengthen services by:

  • improving the patient experience
  • decreasing the length of inpatient stays
  • improving timeliness of admissions
  • improving patient flow across all inpatient and outpatient CACHS services.

Staff from across all disciplines and services within the division attended training and committed to participate in the service improvement projects. Outcomes that have been achieved to date are:

  • decreased length of stay, in particular for Haematology and Medical Oncology patients
  • improved timeliness of admissions
  • improved patient flow in outpatients and screening clinics
  • improved access to treatment information in patient files
  • increased referrals from GPs to BreastScreen ACT
  • improved Health Roundtable benchmarked data
  • reduced call abandonment rates despite servicing an increased number of calls.

In October 2015, a queue management system (QFlow) was implemented at Belconnen Community Health Centre. QFlow functionality is similar to touch screen ticketing kiosks used in government shopfronts. With English and eight alternative language options clients can register their arrival for an appointment or request assistance from reception staff using these kiosks. QFlow updates the primary appointment system and directs the client to the correct area for their appointment. Reception staff are now able to streamline the process of assisting clients. Average times to access services have reduced and the time waiting at reception has reduced to less than two minutes because of better client flow.

During December 2015, a new breast screening clinic opened at the Belconnen Community Health Centre. The opening of a third location for screening in Canberra has provided more choice and improved access for women in Canberra’s north. It also builds capacity for future growth, as the target population for screening increases.

The 2016 World Cancer Day on 4 February 2016 provided an opportunity to highlight what each of us, and the Canberra Region Cancer Centre (CRCC), can do to reduce the impact of cancer on our community. The theme for 2016 is ‘We Can, I Can’ and it aims to explore how everyone can contribute to reducing the global burden of cancer by achieving greater equity in cancer care and making fighting cancer a priority.

During 2–4 February 2016, in the lead up to World Cancer Day, Canberrans were invited to participate in the three-day World Cancer Day event at the CRCC, which provided:

  • cancer information sessions
  • daily tours of the CRCC
  • the opportunity to browse approximately 30 supporter stalls.

All events over the three days were very well attended and supported.

The Rapid Assessment Unit (RAU) for Cancer Services provides an alternative access point for cancer patients, currently receiving or three months post-treatment, who require management of symptoms and side effects relating to their cancer and/or cancer treatment.

Using ACT Government budget funding, the unit expanded in 2015–16 with the addition of a Nurse Practitioner and Advanced Practice Nurse to the service. This ongoing change in model has resulted in an increased capacity to manage cancer patients outside of the Emergency Department. Further work is being undertaken to improve access to the service and subsequently increase the ability to assess and treat patients, thereby reducing Emergency Department presentations and admissions to hospital.

The division participates in Canberra Hospital’s hand hygiene audit programs. To improve the compliance rates CACHS trialled the ‘Hand in Hand Program – Volunteers Auditing Hand Hygiene’. The trial was established to determine if volunteers conducting hand hygiene audits and providing hand hygiene information to patients and families/carers was an effective and appropriate method of monitoring and improving consumer understanding of hand hygiene.

Ten volunteers were trained in auditing staff hand hygiene practices by the Infection Control Clinical Nurse Consultant (CNC), using the Canberra Hospital snapshot audit tool. The volunteers were well accepted by the staff as auditors, and they provided weekly audit results to the staff via the CNCs. The volunteers also engaged consumers in hand hygiene education. The impact of this has been hard to determine, but further work with the rollout of the new hand hygiene bookmark is currently underway.

The Community Development Officer position was established (0.5FTE) and based at the Gungahlin Community Health Centre. Over the past eight months key achievements of this position include:

  • Developing and implementing the Gungahlin Community Health Centre Culturally and Linguistically Diverse (CALD) Access Project, in partnership with the Multicultural Policy Unit. Tours for local CALD groups are scheduled to begin in August 2016.
  • Establishing ongoing liaison and networks with a range of local community groups and service providers, including Commonground Canberra, through Northside Community Services.
  • Establishing an ongoing collaboration with GPs through Capital Health Network.

Performance against accountability indicators

BreastScreen ACT’s access and uptake has had continued success during 2015–16 with:

  • 100 per cent of women receiving screening results within 28 days
  • for women requiring further investigation at an assessment clinic, 90 per cent were provided an appointment within 28 days from their initial breast screening appointment.

Breast cancer screening

Achieving a 60 percent participation rate in breast screening in the ACT remains a challenge for the BreastScreen Australia Program.

Despite a comprehensive recruitment and promotion program, breast screening participation for the 50–69 year old cohort in the ACT has remained steady at 58 per cent. BreastScreen ACT continues to review recruitment strategies and develop new initiatives to improve participation rates.

BreastScreen Australia Program

BreastScreen ACT continues to actively promote the program by:

  • using Electoral Roll data to send invitations to women in the target age group
  • sending routine re-screen invitation letters
  • phoning lapsed attendees and women who do not respond to invitation letters or who fail to attend appointments
  • distributing information packs to all GPs in Canberra
  • conducting community and professional information sessions
  • staffing stalls at various conventions
  • distributing additional resources.

In December 2015, BreastScreen ACT opened a new screening service in Belconnen. This new service will increase the capacity of the program and enable greater access to screening for women in the north and west of Canberra.

In January 2016, the program installed a new mammography and tomosynthesis machine in Civic. This state-of-the-art technology enables three-dimensional imaging of the breast and is used in assessment clinics.

Radiation Oncology

Technology capabilities are a critical component of the Radiation Therapy service. Funding has recently been approved to replace end-of-life major equipment. This will provide further efficiencies and improve access to the service and to more current and targeted radiation therapy treatments, such as Intensity Modulated Radiation Therapy (IMRT).

The planned integration of the oncology information system with other ACT Health systems will support:

  • increased efficiency
  • streamlined processes
  • establishing a complete electronic medical record.

Implementing new technologies provides improved treatments and outcomes for patients. However, the increasing complexity, planning and treatment time is resulting in an increase in demand for Radiation Oncologists, Radiation Therapists and Physics groups and presents ongoing challenges to ensure patients are treated within recommended timelines.

Radiation Oncology will continue developing the following clinical projects:

  • expanding the Stereotactic Radiosurgery/Radiotherapy service to include extra cranial treatment sites
  • expanding verification imaging capabilities, including developing a credentialing program
  • expanding the application of IMRT to include prostate cancer treatment
  • expanding the use the oncology information management system
  • continuing to develop scripting to further automate radiotherapy treatment planning system processes and provide process efficiencies
  • increasing access to IMRT in Radiation Oncology from the current 16 per cent of patients to the recommended 30 to 40 per cent, depending on clinical case mix.

Achievements over the last year include:

  • implementing respiratory gating techniques including:
    • four-dimensional image acquisition, to improve tumour definition
    • deep inspiration breath hold techniques, to reduce the radiation dose to critical organs
  • implementing IMRT for prostate and other large field pelvic cancer treatments, which has increased access to IMRT from the previous 12 per cent to 16 per cent of patients
  • implementing Cone Beam CT (CBCT), which provides three-dimensional volumetric anatomical data for treatment verification imaging
  • increasing patient participation in clinical trials, both investigator initiated trials and cooperative group clinical trials
  • upgrading the Stereotactic Radiosurgery (SRS) imaging system, which improves the efficiency of the SRS treatment process
  • implementing Stereotactic Ablative Radiotherapy (SABR) for patients with lung cancer.

Participating in the Highly Conformal Hypofractionated Image Guided (‘Stereotactic’) Radiotherapy (CHISEL) clinical trial supported development of the SABR clinical technique now offered to our patients.

Awards and nominations

Table 11 identifies the key awards and nominations for 2015–16.

Table 11: Key awards and nominations

Name

Award/nomination

Dr Desmond Yip

Achieved his Professorship through the Australian National University (ANU)

Denise Lamb, Executive Director

Finalist in the 2015 ACT Public Service Awards for Excellence in the Executive Leadership category

Megan Nutt, Anne Booms and Ward 14B

Finalists in the 2016 Nursing and Midwifery Awards

In addition, the Immunology Unit received the highest level of accreditation from the Joint College Training in Immunology and Allergy.

Future directions

Breast cancer screening

The Expanded Target Age Group Project, which promotes screening to women aged 70–74 years, is entering the final year. The participation rate in this cohort has increased from 33.21 per cent in July 2014 to 54 per cent in June 2016. The aim is to achieve 55 per cent participation by June 2017.

Cancer Services

In 2016–17, Cancer Services will focus on:

  • maintaining high-quality, safe care for all patients by reviewing and evaluating current models of care, for example:
    • the Palliative Care consultation service model will be reviewed following the employment of additional resources
    • the role of the Clinical Nurse Specialists expertise to inform and progress shared care models
    • further expansion of the RAU
  • increasing the rotation of nursing staff to enable a more mobile workforce to service the division as a whole
  • providing regular forums and space for clinical staff to put forward their ideas for improving the patient experience and develop improvements in care
  • continuing the Lean Oncology projects to further reduce the length of stay and increase capacity in the outpatient setting.

Radiation Oncology

Radiation remains an important modality for cancer treatment. With improved clinical outcomes of cancer treatment and increased survival rates, minimising radiation therapy-related toxicities becomes a priority. To support this, future directions for Radiation Oncology include:

  • developing the advanced IMRT treatment Volumetric Arc Therapy (VMAT), which provides more precise targeting of the tumour and spares normal tissues, thus minimising related toxicities
  • improving efficiencies by reducing treatment delivery times, which will provide increased access to radiation therapy services
  • implementing a replacement treatment planning system that will support more complex planning techniques and provide system efficiencies
  • developing SRS for metastatic spinal disease
  • investigating software that provides efficiencies in the planning and treatment delivery for cranial SRS with multiple targets
  • replacing end-of-life Linear Accelerators, which will provide state-of–the-art treatment delivery and imaging modalities
  • investigating the feasibility of expanding the brachytherapy service to:
    • provide intraoperative brachytherapy for breast cancer
    • use surface moulds to treat skin cancers
  • increasing participation in clinical trials and translational biological laboratory research studies.

Essential services wait times

Capitalising on and sustaining the work undertaken to reduce the waiting list requires that outpatient services focus on:

  • implementing demand management strategies
  • increasing capacity on a service by service basis. Further work will continue by developing:
  • eligibility and exclusion criteria
  • pre-appointment questionnaires
  • new models of care, including nurse-led initial review/triaging clinics
  • booking rules to assist booking and scheduling staff to appropriately book appointments.

Output 1.5: Rehabilitation, Aged and Community Care

The aim of Output 1.5 is to provide an integrated, effective and timely response to rehabilitation, aged care and community care services in inpatient, outpatient, Emergency Department, subacute and community-based settings.

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

  • ensuring that hospitalised older persons wait an appropriate time for access to a comprehensive assessment by the Aged Care Assessment Team (ACAT), which assists in their:
    • safe return home with appropriate support
    • accessing appropriately supported residential accommodation
  • improving discharge planning to minimise the likelihood of readmission or inadequate support for independent living, following completion of hospital care
  • ensuring that access is 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 healthcare needs of the community.

Overview

During 2015–16, the National Disability Insurance Scheme (NDIS) continued to be rolled out in the ACT. RACC continues to work with clients and the NDIA to support the rollout. Processes and communication strategies are being developed to assist clients, inpatients, staff and providers access the scheme and understand the process once accepted into the scheme.

RACC continues to provide services and equipment funding in line with existing eligibility criteria for clients who are ineligible to access the scheme and for those aged 65 and over.

From July 2015, the Commonwealth implemented a number of reforms to the aged care system including a national approach to aged care assessment through a central, identifiable entry point known as My Aged Care. The ACT Aged Care Assessment Team began using this system on 1 July 2015. To improve performance and client outcomes, RACC staff meet monthly with the My Aged Care Regional Assessment Service (RAS). RAS are responsible for conducting face-to-face home support assessments for older people seeking entry-level support at home. This service ensures clients are referred to the most appropriate aged care services.

Performance against accountability indicators

The Community Nursing and Allied Health performance exceeded the 2015–16 targets for:

  • number of nursing occasions of service, which was set at 84,000 and achieved 91,779
  • number of allied health regional services, which was set at 25,000 and achieved 31,829.

An increase in the number of occasions of service for Community Nursing and Allied Health can be attributed partly to the health complexity of consumers, noting that service delivery may be extended to multiple visits, e.g. chronic wounds with comorbidities. This reflects:

  • demographic changes regarding the ageing population
  • an increase in chronic disease
  • consumers preferring to stay in their own homes for as long as possible.

The service capacity provided by these teams has increased due to:

  • improved staffing levels gained from budget funding from 2013–15
  • implementing changes in models of care.

Hospitalised older persons

RACC supports 44 inpatient beds at Canberra Hospital for older people, including 26 acute and 18 subacute beds. After a period of staff shortages, the Geriatrician Team is fully staffed enabling the team to better respond to the needs of the hospitalised elderly patients.

There have been several improvements to care for the hospitalised elderly patients in the Acute Care of the Elderly Unit (Ward 11A). Improvements in food services have been developed to provide a more appropriate service that better caters for the needs of the elderly.

This service has been developed in partnership with the food services team and includes dedicated food service staff for this area. Having dedicated and trained food service staff who are familiar to the patients is important for those with dementia because they are able to interact with them in a more engaging and meaningful manner, for example:

  • providing words of encouragement
  • opening packets/drinks or
  • placing a straw in a drink.

Frailty and associated falls are areas of risk and are being addressed by establishing a Falls Minimisation Room. This four-bed room has a dedicated Assistant in Nursing allocated to ensure continuous:

  • observation
  • interaction/diversion activities
  • monitoring under the supervision of a RN.

Access to services

There is increasing demand for some community-based allied health services, such as Nutrition, Occupational Therapy and Physiotherapy. In response to these increases, changes have occurred in their models of care including:

  • The Community Occupational Therapy service established a clinic assessment model based at the Independent Living Centre in Weston. This has improved efficiency by offering an alternate service to home visits while providing exposure to the shopfront displays for people with limited physical capacity.
  • The Community Physiotherapy service has established clinics run by physiotherapy assistants to review and provide exercise guidance for non complex clients. This allows the physiotherapists to see more complex cases.
  • Access to health coaching provided by community care health professionals has improved by establishing individual health coaching clinics. Individual clinics significantly improve access to consumers who would not be able to participate in or be suitable for a group intervention, e.g. non-English speaking consumers or those with mental health conditions, such as social anxiety.

The Tuggeranong Walk-in-Centre (WiC) opened on 26 June 2014 and the Belconnen WiC on 1 July 2014. The centres provide nurse-led services to the ACT community between 7:30 am and 10:00 pm, 365 days a year.

Presentations to the WiCs continue to increase, however, the number of clients who did not wait remains very low. The top presentations for the WiCs for 2015–16 have been:

  • urinary tract infections
  • common colds
  • wound dressings
  • wounds and lacerations
  • ear conditions
  • skin conditions
  • muscularskeletal conditions
  • gastro diarrhoea
  • gastro vomiting
  • ear, nose and throat (ENT) conditions
  • upper respiratory tract infections, i.e. sore throats.

The WiCs provide an alternative to attending an Emergency Department, leaving Emergency Departments with greater capacity to assist the more serious cases of injury and illness.

Rehabilitation

RACC introduced the Rehabilitation at Home Program in September 2015, which:

  • provides specialised Multidisciplinary Allied Health services to adults in the ACT
  • facilitates early discharge from inpatient units at Canberra Hospital by providing home-based subacute therapy.

The program also aims to prevent avoidable admission to hospital by providing therapy in the patient’s home.

In February 2016, the Canberra Hospital Acute Subacute Early Rehabilitation Service (CHASERS) commenced. The goal is to improve the triaging and fast-tracking of acute patients into appropriate subacute services. It aims to create a more proactive model of rehabilitation and to prevent functional decline in patients through early intervention. In the three months since the CHASERS Program commenced, the total number of rehabilitation consultations increased by 21 per cent while consultation times reduced by 20 per cent.

The RACC Speech Pathology Service is participating in a cluster randomised control trial with Queensland University: Action Success Knowledge Program (ASK trial) - Reducing the impact of aphasia in stroke patients and their caregivers a year post onset via a brief early intervention program. The research is led by a team of leading international researchers in aphasia. Canberra Hospital is the only participating site in the ACT.

A number of initiatives have also been introduced to improve rehabilitation services in the ACT, including the use of new technology to assist people achieve their goals. This has included:

  • ableX, which is a solution designed to accelerate the rehabilitation of arms and hands after a stroke or brain injury. The system comprises a suite of computer-based exercises in a game format, which are designed to promote both movement and cognitive skills.
  • Neurofeedback, which is a form of brain training that uses electrical brain recordings to take a client through a process of brain self-regulation. Neurofeedback requires very little physical or psychological effort from a patient. This can help create a more activated, alert, awake brain.
  • Introducing neurofeedback therapy in Clinical Psychology services, which will also allow psychological interventions to be successfully provided to rehabilitation and aged care clients, who previously were not able to engage meaningfully in conventional psychological therapy. This therapy will improve therapeutic access to clients who are severely depressed with very impaired motivation and volition.

Dementia care

The Dementia Care in Hospitals Program continued throughout the year. This program is an all-of-hospital education program aimed at improving hospital care of patients with cognitive impairment. It is delivered in partnership with Alzheimer’s Australia ACT and supported by Carer’s ACT and the Health Care Consumers’ Association.

The program is intended to be rolled out to all acute medical and surgical wards of Canberra Hospital by the end of 2016.

Partnership negotiations have been undertaken with Alzheimer’s Australia ACT and Dementia Behaviour Management Services (DBMAS) to develop a support model. The model will focus on developing person-centred care approaches, including considering changes to the care environment to minimise behaviour escalation/crisis situations.

Awards and presentations

As explained in Table 12, a number of RACC staff received awards during 2015–16.

Table 12: RACC staff awards

Name

Award

Jo Dix, Allied Health Assistant

Awarded the Allied Health Assistant Excellence award

Roslyn Stanton, Physiotherapy Clinical Educator

Completed her PhD ‘Feedback in Rehabilitation following Stroke’ in April 2016

Anna Snodin

Awarded the Allied Health Clinical Excellence Award for 2015 for her:

  •  contribution to the aphasia project in the Rehabilitation Independent Living Unit (RILU)
  •  team work and ability to support and develop other staff members

Sema Diler

Awarded the Early Career Excellence Award 2016, which included a professional development grant

Kathryn O’Flynn

Nominated for the Early Career Excellence Award 2016 and was awarded a Certificate of Commendation and professional development grant

Sema Diler, Occupational Therapy

Received the 2016 award for Allied Health Early Career Excellence

Dominic Furphy, Physiotherapy Manager

Received the 2016 award for Allied Health Management and Leadership Excellence

As explained in Table 13, a number of RACC staff gave notable presentations during 2015–16.

RACC staff presented at events around the world, including Australia, Germany, Italy, Poland and Thailand.

Table 13: RACC staff presentations

Name/position

Presentation title

Event details

Judith Barker, Community Nursing Nurse Practitioner, Wounds

Management of patients with venous leg ulcers: Current best practice

European Wound Management Association Conference, May 2016, Germany

Judith Barker, Community Nursing Nurse Practitioner, Wounds, on behalf of Wounds Australia

Overview of the venous leg ulcer guideline and Aseptic technique

Cheryl Jannaway, Stoma Clinical Nurse Consultant

Advantage of a stoma nurse in Community (poster)

AASTN/APFCP 40th biannual conference, October 2015

Rosalyn Stanton, Physiotherapy Clinical Educator

The effect of information feedback on training standing up following stroke: a feasibility study

Combined SMART Strokes SSA conference in Melbourne, in September 2015, and at the Australian Physiotherapy Association conference, on the Gold Coast, October 2015

Anil Paramadhathil, Director, Geriatric Medicine

Re-presentations to ED by elderly patients – Can this be reduced?

  • General Practice Liaison Officer National Conference in Canberra, March 2016
  • Preventing Unnecessary Hospital Emergency Department Transfers for Older People Forum, Melbourne, 5-6 May 2016

D Huang, G Spyropoulos, K Nicholls and A Fisher

Trends in orthogeriatric admissions in Canberra Hospital in the 21st century (2005–2014)

Canberra Health Annual Research Meeting, August 2015

N Soerjadi, W Srikusanukul and A Fisher

Renal dysfunction in elderly hospitalised medical patients: types, prevalence, clinical characteristics and relation to short-term outcomes

Canberra Health Annual Research Meeting, August 2015

B Lau, W Srikusanukul and A Fisher

Iron status in acute care elderly patients: relation to co-morbidity and short-term outcomes

Canberra Health Annual Research Meeting, August 2015

A Fisher

Bone-cardiovascular axis: biomarkers of bone metabolism as indicators of cardiovascular diseases and predictors of outcomes in orthogeriatric patients

19th Annual Meeting of European Council for Cardiovascular Research (ECCR), October 2015, Poiano, Lake Garda, Italy

Cardiovascular diseases and osteoporosis: bidirectional pathophysiological links and practical considerations

PCS 2nd Annual World Congress of Cardiothoracic-Renal Diseases-2015, October 2015, Warsaw, Poland

HH Naing, W Srikusalanukul and A Fisher

Characteristics and risk factors for geriatric hospital readmissions

International Association of Gerontology and Geriatrics (IAGG) Congress 2015, October 2015, Thailand

N Soerjadi, W Srikusalanukul and A Fisher

Acute kidney injury in hospitalised elderly medical patients: types, incidence, risk factors and relation to clinical outcomes

Royal Australasian College of Physicians Annual Congress 2016, May 2016, Adelaide

A Haque, A Paramadhathil, W Srikusalanukul and A Fisher

Characteristics of hip fracture patients with and without previous minimal trauma fractures: are we missing secondary prevention?

Royal Australasian College of Physicians Annual Congress 2016, May 2016, Adelaide

HH Naing, W Srikusalanukul and A Fisher

Osteocalcin: pathophysiological links and clinical considerations with and without diabetes mellitus [AT25]

Australian and New Zealand Society for Geriatric Medicine Annual Scientific Meeting, June 2016, Cairns, Queensland

B Lau, W Srikusalanukul and A Fisher

Anaemia in hospitalised geriatric patients: an underestimated problem [OR 44]

Australian and New Zealand Society for Geriatric Medicine Annual Scientific Meeting, June 2016, Cairns, Queensland

N Soerjadi, W Srikusalanukul and A Fisher

Chronic kidney disease(CKD) in hospitalised geriatric patients: prevalence, characteristics and impact on outcomes [OR 43]

Australian and New Zealand Society for Geriatric Medicine Annual Scientific Meeting, June 2016, Cairns, Queensland

Future directions

Hospitalised older persons It is anticipated that with the current ageing population, the demand on hospital beds by elderly patients will increase. A new Model of Care (Ortho-geriatrics) is currently being developed to provide efficient and effective care for elderly patients with hip fractures.

Partnerships with the following external stakeholders are being strengthened to facilitate seamless care across various care settings:

  • Capital Health Network
  • Alzheimer’s Australia.

DBMAS are working alongside hospital staff on a regular basis to provide case-specific support with selected clients that are eligible for DBMAS.

Discharge planning

RACC will continue to strengthen the strategies introduced in 2015–16 in regards to patients experiencing a long length of stay. This includes increasing referrals to:

  • ambulatory services, including Community Rehabilitation teams or
  • community-based services.

This will support the principle of rehabilitation continuing outside the inpatient setting being implemented.

Some patients are experiencing significant wait times when accessing supported accommodation and home modification services. In addition, carer needs are increasing. RACC will continue to work collaboratively with the NDIA regarding long stay patients whose discharge is reliant on the NDIS.

Access to services

The Commonwealth Government announced further reforms to aged care services in the 2015–16 Budget, including a commitment to a single ‘care at home’ program. RACC will continue to adapt our service model in response to these reforms.

Upgrades to the My Aged Care system continue on a regular basis, including the introduction of a new web-based referral form for GP, Community and Hospital referrers. RACC will continue to work with the Commonwealth to ensure appropriate education is provided on these new initiatives.

The University of Canberra Hospital (UCPH) has entered its construction phase. Extensive planning has gone into ensuring that the patient spaces support the Model of Care by providing the best therapeutic space. This includes the innovative use of Information and Communications Technology (ICT) solutions to future proof the potential of UCPH.

Throughout 2016–17, medical, nursing, allied health and administrative staff will concentrate on bringing the vision of the RACC Model of Care together with some innovative changes and supports to clinical practice. Research will be an important part of UCPH. The collaborative relationship with University of Canberra will be enhanced, including the opportunity for combined research projects.

Output 1.6: Early Intervention and Prevention

The aim of Output 1.6 to improve the health and wellbeing of the ACT population through a range of programs, services and initiatives, focused on early intervention, prevention and health promotion.

The key strategic priorities for early intervention and prevention include:

  • encouraging and promoting healthy lifestyle choices to decrease the rates of conditions such as obesity and diabetes and reduce risky health behaviours, such as smoking and alcohol consumption
  • maintaining high levels of immunisation.

Overview

ACT Health aims to improve the health and wellbeing of the ACT population through a range of programs, services and initiatives, focused on early intervention, prevention and health promotion. The key strategic priorities for early intervention and prevention include:

  • screening for cancer
  • encouraging and promoting healthy lifestyle choices to decrease the rates of conditions such as obesity and diabetes
  • reducing risky health behaviours such as smoking and alcohol consumption
  • maintaining high levels of immunisation.

Tackling the risk factors for chronic disease including the relatively high rates of overweight and obesity is a long-term endeavour. The ACT Chief Health Officer’s Report 2016 shows some success, with the ACT:

  • reducing smoking rates across the general population
  • achieving relatively high immunisation rates
  • achieving some early signs of improvements in children’s diet with a fall in sugary drink consumption.

Performance against accountability indicators

The ACT continued to achieve high childhood immunisation coverage in the general population. During the first three-quarters of 2015–16 the Australian Childhood Immunisation Register (ACIR) reported the ACT as above the national average for children fully immunised in all three age cohorts, which are:

  • 12 months
  • 24 months
  • five years.

Well Women’s Checks were provided to 46 per cent of women from CALD communities, which is an improvement on the 2014–15 result. In collaboration with the Health Improvement Branch (HIB), which oversees the Cervical Screening Register, eligibility for Well Women’s Checks was reviewed to include:

  • young women who had previously not initiated cervical screening
  • women who have not been screened for over three years.

This is believed to be consistent with the eligibility criteria targeting vulnerable women.

In 2015–16, 97 per cent of children aged 0 to 14 who entered substitute and kinship care in the ACT were referred to the Child at Risk Health Unit’s Out-of-Home Care Clinic. This is in line with the target of 90 per cent.

Promoting healthy lifestyle choices

ACT Health continued to support the implementation of the Towards Zero Growth: Healthy Weight Action Plan. The ACT Chief Health Officer is the technical advisor to the steering group for this whole-of-government initiative.

The Population Health Division chairs the ACT Healthy Weight Initiative Food Environment Implementation Group (FEIG). The FEIG oversaw a community consultation examining methods of:

  • increasing the availability and promotion of healthy food and drinks
  • reducing unhealthy food and drink marketing.

The consultation received over 500 responses and the findings will inform future actions.

The Choose Healthier pilot project is being delivered by ACT Health in partnership with the Canberra Business Chamber and supported by the ACT Nutrition Support Service. Five local businesses are participating in the pilot project to trial voluntary actions to increase the promotion and availability of healthier food and drinks:

  • The Hellenic Club in Woden has introduced three new healthier children’s meals to their menu. The meals are promoted with Choose Healthier branded in-store marketing and colour-in placemats.
  • Limelight Cinema in Tuggeranong has introduced a low kilojoule frozen yoghurt and is marketing it as a ‘combo’ with a bottle of water at a competitive price.
  • Tommy & Me café in Macgregor has introduced additional healthier choices to the standard menu, including a new refillable snack pack for toddlers. The refillable snack packs can be filled with a wide range of easy to hold, nutritious choices.
  • Two IGA supermarkets, Nicholls and Drakeford, are highlighting and promoting healthier food and drink choices from within each grocery category. This comprises Choose Healthier shelf tickets, banners, floor decals and fridge surrounds. A ‘hero shelf’ at the front of each store is being stocked with healthier convenience meal options.

Strategies found to be successful under the pilot will be promoted to other businesses Canberra-wide. ACT Health supported increased access to free drinking water at public events through its eight portable water refill stations. These supplied 17 events with over 22,000 litres of drinking water during the period 1 July 2015–1 May 2016.

The Population Health Division has responsibility for the overarching evaluation of the Healthy Weight Initiative (HWI). The first HWI evaluation report was incorporated into the annual HWI Report Card, for which CMTEDD has responsibility, and released as the HWI Progress Report to June 2016. Early indications suggest:

  • fewer children are drinking sugary drinks on a regular basis
  • children are eating adequate amounts of fruit
  • we are on track to meet our target of zero growth in the proportion of children and adults affected by overweight and obesity in the ACT.

The HWI is a whole-of-government approach focused on addressing the main drivers of the obesity epidemic by making improvements in active living environments and food environments across the ACT. An overarching Steering Committee monitors and coordinates policy and program actions across six key themes:

  • schools
  • workplaces
  • urban planning
  • food environment
  • social inclusion
  • information and data.

The ACT Health Promotion Grants Program has provided over $2.7 million for 39 community organisations to tackle the risk factors for chronic diseases, including:

  • preventing overweight and obesity
  • reducing alcohol- and tobacco-related harms
  • promoting healthy active ageing.

Examples of results of this investment to date include:

  • One in three adults in the target group have been reached by the Heart Foundation LiveLighter healthy weight education campaign, with over 28,000 website visits and more than 2,300 people registering for the free meal and activity planner.
  • Fifty pharmacies across the ACT are participating in the Pharmacy Guild of Australia Community Pharmacy Smoking Cessation Program with 290 pharmacists and assistants having completed face-to-face smoking cessation counselling training.
  • Sixty-eight local sporting clubs have been accredited under the Australian Drug Foundation Good Sports Program to make sporting clubs healthier, safer and more family friendly. Twenty-one clubs have also received healthy eating accreditation to improve healthy food promotion and supply.
  • The Foundation for Alcohol Research and Education Pregnant Pause campaign raised awareness of the message that zero alcohol consumption is the safest option when pregnant.
  • The Lyneham Pre-School Unit at Lyneham Primary School used creative art activities to promote fresh food to pre-schoolers. The project saw an increase in fresh food and a decrease in processed foods in children’s lunch boxes and an increase in fruit and vegetable consumption.
  • Fifty-two schools have been involved in the Physical Activity Foundation Ride or Walk to School Program, reaching over 20,000 students. Two-thirds of these participating schools reported an increase in active travel at their school.

Children

ACT Health delivers a range of programs for children and young people aged 0–18 years aimed at reducing the risk factors that contribute to:

  • the development of chronic disease later in life
  • the rates of overweight and obesity.

Sixty-five Early Childhood Education and Care (ECEC) services in Canberra participated in the Kids at Play (Active Play) Program from July 2015 to June 2016, reaching over 3,000 children aged three to five years of age. The program contributes to improved developmental outcomes for children aged three to five years in ECEC services by building the capacity of early childhood educators and increasing awareness of the importance of active play with parents.

Sixty-three schools are participating in the Fresh Tastes: healthy food at school program, reaching approximately 24,500 students. More schools are becoming involved each term. Fresh Tastes supports ACT primary schools to:

  • improve student, family and teacher knowledge of, access and consumption of healthy food and drinks
  • implement relevant policies, e.g. ACT Public School Food and Drink Policy. Fresh Tastes provides curriculum support for:
  • nutrition education
  • growing and cooking healthy food
  • healthy food and drink options.

As of June 2016, 599 teachers have participated in professional learning on delivering nutrition education to students. A number of businesses and community organisations partner and support the schools.

Fifty-two ACT primary schools are involved in the Ride or Walk to School (RWTS) Program, which aims to increase physical activity, reaching approximately 20,000 students. RWTS Program data is indicating an increase in active travel to/from school in Year 6 students. The program is delivered by the Physical Activity Foundation through an ACT Health, Healthy Canberra Grant. The RWTS Program will expand in 2016–17, using a revised model. At least 56 new primary and high schools will have access to an active travel to school program over the next two years.

Four RWTS schools are currently trialling infrastructure improvements around schools and promoting strategies to better engage parents under a pilot known as Active Streets. This pilot is implemented by Territory and Municipal Services in partnership with ACT Health and will be extended to more RWTS schools over the next two years. Nine ACT high schools are participating in It’s Your Move (IYM), which supports students to design and implement their own innovative school health improvement projects. These projects aim to increase physical activity and healthy eating and reduce unhealthy weight gain in young people aged 12–16 years. IYM was piloted from 2012–2014 in three ACT high schools and demonstrated promising results with the rates of overweight and obesity in the target group decreasing or remaining stable over the study period. This program informed the development of IYM learning materials, for use in 2017, by year nine and ten students. IYM incorporates:

  • systems thinking
  • design thinking
  • student innovation
  • digital technology.

The elective will be ready for delivery in 2017.

Families

Good Habits for Life is a locally developed behaviour change campaign, which targets families with young children, and encourages physical activity and healthy eating. Between July 2015 and June 2016 there were 54,540 unique page views to the Good Habits for Life website. In April 2016, the program’s Sugar Swap Challenge was delivered and encouraged families to swap sugary cereals, drinks and snacks for healthier options. Over 800 people signed up for the challenge.

Tobacco smoking remains the single most preventable cause of death and disease in Australia. The ACT has a strong record of achieving tobacco control and smoke-free environments, which is reflected in our rates of tobacco use. Smoking rates are higher among certain subgroups in the ACT, including young pregnant women. The Smoking in Pregnancy Project, funded under the 2015–16 ACT Budget Initiative, is implementing:

  • smoking care training for health professionals
  • counselling and, if required, appropriate nicotine replacement therapy for pregnant women and their partners
  • behaviour change campaigns to help reduce smoking rates in young women and young pregnant women.

Workers

ACT Health delivers programs to promote and support healthy lifestyles within, and through, ACT workplaces.

The ACT Healthier Work Service developed and now partially funded by ACT Health is implemented by Access Canberra. It supports ACT workplaces to implement staff health and wellbeing programs. In 2015/16 over 140 local businesses are engaged in the program and over 70 businesses across a range of sectors achieved Healthier Work recognition.

ACT Health runs ‘my health’ a comprehensive staff health and wellbeing program for the ACT Health workforce of over 6,000 employees. As a part of the program, ACT Health introduced the Healthy Food and Drink Choices Policy to increase the range and number of healthy food and drink choices available to staff, volunteers and visitors at ACT Health facilities and events. As a result:

  • drink vending machines are now largely compliant with the Policy
  • contracts for food outlets across ACT Health include a requirement to comply with the Policy.

The Population Health Division continued to develop and participate in targeted immunisation promotional activities. The Population Health Division had representatives on the ACT Health stalls at the Canberra Retirement, Lifestyle and Travel Expo (May 2016) and the Seniors Week Expo (March 2016) to promote the importance of immunisation for older people.

The Office of the ACT Chief Health Officer has been working with the Capital Health Network to develop a website called Live Healthy Canberra. The website will provide a searchable directory of local programs that help people to improve their physical activity and nutrition levels.

The Healthy Weight Initiative Evaluation Implementation Group proposed that a project be developed to improve the data capture and management tools available in the Active travel space. The group is chaired by ACT Health.

The Territory and Municipal Services Directorate developed a Cordon Count Canberra App, which enables observers to count cyclists and walkers. It is available across all mobile devices and was used during the annual cordon count in February–March 2016. An option for ‘intercept’ survey questions has been added to the app by ACT Health to allow for deeper analysis of active travel participation. The intercept feature has been extensively tested and is ready for implementation in counting situations where more in-depth questions can be asked.

The ACT Chief Health Officer has signed an agreement with Capital Health Network to share biometric data related to weight. This data will provide a more detailed understanding of the level of overweight and obesity in the ACT population and inform the development of targeted interventions.

Early intervention and prevention programs

In May 2013, the ACT Minister for Health endorsed the ACT Chronic Conditions Strategy—Improving Care and Support 2013–18, building on the previous strategy. The strategy sets the direction of care and support for those living with chronic conditions in the ACT and outlines a collaborative approach to this vitally important area of health care. The strategy’s implementation and evaluation is being overseen by the ACT Primary Health and Chronic Condition Steering Committee.

At 30 May 2016, the ACT Cervical Screening Program had participation tracking at 57.9%, which is the third highest in Australia and higher than the national average. During 2015–16:

  • 34, 030 women were screened and provided their details to the register
  • 19, 514 reminder letters were sent out to prompt women who were overdue for their screen test
  • 66 information sessions were held to promote two-yearly cervical screening even among women who are vaccinated against Human Papilloma Virus (HPV)
  • the program continued to promote the importance of ‘regular cervical screening test’ through social media, to community groups, at women’s health events and through 98 per cent of general practices
  • the program delivered messages via community radio in 21 languages to promote screening to women from the Aboriginal and Torres Strait Islander community, and women from non-English speaking backgrounds.

BreastScreen ACT is part of a national population breast screening program that is aimed at reducing deaths from breast cancer through early detection.

For more information, see B.2 Performance analysis—Output 1.4: Cancer Services, page 122. The results of the kindergarten health checks continue to be sent to the family’s GP (if nominated on the consent form) for ongoing support.

The School Kids Intervention Program (SKIP) commenced as a pilot on February 2015. This program is for children 4–12 years who are overweight, either on the:

  • 85% percentile or above with comorbidities or
  • 95% percentile without comorbidities.

The program is family-oriented and multidisciplinary information, including:

  • nutrition
  • paediatric (medical)
  • psychology
  • exercise physiology.

SKIP has received 95 referrals since it began to May 2016.

As part of the Commonwealth-funded National Bowel Cancer Screening Program (NBCSP), endoscopy services are provided to patients. CHHS operates a nurse-led colonoscopy pathway to support NBCSP participants.

Immunisation rates

The Population Health Division worked with the Commonwealth Department of Health to implement changes to the National Immunisation Program Schedule in the ACT. Changes included:

  • in March 2016, adding a Diptheria, Tetanus, Pertussis (DTPa) booster for children at 18 months
  • on 1 January 2016, introducing the national No Jab No Pay requirements.

A new program was introduced in 2015–16, involving sending postcards to parents of children at 12 months, 18 months and four years to remind them that their child’s next immunisation is due soon. Preliminary results indicate the introduction of this program has reduced the number of letters being sent to families of children overdue for immunisations in the three cohorts. In addition, this targeted program was expanded for the Aboriginal and Torres Strait Islander community to include reminder postcards at two, four and six months. Educational activities have continued during 2015–16 for both new and existing immunisation programs.

Education evenings were held for immunisation providers in:

  • January 2016, to discuss No Jab No Pay, new immunisation programs and pertussis in review
  • April 2016, to discuss Influenza vaccination.

Both evenings were well received with in excess of 140 attendees at each session. Staff from the Population Health Division also conducted opportunistic outreach immunisation education for a variety of audiences, including:

  • at Capital Health Network Nurse Network meetings
  • for new and post graduate paediatric nursing students
  • for Canberra Institute of Technology (CIT) enrolled nursing students
  • for nursing staff within the maternity units at the major hospitals.

Aboriginal and Torres Strait Islander vaccination coverage rates continue to fluctuate and must always be read with caution given the low numbers of Aboriginal and Torres Strait Islander children in the ACT. During 2015–16, the ACT was above the national average in cohort 1 and maintained rates above 90 per cent in cohort 3. Coverage rates in cohort 2 still remain a challenge and can be attributed partly to changes in the definition of ‘fully immunised’ in December 2014. Further targeted activities that were introduced during the financial year included:

  • mailing reminder postcards
  • developing new posters and pamphlets
  • continuing to mail quarterly letters to families with children overdue for immunisation.

The introduction of the national ‘No Jab No Pay’ requirements, which links family assistance payments to immunisation status, has resulted in an increase in the number of overseas immunisation record transcriptions and distribution in catch-up vaccinations.

Future directions

Promoting healthy lifestyle choices

ACT Health will continue to support implementation of the Towards Zero Growth: Healthy Weight Action Plan. This will include renewed efforts to make it easier for Canberrans to make healthier choices by:

  • improving our food environment, including for example including in workplaces, schools, shops, restaurants and sport and recreation venues
  • disseminate information via a range of multi-media channels.

ACT Health will produce an annual evaluation of the HWI.

Health promotion programs in schools will expand in 2016–17. The ACT will continue to work with the Commonwealth Department of Health during 2016–17 to implement changes to the National Immunisation Program Schedule. New vaccines to be added include Zostavax for persons over 70 years, which is anticipated to be introduced in November 2016.

Further changes to reporting requirements as a result of No Jab No Pay will include extending the ACIR to become a whole-of-life register.

Early intervention and prevention programs

From May 2017, the Commonwealth Department of Health is renewing the Cervical Screening Program based on the latest evidence. The program will include:

  • a new test pathway
  • new testing frequency recommendations
  • a new National Cancer Register.