Annual Report 2007 - 2008
Contents
1.
Management and Governance
2.
GICS background, Grampians Region demographics and Cancer Profile
3.
Mission
4.
Multidisciplinary Care
5.
Care Co-ordination
6.
Supportive Care
7.
Reduction in unwanted variation in care
8.
Old and new GICS funded projects
9.
Future focus
10.
Financial statement
Foreword
On behalf of the Grampians Integrated Cancer Service (GICS) we are pleased to present the
2007/08 Annual Report.
This report outlines the year’s activities and achievements.
Again it has been a busy and successful year with a number of new initiatives in our major work
areas of multidisciplinary care, supportive care, reducing unwanted variation in care and care
coordination.
These processes will lead to our ultimate objective which is to improve the survival and quality of
life of patients with cancer.
An initiative for the next year will be to develop further programs in supportive care which is to be
a major statewide initiative under the auspices of the Victorian Cancer Action Plan.
The success of our program depends ultimately on the practitioners who deliver direct services to
patients with cancer and their families from whom there has been a high level of cooperation.
Chris Scott
Chair
Stephen Vaughan
Director
L – R Sharon Daly, Eleanor Whitehead, Stephen Vaughan, Maree White, Nicole Pelchen, Robyn McIntyre
Front – Sarah Gillett, Carole Jones
1.
Management and Governance
Governance
Ballarat Health Services (BHS) is the Fund-holder for GICS. All financial, payroll, HR, fleet and
other support services are supplied by BHS. GICS is governed by the Executive Committee
which meets on a bi-monthly basis and comprises of senior managers and clinicians representing
the regional service providers. The Executive members in the year 2007/2008 were as follows:
Mr Chris Scott
Dr David Brumley
Dr Andrew Dean
Dr John Gallichio
Dr Paul Hemming
Dr Robert Grenfell
Dr Rodney Bond
Dr Sharon Wallace
Mr Ian Campbell
Mr Andrew See
Ms Claire Letts
Ms Sue Daly
Ms Helen Wade
Wimmera Health Care Group
Grampians Palliative Care Consortium
St.John of God Health Care
Ballarat Health Services
Ballarat Div. of GPs
Natimuk Surgery
Ballarat Oncology Services
St.John of God Pathology
Horsham Base Hospital
BAROC
Stawell Regional Health
DHS Ballarat
Central Highlands PCP
The Lead Clinicians Group is a reference group for GICS representing the Tumour Streams
operating in the Grampians Region. Members of the Lead Clinicians Group in 2007/2008 were:
Mr Stephen Tobin
Mr David Deutscher
Mr Bruce Stewart
Mr Mark Guirguis
Dr Deepika Monga
Mr Richard McMullin
Mr Damian Tange
Central Highlands Surgeons
Ballarat Surgical Clinic
The Specialist Centre
Ear Nose Throat Ballarat
Dunbar House Obstetrician & Gynaecologist
Ballarat Urology Clinic
Visiting Neurosurgeon
Structure and staff
The FTE employed by GICS as at end of June 2008 was 6.42, this was comprised of 8 staff
members, up from 6 staff at the end of the previous financial year. GICS organisational structure
is as follows. The Program Manager of GICS reports to the Director and all other staff report into
the Program Manager.
Two new positions were created in early 2008 in order to solidify the staffing structure of GICS
and build engagement in quality and data management activities. Sharon Daly was appointed to
the quality position and Nicole Pelchen to the data management position. As well, at the end of
2007 Colleen O’Hara moved on from her position as Program Manager of GICS to take up the
position of Business Manager – Oncology, within St. John of God Hospital in Ballarat. Colleen’s
role in the start-up of GICS and the service mapping and multidisciplinary activities was pivotal to
the organisation’s early successes.
A new Program Manager, Eleanor Whitehead, was appointed in April 2008.
2.
Grampians Region demographics and Cancer Profile
The Grampians Victorian Government Department Region (VGDR) contains the Local
Government Agencies (LGA) of:
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Ararat
Ballarat
Golden Plains
Hepburn
Hindmarsh
Horsham
Moorabool
Northern Grampians
Pyrenees
West Wimmera
Yarriambiack
The Grampians region has a population of about 216,065 people in 2005 which is 4.3 percent of
Victoria’s population. It covers an area of 48,611 square kilometres, or 21.4 percent of the area of
Victoria. GICS is the smallest of the regional integrated cancer services in population terms;
nevertheless it covers over 20% of the state.
ICS Divisions
Loddon Mallee
Hume
Grampians
Gippsland
Metropolitan Melbourne
Barwon South Western
50
0
Original: 02Reg_Vic.WOR
Regional boundaries based on Local Government Areas as at 1 July 1995
Produced by: Paula Morrissey, Metro Health & Aged Care, 17/05/02
100
6
Kilometres
Table 1: Population breakdown by LGA
Ararat (RC)
Ballarat (C)
Golden Plains (S)
Hepburn (S)
Hindmarsh (S)
Horsham (RC)
Moorabool (S)
Northern Grampians (S)
Pyrenees (S)
11444
88777
16887
14800
6392
19177
26721
12687
6552
West Wimmera (S)
Yarriambiack (S)
Grampians VGDR
Non Metro Victoria
Metro Melbourne
Victoria
4710
7918
216065
1387077
3634809
5021886
Source: DHS, Spend/Demand – Telecommunications in Regional and Rural Victoria, 2007.
Between 2003 and 2021, the population of the region is estimated to increase by 3.3 percent. The
municipalities of Golden Plains (24.8%), Moorabool (16.2%) Hepburn (12.2%) and Ballarat (6.7%)
will experience sizable increases. The population will decline in the municipalities of West
Wimmera (-18.2%), Hindmarsh (-15.9%), Yarriambiack (-13%), Pyrenees (-10.8%), Ararat (-10%)
and Northern Grampians (-3.3%). The population of Horsham will barely increase.
Accessed 13.06.08: Council to Homeless Persons Victorian Regional Consultation Report 2003
http://www.chp.org.au/public_library/items/2005/01/00021-upload-00001.doc
Cancer incidence in Grampians Region, 2003-2005
During the period 2003-2005, there were on average 1,110 new cancers diagnosed each year in
the Grampians region.
About 56% of new cancers were diagnosed in males and 71% in persons aged over 60 years.
Cancer rates in the region were very similar to those for the whole state (Grampians rates were
347, 263 and 301 new cases per 100,000 persons per year in males, females and persons
compared to rates of 344, 261 and 299 new cases per 100,000 persons per year in males,
females and persons for Victoria)
New cases in 3 years (2003-2005) by age group and sex:
Age group
Under 20
20-39
40-59
60-79
80+
Total
Males
11
50
360
1,083
345
1,849
Females
11
76
434
650
310
1,481
Total
22
126
794
1,733
655
3,330
% of total
0.7%
3.8%
23.8%
52.0%
19.7%
100.0%
New cases in 3 years (2003-2005) by leading cancer sites:
Leading cancer sites
Prostate
Bowel
Breast
Lung
Melanoma
Lymphoma
Head & Neck
Leukaemia
Kidney
Uterus
Other sites
Total
Males
543
315
214
138
81
78
54
53
373
1,849
Females
220
423
106
141
79
23
45
28
69
347
1,481
Total
543
535
423
320
279
160
101
99
81
69
720
3,330
% of total
16.3%
16.1%
12.7%
9.6%
8.4%
4.8%
3.0%
3.0%
2.4%
2.1%
21.6%
100.0%
Source: Cancer statistics from the Victorian Cancer Registry
Demand for Cancer Services in the Grampians Region:
The projected demand for acute inpatient treatment of cancer is expected to grow by at least 4%
per annum, and up to 12% per annum.
This means that acute hospital admissions (where cancer is the primary cause of admission) will
exceed 7,100 per annum in 2017 from a base of 4,300 in 2003 using the most conservative
assumptions. Based on the current trend, it is likely that demand will exceed 11,000 separations
by 2017.
Most cancer treatments occur in the ambulatory setting, particularly chemotherapy and
radiotherapy, whether or not patients are admitted.
Presently, the Grampians region treats 86.5% of all Grampians residents diagnosed with cancer
that requires admission to a hospital; 13.5% are treated in other regions.
Source: GICS, Cancer Service Plan 2006.
3.
Mission
The key principles for Integrated Cancer Services are:
o
o
o
o
o
An integrated approach in delivering the right treatment in a timely manner as early as
possible in the cancer journey
Regional health services working better together to provide the integrated care
More effective local co-ordination of care
A rational approach to cancer service planning and delivery
Improved survival and quality of life for patients
Thus the Integrated Cancer services were established with 4 key priority areas to address:
o
o
o
o
Multidisciplinary Care
Care Co-ordination
Supportive Care
Reduction of unwanted variation of care
4.
Multidisciplinary Care
The GI, Breast, Neurological, Head and Neck and Thoracic tumour stream MDMs continued
through 2007/2008 with patient numbers increasing in all streams. Engagement of clinicians has
been solid with the MDMs becoming viewed as integral to cancer patient care planning.
At the beginning of 2008 an MDM commenced on a monthly basis in the Wimmera to cover
patients from Wimmera Health Services. Due to the small population base it is a multi-tumour
meeting. Use of teleconferencing has enhanced the meetings, however it has been difficult to
achieve the inclusion of physicians by VC/Webcam from e.g. Melbourne.
Continuous quality improvement activities have been undertaken across all tumour stream MDMs
to optimise the meeting proceedings and outcomes.
5.
Care Co-ordination
The two Cancer Nurse Navigators, supported by substantial grants from GICS, commenced work
in late 2007 and have worked hard to gain acceptance of the new model of working. It is
envisaged that Nurse Navigators will assist in the facilitation of the cancer journey for patients.
They will identify gaps in the pathway and service and will ensure as far as possible that patients
have access to services to meet all of their medical and psychosocial needs. GICS staff
members have worked with the Nurses to design data capture systems to allow them to review
and analyse their patient base. They are expected to report in late 2008. Other care coordination projects are listed below.
6.
Supportive Care
Consultant Sheila Hirst has conducted a consultation process between the ICS and other Health
Care professionals from across the disciplines involved in Supportive Care delivery. Workshops
have been run to look at the model proposed for implementing a Supportive Care Initiative across
the state. The aim of the initiative is to reduce the impact of cancer on patient’s lives and improve
patient and family outcomes. It is expected that the initiative will be rolled out in the second half
of 2008 with a suite of documents including screening tool, literature review and the
implementation guidelines.
7.
Reduction of unwanted variation of care
During the 07-08 financial year, GICS took part in three DHS-initiated audits which incorporated
all applicable treated tumour streams for the region. Some 150 patient records were reviewed
and results submitted to the Department of Human Services Cancer and Palliative Care Unit.
Educational presentations at MDMs covered best practice approaches to various care situations
GICS ran several education and training sessions throughout the year.
 Dental – Bisphosphonates & Osteonecrosis of the jaw – held twice, once in Ballarat
and once in Horsham
 Egg and sperm freezing - Ballarat IVF clinic - held in Ballarat
 Haematology dinner meeting – Myeloproliferative Disorders - held in Ballarat
8.
New 2007/2008 projects
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Improving Patient Care Coordination in the Stawell Day Oncology Unit
Qigong - Life Energy Program
Look Good… Feel Better Program for East Grampians Health Service Ararat
Cancer Care Navigator - St John of God Health Care
Enhancing quality care. Introducing the Cancer Palliative Care Nurse Navigator
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Best practice in the delivery and administration of chemotherapy
Psychosocial Support for Men with Cancer
Development of a Specialist Outpatient Oncology Rehabilitation Program
Projects completed/reported in 2007/2008
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Mapping the psychosocial support services and needs of people in the Grampians
Region
Development of GICS Website
Development of GICS 5 year Information Technology Strategic Plan
Improving access to clinical trials for cancer patients in the Ballarat area
A model for clinical trials in the rural areas
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9.
Future Focus
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Strategic planning – will incorporate the expected Victoria Cancer Action Plan and the
Supportive Care implementation
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Quality systems – the GICS IT plan details the future plans for data systems. GICS will
facilitate regional engagement in exploring and comparing oncology management system
options. Internet based meeting systems will be reviewed and GICS will use such
systems to widen the possibilities of attendance at MDMs by clinicians working remotely.
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Supportive Care – GICS will set up an advisory group and will engage a project officer to
assist in implementation of the initiative when the guidelines and document suite are
made available by the DHS.
10.
Financial report for the year ended 30th June 2008
Revenue
Income
$1,052,473.00
Expenditure
Salaries and Wages total including on-costs
$480,252.00
Vehicle costs
$ 17,635.00
Rent
$ 35,367.00
*Internal costs
$203,718.00
Project grants
$209,389.00
Overall Total
$946,361.00
Surplus
$106,112.00
NB *Internal costs includes Fund holder overhead charges, office running costs including
GRAHnet charges, cost of running MDMs and other meetings, IT and office equipment, staff
training and conference expenses.
1015 Mair Street, Ballarat Vic 3350
PO Box 577, Ballarat Vic 3353
Phone: (03) 5320 4782
Fax:
(03) 5320 4076
Internet: www.gics.com.au