Population Western NSW Local Health District
• 261,734 people
• 24,800 Aboriginal – 9.5%
• 1.3% population growth to 2031
Services
• 37 Hospitals
• 60+ service locations
Budget
• $700M+ Expenditure
Staff
• 7,200 Employees
• 4,900 Full Time Equivalent
• 38% >50 years
Activity
• 188,724 ED presentations – 72%
• 82,449 Admissions - 31%
• 785 Patients in beds daily
• 1,058,823 non admitted occasions of service

Strategic Health Services Planning Process
• Health Needs Assessment Jan – March
• Board Workshop 6 March - strategic priorities were agreed
• Meetings with Clinician Groups 7 March - over 120 attendees
• 3 leaders workshops held in March, April and June – 30+ participants
• Many consultations with:
– Aboriginal Community Controlled Health Services
– Western & Far West Medicare Local’s
– 37 Local Health Councils
– Clinical Councils
– Groups of GP’s
– Other Government Agencies
• Open opportunity for emails with staff giving suggestions and ideas

Remote
North West
Dubbo
Orange
Bathur st

Life expectancy at birth 2005-07
82
81
80
79
79,1
78
77
Western NSW
80,4 80,4
81,6
Murrumbidgee Hunter New England NSW

1 000
980
960
940
920
900
880
860
840
820
800
Bathurst Orange
Socio Economic Status lower is more disadvantaged
Dubbo
WNSW = 958
NSW = 994
North West Remote
Rural NSW= 958
860
840
820
Far West Murrumbidgee New England
800
1 000
980
960
940
920
900
880

Premature mortality (ages 0-74) 2003-07
500
450
400
350
300
WNSW = 325
Rural NSW = 311
250
200
Bathurst Orange Dubbo North West Remote
250
NSW = 253
Far West Murrumbidgee New England
200
350
300
500
450
400

High numbers of patients presenting to
Emergency Departments
WNSW LHD Residents ED presentations / 1,000 Population
1600
1400
1200
1000
800
600
400
200
0
Bathurst Group Orange Group Dubbo Group North West Group Remote Group
Rate/1000

60
25
20
45
40
35
30
55
50
Bathurst
High rates of Hospitalisation
WNSW = 40.6
North West Remote
NSW = 36.6
Rural NSW = 40.2
60
25
Far West Murrumbidgee New England
20
45
40
35
30
55
50
Orange Dubbo

Informed by the Health Needs Assessment
Interventions likely to provide the greatest population health outcome gains:
1. Smoking prevention and cessation
2. Nutrition and physical activity interventions
3. Diabetes prevention and management
4. Well child care during the first 1,000 days of life
5. Mental health - strengthening community care and support

The case for change
Pressures on organisation and services are intensifying as a result of :
– Difficulties in sustaining services in rural and remote communities
– Persisting poor health outcomes of our Aboriginal population
– Issues in the configuration and ways of working of our hospital and community services
– The need to strengthen performance against key clinical and financial measures
This is also a time of opportunity
– Commonwealth and State reforms - higher levels of local decision making, new funding and, policy intent to development integrated services that improve access and outcomes

•
•
•
•
•
• Considers the strengths and weaknesses of current service configuration and performance
Presents broad options for future configuration
Has a 10-year planning horizon, with a focus on 5 years, a
‘roadmap’ for the first 3 years
Includes financial projections and impacts
100+ actions to be implemented
13 performance indicators for monitoring achievement

Priorities
Western NSW Local Health District Board
1. Develop a coherent Western NSW system of care
2. Support high performing primary care
3. Close the Aboriginal health gap
4. Improve the patient experience
5. Live within our means

Developing a coherent Western NSW system of care
• Focus on providing care as close to home as possible with a well organised system of accessing specialised care when needed
• Strengthen the role of the Patient Flow Unit to improve support for
patients needing transfer to other services
• Develop district-wide clinical streams, with membership from primary care
• Provide increased and well coordinated specialist outpatient services, outreach clinics and support for primary care with Medicare Locals
• Implement a world class telehealth network to decrease travel for rural patients and improve support for rural clinicians
• Decrease the number of patients needing to go to Sydney for care through improving the capability of services

Support high performing primary care
1. Develop strong partnerships with Medicare Locals and
Aboriginal Community Controlled Health Services
2. Lead an increased focus on equity of access throughout the region
3. Deliver increased specialist support for primary care
4. Shift to planned and structured preventive care
5. Expand HealthOne and Connecting Care initiatives
6. Transform service and business models in rural and remote communities

Close The Gap in Aboriginal Health Outcomes
• Strengthen strategic partnerships with Aboriginal community controlled health services, and agree an agenda for change
• Strengthen existing action to boost Aboriginal employment
• Strengthen existing action to develop LHD staff cultural
awareness, and build towards responsiveness and competence
• Implement the Aboriginal Health Service Plan when finalised in coming months

Improving Patient’s Experience
• Implement a patient centred care framework to improve
– Communication
– Patient safety
– Quality
– Cultural responsiveness
• Engage patients, families and carers in planning and review of services
• Design, implement and monitor patient-centred care pathways, with a focus on improving care quality, efficiency and equity of access
• Improve transport and accommodation support for patients and families accessing services a significant distance from their home community

Living within our means
• Balance all future decisions with considerations on quality of care, health of the population and affordability – the Tripple Aim framework
• Ensure clinical decision making is supported with best practice evidence and takes consideration of affordability
• Deliver transparent, timely and accurate reporting of performance information to accountable clinical and managerial leaders
• Establish a ‘whole of system’ district-wide Efficiency Improvement Program within a clinical governance framework
• Undertake value for money reviews of outsourced services
• Develop a Strategic Investment Fund to shift resources to prioritised services and models of care, with an emphasis on supporting cost-effective ambulatory, and primary and community based delivery

’Future-proofing’ of the Western NSW health system requires adoption of new ways of working that make access and outcomes more equitable, and make better use of the available workforce and funding.

Questions ?