EXECUTIVE SUMMARY

Preamble

Country SA PHNs (CSAPHN) geographically large and demographically diverse region creates some interesting complexities for a needs analysis. The analysis describes an overall picture of the needs of the region, though perhaps in a somewhat generic way. Due to data aggregation and suppression in fundamental administrative datasets, the needs of the smaller communities within the broader geography are not identified using this method alone.

In managing this the CSAPHN has provided a general needs analysis of our sub-regions but works at a more localised level with our Local Health Clusters (Community Advisor Committees) to identify needs targeted to individual or small groups of individual communities.

The overarching context for consideration by this needs assessment, is a region covering an area greater than 900,000 square kilometres and a population density fewer than 2 persons per square kilometres. Our region comprises over 100 communities of significant size, with only 10 communities over 10,000 persons and the remainder in the range of approximately 500 to 2000 persons.

Given the geographically large and demographically diverse region it serves, CSAPHN considers the assessment presented here as a stepping stone towards continual, in depth assessment of the local context, needs and priorities.

Summary

The Country SA PHN (CSAPHN) needs assessment utilises an iterative approach where information gained between submissions, including emerging needs, is incorporated to refresh analysis and triangulation for determining opportunities for action. Over time, it is expected that large parts of the documentation will remain static. This reflects the incremental shifts in population demographics, health risk behaviour, disease prevalence and improvements in health outcomes in response to implemented initiatives or other factors.

CSAPHN’s needs assessment approach, integrates data available publicly or obtained confidentially from the Australian Department of Health and key partners such as SA Health and the six South Australian regional Local Health Networks, with additional evidence collected through stakeholder consultations. An overview of the principal data sources used is documented in the Needs Assessment Data Report - November 2018 which includes a holistic look at demographic, health, and health service patterns to identify locations and populations with particular health and service needs as well as country SA-wide priorities.

The needs assessment process highlights the importance of investigating chronic condition and their risk factors, including resultant progression to multimorbidity, to fully realise opportunities for primary and secondary prevention in future CSAPHN work. Commonly identified examples include; type 2 diabetes, cardiovascular disease, chronic kidney disease, as well as chronic pain, which can relate to a wide range of other chronic conditions including the afore mentioned, arthritis, cancer and depression or pain resulting from another unresolved issues or injury. However, the magnitude of these disease burdens and service needs are likely to be underestimated owing in part to the difficulty of timely diagnosis along with the difficulty in obtaining accurate statistics, especially at the small area level.

Moreover, the interrelated nature of socioeconomic determinants, risk factors, and health status, suggests that acting on any one of the principal needs identified in this report will positively impact on other needs, stated or unstated. In addition, missing a key need relevant to service access, even where the actual need is located further upstream and not necessarily within the purview of the PHN, risks diminishing the success of programs designed to increase service availability and appropriateness.

The data illustrates that remote regions within our catchment are predominantly home to higher concentrations of disadvantaged populations with less equitable access to services than the rest of South Australia and indeed, Australia. There is a continuing need to investigate and advocate for services that enable access to services in rural and remote regions that are critical to improving health and wellbeing but are not within the remit of PHNs. The issue of transport availability as a determinant of access to service is raised consistently across the region as an important issue impacting on health service access and utilisation. Continuation of activities in a local setting, supplemented with or totally replaced with innovative solutions, palatable to consumers and providers, needs to be investigated further.

Data Needs and Gaps

Data collection and analysis is an ongoing process that represents an integral part of systematic stakeholder engagement and collaboration in the PHN commissioning cycle. As pointed out above, there continues to be gaps in the data currently available to Country SA PHN, some of which will be addressed through continual service mapping. This includes data on private providers in the allied health, aged care and disability spaces for which assessment of the actual level of care and operating hours, including afterhours, are made available by providers.

Stakeholder consultations have been integrated into the agreed mission of both Clinical Councils and the Community Advisory Committees (Local Health Clusters or LHCs). These permanent structures provide a springboard for periodic consultations with the wider community to obtain a broad and localised perspective, including the views of hard-to-reach consumers. Meaningful engagement and consultation with consumers, carers, local councils, and localised service providers are essential to provide context and add affirmation to data and priorities obtained through more traditional research and needs analysis modalities. In addition, the translation of the results from the needs assessment into service design and commissioning depends on an accurate understanding of existing local context.

With PHN responsibilities in the areas of mental health, suicide prevention and alcohol and other drugs programs, there has been focus on sourcing locally relevant health data and a detailed understanding of the spectrum and capacity of services provided to inform commissioning processes. To investigate needs and service gaps specifically related to alcohol and other drugs, in addition to utilising the PHN Drug and Alcohol toolkit and secure data, CSAPHN formulated a targeted survey focusing on identified parties and in-scope interventions. During the 2016 – 2017 period community consultations focusing on mental health, alcohol, and other drugs were conducted. Local service providers and community members engaged to provide context to data already gathered through the literature. Moreover, CSAPHN continues to engage in ongoing consultations and joint development of service delivery models and resource distribution with key stakeholders.

The PHN continues to work with key partners in undertaking the continuous consultation and engagement needed for joint planning with the newly formed country based LHNs. The continuation of efforts will be crucial to ensuring effective and informed commissioning not only in general and mental health, but in all priority areas.

Requirements for further developmental work relate predominantly to (1) continuing comprehensive, in depth service mapping; (2) obtaining and analysing quality practice data from a range of GP practices throughout the region, and (3) building and refining stakeholder engagement structures that enable ongoing consultation. These three requirements will form the foundations of ongoing CSAPHN activities.