Esml 2014 needs assessment report by Eastern Sydney ML

Eastern Sydney Medicare Local Needs Assessment Report 2014 - FINAL

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Acknowledgements The Eastern Sydney Medicare Local would like to acknowledge the Australian Government Department of Health for funding the implementation of this Comprehensive Needs Assessment and subsequent report. Sincere thanks are extended to the organisations who contributed to the planning, implementation and data collection of this needs assessment, in particular the South Eastern Sydney Local Health District Population Health and Planning Unit. In addition, we would like to acknowledge the feedback and contribution of each of the stakeholders that contributed to this needs assessment and the resultant strategies.

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Table of Contents Acknowledgements ............................................................................................................................ 2 Introduction....................................................................................................................................... 6 Executive Summary ............................................................................................................................ 7 Project Methodology.......................................................................................................................... 9

3.1

Planning and governance................................................................................................. 9

3.2

Development of sub-regional profiles ........................................................................... 11

3.3

Stakeholder engagement............................................................................................... 11

3.4

Identification and prioritization of primary care needs and service gaps ..................... 12

3.5

Development of this needs assessment report ............................................................. 13

3.6

Key success factors ........................................................................................................ 13

3.7

Challenges ...................................................................................................................... 13

3.8

Lessons learned.............................................................................................................. 13

Population Characteristics ................................................................................................................ 15

4.1

Approach........................................................................................................................ 15

4.2

Population characteristics ............................................................................................. 16

4.2.1

Population demographics .............................................................................................. 17

4.2.2

Birth rate ........................................................................................................................ 18

4.2.3

Cultural characteristics .................................................................................................. 18

4.2.4

Aboriginal and Torres Strait Islander community .......................................................... 21

4.2.5

Family structure ............................................................................................................. 22

4.2.6

Private health insurance coverage ................................................................................ 22

4.2.7

Broadband internet access ............................................................................................ 23

4.3

Social determinants of health ........................................................................................ 24

4.3.1

Socio-economic characteristics ..................................................................................... 24

4.3.2

Income ........................................................................................................................... 24

4.3.3

Employment industry .................................................................................................... 26

4.3.4

Employment status ........................................................................................................ 26

4.3.5

Education levels ............................................................................................................. 26

4.3.6

Homelessness ................................................................................................................ 27

4.3.7

Social cohesion / community strength .......................................................................... 28

4.3.8

Barriers to accessing services ........................................................................................ 28

4.4 4.4.1

Health characteristics .................................................................................................... 30 Self-reported health status ............................................................................................ 30

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4.4.2

Health risk factors .......................................................................................................... 31

4.4.3

Immunisation, infant mortality and wellbeing .............................................................. 31

4.4.4

Prevalence of chronic disease........................................................................................ 34

4.4.5

Cancer screening rates................................................................................................... 34

4.4.6

Prevalence of cancer...................................................................................................... 36

4.4.7

Disability ........................................................................................................................ 37

4.4.8

Mortality ........................................................................................................................ 38

4.4.9

Incidence of alcohol-related domestic violence ............................................................ 39

4.4.10

Sexually Transmissible Infections (STIs)......................................................................... 40

4.4.11

Infectious disease .......................................................................................................... 43

4.5

Health service utilisation ............................................................................................... 44

4.5.1

Primary care utilisation .................................................................................................. 44

4.5.2

Hospital admissions ....................................................................................................... 45

4.5.3

Top 10 causes for hospital admission ............................................................................ 46

4.5.4

Ambulatory care sensitive conditions (ACSCs) .............................................................. 46

4.5.5

Hospitalisations relating to conditions of interest ........................................................ 47

4.5.6

Hospitalisations associated with risk factors ................................................................. 49

4.5.7

Mental health services................................................................................................... 51

4.5.8

Home and community care (HACC) ............................................................................... 51

Service Availability ........................................................................................................................... 53

5.1

Approach........................................................................................................................ 53

5.2

Health service availability .............................................................................................. 53

5.2.1

Hospitals ........................................................................................................................ 53

5.2.2

General Practitioners ..................................................................................................... 54

5.2.3

Allied health services ..................................................................................................... 56

5.2.4

Mental health services................................................................................................... 56

5.2.5

Community health services ........................................................................................... 57

5.2.6

Aged care services ......................................................................................................... 58

Stakeholder Engagement.................................................................................................................. 59

6.1

Aims of stakeholder engagement .................................................................................. 59

6.2

Stakeholder engagement plan ....................................................................................... 59

6.2.1

Engagement with ESML Staff ......................................................................................... 61

6.2.2

Engagement with the ESML CNA Project Steering Committee ..................................... 61

6.2.3

Face-to-face meetings ................................................................................................... 61

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6.2.4 6.3

Stakeholder forums ....................................................................................................... 63 Qualitative feedback ...................................................................................................... 64

6.3.1

Staff engagement........................................................................................................... 64

6.3.2

Face-to-face meetings ................................................................................................... 65

6.3.3

Stakeholder forums ....................................................................................................... 67

6.4

Barriers and issues ......................................................................................................... 73

6.5

Future strategic partnerships ........................................................................................ 73

Primary care needs identification ..................................................................................................... 75

7.1

Approach........................................................................................................................ 75

7.2

Primary care needs and service gaps............................................................................. 75

7.2.1

Provide clear referral pathways to improve the care coordination efforts of primary care providers. ............................................................................................................... 75

7.2.2

Better empower consumers by providing more detailed information regarding available services ........................................................................................................... 77

7.2.3

Create better awareness of GPs and primary care service providers with special interests. ........................................................................................................................ 78

7.2.4

Improve primary care outreach services to better service priority neighbourhoods. .. 80

7.2.5

Improve childhood immunisation rates. ....................................................................... 80

7.2.6

Identify strategies to address growing primary care service demand. ......................... 81

7.2.7

Encourage a holistic approach for people experiencing severe mental illness. ............ 82

7.2.8

Reduce the inappropriate use of alcohol and prescription medications. ..................... 83

7.2.9

Improve the availability of youth-related primary care services................................... 84

7.2.10

Better understand the primary care issues / needs of residents living on Lord Howe Island .............................................................................................................................. 85

Needs Prioritisation ......................................................................................................................... 87

8.1

Approach........................................................................................................................ 87

8.2

Priorities identified ........................................................................................................ 88

8.3

Exclusions ....................................................................................................................... 89

8.4

Endorsement of recommendations ............................................................................... 89

Conclusions...................................................................................................................................... 90 Appendix A â&#x20AC;&#x201C; Data Collection and Limitations ................................................................................... 91 Appendix B â&#x20AC;&#x201C; Stakeholder Forum Summaries .................................................................................... 92

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1 Introduction Eastern Sydney Medicare Local (ESML) was established in July, 2012 as an independent organisation that coordinates primary health care delivery for approximately 400,000 residents living across 7 sub-regions including Waverley Local Government Area (LGA), Woollahra LGA, Randwick LGA, Botany Bay LGA, Sydney-East Statistical Local Area (SLA), Sydney-Inner SLA and Lord Howe Island. The ESML catchment includes Darling Harbour, the Sydney Central Business District (CBD) and Watson’s Bay to the North, Sydney International Airport to the west, and some of Sydney’s finest beaches and tourist attractions to the South and East. Although the population is associated with a fairly high socio-economic status, areas such as Sydney-Inner SLA are culturally diverse, while other regions contain numerous public housing neighbourhoods and areas of socio-economic disadvantage. ESML is responsible for addressing local population health needs and service gaps by supporting primary health care professionals to integrate health care service delivery across this diverse region. Through key partnerships with the South Eastern Sydney Local Health District, St Vincent’s Health Network and Sydney Children’s Hospital Network, ESML is responsible for ensuring local health care services work together to meet local primary health care needs. The Australian Department of Health, as a condition of providing annual funding to ESML, is requiring that ESML deliver a completed Comprehensive Needs Assessment (CNA) Template by 16 May 2014 which clearly defines and prioritises the primary health care needs of the 400,000 people residing throughout their catchment. . 360health Pty Ltd and Paxton Partners Pty Ltd were engaged by ESML to assist in the development of this Comprehensive Needs Assessment and appreciate the opportunity to be involved in this important program of work.

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2 Executive Summary Eastern Sydney Medicare Local (ESML), with assistance from 360health Pty Ltd and Paxton Partners, completed a five-stage comprehensive population health needs assessment over a period of five months, from November 2013 through May 2014. The aims of this needs assessment process included:  understanding the unique characteristics of the approximately 400,000 residents living within the ESML catchment and identifying opportunities to improve their health; 

assessing the level of primary health care service availability and whether it meets current and future service demand;



identifying the priorities in which to focus over the coming one to three years as a means to improve health and reduce inequalities within the population; and then



utilising this data and understanding to develop a Comprehensive Needs Assessment (CNA) Template as a key deliverable to The Department of Health by 16th May 2014.

During Stage 1, ESML created a project governance structure led by Ms Shona Dutton, ESML Director, Population Health and Planning, working under the auspices of Mr Darrell Williams, Chief Executive Officer. The governance structure also included a Project Steering Committee comprised of representatives from the South Eastern Sydney Local Health District (SESLHD), General Practice, consumers and 360health Pty Ltd. During Stage 2, ESML, Paxton Partners and 360health worked collaboratively to obtain and analyse relevant data from national (e.g. Australian Bureau of Statistics (ABS), Australian Institute of Health and Welfare (AIHW) and the Public Health Information Development Unit (PHIDU)), state (e.g. NSW Ministry of Health, Ambulance Service of NSW) and local (e.g. South Eastern Sydney Local Health District (SESLHD)) entities. These data were used to develop 6 sub-regional population health profiles that describe the population health status, social determinants, health service utilisation and availability associated with 1 the 400,000+ residents within ESML’s 6 sub-regions. The six sub regions profiled were :  Botany Bay Local Government Area (LGA) 

Randwick LGA



Waverley LGA



Woollahra LGA



Sydney-East Statistical Local Area (SLA), and



Sydney-Inner SLA.

ESML and 360health then used the information provided through the 6 sub-regional profiles to develop and execute a stakeholder engagement strategy aimed to 1) validate the quantitative data within the sub-regional profiles ,2) fill any information gaps that may exist relating the primary care needs of residents in the region, 3) educate key stakeholders on any unique population and community characteristics associated to residents living in the catchment, and 4) complement any existing stakeholder engagement currently underway by ESML staff.

Due to a total population of 361 at 2011 Census on Lord Howe Island, a substantive sub-regional profile was not developed for Lord Howe Island due to a lack of data and for privacy reasons. Eastern Sydney Medicare Local Needs Assessment Report 2014 - FINAL

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A total of seven face-to-face meetings were held with NSW Department of Planning and Infrastructure, Botany Bay Council, City of Sydney Department of Social Programs, SESLHD Drug & Alcohol Unit, SESLHD Department of Multicultural Health, Justice Health and Housing NSW. th

In addition, four stakeholder forums were conducted by ESML from 18 -24 March 2014 that were attended by 56 people representing community-based service organisations (e.g. Multicultural Resource Centre and other NGOs), members of the SESLHD and ESML staff and the broader community. ESML sought input from these attendees on 1) what services are working well, 2) what services are not working well (service gaps), and 3) ideas and suggestions on ways to improve primary care care services. These consultations and forums were used to obtain qualitative data as well as to request and obtain further data to fill any gaps in the previously collected quantitative data. Upon completion of stakeholder engagement, ESML and 360health collaborated to identify the primary care issues/needs of residents living within the ESML catchment by triangulating the quantitative data made available through the 6 sub-regional profiles with the qualitative data obtained during stakeholder engagements. Nine primary care issues /needs were identified. They include: 1. Provide clear referral pathways to improve the care coordination efforts of primary care providers. 2. Better empower consumers by providing more detailed information regarding available services. 3. Create better awareness of GPs and primary care service providers with special interests. 4. Improve primary care outreach services to better service priority neighbourhoods. 5. Improve childhood immunization rates. 6. Identify strategies to address growing primary care service demand. 7. Encourage a holistic approach for people experiencing severe mental illness. 8. Reduce the inappropriate use of alcohol and prescription medications. 9. Improve the availability of youth-related primary care services. 10. Better understand the primary care issues / needs of residents living on Lord Howe Island. Using a weighted scale against key selection criteria such as feasibility and impact on priority populations, ESML staff then condensed and prioritised these nine issues/needs into seven key primary care priorities which now form the key outputs of ESMLâ&#x20AC;&#x2122;s 2014 CNA Report. The seven priorities include: 1. Provide clear referral pathways to improve the care coordination efforts of primary care providers. 2. Better empower consumers by providing more detailed information regarding available services. 3. Identify strategies to address growing primary care service demand. 4. Improve childhood immunisation rates. 5. Encourage a holistic approach for people experiencing severe mental illness. 6. Reduce the inappropriate use of alcohol and prescription medications. 7. Improve the availability of youth-related primary care services. 8. Better understand the primary care issues / needs of residents living on Lord Howe Island. Mr Darrell Williams, CEO of ESML presented these proposed priorities to the ESML Board during a regularly-scheduled Board meeting held the evening of Monday, 28 April 2014. The Board officially endorsed all seven priorities as the basis to set their strategic direction and accepted them as organisational priorities to be addressed within the 2014-2015 ESML Annual Plan.

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3 Project Methodology Eastern Sydney Medicare Local (ESML) adopted a five-stage methodology to ensure the successful delivery of a relevant and meaningful CNA Report. Figure 3.1 provides an overview of this approach, with details regarding each stage provided below. Figure 3.1: Five-stage methodology used to develop ESML’s Comprehensive Needs Assessment Report Planning and governance

• Identify required resources • Project Lead • Project Steering Committee • Role of the Board • Budget

3.1

Development of sub-regional profiles • Identify relevant data sets and sources • Collection of data • Analysis of data • Development of subregional profiles

Stakeholder engagement

• Identify stakeholders who can validate subregional findings • Identify stakeholders who can fill gaps in information and knowledge • Develop communications strategy, using a blend of costeffective communication channels • Execute the strategy

Needs identification and prioritisation • Identify population health needs • Identify primary care service gaps • Reconcile and prioritise in line with Federal, State and local needs and requirements

Development of the Comprehensive Needs Assessment (CNA) • Utilise the Guide to develop the annual Report and complete the Template

Planning and governance

Under the auspices of the ESML Chief Executive Officer (Mr Darrell Williams), Ms Shona Dutton, Director of Population Health and Planning, provided day to day operational and relationship management responsibilities. As Project Officer, Ms Dutton initiated the first stage of the project during November 2013 by:  creating a clear statement of the aims and objectives of the needs assessment process and its role in shaping the activities of the ESML; 

identifying all key timelines and deliverables associated with the project;



identifying any associated risks and developing risk mitigation strategies;



identifying key internal and external resources;



identifying key stakeholders that might be included on the Project Advisory Committee; and



finalising a formal project plan which met ESML’s timing and budget requirements and was aligned to the CNA Reporting Template.

ESML then engaged 360health Pty Ltd and Paxton Partners to provide consultancy services during all developmental stages of ESML’s Needs Assessment Report.

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To ensure the development of a relevant and meaningful report, Ms Dutton convened an internal Project Committee during December 2013 whose members are provided in Table 3.1. Table 3.1: ESML CNA Project Committee

Project Committee Member

Role

Ms Shona Dutton

Director, Population Health and Planning

Ms Amy Young

Manager, Population Health

Ms Lorna Stevens

Manager, Community and Stakeholder Engagement

Ms Lissa Smith

Consultant, 360health Pty Ltd

Once established, the ESML CNA Project Steering Committee then formalised the remaining project governance arrangements by forming the ESML CNA Project Steering Committee and finalising its’ Terms of Reference. Members of the ESML CNA Project Advisory Committee are listed in Table 3.2. Table 3.2: ESML CNA Project Steering Committee

Project Advisory Committee Member

Title

Organisation

Dr Gary Nicholls

General Practitioner

Cooper Street Clinic

Mr Greg Stewart

Director of Ambulatory and Primary Care

SESLHD

Ms Julie Dixon

Director of Population Health and Planning

SESLHD

Mr Reg Ryan

Consumer Representative

Mr Darrell Williams

Chief Executive Officer

ESML

Ms Shona Dutton

Director, Population Health and Planning

ESML

Ms Lissa Smith

Consultant

360health Pty Ltd

Sponsored by the ESML CEO (Mr Darrell Williams) and facilitated by the Project Officer (Ms Shona Dutton), the first ESML CNA Project Advisory Committee was held during March 2014. In all, this committee met two times over a 4-month period to inform the development of this CNA Report.

Stage 1 deliverables

Eastern Sydney Medicare Local Needs Assessment Report 2014 - FINAL

• Agreement to final project methodology and timelines • Finalisation of ESML CNA Project Steering Committee Terms of Reference • Initial project engagment with the CNA Project Steering Committee

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3.2

Development of sub-regional profiles

ESML worked collaboratively with Paxton Partners and 360health to generate profiles that describe the population demographics, health status, social determinants, health service utilisation and 2 availability associated with its 400,000+ residents within ESML’s 6 sub-regions including:  Botany Bay Local Government Area (LGA) 

Randwick LGA



Waverley LGA



Woollahra LGA



Sydney-East Statistical Local Area (SLA), and



Sydney-Inner SLA.

The development of these 6 sub-regional profiles was essential to the overall development of the CNA, as the distinct characteristics, service gaps and primary care needs of each of the sub regions were identified during the process. This proved vital in assisting the ESML in better designing and implementing strategies to address pockets of particular need. Obtaining and analysing the available quantitative data was considered a critical process in identifying and prioritising overall health and primary care service needs of those residents within the ESML catchment. ESML worked collaboratively with Paxton Partners and 360health to obtain and analyse relevant data from national (e.g. Australian Bureau of Statistics, Australian Institute of Health and Welfare, and the Public Health Information Development Unit), state (e.g. HealthStats NSW, NSW Planning and Infrastructure) and local (e.g. South Eastern Sydney Local Health District) entities to build population health profiles. These included the population and community characteristics, health risk status, health status (long-term conditions, infectious disease, disability), health service availability and health service utilisation levels for each sub-region. Aggregate key findings from these 6 sub-regional population health profiles can be found in Chapter 4: Population Characteristics and Chapter 5: Service Availability.

Stage 2 deliverables

3.3

• Delivery of six sub-regional sub-regional profiles.

Stakeholder engagement

Upon completion of the 6 sub-regional profiles, ESML and 360health developed and implemented a stakeholder engagement strategy to include the ESML staff, local service providers and Councils, as well as state agencies and the broader community. ESML’s stakeholder engagement strategy was designed to:  validate the findings of the six sub-regional population health profiles; 

fill any information gaps relating to primary care service needs and gaps throughout the ESML catchment; as well as



educate key stakeholders on any unique population and community characteristics associated to residents living in the catchment, and



complement any existing stakeholder engagement currently underway by ESML staff.

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Using the outputs from the 6 sub-regional profiles as guidance, 360health collaborated with ESML to identify all individuals and organisations to be consulted, the appropriate technique to be used and the timelines associated to each. A decision was made to incorporate the following techniques to meet the above objectives:  engagement with the ESML staff; 

engagement with the ESML CNA Project Steering Committee;



completion of 7 semi-structured face-to-face meetings with selected key individuals and representatives of key stakeholder organisations; and



completion of 4 stakeholder engagement forums within the sub-regional areas to address unique pockets of population health or service need.

Detailed methodology and key findings from ESML’s Stakeholder engagement can be found in Chapter 6.

Stage 3 deliverables

3.4

• Delivery of ESML's CNA Stakeholder engagement plan • Successful execution of the ESML CNA Stakeholder engagement plan

Identification and prioritization of primary care needs and service gaps

Key members of the ESML then met to identify the primary care needs and service gaps of residents within their catchment. During this workshop, primary care needs and service gaps were identified by triangulating the quantitative population and community characteristics data, the health services availability data and the qualitative data (service gaps) obtained through stakeholder engagement. As a result, 9 primary care issues / needs were identified through this process. Following their identification ESML adopted a weighted scoring mechanism to prioritise these needs so that community stakeholders could see that their input had been recognised and that there has been a transparent process used to determine which needs could be addressed by ESML’s available resources and funding. The process to prioritise the 9 identified population health needs applied a weighted voting scale against a set of priority setting criteria to identify whether each priority:  reflected ESML’s overall mission and aims; 

aligned with Commonwealth health priorities;



aligned with the NSW Ministry of Health priorities;



aligned with the priorities of the local health districts, including SESLHD, St Vincent’s Local Health Network and Sydney Children’s Hospital Network;



impacted on disadvantaged populations;



impact versus investment;



internal capacity and/or capability; and



feasibility

Detailed information regarding the primary care issues/needs identified by ESML can be found in Chapter 7. Detailed methodology, ranking and rationale for ESML’s primary care prioritisations can be found in Chapter 8. Eastern Sydney Medicare Local Needs Assessment Report 2014 - FINAL

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Stage 4 deliverables

3.5

• Identification of primary care service needs and gaps within the ESML catchment • Prioritisation of primary care service needs and gaps within the ESML catchment

Development of this needs assessment report

As a final step, ESML, 360health and Paxton Partners worked collaboratively to bring together the information generated by the quantitative and qualitative data analysis, stakeholder engagement and the needs identification and prioritisation processes to develop ESML’s 2014 CNA Report.

Stage 5 deliverables

3.6

• Delivery of the final ESML Comprehensive Needs Assessment Report. • Delivery of the Comprehensive Needs Assessment Template.

Key success factors

The following factors led to the successful implementation of ESML’s CNA process:  recognition by the ESML CEO of the required internal resources to complete this extensive program of work; 

budget approved by the ESML CEO to engage all necessary external resources;



initiation of work in November 2013 which provided ample time to establish the project teams prior to the Christmas and New Year’s holidays; and



engagement of 360health and Paxton Partners, whose staff have significant experience in all phases of development for Medicare Local 2013 CNA Reports.

3.7

Challenges

The following challenges were identified and addressed during the implementation of ESML’s Comprehensive Needs Assessment process:  ESML staff had to manage and prioritise their day-to-day responsibilities and competing priorities (e.g. accreditation) with their involvement in development of this Report; and 

ESML recognised the time constraints that may have prevented full participation from members of the Project Steering Committee.

The latter was managed by communicating and distributing materials to Project Steering Committee members outside of the Project Steering Committee meetings, as required.

3.8

Lessons learned

The following lessons were learned by the ESML on how they expect the CNA process to evolve:  ESML allowed ample time to carry out all necessary community consultations. 

The attendance at the stakeholder consultation events was above expectations. In addition there was a wide range of both health professionals and consumers in attendance, including many high level, senior staff.

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

Participation from NGO’s was also strong.



Collaboration with key stakeholders is essential in the needs assessment process. A number of key future partnerships could be identified and relationships formed.

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4 Population Characteristics This Chapter describes the population demographics, health status, social determinants, health service utilisation levels associated with the 400,000+ residents within ESML’s 6 sub-regions.

4.1

Approach

In order to identify the population and health characteristics of residents within the Eastern Sydney Medicare Local (ESML), six sub-regional profiles were developed, one for each of the 4 Local Government Areas (LGAs) and 2 Statistical Local Areas (SLAs). These sub regional profiles included a range of indicators, including socio-demographic characteristics, health risk factors, chronic disease prevalence, and health service utilisation, with each indicator benchmarked against the overall ESML catchment and New South Wales, whenever possible. The information within the sub-regional profiles was then aggregated to the level of the ML and used to develop this summary of the population characteristics of the ESML catchment population. The aim of this process was to identify population health needs within ESML by benchmarking data on key indicators at the ESML level to NSW as a whole. In most cases this was possible using the available data; however certain data sets did not provide information at a ML level. As such, information has been presented in two different formats to represent the ESML catchment area population in this report:  ESML: covers the populations of Sydney-Inner Statistical Local Are (SLA), Sydney-East SLA, Waverley LGA, Woollahra LGA, Randwick LGA and Botany Bay LGA. 

Eastern Sydney: covers the populations of Sydney LGA (rather than separate SLAs for Sydney Inner and East), Waverley LGA, Woollahra LGA, Randwick LGA, Botany Bay LGA.

Each profile also included a chapter that summarised the availability of primary care services within the local area. This identified whether service provision in the sub region appeared adequate to meet the current and future health needs of residents living in priority (disadvantaged) neighbourhoods, as well as the sub region as a whole. Whenever possible, each indicator within the sub regional profiles was benchmarked against the average across both the total population of the ESML catchment, and New South Wales as a whole. The process to compile the quantitative analysis included:  liaising with representatives of ESML to determine the form and content of the sub-regional profiles and CNA report, including the availability of any relevant data held by ESML that may inform the development of these documents; 

sourcing, compiling and analysing data from ESML, publicly-accessible data sets and other state and local organisations to feed into the development of ESML’s sub-regional profiles and CNA report;



synthesising the data to construct sub-regional profiles that describe the population characteristics and determinants of health need; and



consolidating the information contained in the sub-regional profiles to produce a CNA report that presents the main population characteristics and determinants of health need across the ESML catchment area.

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4.2

Population characteristics

Overview Table 4.1 provides general characteristics of the ESML catchment and NSW at a glance. The table above shows that the population within the ESML catchment area have greater employment opportunities (2.7% unemployment rate) compared to NSW as a whole (5.3%) as well as enjoying a relative degree of prosperity, as shown by the higher levels of private health insurance coverage within the Medicare Local (ML) catchment area. The forecast population growth of 12.9% within the ESML catchment area is noticeable but below the anticipated levels across NSW as a whole (15.3%). The ESML growth is driven in large part by the anticipated growth in a few key sub regions (see Section 4.2.1). No average household income figure is available across the ML catchment, but given the information available (see Section 4.3.2) it is likely that the average household income would be above the NSW average. That stated, there are definitely degrees of disparity across communities within the region. Table 4.1: Characteristics of ESML catchment and NSW at a glance

Indicator

ESML Catchment

NSW

Population

383,014

7,211,486

Population growth forecast (2011 – 2025)

12.9%

15.3%

% Indigenous persons

0.9%

2.5%

Average household income*

N/A

$64,324

Unemployment^

2.7%

5.3%

% Speak English in the home^

69.8%

76.5%

Private health insurance coverage

56.6%

48.2%

Source: ^Australian Bureau of Statistics; *City profile (profile.id); (unmarked) Public Health Information Development Unit and Australian Bureau of Statistics; N/A equals ‘not available’

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4.2.1

Population demographics

Headlines  A large proportion of the population within the ESML are aged between 20-39. 

Anticipated population growth is greatest for the 65+ age range through 2025.



There is a lower proportion of Indigenous Australians within the ESML compared to NSW as whole.

Figure 4.1 shows that the population profile of Eastern Sydney includes a much higher proportion of residents aged 20-44, compared to NSW. These age ranges account for 48% of the total population within Eastern Sydney, compared to 35% across NSW as a whole. In contrast, a smaller proportion of the Eastern Sydney population is aged under 19 (18%) or over 45 (34%) compared to NSW as a whole (25% aged under 19 and 40% aged over 45 respectively). Figure 4.1: Population profile (by age)

Source: PHIDU and Australian Bureau of Statistics (2013)

Population growth forecasts for Eastern Sydney and NSW between 2011 and 2025 are provided in Figure 4.2. According to the ABS, population growth is expected to be lower in Eastern Sydney (12.9%) compared to NSW as a whole (15.3%) over the period. For both regions growth is expected to be greatest within older populations, with Eastern Sydney and NSW anticipating increases of 36.1% and 36.9% respectively in the over 65 year old age bracket. Within the Eastern Sydney region the fastest growing areas are forecast to be Sydney Inner (88.5%), Waverley (12.6%), and Sydney East (12.2%).

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Figure 4.2: Forecast population growth (2011 to 2025, by age)

Source: PHIDU and Australian Bureau of Statistics (2013)

4.2.2

Birth rate

As noted in Figure 4.3, the birth rate within the Eastern Sydney region (1.31 births per female) is lower than the average for NSW overall (1.80), with all of the six sub regions having birth rates below the NSW figure. Within the ESML catchment areas the birth rate ranges from a high of 1.73 births per female in Botany Bay to a low of 0.81 in Sydney Inner. Figure 4.3: Birth rates

Source: PHIDU and Australian Bureau of Statistics (2013)

4.2.3

Cultural characteristics

The majority of the population in the ESML catchment identifies English as their primary language (70%). This is lower than the average across NSW (77%). Figure 4.4 shows the major primary languages spoken at home in the ESML catchment, with the exception of English. Chinese (6.9%), Greek (2.9%), South East Asian (excluding Thai (2.7%)), Iberian languages (2.4%), Middle Eastern languages (1.6%), South Asian languages (2.4%) and East Slavic (1.5%) are the most common primary languages other than English spoken at home across the catchment. In regards to the major non English speaking communities they are generally focused in specific areas of the sub regions. These include: ď&#x201A;ˇ Chinese: 10% of the population of Randwick are native Chinese speakers as are 24% of the population in Sydney Inner ď&#x201A;ˇ Greek: 6% of the population of Botany Bay are native Greek speakers Eastern Sydney Medicare Local Needs Assessment Report 2014 - FINAL

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ď&#x201A;ˇ ď&#x201A;ˇ

Indo Aryan: 6% of the population of Botany Bay are native speakers of Indo Aryan dialects South East Asian languages: 10% of the population of Sydney Inner is native speakers of South East Asian dialects (excluding Thai) with 9% of the population being native speakers of Thai. Figure 4.4: Primary languages spoken at home

Source: Australian Bureau of Statistics (2012)

Some of the groups of languages noted on the graph above are composed of multiple dialects. Further breakdowns of these groups consisting of multiple different dialects are provided below. South East Asian languages (excluding Thai) As noted in Figure 4.5, 1.83% of the population within the ESML catchment speaks Indonesian in the home compared with 0.38% of the population of NSW. The second most common South East Asian language spoken is Tagalog with 0.40% of the ESML catchment which is lower than the proportion of speakers in NSW as a whole (0.57%). Figure 4.5: Breakdown of South East Asian (excluding Thai) languages

Source: Australian Bureau of Statistics (2012)

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Iberian languages Figure 4.6 provides a breakdown of Iberian languages. 1.68% of the ESML catchment population speaks Spanish in the home compared with 0.85% of the NSW population. There are also higher percentages of Portuguese speakers (0.74%) in the ESML catchment compared with NSW (0.25%). Figure 4.6: Breakdown of Iberian languages

Source: Australian Bureau of Statistics (2012)

Arabic languages Figure 4.7 provides a breakdown of Arabic languages. 0.87% of the ESML catchment population speaks Arabic in the home compared with 2.81% of the NSW population. With regards to Hebrew speakers there are 0.57% in the ESML catchment compared with 0.05% in NSW. Figure 4.7: Breakdown of Arabic languages

Source: Australian Bureau of Statistics (2012)

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South Asian languages Figure 4.8 provides a breakdown of South Asian languages. 0.65% of the ESML catchment population speaks Bengali in the home compared with 0.33% of the NSW population. With regards to Hindi speakers there are 0.40% in the ESML catchment compared with 0.80% across NSW as whole. Figure 4.8: Breakdown of South Asian languages

Source: Australian Bureau of Statistics (2012)

4.2.4

Aboriginal and Torres Strait Islander community

As noted in Figure 4.9, Indigenous Australians comprise 0.9% of the total population of the ESML catchment area, which is lower than NSW as whole (2.4%). The largest proportion of the Indigenous population within ESML is aged between 0-19, which is consistent with the age profile of Indigenous persons across NSW as a whole. Within the ESML catchment the proportion of Indigenous Australians ranges from a high of 1.5% within Botany Bay to a low of 0.2% in Woollahra. In terms of total Indigenous residents, the sub regions with the largest Indigenous populations are Randwick (1,842) and Botany Bay (613). Figure 4.9: Indigenous persons population profile, by age

Source: PHIDU and Australian Bureau of Statistics (2013)

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4.2.5

Family structure

Figure 4.10 shows a breakdown of the predominant family structures living within the catchment. The most common family type in the ESML catchment is a ‘couple family with no children’ (22%), which is broadly consistent with NSW as a whole (24%). The ESML catchment also has lower levels of ‘one parent families’ (7%) and ‘couple family with children’ (19%) compared to NSW (11% and 30% respectively). Despite the ‘couple family with children’ being the second highest proportion in the ESML catchment (19%), in Sydney East and Sydney Inner this group only contributes 6% and 3% to the overall populations. Figure 4.10: Family structure

Source: Australian Bureau of Statistics (2012)

4.2.6

Private health insurance coverage

Figure 4.11 shows that 57% of Eastern Sydney residents have private health insurance compared to 48% across NSW as a whole. Across the sub regions within Eastern Sydney, Woollahra has the highest level of private health insurance coverage (74%), while Botany Bay has the lowest (38%). Figure 4.11: Private health insurance coverage

Source: PHIDU and Australian Bureau of Statistics (2013)

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4.2.7

Broadband internet access

Figure 4.12 shows that broadband internet penetration within the ESML catchment area (75%) is higher than across NSW as a whole (70%). Within the ESML catchment Sydney Inner has the highest rate of broadband internet access (80%) while Botany Bay has the lowest (68%). Figure 4.12: Broadband internet access at home

Source: PHIDU and Australian Bureau of Statistics (2013)

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4.3

Social determinants of health

Headlines  Incomes are higher and unemployment lower within the ESML catchment when compared to NSW as a whole, but there are substantial variations across the sub regions within the ESML 

There are lower levels of income support across the ESML catchment when compared with NSW as a whole



There are proportionately higher levels of homelessness in Sydney Inner and Sydney East compared to NSW.

4.3.1

Socio-economic characteristics

The Socio-Economic Indexes for Areas (SEIFA) provides measures for socio-economic advantage and disadvantage by geographic area. Figure 4.13 highlights the respective percentile rank for both socio economic advantage and disadvantage for each of the sub regions within ESML. Higher percentile ranks indicate greater levels of advantage / less disadvantage. Figure 4.13: Comparison of SEIFA Advantage and Disadvantage percentiles

Source: Australian Bureau of Statistics (2013)

4.3.2

Income

Figure 4.14 shows that average annual household incomes for residents in the ESML catchment and NSW as a whole. Within the ESML catchment there are a higher proportion of households earning more than $78,000 and a lower proportion earning less than $41,000 when compared to NSW. Of the sub-regions all report a higher proportion of the population earning over $65,000 when compared to the NSW average. In terms of the range of incomes, the sub-region with the highest annual average household income is Woollahra with an average of $124,696 whilst the lowest is Botany Bay at $64,740.Closer inspection of the data reveals significant income disparities across ESML. Average household incomes for the other sub-regions are not as diverse as those between Woollahra and Botany Bay but still show some noticeable variations. These include:  Waverley - $99,424 

Sydney LGA - $85,227

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ď&#x201A;ˇ

Randwick - $82,004 Figure 4.14: Average household income

Source: Australian Bureau of Statistics (2012)

Figure 4.15 shows that a lower proportion of people within Eastern Sydney receive income support compared with the NSW population as a whole. The proportion of Eastern Sydney residents receiving income support is approximately half of the NSW figure for all types of income support captured. This reflects the relatively higher incomes and socio-economic advantage for the ESML catchment area illustrated in Figure 4.13 and Figure 4.14. Despite the overall level of income support for Eastern Sydney being consistently lower than for NSW as a whole there is significant variation across the ESML sub-regions. For instance, the percentage of welfare-dependent families in Botany Bay (6.8%) is double that of those in Sydney East (3.4%). Additionally, the proportion of people receiving a disability pension in Botany Bay (4.7%) is almost three times the level in Woollahra (1.3%). Figure 4.15: Income support

Source: PHIDU and Centrelink (2013)

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4.3.3

Employment industry

Figure 4.16 provides the top five industry sectors for employment. An analysis of the jobs held by residents within the ESML catchment area reveals that the top five industry sectors of employment are professional, scientific and technical services (7.6%). health care and social assistance (5.3%), financial and insurance services (4.7%), retail trade (4.0%) and accommodation and food services (4.0%). Together, these five industries employ 25.7% of the population, with the comparable rate across NSW as a whole being 18.9%. Figure 4.16: Top five Industry sectors of employment

Source: Australian Bureau of Statistics (2012)

4.3.4

Employment status

As stated in Figure 4.17, the percentage of people who are unemployed within Eastern Sydney is 2.72%, less than half the unemployment rate for NSW as a whole (5.25%). However, within the sub regions there is significant variation in the unemployment rates. The data shows that Sydney East has the highest unemployment rate of 4.1% compared to Woollahra (1.5%) which has the lowest. Botany Bay has the second highest unemployment rate within the ML (3.5%) combined with the lowest average household income and the highest level of disadvantage as per the SEIFA score. This suggests that Botany Bay is the least economically advantageous of the sub regions. Figure 4.17: Unemployment

Source: PHIDU and Australian Bureau of Statistics (2013)

4.3.5

Education levels

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Within the ESML catchment 58% of people aged over 15 years have completed Year 12 schooling or equivalent. As noted in Figure 4.18, this is substantially higher than the figure for NSW as a whole (38%). The lower rates of completion for other years of schooling (i.e. year 11 and below) are likely to be related to the high completion rates for year 12, rather than significant disparities in the level of schooling obtained. Figure 4.18: Highest year of school completed

Source: Australian Bureau of Statistics (2012)

Data available from PHIDU shows that secondary school participation at age 16 in the ESML catchment area is 83%, which is broadly in line with NSW as a whole (80%). The proportion of school leavers that go on to pursue higher education qualifications from the ESML catchment population is 41% compared to 30% for NSW as a whole. As noted in Figure 4.19, there is a large variation within the sub regions as to the percentage of school leavers that continue to higher education. At the lower end of the spectrum Sydney East (33%), Woollahra (34%) and Botany Bay (36%) are all below average for the ESML catchment. Randwick (42%) and Waverley (50%) are just above the average for the catchment, whilst in Sydney Inner 68% of school leavers go onto higher education.

% of population age cohort

Figure 4.19: Secondary school participation 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Eastern Sydney Secondary School participation at age 16

New South Wales School leavers continuing to higher education

Source: PHIDU and Australian Bureau of Statistics (2012)

4.3.6

Homelessness

Figure 4.20 shows that the per-capita rate of homelessness in the ESML catchment area (1.14%) is higher than the level across NSW as a whole (0.76%). The homelessness data encapsulates a Eastern Sydney Medicare Local Needs Assessment Report 2014 - FINAL

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number of differing social groups including people in ‘temporary housing’, ‘severely crowded dwellings’ and those in ‘improvised dwellings.’ The higher percentage of homelessness within the ESML catchment area is primarily driven by the Sydney East and Sydney Inner regions with proportions of 2.9% and 3.7% respectively. In terms of total numbers of homelessness this translates into 1,502 people for Sydney East and 967 for Sydney Inner. Figure 4.20: Homelessness

Source: Australian Bureau of Statistics (2012)

4.3.7

Social cohesion / community strength

Figure 4.21 shows that Eastern Sydney and NSW as a whole are broadly in line when it comes to indicators of community strength. Both areas feel that they can get support in a time of crisis (both over 80%) with only approximately 5% of the population disagreeing with the acceptance of foreign cultures. For the majority of indicators of community strength the data from the individual sub regions are in line with each other. However, with regards to the ‘disagree with acceptance of other cultures’ the proportion within Sydney Inner (9.7%) is noticeably higher than the other sub regions with the second largest figure being 5.8% in Botany Bay and the lowest being 4.9% in Waverley and Woollahra. Figure 4.21: Indicators of community strength

Source: PHIDU and Australian Bureau of Statistics (2013)

4.3.8

Barriers to accessing services

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Figure 4.22 shows the major barriers to accessing services for the Eastern Sydney population and those within NSW as a whole. Despite the high overall levels of income and socio-economic advantage across ESML, affordability is evident as a barrier to access, with 8.8% of residents citing an inability to afford medical treatment and 5.5% noting that they could not afford medication. A large proportion of people cited that they did not access information through the internet (20.7%), which may hinder knowledge about service availability and the ability to access services in a timely manner. There was a large degree of variation within the sub regions with regards to the proportion of the populations who could not afford medical treatment. This ranged from a high of 11.9% in Botany Bay to a low of 5.2% within Woollahra. Additionally Sydney Inner (11.1%), Sydney East (9.6%) and Randwick (9.5%) all had above average proportions of the population stating that they could not afford medical treatment as a reason for not accessing services. Figure 4.22: Barriers to accessing services

Source: PHIDU and Australian Bureau of Statistics (2013)

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4.4

Health characteristics

Headlines  Low levels of childhood immunisation compared with NSW as whole. 

Levels of pertussis and pneumococcal notifications both decreased in 2012.



Most health risk factors are generally lower than the NSW average.



Higher levels of alcohol-related domestic violence.



Rising levels of STI notifications.



Decreasing levels of infectious disease notifications.

4.4.1

Self-reported health status

Figure 4.23 shows that the levels for fair or poor self-assessed health in Eastern Sydney (12.5%) are lower than across NSW as a whole (16.6%). It also illustrates that the levels of those with restricted core activities are lower within Eastern Sydney (9.3%) than across the state (11.5%). With regards to the proportions of the population with ‘fair or poor self-assessed health’ Botany Bay (17.8%) and Sydney Inner (15.4%) have the highest levels whilst Woollahra (9.7%) and Waverley (11.9%) show the lowest levels. These findings appear to indicate that self-assessed health status is largely consistent with the social determinants of health reported in Section 4.3.

Figure 4.23: Self assessed health

Source: PHIDU and Australian Bureau of Statistics (2013)

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4.4.2

Health risk factors

Figure 4.24 shows that the health risk profile of Eastern Sydney varies when compared to the average across NSW as a whole, but that the proportion of the population at risk is generally lower. The exception to this relates to overweight persons, where the proportion of the population that is overweight is higher in Eastern Sydney than across NSW. For many of the health risk factors identified below there are noticeable levels of variation within the sub regions. These include:  Smoking: 20% of the population within both Sydney East and Sydney Inner identify themselves as smokers compared with 13% in Woollahra 

Physically inactive persons : 40% of the Botany Bay population are physically inactive compared to 24% within Woollahra



Overweight persons: 24% of the population within Sydney East is overweight compared to a low of 19% in Sydney Inner.

Figure 4.24:Health risk factors

Source: PHIDU and Australian Bureau of Statistics (2013)

4.4.3

Immunisation, infant mortality and wellbeing

Childhood immunisation Figure 4.25 shows the percentage of children that are fully immunised at one, two and five years of age. For all ages, immunisation rates within Eastern Sydney are lower than those for NSW as a whole. Indeed, Eastern Sydney has some of the lowest levels of childhood immunisation in Australia, however within the sub regions there is a degree of variation. At the various levels these include:  1 year: 94% of children in Botany Bay are fully immunised at the age of 1 compared to 87% in Waverley 

2 years: 92% of children in Botany Bay are fully immunised compared to 78% in Sydney Inner



5 years: 89% of children in Botany Bay are fully immunised compared to 68% in Sydney Inner, 77% in Sydney East and 80% in Waverley.

When comparing childhood immunisation levels with socio-demographic characteristics and social determinants of health, areas of low childhood immunisation therefore appear to be typically

Physically inactivity is classified by PHIDU as someone who ‘Did not exercise in the two weeks prior to interview through sport, recreation or fitness (including walking) – excludes incidental exercise undertaken for other reasons, such as for work or while engaged in domestic duties’. 3

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associated with areas of high cultural diversity (such as Sydney Inner) or high incomes / socioeconomic advantage (such as Waverley). Figure 4.25: Percentage of children fully immunised

Source: PHIDU and Australian Childhood Immunisation Register / Medicare Australia (2013)

Pertussis Figure 4.26 shows the number of pertussis notifications in Eastern Sydney each year from 2008-12. The graph shows that the volume of notifications increased across Eastern Sydney from 2008-2011 but have subsequently declined and in 2012 had dropped below the 2008 levels. No data was available at a NSW wide level for comparison or benchmarking. Figure 4.26: Pertussis notifications

Source: South Eastern Sydney Local Health District

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Pneumococcal As noted in Figure 4.27, the number of Pneumococcal notifications has increased from 23 in 2008 to 31 in 2012 for the Eastern Sydney region, representing an increase of 34%. However, this is down from a peak of 41 notifications in 2011 as illustrated on the graph below. No data was available at a NSW wide level for comparison or benchmarking. Figure 4.27: Pneumococcal presentations

Source: South Eastern Sydney Local Health District

Maternal and child health Figure 4.28 shows the percentage of low birth weight babies and the percentage of mothers who smoke whilst pregnant within the Eastern Sydney region and across NSW as a whole. The graph shows that the Eastern Sydney region has a lower rate of low birth weight babies (5.5%) than NSW (6.1%), as well as lower rates of smoking whilst pregnant (2.5% compared to 12.0%). With regards to the percentage of low birth weight babies, Botany Bay and Sydney East had the highest levels (7.2% and 7.1% respectively), whilst Waverly and Woollahra had the lowest (4.6% and 4.5%). Figure 4.28: Percentage of low birth weight babies and mothers who smoke whilst pregnant

Source: PHIDU and NSW Ministry of Health (2013)

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4.4.4

Prevalence of chronic disease

Figure 4.29 shows that the prevalence rates for chronic diseases within the Eastern Sydney region are broadly in line with NSW as whole in regards to type 2 diabetes, high cholesterol, mood disorders and respiratory system disease. The greatest variation is in the percentage of the population suffering from circulatory system diseases, where the prevalence in Eastern Sydney is 16% lower than in NSW as a whole. There is general alignment within the sub regions with regards to the prevalence of chronic diseases. However, in the case of circulatory system diseases there is a degree of variation with 15% of the population of Botany Bay reported having some circulatory system disease, compared to 10% in Sydney Inner and Sydney East. Figure 4.29: Prevalence of selected chronic conditions

Source: PHIDU and Australian Bureau of Statistics (2013)

4.4.5

Cancer screening rates

Figure 4.30 shows the percentage of people who were eligible for, and participated in bowel and cervical cancer screening programs in 2010. 30% of those eligible in Eastern Sydney participated in the bowel cancer screening program which was lower than the percentage for NSW as a whole (35%). 60% of those eligible for the cervical cancer screening program within the Eastern Sydney region took part compared with 56% across NSW. No data was available regarding breast cancer screening. With regards to cervical cancer screening participation there is a noticeable variation within the sub regions with 74% of the eligible participants in Woollahra participating compared to 35% within Sydney Inner. Cultural and language barriers may be underpinning these results.

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Figure 4.30: Cancer screening rates

Sources: PHIDU and Department of Health and Ageing (2010). Formal publication and reporting of the NBCSP data is undertaken by the Australian Institute of Health and Welfare on behalf of the Department of Health and Ageing. NBCSP data included in this report provided by the Department of Health and Ageing is not part of the formal publication and reporting process for NBCSP data; PHIDU and NSW Central Cancer Registry (2009 and 2010).

Figure 4.31 shows the proportion of test results in relation to cancer screening programs that indicated some form of abnormality. The percentage of bowel cancer screening participants that showed some form of abnormality was 7.3% in Eastern Sydney which was lower than the rate of 8.4% for NSW as a whole. The rate of low-grade abnormalities from the cervical cancer screening was 4.6% in Eastern Sydney compared with 3.2% in NSW. The rate of high-grade cervical screening abnormalities in Eastern Sydney was 0.8% compared with 0.6% in NSW. Within the sub regions there was a degree of variation in terms of the outcomes of cancer screenings. The positive tests from bowel cancer screening were highest in Botany Bay (9.6%) and lowest within Waverley (5.7%). With regards to the outcomes of the cervical cancer screenings held, the highest level of positive tests for high grade cervical cancer was in Waverley (0.96%) and the lowest in Woollahra (0.68%) The highest level of positive tests that indicated a low-grade cervical abnormality was in Sydney East (5.5%) and the lowest Botany Bay (3.1%).

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Figure 4.31: Comparison of cancer screening outcomes

4.4.6

Prevalence of cancer

Figure 4.32 shows the prevalence of certain cancer types across each of the ESML sub regions and NSW as a whole. Unfortunately, no data at the Medicare Local level was available. The prevalence of specific cancer types are broadly in line across the sub regions and NSW as a whole (e.g. prostate is the most common form and cervical cancer the least). However, when looking at the variations in regards to the prevalence of specific cancer types within the sub regions it is noticeable that there is a wide range of incidences. These include:  Breast: within Woollahra there is a prevalence rate for breast cancer of 0.81 per 1,000 population with 0.65 in Randwick being the next highest and 0.54 in Botany Bay the lowest 

Lung: within Sydney LGA the prevalence rate for lung cancer is 0.56 per 1,000 population with Botany Bay having the next highest rate (0.47) and Woollahra the lowest (0.39)



Prostate: there is large variation in the incidences of prostate cancer between the highest levels (0.93 per 1,000 population in Woollahra and 0.92 in Sydney LGA) compared to those with the lowest rates (0.75 in Waverley and 0.69 in Botany Bay)



Melanoma: Woollahra (0.55 per 1,000 population), Waverley (0.48) and Randwick (0.46) all have noticeably higher levels of melanoma than Sydney LGA (0.35) and Botany Bay (0.27).

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Figure 4.32: Prevalence of selected cancers

Source: Cancer Institute NSW (2010)

4.4.7

Disability

Profound or severe disabilities 'People with profound/severe disability are those who need some ongoing help or supervision with 4 communication, self-care and/or mobility for six months or more’ . Figure 4.33 shows that the levels of profound or severe disability are generally lower in Eastern Sydney than they are across NSW as a whole. Within each category there was a notable range of results in relation to the sub regions. These included:  Profound or severe disability: the highest level was in Botany Bay (4.9%) and the lowest in Sydney Inner (1.1%) 

Profound or severe disability aged over 65: 21% of the over 65 population within Botany Bay suffer from a severe disability compare to 8% within Sydney Inner. Figure 4.33: Proportion of people with profound or severe disabilities

Source: PHIDU and Australian Bureau of Statistics (2013) 4

Australian Bureau of Statistics, accessed from http://www.abs.gov.au/ausstats/abs@.nsf/Products/4367.0~20072008~Main+Features~Introduction?OpenDocument; on 5 Feb 2014 Eastern Sydney Medicare Local Needs Assessment Report 2014 - FINAL

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Need for assistance with core activities Figure 4.34 shows that the proportion of people who require assistance with core activities is lower within the ESML catchment (2.96%) than it is across NSW as a whole (4.69%). With regards the range of results from the sub regions Sydney East had the highest proportion of people in need of assistance with core activities (4.9%) and Sydney Inner the lowest (0.6%). Figure 4.34: Proportion of people who have need for assistance with core activities

Source: Australian Bureau of Statistics (2013)

4.4.8

Mortality

Premature mortality refers to deaths among people aged less than 75 years. Figure 4.35 presents mortality rates from chronic conditions across Eastern Sydney and NSW as a whole for persons aged between 0 and 74. The data shows that premature mortality is higher across NSW as a whole than the within the Eastern Sydney region for all causes reported in Figure 4.35. There are substantial variations in the level of premature mortality by cause across the ESML sub regions, including:  Cancer: there are 0.77 premature deaths per 1,000 people in Woollahra compared to 1.09 in Botany Bay 

Circulatory system disease: there are 0.62 premature deaths per 1,000 people in Sydney East compared to 0.29 in Woollahra and 0.33 in Waverley



Respiratory disease: there are 0.18 premature deaths per 1,000 of the population in Botany Bay and 0.15 in Sydney East compared to 0.05 in Woollahra



External causes: there are 0.43 premature deaths per 1,000 population in Sydney East compared to 0.19 in Waverley



Suicide: the suicide rate in Sydney East is 0.21 per 1,000 population which is almost double the next highest (Sydney Inner - 0.12). The lowest rates of suicide were recorded in Botany Bay and Waverley (0.08 per 1,000 population).

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Figure 4.35: Premature mortality from chronic disease (ages 0 to 74 years) and external causes

Source: PHIDU and Australian Bureau of Statistics (2013)

Avoidable mortality A potentially avoidable death is one that, theoretically, could have been avoided given an understanding of causation, the adoption of available disease prevention initiatives and the use of 5 available health care. Figure 4.36 illustrates that the per-capita rate of avoidable mortality in Eastern Sydney (0.82 per 1,000 of the population) is 10% lower than the NSW rate (0.91). With regards to the range of potentially avoidable deaths per 1,000 persons within the ESML sub regions, Woollahra has the lowest rate (0.65 per 1,000 population), whilst Sydney LGA has the highest rate (1.39 per 1,000 persons). Figure 4.36: Potentially avoidable deaths per 1,000 persons

Source: Health Statistics NSW and NSW Ministry of Health

4.4.9

Incidence of alcohol-related domestic violence

Figure 4.37 illustrates that the alcohol-related domestic violence rates are higher across Eastern Sydney (1.45 incidences per 1,000 population) than within NSW as a whole (1.39).

Australian Bureau of Statistics, accessed from http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/1370.0~2010~Chapter~Potentially%20avoidabl e%20deaths%20 on 5 February 2014 Eastern Sydney Medicare Local Needs Assessment Report 2014 - FINAL

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Within the sub regions Sydney LGA has the highest rate of alcohol related domestic violence (2.4 per 1,000 population) and Woollahra the lowest (0.6 per 1,000 population). Figure 4.37: Comparison of alcohol related domestic violence incidence

Source: NSW Bureau of Crime Statistics and Research (2012)

4.4.10 Sexually Transmissible Infections (STIs) HIV Figure 4.38 illustrates the volume of HIV notifications since 2011. The data is split between those notifications that occurred in Sydney LGA (dark blue) and those in the rest of the ESML catchment (light blue). The reason the data has been presented in this format is due to the sensitivities around providing it at an LGA level due to the low levels of notifications in certain LGAs. The data shows that from 2011 to 2012 notifications increased in Sydney LGA by 31%, but decreased by 20% in the rest of the region. This resulted in a 15% overall increase. Figure 4.38: HIV notifications

Source: South Eastern Sydney Local Health District

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Chlamydia Figure 4.39 shows the annual number of notifications of Chlamydia within Eastern Sydney over the period from 2008-12. The overall number of notifications for Eastern Sydney has increased from 1,887 in 2008 to 2,556 n 2012, representing an increase of 35%. Of the 2,556 notifications of Chlamydia in 2012 1,258 (49%) occurred within the Sydney LGA, with notifications in the LGA up 14% from 2011. Figure 4.39:Chlamydia notifications

Source: South Eastern Sydney Local Health District

Rectal Chlamydia in males Figure 4.40 shows the annual number of notifications of rectal Chlamydia in males in Eastern Sydney over the period from 2008-12. The overall number of notifications for Eastern Sydney has increased from 249 in 2008 to 429 in 2012, representing an increase of 72%. Of the 429 notifications in 2012, 329 (77%) occurred within the Sydney LGA, with notifications in the LGA up 24% from 2011. Figure 4.40: Rectal Chlamydia notifications

Source: South Eastern Sydney Local Health District

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Gonorrhea Figure 4.41 shows the annual number of notifications of gonorrhea in Eastern Sydney over the period from 2008-12. The overall number of notifications for Eastern Sydney has increased from 384 in 2008 to 1,114 in 2012, representing an increase of 290%. The areas of the greatest percentage growth over the period have been Botany Bay (473%) and Woollahra (433%). However both started with relatively low numbers of notifications (11 and 24 respectively). In terms of actual notifications Sydney LGA has seen the greatest increase, with instances rising from 262 in 2008 to 751 in 2012. Additionally the number of notifications has increased from 464 in 2011 to 751 in 2012 representing a 162% increase within the most recent year that data is available for. Figure 4.41: Gonorrhea notifications

Source: South Eastern Sydney Local Health District

Syphilis Figure 4.42 shows the annual number of notifications of Syphilis in Eastern Sydney over the period from 2008-12. The overall number of notifications for Eastern Sydney has increased from 179 in 2008 to 191 in 2012, representing an increase of 6%. Of the 191 notifications 136 occurred within Sydney LGA representing 71% of the total notifications. This figure was up from 112 notifications in 2011, an increase of 21%. Figure 4.42: Syphilis notifications

Source: South Eastern Sydney Local Health District

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4.4.11 Infectious disease Hepatitis B As noted in Figure 4.43, there has been a downward trend in the number of Hepatitis B notifications in Eastern Sydney from 210 in 2008 to 137 in 2012, a decrease of 35%. The areas with the greatest number of Hepatitis B notifications amongst the sub regions in 2012 were Randwick (37), Botany Bay (21) and Sydney LGA (67). Figure 4.43: Hepatitis B notifications

Source: South Eastern Sydney Local Health District

Hepatitis C Figure 4.44 illustrates the number of Hepatitis C notifications in the Eastern Sydney region annually from 2008 to 2012. The overall figure for Eastern Sydney has declined from 256 notifications in 2008 to 179 in 2012, a decrease of 30%. As with Hepatitis B the sub regions with the greatest number of notifications are Botany Bay (15), Randwick (46) and Sydney LGA (100). Figure 4.44: Hepatitis C notifications

Source: South Eastern Sydney Local Health District

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4.5

Health service utilisation

Headlines  There are higher levels of hospitalisation per 1,000 population in Eastern Sydney when compared to NSW as whole 

There are higher levels of hospitalisations from risk factors (smoking, alcohol related, falls) in Eastern Sydney compared to NSW as a whole



There are lower levels of preventable hospitalisations in Eastern Sydney compared to NSW as a whole



Hospitalisations from coronary heart disease, high body mass and diabetes are all above NSW averages

4.5.1 Primary care utilisation Primary care utilisation Figure 4.Figure 4.45 shows that the number of primary care services per-capita billed to the MBS for Eastern Sydney were generally lower than those for NSW as a whole. When looking at the outputs within the sub regions of Eastern Sydney there are a number of notable variations between them. These include:  45 year old health checks: in Botany Bay there are 55 checks per 1,000 population compared to 27 in Woollahra. 

GP health assessments: Botany Bay (201 per 1,000 population) and Randwick (167) have the highest rate of MBS billed services with Woollahra (93) and Sydney Inner (97) having the lowest.



Practice nurse services: Botany Bay (157 per 1,000 population) and Sydney East (162) have the highest level Practice Nurse services with Waverley (79) and Woollahra (90) having the lowest levels



Mental health care plans: In Sydney Inner there were 154 mental health care plans per 1,000 population prepared by GPs. No other sub region had more than 98, with Randwick having the lowest level of 77.

This data seems to show a generally inverse relationship between the number of services billed to the MBS and levels of private health insurance coverage. Interestingly, areas of low private health insurance coverage, such as Botany Bay, generally reported high rates of billing to the MBS, whereas areas of high PHI coverage such as Waverley and Woollahra tended to report receiving a lower number of MBS services.

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Figure 4.45: Selected primary care services

Source: PHIDU and Department of Health and Ageing (2013)

Figure 4.46 shows that the level of GP MBS services delivered per person per year is lower in the Eastern Sydney region (5.1 services per person) than across NSW as a whole (5.8). When looking at the range of GP services provided per person at the sub regional level the highest rates were found to be in Botany Bay (6.3 services per person) with the lowest in Sydney Inner (3.5). Figure 4.46: MBS GP services per person

Source: PHIDU and Department of Health and Ageing (2013)

4.5.2 Hospital admissions Figure 4.47 illustrates that the hospitalisation rates for Eastern Sydney (404 per 1,000 population) are 12% higher than the whole of NSW rate (360). The admission rates across Eastern Sydney are all relatively consistent with four of the five regions having levels in excess of 400 per 1,000 population, with only Sydney LGA (321 per 1,000 population) falling below that level.

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Figure 4.47: Hospitalisation rate

Source: NSW Health Statistics and NSW Ministry of Health (2011)

4.5.3 Top 10 causes for hospital admission Figure 4.48 outlines the top 10 causes of hospitalisation within the ESML catchment area by Diagnosis-Related Group (DRG) along with the number of separations for each DRG. It shows that same day rehabilitation is the most common cause of hospitalisation across ESML by a significant margin. Other common causes for hospitalisation included investigatory procedures such as nd th rd th gastroscopy (2 and 7 ), colonoscopy (3 ) and endoscopy (5 ). Metal health-related disorders were also the fourth-most-common reason for hospital admission. Figure 4.48: Top 10 causes of hospitalisation

Source: South Eastern Sydney Local Health District

4.5.4 Ambulatory care sensitive conditions (ACSCs) Ambulatory care sensitive conditions (ACSCs) are those for which hospitalisation is thought to be avoidable with the application of preventive care and early disease management, usually delivered in the ambulatory setting. Figure 4.49 shows that the levels of preventable hospitalisations for ACSCs are lower in Eastern Sydney (20.7 per 1,000 population) than NSW as a whole (23.8). This may suggest that the higher rates of hospitalisation overall across Eastern Sydney (as shown in Figure 4.) are for more complex disorders that are not easily preventable through primary care interventions. Across the sub regions the highest levels of preventable hospitalisations were recorded in Botany Bay (25.6 per 1,000 population) and Randwick (23.3) with the lowest rate being recorded in Woollahra (19.3).

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Figure 4.49: Preventable hospitalisations for ambulatory-care sensitive conditions

Source: NSW Ministry of Health and Health Statistics NSW (2012)

4.5.5 Hospitalisations relating to conditions of interest This section presents data describing the number of hospitalisations per 1,000 persons for stroke, coronary heart disease and diabetes. Stroke Figure 4.50 shows the number of hospitalisations per 1,000 population as a result of stroke are lower across the Eastern Sydney region (1.37 per 1,000 population) compared to NSW as a whole (1.43). The figure for Eastern Sydney is based on the smoothed number of separations and rate per 100,000 extracted from NSW Health Statistics data. Across ESMLâ&#x20AC;&#x2122;s sub regions the prevalence of stroke related hospitalisations ranges from a low of 1.12 per 1,000 population in Waverley to 1.56 within the Sydney LGA. Figure 4.50: Stroke hospitalisations

Source: NSW Ministry of Health and Health Statistics NSW (2012) Note: * The data available for the Sydney LGA includes the east, inner, south and west but excludes Northern Sydney. This differs from the area covered by the ESML catchment which includes only Sydney (Inner) and Sydney (East).

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Coronary artery disease Figure 4.51 shows that the number of hospitalisations as a result of coronary heart disease per 1,000 population is higher within Eastern Sydney (6.7 per 1,000 population) than across NSW as a whole (6.1). This is in part driven by the high rates within Botany Bay (10.6) and Randwick (8.7). The figure for Eastern Sydney is based on the smoothed number of separations and rate per 100,000 extracted from NSW Health Statistics data. Figure 4.51: Coronary heart disease hospitalisations

Source: NSW Ministry of Health and Health Statistics NSW (2012)

Diabetes Figure 4.52 shows level of diabetes related hospitalisations per 1,000 population is higher within Eastern Sydney (1.6 per 1,000 population) than NSW as a whole (1.5). Within Eastern Sydney there is noticeable variation at the sub regional level with Botany Bay (2.1) and Randwick (1.9) having the highest levels of diabetes-related hospitalisations and Woollahra (1.1) the lowest. The figure for Eastern Sydney is based on the smoothed number of separations and rate per 100,000 extracted from NSW Health Statistics data. Figure 4.52: Diabetes related hospitalisations

Source: NSW Ministry of Health and Health Statistics NSW (2012)

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4.5.6 Hospitalisations associated with risk factors This section presents data on hospitalisations arising from modifiable risk factors, including alcohol, smoking, high body mass and falls. Alcohol Figure 4.53 shows that the number of alcohol-related hospitalisations is 31% higher in Eastern Sydney (8.8 per 1,000 population) compared with NSW as a whole (6.7). This is partially driven by high rates of alcohol-related hospitalisation in the Sydney (9.9), Waverley (9.4) and Woollahra (9.7) LGAs. The figure for Eastern Sydney is based on the smoothed number of separations and rate per 100,000 extracted from NSW Health Statistics data. Figure 4.53: Alcohol related hospitalisations

Smoking Figure 4.54 shows that the levels of smoking-related hospitalisations are higher in the Eastern Sydney region (6.2 per 1,000 population) compared to NSW as a whole (5.7). The areas within Eastern Sydney with the highest levels of smoking-related hospitalisations are Botany Bay (6.5 per 1,000) and Woollahra (6.3), with Waverley having the lowest level of smoking related hospitalisations (5.9). The figure for Eastern Sydney is based on the smoothed number of separations and rate per 100,000 extracted from NSW Health Statistics data. Figure 4.54: Smoking related hospitalisation

Source: NSW Ministry of Health and Health Statistics NSW (2012)

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High body mass Figure 4.55 illustrates the levels of hospitalisation related to high body mass are higher within Eastern Sydney (4.6 per 1,000 population) than across NS as a whole (4.4). This has been primarily driven by the above average rates of hospitalisations related to high body mass in Botany Bay (6.3) and Randwick (5.0). Additionally Botany Bay has the highest proportion of obese persons in the ML (14.3%). However, Randwick shows the second lowest level of obesity (11.8%) suggesting that there is no direct link between the level of the population with high body mass and those classified as obese. Woollahra has the lowest level of obesity (11.6%) and the Eastern Sydney average (12.6%) is below that of NSW as whole (14.0%). The figure for Eastern Sydney is based on the smoothed number of separations and rate per 100,000 extracted from NSW Health Statistics data. Figure 4.55: High body mass related hospitalisations

Source: NSW Ministry of Health and Health Statistics NSW (2012)

Falls Figure 4.56 shows that the number of fall-related injuries per 1,000 population aged over 65 is 19% higher in Eastern Sydney (37.1 per 1,000 population) than across NSW as a whole (31.3). All of the sub regions recorded levels above the NSW average with Randwick having the highest level (39.9) and Woollahra the lowest (32.9). The figure for Eastern Sydney is based on the smoothed number of separations and rate per 100,000 extracted from NSW Health Statistics data. Figure 4.56: Fall related injuries

Source: NSW Ministry of Health and Health Statistics NSW (2012)

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4.5.7

Mental health services

Figure 4.57 illustrates the correlation between the percentages of total ESML residents in each sub region compared to the percentage of total ATAPS referrals. The graph shows that Randwick provides a disproportionate number of ATAPS referrals (48% of all referrals compared to the population of the sub region (36%). All other sub regions have greater proportions of the ML population that they do residents with ATAPs referrals. This discrepancy between the two (population minus ATAPS referrals) is greatest in Woollahra (6%) and Botany Bay (5%). No data was available for NSW as a whole. Figure 4.57: Percentage of ATAPS referrals by sub region

Source: Eastern Sydney Medicare Local

4.5.8 Home and community care (HACC) Figure 4.58 shows characteristics of HACC clients in Eastern Sydney compared to NSW as a whole. Major differences in the profile of HACC clients in Eastern Sydney relate to the proportion of nonEnglish speaking clients (19.5%), compared to NSW (10.5%), the percentage of clients living alone (46.1% across ESML compared to 38.8% for NSW) and the level of clients with carers (11.3% for ESML compared to 20.9% across NSW). Figure 4.58: Characteristics of HACC clients

Source: PHIDU and Department of Health and Ageing (2013)

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With regards to the variations across the ESML sub-regions the following results are pertinent:  Clients living alone: 59.7% of clients live alone in Sydney East compared with a low of 36.2% in Botany Bay 

Clients with carer: 12.6% of HACC clients in Woollahra have a carer compared with a low of 5.8% in Sydney East



Indigenous clients: 3.0 % of HACC clients in Botany Bay and Sydney Inner are Indigenous compared to a low of 0.3% in Waverley



Non English speaking clients: 29.3% of HACC clients in Botany Bay do not speak English compared to a low of 16.3% in Waverley.

Figure 5.59 presents the number of instances of care for selected HACC services across the Eastern Sydney region compared to NSW as a whole. Notably, the greatest variances in HACC service utilisation relate to:  Centre-based day care services (3.6 instances per 1,000 compared to 2.6 in NSW) 

Care coordination services (3.1 instances per 1,000 compared to 4.3 in NSW)



Allied health care in the home (4.2 instances per 1,000 compared to 2.6 in NSW). Figure 5.59: Utilisation of HACC services

Source: PHIDU and Department of Health and Ageing (2013)

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5 Service Availability This Chapter describes the level of health services currently available to meet the needs of the 400,000+ residents within ESML’s 6 sub-regions.

5.1

Approach

The approach used to compile information on service availability within the ESML catchment mirrored the approach used to define the population characteristics found in Chapter 4. The process to compile the quantitative analysis included:  liaising with representatives of ESML to determine the form and content of the sub-regional profiles and Comprehensive Needs Assessment (CNA) report, including the availability of any data held by ESML that may inform the development of these documents;  sourcing, compiling and analysing data from stakeholders, publicly-available resources and other sources to feed into the development of ESML’s sub-regional profiles and CNA report;  synthesis of the data to construct sub-regional profiles that describe the population characteristics and determinants of health need; and  synthesis and consolidation of the information contained in the sub-regional profiles to produce a CNA report that presents the main population characteristics and determinants of health need across the ESML catchment area.

5.2

Health service availability

Headlines  Availability of GPs is above a national benchmark but below NSW average levels. 

Large variation across the sub regions in terms of the availability of community and mental health providers.



Below the NSW average for the availability of aged care beds.

5.2.1

Hospitals

There are a number of public and private hospitals of various size and type throughout the ESML catchment area. The largest of these is the Prince of Wales hospital in Randwick which acts as the major tertiary and trauma unit in the region. Eastern Sydney is well served by a variety of hospitals of varying size, sector and service mix. Other major hospitals include St Vincent’s Darlinghurst, Royal Hospital for Women, Sydney Children’s Hospital, Prince of Wales Private and St Vincent’s Private Hospital. As noted in Table 5.1, there are six public hospitals within the ESML catchment area (3 in Randwick, 2 in Sydney Inner and 1 in Sydney East), providing approximately 1,200 inpatient beds. Prince of Wales, St Vincent’s and Sydney / Sydney Eye hospitals all provide general, 24 hour emergency services. Specialist emergency services are available for women and children via the Royal Women’s and Sydney Children’s Hospitals.

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Table 5.1: Hospitals located within the ESML catchment by type

Sub region

Hospital type

No of beds

Prince of Wales Hospital

Randwick

Principal referral hospital

526

Royal Hospital for Women

Randwick

Specialist hospital for women and babies

122

Sydney Children’s Hospital

Randwick

Specialist children’s hospital

142

St Vincent’s Darlinghurst

Sydney – East

Principal referral hospital

358

Sydney Hospital

Sydney – Inner

Tertiary referral for hand trauma, emergency room

Sydney Eye Hospital

Sydney – Inner

Specialist in eye, hand and sexual health as well as specialist alcohol and other drug treatment services

War Memorial Hospital

Waverley

Sub-acute / rehabilitation and assessment facility for people aged over 60 years

Sydney Dental Hospital

Sydney – East

Outpatient dental Services

St Vincent’s Private Hospital

Sydney – East

Private hospital, providing a broad spectrum of inpatient services excluding obstetrics and paediatrics

250

Prince of Wales Private

Randwick

Private inpatient, day surgery, comprehensive service offerings including coronary and intensive care

168

Rehabilitation hospital

N/A

Hospital name Public acute hospitals

Public, non-acute facilities

Private acute hospitals

Private, sub-acute facilities Eastern Suburbs Private Randwick Hospital Sacred Heart Hospice

Sydney – East

Public / private, palliative care and rehabilitation

St Luke’s Hospital

Sydney – East

General, surgical and rehabilitation hospital

Wolper Jewish Hospital

Woollahra

Specialist medical and rehabilitation centre

5.2.2 General Practitioners Figure 5.1 shows that the number of GPs per 1,000 population is lower within Eastern Sydney when compared to NSW. The graph also provides a benchmark number of GPs per-capita, which has been 6 identified from research undertaken and published in the Australian Journal of Rural Health . 6

Benchmark figure is 1 GP per every 1133 people (0.88 per 1,000) based on: May J, Jones et all, ‘GP perceptions of workforce shortage in a rural setting’ (2007); Wilkinson D. Inequitable distribution of general practitioners in Australia, Australian Eastern Sydney Medicare Local Needs Assessment Report 2014 - FINAL

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The Eastern Sydney average (1.77 per 1,000 population) meets the benchmark of 0.88 GP per 1,000 population, but is lower than the NSW figure (3.5) Within the ESML sub-regions, Sydney LGA (2.26 GP’s per 1,000 population) and Woollahra (2.07) have the highest number of GPs per capita, whilst Botany Bay (0.88) and Randwick (1.41) reported the lowest.

Figure 5.1: GPs per 1,000 population

Source: Health Workforce Australia (2013)

After hours GP services ‘After hours’ services are defined as any primary service that is open: 

Before 8:00am and after 6pm weekdays



Before 8:00am and after 12:00pm on Saturdays



All day Sundays and public holidays.

The data illustrated in Figure 5.2 shows the number of general practices in the region registered with the ESML after hours program. There are 191 such practices within the ESML catchment area and the graph shows their distribution throughout the sub regions. The high number of after-hours GP clinics in Randwick is somewhat surprising, considering that the HWA data discussed above indicates that Randwick has the second-lowest number of GPs per capita of any sub-region across ESML.

Journal of Rural Health (2000); May J, Morrissey et al ‘Supporting the rural GP workforce: impact of a managed care practice. In, Proceedings, General Practice & Primary Health Care Conference; 5-7July 2006; Perth, WA; (2006). Eastern Sydney Medicare Local Needs Assessment Report 2014 - FINAL

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Figure 5.2: After hours GP clinics

Source: Eastern Sydney Medicare Local

5.2.3 Allied health services Figure 5.3 Figure shows the number of Allied health practitioners per 1,000 population by discipline across the Eastern Sydney region, compared to NSW as a whole. The graph shows that Eastern Sydney has higher levels of Allied health practitioners for all disciplines except of Podiatry. The rates of allied health availability are broadly in line with the rate across NSW except for Occupational Therapists (OTs), Optometrists and Psychologists, where the Eastern Sydney region has substantially more practitioners’ per-capita. Figure 5.3: Allied health Practitioners

Source: Health Workforce Australia (2013)

5.2.4

Mental health services

Figure 5.4 shows the total number of providers of ‘Access to Allied Psychological Services’ (ATAPS) by sub region, as well as providing a calculation to show the number per 100,000 population. By comparing the two different metrics we can see that despite having a high number of ATAPS providers Randwick has a noticeably lower level of providers per 100,000 population (18) compared to Waverley (36) Woollahra (33) and Sydney LGA (31). The graph also highlights the low level of ATAPS providers within Botany Bay (13 per 100,000 population). This data was provided by ESML and as such no NSW wide data has been made available for the purposes of comparison.

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Figure 5.4: Number of ATAPS providers

Source: Eastern Sydney Medicare Local

Table 5.2 illustrates the number of available mental health facilities within the ESML catchment area at an aggregated and a sub-regional level. Many of the facilities within the region will offer more than one service type. However, in order to identify the number of facilities in the region we have only included each facility once in the table below. This means that they have been grouped under the classification that best fits their primary service offering. Table 5.2: Mental health providers Adolescent mental Health General mental health services General Mental Health Services Mental Health Advocacy Mental health assessment/triage/ crisis response Mental health case management/continuing care Mental health information/referral Mental health inpatient services (hospital psychiatric unit) Mental Health non-residential rehabilitation Mental health residential rehabilitation/community care unit Psychiatry (requires referral) Psychology ESML Total

Botany Sydney Sydney Randwick Waverley Woollahra Bay (C) - Inner (C) - East (c) (A) (A) 0 0 1 0 0 0 0 2 1 3 0 0 0 2 1 3 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 2 4 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 20 5 2 6 2 0 15 1 6 7 4 0 43 13 15 14 6

ESML Total 1 6 6 0 1 1 6 1 1 0 35 33 91

Source: Eastern Sydney Medicare Local / National Health Service Directory (2013)

5.2.5

Community health services

Table 5.3 illustrates the number of unique community health service facilities within the ESML catchment area at an aggregated and a sub-regional level. As was the case with mental health facilities, many of the community health facilities within the region will offer more than one service type (listed in the first column of the table below). However, in order to identify the number of facilities in the region we have only included each facility in the table below once. This means that they have been grouped under the classification that best fits their primary service offering.

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Table 5.3: Community health centres

Aboriginal health Community cancer services Community health care Health advocacy/liaison services Health information /referral Immunisation Maternal and child health Nursing lead clinics Sexual health Social support Veterans services Women's health clinic Youth drop in/assistance/support Total

Botany Bay 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Sydney Sydney Randwick Waverley Woollahra (C) - Inner (C) - East (c) (A) (A) 1 1 0 0 0 2 1 1 0 1 4 2 2 2 2 1 1 0 0 0 8 4 2 0 0 1 0 1 0 1 1 0 1 0 0 0 0 1 0 0 5 4 0 0 0 0 0 0 0 0 1 1 0 0 0 2 0 2 0 0 2 0 0 1 0 28 14 10 3 4

Total 2 5 12 2 14 3 2 1 9 0 2 4 3 59

Source: South East Sydney Local Health District (2013) and National Health Services Directory (2013)

5.2.6 Aged care services Figure 5.5 illustrates the availability of aged care services across Eastern Sydney and NSW as a whole broken down into high, low and community-based aged care. This shows that there are higher levels of high care facilities across Eastern Sydney (45.7 places per 1,000 people over 70) compared to NSW as a whole (45.2). However, there are a lower number of places per 1,000 population across Eastern Sydney for low (34.8) and community aged care (16.2) compared to NSW as a whole (42.3 and 24.3 respectively). There is a noticeable degree of variation regarding the level of aged care places available at a subregional level:  High care: there are 77 high care places per 1,000 population in Sydney East compared a low of 18 in Woollahra 

Low care: there are 91 low care places per 1,000 population in Sydney East compared to a low of 9 in Sydney Inner and 14 in Botany Bay



Community care: there are 65 and 63 community care places per 1,000 population in Sydney East and Sydney Inner respectively compared to a low of 2 in Randwick and 28 in Waverley. Figure 5.5: Aged care availability

Source: PHIDU and Department of Health and Ageing (2013)

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6 Stakeholder Engagement This Chapter provides an overview of the ESML CNA stakeholder engagement plan and a summary of the qualitative data collected through stakeholder engagement to understand the primary health service needs and service gaps of residents.

6.1

Aims of stakeholder engagement

The aims of ESML’s stakeholder engagement plan associated to the development of a Needs Assessment Report were to:  validate the findings of the six sub-regional population health profiles;

6.2



fill any information gaps relating to primary care service needs and gaps throughout the ESML catchment;



educate key stakeholders on any unique population and community characteristics associated to residents living in the catchment, and



complement any ESML stakeholder engagement strategies currently underway by staff.

Stakeholder engagement plan

An effective community consultative plan reflects a multi-faceted approach, one which leverages existing engagement channels with intuitive, cost-effective channels that best engage key stakeholders and the broader community. ESML used the findings from the 6 sub-regional profiles to inform the development of their Community Engagement Strategy (Figure 6.1). As based on the engagement principles advocated by the International Association for Public Participation (IAP2), a variety of engagement methods were chosen to ensure that the above objectives were met; notably, the use of face-to-face meetings with subject matter experts and a series of stakeholder engagement forums.

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Figure 6.1: ESML CNA Stakeholder Engagement Plan

Face-to-face meetings with subject matter experts

Finalise the 6 sub-regional profiles

ESML Staff ESML CNA Project Steering Committee

Stakeholder Engagement Forums (by invitation)

Botany Bay LGA

Randwick LGA

Botany Bay Council Waverley LGA City of Sydney Council Woollahra LGA SESLHD Multi-cultural Services SESLHD Drug and Alcohol Unit

Sydney SLA

Housing NSW

NSW Planning and Infrastructure

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As detailed in Figure 6.2, ESML’s stakeholder engagement plan was executed over a 6 week period. Figure 6.2: Execution of the ESML Community Engagement Strategy ESML staff engagement

ESML CNA Project Steering Committee

• Held in conjunction with regularly scheduled staff meeting (includes all staff) • Held 26 February 2014

• Sought feedback on the 6 draft sub-regional profiles • Held Tuesday, 11 March 2014

Face-to-face meetings

Stakeholder forums

• Key service providers and organisations approached based on the outputs of the 6 subregional profiles. • 7 meetings held • Held 12 February - 2 April 2014

• Invitations extended to key service providers and health professionals as based on the outputs of the 6 subregional profiles. • Forums held in Botany Bay, Waverley, Randwick and Sydney. • Held 18th 24th March 2014

6.2.1 Engagement with ESML Staff ESML staff was formally engaged with development of the Comprehensive Needs Assessment Report process during a regularly scheduled staff meeting held 26 February 2014. The aims of engagement with ESML staff were three-fold: 

to share the high-level findings from the 6 sub-regional population health profiles;



to validate (or not) the ESML Project Steering Committee’s thinking on the unique socioeconomic characteristics, health status profiles, and primary care service needs and gaps of their community; and



to seek assistance in engaging key stakeholders and the broader community.

The feedback received from stakeholders attending the community forums is discussed in detail in Section 6.3.1. 6.2.2 Engagement with the ESML CNA Project Steering Committee A Project Steering Committee meeting was held on the evening of Tuesday, 11 March 2014 to solicit feedback from the members on the 6 sub-regional profiles. The primary objectives of this meeting were to: 1. Discuss the availability and limitations of data. 2. Validate the findings of the six sub-regional population health profiles. 3. Fill any information gaps relating to primary care service needs and gaps throughout the ESML catchment. ESML staff sought feedback separately from members unable to attend. 6.2.3 Face-to-face meetings A total of seven face-to-face meetings were held with NSW Department of Planning and Infrastructure, Botany Bay Council, City of Sydney Department of Social Programs, SESLHD Drug & Alcohol Unit, SESLHD Department of Multicultural Health, Justice Health and Housing NSW. Table 6.1 outlines the specific aims of these consultations. Table 6.1: Purpose of engagement for face-to-face meetings

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Organisation

Purpose for engagement

NSW Planning and Infrastructure



Learn more details regarding the (confirmed) high growth areas within the ESML catchment area over the next 1-3 years.

Botany Bay Council



Share and validate the results of the Botany Bay sub-regional profile.



Discuss what is working well, not working well in meeting the primary care service needs of Botany Bay residents.



Discuss ways in which ESML and the Council can work together to better meet the primary care needs of its residents.



Share and validate the results of the Sydney-Inner and Sydney-East sub-regional profiles.



Discuss what is working well, not working well in meeting the primary care service needs of Sydney residents.



Discuss ways in which ESML and the Council can work together to better meet the primary care needs of its residents.



Share and validate the results of the sub-regional profiles as they relate to risky drug and alcohol behaviours.



Discuss what is working well, not working well in meeting the primary care service needs of residents experiencing risky or addictive drug and alcohol behaviours.



Discuss ways in which ESML and the SESLHD can work together to better meet the primary care needs of these residents.



Share and validate the results of the sub-regional profiles as they relate to the needs of multicultural communities.



Discuss what is working well, not working well in meeting the primary care service needs of multicultural residents.



Discuss ways in which ESML and the SESLHD can work together to better meet the primary care needs of these residents.



Share and validate the results of the sub-regional profiles as they relate to released prisoners returning to the ESML catchment.



Discuss what is working well, not working well in meeting the primary care service needs of these residents.



Discuss ways in which ESML and Justice Health can work together to better meet the primary care needs of these residents.



Share and validate the results of the sub-regional profiles as they relate to homelessness.



Discuss what is working well, not working well in meeting the primary care service needs of imminently homeless, homeless and newly tenanted residents.



Discuss ways in which ESML and the SESLHD can work together to better meet the primary care needs of imminently homeless, homeless and newly tenanted residents.

City of Sydney CouncilSocial Programs

SESLHD Drug and Alcohol

SESLHD Multi-cultural Health

Justice Health - Long Bay Correctional Complex Care Navigation Team

Housing NSW

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A detailed summary of the feedback obtained from key stakeholders during these face-to-face meetings can be found in Section 6.3.2. 6.2.4 Stakeholder forums th th As noted in Table 6.2, four stakeholder forums were conducted by ESML from 18 -24 March 2014 that were attended by 56 people representing community-based service organisations (e.g. Multicultural Resource Centre and other NGOs), members of the SESLHD and ESML staff and the broader community. Table 6.2: Summary of attendance at ESML Stakeholder Forums

Location

Date

Botany Bay LGA

Thursday, 20 March 2014

Randwick LGA

Tuesday, 18 March 2014

Sydney SLAs

Friday, 21 March 2014

Waverley LGA

Monday, 24 March 2014

All logistics including venue selection and hire, and catering requirements were handled by Ms Lorna Stevens, Manager of Community and Stakeholder Engagement for ESML. Venues were primarily selected due to their a) close proximity to public transport and b) accessibility. Each stakeholder forum followed a consistent 3 ½ hour agenda: 

Welcome / Forum aims and objectives / Overview of ESML – provided by a representative of the ESML Management Team



Eastern Sydney Medicare Local Needs Assessment Sub-profile results – provided by Ms Lissa Smith, Consultant, 360health



Breakout sessions regarding local health needs (#1)



Morning Tea



Breakout sessions regarding local health needs (#2)



Summary



Forum close - lunch

Whenever possible, the breakout sessions provided participants with an opportunity to comment on the provision of services relating to a particular topic or area of interest, with emphasis placed on challenges encountered by vulnerable populations. These topics included:  After Hours Health Services 

Aged Care



Chronic Disease and Cancer



Homelessness



Maternal / Infant / Child



Mental health / Drug and Alcohol



Other issues which participants expressed an interest in during the session

As outlined in Figure 6.3, a consistent approach was deployed by ESML facilitators for the breakout sessions (all of whom had received training from 360health prior to the forums to ensure a consistent approach to facilitation of the ‘break-out sessions’). Attendee input was sought for three key questions relating to ESML’s Needs Assessment Report process by facilitators during each of the break-out sessions. Eastern Sydney Medicare Local Needs Assessment Report 2014 - FINAL

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Figure 6. 3: Key questions pursed by Stakeholder Forum facilitators

What primary care services are working well and meeting residents' needs?

What primary care services are not working well or are not meeting residents' needs?

What ideas and suggestions do you have that may make a positive impact?

Participants of each of the break-out sessions were then asked to review their group’s list of suggestions and vote on three ideas or suggestions they personally believed would have the greatest impact on improving patient care. Votes were cast using coloured sticky dots which denoted the participant’s self-identified role as either a service provider (red) or consumer (blue). Participants were also allowed an opportunity to vote as a service provider and as a consumer if they felt inclined. The feedback received from stakeholders attending the community forums is discussed in detail in Section 6.3.3.

6.3

Qualitative feedback

This section summarises the qualitative feedback collected during engagement with ESML staff, the seven semi-structured face-to-face meetings with key stakeholders, as well as the four Stakeholder Forums. 6.3.1 Staff engagement As detailed in Table 6.3, a number of key primary care needs and service gaps were identified by staff during staff engagement. Table 6.3: Key primary care needs and service gaps identified by ESML staff

Population General ESML population

Botany Bay LGA subregion

Primary care needs and service gaps  Access to allied health in the after-hours period 

Changes in training of practitioners have resulted in changes to health care provision and diverse range of quality.



Low immunisation rates.



Lack of knowledge between service providers as to available service provision.



Lack of knowledge of healthdirect, helplines and how to access after hour services



Transport availability to get to medical appointments



No specialist medical services or referrals to specialists



Access to culturally appropriate services for Aboriginal and Torres Strait Islander people



Lack of multicultural appropriate services



Ability to find practices that bulk bill



Availability of female GPs

 Randwick LGA sub-region



High transient student population, leading to increases in issues like sexual health



Big and diverse geographically - lots of services in the northern

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Population

Primary care needs and service gaps part, but not so many in the southern 

Services for prisoners released from Long Bay Jail and returning to the local community.



Transient population, tourists, backpackers and an increase in alcohol related incidences linked to tourism



Underage drinking issues

Woollahra LGA sub-region



Low immunisation rates

Sydney-Inner SLA subregion



Transient population due to tourism and the high number of office workers.



The population seen by health professionals isn’t always representative of the actual population of the area



Lack of accredited practices for Aboriginal patients, therefore issues with being able to access PBS co-payments



Homelessness



Mental health issues



Higher rates of homelessness



Increase issues with alcohol related violence



This area is a designated entertainment precinct in which attracts people from all over



Capacity of services at St Vincent’s Hospital



Issues with affordability

Waverley LGA sub-region

Sydney-East SLA subregion

6.3.2 Face-to-face meetings Common themes that emerged during seven semi-structured face-to-face meetings with key stakeholders are provided in Table 6.4. Table 6.4: Common themes from the face-to-face meetings

Issue / Need

What we heard…

High population growth

 Sydney is a rapidly growing city. Current forecasts suggest that more than 1.3 million additional people will be living in Sydney by 2031, requiring 545,000 more homes and 625,000 more jobs.  High levels of growth in both Sydney - Inner, Botany Bay and Randwick through 2015.  Mascot Station, Randwick and Anzac Parade South have all been designated as Urban Activation Precincts (UAPs) by the NSW Government.  Sydney-Inner will continue to attract a culturally-diverse cohort of young professionals and couples.  Botany Bay is experiencing high growth at Mascot Station, in close proximity to Sydney Airport, attracting a culturally-diverse cohort of young professionals and couples.  Planning typically focuses on new infrastructure required for

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Issue / Need

What we heard… transport and education but seldom, if ever, for primary health care services.  How can we meet the level of Primary Health care services to accommodate this growth?  Are providers able to develop succession planning to continue to deliver services?  Outreach services are needed to meet the needs of vulnerable populations.

Primary care service providers need clear referral pathways

 Greater onus is being placed on GPs to case manage complex cases.  There is a general lack of knowledge regarding the availability of services to meet specific needs, their location / eligibility criteria / payment models (bulk-billed service?), and the identification of available GP specialists / Allied Health / NGOs that provide these services.  The most compelling need for information exists for services addressing:  Drug and alcohol, primarily alcohol and addiction to prescription medications (all ages)  Mental health (full spectrum)  Child health  Multi-cultural aged care  Homelessness  Released prisoners  Refugees and asylum seekers

Consumers need more information regarding available services

 The most compelling need for information exists for services addressing:  Bilingual services  “Special interest” GPs and other primary care providers  Mental health (full spectrum)  Child health  Disability  Multi-cultural aged care services  Culturally-appropriate services, with specific interest in chronic disease management

Risky alcohol and drug behaviours

 The ESML catchment includes a number of popular beaches, Darling Harbour, Kings Cross and the Sydney CBD, all of which attract tourists and young residents to the area.  Risky alcohol behaviour is overwhelming the most prevalent issue, followed by inappropriate use and addiction to prescription opiates and benzodiazepines.  Drugs and alcohol create a vicious cycle, and open the door to a whole plethora of problems including domestic violence,

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What we heard…

Issue / Need

unemployment and loss of tenancy.  There is a lack of service provision addressing these needs in the Southern region of the ESML catchment area whose population has some of the greatest needs.  The cost of housing in the ESML catchment and greater Sydney metro is untenable for many.

Housing stress

 There is growing mortgage and rent stress across the catchment.  There are over 53,000 on the public housing wait list in NSW.  There is a need for varied strategies to address the imminently homeless, the homeless and those newly tenanted.  Although the ESML catchment is highly affluent, there are a large number of public housing units in the area including Surry Hills, The Rocks, Maroubra, La Perouse and Malabar.  The greatest demand for public housing services remains in Randwick (largest population) and Botany Bay (largest need). Community engagement

 Councils, in some cases, are providing community services to fill service gaps (e.g. community transport, immunisation services)  There is a need for more multi-cultural community engagement, to fight social isolation and to build a stronger sense of community in some of the most disadvantaged neighbourhoods.  Hoarding and squalor are growing concerns.

6.3.3 Stakeholder forums As detailed in Table 6.5, 56 people attended the sessions including representatives from communitybased service organisations (e.g. Multicultural Resource Centre and other NGOs), members of SESLHD and ESML staff, and the broader community. Table 6.5: Summary of attendance at ESML Stakeholder Forums

Location Botany Bay LGA

Date Thursday, 20 March 2014

Total number of participants 13

Randwick LGA

Tuesday, 18 March 2014

Sydney SLAs

Friday, 21 March 2014

Waverley LGA

Monday, 24 March 2014

Total

The following tables outline the key common threads associated to each of the themes pursued during the ESML Stakeholder Forums.

After Hours Health Services Table 6.6 outlines the key qualitative data collected regarding what is working well, what is not working well, service needs and gaps, and ideas and suggestions as they relate to after hours health services in the ESML catchment. Eastern Sydney Medicare Local Needs Assessment Report 2014 - FINAL

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Table 6.6: Community feedback regarding after hours health services

After hours health services What services are working well and meeting patients' needs? What services are not working well or are not meeting patients' needs?



Bulk billing health services



After hours GP service works well



Ageing GP workforce and closing books



Need for after-hours mental health care – psychologist etc.



Need for after hours allied health



Lack of translation



After hours care for homeless people



Lack of GP coverage in Woolloomooloo



Inconsistency in quality of service



Safety concerns for both the providers and patients



People are unaware of services available through NGOs



Because of influx of workers into the CBD, people may be accessing more than one GP or service provider; neither of whom is sharing data.

What ideas and suggestions do you have that may make a positive impact?



Lack of dental, pharmacy services



Promotion of services



Culturally appropriate services



Mental health, dental, pharmacy services after hours



More awareness of bulk billing health services

Aged Care Table 6.7 outlines the key qualitative data collected regarding what is working well, what is not working well, service needs and gaps, and ideas and suggestions as they relate to aged care services in the ESML catchment. Table 6.7: Community feedback regarding aged care services

Aged care services What services are working well and meeting patients' needs?

 Cultural sensitivity training for LGBTI awareness  Stepping On program – higher use in CALD communities  Each hospital have individual Geriatric Teams for assessment  Improvements in preventative health HACC Services  Prince of Wales – world class experts in falls

What services are not working well or are not meeting patients' needs?

 There are wait lists for home based care for client and carers  People need to identify services during transitional periods  The Commonwealth home care program is still in development, funding unsure

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Aged care services  Not enough collaboration between service providers  Discharge planning – people still falling through gaps, not linked with post –acute or home support services  Too much variation with the Aged Care Assessment Teams (ACATs)  Growing isolation due to cultural changes  Grouping all ageing people in the same way  Lack of GP knowledge of appropriate services  Good services but not enough funding to extend them  Long wait list for packages  Strong sense of entitlement – need means testing  Lack of day care facilities  Older carers of younger children with disability – lack of support  My Aged Care not meeting information needs What ideas and suggestions do you have that may make a positive impact?

 Average age for homeless, metabolic, drug and alcohol issues and severe mental health reduced to 50 yrs –  Bring hospital expertise out into the community  Cultural awareness training  Awareness of packages for Aged Care service providers & criteria – Navigation Tool

Chronic disease and cancer Table 6.8 outlines the key qualitative data collected regarding what is working well, what is not working well, service needs and gaps, and ideas and suggestions as they relate to chronic disease and cancer services in the ESML catchment. Table 6.8: Community feedback regarding chronic disease and cancer services

Chronic disease and cancer services What services are working well and meeting patients' needs?



Large corporations are providing health programs



Availability of large open spaces/park



Allied health professionals that give adequate information and service



Existing relationships between professionals



Access to high specialist population – spoilt for choice

 Community members talk to each other about services available and where to go for free services What services are not working well or are not meeting patients' needs?



Lack of GPs – high waiting times



High waiting times for specialists



Not enough bulk billing



Medicare claims: not enough focus on the prevention

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Chronic disease and cancer services

What ideas and suggestions do you have that may make a positive impact?



GPs over prescribing instead of referring to alternative services/AHP



General lack of access top allied health



Work culture: working long hours



Only 2% Hepatitis C patients seek/receive treatment



Stigma fears



Pain management – poorly understood / under-utilised



Affordability issues



Perceived fear of how information is used



Fragmented care – limited options



Lack of Hepatitis resources to meet emerging need priority



Attitude of GP and allied health services toward homeless –some good, some not so good



No incentives for GPs to see homeless population groups



Pensioners with chronic disease not being reviewed with medications



Homeless not showing up for appointments



Vulnerable populations access ED first.



Transport community services



Transfer of information between health professionals



Vulnerable clients not going to follow up – reliance on case managers is not realistic.



More encouragement/education for GPs to refer to allied health services



Clearer pathway for patients to accessing AHP/alternative services



Better co-ordination of patient services



Holistic care



Better transitions post-discharge



Incentive for GPs to see homeless population



Awareness for Hep B and C – early detection and increased monitoring of Hep B

Homelessness Table 6.9 outlines the key qualitative data collected regarding what is working well, what is not working well, service needs and gaps, and ideas and suggestions as they relate to primary care services for homeless people living in the ESML catchment. Eastern Sydney Medicare Local Needs Assessment Report 2014 - FINAL

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Table 6.9: Community feedback regarding homelessness

Homelessness What services are working well and meeting patients' needs?

 Dental services provided by Mission Australia  Aboriginal community services  Youth care coordination\homeless service  WISH  City of Sydney – public spaces – identifying population on street  Liaison officer – guidance  Partners in Recovery program  Homeless Persons Coalition  Jewish housing scheme

What services are not working well or are not meeting patients' needs?

 Clinical assessments  Primary health care supports  Stigma  Limited resources in primary health care  Safe and suitable housing for single adults  Streamlining / integration of services  Lack of follow up support for care plans

What ideas and suggestions do you have that may make a positive impact?

 Partnership in services – engagement  GP outreach – proactive / flexible service  Comprehensive clinical assessment

Maternal / Infant / Child Table 6.10 outlines the key qualitative data collected regarding what is working well, what is not working well, service needs and gaps, and ideas and suggestions as they relate to primary maternal / infant / child care services for people living in the ESML catchment. Table 6.10: Community feedback regarding primary maternal / infant / child care services

Maternal / infant / child What services are working well and meeting patients' needs?

 GP Antenatal Shared care

What services are not working well or are not meeting patients' needs?

 Immunisation rates are lower

 Some organisations offer Child Care  Pregnancy planning and nutrition  Expense of childcare and waiting list  Chlamydia in student population  Unknown issues around child and maternal health  Speech pathology and allied health

What ideas and suggestions do you have that may make a positive impact?

 Increase knowledge of child related services within the CBD  Support groups – culturally appropriate/key event days

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Mental health / Drug and Alcohol Table 6.11 outlines the key qualitative data collected regarding what is working well, what is not working well, service needs and gaps, and ideas and suggestions as they relate to mental health / drug and alcohol services for people living in the ESML catchment. Table 6.11: Community feedback regarding mental health / drug and alcohol services

Mental health / drug and alcohol services What services are working well and meeting patients' needs?

 Crisis Teams  Partners in Recovery  Nurses in GP practice  Connections program provided by Justice Health  SVH mental health team  Transcultural mental health centre  PHAMS helps facilitate engagement mental health with the health service  headspace coming to Bondi Junction  Antenatal assessments  St Vincent’s ATAPS workers are liaising with the Aboriginal community  Opioid Clinic – Prescribed Langton Centre  NSW Police showing respect and knowledge around mental health  Working with Mental Health clients and their families in PIR  SESLHD has organised a Drug and Alcohol reference group

What services are not working well or are not meeting patients' needs?

 Support for youth and the families of youth who have mental health or drug and alcohol issues  Integrated care models  Culturally appropriate education and services  Multiple care – primary care (GPs) identification and coordination issue  People may be accessing more than one GP or service provider; neither of whom is sharing data.  Lack of proper service referrals to appropriate services.  GPs do not have the capacity to manage chronic complex needs  More focus is needed on mental + physical health  Early dementia and supports  Social stigma  Social isolation  Limited access to psychology, trauma/sexual assault services  Culturally appropriate services for Aboriginal and Torres Strait Islanders

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Mental health / drug and alcohol services  Limited services for vulnerable families  Hoarding and Squalor – children growing up in these conditions, jeopardises their tenancies  Housing waitlists  Prescription medication, performance enhancing drugs  Injections are leading to Hep C  Prescribed opioids  Inconsistent GP engagement  High turnover of practice nurses What ideas and suggestions do you have that may make a positive impact?

 Build relationship and making direct connections  Care coordination and case management support  Support services for limited primary care capacity  Knowledge/updates of available services  Educate GPs about prescribing opiates and benzodiazepines  Need more community based facilities  More support is needed for parents and families regarding early intervention  GPs need a referral pathway to drug and alcohol services  Need more practice nurses and more support for professional development in these areas.

6.4

Barriers and issues

As a whole, the aim of the community and stakeholder engagement activities was met as a result of a strong community and stakeholder engagement strategy embedded in all work carried out by ESML. ESML experienced only a small number of barriers and issues whilst undertaking the comprehensive needs assessment process, these included  A fifth community forum in the Woollahra LGA was originally scheduled but subsequently cancelled due to limited registration numbers. The small number of people registered to this forum were given the opportunity to attend another event, which was well received.  Some feedback that daytime sessions were difficult to attend  One discussion that the notice period was insufficient  Feedback that the sessions were too long at 3.5 hours in duration  The number of consumer representatives were limited, however, a large number of service providers in attendance, lived within the ESML catchment area, and could provide valuable input as both a service provide and consumer.  Service providers generally wanted to discuss needs around the field they work in, which in turn some topic areas may not be as thoroughly discussed.

6.5

Future strategic partnerships

As a result of the comprehensive needs assessment process, a number of potential future partnerships have been identified by ESML. These are detailed below: Table 6.12: Potential partners and rationale

Potential Partner Organisation Eastern Sydney Medicare Local Needs Assessment Report 2014 - FINAL

Rationale for partnership Page 73

Potential Partner Organisation Waverley Council



City of Sydney Council



Randwick Council Woollahra Council

 

Botany Bay Council



Justice Health



NSW Planning and Infrastructure



SESLHD Drug and Alcohol

  

 

SESLHD Multi Cultural Health



Benevolent Society Barnados Multicultural Stakeholder Advisory Committee - SESLHD

  

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Rationale for partnership Waverley keen to work with ESML on capacity building projects Discussions about how the Community Needs Assessment information can be used to collaborate with community focussed projects Potential collaboration with community focussed projects Potential collaboration around provision of primary health care – referral pathways and gaps. Initial discussions about an Early Intervention project seeking to improve referral pathways The Community Needs Assessment to assist in determining where most support is needed for rehabilitation Identification of high growth areas will assist in informing the primary health care needs of the community Sharing and interpreting data to better understand service availability and utilisation patterns. Service mapping of all available services and build pathways to educate and support GPs in various treatment options. Workforce development in primary care including: o Proper referral pathways o Appropriate prescription behaviours o Medico-legal requirements associated to prescription behaviours Encourage a healthy relationship between D&A patients The Aboriginal CCSS workers and the opportunity for them to link up with our workers involved in doing D&A work at La Perouse Community Centre. Esme Holmes, Jo (counsellor), Apo (Staff Specialist) and Pratichi (D&A registrar) attend La Perouse to run D&A Clinic and various project work, and it would be good to look at opportunities to work better together LHD and ML to work together to develop more culturally sensitive pathways to primary health care Develop referral pathways Develop referral pathways Requested ESML participation in this committee to improve referrals/pathways

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7 Primary care needs identification This Chapter describes the primary care issues / needs of residents living within the ESML catchment and the approach used to identify them.

7.1

Approach

Members of the ESML Senior Leadership and Population Health teams met for a workshop on Tuesday, 2 April to identify the primary care needs and service gaps associated with their population. As noted in Figure 7.1, the ESML staff adopted best practice by electing to triangulate the quantitative data regarding the population characteristics made available through the six sub-regional profiles (Chapter 4), with the quantitative data associated with health service availability (Chapter 5) and the qualitative data compiled through stakeholder engagement (Chapter 6) to identify the primary care needs and service gaps associated to the residents in their catchment. Figure 7.1: Triangulation approach to identify primary care issues/needs

Health care service availability

Population characteristics

Stakeholder engagement

Identification of primary care issues / needs

7.2

Primary care needs and service gaps

As a result of the triangulation process, ten primary care issues / needs were identified: 7.2.1

Provide clear referral pathways to improve the care coordination efforts of primary care providers.

There was a consistent perception expressed throughout stakeholder engagement that general practitioners, practice nurses and other primary care providers have limited capacity to provide an appropriate level of care coordination services to their most complex patients. In efforts to support health care providers in this role, stakeholders recommended that clear pathways be provided to primary care service providers to streamline decisions regarding service options and availability, and the locations, eligibility criteria and payment requirements (bulk-billed service) associated with them. Service gaps are most apparent for people experiencing: Eastern Sydney Medicare Local Needs Assessment Report 2014 - FINAL

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

addictions to alcohol or prescription opiates;



full spectrum mental illness including youth and adults;



homelessness; and



a need for culturally appropriate aged care services.

In addition to capacity challenges, the community reported that primary care providers are often knowledgeable of community health services provided by one local health district, but not necessarily others. This is of particular challenge to ESML, with three local health networks operating within their catchment area: South Eastern Sydney Local Health District, St Vincent’s Health Network and Sydney Children’s Hospital Network. It is recommended that ESML work collaboratively with general practitioners, practice nurses, local allied health professionals as well as the three local health networks operating within their catchment area to define referral pathways associated to the most complex cases. In summary, the recommendation to provide referral pathways for select services is based on the following:

Population characteristics • 35% of Sydney-Inner residents, 53% of Botany Bay residents, and 67% of Randwick residents speak English as their primary language. • Higher rates of welfaredependence and disability pension in Botany Bay. • Rates of homelessness in Sydney-Inner (3.7%), Sydney-East (2.9%), and the broader ESML catchment (1.14%) are higher than the rate across NSW (0.76%). • Higher rates of population growth 65+ years anticipated as compared to other age ranges. • Higher rates of nonEnglish speaking HACC clients • Higher rate of HACC clients living alone.

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Health characteristics

Service gaps

• Lower rates of GP health assessments and enhanced primary care services. • Lower rates of practice nurse services. • Hospitalisaton rate 12% higher as compared to NSW. • Higher rates of alcoholrelated admissions. • Community reports the prevalence of mental illness is hard to measure in certain communities due to cultural stigma.

• Availability of afforadable primary care services is currently lowest in areas of highest health risk and need. • ESML Allied Health Professionals (AHPs) report a lack of clinical recognition. • ESML AHPs report a lack of sharing of clinical information. • Community reports that primary care providers may be knowledgeable of community health services in one local health district, but not others. • Community reports inadequate availability of drug and alcohol, mental health and culturally appropriate services in Maroubra, Malabar and areas south, without adequate transport for residents to access available services in Sydney, Randwick and Surry Hills to the north.

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7.2.2

Better empower consumers by providing more detailed information regarding available services.

At face value, there appears to be sufficient availability of health care services within the ESML catchment to meet current demand. There are 6 public hospitals located with the ESML catchment (Section 5.2.1), 1.77 GPs per 1,000 population (Section 5.2.2) and higher rates of availability of allied health professionals as compared to NSW as a whole. However, when seeking to validate the high availability of services during stakeholder engagement, there was consistent feedback that uncertainties exist for patients, families and carers during early diagnosis or critical transition periods regarding what services are available, the scope of those services, and the locations, eligibility criteria, payment requirements and transport associated to each. Information gaps were most apparent for:  those consumers in a critical transition phase of their lives (e.g. aged care services, released prisoners); 

those accessing disability services; and



consumers seeking culturally appropriate services.

Similar to issues for primary care providers stated in Section 7.2.1, there is an added complexity in sourcing available services within the catchment, as residents may be knowledgeable of services provided by one local health district, but not others. This is particularly challenging for ESML, with three local health networks operating within their catchment area: South Eastern Sydney Local Health District, St Vincent’s Health Network and Sydney Children’s Hospital Network. It should be noted that the most significant concerns were expressed about the ability of those with disabilities and parents or carers of children with disabilities to understand the complexity (or not) of accessing services through the evolving funding arrangements being introduced under DisabilityCare (formerly known as the National Disability Insurance Scheme). In summary, the recommendation to provide decision primary care service-related information to consumers, families and carers is based on the following:

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7.2.3

Health characteristics • Hospitalisaton rate 12% higher as compared to NSW. • Higher rates of hospital admission relating to health risk factors. • Higher % of people in Sydney East and Randwick who have a profound or severe disablity aged 65+ years. • The rate of falls was 19% higher as compared to NSW as a whole.

Service gaps • Availability of afforadable primary care services is currently lowest in areas of highest health risk and need. • ESML Allied Health Professionals (AHPs) report a lack of clinical recognition. • Community reports inadequate availability of appropriate services in areas south, without adequate transport for residents to access available services in Sydney, Randwick and Surry Hills to the north.

Create better awareness of GPs and primary care service providers with special interests.

Relating to issues stated in Section 7.2.1 and 7.2.2, the community also reported that it is extremely difficult to locate GPs and other primary care professionals who have a special interest or ability in:  providing bilingual services; 

providing translation services;



treating mental health issues;



treating drug and alcohol issues, especially as they relate to alcohol and addiction to prescription opiates



providing primary care services to the homeless;



engaging with released prisoners; and



providing primary care services to refugees and asylum seekers.

It should be noted that the community acknowledged issues in providing this information, as it may create a situation in which a minority of providers assume responsibility for more complex cases. Further planning is required to potentially bolster the availability of these services, especially in neighbourhoods of highest need such as Eastlakes, Daceyville, Maroubra, Malabar and other areas to the south. In summary, the recommendation to assist the community in identifying primary care professionals who have a special interest or ability is based on the following:

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Population characteristics • 35% of Sydney-Inner residents, 53% of Botany Bay residents, and 67% of Randwick residents speak English as their primary language. • Higher rates of population growth 65+ years as compared to other age ranges. • Long Bay Correctional Faiclity is located in the Randwick LGA. • Rates of homelessness in Sydney-Inner (3.7%), Sydney-East (2.9%), and the broader ESML catchment (1.14%) are higher than the rate across NSW (0.76%).

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Health characteristics • Hospitalisaton rate 12% higher as compared to NSW. • Higher rates of hospital admission relating to health risk factors. • Higher rates of alcoholrelated admissions. • Community reports the prevalence of mental illness is hard to measure in certain communities due to cultural stigma.

Service gaps • Service availability is currently lowest in areas of highest health risk and need for afforadable primary care services. • ESML Allied Health Professionals (AHPs) report a lack of clinical recognition. • Community reports inadequate availability of appropriate services in points south, without adequate transport for residents to access available services in Sydney, Randwick and Surry Hills.

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7.2.4

Improve primary care outreach services to better service priority neighbourhoods.

Again, statistics would show that the ESML is fairly affluent and educated. However, the lack of housing affordability was, by far, one of the strongest emerging issues identified through stakeholder 7 engagement, with Botany as one of the most dramatically affected communities nationally . Affordability issues relating to housing and health care are often inextricably linked. Botany Bay is certainly no exception, with over 10% of Botany Bay residents stating they could not afford medical treatment and over 9% stating they could not afford medications. Almost 5% of residents in Botany Bay reported that lack of transport prohibited access to services. Extending beyond the lack of housing affordability, greatest concerns were expressed for the lack of primary care services accessible to people imminently homeless, homeless or newly tenanted in public housing in areas such as La Perouse, Surry Hills and Malabar. The rate of homelessness in Sydney-Inner (3.7%), Sydney-East (2.9%), and the broader ESML catchment (1.14%) are higher than the rate across NSW (0.76%). These rates may be poised to continue with the closure of public housing units in The Rocks and higher rates of rent stress continuing across the Sydney metro region. In summary, the recommendation to bolster primary care outreach services to priority neighbourhoods is based on the following:

Population characteristics • Rates of homelessness in Sydney-Inner (3.7%), Sydney-East (2.9%), and the broader ESML catchment (1.14%) are higher than the rate across NSW (0.76%). • 10% of Botany Bay residents stating they could not afford medical treatment • 9% of Botany Bay residents state they could not afford medications. • Almost 5% of residents in Botany Bay reported that lack of transport prohibited access to services.

Health characteristics • Hospitalisaton rate 12% higher as compared to NSW. • Higher rates of hospital admission relating to health risk factors.

Service gaps • Service availability is currently lowest in areas of highest health risk and need for afforadable primary care services. • ESML Allied Health Professionals (AHPs) report a lack of clinical recognition. • ESML AHPs report a lack of sharing of clinical information. • Community reports inadequate availability of appropriate services in points south, without adequate transport for residents to access available services in Sydney, Randwick and Surry Hills.

7.2.5 Improve childhood immunisation rates. The rates of children within the ESML catchment that are fully immunised at 1 year, at 2 years and at 5 years are substantially lower as compared to NSW as a whole. The sub-regions of Sydney-Inner and Waverley demonstrate the widest gaps. Of significance, only 87% in Waverley are immunised at

http://www.theaustralian.com.au/national-affairs/on-the-map-where-home-costs-hurt/story-fn59niix1226865766285#; accessed 20 April 2014. Eastern Sydney Medicare Local Needs Assessment Report 2014 - FINAL

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1 year, only 78% of children living in Sydney-Inner are fully immunised at 2 years, and only 68% of children living in Sydney-Inner and 80% living in Waverley are fully immunised at 5 years. Efforts need to be made first to understand the cause(s) of these low immunisation rates (e.g. lack of data integrity, attitudes) and then identify strategies to improve them. In summary, the recommendation to bolster immunisation rates in the ESML catchment is based on the following:

Population characteristics • Children aged 0-5, primarily living in Waverley LGA and Woollahra LGA.

7.2.6

Health characteristics

Service gaps • Only 87% in Waverley are immunised at 1 year. • Only 78% of children living in Sydney-Inner are fully immunised at 2 years. • Only 68% of children living in Sydney-Inner and 80% living in Waverley are fully immunised at 5 years.

Identify strategies to address growing primary care service demand.

At face value, there appears to be sufficient availability of health care services within the ESML catchment to meet current demand. There are 6 public hospitals located with the ESML catchment (Section 5.2.1), 1.77 GPs per 1,000 population (Section 5.2.2) and higher rates of availability of allied health professionals as compared to NSW as a whole. However, the following local conditions are creating pressure on the ability to meet primary care service demand now and into the near future within the ESML catchment:  the lowest availability primary care services (GPs, allied health, community health services) are currently in areas which represent the highest levels of health risk behaviours and social disadvantage; and 

high population growth is expected in the Inner-Sydney LGA and the Botany LGA during the next 1-3 years.

In summary, the recommendation to develop strategies to meet current and future primary care service demand in the ESML catchment is based on the following:

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Population characteristics • Population growth forecast fis 88.5% for the Sydney-Inner SLA, 12.6% for Sydney-East SLA and 6.2% for Randwick LGA to 2025. • Mascot Station, Randwick and Anzac Parade South have been designated as Urban Activation Precincts (UAPS). • High density population growth will occur at Mascot station during the next 1-3 years. • Rates of homelessness in Sydney-Inner (3.7%), Sydney-East (2.9%), and the broader ESML catchment (1.14%) are higher than the rate across NSW (0.76%).

7.2.7

Health characteristics

Service gaps

• Hospitalisaton rate 12% higher as compared to NSW. • High rate of hospitalisations relating to coronary artery disease, primary attributed to residents in Botany Bay and Randwick. • High rate of hospitalisations relating to diabetes primary attributed to residents in Botany Bay and Randwick. • High rate of hospitalisations relating to smoking, high body mass,falls as compared to NSW.

• Service availability is currently lowest in areas of highest health risk and need for afforadable primary care services. • Community reports inadequate availability of drug and alcohol, mental health and culturally appropriate services in Maroubra, Malabar and areas south, without adequate transport for residents to access available services in Sydney, Randwick and Surry Hills to the north. • There is currently no Community Health Centre located in Botany Bay.

Encourage a holistic approach for people experiencing severe mental illness.

During stakeholder engagement, the community reported the need for a more holistic primary care approach for people experiencing mental illness. These concerns have been supported through recent studies that have shown that people experiencing severe mental illness have higher rates of mortality and physical morbidity when compared to the general population. Research identified that clients of public mental health services 8 die on average of 25 years earlier than the general public. Although a third of premature deaths are accounted for by suicide (particularly in the first 5-10 years), the higher rate of physical mortality for people experiencing severe mental illness is attributable to preventable conditions such as cardiovascular disease, breast and lung cancers and respiratory conditions. Further exploration is recommended between representatives of ESML’s related programs such as Connecting Care, ATAPS and Closing the Gap, and its strategic partners-Eastern Sydney Partners in Recovery, Justice Health, and the three local health districts to identify service models which will improve the physical health outcomes for people experiencing severe mental illness. In summary, the recommendation to encourage a more holistic primary care approach for those experiencing severe mental illness in the ESML catchment is based on the following:

http://www.health.nsw.gov.au/mhdao/summit/Documents/Key-facts-sheet.pdf; accessed 20 April 2014.

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Population characteristics • Based on a standard prevalence rate of 2%, approximately 8,000 residents within the ESML catchment are experiencing severe mental illness. • Rates of homelessness in Sydney-Inner (3.7%), Sydney-East (2.9%), and the broader ESML catchment (1.14%) are higher than the rate across NSW (0.76%).

7.2.8

Health characteristics

Service gaps

• Community reports the prevalence of mental illness is hard to measure in certain communities due to cultural stigma.

• Service availability is currently lowest in areas of highest health risk and need for afforadable primary care services. • ESML Allied Health Professionals (AHPs) report a lack of clinical recognition. • Community reports inadequate availability of drug and alcohol, mental health and culturally appropriate services in Maroubra, Malabar and areas south, without adequate transport for residents to access available services in Sydney, Randwick and Surry Hills to the north. • There is currently no Community Health Facilities or Mental Health providers located in Botany Bay. • Botany Bay LGA has the lowest level of ATAPS providers.

Reduce the inappropriate use of alcohol and prescription medications.

During stakeholder engagement, the community reported concerns regarding the inappropriate use of alcohol and prescription medications, namely opiates and benzodiazepines. High levels of risky alcohol behaviour can be partially attributed to the amount of tourists which visit sites within the ESML catchment each day. Highest areas of concern include Kings Cross and Darlinghurst in Sydney-East SLA and the world-renown beaches found throughout the Waverley LGA. Beyond the concerns associated with this transient population, residents within the catchment also demonstrate a higher level of alcohol-related incidences as compared to the NSW population. While the community commended the services provided by the Langton Centre in Surry Hills, there was general consensus that the availability of drug and alcohol services are too highly condensed within Sydney and Surry Hills, with virtually no services available to residents in areas south such as Maroubra and Malabar. Further exploration is recommended between representatives of ESML and its strategic partnersEastern Sydney Partners in Recovery, Justice Health, and the three local health districts to identify service models which will reduce the level of inappropriate use of alcohol and prescription medications. Eastern Sydney Medicare Local Needs Assessment Report 2014 - FINAL

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In summary, the recommendation to affect a reduction in the inappropriate use of alcohol and prescription medications in the ESML catchment is based on the following:

Population characteristics • 48% of residents living in the ESML catchment are ages 20-44. • Rates of homelessness in Sydney-Inner (3.7%), Sydney-East (2.9%), and the broader ESML catchment (1.14%) are higher than the rate across NSW (0.76%).

7.2.9

Health characteristics

Service gaps

• The rate of alcohol-related hospitalisations is 31% higher as compared to NSW. • The incidence of alcoholrelated domestic violence is higher in ESML (1.45 incidences per 1,000 pop) as compared to NSW (1.39). • Local service providers report an increase in the inappropriate use of prescription medications across the catchment.

Improve the availability of youth-related primary care services.

Although only 18% of residents living in the ESML catchment are aged 19 years or younger and the current birth rate is lower as compared to NSW, the community reported a general concern over the lack of primary care services directed to the needs of youth. Lack of services was most commonly noted for:  culturally appropriate parenting support, especially for young women; 

sexual health;



children whose parents are experiencing mental illness;



risky or inappropriate drug and alcohol behaviours; and



learning and physical development (e.g. speech pathology).

Further exploration is recommended between representatives of ESML and the three local health districts to clearly identify youth-related primary care service gaps and strategies to address them. In summary, the recommendation to improve the availability of youth-related primary care services in the ESML catchment is based on the following:

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Population characteristics • 18% of residents living in the ESML catchment are aged 19 years or younger. • 35% of Sydney-Inner residents, 53% of Botany Bay residents, and 67% of Randwick residents speak English as their primary language.

Health characteristics

Service gaps

• Community reports the prevalence of mental illness is hard to measure in certain communities due to cultural stigma. • The incidence of HIV, Chlamydia, rectal Chlamydia and gonrrhea notifications has increased.

• Service availability is currently lowest in areas of highest health risk and need for affordable primary care services. • ESML Allied Health Professionals (AHPs) report a lack of clinical recognition. • The rates of children within the ESML catchment that are fully immunised at 1 year, at 2 years and at 5 years are substantially lower as compared to NSW as a whole. • There is currently no Community Health Facilities or Mental Health providers located in Botany Bay. • Community reports a lack of culturally appropriate parenting support services. • Community reports a lack of youth-related drug and alcohol services.

7.2.10 Better understand the primary care issues / needs of residents living on Lord Howe Island Due to such a small population (2011 Census regarding the health status and health service Lord Howe Island. ESML has acknowledged service providers and the broader community primary care issues / needs of residents there.

population: 361), very little usable data is available utilisation levels associated with residents living on that community engagement is required with both to fill information gaps and better understand the

In summary, the recommendation for ESML to better understand the primary care issues / needs of residents living on Lord Howe Island is based on the following:

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Population characteristics • Located northeast of Sydney, a population of 361 was reported during the 2011 Census. • Tourism is a leading industry for the community.

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Health characteristics • Due to privacy reasons or the unavailability of data, Health risk status and health utilisation patterns are unknown.

Service gaps • A full appraisal of primary care services has not been completed for some time. • The effects (or not) of tourism on primary care service demand on Lord Howe Island is unknown. • ESML recognises the need for community and stakeholder engagement to fill information gaps.

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8 Needs Prioritisation This Chapter describes the primary care priorities for residents living in the ESML catchment and the approach used to prioritise them.

8.1

Approach

Various members of the ESML Senior Leadership and Population Health teams convened for a workshop on Monday 14 April to prioritise the nine identified primary issues / needs. Each attendee was provided a synopsis of each issue/need along with the supporting evidence and reasoning. During the course of the workshop, each of the following primary care issues / needs outlined in Section 7.2 of this Report was addressed in detail:  Provide clear referral pathways to improve the care coordination efforts of primary care providers. 

Better empower consumers by providing more detailed information regarding available services.



Create better awareness of GPs and primary care service providers with special interests.



Improve primary care outreach services to better service priority neighbourhoods.



Improve childhood immunization rates.



Identify strategies to address growing primary care service demand.



Encourage a holistic approach for people experiencing severe mental illness.



Reduce the inappropriate use of alcohol and prescription medications.



Improve the availability of youth-related primary care services.



Better understand the primary care issues / needs of residents living on Lord Howe Island.

Prior to the workshop, each attendee also received a copy of the voting instructions and a description of the selection criteria provided in Table 8.1 that would be used to prioritise the identified needs. Table 8.1: Criteria used to identify primary care priorities

Criteria

Description

Reflects ESML's mission and aims

Does this issue/need reflect the overall remit and mission of ESML?

Aligns with the Commonwealth health priorities

How does this issue/need align with Commonwealth priorities?

Aligns with State health priorities

How does this issue/need align with the NSW Ministry of Health priorities?

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Criteria

Description

Aligns with the priorities of the three local health districts

How does this issue/need align with the service and strategic plans of South Eastern Sydney Local Hospital Network, the St Vincentâ&#x20AC;&#x2122;s Local Network and Sydney Childrenâ&#x20AC;&#x2122;s Local Network?

Impacts on priority populations

Will there be an impact on priority neighbourhoods or vulnerable groups such as those with low health literacy or socio-economic levels?

Impact versus investment

Can the priority impact on other groups such as workforce or finances?

Available budget

Whilst it may be difficult to specify the exact budget required for a given activity associated to an issue/need, does it appear that the activity will require funding? If so, will the costs associated be available under the flexible funding budget?

Internal capacity and capability

Does ESML have the level of internal capacity and/or capability to deliver activities associated to this issue/need?

Feasibility

Is success achievable? Can the activities associated to this issue make an impact over the next 1-3 years?

As a result of the workshop, each of the primary care issues/needs outlined in Section 7.2 of this Report was fully considered, accepted or consolidated to form the primary care priorities for residents living in the ESML catchment. The details regarding the activities and key measures of success for each priority are outlined in Section 8.3.

8.2

Priorities identified

Each of the primary care issues/needs listed in Section 7.2 were given full consideration during the prioritisation workshop. As a result of voting the following primary care issues/needs were identified by ESML as priorities for the next 1-3 years: 1. 2. 3. 4. 5. 6. 7. 8.

Provide clear referral pathways to improve the care coordination efforts of primary care providers. Better empower consumers by providing more detailed information regarding available services. Identify strategies to address growing primary care service demand. Improve childhood immunisation rates. Encourage a holistic approach for people experiencing severe mental illness. Reduce the inappropriate use of alcohol and prescription medications. Improve the availability of youth-related primary care services. Better understand the primary care issues / needs of residents living on Lord Howe Island.

Although all primary care issues/needs listed in Section 7.2 were not ultimately listed as priorities, each was accounted for by consolidated a number of the issues/needs into a broader priority. Table 8.2 provides the cross-mapping which occurred to account for all 9 issues/needs listed in Section 7.2.

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8.2: Consolidation of issues / needs to form priorities

Initial primary care issue(s) /need(s)â&#x20AC;Ś

Forms the priorityâ&#x20AC;Ś

1. Provide clear referral pathways to improve the care coordination efforts of primary care providers.

2. Better empower consumers by providing more detailed information regarding available services.

3. Create better awareness of GPs and primary care service providers with special interests. 4. Improve primary care outreach services to better service priority neighbourhoods.

3. Identify strategies to address growing primary care service demand.

6. Identify strategies to address growing primary care service demand. 5. Improve childhood immunisation rates.

4. Improve childhood immunisation rates.

7. Encourage a holistic approach for people experiencing severe mental illness.

5. Encourage a holistic approach for people experiencing severe mental illness.

8. Reduce the inappropriate use of alcohol and prescription medications.

6. Reduce the inappropriate use of alcohol and prescription medications.

9. Improve the availability of youth-related primary care services.

7. Improve the availability of youth-related primary care services.

10. Better understand the primary care issues / needs of residents living on Lord Howe Island.

8. Better understand the primary care issues / needs of residents living on Lord Howe Island.

8.3

Exclusions

None of the primary care issues/needs listed in Section 7.2 were excluded from the priorities listed in Section 8.2.

8.4

Endorsement of recommendations

The proposed 2014 ESML CNA priorities were presented by Mr Darrell Williams, CEO of ESML, to the ESML Board during a regularly-scheduled Board meeting held the evening of Monday, 28 April 2014. The Board officially accepted and endorsed the priorities as stated above in Section 8.2.

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9 Conclusions While the ESML management team has tentatively accepted the seven primary needs as organisational priorities to be addressed during the 2014-2015 fiscal year, the organisation recognises that other primary care needs and service gaps brought forth through this comprehensive needs assessment process by service providers and the broader community have yet to be addressed due to capacity, capability or funding constraints. While ESML may not be in a position to provide or commission all the recommended ideas and suggestions brought forth through stakeholder engagement, the organisation acknowledges that it can play a key advocacy role at a federal, state and local level to affect change on behalf of the General Practitioners, Allied Health professionals and residents within their local community. ESML intends to build on the stakeholder consultations originating from the project, with a strong commitment to consider community engagement as a key input to its ongoing strategic direction.

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Appendix A – Data Collection and Limitations Data was gathered from a number of different sources including the Australian Bureau of Statistics (ABS), Public Health Information Development Unit (PHIDU), South East Sydney LHD, Health Statistics NSW and ESML at the LGA or SLA level. We have relied on the data provided wherever possible and have avoided carrying out extrapolations or making assumptions in interpreting the data. Data Limitations 1. Comparable data sets were not always available when comparing sub-regional information to the ML level. As such two points of comparison have been primarily used and presented against a NSW figure (where possible) - ESML and Eastern Sydney. 2. Large portions of respondents to certain data sets (e.g. in ABS census data) had either not responded or marked answers as ‘not applicable’. In all cases where this has occurred these responses have been excluded from the graphical representations presented in this report. As a result, some figures presented in this report do not always total 100%. 3. The Health Workforce Australia data used to present the levels of Allied Health practitioners does not take into consideration those disciplines that are self-regulated. 4. Due to a small population size of approximately 350 residents, data relating to residents on Lord Howe Island have not been included (where data is presented at the sub-regional and ML level) due to privacy reasons.

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Appendix B – Stakeholder Forum Summaries LGA region: Botany Bay Date of the meeting: 20th March 2014 Venue: Botany Community Centre TOPIC: Chronic Disease Facilitators

Organisation

Lissa Smith

360health Pty Ltd

Attendee Type

Service providers

Consumers/patients

Questions What services are working well and meeting patients’ needs?

Responses  St George Hospital – Liver Clinic  St Vincent’s - Liver Clinic  New treatments expected for Hepatitis C on PBS  Agency for Clinical Innovation (ACI) – working group – interagency partnerships  Prince of Wales (POW) Pain Management Clinic  Kingsford Legal Services  HIV/AIDS Legal Centre (HALC)  People more empowered  Cultural Awareness Training for GP’s  Only 2% Hepatitis C patients seek/receive treatment  Stigma fear  Side effects  Pain management – poorly / under  Lack of patient management services  Affordability issues  Fear of how information used and reality  Fragmented care – limited options Idea or suggestion # of Service # of Votes Consumer Votes 1  GP’s educated/trained in treating Hepatitis C 2  Trusted information different channels = online brochures  More HIV testing needed 1 1  More awareness of existing patient services 6  Better co-ordination of patient services 4  Advocacy for a more holistic approach  Chronic Disease Management Nurse in all 3 GPS’s practice.  Increase GP referral to Get Healthy 3 Programmes/HEAL 3  Better transition post-discharge 5

What services are not working well or are not meeting patients’ needs?

What ideas and suggestions do you have that may make a positive impact?

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LGA region: Botany Bay     

Holistic approach to physical and Mental Health, legal, housing Culturally appropriate information Promoting healthier communities Joint resources GP, nurses and pharmacists Better processes for Advanced Care Directive

1 2

General  Aboriginal communities – representations  Region is “off the radar:  Physiologists not setting up in Botany  Council not as vocal  Property values sky rocketing  Public transport (across suburbs)  Workers during day not at night

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LGA region: Botany Bay Date of the meeting: 20th March 2014 Venue: Botany Community Centre TOPIC: Mental Health Facilitators

Organisation

Lissa Smith

360health Pty Ltd

Attendee Type

Service providers

Consumers/patients

Questions What services are working well and meeting patients’ needs?

Responses  PHaMs helps facilitate engagement Mental Health with the health service  Headspace coming into Catchment  Antenatal Assessment  St Vincent’s ATAPS worker liaising with Aboriginal Community  Home visiting for new Aboriginal Mothers  Opioid Clinic – Prescribed Langton Centre  PHaMs waiting lists manageable at this stage  NSW Police showing respect and knowledge around Mental Health  Working with Mental Health clients and their families in Partners in Recovery (PIR)  SESLHD have organised Drug and Alcohol reference group

What services are not working well or are not meeting patients’ needs?

     

What ideas and suggestions do you have that may make a positive impact?

Limited access to psychology Limited availability of trauma/sexual assault services Culturally appropriate services for Aboriginal and Torres Strait Islanders Access to headspace may be difficult – cost etc. Limited services to vulnerable families Hoarding and Squalor – children growing up in these conditions, jeopardises their tenancies  Housing waitlists  Prescription medication, performance enhancing drugs  Injection leading to Hep C  Prescribed Opioids  Mortgage stress  Childcare  Inconsistent & GP engagement  High turnover of practice nurses Idea or suggestion # of Service # of Providers Consumer Votes Votes 6  Educating GPs about prescribing opioids and Mental Health benzodiazapines 1  Access to dietician and gym access  Need more community based facilities 7  Services for families, parenting and early

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LGA region: Botany Bay           

intervention More GPs educated in Methadone prescription GP referral pathway to drug and Alcohol Services ML more involved in child protection and violence prevention working groups Educate GPS about domestic violence statewide framework Educate GPS more about domestic violence More information about GP specialty Better support needed post discharge Better transition post discharge Better assistance post prison release Need more practice nurses and more support, Professional development Structure More services needed for children of parents with Mental Health Issues.

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2 5 2

1 3 2 6 1

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LGA region: City of Sydney Date of the meeting: 21st March 2014 Venue: Sydney RSL TOPIC: Aged Care Facilitators

Organisation

Lissa Smith

360health Pty Ltd

Attendee Type

Number of Attendees 12

Service providers

Consumers/patients

Questions What services are working well and meeting patients’ needs?

Responses  Uniting Care  Lesbian, Gay, Bisexual, Trans/Transgender, Intersex (LGBTI) inclusiveness  Cultural sensitivity training for LGBTI awareness  Stepping on program – higher use in culturally and linguistically diverse (CALD) communities  Tapping NGO Volunteers for programs that lack funding  Each hospital have individual Geriatric Teams for assessment  Improvements in preventative health  Home and Community Care (HACC) Services  Some populations ageing faster e.g. Aboriginal and Torres Strait Islander people  Home based care for client and carers – wait lists etc.  Service identification during transitional periods  Healthy aged care reform – Commonwealth home care program still in development, funding unsure  Funding allocation for community based programs  Not enough collaboration between service providers  Discharge planning – people still falling through  GAPS + not linked with post –acute or home support services  St Vincent Restructure  Areas that sit outside catchment locations  Too much variation with the work the Aged Care Assessment Teams (ACAT)  Care Coordination by families  Growing isolation due to cultural changes  Grouping all ageing people in one way  GP knowledge of appropriate services Idea or suggestion # of Service # of Votes Consumer Votes 1 1  Training specific to aged care services for diverse communities 4 1  Community education regarding ageing family and carers 3 2  Improve resources for carers 1  Multi language resources

What services are not working well or are not meeting patients’ needs?

What ideas and suggestions do you have that may make a positive impact?

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LGA region: City of Sydney    

Develop processes for information distribution Culturally diverse healing ageing groups Rethinking what ageing is including mixed aged involvement ML to collaborate with ethnic organisations

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LGA region: City of Sydney Date of the meeting: 21st March 2014 Venue: Sydney RSL TOPIC: Maternal/Child Facilitators

Organisation

Lissa Smith

360health Pty Ltd

Attendee Type

Number of Attendees 12

Service providers

Consumers/patients

Questions What services are working well and meeting patients’ needs?

Responses  GP Antenatal share cared  Some organisations offer child care  Pregnancy planning and nutrition

What services are not working well or are not meeting patients’ needs?

    

What ideas and suggestions do you have that may make a positive impact?

Idea or suggestion             

Immunisation rates are lower Expense of childcare and waiting list Chlamydia in student population Unknown issues around child and maternal health Speech pathology and allied health

Qualify to get access for psychological services Affordability and time for specific services Issues with sexually transmitted diseases amongst tourists Issues with mental health amongst international students. Continued support from ML regarding immunisation Support to upload to ACIR Increase knowledge of child related services & CBD population Support for Youth, international students – gambling Eating disorders, mental health, study pressures Culturally appropriate services Support groups – culturally appropriate/key event days Sexual health education Better understand child and mental health in Eastern Sydney region.

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# of Service Votes

# of Consumer Votes

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LGA region: City of Sydney Date of the meeting: 21st March 2014 Venue: Sydney RSL TOPIC: Mental Health Facilitators

Organisation

Lissa Smith

360health Pty Ltd

Attendee Type

Number of Attendees 12

Service providers

Consumers/patients

Questions What services are working well and meeting patients’ needs?

Responses  Homeless service  Soup kitchen  Crisis service  Partners in Recovery (PIR)  Nurses in GP practice  Drug and Alcohol (D & A) / mental (East Sydney Doctors) o Company appointment for specialist  Connections program – justice health  SVH mental health team  Homeless team  Youth care worker  Transnational mental health centre o Good referral service  Family / young population who have mental D&A  Lack of communication  Partnership of services  Ongoing care  Multiple care – primary care (GPs) identification and coordination issue  CBD population have one GP in CBD and their local area – coordination issue.  Education  Service referral o Access to services o Mismatch of service  Chronic complex needs – GP capacity? Limited, too busy? Time  More focus on physical health  Early dementia and supports  Language barrier- poor understanding of treatment  Patterns and health behaviours  Social stigma  Social isolation  Engagement in Primary Health Care  Services changes and no update  No support services o Health needs

What services are not working well or are not meeting patients’ needs?

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LGA region: City of Sydney o o

What ideas and suggestions do you have that may make a positive impact?

Social issues Looking at holistic picture

Idea or suggestion            

MBS items and funding model Building relationship and making direct connections Dental Service ESML website as categorised service diversity Care coordination and case management and support Transition of care – continuity of care High complex needs – comprehensive assessment HSNet Support services for limited PHC setting e.g. Health Professional in GP practice Community education Knowledge/updates of service Sustainable community service

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# of Service Providers Votes 1 4

# of Consumer Votes

1 2 7 3 1 1 5 4 1 3

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LGA region: City of Sydney Date of the meeting: 21st March 2014 Venue: Sydney RSL TOPIC: Homelessness Facilitators

Organisation

Lissa Smith

360health Pty Ltd

Attendee Type

Number of Attendees 12

Service providers

Consumers/patients

Questions What services are working well and meeting patients’ needs?

Responses  Dental Service in Mission Australia Centre  Aboriginal community service  Youth care coordination\homeless service  South Eastern & Northern Sydney Family referral Service  GP Outreach Services  Partnership specialist service  Community homeless services o Local o Housing NSW  DIFFERENT LOCATION  Woolloomooloo  Wish  City of Sydney – public space – identifying population on street  Liaison officer - guidance  Less access compares to health services data system documentation  Evidence based  Assessment – identifying population  Primary health care supports  Stigma  Limited resources in PHC  Safe and suitable housing for single adult  Streamlining of service  Follow up support for care plans Idea or suggestion # of Service # of Providers Consumer Votes Votes  Education in community 6  Partnership in services – engagement 1  Improved access to health services 1  Evidence based assessment 7  GP outreach – Proactive / flexible service

What services are not working well or are not meeting patients’ needs?

What ideas and suggestions do you have that may make a positive impact?

  

Health professional- practical Multicultural support- bilingual, training, education Referral pathways / Coordination Health Care

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LGA region: City of Sydney           

Intersectorial AX Service directory easy/special interest/categorised Direct meeting to build relationship (face to face) Single adult homeless service, acute? longterm? More housing system support Flexible model Engagement Family support Comprehensive? intersectoral/assessment Care plan process – coordination Identification in other areas as people move early intervention and prevention

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LGA region: City of Sydney Date of the meeting: 21st March 2014 Venue: Sydney RSL TOPIC: Chronic Disease and Cancer Facilitators

Organisation

Lissa Smith

360health Pty Ltd

Attendee Type

Number of Attendees 12

Service providers

Consumers/patients

Questions What services are working well and meeting patients’ needs?

Responses  Large corporates – health programs in place o Internal wellbeing o Health food o Encourage exercise/active o Access to open space  Chinese medicine for treating chronic disease (& prevention)  Also provides culturally appropriate services  Bike pathways allow for better access  Availability of large open spaces/park  Hyde Park/Domain, Lady Mac. Chair   Lack of GPs – high waiting times  High waiting times for specialists  Not enough bulk billing  Issue: high rent for GPs hard to bulk bill  Medicare claims: not enough focus on the prevention (risk factors) i.e. There should be incentive (Medicare) for chronic disease  GPs over prescribing instead of referring to alternative services/AHP  General lack of access top allied health  Work culture: working long hours  Idea or suggestion # of Service # of Votes Consumer Votes 1  Utilise Chinese medicine in chronic disease more 4 1  More encouragement/education for GPs to refer to allied health services 1  GPS to refer to specific service that will look after the management of the preventive 2 1 case.  Rebate to alternative services 1  Tailoring care to the consumer

What services are not working well or are not meeting patients’ needs?

What ideas and suggestions do you have that may make a positive impact?

 

Tracking GPs referral to alternative services/allied health Clearer pathway for patients to accessing

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LGA region: City of Sydney    

AHPs/alternative services Community days – encourage people to use Martin Place: good for disseminating health information/event Not enough services for the homeless etc. Appropriate food for the homeless

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LGA region: City of Sydney Date of the meeting: 21st March 2014 Venue: Sydney RSL TOPIC: AFTER HOURS Facilitators

Organisation

Lissa Smith

360health Pty Ltd

Attendee Type

Number of Attendees 12

Service providers

Consumers/patients

Questions What services are working well and meeting patients’ needs?

Responses  Local Information  Information at point of contact (from personal interaction)  MDS working well (in some cases)  (Prompt / Level of care/Info exchange with regular GP).

What services are not working well or are not meeting patients’ needs?

       

What ideas and suggestions do you have that may make a positive impact?

Idea or suggestion     

Pharmacy After Hours Coordination of After Hours information Updating this information Too many “Pathways” Parking (for GPs on Home visits) City of Sydney has health carers parking permit “new” or “strangers” coming to house to provide services – security fears Capacity to take on after hours services in small practices

More Services – What Haves? Partnerships – sharing learning’s/resources – timely information for those in need. Awareness raising of after hours services Support services for carers and family of elderly people in need (MH) Frequently asked questions o Most relevant information built up over time/experience o Highlighting service gaps with FAQ’s o Locally specific information o Promote health carers parking permits from City of Sydney o Better Triage of patients on telephone

Eastern Sydney Medicare Local Needs Assessment Report 2014 - FINAL

# of Service Providers Votes

# of Consumer Votes 1 2

Page 105

LGA region: City of Sydney o

   

Overseas students and social isolation Possibility of nurses providing extra services and triage of patients to GP’s (+? Prescribe/administer meds) What health issues are presenting to after hour services? Preferences of different ethnic groups for community languages - media NSW Health Publication “Walking in Carers”

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LGA region: Randwick Date of the meeting: 18th March 2014 Venue: Randwick Town Hall TOPIC: Aged Care Facilitators

Organisation

Lissa Smith

360health Pty Ltd

Attendee Type

Number of Attendees

Service providers

Consumers/patients

Questions What services are working well and meeting patients’ needs?

Responses  Prince of Wales (POW) – world class experts in falls etc.  GP and specialist outreach  Good models available – not enough *Home ownership 1950’s immigrants – discussion about implications of houses owned by older immigrants whose children cannot afford to buy locally so move away leaving parents isolated

What services are not working well or are not meeting patients’ needs?

What ideas and suggestions do you have that may make a positive impact?

 Good services but not enough funding to extend them  Not enough age care facilities  Long wait list for packages  Homeless, mental health issues  Aged care and complex health issues  Lack of culturally specific facilities – ATSI & CALD  Lack of understanding of the quality  Strong sense of entitlement – need means testing  Isolation  Lack of day care facilities  Older carers of younger children with disability – lack of support  My Aged Care not meeting information needs Idea or suggestion # of Service # of Provider Consumer Votes Votes 7 2  Aged care for homeless and severe mental health reduced to 50 yrs. – metabolic, drug and alcohol issues 8 7  Hospital expertise out in the community  Understanding which GP’s service which 1 1 facilities 1 1  Cultural awareness training  Awareness of packages for Aged Care service 8 3 providers & criteria – Navigation Tool 2 4  Transitional information & support

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LGA region: Randwick Date of the meeting: 18th March 2014 Venue: Randwick Town Hall TOPIC: Mental Health Facilitators

Organisation

Lissa Smith

360health Pty Ltd

Attendee Type

Number of Attendees

Service providers

Consumers/patients

Questions What services are working well and meeting patients’ needs?

Responses  NSW Police making an effort  Relationships with acute care teams  Mental health access line  Police are more respectful towards MH clients  Sense of engagement  Community packages  Acute care team in Randwick  Mental health nurse incentive program  Headspace is new to the area  Sydney Children’s has a special unit  Fams has early psychosis intervention  Art therapy in Double Bay  POW aged psychiatric services  Multicultural counselling service  Community development  Outreach and building relationships  Mental Health Care Plan  Acute care teams hard to access/mixed experiences  Availability of beds  Discharge planning is poor  Stigma in certain cultures  People dealing with medication not counselling due to cost  Unsuccessful students returning home  Not enough detox and rehab services  Poor services for refugees  People dealing with severe conditions cannot be expected to understand health system  Alcohol and domestic violence  Kids and ice  Hard to capture a patient long enough for stability  Tourists access ED instead of GP’s

What services are not working well or are not meeting patients’ needs?

What ideas and suggestions do you have that may make

Idea or suggestion

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# of Service Votes

# of Consumer Votes Page 108

LGA region: Randwick a positive impact?

                

MOU between police and mental health service More awareness of mental health access line Similar model to domestic violence where consumers give permission to be contacted Acute care team needs more resources Provide after-hours services Promote available services Mapping rehab and detox services and hours of access ML provides in service for navigating Australian Health System for refugees Promote health literacy Compulsory medication review Encourage pharmacists to become engaged Encourage GP’s to get decision support software Focus of children who are impacted and carers Training for community care workers How do you support primary care services for tourists Hostels to provide info Commonwealth responsibility for tourists

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1 5 5 2 2

3 2 2

1 4 2

2 1

3 4

1 1

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LGA region: Randwick Date of the meeting: 18th March 2014 Venue: Randwick Town Hall TOPIC: After Hours Facilitators

Organisation

Lissa Smith

360health Pty Ltd

Attendee Type

Number of Attendees

Service providers

Consumers/patients Questions What services are working well and meeting patients’ needs?

Responses  Bulk billing health services  Maintaining private health insurance – GP management plans  After hours GP service works well

What services are not working well or are not meeting patients’ needs?

 

What ideas and suggestions do you have that may make a positive impact?

Ageing GP workforce & closed books Need for after-hours mental health care – psychologist etc. & allied health after work  Private health insurance can lead to over utilisation  No translation  Homeless people – after hours care  No GP access in Woolloomooloo  Isolation  Internet and phone access  Inconsistency in quality of service  Safety concerns  There are services available through NGO’s but people are unaware  Lack of continuity with one GP – doesn’t share info  Dental services – waiting lists  Wait list for specialists i.e. speech pathology Idea or suggestion # of Service # of Votes Consumer Votes 9 5  Promotion of services 3  Translation 4 3  Culturally appropriate services 7  Completed mapping exercise of GP’s in area 1 2  Advertising GP specialities 8 1  Mental health services after hours 5 4  More awareness of bulk billing health 1 services 

Improve dental services wait lists

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LGA region: Waverley Date of the meeting: 24th March 2014 Venue: Waverley Council Chambers TOPIC: Chronic Disease Facilitators

Organisation

Lissa Smith

360health Pty Ltd

Attendee Type

Number of Attendees

Service providers

Consumers/patients

Questions What services are working well and meeting patients’ needs?

Responses  Breast screening  Increase media coverage o Awareness o GPs good at referring o Community vans  Hep B – vaccinated and screened well  Allied health professionals that give adequate information and service  Existing relationships between professionals  Access to high specialist population – spoilt for choice  Community members talk to each other about services available and where to go for free services  Knowledge of GP – correlates with patients they serve e.g. hepatitis  Multicultural pap smears  Prostate cancer – screening is controversial  Lack of Hepatitis resources to meet emerging need priority  Social services  Attitude of GP services for homeless – allied health, some good, some not so good  No incentives for GPs to see homeless population groups  Pensioners with chronic disease not being reviewed with medications  Asian migrants screened for Hep B  Visas and screening  Homeless not showing up  Vulnerable populations access accident and emergency first.  Transport community services  Discharge summaries follow up  Transfer of information between health professionals  Vulnerable clients not going to follow up – reliance on health professionals is not realistic.  Different computer systems e.g. community health and LHD Idea or suggestion # of Service # of Votes Consumer Votes 4 0  Awareness for Hep B and C – early detection and increased monitoring of Hep B

What services are not working well or are not meeting patients’ needs?

What ideas and suggestions do you have that may make a positive impact?

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LGA region: Waverley 

Cultural Change – GPs



Education to health care workers and the community – e.g. Hep B – importance of monitoring and screening System recall and reminders for sexual health



Target GPs for long term



Increase links to refer to specialist although refer back to GP GP registrar for vulnerable populations e.g. homeless and other vulnerable populations GP training clinic – homeless drop in

Funding for workforce for GP clinics for homelessness Need more transport services for people with chronic issues Incentive for GPs to see homeless population

Travellers drug and alcohol and sexual health screening Linking in people with comorbidities with GPs

Electronic communication and transfer of information Software systems need to talk to each other e.g. between health district and community health

        

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LGA region: Waverley Date of the meeting: 24th March 2014 Venue: Waverley Council Chambers TOPIC: Chronic Disease Facilitators

Organisation

Lissa Smith

360health Pty Ltd

Attendee Type

Number of Attendees

Service providers

Consumers/patients

Questions What services are working well and meeting patients’ needs?

What services are not working well or are not meeting patients’ needs?

What ideas and suggestions do you have that may make a positive impact?

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LGA region: Waverley 

Cultural Change – GPs



Education to health care workers and the community – e.g. Hep B – importance of monitoring and screening System recall and reminders for sexual health



Target GPs for long term



Increase links to refer to specialist although refer back to GP GP registrar for vulnerable populations e.g. homeless and other vulnerable populations GP training clinic – homeless drop in

Funding for workforce for GP clinics for homelessness Need more transport services for people with chronic issues Incentive for GPs to see homeless population

Travellers drug and alcohol and sexual health screening Linking in people with comorbidities with GPs

Electronic communication and transfer of information Software systems need to talk to each other e.g. between health district and community health

        

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LGA region: Waverley Date of the meeting: 24th March 2014 Venue: Waverley Council Chambers TOPIC: Homelessness Facilitators

Organisation

Lissa Smith

360health Pty Ltd

Attendee Type

Number of Attendees

Service providers

Consumers/patients

Questions What services are working well and meeting patients’ needs?

Responses  Partners in Recovery program  Homeless persons coalition  Housing project  Jewish housing scheme

What services are not working well or are not meeting patients’ needs?

    

What ideas and suggestions do you have that may make a positive impact?

Affordable housing Services for the population of people at risk of homelessness Ageing community not being close to family and support systems Liaison with the police, health and community service is lacking Accessing health support around mental health and drug and alcohol issues  Lack of GPs for homeless population Idea or suggestion # of Service # of Votes Consumer Votes 1 1  Better access and support to at risk of homeless population 1 1  More resources at the local level     



More streamlined processes to assist in navigating the system Norman Andrews drop in centre could provide GP services Ask services regarding their ability to bulk bill for homeless people More outreach primary health care services

Find homeless friend GP prepared to work with homeless population within the community Encourage volunteers and get in touch with the council volunteer service

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LGA region: Waverley Date of the meeting: 24th March 2014 Venue: Waverley Council Chambers TOPIC: Mental Health, Drug and Alcohol Facilitators

Organisation

Lissa Smith

360health Pty Ltd

Attendee Type

Number of Attendees

Service providers

Consumers/patients

Questions What services are working well and meeting patients’ needs?

Responses  Co-location of mental health workers in community  Communication between local NGO services is improving  Awareness of mental health issues is increasing and stigma is decreasing  In some instances good relationships with GPs  Lots of good mental health services  Good access to counselling services  Education of young people about availability of Medicare card to seek their own treatment  Police up skilled in knowledge of mental health issues  Drug and alcohol – stigma from health professionals makes it hard to access services  Lack of focus on physical health needs around drug and alcohol  Disconnection between public and private services  Doctor shopping  GP referral can often be a barrier especially with children  Gap in services for CALD communities  Hoarding and squalor  Discharge planning  Housing Idea or suggestion # of Service # of Votes Consumer Votes 5 0  Discharge planning – get more services involved from the beginning of treatment 5 0  Increase GP awareness programs/training programs to better manage drug and alcohol patients and increase understanding of mental health issues 0  Medicare incentives for drug and alcohol and 4 mental health clients 2 0  Joint hoarding and squalor program

What services are not working well or are not meeting patients’ needs?

What ideas and suggestions do you have that may make a positive impact?

 

Pre-fill mental health treatment plan – provide to patient to take to GP Improved communication with police mental health liaison officer

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LGA region: Waverley Date of the meeting: 24th March 2014 Venue: Waverley Council Chambers TOPIC: Aged care Facilitators

Organisation

Lissa Smith

360health Pty Ltd

Attendee Type

Number of Attendees

Service providers

Consumers/patients

Questions What services are working well and meeting patients’ needs?

Responses  Good transport – but a challenge for the elderly  Bondi Waters has a facility for day sessions but under utilised  Community transport is good but more needed for the aged  Waverley has increased private insured residents who can access good rehab  For non-private insured residents they can go to War Memorial  Non private insured patients have to pay a gap  Waiting lists are high for out patients at War Memorial  Getting drivers for community transport is hard, also parking for the buses.  Too much accessing, not enough doing – top heavy.  ACAT is having to case manage for packages – referrals being made to packages when they are not meant to  Big backlog with ACAT because patients are meant to choose their own packages but patients cant so ACAT is ending up having to do it  CALD patient literacy especially for the older or patients with dementia  People end up staying in hospital longer waiting for transitional package  Understanding ML chronic care coordination and follow up.  Gap after chronic and aged care – not all patients who have chronic disease are elderly  Discharge follow up is happening in theory but not seen in the community  Changes in the system are hard to navigate  HACC is tightening up on 1st July – people may end up in nursing home without support. Low level home care people could suffer Idea or suggestion # of Service # of Votes Consumer Votes 7 1  Mini buses easier to park for community transport – like Edgecliff example 6 1  More CDC packages

What services are not working well or are not meeting patients’ needs?

What ideas and suggestions do you have that may make a positive impact?

 

Continued simple low level pathways for home care services Easier access and simplified information o Less mission statements o Include service changes o Detailed operational stuff

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LGA region: Waverley



 

o Online for service providers o Referral forms o Who to talk to Less accessing by a group of people o One capable person o Then case managed More higher level packages – level 3 and 4 not specific for CALD needs and need more funding Discharge planning including transition care and patient literacy about this Rigid rules about transitional packages and when they kick in

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LGA region: Waverley Date of the meeting: 24th March 2014 Venue: Waverley Council Chambers TOPIC: Child, Infant and Maternal Health Facilitators

Organisation

Lissa Smith

360health Pty Ltd

Attendee Type

Number of Attendees

Service providers

Consumers/patients

Questions What services are working well and meeting patients’ needs?

Responses  Royal Hospital for Women provides a variety of services  Large After hours sector  Tomberton Assist clinic

What services are not working well or are not meeting patients’ needs?



  

         

Royal Hospital for Women o Various staff seeing one patient – client referral from GP to other services e.g. ENT, audiologist has access to an item number, however GP model can hold up referral process which can cause patient distress, especially more in some population groups like CALD. o Continuity of care – complicated pregnancies Lack of midwives in public system – patient choice if not happy with service Lack of knowledge of medical model – in emerging communities, where to go for help Parents of children with a disability – o Increased mental health issues o Diagnosis with a disability – a lot of responsibility falls on the mother Caring for children with chronic conditions – mothers health not always addressed Post natal depression Lack of awareness of importance of parents health and wellbeing of people who have children with a disability Cultural stigma (CALD) Lack of definition of disability within Aboriginal and Torres Strait Islander community – lack of services in this group Siblings and family members with mental health – e.g. kids caring for parents with mental health issues Lack of understanding of signs and symptoms of disability and detection of children GP lack of understanding about child development GP choice/discretion where they refer parents (with kids too) Link between private and public sectors doesn’t work e.g. early childhood and private allied health professionals

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LGA region: Waverley 

What ideas and suggestions do you have that may make a positive impact?

IVF clinics o Caring for people who are not successful o Left to pick up the pieces on their own o Continued support o Nowhere to go for help  No home visiting service after 6 weeks – often who you know gets you help  Language barrier – access to the right service  Transport  Mind foundation – vaccine and autism theory  Mentality of safety (herd) vaccination and avoidance  Informal reliance of family to help  Young people aren’t accessing health services o Cost and access o Don’t know rights o Bulk billing practices – intimidating and not friendly Idea or suggestion # of Service # of Votes Consumer Votes 2 2  Education of future parents on expectations of the health system 0  Looking at emerging populations e.g. Bengali 1 o Young pregnant women to get screened o Increase awareness of screening importance o Cultural awareness 1 0  Acknowledge health needs of parents who have children with disabilities 2 1  National disability insurance scheme – ML link between NDIS and parents 1 0  Improved understanding of child development – increase education of GPs about responding to children who present with developmental issues 3 0  Compulsory appointments to paediatrician 



ML look at early diagnosis of children with diagnosis of disability o Impact on family o Help family members o Respite – connecting with other mothers o Informing GPs of where to refer patients Allied health professionals (private sector) talking to parents regarding pathways to other early childhood development services Educating people on where they need to go –

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LGA region: Waverley



 



  



pathways to navigate the system, other services GPs to address immunisation rate by o Using a case study o Media Release o Scare tactics Address the cause as to why people are not vaccinating – mentality of the link/causation Link ML with early intervention/autism groups e.g. a parent of a child with autism speaking to other parents Target grandparents as to how dangerous vaccine preventable diseases are which may have some influence on parents Promote to parents with older kids that were not immunised as kids Link in with neonatal clinics and disability services Focus more broadly beyond immunisation – have a staff member at ML to look more widely at children, mothers etc. ML link in with family services – NSW kids and families, department of health, NSW youth policy.

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LGA region: Waverley Date of the meeting: 24th March 2014 Venue: Waverley Council Chambers TOPIC: After Hours Facilitators

Organisation

Lissa Smith

360health Pty Ltd

Attendee Type

Number of Attendees

Service providers

Consumers/patients

Questions What services are working well and meeting patients’ needs? What services are not working well or are not meeting patients’ needs?

Responses  After hours service – fridge magnet  Mental health line – first aid courses  Pharmacists good after hours services – particularly in Bondi

What ideas and suggestions do you have that may make a positive impact?

 GPs very rushed after hours appointments – especially bulk billing GPs  Affordability – can be around $150 for an after-hours consultation  Lack of knowledge  Better promotion of services – schools, social media  Wait time in ED – elderly are especially vulnerable  Lack of specialists after 5pm and weekends (not quite emergency)  Distinction between after hours and 24 hours  Access to internet for people where English is their second language Idea or suggestion # of Service # of Votes Consumer Votes 2 1  Consumers more aware of MBS numbers and bulk billing item numbers 0 0  Those clinics open for extended hours – consumers can get longer appointments 0 0  More GP promotion of quieter hours in their practices 2 0  App of youth services promoting services 24/7 0  Medicare local and partners promote mental 2 health service and other services e.g. council interagency  After hours services – fridge magnet/sticker with additional information about rubbish collection, local council contacts to promote after hours services  After hours pharmacists and GPs to be promoted better 0  Promotion/education of police and hospitals 5 of services available and when 1  Create a more 24/7 service – availability of all 4

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services after 5 flexible working ď&#x201A;ˇ

GP clinic in hospital on same site after triage â&#x20AC;&#x201C; GP casualty, Balmain Hospital 6-12pm Model

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