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Company Name (ABN 000000000), trading as Name of Company’s Trading Name (if different from Company’s Name)
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Acknowledgments The Eastern Sydney Medicare Local would like to acknowledge the Australian Government Department of Health for funding the preparation of this report.
We extend sincere thanks to those representatives that contributed to the preparation of this report specifically, the South Eastern Sydney Local Hospital District Planning and Population Health Unit.
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Contents 1. 2.
Introduction ........................................................................................................................ 6 Population and community characteristics ..................................................................... 7 2.1. 2.2. 2.3. 2.4. 2.5. 2.6. 2.7.
3.
Social determinants of health ......................................................................................... 12 3.1. 3.2. 3.3. 3.4. 3.5. 3.6. 3.7.
4.
Self-reported health status ...........................................................................................................17 Health risk factors .........................................................................................................................17 Immunisation, infant mortality and wellbeing ...............................................................................18 Prevalence of chronic disease .....................................................................................................20 Cancer screening rates ................................................................................................................20 Prevalence of cancer ....................................................................................................................21 Disability .......................................................................................................................................22 Mortality ........................................................................................................................................23 Alcohol-related domestic violence incidences ..............................................................................24 STI Rates......................................................................................................................................24 Infectious diseases .......................................................................................................................27
Health service availability ............................................................................................... 28 5.1. 5.2. 5.3. 5.4. 5.5. 5.6.
6.
Socio-economic characteristics ....................................................................................................12 Income ..........................................................................................................................................12 Employment ..................................................................................................................................13 Education levels ...........................................................................................................................14 Homelessness ..............................................................................................................................15 Social cohesion / community strength ..........................................................................................16 Barriers to accessing services......................................................................................................16
Health characteristics and risk factors........................................................................... 17 4.1. 4.2. 4.3. 4.4. 4.5. 4.6. 4.7. 4.8. 4.9. 4.10. 4.11.
5.
Population characteristics ..............................................................................................................7 Birth rate .........................................................................................................................................8 Cultural characteristics ...................................................................................................................8 Aboriginal and Torres Strait islander community .........................................................................10 Family structure ............................................................................................................................10 Private health insurance coverage................................................................................................11 Broadband internet access ...........................................................................................................11
Hospitals .......................................................................................................................................28 General practitioners ....................................................................................................................28 Allied health ..................................................................................................................................29 Mental health services ..................................................................................................................30 Community health services ..........................................................................................................31 Aged care .....................................................................................................................................31
Health service utilisation ................................................................................................. 32 6.1. 6.2. 6.3. 6.4. 6.5. 6.6. 6.7. 6.8.
Primary care utilisation .................................................................................................................32 Hospital admission .......................................................................................................................33 Top 10 causes of hospital admission ...........................................................................................33 Ambulatory care sensitive admissions .........................................................................................34 Number of hospitalisations for conditions of interest....................................................................34 Hospitalisations resulting from risk factors ...................................................................................36 Mental health services ..................................................................................................................38 Home and community care ..........................................................................................................38
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List of figures Figure 1: Population profile ............................................................................................................................................ 7 Figure 2: Forecast population growth ............................................................................................................................ 8 Figure 3: Birth rates ........................................................................................................................................................ 8 Figure 4: Primary languages spoken at home ............................................................................................................... 9 Figure 5: Breakdown of South East Asian (excl Thai) languages ................................................................................... 9 Figure 6: Indigenous persons population profile ........................................................................................................... 10 Figure 7: Family structure ............................................................................................................................................ 10 Figure 8: Private health insurance coverage ................................................................................................................ 11 Figure 9: Broadband internet access at home, ............................................................................................................. 11 Figure 10: Comparison of SEIFA Advantage and Disadvantage percentiles ................................................................ 12 Figure 11: Annual household income ........................................................................................................................... 12 Figure 12: Income support ............................................................................................................................................ 13 Figure 13: Top five Industry sectors of employment ..................................................................................................... 13 Figure 14: Unemployment ............................................................................................................................................ 14 Figure 15: Highest year of school completed ................................................................................................................ 14 Figure 16: Secondary school participation .................................................................................................................... 15 Figure 17: Homelessness ............................................................................................................................................. 15 Figure 18: Indicators of community strength, ................................................................................................................ 16 Figure 19: Barriers to accessing services ..................................................................................................................... 16 Figure 20: Self assessed health .................................................................................................................................. 17 Figure 21 Health risk factors ......................................................................................................................................... 17 Figure 22: Percentage of children fully immunised ....................................................................................................... 18 Figure 23: Pertussis notifications .................................................................................................................................. 18 Figure 24: Pneumococcal presentations ....................................................................................................................... 19 Figure 25: Percentage of low birth weight babies and mothers who smoke whilst pregnant ........................................ 19 Figure 26: Prevalence of selected chronic conditions ................................................................................................... 20 Figure 27: Cancer screening rates................................................................................................................................ 20 Figure 28: Comparison of cancer screening outcomes................................................................................................. 21 Figure 29: Prevalence of selected cancers ................................................................................................................... 21 Figure 30: Proportion of people with profound or severe disabilities............................................................................. 22 Figure 31: Proportion of people who have need for assistance with core activities ..................................................... 22 Figure 32: Premature mortality from chronic diseases .................................................................................................. 23 Figure 33: Potentially avoidable deaths ..................................................................................................................... 23 Figure 34: Comparison of alcohol related domestic violence incidences ..................................................................... 24 Figure 35: HIV notifications ........................................................................................................................................... 24 Figure 36:Chlamydia notifications ................................................................................................................................. 25 Figure 37: Rectal chlamydia notifications ..................................................................................................................... 25 Figure 38: Gonorrhea notificationsSource: South East Sydney Local Health District .................................................. 26 Figure 39: Syphilis notifications .................................................................................................................................... 26 Figure 40: Hepatitis B notifications ............................................................................................................................... 27 Figure 41: Hepatitis C notifications ............................................................................................................................... 27 Figure 42: GP’s per 1000 population ............................................................................................................................ 28 Figure 43: After hours GP clinics .................................................................................................................................. 29 Figure 44: Allied health Practitioners ........................................................................................................................... 29 Figure 45: Number of ATAPS providers ....................................................................................................................... 30 Figure 46: Aged care availability ................................................................................................................................... 31 Figure 47: Selected primary care services ................................................................................................................... 32 Figure 48: MBS GP services per person ...................................................................................................................... 32 Figure 50: Hospitalisation rate ...................................................................................................................................... 33 Figure 51: Top 10 causes of hospitalisation ................................................................................................................. 33 Figure 52: Preventable hospitalisations for ambulatory-care sensitive conditions ........................................................ 34 Figure 53: Stroke hospitalisations ................................................................................................................................. 34 Figure 54: Coronary heart disease hospitalisations ...................................................................................................... 35 Figure 55: Diabetes related hospitalisations ............................................................................................................... 35 Figure 56: Alcohol related hospitalisations .................................................................................................................. 36 Figure 57: Smoking related hospitalisation .................................................................................................................. 36 Figure 58: High body mass related hospitalisations .................................................................................................... 37 Figure 59: Number of falls per 1000 population 65 and over ........................................................................................ 37 Figure 60: Percentage of ATAPS referrals by sub region ............................................................................................. 38 Figure 61: Characteristics of HACC clients .................................................................................................................. 38 Figure 62: Utilisation of HACC services ........................................................................................................................ 39
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Glossary of Terms Term Eastern Sydney Medicare Local
Eastern Sydney ESML SLA LGA ML ABS PHIDU
Explanation Refers to an independent organization that coordinates primary health care delivery for residents living within the sub-regions of Sydney-Inner SLA, Sydney-East SLA, Waverley LGA, Woollahra LGA, Randwick LGA, Botany Bay LGA and Lord Howe Island Refers to data associated with Sydney LGA, Waverley LGA, Woollahra LGA, Randwick LGA, Botany Bay LGA, but excludes Sydney-North LGA, Sydney West LGA and Lord Howe Island LGA Eastern Sydney Medicare Local Statistical Local Area Local Government Area Medicare Local Australian Bureau of Statistics Population Health Information Development Unit
Data Data was gathered from a number of different data sets and sources including the Australian Bureau of Statistics (ABS), Public Health Information Development Unit (PHIDU), South East Sydney LHD, NSW Health Stats and ESML. We have relied on the data wherever possible and have avoided carrying out an extrapolations or making assumptions around the data and how it can be interpreted. Data Limitations 1. Comparable data sets were not always available when comparing sub regional information to the Medicare Local level. As such two points of comparison have been primarily used and presented against a NSW figure (where possible); ESML catchment and Eastern Sydney. 2. Large portions of respondents to certain data sets (e.g. in ABS census data) had either not respondent or marked the question non applicable. In all cases where this has occurred these responses have been excluded from the graphical representations of the analysis undertaken. The result of this is that figures presented in certain graphs in this profile do not always total 100%. 3. The HWA 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 sub-regional level due to privacy reasons.
Disclaimer th This report is prepared solely for the purpose set out in our job arrangement letter dated 10 December 2013 and is not to be used for any other purpose. The information provided in this report is based on information supplied by Eastern Sydney Medicare Local and other publicly available data sources. Paxton Partners has not verified the detailed assumptions and has relied on the information and data as sourced. The scope of work for this project did not include procedures considered necessary under generally accepted auditing standards for the purposes of expressing an opinion on the data provided. Accordingly, Paxton Partners does not express such an opinion
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1. Introduction The Randwick Local Government Area (LGA) (2011 pop: 137,757) is an inner south eastern suburb of 1 metropolitan Sydney in New South Wales . Spanning 36 square kilometers, this LGA is bordered by the Woollahra and the Waverley Councils in the north, the Tasman Sea in the east, Botany Bay in the south and the cities of Botany Bay and Sydney in the west. Suburbs in this catchment include Chifley, Clovelly, Coogee, Kensington, Kingsford, La Perouse, Little Bay, Malabar, Maroubra, Matraville, Port Botany, Phillip Bay, Randwick and South Coogee. The Eora nation are the traditional owners of these lands. One of Sydney's largest parks, Centennial Park, lies within the city boundary of Randwick. Long Bay Correctional Complex, an Australian maximum and minimum security prison for males and females, is located in Malabar. The University of New South Wales is also located within this LGA. Table 1.1 provides general characteristics of the Randwick sub-region at a glance. Table 1: Characteristics of the Randwick sub-region at a glance
Indicator Population Population growth forecast (2011 – 2025) % indigenous persons Average household income* Unemployment % Speak English in the home^ Private health insurance coverage
Value 137,757
Sub-region Rank within ML 1
Medicare local
NSW
383,014
7,211,486
6.2%
4
12.9%
15.3%
1.3% $82,004 2.6% 67.5% 52.8%
2 5 3 4 4
0.9% N/A 2.7% 69.8% 56.6%
2.5% $64,324 5.3% 76.5% 48.2%
Source: ^Australian Bureau of Statistics; *City profile (profile.id); (unmarked) Public Health Information Development Unit and Australian Bureau of Statistics.
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2. Population and community characteristics Headlines
The largest population of the sub regions within the ESML catchment.
Low levels of expected population growth.
High proportion of indigenous population compared to other sub regions.
2.1. Population characteristics Figure 1 shows that the population profile of Randwick sub-region is higher than the overall Medicare Local (ML) catchment for age ranges 0-24. These age ranges account for 30.6% of the total population within the Randwick catchment area, compared to 26.8% across the ML catchment. In contrast, a smaller proportion of Randwick's population is aged between 25 and 49 years (41.1%) compared to the Eastern Sydney Medicare Local (ESML) catchment (45.4%). Figure 1: Population profile
Source: PHIDU and Australian Bureau of Statistics (2013)
Population growth forecasts for Randwick between 2011 and 2025 are provided in Figure 2. According to the Australian Bureau of Statistics (ABS), population growth is expected to be lower for this subregion compared to the wider E S ML catchment area with an overall increase of 6.2% from 2011 to 2025 compared to 12.9% for the ESML catchment. For the ages 0-19 negative population growth is forecast in Randwick compared to an increase across the ESML population. According to NSW Planning and Infrastructure, high development areas over the coming years include the former Prince Henry Hospital site, Maroubra Town Centre, Anzac Parade at Malabar and additional student accommodations at University of New South Wales.
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% growth (2011 to 2025)
Figure 2: Forecast population growth
80% 70% 60% 50% 40% 30% 20% 10% 0% -10%
Randwick (C)
Eastern Sydney
New South Wales
Source: PHIDU and Australian Bureau of Statistics (2013)
2.2. Birth rate The birth rate in Randwick is 1.5 children per female which is lower than the average for NSW overall (1.80 births per female) but above the ESML catchment average of 1.31. Figure 3: Birth rates
Source: PHIDU and Australian Bureau of Statistics (2013)
2.3. Cultural characteristics The majority of the population within the Randwick LGA identifies English as their primary language (68%) however; this is lower than the average for both the ESML (70%) and NSW (77%). The graph below shows the other major languages spoken at home in Randwick, with the exception of English. Chinese (9.5%), Greek (4.2%), South East Asian (excluding Thai) (3.0%) and Iberian dialects (2.5%) are the other most common primary languages spoken in Randwick homes.
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Figure 4: Primary languages spoken at home
Source: Australian Bureau of Statistics (2012)
Of the 2,900 (2.5%) people who identified Iberian as there preferred language spoken in the home 1,975 (68%) speak Spanish with the remaining 917 (32%) speaking Portuguese. A breakdown of the South East Asian (excluding Thai) languages shows that 2.10% of the Randwick population speaks Indonesian in the home compared with 1.83% of ESML population and 0.38% of NSW. There are also higher percentages of Malay speakers in the Randwick population compared with those of ESML and NSW. Figure 5: Breakdown of South East Asian (excluding Thai) languages
Source: Australian Bureau of Statistics (2012)
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2.4. Aboriginal and Torres Strait islander community Indigenous Australians comprise 1.3% of the total population of the Randwick sub-region, which is higher than for the ESML catchment (0.9%) but lower than NSW (2.4%). The highest proportion of the Indigenous population within Randwick is within the younger age ranges from 0-19. Figure 6: Indigenous persons population profile, by age
Source: PHIDU and Australian Bureau of Statistics (2013)
2.5. Family structure Figure 6 shows a breakdown of predominant family structures living within the catchment. The most common family type in Randwick is a ‘couple family with children’ (25%), which is higher than the ESML catchment (19%) but lower than NSW (30%). Randwick also has higher levels of ‘one parent families’ (8%) compared to the ESML (7%). Figure 7: Family structure
Source: Australian Bureau of Statistics (2012)
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2.6. Private health insurance coverage Figure 8 shows that 52.8% of Randwick residents have private health insurance. This compares to 56.6% of residents within the ESML catchment and 48% across NSW. Figure 8: Private health insurance coverage
Source: PHIDU and Australian Bureau of Statistics (2013)
2.7. Broadband internet access Figure 9 shows that broadband internet penetration within households in Randwick (74.1%) is lower than in the ESML catchment area (74.7%) but higher NSW (69.9%). Figure 9: Broadband internet access at home,
Source: PHIDU and Australian Bureau of Statistics (2013)
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3. Social determinants of health Headlines
Higher proportion of the population on income support than the ESML average.
Healthcare and social assistance is the largest employment industry.
Low levels of homelessness in relation to the ESML and NSW averages.
3.1. Socio-economic characteristics The Socio-Economic Indexes for Areas (SEIFA) index score for socio-economic advantage and th disadvantage in Randwick is 1062, which ranks 4 out of the 6 sub regions within ESML. The graph below highlights the respective percentile rank for both socio economic advantage and disadvantage. Figure 10: Comparison of SEIFA Advantage and Disadvantage percentiles
Source: Australian Bureau of Statistics (2013)
3.2. Income Figure 11 shows that a higher proportion of households in Randwick earn over $53,000 compared to the NSW average. When compared to the overall income levels across the ESML catchment, Randwick is broadly similar, but has a lower proportion of residents earning more than $78,000 per annum. Figure 11: Average household income
Source: Australian Bureau of Statistics (2012)
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Figure 12 shows that a higher proportion of people within Randwick receive disability pensions, compared to the ESML catchment as a whole, but a lower proportion of persons receive unemployment benefits. Additionally, Randwick families that are ‘welfare-dependent’ are approximately 18% higher than the overall ESML population. Figure 12: Income support
Source: PHIDU and Centrelink (2013)
3.3. Employment Industry An analysis of the jobs held by residents of Randwick reveal that the top five industry sectors of employment are healthcare and social assistance (6.0%), professional , scientific and technical services (5.8%), education and training (5.0%), retail trade (3.8%) and financial and insurance services (3.7%). Together, these five industries employ 24.2% of the population, which is lower when compared to the ESML catchment area (25.6%) but higher than NSW average (17.7%). Figure 13: Top five Industry sectors of employment
Source: Australian Bureau of Statistics (2012)
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Employment status The percentage of people who are unemployed within the Randwick sub region is 2.64%, which is lower than ESML catchment (2.72%) and the NSW average (5.25%). Figure 14: Unemployment
Source: PHIDU and Australian Bureau of Statistics (2013)
3.4. Education levels Within the Randwick sub-region 55% of people aged over 15 years have completed Year 12 schooling/ or equivalent. This is lower than ESML (58%) but higher than the overall figure for NSW (38%). Figure 15: Highest year of school completed
Source: Australian Bureau of Statistics (2012)
Data available from PHIDU shows that secondary school participation at age 16 in Randwick (85%) is higher than within the ESML catchment (83%) and NSW (80%). The proportion of school leavers from Randwick that go on to pursue higher education qualifications ( 42%) is also higher than ESML catchment area (41%) and the NSW average (30%).
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Figure 16: Secondary school participation
Source: PHIDU and Australian Bureau of Statistics (2012)
3.5. Homelessness Figure 17 shows that the per-capita rate of homelessness in Randwick (0.65%) is lower than the levels across the ESML (1.14%) and NSW (0.76%). Figure 17: Homelessness,
Source: Australian Bureau of Statistics (2012)
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3.6. Social cohesion / community strength Figure 18 shows that Randwick is broadly in line with the ESML and NSW when it comes to indicators of community strength. All 3 demographics feel strongly that they can get support in a time of crisis (all over 80%) with only approximately 5% of the population disagreeing with the acceptance of foreign cultures. Figure 18: Indicators of community strength,
Source: PHIDU and Australian Bureau of Statistics (2013)
3.7. Barriers to accessing services Figure 19 shows the major barriers to accessing services across Randwick. The most significant barrier to accessing services within the sub region was not accessing the internet (22%), with 9.5% of residents not able to afford medical treatment, 5.3% citing an inability to afford medication and 3.9% reporting transportrelated barriers to accessing services. Figure 19: Barriers to accessing services,
Source: PHIDU and Australian Bureau of Statistics (2013)
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4. Health characteristics and risk factors Headlines
Higher levels of childhood immunization than the ESML average.
Higher proportionate levels of people with profound or severe disabilities than the ESML and NSW averages.
Higher levels of preventable deaths and avoidable hospitalisations than the ESML averages.
4.1. Self-reported health status Figure 20 shows that the levels for fair or poor self-assessed health in Randwick (12.5%) is the same as the ESML catchment area (12.5%) and lower than the NSW (16.6%) average. It also illustrates that the levels of those with restricted core activities are higher in Randwick (10.1%) than the ESML catchment area (9.3%) but again lower than NSW average (11.5%). Figure 20: Self assessed health
Source: PHIDU and Australian Bureau of Statistics (2013)
4.2. Health risk factors Figure 21 shows that there are lower proportions of overweight and obese persons in Randwick compared to the ESML catchment. This is also true of the proportions of smokers, persons with risky alcohol consumption levels and the psychologically distressed. Only is the proportion of physically inactive persons higher in Randwick (30.8%) than the ESML catchment (30.6%). Figure 21 Health risk factors
Source: PHIDU and Australian Bureau of Statistics (2013) www.esml.org.au Level 1, 5 Rosebery Avenue, Rosebery NSW 2018 t 02 9663 5958 f 02 9663 5817
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4.3. Immunisation, infant mortality and wellbeing Childhood immunisation Figure 22 shows the percentage of children that are fully immunised at one, two and five years of age. For all ages, immunisation rates in Randwick are higher than in the ESML catchment. Figure 22 also shows a gradual decline in the proportion of children fully immunised as they get older. Figure 22: Percentage of children fully immunised
Source: PHIDU and Australian Childhood Immunisation Register / Medicare Australia (2013)
Pertussis The graph below shows the number of pertussis notifications in Randwick each year from 2008-12, along with an overall figure for Eastern Sydney (comprising Botany Bay, Randwick, Sydney, Waverley and Woollahra LGA’s). The data used shows that the volume of notifications increased across Randwick from 2008-2011 but have subsequently declined and in 2012 were below the 2008 levels. Figure 23: Pertussis notifications
Source: South Eastern Sydney Local Health DIstrict
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Pneumococcal As shown in the graph below, the number of pneumococcal notifications was roughly the same in 2012 as it had been in 2008. However, there was a spike in notifications in 2011 with 15 reported cases, a 200% increase from 2010. For the Eastern Sydney ML catchment the number of notifications has increased from 23 per annum to 31, representing an increase of 34%. Figure 24: Pneumococcal presentations
Source: South Eastern Sydney Local Health DIstrict
Low birth weight babies Figure 25 shows the percentage of low birth weight babies and the percentage of mothers who smoke whilst pregnant within the Randwick sub region, ESML and NSW. Randwick has a lower rate of low birth weight babies (5.48%) than ESML catchment average (5.53%) and NSW (6.12%). The level of women who smoke whilst pregnant in Randwick is 2.44% compared with 2.48% in the ESML and 11.99% in NSW as a whole. Figure 25: 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. Prevalence of chronic disease Figure 26 shows that the prevalence rates for chronic diseases within the Randwick sub region are broadly in line with those shown for both the ESML catchment area and NSW with no variation being greater than 1% of total population. Figure 26: Prevalence of selected chronic conditions
Source: PHIDU and Australian Bureau of Statistics (2013)
4.5. Cancer screening rates Figure 27 shows the percentage of people who were eligible for, and participated in bowel and cervical cancer screening programs in 2010. 32% of those eligible in Randwick participated in the bowel cancer screening program which higher than the ESML (30%) but lower than NSW (35%). 59% of those eligible for the cervical cancer screening program in Randwick took part compared with 60% in the ESML catchment and 56% across NSW. No data was available regarding breast cancer screening. Figure 27: 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 28 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% in Randwick which was lower than both in the ESML catchment (7.3%) and NSW (8.4%). The rate of low-grade abnormalities from the cervical cancer screening was 4.1% in Randwick compared with 4.6% in the ESML catchment and 3.2% in NSW. The rate of high-grade cervical screening abnormalities in Randwick and the ESML catchment areas was 0.8% compared with 0.6% in NSW.
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Figure 28: Comparison of cancer screening outcomes
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).
4.6. Prevalence of cancer Figure 29 shows the prevalence of certain cancer types across the LGAs comprising ESML and NSW as a whole. No data at the Medicare Local level was available. Although there are no identifiable cancer types that are significantly more prevalent in Randwick compared to other sub-regions, Randwick did report the second-highest prevalence of breast cancer, behind Woollahra. Figure 29: Prevalence of selected cancers
Source: Cancer Institute NSW (2010)
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4.7. Disability Profound or severe disabilities 'People with profound/severe disability are those who need some ongoing help or supervision with 2 communication, self-care and/or mobility for six months or more . Figure 30 shows the proportion of persons with profound or severe disability within the Randwick sub region, ESML and NSW. The graph shows that levels of profound or severe disability are higher in Randwick compared to ESML catchment area, and higher than both the ESML catchment and NSW for persons aged 65 or more. Figure 30: Proportion of people with profound or severe disabilities
Source: PHIDU and Australian Bureau of Statistics (2013)
Need for assistance with core activities The proportion of people who require assistance with core activities in Randwick (3.49%) is higher than the ESML catchment area (2.96%) but lower than the NSW average (4.69%). Figure 31: Proportion of people who have need for assistance with core activities
Source: PHIDU and Australian Bureau of Statistics (2013)
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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 www.esml.org.au Level 1, 5 Rosebery Avenue, Rosebery NSW 2018 t 02 9663 5958 f 02 9663 5817
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4.8. Mortality Premature mortality refers to deaths among people aged less than 75 years. Figure 32 presents mortality rates from chronic conditions in Randwick for persons aged between 0 and 74. The data shows that premature mortality is higher in Randwick than the ESML average for cancer, circulatory system disease and respiratory system disease, whilst having lower rates of premature mortality related to external causes and suicide. The levels of premature mortality are higher in NSW on average than in Randwick for all categories. Figure 32: Premature mortality from chronic disease (ages 0 to 74 years) and external causes
Source: PHIDU and Australian Bureau of Statistics (2013)
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 3 available health care. The graph below illustrates that the per-capita rate of avoidable mortality i n R a n d w i c k (0.88 deaths per 1,000 persons) is 7 % higher than the ESML rate (0.82 deaths per 1,000 persons) and 3% lower than the NSW rate (0.91 deaths per 1,000 persons). Figure 33: Potentially avoidable deaths
Source: Health Statistics NSW and NSW Ministry of Health
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4.9. Alcohol-related domestic violence incidences The graph below illustrates that the alcohol-related domestic violence rates are lower in the Randwick sub region (1.0 incidence per 1000 population) than in both Eastern Sydney (1.5) and NSW (1.4) Figure 34: Comparison of alcohol related domestic violence incidences
Source: NSW Bureau of Crime Statistics and Research (2012)
4.10. Sexually Transmissible Infections HIV The graph below illustrates the volume of HIV notifications since 2011. The data is split between those notifications that occurred in Sydney LGA and those in the rest of the ESML catchment. 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 LGA’s. 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 and that this resulted in a 15% increase overall. The data provided for 2013 only covered the period from January – September so has not been used for comparative purposes. Figure 35: HIV notifications
Source: South Eastern Sydney Local Health District
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Chlamydia The graph below shows the annual number of notifications of chlamydia in Randwick over the period from 2008-12. Alongside this the graph tracks the overall number of notifications across Eastern Sydney (comprising Botany Bay, Randwick, Sydney, Waverley and Woollahra LGA’s). The number of notifications has risen from 392 to 521 per annum in Randwick over the period representing an increase of 33%. The overall number of notifications for Eastern Sydney has increased from 1887 to 2556 per annum, representing an increase of 35%. Figure 36:Chlamydia notifications
Source: South East Sydney Local Health District
Rectal Chlamydia in males The graph below shows the annual number of notifications of rectal chlamydia in males in Randwick over the period from 2008-12. Alongside this the graph tracks the overall number of notifications across Eastern Sydney. The number of notifications has decreased from 26 to 22 per annum in Randwick over the period representing a decrease of 15%. The overall number of notifications for Eastern Sydney has increased from 249 to 429 per annum, representing an increase of 72%. Figure 37: Rectal chlamydia notifications
Source: South East Sydney Local Health District
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Gonorrhea The graph below shows the annual number of notifications of gonorrhea in Randwick over the period from 2008-12. Alongside this the graph tracks the overall number of notifications across Eastern Sydney. The number of notifications has risen from 43 to 116 per annum in Randwick over the period representing an increase of 170%. The overall number of notifications for Eastern Sydney has increased from 384 to 1114 per annum, representing an increase of 190%. Figure 38: Gonorrhea notifications
Source: South East Sydney Local Health District
Syphilis The graph below shows the annual number of notifications of syphilis in Randwick over the period from 2008-12. Alongside this the graph tracks the overall number of notifications across Eastern Sydney. The number of notifications has risen from 12 to 20 per annum in Randwick over the period. The overall number of notifications for Eastern Sydney has increased from 179 to 191 per annum, representing an increase of 6%. Figure 39: Syphilis notifications
Source: South East Sydney Local Health District
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4.11. Infectious diseases Hepatitis B From 2008 – 2012 there has been a downward trend in the number of notifications in both Randwick and in the Eastern Sydney region. In Randwick the number of notifications has gone from 51 in 2008 to 37 in 2012, a decrease of 27%. In Eastern Sydney they have decreased from 210 in 2008 to 137 in 2012, a decrease of 35%. This is illustrated on the graph below. Figure 40: Hepatitis B notifications
Source: South East Sydney Local Health District
Hepatitis C The graph below illustrates the number of Hepatitis C notifications in Randwick and the Eastern Sydney region annually from 2008 to 2012. The number of notifications in Randwick has remained relatively stable with 46 notifications in 2008 and 2012. The peak was 62 in 2009. The overall figure for the Eastern Sydney region has declined from256 notifications in 2008 to 179 in 2012, a decrease of 30%. Figure 41: Hepatitis C notifications
Source: South Eastern Sydney Local Health District
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5. Health service availability Headlines
There are four hospitals in Randwick including the Prince of Wales hospital, a major tertiary facility.
High levels of ‘High care’ aged beds available when compared to ESML and NSW.
Large number of after hour’s GP clinics as compared to the other sub regions.
5.1. Hospitals The Randwick sub region houses the Randwick health campus which comprises the Prince of Wales hospital, a major tertiary, trauma and teaching hospital as well as the Royal Hospital for Women and the Sydney Children’s Hospital. The area is also home to the Prince of Wales Private Hospital. Hospital name Prince of Wales Hospital Prince of Wales Private Royal Hospital for Women Sydney Children’s Hospital
Hospital type Full service tertiary facility Inpatient, day surgery, comprehensive service offerings including coronary and intensive care Specialist hospital for women and babies Full range of specialist services to treat children
No of beds 526 168 122 142
5.2. General practitioners The graph below shows that the number of GPs per 1000 population in Randwick (1.4 per 1000 population) is the second lowest of the sub regions across ESML, as well as being below the Eastern Sydney average (1.77). However, the availability of GPs within Randwick is above the national benchmark 4 of 1 GP for every 1133 residents (or the equivalent of 0.88 per 1,000 capita). Figure 42: GP’s per 1000 population
Source: Health Workforce Australia (2013) Note: Sydney LGA includes other areas of the city besides Sydney East and Inner
4
Benchmark figure is 1 GP per every 1133 people (0.88 per 1000) 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 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). www.esml.org.au Level 1, 5 Rosebery Avenue, Rosebery NSW 2018 t 02 9663 5958 f 02 9663 5817
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After hours 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; and
All day Sundays and public holidays.
The data illustrated on the graph below details the number of general practices in the region registered with the ESML after hour’s program. The graph shows that there are 51 such practices in Randwick. Figure 43: After hours GP clinics
Source: Eastern Sydney Medicare Local
5.3. Allied health As shown in Figure 44, Randwick has above average levels of allied health practitioners for all disciplines on a per-capita basis, with the exception of chiropractors. Figure 44: Allied health Practitioners
Source: Health Workforce Australia (2013) Note: Sydney LGA includes other areas of the city besides Sydney East and Inner
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5.4. Mental health services Figure 45 shows the total number of ATAPS providers by sub region, as well as providing a calculation to show the number per 100,000 population. The graph shows that there are 23 ATAPS providers in Randwick, which is equal to 18 per 100,000 population. Figure 45: Number of ATAPS providers
Source: Eastern Sydney Medicare Local / National Health Service Directory (2013) Note: Sydney LGA includes other areas of the city besides Woollahra
The table below illustrates the volume of available mental health facilities within the ESML catchment area. Many of the facilities within the region will offer more than one of the types of services 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 bests first their primary service offering. The table shows that Randwick has 16 facilities delivering mental health services out of the ESML total of 91. Table 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 Bay 0 0 0 0 0 0 0 0 0 0 0 0
0
Sydney (C) - Sydney (C) Inner East Randwick (c) Waverley (A) Woollahra (A) ESML Total 0 1 0 0 0 1 2 1 3 0 0 6 2 1 3 0 0 6 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 1 2 4 0 0 0 6 0 0 0 1 0 1 0 0 1 0 0 1 0 0 0 0 0 0 20 5 2 6 2 35 15 1 6 7 4 33
43
13
15
14
6
91
Source: Eastern Sydney Medicare Local / National Health Service Directory (2013)
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5.5. Community health services The table below illustrates the volume of available unique community health service facilities within the ESML catchment area. Many of the facilities within the region will offer more than one of the types of services 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 classifications that best first their primary service offering. The table shows that Randwick has 10 facilities delivering community care services out of an ESML total of 59 which means that Randwick has 17% of the total within ESML. Table 3: Community health care facilities Botany Bay 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
0 0 0 0 0 0 0 0 0 0 0 0 0
Total
0
Sydney (C) - Sydney (C) Inner East Randwick (c) Waverley (A) Woollahra (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)
5.6. Aged care Figure 46 illustrates the availability of aged care services across the Randwick sub region, ESML and NSW broken down into high, low and community-based aged care. This shows that there are higher levels of high care facilities in Randwick (52 places per 1000 people over 70) compared to the ESML catchment (46) and NSW (45). However, when it comes to the availability of community aged care Randwick (2 places per 1000 people aged 70+) has lower levels than the ESML catchment (16) and NSW (24). Figure 46: Aged care availability,
Source: PHIDU and Department of Health and Ageing (2013)
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6. Health service utilisation Headlines 
Higher levels of hospitalisation per1000 population compared to ESML and NSW averages.

High proportion of total ESML wide ATAPS referrals.
6.1. Primary care utilisation Figure 47 shows the number of primary care services per-capita billed to the MBS for Randwick residents were higher than t h e E S M L c a t c h m e n t for GP health assessments for persons aged over 75, GP enhanced primary care services and practice nurse services. However, on a per-capita basis, the number of services billed using the MBS were lower than the ESML catchment average for 45 year old health checks and GP mental health plans. Figure 47: Selected primary care services
Source: PHIDU and Department of Health and Ageing (2013)
Figure 48 shows that the level of GP MBS services delivered per person per year is higher in Randwick (5.6) than Eastern Sydney (5.1) but lower than the NSW average (5.8). Figure 48: MBS GP services per person
Source: PHIDU and Department of Health and Ageing (2013)
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6.2. Hospital admission Figure 49 illustrates that the hospitalisation rates for Randwick (419 per 1000 population) are higher than the Eastern Sydney catchment area (404) and the NSW average (360). Figure 49: Hospitalisation rate per 1000 persons,
Source: Health Statistics NSW and NSW Ministry of Health (2011)
6.3. Top 10 causes of hospital admission The graph below outlines the top 10 causes of hospitalisation within Randwick by DRG along with the number of separations. It shows that rehabilitation, same day (Z60C) is the largest cause of hospitalisation in the sub region. The graph below is based on data provided by the LHD using a postcode analysis. For the purposes of this exercise it was assumed that the following postcodes constitute the nearest available match to Randwick LGA: 2010, 2011, 2018, 2031, 2032, 2033, 2034, 2035, 2036 and 2052. Figure 50: Top 10 causes of hospitalisation
Source: South East Sydney Local Health District
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6.4. Ambulatory care sensitive admissions 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. The graph below shows that the levels of preventable hospitalisation for ambulatory care sensitive conditions in Randwick (23.0 per 1000 population) are 11% higher than Eastern Sydney (20.7) catchment and 3% lower than the NSW average (23.8). Figure 51: Preventable hospitalisations for ambulatory-care sensitive conditions
Source: NSW Ministry of Health and Health Statistics NSW (2012)
6.5. Number of hospitalisations for conditions of interest This section presents data describing the number of hospitalisations per 1000 persons for stroke, coronary heart disease and diabetes.
Stroke Figure 51 shows that Randwick's number of hospitalisations from strokes (1.34 per 1000 of the population) is lower than the NSW average (1.43). No data is available for the overall ESML catchment; however, the available data indicates that Randwick is in the mid-range compared to other sub-regions within the ESML catchment. Figure 52: 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 heart disease nd
Figure 52 shows that levels of hospitalisations from coronary heart disease are 2 highest in Randwick (8.7 per 1000 population) of any sub-region across the ESML catchment. CHD hospitalisations for Randwick residents are also 45% higher than the NSW average (6.1 per 1000 population). Figure 53: Coronary heart disease hospitalisations
Source: NSW Ministry of Health and Health Statistics NSW (2012)
Diabetes Figure 54 shows that the level of diabetes-related hospitalisations in Randwick (1.88 per 1000 population) nd is the 2 highest across the 5 sub regions within the ESML catchment. Diabetes-related hospitalisations for Randwick residents are also 30% higher than the average across NSW (1.45). Figure 54: Diabetes related hospitalisations
Source: NSW Ministry of Health and Health Statistics NSW (2012)
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6.6. Hospitalisations resulting from risk factors This section presents data on hospitalisations arising from modifiable risk factors, including alcohol, smoking, high body mass and falls.
Alcohol Figure 55 shows that Randwick (7.4 per 1000 population) has lower levels of alcohol-related hospitalisations compared to all other LGA’s in the ESML catchment, with the exception of Botany Bay, but is higher than the NSW average. Figure 55: Alcohol related 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).
Smoking Figure 56 shows that the levels of smoking-related hospitalisations are higher in Randwick (6.06 per 1000 population) the NSW average (5.65) and is the second highest of the sub regions within ESML. Figure 56: Smoking related hospitalisation
Source: NSW Ministry of Health and Health Statistics NSW (2012)
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High body mass Figure 57 illustrates that the levels of hospitalisation related to high body mass are 12% higher in Randwick (4.95 per 1000 population) than in NSW (4.41). The numbers of hospitalisations attributable to high body mass in Randwick are the 2nd highest of any sub-region across the ESML catchment. Figure 57: High body mass related hospitalisations
Source: NSW Ministry of Health and Health Statistics NSW (2012)
Falls Randwick sub region has the highest level of fall related hospitalisations for those aged 65 years and over in ESML catchment (39.89 per 1000 population). This is 28% higher than the NSW average of 31.29. Figure 58: Number of falls per 1000 population 65 and over
Source: NSW Ministry of Health and Health Statistics NSW (2012)
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6.7. Mental health services The graph below 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 has 36% of the residents in ESML and provides 48% of the ATAPS referrals. Figure 59: Percentage of ATAPS referrals by sub region
Source: Eastern Sydney Medicare Local
6.8. Home and community care Figure 60 shows characteristics of HACC consumers in Randwick, compared to the ESML catchment overall and NSW. The greatest variances between Randwick, ESML and NSW in terms of HACC consumers are:
Clients living alone (44.4% compared to 46.1% across ESML and 38.6% in NSW)
Total clients per 1,000 population (38.4% compared to 33.7% across ESML and 36.7% in NSW)
Clients with carer (12.1% compared to 11.3% across ESML and 20.9% in NSW).
Figure 60: Characteristics of HACC clients
Source: PHIDU and Department of Health and Ageing (2013)
Figure 61 presents the number of instances of care for selected HACC services across Randwick, which shows that Randwick residents are more frequent consumers of most HACC services than both the overall ML and NSW. Notably, the greatest variances in HACC service utilisation relate to:
Centre-based day care services (3.82 instances per 1000 compared to 3.6 across ESML and 2.6 www.esml.org.au Level 1, 5 Rosebery Avenue, Rosebery NSW 2018 t 02 9663 5958 f 02 9663 5817
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in NSW)
Care coordination services (3.10 instances per 1000 compared to 3.1 across ESML and 4.3 in NSW)
Domestic assistance (8.4 instances per 1000 compared to 6.6 across ESML and 7.72 in NSW)
Transport services (7.8 instances per 1000 compared to 8.1 across ESML and 8.9 in NSW)
Allied health care in the home (4.4 instances per 1000 compared to 4.2 across ESML and 2.6 in NSW). Figure 61: Utilisation of HACC services
Source: PHIDU and Department of Health and Ageing (2013)
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