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1
Naracoorte
10 Year Local Health Service Plan
2011 2020
Naracoorte Area Health Advisory Council
Naracoorte Health Service
Country Health SA Local Health Network
2
10 Year Local Health Service Plan
Naracoorte Health Service
2011 - 2020
Table of Contents
1. Executive Summary .......................................................................................................3
2. Catchment summary......................................................................................................5
3. Needs Analysis summary..............................................................................................7
4. Local implications of Statewide plans..........................................................................9
5. Planning Principles...................................................................................................... 10
6. Service Delivery Plan................................................................................................... 11
6.1 Core Services to be Sustained ............................................................................... 11
6.2 Strategies for new / expanded services .................................................................. 14
7. Key Requirements for Supporting Services............................................................... 19
7.1 Safety & Quality...................................................................................................... 19
7.2 Patient Journey ...................................................................................................... 20
7.3 Cultural Respect..................................................................................................... 21
7.4 Engaging with our community................................................................................. 23
7.5 Local Clinical Networks .......................................................................................... 24
8. Resources Strategy ..................................................................................................... 25
8.1 Workforce............................................................................................................... 25
8.2 Infrastructure .......................................................................................................... 26
8.3 Finance .................................................................................................................. 26
8.4 Information Technology .......................................................................................... 27
8.5 Risk Analysis .......................................................................................................... 27
9. Appendix ...................................................................................................................... 28
9.1 Leadership Structure .............................................................................................. 28
9.2 Methodology........................................................................................................... 28
9.3 Review Process...................................................................................................... 28
9.4 Glossary................................................................................................................. 28
Date: 3 June 2011
3
1. Executive Summary
Background and context
The Naracoorte and Area Health Advisory Council (NAHAC) together with the Naracoorte Health
Service (NHS), with the support of the Country Health SA Planning Projects Team, have worked
closely in the development of the 10 Year Health Service Plan including implementation of the
community consultation and oversight of the planning process.
As a major stakeholder, the Kincraig Medical Clinic medical officers in Naracoorte were involved with
the consultation and engaged closely with the Planning Team in providing information and advice
towards development of the 10 Year Health Service Local Plan. The Kincraig Medical Clinic is an
important partner in the delivery of a broad health service for the residents of the Naracoorte
catchment.
Naracoorte Health Service provides care to the Naracoorte Lucindale Council catchment extending
into western Victoria. It is recognised that residents living in Avenue and other areas west of
Lucindale in the Naracoorte and Lucindale Statistical Local Area (SLA) also access services from the
Kingston Soldiers Memorial Hospital. For more complex services such as maternity services, the
Naracoorte Health Service catchment extends to centres including Bordertown, Kingston and Robe.
Between July to December 2009 the community consultation process sought feedback on the health
service needs of the local population. In early 2010, the Naracoorte Executive Team, in partnership
with Health Advisory Council (HAC) members, undertook a needs analysis process to capture the
strengths, weaknesses, opportunities and threats (SWOT) of existing services and future directions.
The needs analysis has drawn on information obtained through the consultation process and analysis
of the Health Service Profile and other relevant data. A total of 56 consultation activities were held
using 72 volunteer hours to obtain this data.
Key components of the Plan
Key evidence which supports the strengthening of existing services, as well as the development of
new programs, includes the projected population statistics, the right for people to access services
close to home within resources, as well as a high prevalence of chronic disease (asthma,
cardiovascular disease and mental illness) in comparison to the overall South Australian rate. It is
noted that the Aboriginal and Torres Strait Islander population represents 1.1% of the catchment
population compared with 3.1% across South Australia. Residents who speak a language other than
English at home represent 4.2% of the catchment population. Population projection data indicates that
there will be a slight increase in the catchment population to the year 2021.
Sustaining, maintaining and developing current services to meet the growth and needs of the
community is the primary focus of the plan including 24/7 emergency services, acute inpatient care,
elective surgery, maternal and neonatal care, aged care, community and outpatient care, palliative
care, clinical support services, medical specialties services, mental health services, and services to
meet the cultural diversity of residents in the area including Aboriginal people who have poorer health
outcomes.
Recommendations
Upgrade of facilities is required across the health site, including GP practice moving to NHS
grounds and upgrade of hospital, aged care and community areas.
Investigation of the ability to have a CT scanner on site.
Ongoing review and planning of acute care hospital, aged care and community health services
to meet the projected growth of the area including rehabilitation, secure dementia unit on site,
mental health services, preventative health programs, primary health care.
Continue to refine service provision in response to the range of available specialists,
community need for maintaining services in place, and building the range of services in
response to need.
Implement strategies to improve timely access to elective surgery in pressure areas (e.g.
orthopaedics) and further improve timely access to other areas of identified surgical need.
Ongoing workforce development, recruitment and retention of community, hospital and
medical health professionals.
4
Strengthen links between health services and culturally and linguistically diverse and
Aboriginal client groups.
Improve information and communications technology (ICT) support to meet clinical and non
clinical requirements.
5
2. Catchment summary
Introduction
The township of Naracoorte is located approximately 335 kilometres south-east of Adelaide and
approximately 100 kilometres north of Mount Gambier Country General Hospital.
The Naracoorte Health Service is situated within the Naracoorte Lucindale Local Government area.
The catchment area for the health service encompasses the Naracoorte and Lucindale Statistical
Local Area which includes Kybybolite and Frances to the north-east, Struan and Wrattonbully to the
south, and Lucindale and Avenue to the west although the latter also accesses services in Kingston
(see map below). The catchment also extends into Victoria, with residents from Apsley, Minimay,
Neuarpurr, Bringalbert, Langkoop and Poolaijelo, accessing regular health services from the
Naracoorte Health Service.
Reference: http://www.atlas.sa.gov.au/
Population
The resident population for the Naracoorte catchment is 8,799 (ERP, 2011), and 695 from the
Victorian catchment area (ABS, 2006). People from Aboriginal and Torres Strait Islander backgrounds
comprise 1.1% of the Naracoorte catchment compared with 3.1% of the total country South Australian
population. Approximately 4.2% of the population in the Naracoorte catchment speak a language
other than English at home, compared with 3.9% of the total country South Australian population.
When compared with country South Australian averages, in the Naracoorte catchment there is a
higher proportion of the population in the 0-14 age group, and a slightly lower proportion in the 15-24
age group. Approximately one-third of the population is under 24 years of age. The projected
population for the catchment area is estimated to increase slightly by the year 2021. The fertility rate
for the catchment is approximately 2.3. This is above replacement level and higher than the South
Australian rate (1.82). The indirect standardised death rate for the catchment (6.4) is slightly higher
than the South Australian average (6.1).
6
The broader Limestone Coast region (which includes Naracoorte, Bordertown, Kingston, Penola,
Millicent and Mount Gambier) had an estimated 589,000 overnight visitors and 1,758,000 day visitors
in 2007. There were 13,000 visitors to Naracoorte in 2008.
Table 1: Naracoorte catchment population
Nar/Luc
SLA
Vic
CDs*
Total
Area No. Area %
USE
Cluster
Cluster*
%
Country
SA % SA total %
Total Population 8,799 695 9,494
19,806 490,635 1,667,444
Males 4,545 354 4,899 51.6% 10,289 51.9% 50.5% 49.4%
Females 4,254 341 4,595 48.4% 9,517 48.1% 49.5% 50.6%
0-14 years 1,673 151 1,824 19.2% 3,764 19.0% 20.4% 18.5%
15-24 years 1,075 55 1,130 11.9% 2,356 11.9% 11.4% 13.3%
25-44 years 2,339 162 2,501 26.3% 5,133 25.9% 25.1% 26.7%
45-64 years 2,409 209 2,618 27.6% 5,469 27.6% 27.3% 26.1%
65-84 years 1,106 105 1,211 12.8% 2,670 13.5% 13.9% 13.4%
85 years and over 197 13 210 2.2% 414 2.1% 1.8% 2.0%
ATSI* 94 6 100 1.1% 208 1.1% 3.1% 1.7%
CALD* (Speaks a
language other than
English at home)
599 10 609 6.4% 823 4.2% 3.9% 12.2%
Source: Projected population by age and sex SLAs in South Australia, 30 June 2011,
Department of Planning and Local Government
*Source: 2006 ABS Census
Socioeconomic factors
The catchment region has been identified as outer regional indicating a moderate level of remoteness
when compared with other South Australian locations. The catchment reflects a moderate degree of
socioeconomic disadvantage.
Based on data which monitors the trends of diseases, health related problems, risk factors and other
issues across major regional areas, the South East region demonstrates higher levels of risk factors
for overweight, obesity, physical inactivity, and smoking when compared with total South Australia.
The prevalence of chronic disease for persons aged 16 years and over in the South East region
demonstrates a higher prevalence of diabetes when compared with total South Australia.
The Limestone Coast is one of South Australia's highly productive and diverse agricultural regions
with a range of products including vegetables, wine grapes, cereal grain, softwood timber, pastures
and livestock. Fishing is also a major contributor to the regional economy and aquaculture an
emerging industry. Unique natural attractions such as the World Heritage listed Naracoorte Caves
and the Blue Lake at Mount Gambier contribute to an active tourism industry.
Agriculture, forestry and fishing make up 29% of total employment across the Naracoorte catchment,
followed by manufacturing (12%) and retail trade (11%). The Upper South East region, along with
other major areas of the State, has been identified for exceptional circumstances due to the prevailing
drought.
7
3. Needs Analysis summary
Introduction
The Naracoorte and Area Health Advisory Council (NAHAC) has worked with Country Health SA to
develop a 10 year Health Service Plan for the Naracoorte area. The role of the NAHAC was to consult
with the local community to discuss health issues, priorities and needs and to provide advice on
behalf of the local community to Country Health SA Local Health Network (CHSALHN). To achieve
this, the NAHAC conducted discussion groups and face-to-face interviews between July and
December 2009. Participants in the consultations identified health problems, suggestions to improve
health services and information for future health service delivery locally and in the South East.
Activities undertaken during the consultation process, including hours of NAHAC member time
dedicated to the process, are outlined in the following table.
Activity Number Activities
Number
Participants
Volunteer
Hours
Discussion Groups/Forums/ 22 NA 66
Face to face Interviews 3 3 6
Written Submissions 3 3
Staff and Health Service
providers Survey 28
Total 56 6 72
As part of the Naracoorte area 10 year health service planning process, the Naracoorte Health
Service and NAHAC undertook a needs analysis to capture the strengths, weaknesses, opportunities
and threats of existing services and future directions.
A small working group with key staff from the health site and the CHSALHN Planning Officer collated
and considered all of the information from the HAC community and stakeholder consultations, the
Health Service Profile and existing local, state and national strategic directions and plans.
Overall priorities from the needs analysis by service delineation returned the following information:
Emergency Services
GP practice relocation.
Maintain and strengthen 24 hour access to Accident and Emergency (A&E).
Development of business case for CT scanner for Upper South East.
Improve communication with identified stakeholders.
Clarify access to A&E especially out of hours.
Acute Care
Maintain current services and increase services to meet the needs of the community.
Explore opportunities to increase academic research and training.
ICT critical to support clinical requirements and planning for the future.
Aged Care
Upgrade facilities to current standards allowing for equity of accommodation standards.
Develop business case for establishment of dementia unit.
Further opportunities for developing alternative care models, especially community based.
Increase community awareness of participation in volunteer services.
8
Community Health and Outpatient Services
Further develop a service plan in partnership with South East Regional Community Health
Service (SERCHS) for continuity and available services for allied / community based health
services in consultation with cluster resources.
Development of a service plan for the provision of dental and hearing services.
Accessing services across a 7 day week including contingencies.
Investigate further opportunities for joint projects between the main health providers Kincraig
Medical Clinic, SERCHS and NHS.
Investigate opportunities for simplifying access for consumers.
Palliative Care
Contribute to cluster review and plan palliative care services including a review of palliative
care programs with a view to streamlining services.
Develop plan for upgrade, replacement and storage of palliative care equipment.
Recruitment and training of existing and new staff for palliative care services 24/7.
Respite Care
Need for coordinated case management approach to respite care.
Increased focus on family preparation for respite as a planned approach rather than in a crisis
situation.
Dementia specific facility inclusive of respite for emergency access.
Clinical Support Services
Recruitment of staff to support radiology and ultrasound service.
Progress the issue of digital imaging / results for radiology services.
Develop a business plan for the installation of CT scanner for Upper South East.
Medical and GP Specialists
Move Kincraig Medical Clinic to hospital grounds to support clinical care, ease of access and a
health focus on one site.
Attract additional visiting specialists in response to the needs of the community (e.g.
endocrinologist, psychiatrist, gerontologist, paediatrician, neurologist).
Secure places for GP training for obstetrics and anaesthetics.
Attraction and retention of skilled health care staff.
Establishment of new and building on existing services in response to community need (e.g.
pain clinic, chemotherapy).
Mental Health
Increased focus on mental health, in all areas from prevention to acute crisis.
Improve supports for situational crisis including admission, timely transport and safe spaces
consistent with Mental Health Act (2009) guidelines.
Continue to support staff / medical officers through Rural and Remote Mental Health Service,
education, consultant support.
Maternal and Neonatal Health
Continue to support staff / medical officers through on site training and education.
Ensure ongoing consultant support for obstetrics, gynaecology and paediatrics.
Recognise and address the needs of culturally and linguistically diverse client groups.
Oral Health
Increase surgical oro-maxillo-facial sessions in response to demand.
Increase visiting dentist to residential aged care area.
Key Supporting Services
NHS requires high level of maintenance support to allow for service provision.
Changes in corporate structure has impacted on access to local workforce.
Work environment is challenging due to age of facilities.
Key evidence which supported the strengthening of core services as well as the development of new
and expanded services is supported by data gathered by NHS and NAHAC including bed days,
waiting times and demand for services.
9
4. Local implications of Statewide plans
The Strategy for Planning Country Health Services in South Australia, endorsed in December 2008,
builds on the vision in South Australia s Health Care Plan 2007-2016, South Australia s Strategic
Plan, and the SA Health Aboriginal Cultural Respect Framework and sets out how to achieve an
integrated country health care system so that a greater range of services are available in the country,
meaning fewer country residents will need to travel to Adelaide for health care.
The Strategy identifies the need for significant changes to achieve a sustainable health system that
addresses the contemporary challenges facing the health system. The main factors contributing to an
increasingly unsustainable health system include the ageing population, increasing prevalence of
chronic diseases, disability and injury, poorer health of Aboriginal people and people of lower
socioeconomic status, and increasing risks to society from communicable diseases, biological threats,
natural disasters and climate change.
A number of Statewide Clinical Service Plans have been developed, or are currently under
development, providing specific clinical direction in the planning of services. Interpreting these plans
for country South Australia and specific health units is an important element of the planning process
for Country Health SA. The enabling factors which are demonstrated across the statewide clinical
plans include:
Multi-disciplinary teams across and external to the public health system.
Patient focused care.
Care as close to home as possible.
Teaching and research integrated in service models.
Integrated service model across the continuum of care.
Streamlining access to specialist consultations.
Increasing use of tele-medicine.
Improving Aboriginal health services.
Focus on safety and quality.
Recruiting and developing a workforce to meet future service models.
Engaging closely with consumers and community.
Developing the infrastructure to meet future service models.
Clinical networking and leadership.
Connecting local patients with pathways to higher level care needs.
Reducing progression to chronic disease for at risk populations.
Strategies within the Statewide Clinical Service Plans which support the achievement of local needs
have been integrated through the 10 Year Health Service Plans.
10
5. Planning Principles
The Strategy for Planning Country Health Services in South Australia set out important principles
which have been used to guide the local planning which include:
1. Focusing on the needs of patients, carers and their families utilising a holistic care
approach.
2. Ensuring sustainability of country health service provision.
3. Ensuring effective engagement with local communities and service providers.
4. Improving Aboriginal health status.
5. Contributing to equity in health outcomes.
6. Strengthening the IT infrastructure.
7. Providing a focus on safety and quality.
8. Recognising that each health service is part of a total health care system.
9. Maximising the best use of resources.
10. Adapting to changing needs.
11
6. Service Delivery Plan
6.1 Core Services to be Sustained
Service Category Service Description Target Group Directions over next 10 years
Emergency Service 24/7 access to A&E with lower triage
patients reporting directly to GP
when the local practice is open Mon-
Fri, and at session times on
weekends
On call emergency response is
supported by local medical officers
with nursing staff available to support
emergency response through the
theatre on call roster
Duty doctor works on site out of
MacMillan Wing providing prompt
response to emergency calls during
clinic times
Naracoorte /
Lucindale and
Western Victoria
community and
visitors
Redevelopment of A&E area both at Hospital and for Kincraig
Medical Clinic practice
Relocation of entire GP practice on site
Maintain and strengthen 24 hour access to A&E
Develop a business case for CT scan for the Upper South East
Improve current communication and workplace strategies with key
stakeholders to provide a more comprehensive A&E service to the
community
Clarify access to A&E especially out of hours
Review and seek funding to increase emergency care training
opportunities
Continue to review security for staff safety
See section 8.1
Acute Inpatient Care Broad range of acute care services
including high level acute
Broad range of both day and
overnight stay surgical services
(including orthopaedic, gynaecology,
ENT, urology, plastics and general
surgery specialties)
Rehabilitation services post
orthopaedic surgery available on site
(hydrotherapy pool)
Naracoorte /
Lucindale and
Western Victoria
community and
visitors
Maintain current services and increase services to meet the needs of
the community
Explore opportunities to increase academic research and training
ICT critical to support clinical requirements and planning in the future
Review and seek funding to increase acute care training
opportunities
Review of funding levels to provide timely access to elective surgery
Increase opportunities for local pre-habilitation and rehabilitation
services for orthopaedic surgery in conjunction with rehabilitation
services provided at Mt Gambier Hospital
Continue to progress plans to upgrade NHS facilities
See section 8.1
Aged Care A number of a aged care providers
available to the community
Range of home based, low and high
level care services to those
assessed as needing residential care
Naracoorte /
Lucindale and
Western Victoria
community
Surgical services also
provided to Upper
South East Cluster
for a wide range of
Upgrade facilities at NHS to current standards
Explore opportunities for developing alternate care models,
especially community based1
Increase community awareness of participation in volunteer services
See sections 6.2 and 8.1
1
Health Services Framework for Older People 2009-2016
12
services
Community Health &
Outpatient services
Community health services provided
by SERCHS
Private providers support community
needs for allied health consultations
and care
Wide range of services available
Hydrotherapy pool available for
community use
Naracoorte /
Lucindale and
Western Victoria
community
Further develop a service plan in partnership with SERCHS for
continuity of services for allied / community based health services in
consultation with cluster resources2
Develop a service plan for the provision of dental and hearing
services
Investigate further opportunities for joint projects between main
health providers Kincraig Medical Clinic, SERCHS and NHS
Investigate opportunities for simplifying access for consumers to care
and services
See sections 6.2 and 8.1
Palliative Care Flexible and responsive service
available across the continuum of
care
Professional service offered by
SERCHS across the Upper South
East cluster
Dedicated palliative care room
Naracoorte /
Lucindale and
Western Victoria
community
Contribute to cluster review and plan palliative care services
including a review of palliative care programs with an aim to
streamline services3
Develop and plan for upgrade and replacement of palliative care
equipment
Review and seek funding to increase training opportunities
See sections 6.2 and 8.1
Respite Care A variety of providers of respite care
in the area providing different options
for care in response to individual
need / best fit
ACAT team provides a coordinated
multi-disciplinary approach to respite
Naracoorte /
Lucindale and
Western Victoria
community
Move to a case management approach to respite care
Increase focus on family preparation for respite in a planned manner,
as opposed to crisis management
Investigate and extend ability to manage dementia specific respite for
crisis situations4
Review and seek funding to increase training opportunities
See section 8.1
Clinical Support
Services
Radiology services provided on site
24/7 on call
Limited access to ultrasound
Small workforce available locally
Gribbles patient collection services
available Mon-Fri
Access to pharmacy services
(including starter packs of medication
available after hours)
Naracoorte /
Lucindale and
Western Victoria
community and
visitors as well as
across entire Upper
South East area
Recruitment of staff to support radiology and ultrasound services
Progress the issue of digital imaging and reading of results for
radiology services
Planning and expanding radiology services to the Naracoorte /
Lucindale and Western Victoria cluster (including exploring options
for electronic records)
See sections 6.2 and 8.1
Medical Specialist
Services
GP services currently provided
locally at Kincraig Medical Clinic
(including choice of GP)
Duty doctor and some medical
Naracoorte /
Lucindale and
Western Victoria
community and
Progress Kincraig Medical Clinic plans to move practice to hospital
grounds thereby providing support to clinical care, providing ease of
access and an increased focus on health at one site
Attract additional visiting specialists in response to the needs of the
2
Chronic Disease Action Plan for South Australia 2009-2018
3
Palliative Care Services Plan 2009-2016
4
South Australia s Dementia Action Plan 2009-2010
13
officers consult on site at NHS
Wide range of visiting specialists
provide both a consulting and
surgical service supported, when
needed, by local medical practice
visitors
Specialty services
support Upper South
East cluster
community including endocrinologist, psychiatrist, gerontologist,
paediatrician, neurologist
Secure places for GP training for obstetrics and anaesthetics
Establish a additional building for existing services in response to
community need pain clinic, chemotherapy
See section 8.1
Mental Health In-patient care available
Visiting community mental health
workforce
Range of mental health programs
and services available through
SERCHS
Access to Rural and Remote Mental
Health Services through
telemedicine
Naracoorte /
Lucindale and
Western Victoria
community and
visitors
Increase focus on mental health in all areas from prevention to acute
crisis5
Improve supports for situational crisis
Support limited treatment beds for the South East
Continue to support staff and medical officers through educational
opportunities, consultant support and through provision of links to
supports such as Rural and Remote Mental Health Services
Maternal & Birthing
Services
Low risk single birth
Theatre and staffing available for
caesarean sections 24 hours a day,
7 days a week
Antenatal care provided through
private practice
Antenatal booking in clinics offered
to all women
Community midwife visits postnatally
Naracoorte /
Lucindale and
Western Victoria
community plus
residents of entire
Upper South East
area as Naracoorte is
the only obstetric
provider in the cluster
Continue to support staff and medical officers through on site training
and education
Ensure ongoing support through a visiting consultant service for
obstetric and gynaecology patients
Recognise and address the needs of culturally and linguistically
diverse clients
Review and seek funding to increase midwifery training opportunities
See section 8.1
Oral Health Visiting specialist provides surgical
care
Dental service available through
private providers and school dental
services
Visiting service to residential care
Naracoorte /
Lucindale and
Western Victoria
community and
visitors
Increase surgical oro-maxillo-facial sessions in response to demand
Increase visiting dentist to residential aged care area
Aboriginal Health Support provided by local Aboriginal
Health Care worker
Services also provided out of
Pangula Nunamara located in Mount
Gambier
Visiting clinic accessible to clients
throughout the South East area
Naracoorte /
Lucindale and
Western Victoria
Aboriginal community
and visitors
Implementation of the Aboriginal Patient Pathways Officer position
Link into initiatives planned and identified by local South East
Aboriginal Health Advisory Committee (AHAC)
Link to Aboriginal Nursing and Midwifery Plan managed through
South East Directors of Nursing group
See section 8.1
5
South Australia s Mental Health and Wellbeing Policy
14
6.2 Strategies for new / expanded services
Service objective: Relocate the entire GP practice to Naracoorte Health Service thereby providing health services on one site for the community
Target group: Upper South East area inclusive of Naracoorte / Lucindale and Western Victoria community and some procedures for the Kingston and
Bordertown communities
Critical milestones: NA
Outcomes Strategies Time Frames
Kincraig Medical Clinic to move entire practice to NHS site,
allowing for ready access to services and prompt response
to emergency care
More appropriate consultation rooms available to the
community
NHS to support the move and progress their support though SA Health
Maintain effective communication of plans with both Kincraig Medical Clinic
and NHS. CHSALHN to be informed of progress and contacted as required
TBD
Service objective: Investigate the opportunity to establish an Upper South East based CT scanner at Naracoorte
Target group: Upper South East area inclusive of Naracoorte / Lucindale and Western Victoria community, Kingston and Bordertown communities
Critical milestones: NA
Outcomes Strategies Time Frames
Determine support for a CT scanner for use by Upper
South East health services
Monitor and review demand for services locally
Explore potential for having service provided at Naracoorte
Establish a core group to investigate options available
Develop a business case should the need be justified
TBD
15
Service objective: Enhance surgical services in response to community need
Target group: Upper South East area inclusive of Naracoorte / Lucindale, Western Victoria, Kingston and some procedures for the Bordertown
community
Critical milestones: NA
Outcomes Strategies Time Frames
Specialist services will be responsive to the needs of the
community
Identified gaps in service provision will be investigated and
where possible addressed
NHS to review service needs in response to Booking List Information System
(BLIS) data, leakage to other sites as well as community feedback
Maintain effective communication of surgical service provision between
Kincraig Medical Clinic and NHS and individual specialists as required
TBD
Service objective: To provide effective pre-hablitation and rehabilitation to the community6
Target group: Upper South East area inclusive of Naracoorte / Lucindale, Western Victoria, Kingston and some procedures for the Bordertown
community
Critical milestones: NA
Outcomes Strategies Time Frames
Rehabilitation services are provided as close to home as
possible
NHS and local physiotherapy area to work together to identify areas of need
and use this data to lobby for facilities and funding
Strengthen linkages to rehabilitation services in the Country General Hospital
at Mount Gambier
TBD
6
Statewide Rehabilitation Service Plan 2009-2017
16
Service objective: To provide safe, appropriate dementia care to the Upper South East client group7
Target group: Upper South East area inclusive of Naracoorte / Lucindale, Western Victoria, Kingston and some procedures for the Bordertown
community
Critical milestones: NA
Outcomes Strategies Time Frames
Address the needs of people with dementia and provide
care as close as possible to home
Upper South East cluster to work with other aged care providers to determine
the extent of need for dementia specific accommodation
Develop a business case to support the establishment of a dementia specific
unit should the need be justified
TBD
Service objective: Strengthen primary and preventative health care provided to the community8
Target group: Naracoorte / Lucindale and Western Victoria community
Critical milestones: NA
Outcomes Strategies Time Frames
Address the needs of the community for primary health
care, preventative health care and early intervention
Use demographic data to identify areas of need
Specific focus on smoking cessation
Continue to identify opportunities to work collaboratively across NHS, Kincraig
Medical Clinic and SERCHS
Explore opportunities for developing alternate models of care with particular
emphasis on those that are community based
Explore opportunities to establish a 7 day per week service for community
based services including contingencies
TBD
7
South Australia s Dementia Action Plan 2009-2010
8
Strategy for Planning Country Health Services in South Australia
17
Service objective: Strengthen chemotherapy services offered to the Upper South East community9
Target group: Naracoorte / Lucindale and Western Victoria community
Critical milestones: NA
Outcomes Strategies Time Frames
Increase the options for available care to the community in
relation to chemotherapy care
Strengthen understanding and knowledge of health care
professionals in relation to chemotherapy management
Explore opportunities for a GP special interest in chemotherapy management
care
Explore opportunities for extending understanding of chemotherapy including
access to resources, education, equipment and training for nursing staff
Strengthen cultural respect aspects of chemotherapy management provided
Examine and strengthen partnership potential with other chemotherapy
providers
TBD
Service objective: Strengthen palliative care services offered to the Upper South East
Target group: Naracoorte / Lucindale and Western Victoria community
Critical milestones: NA
Outcomes Strategies Time Frames
Increase the options for available care to the community in
relation to palliative care
Strengthen understanding and knowledge of health care
professionals in relation to palliative care
Explore opportunities for GP special interest in palliative care
Explore opportunities for extending understanding of palliative care including
access to resources, education, equipment and training for nursing staff
Strengthen cultural respect aspects of palliative care provided
Examine and strengthen partnership potential with other palliative care
providers10
TBD
8
Strategy for Planning Country Health Services in South Australia
9
Statewide Cancer Control Plan 2011 - 2015
10
Palliative Care Services Plan 2009-2016
18
Service objective: Enhanced maternal and neonatal care services
Target group: All women having babies, and their families; Considering Aboriginal women, CALD women
Critical milestones: NA
Outcomes Strategies Time Frames
Establish broader choice of maternal care service models
Through the redevelopment, enhance services to accommodate birthing
needs (including redevelopment and refurbishment of maternity area)
Ensure the needs of Aboriginal women and those from culturally and
linguistically diverse backgrounds are met
Establish links with the South East Migrant Resource group and local support
networks for CALD populations
Develop processes and ensure training and education for nursing staff to
manage the complexity of activity and acuity
TBD
Service objective: Enhanced Aboriginal health care services
Target group: All Aboriginal and Torres Strait Islander patients accessing services
Critical milestones: NA
Outcomes Strategies Time Frames
Improve health outcomes for Aboriginal and
Torres Straight Islanders
Work to achieve the workforce target for the proportion of Aboriginal staff employed by the
health service
Continue to consult with South East Aboriginal Health Advisory Committee in relation to
service delivery, access and opportunities for service growth
TBD
19
7. Key Requirements for Supporting Services
7.1 Safety & Quality
Objective: Continue to improve the quality and safety of care in a sustainable manner
Critical milestones: NA
Outcomes Existing Strategies Sustained Strategies for the Future
Sustainable skilled employment
models in place to deliver the local
service profile
Continue to build the skills of clinicians to deliver
the service profile
Enhance clinician involvement in clinical governance leadership
Continual improvement and
patient-centred approach
underpinning service delivery
Maintain Australian Council on Healthcare
Standards (ACHS) accreditation
Meet Australian College of Operating Room
Nurses (ACORN) Standards
Credentialing via CHSALHN
Investigate options to install a CT scanner at Naracoorte
Improve capacity to effectively care for bariatric clients
Improve capacity for rehabilitation clients
Improve capacity to care for the needs of those requiring a secure
dementia unit
Improve capacity for limited treatment beds in the South East, with
low stimulus rooms installed at Naracoorte
Monitor readmission and frequent users of the Hospital to analyse
opportunities for improved care models
Contribute to a cluster-wide accreditation framework
Developing the consumer role in safety
Re-develop medical records to reflect guardianship orders
Integrated access across the
health system
24 hr access to remote specialist support
particularly in the areas of obstetrics, paediatrics,
stroke services and cardiology (iCCnet)
Access to perinatal practice guidelines and
maternal and neonatal standards which ensure
the provision of evidence based care
Use web based links to ensure updated
references are available to support staff clinical
practice
Strengthen community based support following discharge
Further expansion of statewide and Country Health SA clinical
networks
Expand relationships and combine resources within Upper South
East cluster
Improve the use of knowledge, information management and
technology to increase quality and safety
20
7.2 Patient Journey
Objective: Increase the accessibility of the health system to reduce the impact on the patient journey
Critical milestones: NA
Outcomes Existing Strategies Sustained Strategies for the Future
Access to safe and quality care
near home
Discharge / Patient Liaison Officer in place
RIBS funding able to be accessed in response to
need
Explore opportunities for access to Transitional Care Package (TCP)
funding model (not available in Upper South East cluster)
Explore nurse practitioner and other workforce models that enable
increased local access to services
Increase use of telemedicine to access services locally
Support staff and medical specialists to provide local care
In collaboration with Mount Gambier and District Hospital and Health
Service (Country General Hospital in the South East), South East
Regional Community Health Services and Pangula Mannamurna,
manage the majority of health care needs so that only patients
requiring highly specialised or complex care will need to access this in
Adelaide
Provide a smooth and supported
journey when people do need to
travel to access services
Red Cross car used as suitable
Access to SA Ambulance Services for transport
when clinically indicated
Review of transport delays for people with mental
illness
Enhance coordination across the statewide health system to ensure a
client orientated approach when having to travel for more specialised
services
Explore initiatives and develop options to support local community
accessing transport for heath related appointments including:
o Transfers for people with mental illness to a site of appropriate
care (pending Limited Treatment Centre at Mount Gambier)
o Establishment of a CT scanner at Naracoorte if supported by the
business case
Continue to focus on improvement of discharge planning and
coordination
Contribute feedback / solutions to improve the Patient Assistance
Transport Scheme for residents of the catchment
21
7.3 Cultural Respect
Objective: Increase capacity to contribute to the priority of Closing the Gap in Aboriginal health life expectancy
Critical milestones: NA
Outcomes Existing Strategies Sustained Strategies for the Future
Provide a culturally safe and
accessible health service
Build on the strength of existing Aboriginal health
initiatives available to the community
Established annual calendar of Aboriginal and
Torres Islander community events
Established NAIDOC calendar of events
Increase the uptake of Aboriginal Health Impact Statements
Staff trained in cultural awareness, particularly to contribute to their
roles within the health service such as cultural and spiritual
consideration around end of life for palliative care staff. A
comprehensive cultural training program linked to development
reviews and accreditation
Enhance access and appropriateness of services, Aboriginal specific
resources and facilities for Aboriginal families
Engage closely with Aboriginal communities within the catchment to
improve uptake of available services
Ensure all health service programs have an understanding of the
specific needs of the Aboriginal community
Employ and train more Aboriginal people across all levels of the
workforce
22
Objective: Improve relationships with cultural groups who reside in the catchment area
Critical milestones: NA
Outcomes Existing Strategies Sustained Strategies for the Future
Provide a culturally safe and
accessible health service
Build on the strength of existing CALD initiatives
available to the community
Individualised plans established for known
attendances for care (antenatal and birthing)
Identify a clear communication strategy for Kincraig Medical Clinic
and NHS to allow for early identification of clients who fit into this
group so informed choices can be developed in conjunction with the
client
Staff trained in cultural awareness with a comprehensive cultural
training program linked to development reviews and accreditation
Enhance access and appropriateness of services, Aboriginal specific
resources and facilities for Aboriginal families
Engage closely with the Aboriginal communities within the catchment
to improve uptake of services that are available
Ensure all health service programs have an understanding of the
specific needs of the Aboriginal community
Employ and train more Aboriginal people across all levels of the
workforce
23
7.4 Engaging with our community
Objective: Increase the capacity for the community to contribute to the planning, implementation and evaluation of services
Critical milestones: NA
Outcomes Existing Strategies Sustained Strategies for the Future
Health service needs of the
community are understood
Support the NAHAC to implement their ongoing
role of engaging with their community and local
stakeholders
Support NAHAC members to continue in their
roles as strong advocates for their community on
health related issues
Ongoing follow up of patient questionnaire
information and feedback
Use of communication methods including site
newsletters, displays and notices
Explore opportunities for ongoing and meaningful discussion with the
community through local forums and existing specialty groups
Raise community awareness about support groups
Promote opportunities for volunteering in the Health Service and to
increase human resources and budget for volunteer program
Actively engage community participation in primary health promotion
programs
Ensure that community in smaller towns across the catchment are
able to contribute their needs to the planning, implementation and
monitoring of health services
Build awareness in community of programs that have been
established and how they are accessible
Work in partnership with other agencies to review available transport
options for community to allow better access to services (within
community and to metropolitan areas) and make information available
to the community
Work in partnership with other agencies to review available respite
services for community to allow better access to services within the
area and make information available to the community
24
7.5 Local Clinical Networks
Objective: Enhance relationships with other services locally, regionally and Statewide
Critical milestones: NA
Outcomes Existing Strategies Sustained Strategies for the Future
Formal ties with health service
organisations in the region
Staff are active in committees
Continue networking between government and
non-government organisations
Strengthen relationships with service providers
associated with responding to emergencies
Continue to build partnership with Kincraig
Medical Clinic and SERCHS
Strengthen continuity between hospital and home
based services
Strengthen relationships with other health
services in the catchment to share resources and
improve access to services, such as respite
Establish formalised partnerships with local external agencies to
foster collaboration which leads to better outcomes and more
flexibility in health care for the catchment
Investigate opportunities for support workers to provide pathways to
both community and other relevant services
Increased use of technology for staff education and resourcing and
case conferencing (e.g. online self directed cultural training)
Formal ties with statewide and
Country Health SA clinical
networks
Strengthen networks with metropolitan and
statewide services (such as iCCnet SA
cardiologist, MedStar and Rural and Remote
Mental Health Service) to sustain visiting and
remote access service
Expand collaborative relationships with visiting specialists throughout
the region to build service models that meet local needs
Further expansion of clinical networks with tertiary specialist centres
for coordination of follow up care
Further expansion of statewide and Country Health SA clinical
networks
Establish partnerships with other centres of excellence to share ideas
and resources
25
8. Resources Strategy
8.1 Workforce
Objective: Improve ability to recruit, develop and retain a skilled health workforce
Critical milestones: NA
Outcomes Existing Strategies Sustained Strategies for the Future
Recruitment and retention of the
workforce to support the service
profile
Maintain close ties with local educational
providers TAFE, Uni SA, Deakin University as
well as other South East Health Service providers
Continue to explore opportunities for joint
projects
Strong focus on local based training opportunities
including midwifery. Peri-operative, enrolled
nurse cadetships, graduate programs etc
Employee Assistance Program (EAP) in place for
all staff
Flexible working arrangement opportunities for all
staff
Employment information sessions conducted to
provide information on the range of employment
opportunities for working within the country
Broader recruitment and retention strategies across cluster to address
both ageing workforce and workforce development plus Aboriginal
employment strategy
Build the capacity to support debriefing of staff by providing staff with
an EAP program that is culturally appropriate
Employ and train more Aboriginal people across all levels of the
workforce
Strengthen nursing workforce model and formula to meet the
changing complexity of care needs
Develop a workforce development strategy which responds to the
future challenges of an ageing workforce, staff turnover, contractual
nature of new positions and reducing barriers to gaining employment
Meet future shortage of qualified health staff in the health sector
Train and offer scholarships for professional development to people
within the workforce
Investigate traineeship opportunities for non clinical area in order to
build skill mix and workforce
Highly skilled and qualified
workforce
Have established staff development opportunities
across health site
Mandatory training program
Induction package is monitored and reviewed
Up skill and maintain existing staff and health care professionals
across the health units to achieve future service profile
Focus training on areas as per identified need
Identification, review and development of nurse practitioner positions
Ongoing review and development of consistent mandatory training
program
New workforce models explored Midwifery training commenced on site at NHS in
2009
Increased focus on patient liaison / discharge
planning in 2008
Explore various models for resident medical services which support
resident GPs and medical specialists and visiting medical specialists
Explore additional workforce models to support new and innovative
models of training and care
Targeted expansion of visiting and resident services based on
community need and clinical priority
26
8.2 Infrastructure
Objective: Ensure the infrastructure is able to meet the ongoing demands of the community and is able to respond to changing need
Critical milestones: NA
Outcomes Existing Strategies Sustained Strategies for the Future
Infrastructure and equipment that
meets standards and supports
existing and future service delivery
Extensive planning has been undertaken for
redevelopment of NHS site including SERCHS
Planning phase in conjunction with Kincraig
Medical Clinic to move the clinic on site
CT scanner work group established
Ongoing review of existing equipment for
replacement to maintain services
Continue to lobby for the upgrade of the service including Naracoorte
SERCHS
Support and lobby for the Kincraig Medical Clinic move to progress to
fruition
Undertake a business case to examine improved infrastructure and
equipment needs (including radiology equipment / CT scanner and
car parking)
Major upgrade of facilities needed to support all aspects of care.
Continue to lobby for upgrades in response to needs of community to
ensure ongoing service provision
Improved infrastructure to manage
increasing workforce
Ongoing assessment of suitable workspaces with
increase of specialists / staffing / services
Develop a plan for the expected growth of specialists and community
services
8.3 Finance
Objective: Increase the efficiency and effectiveness in the allocation of resources, balanced with the provision of services as close to home as possible
Critical milestones: NA
Outcomes Existing Strategies Sustained Strategies for the Future
Recognise the impact and need of
ICT on clinical and non clinical
areas
iCCnet trial site for web based medical records
Extensive re-cabling to address capacity issues
Identify opportunities for use of ICT to support clinical and non clinical
areas in order to enhance service provision
Lobby for funding to address areas of need
Support the patient journey
process
Review and monitor patient journey through
admission and discharge coordinator
Review and evaluate the use of RIBS
Identify opportunities for access to additional funding
27
8.4 Information Technology
Objective Increase access to communication and information technology systems to strengthen health care
Critical milestones: NA
Outcomes Existing Strategies Sustained Strategies for the Future
Access to specialised services
through telehealth
Digital medical imaging equipment and reporting
system
Strengthen existing telehealth facilities
Further develop digital medical imaging capacity through:
o Investigation of CT scanner implementation for Upper South
East
o Picture Archiving Communication System
o Updates to fluoroscopy and orthopantomogram (OPG)
o Commissioning of direct radiography general x-ray system
Advocate for flexible funding to enable clinicians in other areas to
effectively utilise telehealth services to improve patient outcomes
Increased local access of staff training and development through
video conferencing
Information system which is
integrated within operational
monitoring, planning and
implementation
AIMS incident monitoring system in place
Review clinical management systems to support coordination of
patient care and facilitate effective transfer of patient information
8.5 Risk Analysis
Objective: Identify and manage the risks associated with implementation of planned strategies
Critical milestones: NA
Outcomes Existing Strategies Sustained Strategies for the Future
Successful implementation of the
service directions identified in the
10 Year Health Service Plan
Maintain the risk register
Maintain health service accreditation
Develop an implementation, monitoring and review strategy for the 10
Year Health Service Plan early identification of risks
Ongoing contribution and participation in the CHSALHN Risk
Management Policy Framework
Ongoing participation and contribution to other CHSALHN nominated
risk management activities
28
9. Appendix
9.1 Leadership Structure
Staff from the Naracoorte Hospital and the Planning Projects Team have coordinated the
development of the 10 Year Local Health Service Plan. The Naracoorte and Area Health Advisory
Council Inc. has undertaken an important role in leading and analysing the community and
stakeholder feedback and providing oversight of the local planning process.
9.2 Methodology
June-Dec 2009 Community, staff and stakeholder engagement strategy planned in partnership
with NAHAC.
December 2009 Community engagement report developed.
January 2010 Final draft Preliminary Service Profile completed.
Feb-March 2010 Needs Analysis workshop.
April-May 2010 Draft Health Service Plan ready for CHSALHN Steering Committee, HACs and
community consultation.
June 2010 Community consultation on draft 10 Year Health Service Plan.
June 2010 Re-draft Plan to include community feedback. Plan to NAHAC for endorsement.
30 June 2010 Final Plan submitted to CHSALHN for sign off by the Minister.
####
9.3 Review Process
A process to determine how this Plan will be monitored and reviewed will be developed
throughout the consultation stage. Feedback on this process is encouraged.
9.4 Glossary
24/7 24 hours / 7 days a week
A&E Accident and Emergency
ABS Australian Bureau of Statistics
ACAT Aged Care Assessment Team
AHAC Aboriginal Health Advisory Council
AIMS Advanced Incident Management System
ATSI Aboriginal & Torres Strait Islander
CALD Culturally and Linguistically Diverse
CHSALHN Country Health SA Local Health Network
CT Computerised Tomography
EAP Employee Assistance Program
ENT Ear, Nose, Throat
GP General Practitioner
HAC Health Advisory Council
29
iCCnet Integrated Cardiac Assessment Regional Network
ICT Information and Communications Technology
KMC Kincraig Medical Centre
NAHAC Naracoorte and Area Health Advisory Council
NAIDOC National Aboriginal Islander Day Observance Committee
NHS Naracoorte Health Service
RIBS Rapid Intensive Brokerage Support
SA South Australia
SERCHS South East Regional Community Health Service
SLA Statistical Local Area
SWOT Analysis of strengths, weaknesses, opportunities and threats
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