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Department for Health and Wellbeing Annual Report 2018-19
Department for Health and Wellbeing Annual Report 2018-19
Agency's contribution — A commitment of $20 million has been made to develop and implement a Rural Health Workforce Plan to address the shortage of health practitioners in rural areas. From January 2019, the number of junior doctors training in country South Australian hospitals has more than doubled.
Agency's contribution — A diagnostic review undertaken by KordaMentha identified that CALHN is currently operating significantly above the nationally agreed efficient price for acute inpatient hospital services. To address the issues identified in the Diagnostic Review, KordaMentha has developed a comprehensive Organisational and Financial Recovery Plan to deliver a step-change in performance over a three-year period from 1 January 2019 to 31 December 2021. Early performance improvements reflect an overall improvement to financial results in 2018-19.
Agency's contribution — Investment in health prevention benefits individuals, communities and government. Preventable health conditions add to the cost of healthcare. For every dollar invested in health promotion, it is estimated that over five dollars in health spending can be saved. Prevention outcomes will be pursued through five strategic levers:
Agency's contribution — The final Repat Master Plan was released on 27 February 2019, following extensive community consultation. This is a plan that delivers on the needs of the community and will take pressure off SA's health system.
Agency's contribution — 24/7 cardiac services have been restored at TQEH, and the cardiac catheterisation labs upgraded with an investment of $4 million. This is in addition to a $263.9 million major upgrade of the hospital. This investment will ensure residents in western Adelaide have access to quality health care, closer to home.
Agency's contribution — $45 million has been invested in order to significantly reduce the number of overdue elective surgery patients in SA.
Agency's contribution — Legislation to decentralise governance of the public health system came into effect on 1 July 2019, devolving decision-making within the public health system through Local Health Network Governing Boards.
Agency's contribution — A roadmap has been developed for the future care and management of older people with significant dementia or complex mental health needs. This will ensure each and every individual receives the right level of care.
Agency's contribution — $23 million has been invested to re-instate the high dependency unit as part of a $114.6 million upgrade at Modbury Hospital.
Agency's contribution — A community-based drug addiction rehabilitation pilot in the Riverland commenced in January 2019.
Agency's contribution — New laws to establish Australia’s first Adult Safeguarding Unit have been passed. The Unit will respond to reports of abuse or neglect of vulnerable adults and raise awareness about elder abuse in the community.
Agency's contribution — Additional resources for mental health services, including suicide prevention funding, a new specialist Borderline Personality Disorder Service and a dedicated Paediatric Eating Disorder Service have been provided.
The department is committed to delivering services that produce positive outcomes to the health and wellbeing of all South Australians by:
These areas of strategic focus strongly support the State government’s objectives to deliver real change in SA that creates better government services.
|Reform SA Health governance||
In 2018-19, work was done to establish Local Health Network Governing Boards and to transition to the devolution of decision making at the local level.
LHN Governing Board Transition Chairs and Transition Board members underwent a system-level induction in May 2019 in preparation for commencement on 1 July 2019.
The structure of the Department for Health and Wellbeing was reviewed during 2018-19. To best fulfil its system leadership functions, a revised department structure came into effect on 6 May 2019.
Four core departmental divisions were established:
Work has commenced to begin the establishment of the Commission on Excellence and Innovation in Health, including the first three Statewide Clinical Networks; Palliative Care, Cardiology and Urgent Care.
|SA Pathology Sustainability Project||SA Pathology underwent an external review to identify opportunities for improvement that provide for appropriate care to be delivered in a sustainable way into the future. The review examined in detail the public and commercial services provided by SA Pathology. An implementation plan was approved to change the operating model in order to place the organisation on a commercial footing and support long-term sustainability while maintaining patient care and safety as a priority.|
|Build a new Women’s and Children’s Hospital||A high-level task force has been driving planning for the new Women’s and Children’s Hospital, with a view to achieving co-location within the Royal Adelaide Hospital (RAH) by 2025-26. This will provide babies and children with better access to medical retrieval through close proximity to the helipad and reduce the need to separate sick mothers and babies.|
|Upgrade hospital infrastructure||
Major capital works upgrades were approved in December 2018 and construction began in April 2019, including for the:
Site master planning for stage 3 redevelopment commenced in April 2019. This will include a new clinical services building to allow the reallocation of clinical functions from the existing Tower building. Construction is underway on a new multi-deck car park with 500 spaces.
The 12-bed acute medical ward was commissioned. Work to establish a Women’s and Children’s hub and midwifery service in the Noarlunga Hospital precinct commenced in 2018-19.
Work commenced to provide funding for a business case to consider a single health hub at this hospital.
Additional vital signs monitors were delivered and are in use.
Work on this upgrade progressed and a concept design report was submitted in March 2019.
An upgrade to surgical facilities will enable general surgery, gynaecology and urology services to remain at the hospital. Planning has commenced and a tender process will follow for building works to start by January 2020.
Murray Bridge Soldiers Memorial Hospital
A $7 million upgrade is planned for the Emergency Department and Central Sterile Services Department. The tender process closed in the last week of June 2019, with construction expected to start in September 2019.
Ardrossan Community Hospital
Funding has been provided to support the provision of Accident and Emergency and other palliative care and sub-acute services at this community-owned, private, not-for-profit hospital.
|Upgrade Ambulance stations||
In May 2019, the SA Ambulance Service (SAAS) completed its $240,000 refurbishment of the Jamestown Ambulance station. The replacement of Hawker and Strathalbyn ambulance stations has been prioritised and are undergoing investigation and development.
During 2018-19 a number of capital works upgrades were completed for volunteer stations including Yunta, Riverton and Tumby Bay.
|Ramping and surge capacity||
In November 2018, the final signed Service Level Agreements between the department and metropolitan LHNs were published. Included were agreed strategies to address ambulance ramping and strengthen the surge capacity of individual hospitals. A Statewide Patient Flow Forum was held on 12 February 2019 which identified issues and solutions to improving flow across the system. A range of these are being explored with the aim to reduce unnecessary time a patient waits for health care throughout their attendance in hospital. Reducing waiting time at all stages of their journey improves patient flow and efficiency. It improves the health system’s capacity to meet increased demand, reduces instances of external ambulance triaging and improves the safety and experience of the patient.
Strategies currently underway to address ramping and surge capacity include:
|Bed numbers||Measures to address LHN patient flow and capacity initiatives include:
|Trial Priority Care Centres||Four Priority Care Centres will be trialled this winter as a strategy to provide more timely treatment for patience and to reduce long waits in Emergency Departments.|
|Maximise use of Intensive Home Based Support Services||The number of consumers making use of Intensive Home Based Support Services has progressively increased during the year with the program now operating at full capacity. Staff have been employed by LHNs to facilitate referrals to the service.|
|Implement Home Hospital Trial to alleviate pressure on Emergency Departments||
Several out-of-hospital pilot programs were run which treated more than 400 patients either at home or within the community, including:
|Reduce elective surgery waiting times||A $45 million investment was announced to significantly reduce the number of patients who are overdue for a colonoscopy or elective surgery procedure. A range of strategies have been developed to reduce the overdue patient lists, including working with the private sector to undertake the procedures, and increasing the number of surgeries carried out across public hospitals, including country and peri-urban hospitals.|
|Publicly report SA Health outpatient waiting times to support patients and their doctors to make informed decisions about treatment options.||
Specialist outpatient services waiting time information has been reported on a quarterly basis from July 2018.
The fourth Specialist Outpatient Waiting Time Report was published on 1 April 2019 (reflecting a census date of 31 January 2019).
|Employ criteria-led discharge as a demand management and patient flow initiative||SA Health partnered with the South Australian Salaried Medical Officers Association (SASMOA) to develop the Hospital Discharge and Criteria Led Discharge Policy. Released in January 2019, it supports nurses, midwives, allied health professionals and junior medical staff to use their knowledge, skills and experience to review and discharge patients using documented clinical criteria.|
|Provide funding to palliative care outreach services, extending the operating hours to 24/7||
A model of care for Specialist Palliative Care Services in SA has been progressed that integrates with SA Health’s contracted end-of-life care service providers that provide services in the consumer’s home.
Funding to the LHNs to extend community outreach palliative care to a 24 hour, 7 days a week service has been allocated. LHNs started to undertake the necessary work to transition to a 24/7 arrangement by 1 July 2019.
|Raise the participation rate of South Australians in Advanced Care Directives||The department continued to partner with the Legal Services Commission and Office for the Public Advocate to promote Advance Care Directives (ACDs) in the community. Sales of the do-it-yourself (DIY) Kit and the ACD form increased by 55 percent from February to March 2019 and to 65 percent by May 2019.|
|Independently review the Enterprise Patient Administration System (EPAS)||The independent review of EPAS concluded and the final report was published on the SA Health website on 29 January 2019 along with the government’s response. As recommended by the review, the EPAS program was cancelled and the Sunrise Electronic Medical Records System will be deployed at the RAH and Mount Gambier Hospital over the next 12 months.|
|Develop a Statewide Mental Health Services Plan 2019-2024||The draft Mental Health Services Plan was developed in partnership between the Chief Psychiatrist and the SA Mental Health Commissioner. A high level of engagement and feedback from a range of key stakeholders was received throughout the development of the Plan. The Plan is expected to be launched in 2019-20.|
|Establish the Lyell McEwin Hospital Mental Health short stay unit||An interim Mental Health Assessment Unit has been established at the Lyell McEwin Hospital, ahead of the construction and commissioning of a brand new $5.5 million facility.|
|Expand support for the prevention of suicide||
In the 2018-19 State Budget, the government provided $2.5 million of funding for suicide prevention over the next four years to 2021-22. This will fund SA Suicide Prevention Networks (SPNs) and associated voluntary groups to increase compassion and break down stigma associated with mental illness and suicide.
By July 2018, 28 SPNs were in place and eight additional SPNs were developed in 2018-19, bringing the total to 36 as at 30 June 2019. Work is underway to develop a further three in 2019-20.
|Establish a paediatric eating disorder service||SA Health has commenced consultation with the Southern Adelaide Local Health Network and the Women's and Children's Health Network on a dedicated paediatric eating disorder service, to ensure access to inpatient and outpatient services for children and young people under 15 years of age with an eating disorder.|
|Enhance the mental health specialist skills of rural General Practitioners||A review of current mental health training resources for rural GPs was undertaken. A package of revised resources was developed in June 2019 for implementation in 2019-20, to support the development of advanced mental health specialist skills.|
|Expand support for people living with Borderline Personality Disorder (BPD)||A statewide BPD service was established for at-risk clients, with a focus on new mothers, their babies and young people. Site construction of a BPD centre was completed in April 2019. The Model of Care and BPD website was officially launched by the Minister in June 2019.|
|Establish a permanent renal dialysis unit in the APY Lands||Funding of $50,000 was provided towards the capital costs of establishing a permanent renal dialysis unit in Pukatja, to be run by Western Desert Dialysis. The unit build was completed in June 2019 with dialysis to commence in early 2019-20.|
|Formalise a clinically endorsed procedure to support Aboriginal traditional healing in a health setting||A formalised agreement, developed in conjunction with the Anangu Ngangkari Tjutaku Aboriginal Corporation was established. This allows ongoing access for patients and supports a culturally responsive and respectful health system that contributes to better outcomes for Aboriginal people. Aboriginal traditional healers, known as Ngangkari, are working hand-in-hand with health professionals to treat patients in hospitals and healthcare facilities across the Northern Adelaide Local Health Network.|
|Better Prevention and Targeted Preventative Health||
Targeted health prevention for high risk groups includes the establishment of Wellbeing SA to address prevention, health promotion and primary health care within SA Health.
Work to establish Wellbeing SA has included extensive consultation with stakeholders which was used to inform the development of the model for Wellbeing SA. Priority populations were identified and actions targeted at these groups will be explored once Wellbeing SA is in operation in 2019-20.
|Healthy Towns||The South Australian Healthy Towns Challenge was launched as part of the Healthy Communities Program. $1 million over four years will be invested to fund preventative health projects in regional areas through grants of up to $50,000 each provided to regional towns annually.
More than 40 applications were received for the first round of grants and a further 27 applications for the second round. Six successful towns were chosen in the first round in 2018 and six more towns received funding for round two, announced in June 2019.
|Beat Cancer||The department has worked with a wide range of stakeholders, including the Cancer Council SA, to ensure funding continues for the Beat Cancer Project. Funding was agreed to be provided by the Commonwealth Government and the Cancer Council SA in mid-2019.|
|Vaccinations for Influenza||
SA Health had distributed 616,762 doses of influenza vaccine by the end of week 13 of the 2019 influenza program (30 June 2019). Vaccines were distributed to children aged between 6 months to less than five years, SA Health healthcare workers, people aged 65 years and over, pregnant women, Aboriginal people and those considered medically at risk.
This represented a 20 percent increase from the number of doses distributed at the same stage of the program in 2018.
|Vaccinations for Measles||Unlike many other states and territories, SA has not had a significant rise in notified measles cases. The National Immunisation Program vaccine supply held by SA is for use in children, young adults up to 20 years of age, and newly arrived refugees. Supply is restricted to these priority cohorts by the Commonwealth.|
|Vaccinations for meningococcal disease||
The SA population is protected against meningococcal disease through the state funded Meningococcal B Immunisation Program and the National Immunisation Program meningococcal ACWY program.
Vaccination programs are implemented in age groups most at risk of disease, namely young children and adolescents.
|Bowel cancer prevention – cut waiting times for patients to receive procedures quickly and prevent progression||A $45 million investment has been made to significantly reduce the number of patients who are overdue for a colonoscopy or elective surgery procedure. SA Health established a panel of approved suppliers for the provision of colonoscopy services to public patients. LHNs continued to undertake additional internal lists and referred suitable patients to private providers. By 30 June 2019, 1,500 patients had been referred to private providers.|
|Clinical Cancer Registry||Preparatory work began for a more efficient collection of data for the Clinical Cancer Registry. This will support the work of the new Commission on Excellence and Innovation in Health, which will be tasked with preparing and implementing a data plan for SA.|
|Expand the Strength for Life Program for older people||SA Health entered into a contract on 1 November 2018 with the Council on the Ageing (COTA) to fund expansion of the Strength for Life (SFL) program. This extends access to older people in Aboriginal, culturally and linguistically diverse, regional and disadvantaged populations. The Prevention and Population Health area continues to support COTA with expansion planning, particularly in relation to evaluation and data collection systems. The program is currently available in more than 90 locations across SA.|
|Introduce a system of Youth Treatment Orders for children under the age of 18, confirmed as suffering from dependence on or at risk of harm from alcohol related or other drug use||The Controlled Substances (Youth Treatment Orders) Amendment Bill 2018 was introduced by the Minister in the Legislative Council in June 2018. It provides the option of court ordered treatment for children and young people experiencing drug dependency. SA Health is leading an interagency working group to develop a draft model of care to address youth substance dependence and to guide the development of the Bill. In the 2019-20 State Budget, $1.75 million was allocated over four years to provide a government-funded legal representation scheme for children subject to Youth Treatment Orders.|
|Limit the number of drug diversions||New legislation enabling the limit on the number of drug diversions came into effect on 1 April 2019. Communication strategies were undertaken with drug diversion assessment providers to ensure they were aware of these legislative changes taking effect. Data continues to be monitored to ensure that the diversion process is working efficiently and in a timely manner, in line with the program’s intent of an early intervention approach.|
|Smoke-free SA prisons by 2020||The government has committed $6.2 million over the next four years within the 2018-19 State Budget to assist the transition to smoke-free prisons. The Adelaide Women’s Prison became smoke-free in February 2019.|
|Outdoor smoking – review the effectiveness and scope of current legislation to limit smoking in outdoor dining areas and other venues||A public consultation process was undertaken to obtain input from the public on ways to strengthen SA’s tobacco control laws. Views presented will help inform future enhancements to the tobacco control legislation.|
|Reduce the abuse of prescription drugs through real time prescription monitoring||As part of the 2018-19 State Budget, $7.5 million was committed over three years (from 2019-20) to support a real-time prescription monitoring (RTPM) solution for Schedule 8 medicines in SA. Development of a project plan commenced in June 2019 to identify, procure and implement an information technology solution that will meet SA Health’s RTPM business requirements.|
|Aboriginal Employment Register||One Aboriginal trainee was successfully recruited from the Aboriginal Employment Register to a position in the department.|
|Transition to Professional Practice Program (TPPP)
for Registered Nurses and Registered Midwives
|SA Health offered 503 registered nursing and 60 midwifery TPPP positions for 2019 in country and metropolitan locations|
|Pharmacy Interns||SA Pharmacy recruited 18 interns across a number of sites in the annual intake.|
|Medical Interns||For the 2019 intern training year, 262 medical interns were appointed.|
|Jobs 4 Youth||One trainee and five graduates were placed in the department during the reporting period.|
|Performance management and development system||Performance|
|Department for Health and Wellbeing (DHW) Performance Review and Development template||The current paper-based template is available on the intranet and achieved a 30.75 percent participation rate.|
|2018-19 SA Study Assistance Program for Nurses and Midwives||With 241 successful recipients in 2018-19, this program supports SA Health nurses and midwives to ensure quality care delivery to patients/clients and to complete post-graduate study.|
|SA Health Leading Clinicians Program||This program assists health professionals in clinical leadership roles to develop their leadership capability and improve patient-centred care. In 2018, 80 clinicians (68 participants and 12 facilitators) completed the program. A further 84 clinicians (72 participants and 12 facilitators) commenced the program in February 2019.
Evaluations consistently demonstrate high levels of satisfaction and valuable contributions to SA Health’s strategies and plans.
|Leadership and Development of the Allied Health and Scientific Professions within SA Health||The Allied Health Professional Reimbursement Program continued with funding support provided to 1,728 Allied and Scientific Health professionals in 2018-19.|
|Partner with the Universities, VET sector and health sites regarding clinical placements (non-medical), teaching, education standards, training and research||
Expansion of the Clinical Placement Management System continued in 2018-19. Bookings for three million clinical placement hours (covering the majority of health professions) continue to be online for more than 243 organisations, with remaining professions to be rolled out during 2019-20.
System logins and Sunrise accounts have been provided for around 7,000 student placements at sites using the Sunrise system.
In 2017 Parliament passed the Health Practitioner Regulation National Law (South Australia) (Remote Area Attendance) Amendment Act 2017, more commonly referred to as ‘Gayle’s Law’, in response to the tragic death of dedicated nurse, Mrs Gayle Woodford in 2016.
Under Gayle’s Law, any health practitioner who provides a health service in response to an out of hours or unscheduled callout in a remote area of SA must be accompanied by a second responder. The Act has been proclaimed to commence on 1 July 2019. It applies to all health services provided by the SA government and local councils, funded by the Commonwealth Government, or provided by medical practitioners, nurses and midwives in private practice.
The detail on how Gayle’s Law will operate is prescribed by regulation and has been the subject of consultation with service providers and peak organisations since the passage of Gayle’s Law.
Manual Task Risk Management System
The department coordinates the Manual Tasks Local Facilitator (MTLF) Training System across SA Health.
There are now around 1,040 MTLFs throughout SA Health providing training, induction and support to reinforce safe work practices. In 2018-19, 193 new facilitators completed the two-day practical training and 332 current facilitators attended refresher sessions. The department has five MTLFs, located at locations with heavier manual task risks.
Risk assessments and control measures continue to be provided for hazardous manual tasks, plant and equipment.
|Slips Trips and Falls Prevention||
The SA Health Prevention of Slips Trips and Falls Policy Directive applies to all SA Health workers, including employees, occupiers, volunteers, contractors, labour hire workers and students.
There were the same number of slip, trip and falls workers compensation claims (seven) received in 2018-19 compared with the previous year for the department.
|Challenging Behaviours||The SA Health Challenging Behaviour Strategy has been developed to prevent and respond to challenging behaviour during health care, to minimise the potential harm to workers and consumers. Resources include a policy directive, policy guideline, toolkit and video. The Challenging Behaviour Strategy and Toolkit are currently under review.|
Psychological Health Strategy
Implementation of the strategy has begun in the LHNs, with an initial focus on building mental health literacy and strengthening supportive leadership skills. Improvements are anticipated as the strategy becomes embedded.
The strategy features three key areas:
|Identification of psychological hazards||Analysis of incidents, claims, and worker survey data to identify ‘hot spots’ and intervention strategies took place and the reporting process was improved. Training and resources were delivered to strengthen mental health literacy and build capacity to identify psychological hazards.|
|Supportive Leadership for Team Wellness Program||Winning the Australian Psychological Society Workplace Excellence Award, this program builds skills in resilience, conflict management, supporting staff through change and responding to psychological hazards in the workplace. In 2018-19, 16 staff members across SA Health undertook a ‘train the trainer’ program. Of these 16 trainers, 6 have delivered components of the Supportive Leadership Program in 2018-19.|
|Mindfulness Based Flourishing Program||This online program was taken up by 1369 SA Health staff who were randomly allocated to either intervention (936) or waiting-list control (433). Preliminary findings suggest that the intervention led to significant improvements in measures of staff resilience and wellbeing and decreases in depression, anxiety and stress. The University of East London is now conducting an evaluation of the program.|
|Job Analysis Management System (JAMS)||
JAMS provides a reliable method to assess, record and inform the key requirements of SA Health job roles, enabling the matching of worker capacity to physical and psychological job demands.
WorkFit Physiotherapists provided tailored job analyses to discuss safe duties and modifications for injured workers with treating health professionals, workers and managers.
|Fatigue Management||In 2018, in line with the SA Health Fatigue Management Strategy, Prevention of Fatigue – An educational risk management guide for South Australian Health Services was published on the SA Health intranet. The guide and associate resources support SA Health to meet the legislative requirements (Sections 19, S27 and S28) of the Work Health and Safety Act 2012 (SA) and its Regulations. It also supports the SA Health Policy Directive Worker Health Wellbeing and Fitness for Work. Designed with a preventative risk management focus, the shared responsibilities of SA Health leaders and workers providing health care and services are emphasised. It provides information and the steps which should be taken by SA Health leaders to identify people and occupational groups that may be at potential risk of fatigue due to specific roles, tasks and/or work patterns. During April 2019, three workshops were arranged targeting Work Health Safety and Injury Management and Human Resources staff to assist with implementation of the guide and resources.|
|Workplace injury claims||2017 - 18||2018 - 19||% change (+ / -)|
|Total new workplace injury claims||21||30||+42.9%|
|Seriously injured workers*||0||0||0.0%|
|Significant injuries (where lost time exceeds a working week, expressed as frequency rate per 1000 FTE)||2.22||4.50||+102.7%|
*number of claimants assessed during the reporting period as having a whole person impairment of 30 percent or more under the Return to Work Act 2014 (Part 2 Division 5).
|Workplace health and safety regulations||2017 - 18||2018 - 19||% change (+ / -)|
|Number of notifiable incidents (Work Health and Safety Act 2012, Part 3)||1||2||+100%|
|Number of provisional improvement, improvement and prohibition notices (Work Health and Safety Act 2012 Sections 90, 191 and 195)||0||0||0.0%|
|Return to work costs**||2017 - 18||2018 - 19||% change (+ / -)|
|Total gross workers compensation expenditure ($)||$404,767||$380,830||-5.9%|
|Income support payments – gross ($)||$134,014||$115,882||-13.5%|
**before third party recovery
Data for previous years is available at https://www.publicsector.sa.gov.au/about/Our-Work/Reporting/Workforce-Information
|Executive classification||Number of executives|
|Executive Level F||1|
|SAES 1 Level||30|
|SAES 2 Level||10|
Data for previous years is available on the Office of the Commissioner for Public Sector Employment website
The Office of the Commissioner for Public Sector Employment has a workforce information page that provides further information on the breakdown of executive gender, salary and tenure by agency.