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Outcome Summary

Outcome 10 aims to improve the capacity, coordination and quality of the Australian health system, through programs that tackle cancer on several fronts through a national approach, and improve chronic disease management and palliative care issues. It also focuses on safety and quality improvements across the health system and a national approach to the effective electronic management of key health information. Furthermore, the outcome aims to contribute to the strategic development of health and ageing policies by engaging with the community and international organisations. The Department worked to achieve this outcome by managing initiatives under the programs outlined below.

Programs Administered Under Outcome 10 (Program Objectives in 2008–09)

Program 10.1 – Chronic Disease – Treatment

  • Improve the prevention, early detection and management of diabetes; and treatment and support for people with cancer, their families and the community.
  • Reduce the social and economic impacts of asthma in Australia.
  • Improve the quality of life for people with arthritis and osteoporosis, and their carers.

Program 10.2 – e-Health Implementation

  • Improve health outcomes through the use of technology to promote a more integrated and coordinated approach to health care.

Program 10.3 – Health Information

  • Facilitate the portfolio’s involvement in collaborative policy development with other jurisdictions.
  • Support the development, gathering and dissemination of information that contributes to the strategic development of health and ageing policies and programs.

Program 10.4 – International Policy Engagement

  • Contribute to international treaties, commitments and memoranda of understanding aimed at improving the quality and capacity of the Australian health system.

Program 10.5 – Palliative Care and Community Assistance

  • Improve access to and the quality of palliative care for people with a terminal illness.
  • Promote the physical health and psycho-social recovery of entrants to Australia under the Humanitarian Program who have pre-migration experiences of conflict and human rights abuses, making them vulnerable to developing mental health problems.
  • Fund counselling; education for mainstream service providers; and community capacity building activities through specialist torture and trauma agencies in each state and territory.

Program 10.6 – Research Capacity

  • Support health and medical research to enable further improvements in the prevention and treatment of type 1 and type 2 diabetes.
  • Support the Australian Commission on Safety and Quality Health Care to lead and coordinate national improvements in safety and quality in health care.
  • Fund medical research to ensure that Australia’s research institutions maintain their competitive edge.
  • Develop options to facilitate access to maternity care in consultation with State and Territory Governments and other stakeholders.
  • Ensure national coordination of antenatal and perinatal services.

Program 10.7 – Health and Medical Investment Fund1

  • Identify opportunities for strategic investment in health infrastructure through the Health and Hospitals Fund.
  • Ensure approved health infrastructure projects commence as soon as practicable and that proponents make progress against agreed milestones.
This chapter reports on the major activities undertaken by the Department during the year, addressing each of the key strategic directions and performance indicators published in the Outcome 10 chapters of the 2008–09 Health and Ageing Portfolio Budget Statements and 2008–09 Health and Ageing Portfolio Additional Estimates Statements. It also includes a table summarising the estimated and actual expenditure for this outcome.

The Primary and Ambulatory Care Division, Portfolio Strategies Division, Ageing and Aged Care Division and Regulatory Policy and Governance Division were responsible for Outcome 10 in 2008–09. The Mental Health and Chronic Disease Division also contributed to this outcome.
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Major Achievements for the Outcome:

  • Supported women with breast cancer, and their families to access information, care and support, by employing more than 30 breast care nurses nationally through the McGrath Foundation. Over 80 per cent of these nurses were located in rural and regional Australia (see Reducing the Burden of Cancer, Improving Support for People Living with Cancer and Improving Cancer Research and Knowledge);
  • Contributed to the development of a National E-Health Strategy that will guide national coordination and collaboration between the Australian and State and Territory Governments in e-Health, and help improve the quality and safety of health care. The strategy was endorsed by Australian Health Ministers in December 2008 (see Improved Clinical Practice and Decision-making through e-Health); and
  • Worked to improve clinical practice in palliative care by funding research and clinical medication studies through the Palliative Care Clinical Studies Collaborative (see Improved Access to, and Quality of, Palliative Care).

A Challenge for the Outcome:

  • Consideration of a proposal for a national Individual Electronic Health Record system was deferred by the Council of Australian Governments in November 2008. While this created some delay in planning for the implementation of a national Individual Electronic Health Record system, the Council of Australian Governments agreed to continue funding foundational work (see Supporting Improved Clinical Practice and Decision-making through e-Health).

Key Strategic Directions for 2008–09 – Major Activities

Reducing the Burden of Cancer, by Improving Support for People Living with Cancer and Improving Cancer Research and Knowledge

Cancer is Australia’s leading cause of burden of disease, with more than 39,000 deaths and over 100,000 new cancer cases diagnosed every year. In 2008–09, the Department worked to help reduce the burden of cancer by providing support for people living with cancer, their families and carers, and increasing knowledge through research. The Department did this by implementing the Government’s national cancer initiatives and the Better Cancer Care and Support for Women package.

National Cancer Initiatives

Prostate cancer is the most commonly diagnosed internal cancer in Australia, with more than 16,000 cases diagnosed each year. In 2008–09, the Department negotiated and funded the establishment of two prostate cancer research centres in Melbourne and Brisbane, to examine ways in which to develop non-invasive diagnostic tests for detecting prostate cancer. The centres will also research new therapies for prostate cancer treatment, and the reliable differentiation between slow growing and aggressive prostate cancers.

The Department negotiated a funding agreement with CanTeen for the establishment of youth cancer networks, to provide coordinated services, support and care for teenagers and young adults with cancer. Funding was also provided for the construction of the Olivia Newton-John Cancer and Wellness Centre in Melbourne, and a new Children’s Cancer Centre at the Women’s and Children’s Hospital in Adelaide. The construction of these centres will commence in 2009–10.
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Better Cancer Care and Support for Women

Breast cancer is the most common invasive cancer diagnosed in Australian women, with more than 12,000 new cases diagnosed each year. A major achievement for the Department this year was the provision of support for women with breast cancer, through funding to the McGrath Foundation for the recruitment, training and employment of breast cancer nurses. By the end of 2008–09 more than 30 nurses were placed around the nation, with over 80 per cent located in rural and regional areas such as Wagga Wagga in New South Wales, Victor Harbor in South Australia, and Kingaroy in Queensland.

The Department also worked with Medicare Australia to introduce arrangements on 24 November 2008 to provide reimbursements of up to $400 for new and replacement external breast prostheses to women who have had a mastectomy as a result of breast cancer.

Through 2008–09, and continuing in 2009–10, the Department will collaborate with the National Breast and Ovarian Cancer Centre in its work in breast and ovarian cancer control, and the Breast Cancer Network Australia to assist its national provision of information and support to people with breast cancer.

Funding for the above activities was sourced from Program 10.1 – Chronic Disease – Treatment.

Improved Chronic Disease Management

Effective prevention and management of chronic disease is a key policy objective in the Australian health system. The Government’s agenda in improving chronic disease management encompasses the need to curb the escalating prevalence of lifestyle preventable chronic disease. In 2008–09, the Department worked to achieve this by increasing people’s knowledge of chronic disease factors. Improving the management of arthritis, osteoporosis and asthma was also a priority.

Increased Awareness of Chronic Disease Factors

During the year, the Department funded five chronic disease centres at the Australian Institute of Health and Welfare to monitor the level, burden, and trends of cardiovascular disease, kidney disease, diabetes, musculoskeletal conditions and asthma. These centres also monitored health expenditure on these five chronic disease areas. This activity facilitated information sharing between key stakeholders such as experts, advocacy groups and policy makers, and promoted community discussion; with the aim of informing efforts to help reduce the health, social and economic burden of chronic diseases on individuals and society. The Department will continue to support this monitoring in 2009–10.
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Arthritis and Osteoporosis Management

The burden of arthritis, osteoporosis or a related musculoskeletal disease is the main disabling condition for an estimated 561,000 Australians; 30 per cent of whom are unable to perform, or need help with, self-care or mobility tasks. In 2008–09, the Department funded programs that focused on primary and secondary prevention, and best practice management of arthritis and osteoporosis. The programs included: data collection, awareness programs, consumer information, health service improvement and health professional educational activities.

The Department also funded peak organisations and other stakeholders to develop clinical guidelines, core competencies and consumer information material. Three of four clinical guidelines for arthritis and osteoporosis commissioned by the Department were endorsed by the National Health and Medical Research Council in 2008‑09. As at 30 June 2009, the remaining guideline was still under consideration by the council. Promotion of the uptake of the guidelines through an Australia-wide education and information campaign will commence in 2009–10.

In 2009–10, the Department will focus on improving the expertise of the health workforce by disseminating the clinical guidelines, and increasing community awareness of these conditions through targeted information activities. The Department will also fund a National Bone and Joint Minimum Dataset and computerised data collection system, which will inform the development of policy and services for people with arthritis, osteoporosis and related musculoskeletal conditions.

Asthma Management

The National Health Survey in 2007–08 found that asthma affected over two million, or 10 per cent of Australians. In 2008–09, the Department funded a range of initiatives to help asthma sufferers to have an improved quality of life and to reduce the cost of asthma management to the community. Under a partnership with the National Asthma Council Australia, the Department supported the training of 1,150 health professionals through education workshops and satellite broadcasts, to encourage the proactive management of the chronic disease.

The Department commenced a review of the National Asthma Strategy. Endorsed by Australian Health Ministers in June 2006, the strategy provides a framework for planning and implementing activities at local, state and territory and national levels, to help raise awareness and manage asthma. The Department’s work on the strategy is taking into account advice from an asthma and respiratory specialist expert group and stakeholder feedback. It will introduce a new asthma management program in 2009–10, to improve asthma care in the community, and build on linkages between asthma and other chronic respiratory diseases, in particular Chronic Obstructive Pulmonary Disease.

Funding for the above activities was sourced from Program 10.1 – Chronic Disease – Treatment.
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Supporting Improved Clinical Practice and Decision-making through e-Health

e-Health is the electronic management of health information that can give health care providers access to up-to-date clinical information and consenting patients’ shared health records. It also allows for the fast transfer of electronic referrals which particularly benefits patients living in rural or remote areas where distance between health services can be an issue. In 2008-09, the Department worked to support improved clinical practice and decision-making through e-Health by leading stakeholders on aspects requiring coordination at a national level, and developing measures to enable the secure electronic exchange of personal information.

National Leadership in e-Health

To ensure that stakeholders worked to agreed directions and standards, the Department collaborated with the states and territories, professional groups and consumers on e-Health projects including foundational aspects of a national Individual Electronic Health Record system. This helped prevent duplication of effort and expenditure on e-Health solutions that are not integrated across the health system.

A major achievement for the Department this year, was contributing to the development of the National E‑Health Strategy, which was released by Australian Health Ministers in December 2008. The strategy was developed by Deloitte following a series of national consultations with Australian, State and Territory Governments, and a wide range of stakeholders including general practitioners, medical specialists, health information specialists and health service managers. The strategy guides national coordination and collaboration in e-Health, and includes sufficient flexibility for individual states and territories, and the public and private health sectors, to determine how they will implement e-Health within a common framework and set priorities.

The Department also led the development of a proposal for the establishment of an Individual Electronic Health Record system, which was submitted to the Council of Australian Governments for consideration in November 2008. While full consideration of the proposal was deferred, the council agreed to inject additional funding to support work relating to individual health identifiers, authentication, secure messaging standards and clinical terminologies. The Department will continue to work with the National E-Health Transition Authority and jurisdictions in 2009–10, to ready the health sector for implementation of national electronic health records, pending further government consideration.

National Standards to Enable Compatibility of e-Health Systems

In 2008–09, the Department supported the development of national standards to enable the compatibility of e‑Health systems so that electronic health information can be securely communicated across Australia. Providing a smooth and seamless flow and availability of health information to health professionals and service providers will support better, safer health care decision-making and health service delivery.

The Department provided funding to the National Electronic Health Transition Authority and Standards Australia to develop standards for discharge summaries, medication management, referrals, and pathology test ordering and reporting. This will enable clinicians to provide better informed health care to patients, particularly those living with chronic and complex conditions. The Department will continue to support this work in 2009–10, with a view to finalising a number of these national standards during the year.

Funding for the above activities was sourced from Program 10.2 – e-Health Implementation.
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Promoting Australian Health Policy through Participation in Relevant International, Regional and Bilateral Forums

Participation in international, regional and bilateral discussions on health policy helps the Department to ensure that international policy commitments are consistent with Australia’s needs and experience, and assists countries in the region to develop health protection mechanisms, which in turn, can protect Australia from pandemics and other forms of communicable disease transmission. In 2008–09, the Department contributed to the work of key international organisations and collaborated with other government agencies to foster Australian development goals in the region, and provided them with health-related policy advice.

Contribution to Key International Organisations

The Department participated in high level forums of the World Health Organization, during which there was particular focus on global and regional pandemic influenza preparedness and response, primary health care, tobacco control and reducing harmful use of alcohol.

The Department engaged with the Organisation for Economic Cooperation and Development (OECD) through its role as chair of the OECD Health Committee, and contributed to comparative analyses that are being undertaken by the OECD in addressing global health challenges, including: the economics of investing in preventative health measures; the escalating cost of health technologies; the impacts of population ageing; and the burden of chronic diseases. The issues of health workforce shortages; health system performance measurements; and health care financing indicators are also being examined.

In addition, the Department engaged with the Asia Pacific Economic Co-operation through its role as Chair of the Health Working Group. Through this forum, the Department contributed to addressing the connection between health, economic development and security in the region.

Fostering Australian Development Goals in the Region

In 2008–09, the Department continued to work with other Australian Government agencies to support international health development in the Pacific region. For example, the Department, with funding assistance from AusAID, managed the Pacific Senior Health Officials Network to support health systems governance and the development and implementation of effective health policies in the Pacific region. This involved engaging in high level policy dialogue with the Ministries of Health of the member countries. The Department also provided technical expertise and support through specific policy partnership projects with the Ministries of Health in Tonga, Samoa, and Kiribati. Issues explored under these partnerships included workforce planning, health information systems and health library capacity building.

Funding for the above activities was sourced from Program 10.4 – International Policy Engagement.

Health Policy Advice

The Department provided the Department of Immigration and Citizenship with technical and public health advice on communicable diseases and health threats to Australia. This enabled the Department of Immigration and Citizenship to make appropriate migration health policy decisions, ensuring positive health outcomes for Australians and migrants.

Funding for the above activities was sourced from Program 10.4 – International Policy Engagement.
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Improved Access to, and Quality of, Palliative Care

Palliative care helps maintain quality of life for people with a terminal illness, their families and carers. While palliative care is needed by all age groups, it is estimated that about 70 per cent of patients are aged 65 years or older. With the ageing population, this figure is expected to increase. In 2008–09, the Department worked to ensure that quality palliative care was accessible by managing a number of initiatives under the National Palliative Care Program. This included funding grants for local community projects and multi-site drug trials. Education and training for health professionals and advanced care planning were also supported.

Palliative Care in the Community

Through the Local Palliative Care Grants Program, the Department funded 88 projects to help improve the quality and effectiveness of end of life care in community settings. This funding supported organisations to develop and implement care plans for patients living at home, and to deliver transition-to-home support. It also supported training for pastoral care counsellors and volunteers, and the purchase of equipment such as accuturn mattresses, air pressure chairs, tympanic thermometers and portable oxygen concentrators.

The Department also administered funding to Palliative Care Australia to manage grants for the purchase of syringe driver devices on behalf of community based palliative care services. Syringe drivers are lightweight, easy to use devices that ensure constant injection of medications. They are suitable for use in primary care or home environments. The grants are being used to replace the existing Graseby syringe driver devices which are due to be phased out in Australia by 2012.

Palliative Care Clinical Studies Collaborative Drug Trials

During 2008–09, the Department funded the Palliative Care Clinical Studies Collaborative, comprised of four leading Australian universities, to evaluate palliative care medicines. The research aims to build the evidence base to support the listing of palliative care medicines on the Australian Register of Therapeutic Goods and ultimately increase the availability of palliative care medicines to patients through the Pharmaceutical Benefits Scheme.

The collaborative started four clinical research trials across 11 sites, with medications being trialled for the treatment of uncontrolled complex cancer pain, delirium, bowel obstruction and anorexia/loss of appetite. The trials will continue into 2009–10, during which time the collaborative will also commence clinical research on the efficiency of opioids in managing breathlessness in palliative patients.

Palliative Care Education and Training

In 2008–09, the Department supported education and training initiatives for health, aged and community care professionals, to help them to improve the quality of palliative care that they provide. Through the Program of Experience in the Palliative Approach, the Department funded 361 specialist palliative care placements of medical, nursing and allied health staff to improve their understanding of palliative care. The Department also supported around 2,000 health professionals to participate in 101 palliative care workshops.

In addition, the Department funded the Palliative Care Curriculum for Undergraduates project to develop specialist palliative care teaching and educational resources for universities which offer medical, nursing and allied health courses. This resulted in 37 per cent of Australian undergraduate medical, nursing and allied health courses using the Palliative Care Curriculum for Undergraduate materials.

During 2009–10, the Department will continue to implement workforce initiatives so that palliative care education becomes an integral part of medical, nursing, and allied health undergraduate training, and ongoing professional development.
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Advanced Care Planning

The Department funded the Respecting Patient Choices model of advance care planning which encourages people to appoint a guardian and/or enduring power of attorney, and to record an advance directive, either an oral or written instruction, about their future medical care in the event they become unable to communicate. This is important for a palliative care patient as they have an active, progressive and far-advanced disease with little or no prospect of cure.

As a result of the Department’s support, free planning guides and resource kits were made available to health services, general practitioners and residential aged care facilities via websites such as www.caresearch.com.au and www.respectingpatientchoices.org.au. The Department also worked with State and Territory Government departments on options for developing nationally consistent guidelines for advance care planning.

The Department will continue this work in 2009–10, by developing and providing patients with a means of discussing and recording their choices about health care in an advance care plan. This work will be informed by the Government’s response to the National Heath and Hospitals Reform Commission’s final report (discussion relating to the National Health and Hospitals Reform Commission can be found in the Outcome 13 Acute Care chapter).

Funding for the above activities was sourced from Program 10.5 – Palliative Care and Community Assistance.

Promoting Improved Patient Safety

The Department sought to improve patient safety in 2008–09, by supporting the role of the Australian Commission on Safety and Quality in Health Care to lead and coordinate national improvements in safety and quality in health care settings.

The Department provided funding to the Australian Commission on Safety and Quality in Health Care to identify issues, recommend policy directions, and provide strategic advice to health ministers to promote safety and quality care in the health system. The Commission has a five year work program, which identifies patient rights, accreditation of health services, medication safety, and hygiene as priority areas.

The Department supported the Commission to develop the Australian Charter of Healthcare Rights which was approved by Australian Health Ministers on 22 July 2008; and the national patient wristband standard to help prevent errors associated with mismatching patients and their care. The Commission also focused on developing a national approach to the surveillance of health care associated infection in hospitals. Further information relating to the Commission can be found at www.safetyandquality.gov.au.

Funding for the above activities was sourced from Program 10.6 – Research Capacity.
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Health Infrastructure Investment

In 2008–09, the Department, through the Health and Hospitals Fund, was responsible for supporting strategic investments in health infrastructure that will make significant progress towards achieving the Australian Government’s health reform targets, and underpin major improvements in efficiency, access and outcomes of health care. This involved establishing an advisory board and the operational framework for the fund. The Department collaborated with State and Territory Government departments to ensure high quality proposals for funding were received.

The Department provided ongoing support to the Health and Hospitals Fund Advisory Board in its assessment of funding applications and provision of advice to the Government. It also negotiated funding agreements with 11 successful project proponents. Work and planning on these projects commenced in 2008–09. The Department will progressively finalise funding agreements with the remaining 46 project proponents in 2009‑10.

One project is the Stage 3 redevelopment of the Nepean Health Services which will receive $96.4 million from the Health and Hospitals Fund and $41.4 million of state capital works funding. The project is to construct a new block which will include an ambulatory procedures centre with 60 overnight surgical beds and a ten bed medical assessment unit. The intensive care unit will be refurbished and expanded to provide 24 beds. The in-centre renal dialysis service will also be expanded to eight stations.

This project will give people living in the outer Western Sydney areas of Penrith, Blacktown, the Blue Mountains and Hawkesbury, in particular Indigenous people, the aged, and rural and outer-metropolitan population groups better access to services and reduced surgical waiting times. The redevelopment will also provide specialised mental health facilities and dental services.

Funding for the above activities was sourced from Program 10.7 – Health and Medical Investment Fund.
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Performance Information for Outcome 10 Administered Programs

Program 10.1 – Chronic Diseases – Treatment
Indicator:Complete primary care clinical guidelines and undergraduate competencies for arthritis and osteoporosis under the Better Arthritis and Osteoporosis Care Program. Measured by the publication and dissemination of the guidelines and competencies in 2008–09.
Reference Point/Target:Primary care guidelines endorsed by the National Health and Medical Research Council in 2008–09 on a national website.

Publication of the musculoskeletal undergraduate competencies in 2008–09.
Note: This performance indicator was amended in the 2008–09 Health and Ageing Portfolio Additional Estimates Statements, to refer specifically to primary care ‘clinical’ guidelines.
Result: Indicator substantially met.
Three of the four clinical guidelines developed for arthritis and osteoporosis were endorsed by the National Health and Medical Research Council. The Department expects the remaining guideline to be finalised in 2009–10.

The musculoskeletal undergraduate competencies are close to completion. Endorsement by the key health professional organisations of the finalised Australian Musculoskeletal Education Competencies will be achieved in 2009–10.
Indicator:Proportion of Divisions of General Practice invited to host an Asthma Management Program asthma workshop for health professionals conducted by the National Asthma Council Australia.
Reference Point/Target:At least 70% of all Divisions of General Practice invited to host Asthma Management Program asthma workshops.
Note: This performance indicator was amended in the 2008–09 Health and Ageing Portfolio Additional Estimates Statements, to: (1) report on the proportion of Divisions; (2) remove the performance indicator ‘timeliness of action plans available via national mail and marketing’ – as this data is not collected; and (3) refocus the target on the percentage of Divisions attending workshops, rather than on the training and resources available in 2008–09.
Result: Indicator met.
In 2008–09, 100% of Divisions of General Practice (currently 111 Divisions) were invited to host an Asthma Management Program workshop for health professionals conducted by the National Asthma Council Australia. Fifty-seven Divisions (51%) took up the offer, hosting one or more asthma workshops.
Indicator:Proportion of schools registered under the Asthma Friendly Schools Program.

Information and advice is available to consumers via Asthma Foundations in every state and territory.
Reference Point/Target:The registration target for 2008–09 is 80% of all schools nationally.

Information and advice is available nationally in 2008–09.
Note: This performance indicator was amended in the 2008–09 Health and Ageing Portfolio Additional Estimates Statements, to identify the number of schools ‘registered’ not ‘invited’. This ensures consistency between the indicator and the data proposed for collection.
Result: Indicator met.
In 2008–09, more than 85% (8,384) of Australian schools nationally were registered under the Asthma Friendly Schools Program.

Under the Asthma Management Plan Community Support Program, asthma information and advice were made available to consumers and health professionals through Asthma Foundations in every state and territory.
Indicator:Implementation of the National Diabetes Strategy.
Reference Point/Target:Programs and initiatives that aim to prevent and improve the management of diabetes will be implemented on time and within budget in 2008–09.
Result: Indicator met.
The Department provided funding of $0.953 million in 2008–09 to support the work of the National Centre for Monitoring Diabetes and the National Diabetes Register within the Australian Institute of Health and Welfare. The Department also provided funding of $133,898 (GST inclusive) in 2008–09 to the Sydney South West Area Health Service to continue the Australian National Diabetes Information Audit and Benchmarking project and to undertake a second project involving an education and patient centred audit in 2009.

Discussion on other diabetes related activities can be found in the Outcome 2 Access to Pharmaceutical Services and Outcome 5 Primary Care chapters.
Indicator:Implementation of the National Cancer Plan and the Better Cancer Care and Support for Women package of initiatives.
Reference Point/Target:Initiatives that aim to prevent and improve the wellbeing and health outcomes of Australians affected by cancer will be implemented on time and within budget in 2008–09.
Result: Indicator substantially met.
During 2008–09, the Department funded a number of the measures within the Better Cancer Care and Support for Women Package and the National Cancer Plan, including:
    • the External Breast Prostheses Reimbursement Program (implemented on time and within budget);
    • prostate cancer research centres in Melbourne and Brisbane (established on time and within budget);
    • planning for the establishment of youth cancer networks (on time and within budget); and
    • the Olivia Newton-John Cancer and Wellness Centre in Melbourne (implemented on time and within budget).
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Program 10.2 – e-Health Implementation
Indicator:Key stakeholders use electronic clinical communications to support quality and safety in health care.
Reference Point/Target:Increased use of electronic communications by service providers for electronic prescribing, secure electronic messaging and the components of shared health records.
Result: Indicator not met.
A key requirement for progressing the sharing of patient health information through an electronic health record is the development of unique identifiers. In November 2008, the Council of Australian Governments agreed to an Individual Healthcare Identifier being allocated to all Australians. In March 2009, Australian Health Ministers announced that public consultations would be undertaken to support work on legislative proposals for establishing health care identifiers and privacy protections. The Department will coordinate the public consultations during 2009–10.

In 2008–09, a secure electronic messaging requirement was incorporated for general practices’ eligibility for the Practice Incentive Program e-Health Incentive. This will lead to increased adoption and use of secure messaging in general practice, particularly as improvements are made to interoperability between secure messaging providers. These improvements will follow the establishment of a secure messaging standard, currently being developed by the National E-Health Transition Authority and industry and expected to be finalised in the second half of 2009. The allied health and specialist sectors of the health system represent future challenges in pursuing increased adoption and use of secure messaging.
Indicator:Australian Government investment in the National E-Health Transition Authority contributes to the development of nationally consistent e-Health standards and basic infrastructure.
Reference Point/Target:Timely input to National E-Health Transition Authority programs and ensure work is delivered within agreed timeframes.
Result: Indicator met.
In 2008–09, the Department funded the National E-Health Transition Authority for the delivery of its work program. The Department contributed in a sustained and timely manner to this work through representation on the National E-Health and Information Principal Committee, the National Health Chief Information Officers Forum and the National Electronic Health Transition Authority Stakeholder Reference Forum and its sub-groups.

The National E-Health Transition Authority achieved its work program deliverables within the agreed timeframes.
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Program 10.3 – Health Information
Indicator:Effective management of the Australian Government’s contribution towards the annual Australian Health Ministers’ Advisory Council cost-shared budget.
Reference Point/Target:Containment of overall cost-shared budget within agreed budget principles and Australian Government priorities are reflected in the annual Australian Health Ministers’ Advisory Council work plan.
Result: Indicator met.
Containment of the Australian Government’s contribution to the overall Australian Health Ministers’ Advisory Council cost-shared budget was within the agreed budget principles endorsed by the council in June 2008.

The Australian Government’s priorities were reflected in the annual work plans of the six Australian Health Ministers’ Advisory Council Principal Committees. The Department successfully managed the relationships with the council and its principal committees to ensure that the activities undertaken (where applicable) were reflective of current Government priorities.
Indicator:Peak community organisations’ input into policy and program development and delivery, through the Community Sector Support Scheme.
Reference Point/Target:Achievement of agreed plans and targets by funded organisations within agreed timeframes.
Result: Indicator met.
The Department executed 19 funding agreements with peak community organisations through the Community Sector Support Scheme. The organisations: provided community perspectives into the strategic development of health and ageing policies; and collected and analysed consumer information on health and ageing policies and programs before providing that information to the Department. These activities were achieved in accordance with agreed plans and targets, and within agreed timeframes.
Indicator:Improved strategic policy and program development through support for the development, conduct and analysis of national surveys.
Reference Point/Target:Analysis and release of data from the 2007–08 National Health Survey.
Result: Indicator met.
The Department’s support for national-level health surveys enables the Australian Bureau of Statistics to conduct the National Health Survey every three years, instead of every six years. The Australian Bureau of Statistics released the 2007–08 National Health Survey on 11 May 2009. By supporting national-level health surveys such as the National Health Survey, the Department makes a significant contribution to the evidence base available to support ongoing health policy and program development.
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Program 10.4 – International Policy Engagement
Indicator:Promote Australian international leadership in health policy through participation in meetings and other activities under the auspices of the WHO, OECD, APEC and other international and multilateral bodies.
Measured through the number of meetings/activities where Australia has played a leading or significant role.
Reference Point/Target:High level/strategic engagement with WHO Executive Board meetings, the World Health Assembly, chairing the APEC Health Working Group and the OECD Health Committee.
Result: Indicator met.
The Department participated in a number of high-level forums to promote Australian international leadership in health policy. In 2008–09 the Department chaired:
    • the WHO Pandemic Influenza Preparedness Intergovernmental Meeting, to facilitate international negotiations on timely and affordable access to vaccines, anti-viral medicines and other materials and capabilities needed to respond to an influenza pandemic;
    • one meeting of the OECD Health Committee;
    • two meetings of the APEC Health Working Group; and
    • the Pacific Senior Health Officials Network Annual Meeting.
The Department also hosted the inaugural Pacific Middle Managers Residential Module.
Indicator:Timely, consistent and complete Australian policy positions for international negotiations and discussions.

Measured through evidence of effective cross-departmental communications and opportunities for stakeholder participation through a range of forums.
Reference Point/Target:Stakeholders participate in program development.
Result: Indicator met.
Prior to each major annual meeting (including the World Health Assembly in May 2009), the Department met with key stakeholders, in particular the Department of Foreign Affairs and Trade and AusAID, to ensure that a consistent whole-of-department and whole-of-government position was provided to the delegation. Following each major annual meeting as outlined above, the Department debriefed relevant stakeholders and agencies to ensure consistency in the implementation of significant recommendations. This process occurred no fewer than 12 times in 2008–09.
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Program 10.5 – Palliative Care and Community Assistance
Indicator:The Palliative Care in the Community projects are progressed and completed.
Reference Point/Target:Projects that aim to better support palliative care patients, their families and carers in the community are implemented on time and within budget in 2008–09.
Result: Indicator met.
The Department funded 88 projects for a range of activities including: palliative care planning, development and implementation; transition-to-home support; training for pastoral care counsellors and volunteers; and the purchase of equipment for palliative care. The projects were completed on time and within budget.
Indicator:Increased use of palliative care in the community.
Reference Point/Target:Increased engagement at a local, state and territory level with the needs of palliative care patients considered.
Result: Indicator met.
The Department continued to increase engagement with State and Territory Governments through the Palliative Care Intergovernmental Forum, and with peak stakeholders, in order to facilitate a consistent approach to the development and delivery of palliative care initiatives, such as options for developing nationally consistent guidelines for advance care planning and related matters concerning end of life medical decisions by health professionals.

The Palliative Care for People Living at Home initiative is one example of the cooperative Australian, State and Territory Governments approach in the National Palliative Care Program. The initiative aims to improve care options for people who prefer to die at home. Under this initiative, the Department provided funding to the states and territories to undertake 13 projects for the development of flexible approaches to care that support people living at home who require palliative care, and their carers.
Indicator:CareSearch website will meet the information and resource needs of health professionals, volunteers, patients, families and carers.
Reference Point/Target:Increase in use of the CareSearch website by target groups.
Result: Indicator met.
The Australian Palliative Care Knowledge Network (CareSearch) website www.caresearch.com.au met the information and resource needs of the target groups through increased usage by health professionals, volunteers, patients, families and carers in 2008–09. The total number of hits on the website has almost doubled. During 2008–09 hits increased from 9,483,397 in the previous year to 17,467,711.
Indicator:Provision of multi-site drug trials through the Palliative Care Clinical Studies Collaborative.
Reference Point/Target:Increased number of multi-site drug trials.
Result: Indicator met.
The Department has increased the number of multi-site drug trials through the Palliative Care Clinical Studies Collaborative, with four new clinical research trials commenced during 2008–09. These trials have been undertaken across 11 clinical research sites. The research is being undertaken to support the listing of palliative care medicines on the Australian Register of Therapeutic Goods, which will increase access to medicines for palliative care patients.
Indicator:Increased access to services for survivors of torture and trauma.
Reference Point/Target:Over 3,000 clients per annum nationally receive services.
Result: Indicator met.
The Program of Assistance for Survivors of Torture and Trauma promotes the psycho-social recovery of entrants to Australia under the Humanitarian Program who have pre-migration experiences of conflict and human rights abuses, making them vulnerable to developing mental health problems.

Between 1 July 2008 and 30 June 2009, 3,107 people nationally received services under the initiative. During 2008–09, eight specialist torture and trauma agencies across each of the states and territories were funded by the Department to continue to provide individual and group counselling, education for mainstream service providers and community capacity building activities.
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Program 10.6 – Research Capacity
Indicator:Provide support for health and medical research by maintaining the clinical Islet Transplantation Program. This will be measured by the number of research grants provided and progress in the research and clinical program.
Reference Point/Target:Funding initiatives that enhance health and medical research initiated and progressed.
Result: Indicator met.
Health and medical research initiatives that were funded in 2008–09 included:
    • a trial of transport protocol for isolated islets;
    • the development of a simultaneous islet/kidney protocol for potential islet recipients who have type 1 diabetes, require a kidney transplant and are not suitable for a simultaneous pancreas kidney transplant;
    • the investigation of research ideas to support and improve clinical outcomes;
    • two postdoctoral fellowships,
    • a collaborative project focused on building additional sources for islet transplantations; and
    • four basic research projects.
Indicator:Support for Australia’s health and medical research by implementing funding initiatives that improve health and medical research capacity.
Reference Point/Target:Achievement of agreed plans and targets by funded organisations within agreed timeframes.
Result: Indicator met.
In 2008–09, the Department distributed $8.9 million to 25 health and medical research organisations for a range of activities aimed at improving the health and wellbeing of Australians. All funded organisations met their agreed plans and targets within the agreed timeframes.

Performance Information for Outcome 10 Departmental Outputs

Output Group 1 – Policy Advice
Indicator:Quality, relevant and timely advice for Australian Government decision-making measured by ministerial satisfaction.
Reference Point/Target:Ministerial satisfaction.
Result: Indicator met.
Ministers were satisfied with the quality, relevance and timeliness of advice provided for Australian Government decision-making.
Indicator:Production of relevant and timely evidence-based policy research.
Reference Point/Target:Relevant evidence-based policy research produced in a timely manner.
Result: Indicator met.
An evaluation of the Asthma Management Program commissioned by the Department was used to inform policy advice to the Government on the future Asthma Management Program directions.
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Output Group 2 – Program Management
Indicator:Administered budget predictions are met and actual expenses vary less than 0.5% from budgeted expenses measured by comparison of actual expenses against budget.
Reference Point/Target:0.5% variance from budgeted expenses.
Result: Indicator not met.
The actual Administered expenses for Outcome 10 were 2.2% less than budgeted expenses. This was due to an underspend in a number of programs across the outcome.
Indicator:Stakeholders participate in program development through a range of avenues, such as surveys, conferences, meetings, and submissions on departmental discussion papers.
Reference Point/Target:Stakeholders participate in program development.
Result: Indicator met.
During 2008–09, key stakeholders were involved in policy and program development relating to palliative care, through such forums as the Palliative Care Intergovernmental Forum and the Palliative Care Medicines Working Group.

Stakeholders were involved in the evaluation of the Asthma Management Program and an expert group provided advice to the evaluation on consultation strategies and wider policy issues.
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Outcome 10 – Financial Resources Summary

(A)
Budget
Estimate
2008–09
$’000
(B)
Actual
2008–09
$’000
Variation
(Column B
minus
Column A)
$’000
Budget
Estimate
2009–10
$’000
Program 10.1: Chronic Disease - Treatment
Administered Items
    Annual Appropriation Bill 1 (Ordinary Annual Services)
24,640
23,171
(1,469)
70,363
    Annual Appropriation Bill 2 (Other Services)
2,000
-
(2,000)
-
    Special Accounts
      Health and Hospital Fund Health Portfolio Special Account
40,000
40,000
-
42,000
Departmental Outputs
    Annual Appropriation Bill 1 (Ordinary Annual Services)
5,847
5,900
53
6,004
    Revenues from other sources
102
136
34
108
Subtotal for Program 10.1
72,589
69,207
(3,382)
118,475
Program 10.2: e-Health Implementation
Administered Items
    Annual Appropriation Bill 1 (Ordinary Annual Services)
51,427
48,723
(2,704)
52,983
Departmental Outputs
    Annual Appropriation Bill 1 (Ordinary Annual Services)
3,939
3,973
34
4,249
    Revenues from other sources
69
93
24
72
Subtotal for Program 10.2
55,435
52,789
(2,640)
57,304
Program 10.3: Health Information
Administered Items
    Annual Appropriation Bill 1 (Ordinary Annual Services)
7,850
7,758
(92)
8,024
Departmental Outputs
    Annual Appropriation Bill 1 (Ordinary Annual Services)
47
48
1
51
    Revenues from other sources
1
1
-
1
Subtotal for Program 10.3
7,898
7,807
(91)
8,076
Program 10.4: International Policy Engagement
Administered Items
    Annual Appropriation Bill 1 (Ordinary Annual Services)
11,575
11,611
36
14,386
Departmental Outputs
    Annual Appropriation Bill 1 (Ordinary Annual Services)
29
30
1
31
    Revenues from other sources
1
1
-
1
Subtotal for Program 10.4
11,605
11,642
37
14,418
Program 10.5: Palliative Care and Community Assistance
Administered Items
    Annual Appropriation Bill 1 (Ordinary Annual Services)
23,436
23,605
169
26,545
    Special appropriations
      Health Care (Appropriation) Act 1998 - Australian Health Care Agreements - Provision of Designated Health (p)
2,997
2,226
(771)
-
Departmental Outputs
    Annual Appropriation Bill 1 (Ordinary Annual Services)
3,012
3,037
25
3,249
    Revenues from other sources
53
74
21
55
Subtotal for Program 10.5
29,498
28,942
(556)
29,849
Program 10.6: Research Capacity
Administered Items
    Annual Appropriation Bill 1 (Ordinary Annual Services)
25,346
25,647
301
28,357
    Special Accounts
      Health and Hospital Fund Health Portfolio Special Account
46,000
45,000
(1,000)
40,000
Departmental Outputs
    Annual Appropriation Bill 1 (Ordinary Annual Services)
4,086
4,121
35
4,407
    Revenues from other sources
71
100
29
75
Subtotal for Program 10.6
75,503
74,868
(635)
72,839
Program 10.7: Health and Medical Investment Fund
Administered Items
    Special Accounts
      Health and Hospital Fund Health Portfolio Special Account
100,000
100,000
-
383,700
Departmental Outputs
    Annual Appropriation Bill 1 (Ordinary Annual Services)
278
278
-
602
    Revenues from other sources
5
14
9
7
Subtotal for Program 10.7
100,283
100,292
9
384,309
Total Resources for Outcome 10
352,811
345,547
(7,258)
685,270
Outcome 10 Resources by Departmental Output Group
Department of Health and Ageing
    Output Group 1: Policy Advice
8,554
8,477
(77)
9,003
    Output Group 2: Program Management
8,986
9,330
344
9,909
Total Departmental Resources
17,540
17,807
267
18,912
Average Staffing Level (Number)
129
126
(3)
138
(p) = part.

1 The name of this program changed to ‘Health Infrastructure’ during the 2009–10 Budget process.


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