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Outcome 10 - Health System Capacity and Quality

Improved long-term capacity, quality and safety of Australia’s health care system to meet future health needs, including through investment in health infrastructure, international engagement, consistent performance and research.

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Outcome Summary

Outcome 10 aims to improve the long-term capacity, quality and safety of Australia’s health care system. This was achieved by improvements in the management of chronic disease, which included supporting the fight against cancer; supporting electronic health system reform; improving health information; working across jurisdictions to improve policies and programs and engaging in international forums; improving access to palliative care; improving the safety and quality of health services by supporting health and medical research; and building 21st century health infrastructure through the Health and Hospitals Fund.

This chapter reports on the major activities undertaken by the department during the year, reporting against each of the key strategic directions and performance indicators published in the Outcome 10 chapters of the 2009-10 Health and Ageing Portfolio Budget Statements and 2009-10 Health and Ageing Portfolio Additional Estimates Statements. It also includes a table summarising the estimated and actual expenditure for this outcome.

Outcome 10 was managed in 2009-10 by Mental Health and Chronic Disease Division, Primary and Ambulatory Care Division, Regulatory Policy and Governance Division, Ageing and Aged Care Division and Portfolio Strategies Division. The department’s state and territory offices also contributed to the achievement of the outcome.

In addition to the measures reported under this outcome, the department funds a number of preventative health activities through Outcome 1.

Programs Administered under Outcome 10 and 2009-10 Objectives

Program 10.1: Chronic Disease – Treatment

Support evidence-based practice.
Invest in cancer infrastructure.
Curb the prevalence of preventable chronic disease, such as asthma, diabetes, cardiovascular disease and musculoskeletal conditions.

Program 10.2: e-Health Implementation

Improve clinical and administrative decision-making through the development of e-Health standards and infrastructure.

Program 10.3: Health Information

Ensure that Australia’s health care system meets the future needs of the community by investing in health infrastructure and facilitating the exchange of international best practice information on health policies and health system reform.

Program 10.4: International Policy Engagement

Monitor international health policy trends and facilitate the exchange of ideas, information and policies to address regional and global health challenges.

Program 10.5: Palliative Care and Community Assistance

Promote better planning, delivery and coordination of palliative health care.

Program 10.6: Research Capacity

Support Australia’s capacity to undertake health and medical research.
Improve the safety and quality of Australia’s health system.

Program 10.7: Health Infrastructure

Invest in health infrastructure to improve the delivery of care to patients.

Major Achievements

Supported women with breast cancer, and their families, to access information, care and support by employing breast care nurses in 44 communities across Australia through the McGrath Foundation.¹
The Healthcare Identifiers Act 2010 and the Health Identifiers (Consequential Amendments) Act 2010 received Royal Assent on 28 June 2010. This legislation will permit the allocation of individual healthcare identifiers, which will improve patient safety and the availability of essential information to healthcare providers.
Managed the Health and Hospitals Fund, through which three major cancer centres, 17 hospital infrastructure projects, 12 translational research and training facilities and 23 rural primary care infrastructure projects were funded. In addition, funding for 20 regional cancer centre projects was announced, which will deliver improved services and health outcomes for rural and regional cancer patients.
Developed and implemented two palliative care programs worth $14 million to improve palliative care support and services for patients, their families and carers. These programs assisted in providing better practice in palliative care for people with mental illness and dementia. They also provided coordinated palliative care to patients and families in rural and regional areas.

Challenges

Delayed development of some eHealth infrastructure components by the National E-Health Transition Authority due to longer than expected consultation processes required to finalise high level business requirements for the National Authentication Service for Health.
The introduction of guidelines for a palliative approach in community aged care services did not occur in 2009-10 as planned because of delays in obtaining external approval.

Program 10.1: Chronic Disease – Treatment

Program 10.1 aims to reduce the burden of chronic disease in Australia. This was achieved by supporting evidence-based best practice in patient care, investing in cancer infrastructure, and curbing the prevalence of preventable chronic disease such as asthma, diabetes, cardiovascular disease and musculoskeletal conditions.

Key Strategic Directions for 2009-10

In 2009-10, the department’s strategies to achieve this aim were to:

improve the management of chronic disease in Australia; and
improve detection, survival and treatment outcomes for Australians with cancer.

Major Activities

Reducing the Impact of Chronic Disease

Monitoring

In 2009-10, the department funded five national centres at the Australian Institute of Health and Welfare to monitor and report on the level, burden, and trends in chronic diseases. These monitoring centres are for asthma and linked respiratory conditions, arthritis and musculoskeletal conditions, diabetes, cardiovascular disease and chronic kidney disease.

The monitoring centres, with advice from expert advisory committees, coordinate and analyse relevant national data sources to generate reliable, regular and current facts and figures on the chronic diseases. Each centre produces reports which inform the development of policies aimed at reducing the associated disease burden and improving outcomes for people at risk of or living with these diseases. Regular monitoring of chronic diseases provides an insight into the burden of these diseases on the healthcare system and critical data to identify prevention and primary care priorities.

In 2009-10, three of the centres, those focusing on cardiovascular disease, diabetes and chronic kidney disease, produced a collaborative report on the prevention of modifiable risk factors for these related diseases. The report, published in December 2009, presents a new conceptual framework for monitoring prevention services and outcomes in relation to cardiovascular disease, diabetes and chronic kidney disease in Australia.²

The centres also monitored health expenditure on these five chronic diseases. This activity facilitated information sharing between key stakeholders, such as experts, advocacy groups and policy makers, and promoted community discussion. This activity aimed to inform efforts by the department to reduce the health, social and economic burden of chronic diseases on individuals and society. The department will continue to support this monitoring in 2010-11.
image of nurse with patient holding asthma ventilator

image of nurse with patient holding asthma ventilator

Asthma Management

The National Health Survey in 2007-08 found that asthma affected more than two million, or up to 10 per cent, of the population. In 2009-10, the department commenced the implementation of a new four-year phase of the Asthma Management Program. A feature of this program is the inclusion of other linked respiratory conditions, including chronic obstructive pulmonary disease. The program provides a broad framework of activities that focus on prevention, primary care and social inclusion. The department supported the training of primary health care professionals to deliver high quality, patient-centred best practice asthma and respiratory care. It also provided community-based information and support for optimal self-management through school and community initiatives to help Australians to ‘breathe better’. Training and support activities involved strengthening collaborative relationships with non-government organisations with interests in wider lung health issues, such as the Australian Lung Foundation. An evaluation of the four-year program is being undertaken by the University of Wollongong to inform future considerations of the program and to assist in the development of indicators leading to improved information being given to targeted parts of the community. The evaluation commenced in 2009-10 and will include a mid-term review in 2011 and final report in 2013.

The department is facilitating a review of the National Asthma Strategy in consultation with states and territories as requested by the Australian Health Ministers’ Conference on 6 March 2008. 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. It is intended that the new strategy will be endorsed by the Australian Health Ministers’ Advisory Council during 2010.

Arthritis and Osteoporosis

Arthritis and musculoskeletal conditions are the world’s leading cause of long-term pain and disability, affecting six million Australians. In 2009–10, the department, through the Better Arthritis and Osteoporosis Care initiative, funded projects that focused on primary care, secondary and tertiary prevention of arthritis and osteoporosis.³ The projects included self-management, awareness raising, consumer education, health service improvement, data monitoring and evaluation.

The department funded peak organisations, such as Arthritis Australia, to develop a National Bone and Joint Minimum Dataset⁴, a computerised data collection system to inform policy and services for people with arthritis, osteoporosis and related musculoskeletal conditions. The National Health and Medical Research Council endorsed four clinical guidelines for arthritis and osteoporosis, with the final osteoporosis guideline endorsed on 5 February 2010. Usage of the guidelines was promoted through an Australia-wide education and information campaign to be held throughout 2009 to 2011. The community benefits by general practitioners having access to the latest best clinical practice and knowledge and improved clinical pathways for patients.

Consultation and development of National Core Competencies in Musculoskeletal Basic and Clinical Science began in 2009-10 and will be completed in 2010-11. The development of Basic and Clinical Science Frameworks was completed in 2010, and institutions will commence implementation in 2010-11. The department supported the Australian Institute of Health Welfare National Centre for Monitoring Arthritis and Musculoskeletal Conditions and the Institute of Bone and Joint Research to monitor and report on national data and trends regarding the prevalence and management of osteoporosis, rheumatoid arthritis⁵, juvenile idiopathic arthritis⁶ and osteoporosis.

An evaluation of the Better Arthritis and Osteoporosis Care initiative will guide the department on design and implementation of a new four-year phase (2010-11 to 2013-14), in partnership with key stakeholder organisations, focused on prevention, primary care and evidence-based, patient-centred disease management.

Fighting Cancer

Cancer Centres

In 2009-10, the department continued to support the construction of the Children’s Cancer Centre in Adelaide. The new Children’s Cancer Centre will be a fully integrated, dedicated children’s cancer facility that will provide state-of-the-art care and treatment facilities. The Children’s Cancer Centre will also provide a better working environment for doctors and nurses who treat child cancer patients. In preparation for construction of the centre, the South Australian Government relocated some existing treatment areas into temporary locations in early 2010. The department will continue to support and monitor the centre until its expected completion by the end of 2011.

In 2009-10, the department also continued to support the construction of the Olivia Newton-John Cancer and Wellness Centre at the Austin Hospital in Melbourne. This centre will include a radiation oncology centre, an ambulatory oncology centre, a wellness centre and a cancer information and research centre, as well as a research centre to be accommodated by the Ludwig Institute for Cancer Research. In 2009-10, Heidelberg House was demolished and construction of the new centre commenced. Occupancy of the centre is planned for late 2012. The department will further support and monitor the construction of the centre until its completion.

In 2009-10, the department was responsible for strategic investment in health infrastructure through the Health and Hospitals Fund Regional Cancer Centres initiative. This funding will contribute to building a national network of best practice regional cancer centres linked to specialised metropolitan care, resulting in maximum national coverage of essential cancer services. As part of the implementation of this initiative, the department developed the Regional Cancer Centres Guiding Principles, with input from the cancer community and experts, to define the key features of a viable regional cancer centre. The guiding principles formed a key part of the documentation for the open, national invitation to apply process for funding under the Health and Hospitals Fund for new or enhanced regional cancer centres. The invitation to apply was advertised in the national media on 14 November 2009, and closed for applications on 8 January 2010.

The department provided ongoing secretariat support to the independent Health and Hospitals Fund Advisory Board in its assessment of the regional cancer centre funding applications and provision of advice to Government. Between 7 April and 2 June 2010, 20 successful regional cancer centre projects were announced (see Table 10.1.1). These projects will significantly improve access to essential medical services and affordable accommodation facilities for people living in regional and remote communities.

The department has commenced funding negotiations for the successful projects, including with relevant jurisdictions and non-government organisations. The department will finalise funding arrangements in 2010-11.

In 2009-10, the department entered into funding arrangements to provide $150 million towards the development of Lifehouse at RPA: The Chris O’Brien Cancer Centre to be located on the Royal Prince Alfred Hospital campus at Camperdown, Sydney. This project will provide a new, world-class integrated cancer treatment and research facility. The construction activities for this project have commenced and the department will continue to support and monitor the construction of this facility until its expected completion in January 2013.

The work of Lifehouse at RPA will be supported by the Garvan St Vincents Cancer Centre, which is receiving $70 million under the Health and Hospitals Fund. This funding is for the construction of a research and training-focused cancer treatment centre that will focus on: discovery and delivery of new treatments; translational research; promotion of interdisciplinary care; and research on the molecular biology of cancer. The centre will be completed in mid-2012.

The Parkville Comprehensive Cancer Centre will create a leading national comprehensive cancer centre with a critical mass of researchers and clinicians for collaborative translational research in Parkville, including new facilities for the Peter MacCallum Cancer Centre, Melbourne Health cancer services and research, the Ludwig Institute for Cancer Research and University of Melbourne cancer research. In 2010-11, the department will finalise funding arrangements under the National Partnership Agreement on Health Infrastructure for the Parkville Comprehensive Cancer Centre. The centre will be completed in late 2015.

Prostate Cancer Research

In 2009-10, the department continued to support the establishment and operation of two dedicated prostate cancer research centres: the Australian Prostate Cancer Research Centre at Epworth, located at the Epworth Hospital in Melbourne; and the Australian Prostate Cancer Centre – Queensland, located at the Princess Alexandra Hospital in Brisbane and managed by the Queensland University of Technology.

Both centres were established and operational in 2009-10, and will further expand their operations and research capacity in 2010-11. In 2009-10, both centres had fully functioning governance arrangements and continued to recruit key research staff. The fit out of existing facilities was completed and will continue as the centres expand. The department has approved comprehensive research programs for both centres, against which significant progress has been achieved.

The establishment of these centres will improve health outcomes for Australians with prostate cancer and their families and carers. This will improve the understanding and management of the disease and expand the evidence base in the areas of early detection, diagnosis and treatment of prostate cancer. The department will continue to support and monitor the activities of the centres in 2010-11. Both centres will continue to expand and are expected to reach full research capacity in mid-2011.

Youth Cancer Networks

In 2009-10, the department continued to support CanTeen⁷ to implement the Youth Cancer Networks Program. CanTeen worked with each jurisdiction to finalise project proposals, with four projects commencing in 2009-10 and the fifth to commence in 2010-11. Projects include creating or enhancing existing treatment and support services for adolescent and young adult cancer patients, and implementing new models of care for adolescent and young adult patients, including networks and multidisciplinary care teams.

CanTeen worked with national project partners during 2009-10 to finalise proposals, and commenced implementation of seven national projects. These include: a national web portal providing easy access to information about youth cancer services and centres; a minimum dataset of key information to be collected and analysed to facilitate learning about national trends in youth cancer; increased availability of and access to clinical trials for youth cancers; published guidelines for treatment and support; implementation of a needs assessment for young people with cancer; a national network of health professionals interested in youth cancer; and professional development including a postgraduate certificate course for health professionals.

Breast Care Nurses

In 2009-10, the department supported the McGrath Foundation to place breast care nurses in 44 communities around Australia. These breast care nurses provide vital information, care, and practical and emotional support to women diagnosed with breast cancer, their families and carers. Approximately 89 per cent of these nurses are located in rural and remote communities, in areas where there is an identified need for this service. The measure also improves the employment opportunities for nurses in these areas. The department will continue to work with the McGrath Foundation in 2010-11 to ensure the retention of these positions.

Table 10.1.1: Summary of Regional Cancer Centre Projects

Project Name	Funding $ million
Capital Region Cancer Centre	$29.7
Australian Capital Territory total	$29.7
Regional cancer centre - New England and North West	$31.7
Regional cancer centre - Central Coast	$28.6
Regional cancer centre - North Coast	$17.1
Regional cancer centre - Shoalhaven	$23.8
Regional cancer centre - Illawarra	$12.1
Regional cancer centre - Lismore patient accommodation	$2.6
New South Wales total	$115.8
Regional cancer centre - Central Qld	$84.6
Regional cancer centre - Toowoomba & SW Qld	$9.6
Regional cancer centre - Townsville & Mt Isa	$70.1
Regional cancer centre - Nambour¹	$12.7
Regional cancer centre - St Andrew’s Toowoomba	$6.7
Queensland total	$183.7
Regional cancer centre - Whyalla	$69.8
South Australia total	$69.8
Regional cancer centre - Burnie, Hobart & Launceston	$18.7
Tasmania total	$18.7
Regional cancer centre - Ballarat	$42.0
Regional cancer centre - Gippsland	$22.0
Regional cancer centre - Statewide enhancements	$9.5
Regional cancer centre - Rotary Centenary Gippsland accommodation	$1.5
Regional cancer centre - Albury/Wodonga accommodation	$1.5
Victoria total	$76.5
Regional cancer centre - Strengthening Cancer Care in Rural WA	$22.3
Regional cancer centre - South West Health Campus	$23.4
Western Australia total	$45.7
Total Funding Commitments	$539.9
¹ announced after 30 June 2010.

¹Further information at www.mcgrathfoundation.com.au.

²Australian Institute of Health and Welfare 2009. Prevention of cardiovascular disease, diabetes and chronic kidney disease: targeting risk factors. Cat.no PHE 118, Canberra: AIHW.

³ Available at www.health.gov.au/internet/main/publishing.nsf/Content/pq-arthritis.

⁴ A minimum set of data elements agreed for mandatory collection and reporting.

⁵ Chronic and progressive disease in which the body’s own immune system attacks healthy tissue in joints.

⁶ Childhood arthritis affecting children from six months to 16 years.

⁷ Further information available at www.CanTeen.org.au.

⁸The Healthcare Identifiers Service became operational on 1 July 2010.

⁹ Further information available at www.standards.org.au.

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Performance Information for Outcome 10

Program 10.1: Deliverables

Qualitative Deliverables

Reducing the Impact of Chronic Disease
Qualitative Deliverable:	Regular stakeholder participation in program development, through such avenues as surveys, conferences, meetings, and submissions on departmental discussion papers, as measured by the number of stakeholder opportunities provided to participate in program development, including through contributions to evaluations.
Result: Deliverable met.
Between 11 September and 9 October 2009, a public consultation process was conducted for the development of the Regional Cancer Centres Guiding Principles, which were finalised with input from the cancer community and experts. The Australian Institute of Health and Welfare Monitoring Centres for Cardiovascular Disease, Diabetes, Chronic Kidney Disease, Asthma and Linked Respiratory Conditions and Arthritis and Musculoskeletal Conditions have established expert advisory groups to advise on data issues for each of these chronic conditions in order to generate reliable, regular and current facts and figures on the health and welfare of Australians. In 2009-10 these centres produced a number of discussion papers, including Prevention of cardiovascular disease, diabetes and chronic kidney disease: targeting risk factors; Primary Carers of People with Arthritis and Osteoporosis and a Snapshot of Arthritis 2010; and Asthma Among Older People and Asthma, COPD and other Respiratory Diseases in Australia.
Qualitative Deliverable:	The development of a new framework of activities to underpin the Asthma Management Program for 2009-10 to 2012-13, as measured by the acceptance of the new directions of the Asthma Management Program by the Government.
Result: Deliverable met.
The department implemented the new Asthma Child and Adolescent Program, which is delivering asthma information and emergency training, including improved self-management, in schools nationally, and for the first time in preschools. The department continued roll-out of the Community Support Program to educate people about best-practice asthma management and how to access referral pathways. The department extended primary health care practitioner best-practice asthma and respiratory management training to include practice nurses and Aboriginal and Torres Strait Islander health workers.
Qualitative Deliverable:	Improved arthritis and osteoporosis care, as measured by the establishment of consumer data collection arrangements by Arthritis Australia and Osteoporosis Australia. The arrangements will be completed by 31 March 2010.
Result: Deliverable met.
National Bone and Joint Minimum Dataset and computerised data collection system was developed.
Qualitative Deliverable:	Evaluation of the Better Arthritis and Osteoporosis Care initiative, as measured by the development of a plan for activities post 30 June 2010.
Result: Deliverable met.
Evaluation of the Better Arthritis and Osteoporosis Care initiative was undertaken, a final evaluation report was received by the department and a plan developed for activities post 30 June 2010.
Qualitative Deliverable:	Improved chronic disease surveillance and monitoring through best practice analysis of trends and patterns in health information systems, as measured by the delivery of work plan items by the Australian Institute of Health and Welfare on Asthma, Arthritis, Cardiovascular Disease, Diabetes and Chronic Kidney Disease Monitoring Centres.
Result: Deliverable met.
The department has developed revised schedules to its Memorandum of Understanding with the Australian Institute of Health and Welfare. The department specified an ongoing program of data-based publications and online data summaries to inform the prevention and management of major chronic diseases of Asthma and Linked Respiratory Conditions, Arthritis and Musculoskeletal Conditions, Cardiovascular Disease, Diabetes and Chronic Kidney Disease. The department funded the work of the National Centres for Monitoring Asthma, Arthritis, Cardiovascular Disease, Diabetes and Chronic Kidney Disease, and the Australian Institute of Health and Welfare continued their monitoring activities in 2009-10. The work plan items for the cardiovascular disease, diabetes and chronic kidney disease monitoring centres have been delivered as per the agreed schedule. The department also funded 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 2009-10.
Fighting Cancer
Qualitative Deliverable:	Improved cancer treatment and support facilities, as measured by the construction, or progress towards the construction of, the Children’s Cancer Centre in Adelaide, South Australia, Olivia Newton-John Cancer and Wellness Centre in Victoria, and Lifehouse at RPA: The Chris O’Brien Cancer Centre at the Royal Prince Alfred Hospital in Sydney, New South Wales.
Result: Deliverable met.
In 2009-10, building demolition and site preparation for construction of the Children’s Cancer Centre in Adelaide, South Australia was undertaken and construction of the centre commenced. The centre is scheduled for completion by the end of 2011. In 2009-10, building demolition and site preparation for construction of the Olivia Newton-John Cancer and Wellness Centre in Victoria was completed and construction of the centre commenced. The centre is scheduled for completion in 2012, with occupancy expected in late 2012. The department finalised negotiations with Lifehouse at RPA, and is providing funding for this project as construction milestones are achieved. In 2010-11, the department will continue to monitor construction activity.
Qualitative Deliverable:	Improved coordination of prostate cancer research, measured through the implementation, or progress towards implementation, of the research program of the two dedicated prostate cancer research centres.
Result: Deliverable met.
In 2009-10, the Australian Prostate Cancer Research Centre at Epworth and the Australian Prostate Cancer Centre – Queensland worked together to improve the coordination of prostate cancer research, and demonstrated progress towards implementing their respective research programs, which focused on developing improved diagnostic tests, screening tools and treatments for prostate cancer.
Qualitative Deliverable:	Improved services, support and/or care for adolescents and young adults with cancer, measured through the establishment of youth cancer networks.
Result: Deliverable substantially met.
The department continued to work with CanTeen to implement the Youth Cancer Networks Program. Eleven projects began in 2009-10, with the final project beginning in July 2010. These five jurisdictional and seven national projects aim to provide support and care for adolescents and young adults with cancer.

Quantitative Deliverables

Fighting Cancer
Quantitative Deliverable:	Percentage of variance between actual and budgeted expenses.
2009-10 Target:	≤0.5%	2009-10 Actual:	-28.1%
Result: Deliverable not met.
In 2009-10, funding associated with projects under the Regional Cancer Centres initiative could not be accurately predicted until the completion of the assessment and approval process. In addition, the department was unable to commence funding negotiations until the approval of projects had been finalised. This occurred in the last quarter of 2009-10. The department is working closely with successful applicants to finalise funding arrangements in early 2010-11.
Quantitative Deliverable:	Up to 30 breast care nurses employed.
2009-10 Target:	30	2009-10 Actual:	30
Result: Deliverable met.
In 2009-10, the target of employing up to 30 additional McGrath Foundation breast care nurses was reached. Breast care nurses are now in 44 communities around Australia, with 89 per cent of these positions located in rural and remote areas.

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Program 10.1: Key Performance Indicators

Quantitative Key Performance Indicator

Fighting Cancer
Quantitative Indicator:	Percentage of breast care nurses employed through the program.
2009-10 Target:	100%	2009-10 Actual:	100%
Result: Indicator met.
In 2009-10, as in 2008-09, the target of providing up to 30 breast care nurses was met, and the percentage of nurses employed through the program was 100 per cent. McGrath Foundation breast care nurses are now in 44 communities around Australia.

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Program 10.2: eHealth Implementation

Program 10.2 aims to improve safety and quality outcomes, and ensure better clinical and administrative decision-making for all Australians through the development of eHealth standards and infrastructure.

Key Strategic Direction for 2009-10

In 2009-10, the department’s strategy to achieve these aims was to:

support the development of eHealth standards and infrastructure to pave the way for Individual Electronic Health Records.

Major Activities

National eHealth Leadership

In 2009-10, the department provided national leadership in eHealth by demonstrating to the Australian community the health care safety and quality benefits of eHealth, and by developing measures to promote the adoption of eHealth systems to support improved health outcomes. The department developed a legislative and regulatory framework to support the use of identifiers to improve the delivery of health services. The Healthcare Identifiers Act 2010 and the Healthcare Identifiers (Consequential Amendments) Act 2010 received Royal Assent on 28 June 2010 to enable all Australians, their health care providers and healthcare provider organisations to access Healthcare Identifiers.⁸ Healthcare Identifiers will improve patient safety by preventing errors associated with mismatching of patient information and will improve the availability of essential information to health care providers and organisations.

The department, in partnership with state and territory governments, supported the National E-Health Transition Authority to deliver key eHealth building blocks to support the safe and secure electronic exchange of patient information. In 2009-10, the department contributed to national specifications being endorsed by Standards Australia⁹ to enable health providers to communicate more effectively with each other. The transition authority has encountered delays in developing the National Authentication Service for Health, due to longer than expected consultation processes to finalise high level business requirements. This extended consultation was required to ensure the development of the National Authentication Service for Health met the needs of both governments and healthcare providers. The project was expected to be completed in 2009-10, and the transition authority has advised the department that the National Authentication Service for Health is expected to be operational by mid 2012. The department worked with the authority to ensure that interim authentication arrangements are in place during 2010-11.

The department developed a business case for individual electronic health records, which was endorsed by Australian Health Ministers in April 2010. The 2010-11 Budget provided $466.7 million over two years from July 2010 to develop and implement a personally controlled electronic health record system as part of the Government’s National Health and Hospitals Network. In 2010-11, the department will commence work on implementing the system. The system will enable people, who choose to have an electronic health record, to check their key health information online, and provide access to their authorised health care providers. This will improve patient safety, deliver better health care and reduce waste and duplication of resources.
image of doctor

Healthcare Identifiers

Medicare Australia operates the Healthcare Identifiers Service. The service will give individuals and healthcare providers confidence that the right health information is associated with the right individual at the point of care.

There are three types of Healthcare Identifiers:

Individual Healthcare Identifier - allocated to all individuals enrolled in the Medicare program or those who are issued with a Department of Veterans’ Affairs treatment card and others who seek healthcare in Australia.
Healthcare Provider Identifier - Individual—allocated to healthcare providers involved in providing patient care.
Healthcare Provider Identifier - Organisation—allocated to organisations (such as a hospital or medical clinic) where healthcare is provided.

Healthcare Identifiers are created to be used by healthcare providers to improve the security and efficient management of personal health information with strict privacy laws governing how these numbers are used. The identifiers do not replace Medicare or Department of Veterans’ Affairs numbers and do not affect the way medical benefits are claimed. The identifier is not a health record. The information held is limited to demographic information (such as your name, date of birth and sex) which is needed to uniquely identify you and your healthcare providers.

To obtain further information on Healthcare Identifiers, go to www.medicareaustralia.gov.au and follow the links to Individuals and Families, then to Healthcare Identifiers Service for Individuals.

Source: Medicare Australia.

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Performance Information for Outcome 10

Program 10.2: Deliverables

Qualitative Deliverables

National eHealth Leadership
Qualitative Deliverable:	Regular stakeholder participation in program development, through avenues such as surveys, conferences, meetings, and submissions on departmental discussion papers.
Result: Deliverable met.
The department conducted three public consultation rounds for the Healthcare Identifiers Service proposals. This included the release of the exposure draft legislation and regulations. A total of 197 submissions were received from stakeholders. Stakeholder feedback was used to revise the Healthcare Identifiers Service legislation and regulations.
Qualitative Deliverable:	Develop and implement the Australian Government’s response to the National E-Health Strategy.
Result: Deliverable met.
The department led the development and implementation of the Australian Government’s response to the National E-Health Strategy. The strategy proposed that national action focus on four key areas: foundations, solutions, change management, and change and adoption. The department’s activities in eHealth supported the development of the foundational standards and infrastructure to enable interoperability across Australia. In 2009-10, the department funded the National E-Health Transition Authority to develop clinical communications solutions packages in the identified priority areas of referrals discharge; diagnostics and prescribing/medication management. The department also led the development of a business case for individual electronic health records and the change and adoption of eHealth in primary care.
Qualitative Deliverable:	The oversight of NEHTA, including reporting against agreed deliverables as articulated in the NEHTA Board’s approved work program. Performance will be measured by the proportion of agreed deliverables met.
Result: Deliverable substantially met.
In 2009-10, the department provided oversight of the National E-Health Transition Authority, including reporting against agreed deliverables, as articulated in the transition authority board’s approved work program for 2009-10. The department assessed and accepted progress reports for a total of 52 deliverables from the authority. Overall, the authority substantially met the broad policy objectives of developing critical standards, infrastructure, software and systems required to support the connectivity and interoperability of electronic health information systems. Major achievements included delivery of a Secure Messaging Standard; development of draft specifications for electronic transfer of prescriptions, e-discharge and e-referral; extension of the National Product Catalogue and the release of the Systematised Nomenclature of Medicine – Clinical Terms – Australia clinical terminology; completion of Releases One and Two of the Healthcare Identifier Service; delivery of the Model Healthcare Community; development of a Healthcare Identifier Communications Strategy and Implementation Plan; commencement of the Security and Access framework design; and presentation of a draft Compliance and Conformance Concept of Operations to stakeholders. The National Authentication Service for Health was not completed due to longer than expected consultation processes to finalise high level business requirements. This extended consultation was required to ensure the development of the National Authentication Service for Health met the needs of both Governments and the healthcare providers. The project is expected to be in operation by mid-2012.
Qualitative Deliverable:	Timely input to NEHTA programs. This will include contributions to the policy and regulatory parameters for the roll out of Individual Health Identifiers by June 2010. As measured by the completion of the Healthcare Identifiers Service during 2010, and the commencement of activation of Individual Healthcare Identifiers.
Result: Deliverable substantially met.
In 2009-10, the department provided timely input to the National E-Health Transition Authority’s programs through participation on the authority’s Stakeholder Reference Forum, and reference groups for continuity of care, terminology services, medications management, diagnostic services, architecture and technology and identification, and authentication and access. The department also facilitated engagement between industry and the authority to deliver nationally agreed technical specifications for secure message delivery. The department provided input to policy and regulatory parameters for the Healthcare Identifier Service which contributed to the successful passage of the Healthcare Identifiers Bills on 24 June 2010.¹⁰
Qualitative Deliverable:	Individual Health Identifier system, as measured by the introduction of legislation to Parliament.
Result: Deliverable met.
In collaboration with jurisdictions, the National E-Health Transition Authority, Medicare Australia and key stakeholders, the department developed legislation and regulations to establish and support the operations of the Healthcare Identifiers Service. On 10 February 2010, the Healthcare Identifiers Bills were introduced into Parliament. The Healthcare Identifiers Act 2010 and the Healthcare Identifiers (Consequential Amendments) Act 2010 were subsequently passed by Parliament on 24 June 2010. On 29 June 2010, the Federal Executive Council approved the Healthcare Identifiers Regulations 2010 to support the operation of the Healthcare Identifiers Service.

Quantitative Deliverables

National eHealth Leadership
Quantitative Deliverable:	Percentage of variance between actual and budgeted expenses.
2009-10 Target:	≤0.5%	2009-10 Actual:	-2.4%
Result: Deliverable not met.
The administered expenses for Program 10.2 underspent by 2.4 per cent. Program 10.2 underspend was caused by the delays in the passage of the Healthcare Identifiers Bills through Parliament. The delays prevented Healthcare Identifiers from being issued before 1 July 2010. Activities planned for 2009-10 to support the broad adoption of healthcare identifiers through organisations connected with primary care providers and peak representative bodies will now be undertaken in 2010-11.
Quantitative Deliverable:	Number of Individual Healthcare Identifiers activated.
2009-10 Target:	220,000	2009-10 Actual:	0
Result: Deliverable not met.
The Healthcare Identifiers Bills were introduced into Parliament on 10 February 2010 and a Senate Inquiry process was required, with the Bills subsequently passing on 24 June 2010. The delays in passage of the legislation prevented Healthcare Identifiers from being issued before 1 July 2010.

Program 10.2: Key Performance Indicators

Quantitative Key Performance Indicators

National eHealth Leadership
Quantitative Indicator:	Percentage of Australians whose Individual Healthcare Identifier has been activated.
2009-10 Target:	<1%	2009-10 Actual:	0
Result: Indicator not met.
The Healthcare Identifiers Bills were introduced into Parliament on 10 February 2010 and a Senate Inquiry process was required, with the Bills subsequently passing on 24 June 2010. The delays in passing the legislation prevented Healthcare Identifiers from being issued before 1 July 2010.

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Program 10.3: Health Information

Program 10.3 aims to contribute to the strategic development of health and ageing policies, and promote Australian health policy through engaging with international organisations and participating in relevant international, regional and bilateral forums.

Key Strategic Direction for 2009-10

In 2009-10, the department’s strategy to achieve these aims was to:

contribute to the strategic development of health and ageing policies and programs to benefit the Australian health system and in turn the Australian population.

Major Activities

Strategic Development of Health and Ageing Policies

Australian Health Ministers’ Advisory Council

The Australian Health Ministers’ Advisory Council provides support to the Australian Health Ministers’ Conference by advising it on strategic issues relating to the coordination of matters of mutual interest concerning health policy and health services across the nation and, as applicable, with New Zealand. The council also operates as a national forum to facilitate planning, information sharing and innovation in these areas. The effectiveness of the council rests on a spirit of cooperation, with decisions being reached on the basis of consensus among all states and territories.

In 2009-10, five council meetings and 12 Principal Committee meetings were held. Against a background of major health reform activity, these meetings supported the development of final cross-jurisdictional ministerial agreement on important activities including clinical training placements, the National Health and Hospitals Network Agreement (with exception of Western Australia), new registration and accreditation standards, and a breastfeeding strategy.

The provision of clinical training placements for health professionals will include an expansion of clinical placements into non-traditional training settings as part of students’ entry level education programs. The new settings will open up training opportunities in primary, community and mental health, aged care and the private sector.

The council also supported ministerial agreement for the National Health and Hospitals Network Agreement (with exception of Western Australia), including the National Four Hour Access Target (where patients are admitted, treated, discharged or referred for further treatment within four hours) and the Elective Surgery National Access Guarantee (which cuts waiting times for patients receiving elective surgery).

The National Registration and Accreditation Standards, which will apply to all health practitioners registered under the National Registration and Accreditation Scheme, ensures the provision of quality and professional health services to all Australians.

In 2009-10, the council also played a key role in the introduction of the Australian National Breastfeeding Strategy. The strategy recognises the biological, health, social, cultural, environmental and economic importance of breastfeeding, and provides a framework for priorities for Australian governments at all levels to promote, protect, support and monitor breastfeeding throughout Australia.

Community Sector Support Scheme

In 2009-10, the Community Sector Support Scheme provided national secretariat activity support to 19 peak community organisations that focus on meeting the health and ageing needs of the Australian population. This support contributed to public education, debate and consultation, health and aged care consumer representation, information exchange, community organisation forward planning, community organisation membership development, and linkages between community organisations.

The scheme enabled these organisations to represent and promote the interests of their constituents to the department and to Ministers, and to maintain effective links with other relevant stakeholders. The department will continue to work with participating organisations in 2010-11 to support their national secretariat activities.

National-level Health Surveys

The department aims to provide a sound evidence base for health policy and program development. National surveys on health and ageing issues are conducted by the Australian Bureau of Statistics with funding from the department. In 2009-10, the department funded the Australian Bureau of Statistics to conduct the first national Patient Experience Survey. Results from this survey were released in July 2010. The National Health Survey and the National Aboriginal and Torres Strait Islander Health Survey have been incorporated into the Australian Health Survey to be conducted in 2011-12. Further information is available under Program 1.6 – Public Health.
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Performance Information for Outcome 10

Program 10.3: Deliverables

Qualitative Deliverables

Community Sector Support Scheme
Qualitative Deliverable:	Timely production of evidence-based policy research, as measured by the use of information collected from national-level health surveys.
Result: Deliverable met.
National Health Surveys continued to inform a diverse range of research, policy development, performance monitoring and evaluation. The National Health Survey and the National Aboriginal and Torres Strait Islander Health Survey have been incorporated into the new Australian Health Survey, to be conducted in 2011-12. The Australian Health Survey will provide a wealth of information for health policy makers and researchers on the population’s food and nutrient intakes, chronic disease risk factors, prevalence of disease and use of medical services, with the potential to crosslink data such as individual food intake, physical activity, obesity and diabetes risk factors as well as providing comparable data to that from previous national health surveys for effective monitoring.
Qualitative Deliverable:	Regular stakeholder participation in program development, through such avenues as surveys, conferences, meetings, and submissions on departmental discussion papers.
Result: Deliverable met.
The department worked closely with the Australian Bureau of Statistics to develop the 2009-10 Patient Experience Survey.
Qualitative Deliverable:	The national secretariat activities of the organisations under the Community Sector Support Scheme represent and promote the interests of their constituents and maintain effective links with other relevant stakeholders. This is in line with agreed outputs and performance measures.
Result: Deliverable met.
The department supported 19 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 line with agreed plans and targets, and within agreed timeframes.

Quantitative Deliverables

Quantitative Deliverable:	Percentage of variance between actual and budgeted expenses.
2009-10 Target:	≤0.5%	2009-10 Actual:	0%
Result: Deliverable met.
There was no variance between actual and budgeted administered expenses for this program.

Program 10.3: Key Performance Indicators

Qualitative Key Performance Indicators

Strategic Development of Health and Ageing Policies
Qualitative Indicator:	The Australian Health Ministers’ Advisory Council includes the Australian Government’s priorities in its annual work plans.
Result: Indicator met.
The Australian Government’s priorities were reflected in the agreed annual work plans and the cost shared budget arrangements of the Australian Health Ministers’ Advisory Council and its six Principal Committees. The department successfully managed the relationships with the council and its principal committees to ensure that the activities undertaken were reflective of current Government priorities.
Qualitative Indicator:	The information collected through surveys is appropriately obtained and informs the development of Government health policies, as measured by the technical robustness of the survey design, the level of consultation with stakeholders about the survey design, and survey response rates.
Result: Indicator met.
Surveys funded by the department continued to satisfy the requirements of robust survey design, stakeholder consultation, and statistically valid survey responses rates.

Quantitative Key Performance Indicators

Strategic Development of Health and Ageing Policies
Quantitative Indicator:	Containment of overall cost-shared budget within agreed budget principles and Australian Government priorities are reflected in the annual Council work plan.
2009-10 Target:	≤$1.745 million	2009-10 Actual:	$1.746 million
Result: Indicator substantially met.
The overall cost-shared budget was contained within the agreed budget principles as approved by the Australian Health Ministers’ Advisory Council in November 2009. This indicator has been in line with estimates for the previous three years: 2007-08 - $1.675m; 2008-09 - $1.709m and 2009-10 - $1.746m. The department worked with the council’s principal committees to ensure the current Government’s priorities are reflected in the work plans, with significant decisions being reached in areas such as health workforce and pandemic vaccine roll-out.

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Program 10.4: International Policy Engagement

Program 10.4 aims to ensure Australia’s health care system meets the future needs of Australians, by engaging internationally on health issues and facilitating the exchange of international best practice information on health.

Key Strategic Direction for 2009-10

In 2009-10, the department’s strategy to achieve this aim was to:

monitor international health policy trends and promote Australia’s leadership in addressing regional and global health policy challenges.

Major Activities

Facilitating International Engagement on Global Health Issues

In 2009-10, the department engaged in multilateral, regional and bilateral international health policy discussions to promote and protect the health of the Australian population and to ensure Australia’s health system is responsive to international best practice. The department monitored trends and actively participated in discussions on health policy to enhance knowledge and understanding of best practice approaches by: facilitating the participation of senior health officials and technical experts at international meetings; hosting international delegations and visitors from other countries; and participating in activities of multilateral agencies, such as the World Health Organization, the Organisation for Economic Cooperation and Development and Asia-Pacific Economic Cooperation. The department promoted Australia’s leadership in addressing global health policy challenges by chairing key meetings and shaping priorities, particularly in the areas of pandemic influenza preparedness, international recruitment of health personnel, tobacco control and reducing harmful use of alcohol.

In 2009-10, the department continued to work with other Australian Government agencies, in particular the Department of Foreign Affairs and Trade and AusAID, to promote Australia’s strategic interests and development goals, including strengthening bilateral relationships and engagement in the region. The department continued to facilitate the Pacific Senior Health Officials Network which fosters cooperative linkages with health counterparts in the region to promote good governance in Pacific health systems.

Performance Information for Outcome 10

Program 10.4: Deliverables

Qualitative Deliverables

Facilitating International Engagement on Global Health Issues
Qualitative Deliverable:	The International Policy Engagement strategy will enable the department to effectively manage Australia’s leadership in addressing regional and global health policy challenges through the Australian Government’s participation at a range of international fora on health issues.
Result: Deliverable met.
The department made a significant contribution to multilateral organisations, such as the World Health Organization, Organisation for Economic Cooperation and Development (OECD), and Asia-Pacific Economic Cooperation (APEC), on international health policy issues and worked with other Australian Government agencies to ensure that its engagement was in accordance with Australia’s domestic priorities. The department also organised several bilateral meetings with senior health officials to support information sharing and health policy development in the region. The department continued to strengthen its international engagement through its participation in a number of high level forums. In 2009-10, the department promoted Australia’s international leadership in health policy through its role as chair of: three meetings of the OECD Health Committee; one APEC Health Working Group meeting; and the 2009 annual Pacific Senior Health Officials Network meeting.

Quantitative Deliverables

Facilitating International Engagement on Global Health Issues
Quantitative Deliverable:	Percentage of variance between actual and budgeted expenses.
2009-10 Target:	≤0.5%	2009-10 Actual:	-0.3%
Result: Deliverable met.
The actual Administered expenses for Program 10.4 were 0.3 per cent less than the budgeted expenses. This was due to exchange rates at the time of overseas payment transactions.
Quantitative Deliverable:	Number of meetings of the Pacific Senior Health Officials Network attended by representatives of the department.
2009-10 Target:	2	2009-10 Actual:	2
Result: Deliverable met.
In 2009-10, the department co-chaired, and provided secretariat support for, the 2009 annual Pacific Senior Health Officials Network meeting held in Brisbane. The department also chaired the annual network steering committee meeting in 2010. This meeting provides strategic direction for the network.
Quantitative Deliverable:	Number of relevant activities with the health ministries of Indonesia and China involving departmental representatives.
2009-10 Target:	≥5	2009-10 Actual:	5
Result: Deliverable met.
The department continued to engage with the Chinese and Indonesian Ministries of Health in relation to possible new plans of action in health cooperation, through correspondence and meetings in the margins of major international forums. The department continued its role as a member of the Program Management Committee of the AusAID-funded China-Australia Integrated Health and HIV/AIDS Program. This included participation in a meeting of the committee and in an AusAID review of the program.
Quantitative Deliverable:	Manage the department’s relationship with the WHO, OECD and APEC, as measured by departmental participation in international meetings:
2009-10 Target: Number of departmental activities associated with the WHO; 2009-10 Target: Number of meetings of the OECD Health Committee; and 2009-10 Target: Number of meetings of APEC Working Group.	8 2 2	2009-10 Actual: Number of departmental activities associated with the WHO; 2009-10 Actual: Number of meetings of the OECD Health Committee; and 2009-10 Actual: Number of meetings of APEC Working Group.	8 3 2
Result: Deliverable met
The department engaged in the key WHO meetings for 2009-10. These were the 2010 World Health Assembly, Executive Board meetings, Programme, Budget and Administration Committee meetings, the International Agency for Cancer Research (IARC) Governing Council meeting and the 2009 Western Pacific Regional Committee meeting. The department also managed the WHO Fellowships Program and engaged in WHO technical meetings. In 2009-10, the department chaired three OECD Health Committee meetings and participated in two APEC Health Working Group meetings. An additional OECD Health Committee meeting, which was not anticipated, was held to discuss preparations and planning for the Health Ministerial Meeting to be held in 2010-11. The benefits from participating in these key international meetings include increased capacity to recognise and address risks to the health of Australians and enhanced understanding of the characteristics of high quality health systems through learning from partner countries. Priorities include the challenges of communicable diseases, managing the growing burden on non-communicable diseases, and tackling the preventable causes of disease.
Quantitative Deliverable:	Number of international health delegations facilitated by the department.
2009-10 Target:	20-25	2009-10 Actual:	25
Result: Deliverable met.
The department regularly hosted visits of overseas delegations interested in learning more about Australia’s health system. The department also worked with key agencies, such as the Department of Foreign Affairs and Trade and the Department of the Prime Minister and Cabinet, to facilitate meetings with the department for overseas delegates.
Quantitative Deliverable:	Number of representatives from the Portfolio attending: major international meetings (WHO, OECD, APEC); WHO technical meetings; and other bilateral health and ageing commitments.
2009-10 Target:	12-20	2009-10 Actual:	20
Result: Deliverable met.
The department was represented at the major international health meetings (WHO, OECD and APEC). The department was also represented at WHO technical meetings by relevant departmental technical experts.

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Program 10.4: Key Performance Indicators

Qualitative Key Performance Indicators

Facilitating International Engagement on Global Health Issues
Qualitative Indicator:	The promotion of Australia’s leadership in global health policy challenges through supporting a consistent Australian policy approach to international negotiations and discussions on health, as evidenced by relevant cross-governmental consultative forums.
Result: Indicator met.
Prior to each major international meeting, such as the 2010 World Health Assembly, the department coordinates across its program areas and works with external agencies to ensure that a consistent whole-of-department and whole-of-government position is formed on key agenda items and on international health policy developments. The department coordinated with other Australian Government departments which have a shared policy responsibility for international health issues, in particular AusAID and the Department of Foreign Affairs and Trade. Following each major meeting, the department informs relevant program areas and agencies of the outcomes to ensure consistency in the implementation of international health policy.

Quantitative Key Performance Indicators

Facilitating International Engagement on Global Health Issues
Quantitative Indicator:	Number of international meetings attended by senior health and ageing officials.
2009-10 Target:	8-12	2009-10 Actual:	9
Result: Indicator met.
Senior departmental officials participated in the 2010 World Health Assembly, the International Agency for Cancer Research Governing Council, the 2009 WHO Western Pacific Regional Committee Meeting, a WHO High-Level technical meeting, the 2009-10 OECD Health Committee meetings, the 2009 Annual Pacific Senior Health Officials Network meeting and the 2009 Meeting of the Ministers of Health for the Pacific Island Countries.
Quantitative Indicator:	Number of cooperative agreements with overseas health ministries (excluding licences, funding agreements for specific activities under other programs and reciprocal health care agreements).
2009-10 Target:	5-7	2009-10 Actual:	6
Result: Indicator met.
The department has cooperative agreements with Canada, China, Indonesia, Iraq, Israel and Japan. Through these cooperative arrangements, the department facilitated information exchange to support health policy development and build professional networks with overseas counterparts.

Program 10.5: Palliative Care and Community Assistance

Program 10.5 aims to promote better planning, delivery, and coordination of health services and develop and support an integrated palliative care system.

Key Strategic Direction for 2009-10

In 2009-10, the department’s strategy to achieve these aims was to:

improve the standards of palliative care through increased support, training, adoption of a national approach, encouraging the use of quality medicines and research to improve evidence-based care.

Major Activities

Improving Palliative Care Standards

National Palliative Care Strategy

The National Palliative Care Strategy – A National Framework for Palliative Care Service Development (2000) represents the combined commitments of the Australian Government, state and territory governments, palliative care service providers and community-based organisations, to the development and implementation of palliative care policies, strategies and services that are consistent across Australia.

An update to the strategy was announced in April 2009 and was completed, following national consultations, in June 2010. The updated strategy provides an overview on the nature and scope of palliative care in Australia. The strategy identifies four key goal areas and proposes specific action areas under each of these goals as well as initial measures of success.

The updated strategy has been circulated for feedback to members of the Palliative Care Intergovernmental Forum and key stakeholders including Palliative Care Australia. This feedback has been incorporated into the final document Supporting Australians to live well at the end of life: National Palliative Care Strategy 2010. The updated strategy will be submitted to the Australian Health Ministers’ Advisory Council for endorsement by October 2010.

Community Access to Palliative Care

The Local Palliative Care Program funds organisations to provide improved care and support to people requiring palliative care and their families in their communities.

The current round of funding (Round 5) is for projects with a focus on innovative approaches to palliative care for people with mental illness, Alzheimer’s disease or other dementias. Twenty-one organisations are receiving funding of between $271,000 and $600,000.

Access to Quality Palliative Care

Quality palliative care relieves pain, distress and discomfort at the end of life. In 2009-10, the department improved the ability of health and aged care workers to deliver high quality palliative care by funding the provision of specialist palliative placements and workshops for health and aged care professionals. The department also promoted the inclusion of palliative care elements in undergraduate medical, nursing and allied health courses and facilitated the circulation of associated training and educational resources to universities. In 2010-11, the department will continue and expand this work.

Palliative Care Guidelines and Service Standards

Palliative care guidelines and standards are important in ensuring that people across Australia have access to consistently high quality palliative care. Under a contract managed by the department, leading Australian academics and experts in the field developed a set of clinical guidelines for a palliative approach in community aged care services. In 2009-10, the department submitted the guidelines to the National Health and Medical Research Council for approval.

Following approval by the council in 2010-11, the guidelines and a set of associated booklets are expected to be widely distributed to community aged care services, general practitioners, families and other groups. The department will also consider developing a set of training materials to accompany the guidelines.

The department additionally encouraged the use of national quality standards by palliative care services. Under this project, services were encouraged to assess their performance against the standards and to report the results. The national roll-out of the standards project occurred in July 2009, and by the end of June 2010 more than 130 services had agreed to participate.

Access to Palliative Care Medicines

The department funds the Palliative Care Clinical Studies Collaborative, to conduct clinical research medicines trials. Four trials commenced in 2008-09 and a fifth trial commenced in 2009-10. The research is being undertaken to support the registration of a number of medicines used in palliative care on the Australian Register of Therapeutic Goods and subsequently support the listing of these medicines on the Pharmaceutical Benefits Scheme in order to increase access to medicines for palliative care patients. The department has also funded the Palliative Care Clinical Studies Collaborative to build the research capacity of the palliative care sector so that ongoing clinical studies can occur, as well as increasing the evidence base to support the ongoing implementation of studies on medicine use and quality practice in palliative care.

Palliative Care Research

The department funded the National Health and Medical Research Council to continue to manage the Palliative Care Research Program. Since the commencement of the program in 2006, the council has awarded funding of $4 million for 36 research grants, PhD scholarships and postdoctoral fellowships in palliative care. The research program provides grants, scholarships and fellowships to improve the quality of palliative care, inform policy development, improve palliative care research capacity and increase the evidence base for good palliative care practice. In 2010-11, the department intends to continue and expand this work.
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Performance Information for Outcome 10

Program 10.5: Deliverables

Qualitative Deliverables

Improving Palliative Care Standards
Qualitative Deliverable:	In 2009-10, the department, in collaboration with state and territory governments, subject to Ministerial agreement, will start to update the National Palliative Care Strategy, to include the emerging health reform policies and meet the challenges of palliative and end-of-life integration across the health system.
Result: Deliverable substantially met.
An update to the National Palliative Care Strategy was approved by the Minister for Ageing and announced in April 2009. Following a round of national consultation workshops, targeted interviews, surveys and feedback from stakeholders, the updated strategy will be submitted to the Australian Health Ministers’ Advisory Council for endorsement by October 2010.
Qualitative Deliverable:	In line with the Reform Directions in the Caring for People at the End of Life chapter in the A Healthier Future for all Australians – Interim Report December 2008 of the National Heath and Hospitals Reform Commission, the department will work to promote the adoption of advance care planning in residential aged care facilities. In 2009-10, the department will build on the projects it currently funds to increase the use of advance care planning.
Result: Deliverable substantially met.
In 2009-10, the department continued funding an advance care planning project to promote the use of advance care planning in community palliative care services and to develop a quality assurance program for advance care planning. The department also commenced discussions with the project to conduct a national trial of its advance care planning methodology in residential aged care facilities. Substantial agreement has now been reached and the trial is expected to begin in the first half of 2010-11.
Qualitative Deliverable:	In 2009-10, the department will introduce guidelines for the provision of palliative care in community settings to complement those already developed for use in residential settings.
Result: Deliverable not met.
In the latter half of 2009, a set of guidelines for a palliative approach in community settings was submitted to the National Health and Medical Research Council for approval. Delays in receiving comments from overseas peer reviewers have meant that a decision on approving the guidelines will be made in 2010-11. Once approval is given, the guidelines will be distributed to community aged care services, general practitioners and others delivering care in the community.
Qualitative Deliverable:	In 2009-10, the department will provide a chairperson for the Palliative Care Intergovernmental Forum and convene at least two meetings.
Result: Deliverable met.
The department provided a chairperson for meetings of the Palliative Care Intergovernmental Forum in 2009-10. Two meetings were convened during this period - in September 2009 and March 2010.
Qualitative Deliverable:	The palliative care information, available to consumers, practitioners and researchers from the CareSearch website, will be expanded in 2009-10. The department will also fund Palliative Care Australia to provide a range of informative materials for a number of target groups.
Result: Deliverable met.
The number of items in the CareSearch Grey Literature database increased during 2009-10 from 3,888 to 4,012. A total of six new content pages were also added to the website during this period. The department funded Palliative Care Australia to release the following three consumer resources in 21 languages: What is palliative care?, Facts about morphine, and Asking questions can help.
Qualitative Deliverable:	Up to five trials of the use of palliative care medicines in the community will be held in 2009-10.
Result: Deliverable met.
In 2009-10, the department funded the Palliative Care Clinical Studies Collaborative to continue four clinical research trials which commenced in 2008-09. A fifth clinical research trial commenced in 2009-10.

Quantitative Deliverables

Quantitative Deliverable:

Percentage of variance between actual and budgeted expenses.

2009-10 Target:

≤0.5%

2009-10 Actual:

-2.1%

Result: Deliverable not met.

The underspend was largely due to delays in approval of a set of guidelines for a palliative approach in community settings. This caused delays in the distribution of resources and associated training activities to community aged care services, general practitioners and other delivering care in the community.

Improving Palliative Care Standards

Quantitative Deliverable:

Number of health professionals participating in clinical placements through the Program of Experience in the Palliative Approach.

2009-10 Target:

150

2009-10 Actual:

150¹¹

Result: Deliverable met.

The national clinical placements target was met. However, in some jurisdictions, demand for placements was greater than the supply and applications from some health professionals had to be declined.

Quantitative Deliverable:

Number of universities that incorporate palliative care into their undergraduate curricula.

2009-10 Target:

2009-10 Actual:

76¹¹

Result: Deliverable met.

Seventy-six university courses utilised the specially developed palliative care training materials as part of their curriculum by the end of 2009-10. A further 50 courses were reviewing the material for potential inclusion.

Quantitative Deliverable:

Number of research grants, PhD scholarships and postdoctoral fellowships funded.

2009-10 Target:

2009-10 Actual:

Result: Deliverable met.

The targeted number of grants, scholarships and fellowships funded under the Palliative Care Research Program has been met.

Quantitative Deliverable:

Average number of monthly visits to the palliative care information website.

2009-10 Target:

22,000

2009-10 Actual:

45,954¹¹

Result: Deliverable met.

The averaged number of visits to the palliative care information website significantly exceeded the target for 2009-10.

Visits to the palliative care information website, CareSearch – November 2009 to April 2010

Nov 2009	Dec 2009	Jan 2010	Feb 2010	Mar 2010	Apr 2010
48,475	43,441	46,946	43,148	53,220	40,496

¹¹ These figures are current estimates as at 30 June 2010. Final numbers will be known following the submission of final reports from funded organisations.

Program 10.5: Key Performance Indicators

Qualitative Key Performance Indicators

Improving Palliative Care Standards

Qualitative Indicator:

Relevant stakeholders are consulted in the process for updating the National Palliative Care Strategy in 2009-10. The department will hold at least five stakeholder consultations including with state and territory governments, Palliative Care Australia, other sector stakeholders and leading academic and clinical palliative care experts.

Result: Indicator met.

The department conducted an extensive national consultation process involving eight workshops, and 320 surveys and email submissions for the updating of the National Palliative Care Strategy.

State and territory governments, key stakeholders (including Palliative Care Australia) palliative care experts and consumers were given the opportunity to provide feedback throughout the process.

The update of the National Palliative Care Strategy has been successful, with high levels of stakeholder engagement and representation. The updated strategy focuses further national activity to improve the provision of palliative care services across Australia.

Qualitative Indicator:

The department will participate in the Palliative Care Intergovernmental Forum.

The forum will be convened at least twice in 2009-2010.

Result: Indicator met.

The department continued to work with state and territory governments through the Palliative Care Intergovernmental Forum, and with key stakeholders, in order to continue to facilitate a consistent approach to the development and delivery of palliative care initiatives.

The department convened two meetings of the forum in 2009-10. The meetings were held in September 2009 and March 2010.

Qualitative Indicator:

Improved access to palliative care information, as measured by an expansion of the amount of publicly available information on the CareSearch website.

Result: Indicator met.

The department continued to improve access to palliative care information by funding the CareSearch website as a one-stop shop of information and practical resources for people providing, or affected by, palliative care. The number of items in the CareSearch Grey Literature database increased from 3,888 to 4,012. The website also allows and supports dynamic interactions between networks of people so that they can develop, share and apply their knowledge to improve palliative care in Australia.

The number of items in the CareSearch Grey Literature database increased during 2009-10:

Category of literature	11 January 2010	24 May 2010
Conference Abstracts	2,816	2,894
Non indexed journal articles	649	649
Theses	133	137
Other Grey Literature	195	198
Research Studies	95	98
National Program Projects	N/A	37
TOTAL	3,888	4,012

The following new content pages were added to the website during 2009-10:

Complementary therapy;
New PubMed topic searches for prisoners and gay, lesbian, bisexual and transgender;
Bereavement and grief;
Research Connect - which aim to help researchers, project managers and others using the Research Data Management System;
Living alone; and
Multicultural resources – DVDs in Greek, Italian and Cantonese and a webpage with links to resources in other languages.

Qualitative Indicator:

New guidelines for the delivery of palliative care in a community setting will be developed. Palliative care information will be published in community languages as well as English.

Result: Indicator substantially met.

Guidelines for the delivery of palliative care in a community setting were developed and submitted for National Health and Medical Research Council endorsement in 2009-10.

The department funded Palliative Care Australia to publish three consumer resources in 21 languages.

Quantitative Key Performance Indicators

Improving Palliative Care Standards
Quantitative Indicator:	Percentage of local palliative care grants projects progressed and completed in agreed timeframes.
2009-10 Target:	100%	2009-10 Actual:	100%
Result: Indicator met.
The current round of local palliative care grants is funding 21 projects through 2009-10 and 2010-11, with a focus on innovative approaches to palliative care for people with a mental illness, Alzheimer's disease or other forms of dementia. These will be completed in 2010-11.
Quantitative Indicator:	Percentage of multi-site drug trials progressed and completed through the Palliative Care Clinical Studies Collaborative within agreed timeframes.
2009-10 Target:	100%	2009-10 Actual:	100%
Result: Indicator met.
Through the Palliative Care Clinical Studies Collaborative, the four clinical research trials which commenced in 2008-09 continued during 2009-10. A fifth clinical research trial commenced in 2009-10. The drug trials are being undertaken over 11 clinical research sites.
Quantitative Indicator:	Percentage of specialist palliative care services contributing to the palliative care data collection by the Palliative Care Outcomes Collaboration.
2009-10 Target:	66%	2009-10 Actual:	66%¹²
Result: Indicator met.
The majority of specialist palliative care services participate in the work of the Palliative Care Outcomes Collaboration. Some smaller services may have resource constraints on their ability to collect and report data.
Quantitative Indicator:	Percentage of patients covered by the data collection of the Palliative Care Outcomes Collaboration.
2009-10 Target:	85%	2009-10 Actual:	85%¹²
Result: Indicator met.
The majority of larger specialist palliative care services participate in the work of the Palliative Care Outcomes Collaboration. This is the reason why a greater percentage of patients than services are covered by the collaboration’s data collection.

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Program 10.6: Research Capacity

Program 10.6 aims to support Australia’s capacity to undertake health and medical research and improve the safety and quality of Australia’s health system.

Key Strategic Directions for 2009-10

In 2009-10, the department’s strategies to achieve these aims were to:

improve research capacity; and
improve coordination of safety and quality in health care.

Major Activities

Research Capacity

In 2009-10, the department signed seven funding agreements totalling $196.1 million, including five totalling $171.1 million under the Health and Hospitals Fund. The agreements, covering periods of between five and 25 years, are an important investment in updating and enhancing health and medical research infrastructure to assist in improving health outcomes for all Australians.

This investment in health and medical research capacity is crucial to ensure that Australia has the ability to attract and retain the best and brightest researchers who are able to work at the forefront of their fields. Strengthening Australia’s health and medical research capacity will help ensure that all Australians have access to the best possible research and most effective evidence-based health care.

Australian Commission on Safety and Quality in Health Care

The department continued to drive improvement in patient safety 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 supported the commission to deliver its 2009-10 work program. The budget for this work program was approved by all health ministers on 5 March 2009. The commission identified issues, recommended policy directions, and provided strategic advice to health ministers on identifying patient rights, accreditation of health care services, medication safety, patient handovers and healthcare associated infection.

In 2009-10, the commission developed the National Falls Prevention Guidelines 2009 and adapted the World Health Organization’s Surgical Safety Checklist for Australia. Both were endorsed by all health ministers on 13 November 2009. The commission developed the Guide to Clinical Handover Improvement and the National Consensus Statement on Essential Elements for Recognising and Responding to Clinical Deterioration, which were endorsed by all health ministers on 22 April 2010. The commission also continued development of a national approach to the surveillance of healthcare associated infection in hospitals.

Performance Information for Outcome 10

Program 10.6: Deliverables

Qualitative Deliverables

Qualitative Deliverable:	The Australian Commission on Safety and Quality in Health Care identifies issues, recommends policy directions and provides strategic advice to Australian Health Ministers. The commission has a five year work program approved by Health ministers, which includes activities in areas such as infection control, medication safety, clinical handover and accreditation of health services.
Result: Deliverable met.
The department continued to support the Australian Commission on Safety and Quality in Health Care to provide strategic advice to the Australian Health Ministers Conference on safety and quality issues. In 2009-10, the department provided strategic advice on safety and quality matters to the Minister and the commission, and provided ongoing input into the work program of the commission, with departmental participation on commission committees, working groups and workshops.

Quantitative Deliverables

Health and Medical Research Support
Quantitative Deliverable:	Percentage of variance between actual and budgeted expenses.
2009-10 Target:	≤0.5%	2009-10 Actual:	-16.7%
Result: Deliverable not met.
Due to the late announcement in April and May 2010 of the 20 Regional Cancer Centres, funding agreements were not finalised during the 2009-10 financial year. The funding agreements will be finalised during 2010-11.
Quantitative Deliverable:	Variance between budgeted funds and funds allocated to research organisations.
2009-10 Target:	≤0.5%	2009-10 Actual:	-28%
Result: Deliverable not met.
Under Program 10.6 Research Capacity, $78.339 million was allocated for 2009-10 of which $57.668 million was allocated to health and medical research. Health and Medical Research Institutes were allocated $36 million from a total of $40 million under the Health and Hospital Fund Special Account to support investment in health and medical research infrastructure. Of the $36 million, $20.3 million was provided to three organisations as planned and the remaining $15.7 million is for three organisations who have significantly modified their project plans or who have not been successful in raising the matched funds required.

Program 10.6: Key Performance Indicators

Quantitative Key Performance Indicators

Health and Medical Research Support
Quantitative Indicator:	Achievement of agreed plans and targets by funded organisations within agreed timeframes.
2009-10 Target:	≥95%	2009-10 Actual:	100%
Result: Indicator met.
The department provides funding to 49 organisations to support priority research areas and infrastructure development and all of the funded organisations provided the plans and deliverables as per the agreed timeframes.

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Program 10.7: Health Infrastructure

Program 10.7 aims to support improvements in Australia’s health infrastructure which will, with other reforms, deliver better care for patients.

Key Strategic Directions for 2009-10

In 2009-10, the department’s strategies to achieve this aim were to:

identify other opportunities for strategic investment in health infrastructure through the Health and Hospitals Fund; and
ensure that approved health infrastructure projects commence as soon as is practicable and that proponents make progress against agreed milestones.

Major Activities

Health and Hospitals Fund

The Health and Hospitals Fund was established on 1 January 2009 under the Nation-building Funds Act 2008 to support strategic investments in health infrastructure and underpin major improvements in efficiency, access or outcomes of health care. In 2009-10, the department managed 85 health infrastructure projects with combined funding of $3.2 billion. The projects fall under three themes: National Cancer Statement, which includes 33 projects; Hospital Infrastructure and other projects of National Significance, with 40 projects; and Transitional Research and Workforce Training, with 12 projects.

There are major projects in each state and territory and a list of funded projects is located on the department’s website.¹³

Included under the National Cancer Statement theme are 20 projects under the Regional Cancer Centres initiative. These projects will help improve access and support for cancer patients in rural and regional Australia. Further discussion of the Regional Cancer Centres initiative is included under Program 10.1 in this chapter.

In 2009-10, the department has been working with state and territory agencies, non-government organisations, universities and medical research institutes to progress funded projects.

Establish Performance and Reporting Criteria for Projects

In 2009-10, all applications for projects funded through the Health and Hospitals Fund were assessed by an independent Advisory Board against the Health and Hospitals Fund principles and evaluation criteria. There are major projects in each state and territory which will make significant progress towards achieving the Government’s health reform targets and will benefit all Australians.

On 7 December 2009, the National Partnership Agreement on Health Infrastructure was agreed by the Council of Australian Governments. In line with the requirements of the new framework on Federal Financial Relations, funding for projects being undertaken by the state and territories is provided via Implementation Plans under the National Partnership Agreement.

Under the National Partnership Agreement, the Australian Government and the states and territories agree to meet the performance benchmarks, indicators and milestones specified in individual Implementation Plans.

Funding arrangements with other organisations are based on the department’s standard capital works funding agreements.

Infrastructure Management

Negotiating Funding Agreements with Successful Proponents

The department has successfully negotiated funding agreements (and implementation plans) for Health and Hospitals Fund projects totalling more than $2.1 billion. The remaining projects are still being negotiated and these negotiations are expected to be completed by 31 December 2010.

All Health and Hospitals Fund funded projects must be undertaken in accordance with the specification detailed in the application and as assessed by the independent Health and Hospitals Fund Advisory Board. Where applicants wish to significantly change the scope of a project, the Minister must refer the application to the board for reassessment to ensure it still meets the fund’s evaluation criteria.

Funding agreements for all projects contain compulsory performance reporting requirements for organisations. In 2009-10, the department actively monitored the performance of projects by reviewing the regular project reports submitted by organisations. Reports on the progress of all projects are provided to the Minister for Health and Ageing and the Health and Hospitals Fund Advisory Board. Payments are linked to milestones, and organisations are required to provide evidence that milestones have been achieved before progress payments are made.

The department provides a secretariat function for the Health and Hospitals Fund Advisory Board which includes arranging meetings, preparing agenda papers and providing regular project updates to the board. The board met six times in 2009-10.

Performance Information for Outcome 10

Program 10.7: Deliverables

Qualitative Deliverables

Health and Hospitals Fund
Qualitative Deliverable:	Ensure that at least 90 per cent of all projects announced in the 2009-10 Budget are in place by the end of the financial year.
Result: Deliverable substantially met.
The department successfully negotiated agreements for 56 of the 85 (66 per cent) Health and Hospitals Fund projects. Included in the total number of projects are the 20 Regional Cancer Centres initiative projects which were not announced until April and May 2010. Finalising funding arrangements for the remaining projects were delayed for a number of reasons including requests to change project scope, delays in organisations securing additional funding, and finalisation of project plans and planning approvals. In 2010-11, the department will finalise negotiations with the remaining projects.
Qualitative Deliverable:	Ensure that progress reports are received from all proponents in the appropriate timeframe, or that remedial action has been taken.
Result: Deliverable met.
The department received all progress reports from contracted projects in the appropriate timeframe during 2009-10. Each report identified the progress that had been made on each project and demonstrated how activities were meeting the milestones outlined in the agreement. In 2010-11, the department will continue to strengthen its reporting mechanisms to ensure the information received is appropriate and meets the required expectations.
Qualitative Deliverable:	High quality support provided to the Health and Hospitals Fund Advisory Board as evidenced by board satisfaction.
Result: Deliverable met.
The department provided high quality support to the Advisory Board throughout 2009-10. The department provided a high volume of information to the board as part of the Regional Cancer Centre initiative assessment process in addition to status reports on the projects recommended for funding under round one of the fund.
Qualitative Deliverable:	Responsiveness to proponents’ queries with all queries responded to within 21 days.
Result: Deliverable met.
The department monitored communication from external stakeholders carefully. Queries on the fund (via email, letter and/or telephone) were all addressed within the required timeframe.

Quantitative Deliverables

Health and Hospitals Fund
Quantitative Deliverable:	Percentage of variance between actual and budgeted expenses.
2009-10 Target:	≤0.5%	2009-10 Actual:	-33.2%
Result: Deliverable not met.
Due to the late announcement in April and May 2010 of the 20 Regional Cancer Centres, funding agreements were not finalised during the 2009-10 financial year. The funding agreements will be finalised during 2010-11.
Quantitative Deliverable:	Number of funding agreements entered into.
2009-10 Target:	>90%	2009-10 Actual:	66%
Result: Deliverable substantially met.
The department successfully negotiated agreements for 56 of the 85 (66 per cent) Health and Hospitals Fund projects. Included in the total number of projects are the 20 Regional Cancer Centres initiative projects which were not announced until April and May 2010. Finalising funding arrangements for the remaining projects have been delayed for a number of reasons including requests to change project scope, delays in organisations securing additional funding, and finalisation of project plans and planning approvals. In 2010-11, the department will finalise negotiations with the remaining projects.

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Program 10.7: Key Performance Indicators

Qualitative Key Performance Indicator

Health and Hospitals Fund
Qualitative Indicator:	Regular stakeholder participation in program development, through such avenues as surveys, conferences, meetings, and submissions on departmental discussion papers.
Result: Indicator met.
In 2009-10, the department had an excellent working relationship with funded organisations and was committed to a cooperative approach to achieving the successful completion of each project. Feedback is received from key stakeholders through formal and informal channels, including face-to-face meetings, teleconferences, and telephone calls. All organisations that submitted unsuccessful applications were given the opportunity to receive feedback on the application, either in writing, telephone or face-to-face. A number of organisations took up this opportunity and found the feedback helpful and constructive.

Quantitative Key Performance Indicator

Health and Hospitals Fund
Quantitative Indicator:	Number of transfer payments provided within agreed timelines.
2009-10 Target:	90%	2009-10 Actual:	100%
Result: Indicator met.
The department met all procedural and process deadlines to ensure that all transfer payments were provided within the agreed timelines. Trend data is not available for this indicator as the Health and Hospitals Fund was established in 2009.

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Outcome 10 – Financial Resources Summary

	(A) Budget Estimate 2009-10 $’000	(B) Actual 2009-10 $’000	Variation (Column B minus Column A) $’000	Budget Estimate 2010-11 $’000
Program 10.1: Chronic Disease – Treatment
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	66,963	66,840	( 123)	45,079
Special Accounts			-
Health and Hospitals Fund Health Portfolio Special Account	37,287	8,125	( 29,162)	392,533
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	4,919	5,067	148	5,907
Revenues from other sources	85	138	53	89
Unfunded depreciation expense¹	-	-	-	102
Operating loss / (surplus)	-	3	3	-
Total for Program 10.1	109,254	80,173	( 29,081)	443,710
Program 10.2: e-Health Implementation
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	51,289	50,042	( 1,247)	233,475
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	9,435	9,719	284	11,332
Revenues from other sources	164	266	102	171
Unfunded depreciation expense¹	-	-	-	196
Operating loss / (surplus)	-	5	5	-
Total for Program 10.2	60,888	60,032	( 856)	245,174
Program 10.3: Health Information
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	8,024	8,024	-	7,792
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	39	40	1	46
Revenues from other sources	1	1	-	1
Unfunded depreciation expense¹	-	-	-	1
Operating loss / (surplus)	-	-	-	-
Total for Program 10.3	8,064	8,065	1	7,840
Program 10.4: International Policy Engagement
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	13,086	13,049	( 37)	14,386
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	25	26	1	30
Revenues from other sources	-	1	1	-
Unfunded depreciation expense¹	-	-	-	1
Operating loss / (surplus)	-	-	-	-
Total for Program 10.4	13,111	13,076	( 35)	14,417
Program 10.5: Palliative Care and Community Assistance
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	26,545	25,979	( 566)	28,062
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	4,172	4,297	125	5,010
Revenues from other sources	72	118	46	76
Unfunded depreciation expense1	-	-	-	87
Operating loss / (surplus)	-	2	2	-
Total for Program 10.5	30,789	30,396	( 393)	33,235
Program 10.6: Research Capacity
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	27,537	32,530	4,993	20,351
to Safety and Quality in Health Care Special Account	( 5,500)	( 5,500)	-	( 5,500)
Special Accounts
Health and Hospitals Fund Health Portfolio Special Account	40,000	24,300	( 15,700)	159,000
Safety and Quality in Health Care Special Account	13,819	11,827	( 1,992)	11,000
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	97	100	3	116
Revenues from other sources	2	3	1	2
Unfunded depreciation expense¹	-	-	-	2
Operating loss / (surplus)	-	-	-	-
Total for Program 10.6	75,955	63,260	( 12,695)	184,971
Program 10.7: Health Infrastructure
Administered Expenses
Special Accounts
Health and Hospitals Fund Health Portfolio Special Account	356,500	238,100	( 118,400)	401,100
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	996	1,026	30	1,196
Revenues from other sources	17	28	11	18
Unfunded depreciation expense¹	-	-	-	21
Operating loss / (surplus)	-	1	1	-
Total for Program 10.7	357,513	239,155	( 118,358)	402,335
Outcome 10 Totals by appropriation type
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	193,444	196,464	3,020	349,145
to Safety and Quality in Health Care Special Account	( 5,500)	( 5,500)	-	( 5,500)
Special Accounts	447,606	282,352	( 165,254)	963,633
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	19,683	20,275	592	23,637
Revenues from other sources	341	555	214	357
Unfunded depreciation expense¹	-	-	-	410
Operating loss / (surplus)	-	11	11	-
Total Expenses for Outcome 10	655,574	494,157	( 161,417)	1,331,682
Average Staffing Level (Number)	124	127	3	136

¹ Reflects the change to net cash appropriation framework implemented from 2010-11.

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