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Outcome 13 - Acute Care

Improved access to public hospitals, acute care services and public dental services, including through targeted strategies, and payments to State and Territory Governments.

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Outcome Summary

Outcome 13 aims to improve the efficiency of, and access to, public hospitals, acute care services, and public dental services by delivering major reform through the National Healthcare Agreement, the National Partnership Agreement on Hospital and Health Workforce Reform, implementing the Commonwealth Dental Health Program and piloting the provision of mobile dental facilities for Indigenous Australians. The department worked to achieve this outcome by managing initiatives under the programs outlined below.

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 13 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 13 was managed in 2009-10 by the Acute Care Division and the Regulatory Policy and Governance Division.

Programs Administered under Outcome 13 and 2009-10 Objectives

Program 13.1: Blood and Organ Donation Services
  • Increase the number of life saving and transforming organ and tissue transplants for Australians.
  • Implement far-reaching changes to national governance and funding arrangements and systems.
Program 13.2: Medical Indemnity
  • Ensure that the medical indemnity insurance industry is stable and its products are affordable for doctors.
  • Provide eligible doctors with: access to safe and secure medical indemnity insurance; subsidies to keep their medical indemnity insurance premiums affordable; and self-funded run-off cover following their retirement from private medical practice.
Program 13.3: Public Hospitals and Information
  • Improve access to, and the efficiency of, public hospitals and health services.
  • Collecting performance data in key health areas to enhance public accountability and sharpen the incentives for ongoing reform.

Major Achievements

  • Reached agreement with states and territories (with the exception of Western Australia) to establish the National Health and Hospitals Network. These fundamental health reforms will improve health outcomes and the sustainability of the Australian health system.
  • Supported states and territories to deliver enhanced subacute care services in hospital and community settings, achieve targets for increased service delivery, strengthen the subacute care workforce and improve service quality, including through research into best practice models of care, benchmark development and progress towards nationally consistent data definition and collection.
  • More than 40 public hospital emergency departments across all states and territories benefited from the Commonwealth funding assistance under the Taking Pressure Off Public Hospitals initiative. Completed projects include expanded medical assessment units at seven NSW public hospitals ($31.9m over 4 years); a See and Treat Clinic at the Women and Children’s Hospital in SA ($2.4m); a Short Stay Unit at Alice Springs Hospital ($1.6m); and a Walk-In Centre at Canberra Hospital ($9.5m).
  • Supported states and territories to deliver improved elective surgery services through the $300 million Stage Three Elective Surgery Waiting List Reduction Plan National Partnership Agreement. This support was extended through a further $800 million made available over four years under the National Health and Hospitals Network reforms to improve access through the introduction of elective surgery targets and a National Access Guarantee.
  • Supported a safe, secure and affordable quality blood supply by working with states and territories, Government agencies, suppliers and clinical stakeholders to ensure that effective governance arrangements are in place, including through commissioning an administrative review of the national blood arrangements.

Challenges

  • Delayed reduction in waiting lists for public dental services, due to the postponed implementation of the Commonwealth Dental Health Program.
  • Managing the increasing costs of the blood sector. In 2009-10, national blood sector costs were about 11.3 per cent more than in 2008-09. In 2010-11, the department will continue to explore opportunities to strengthen the financial management of the blood sector and ensure sustainability in the provision of blood products and services into the future.

Program 13.1: Blood and Organ Donation Services

Program 13.1 aims to increase the number of life saving and transforming organ and tissue transplants for Australians.

Key Strategic Directions for 2009-10

In 2009-10, the department’s strategies to achieve this aim were to:
  • establish world’s best practice in organ and tissue donation for transplantation; and
  • ensure sustainable access to appropriate and safe blood products.

Major Activities

Improving Australians’ Access to Organ and Tissue Transplants

In 2009-10, the department provided advice and support to the Australian Organ and Tissue Donation and Transplantation Authority, to help implement reforms aimed at establishing Australia as a world leader in organ and tissue donation. The reforms aim to achieve a significant and lasting increase in the number of life-saving and life-transforming transplants for Australians. The department also provided evidence-based policy advice to the Government on organ and tissue donation issues. The number of organ donors in Australia has increased by about 30 per cent on the long-term average since the national reforms were announced in July 2008. There were 149 deceased donors in the six months January-June 2010, noting that the six-monthly average over the past 10 years is 105 deceased donors.

In 2009-10, the department administered funding to support Australian patients in need of a bone marrow, cord blood or peripheral blood stem cell transplant. Typically, these are patients with leukaemia or other life-threatening haematological and immune system diseases. The department provided funding to the Australian Bone Marrow Donor Registry to record the details of volunteer bone marrow donors on the national registry and centrally coordinate the matching of patients with compatible donors, including with international donors when there was no suitable donor available in Australia. In 2009-10, the registry undertook 471 donor searches on behalf of patients in Australia. The department approved financial assistance to 178 patients in Australia through the Bone Marrow Transplant Program to cover the cost of procuring marrow stem cells from international donors. The department also administered funding to the National Cord Blood Collection Network to collect, process, bank and release high quality, compatible umbilical cord blood stem cell units to Australian and international transplant centres for patients in need of a transplant. In 2009-10, 34 units were released for patients in Australia and 83 units for international patients.
image of woman holding a vial of blood

Blood and Blood Products

Continued access to an appropriate, affordable and quality blood supply is an integral part of Australia’s health system. In 2009-10, the department continued to effectively manage the government’s 63 per cent funding contribution to the blood sector through arrangements established in the National Blood Agreement. However, major challenges remain. These challenges centre primarily on balancing rising blood sector costs against universal access; achieving value for money without affecting clinical outcomes; improving transfusion appropriateness; and increasing the evidence base to inform blood policy into the future.

As required under the National Blood Agreement, the department contracted an independent consultant in 2009-10 to undertake an administrative review of the national blood arrangements, on behalf of all governments. It is expected that governments will respond to the findings of this review in 2010-11.

In 2009-10, the department continued to support the work of the Haemophilia Foundation of Australia, by providing funding to assist people with haemophilia, von Willebrand disease and related heritable disorders through activities including advocacy, education and best practice advice on the treatment of these disorders.
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Performance Information for Outcome 13

Program 13.1: Deliverables

Qualitative Deliverables

Qualitative Deliverable: Regular stakeholder participation in program development:
Working collaboratively with the authority, state and territory governments, and sector representatives including non-government and clinical organisations, in relation to organ and tissue donation policy and activities.
Result: Deliverable met.
The department provided advice and support to the Australian Organ and Tissue Donation and Transplantation Authority on issues associated with the implementation of the national reform package.

The department worked collaboratively with state and territory governments and sector representatives to agree a new four-year funding and performance framework, to be implemented from 2010-11, to support the National Cord Blood Collection Network. The new arrangements are intended to strengthen reporting of transplant outcomes and implementation of government policy on cord blood collection strategies and targets.
Improving Australians’ Access to Organ and Tissue Transplants
Qualitative Deliverable: Provision of strategic and practical policy advice based on analysis and research of national and international best practice organ and tissue donation experiences.
Result: Deliverable met.
In 2009-10, the department continued to provide high quality, relevant and timely advice to ministers on organ and tissue donation policy issues. The department also provided support, strategic direction and advice on policy issues to the Australian Organ and Tissue and Transplantation Authority to assist it in implementing the national reform package.

Quantitative Deliverables

Quantitative Deliverable: Percentage of variance between actual and budgeted expenses.
2009-10 Target: ≤0.5% 2009-10 Actual: -0.1%
Result: Deliverable met.
In 2009-10, the department’s administered expenses for Blood and Organ Services were 0.1 per cent less than the revised budget, which is within the set target range. Variations in estimates are largely due to the use of some blood products being less than projected by states and territories in early 2009.

During 2010-11 the department will work with states and territories and the National Blood Authority to improve mechanisms for estimating blood and blood products for future demand.
Improving Australians’ Access to Organ and Tissue Transplants
Quantitative Deliverable: Number of banked cord blood units (funding ceases 30 June 2010).
2009-10 Target:
  • Total;
    • and
  • Indigenous.

2,379
129		 2009-10 Actual:
  • Total;
    • and
  • Indigenous.

2,225
62
Result: Deliverable substantially met.
In 2009-10, the National Cord Blood Collection Network collected, processed, banked and released high quality stem cell units derived from umbilical cord blood for transplant into patients with blood related malignant and immune disorders. The network released 34 cord blood units for transplantation in Australian patients and 83 units for international patients. Total cord blood units banked were close to target despite collection staff shortages at one cord blood bank. Collections from Aboriginal and Torres Strait Islander people were below target. A review of the collection strategies for this and minority ethnic groups is planned for 2010-11.

In April 2010, Health Ministers agreed to continue funding the National Cord Blood Collection Network until 2013-14.

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Program 13.1: Key Performance Indicators

Quantitative Key Performance Indicator

Improving Australians’ Access to Organ and Tissue Transplants
Quantitative Indicator: Percentage of eligible Australians in need of a bone marrow, cord blood or peripheral stem cell transplant who are able to access appropriate treatment.
2009-10 Target: 100% 2009-10 Actual: 100%
Result: Indicator met.
All eligible Australians in need of a transplant have been able to access suitably matched bone marrow, cord blood or peripheral blood stem cells for transplantation.

The department has historically met this indicator.

Program 13.2: Medical Indemnity

Program 13.2 aims to ensure that the medical indemnity insurance industry is stable and its products are affordable for doctors.

Key Strategic Directions for 2009-10

In 2009-10, the department’s strategies to achieve these aims were to:
  • ensure that the medical indemnity insurance industry is stable; and
  • ensure that medical indemnity products are affordable for doctors.

Major Activities

Ensuring Stability

Stability in the medical indemnity industry means that premiums for doctors remain at affordable and predictable levels, which helps insurers to operate within prudential standards. Through the following programs, the department provides ongoing stability to the industry: the High Cost Scheme, the Exceptional Claims Scheme, and the Incurred-But-Not-Reported Scheme. This has flow-on benefits for patients, insurers and the wider health system.

To ensure the stability of the medical indemnity insurance industry, the department in 2009-10 continued to regulate and monitor the operations and activities of medical indemnity insurers. This was achieved through minimising the impact that large claims could have had on the ability of insurers to continue to provide affordable medical indemnity cover for doctors.

Keeping Premiums Affordable

Affordable medical indemnity insurance translates to stable fees for patients. To maintain affordability for medical practitioners, the department continued to administer the Premium Support Scheme and the Run-off Cover Scheme. In June 2010, the department offered renewed contracts to the five medical indemnity insurers to continue administering subsidies under the Premium Support Scheme for three years from 1 July 2010.

Introducing Insurance for Midwives1

Following the passage of legislation in March 2010, from 1 July 2010, privately practicing midwives are able to access adequate and affordable Commonwealth supported professional indemnity insurance. This will allow midwives to meet the requirements of the Council of Australian Governments’ (COAG) National Registration and Accreditation Scheme for health practitioners. All health professionals must have professional indemnity insurance as a condition of their professional registration. Commercial insurance for midwives had not been available since 2002, because of the very small potential premium pool (which tends to make it an unviable commercial proposition) and the lack of accurate and up-to-date data on claims relating to midwifery-led care in Australia.

The department entered a contract with an insurer, Medical Indemnity Group Australia, to provide professional indemnity insurance to midwives. The Midwife Professional Indemnity Commonwealth Contribution Schemes are demand driven programs that respond to claims when they are lodged by the insurer. For claims over $100,000, the Government will pay 80 per cent of the amount exceeding $100,000, and pay 100 per cent of the amount exceeding $2 million. Through a run-off cover scheme, the Government will pay the same level of subsidy for each claim after the midwife leaves the workforce or retires.

Privately practicing midwives, and the women for whom they care, will benefit from the protection of comprehensive insurance.

1 This measure was announced in the Budget in May 2009, as part of a package on maternity services reforms (see Outcome 5.3). Funding for this measure is included in Outcome 13.2.


Performance Information for Outcome 13

Program 13.2: Deliverables

Qualitative Deliverables

Qualitative Deliverable: Timely production of evidence-based policy research through:

Analysis of data provided through the Medical Indemnity National Collection and published in reports by the Australian Institute of Health and Welfare. This data, along with the Australian Government Actuary’s annual report on the cost of the Australian Government’s Run-off Cover Scheme for medical indemnity insurers and the Australian Competition and Consumer Commission’s medical indemnity monitoring report, will be used by the department to analyse the effectiveness of the arrangements and as a base for further policy development. This indicator will be measured by timely provision of policy advice in response to emerging trends.
Result: Deliverable met.
Policy advice on emerging trends in the medical indemnity industry was provided to the government in a timely manner based on analysis and monitoring of qualitative data on medical indemnity trends and issues.
Qualitative Deliverable: Regular stakeholder participation in program development, through avenues such as conferences and regular meetings.
Result: Deliverable met.
The department worked closely with Medicare Australia, the Australian Government Actuary and medical indemnity insurers to ensure that the medical indemnity program continued to meet its policy objectives.

Quantitative Deliverables

Quantitative Deliverable: Percentage of variance between actual and budgeted expenses.
2009-10 Target: ≤0.5% 2009-10 Actual: -74.4%
Result: Deliverable not met.
While the deliverable was not met, the program objectives were substantially met. Medical Indemnity programs only respond to finalised claims when they are lodged by Medical Indemnity insurers. Total claims have been less than estimated by the Australian Government Actuary. Any remaining actuarially estimated liabilities are carried forward.
Keeping Premiums Affordable
Quantitative Deliverable: Percentage of eligible applicants receiving a premium subsidy.
2009-10 Target: 100% 2009-10 Actual: 100%
Result: Deliverable met.
All eligible doctors who applied for a premium subsidy received it.

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Program 13.2: Key Performance Indicators

Quantitative Key Performance Indicator

Keeping Premiums Affordable
Quantitative Indicator: Number of doctors that receive a premium subsidy support under the Premium Support Scheme.
2009-10 Target: 3,468 2009-10 Actual: 2,443
Result: Indicator not met.
This is a reduction from the 2,556 doctors who received a premium subsidy in 2008-09. A reduction in the number of doctors receiving a premium subsidy under the Premium Support Scheme generally indicates that medical indemnity premiums are more affordable.

Program 13.3: Public Hospitals and Information

Program 13.3 aims to improve access to, and the efficiency of, public hospitals and health services by directing funding to state and territory governments for their health care services, and requesting performance data in key health areas to enhance public accountability and sharpen the incentives for ongoing reform.

Key Strategic Directions for 2009-10

In 2009-10, the department’s strategies to achieve this aim were to:
  • support reform of, and improve access to, quality public hospital services including through a new National Healthcare Agreement; and
  • improve access to dental services.

Major Activities

Better Access to Public Hospital Services

National Healthcare Agreement
Under the National Healthcare Agreement, the Commonwealth committed to provide funding of $60 billion over five years from 2008-09. The agreement sets out key policy directions across different health outcomes. On 20 April 2010, the Council of Australian Governments, with the exception of Western Australia, reached an agreement to establish a National Health and Hospitals Network, which will fund from 2011-12, public hospital services, some primary care services and, other than in Victoria, some aged care services. The new funding arrangements for the National Health and Hospitals Network will be managed through previously committed funding to the National Healthcare Agreement. The National Healthcare Agreement funding for the five years from 2009-10, is $27.5 billion.

In 2009-10, the department worked with the states and territories on priority reform areas identified in the agreement for the hospital and related care outcomes. The reform areas included: a move to a nationally consistent approach to activity-based funding for public hospital services which will provide more efficient services to the community; an increase to the proportion of elective surgery patients treated within clinically recommended waiting times; and an improvement in quality of data on non-admitted hospital patient services.

The department worked with the states and territories, and the Australian Institute of Health and Welfare to agree on performance indicators and hospital information as a basis for regular public reporting on all hospitals in Australia through a national hospital website to be released later in 2010.2

National Health and Hospital Network Agreement

In response to the National Health and Hospital Reform Commission’s recommendations3, the department provided extensive support through policy advice to the Government on issues including how to make public hospital funding more sustainable and improve access to, and the quality of, hospital services. This support assisted the Government in reaching an historic Council of Australian Governments’ agreement to fundamentally reform and improve access to public hospital services through a new National Health and Hospitals Network Agreement.

Under this agreement, the Australian Government will be the majority funder of Australian public hospitals, and will move from block to activity-based funding with a commitment to pay 60 per cent of the efficient price of all public hospital services delivered to public patients. The agreement leads to the establishment of new governance arrangements for public hospitals, increases transparency and accountability, and secures a sound basis for funding public hospitals into the future. The agreement will also increase local autonomy and flexibility and encourage clinical engagement.

The first payments to support public hospital capital and recurrent costs were made to the states and territories (with the exception of Western Australia) in June 2010 to enhance the capacity and performance of public hospital emergency departments and elective surgery as well as to enable investment in areas of greatest need, such as subacute care. Projects will commence from 2010-11.

Additional investments through the National Health and Hospitals Network will ensure that patients receive the care they need on time. Of the $7.4 billion invested in reforms under the Network, about $3.5 billion has been allocated to reduce the pressure on public hospitals.

National Partnership Agreement on Hospital and Health Workforce Reform
In 2009-10, the department continued to administer the National Partnership Agreement on Hospital and Health Workforce Reform. Funding was provided to states and territories to reduce pressures in public hospital emergency departments and the department monitored state and territory performance reporting and the timely delivery of funded projects. In 2009-10, more than 40 public hospitals across Australia benefited from this funding.

The department collaborated with the states and territories in 2009-10 to implement reforms to deliver improved subacute care services within the community and hospital settings. A wide range of initiatives were progressively implemented across Australia over the first year of this initiative, including: expansion of rehabilitation, palliative care, geriatric evaluation and management and psycho-geriatric services in metropolitan and regional areas, with a focus on strengthening community-based services. In 2010-11, and future years, the department will continue to monitor and facilitate the implementation of these reforms, including through subacute care data and patient classification system development.

The department also worked closely with the states and territories to commence development of data requirements for the introduction of activity-based funding of hospital related care progressively from 2012-13. This included work on patient classification systems, costing standards and data collections for admitted, subacute, emergency department and outpatient care and hospital-auspiced community health services. The department also collaborated with the state and territory governments to develop business cases and work plans to progress the work required under the National Framework and Implementation Plan for activity-based funding.

In 2010-11, the department will monitor the implementation of the national partnerships through mechanisms such as regular meetings with the states and territories. This approach will ensure that the key timeframes to achieve national partnerships’ objectives are met, including improving the efficiency and the capacity in health and hospital system, as well as health workforce supply.
Hospital Accountability and Performance Program
The Hospital Accountability and Performance program is a key element of the Australian Government’s commitment to nationally consistent hospital-related performance measurement and accountability.

In 2009-10, the department consulted with key stakeholders to develop and implement the ICD-10-AM4, which was published in March 2010, and provides a comprehensive, standard system for the classification of patient conditions.

Other work the department progressed included: implementing recommendations from the review of the AR-DRG Review5 Classification system process to deliver further improvements to this process; publishing the State of Our Public Hospitals Report, June 2010 Report6, which provides an overview of how the public hospital system performed in 2008-09, based on data submitted by states and territories; releasing the National Hospital Cost Data Collection Round 12 report in September 2009, for public and private hospitals; consulting with the private hospital sector to streamline reporting requirements, improve data quality, and enhance compatibility with the public sector; and providing funding to the states and territories to conduct Round 13 of the National Hospital Cost Data Collection for the collection of cost data for public and private hospitals to produce national cost weights for the Australian Refined Diagnostic Related Groups.
Elective Surgery
Elective surgery is surgery that, in the opinion of the treating clinician, is not an emergency and can be delayed for at least 24 hours. Demand for this surgery is increasing in Australia as the public hospital system struggles to cope with growing patient demands and stretched budgets. Improving elective surgery performance is important in helping more patients receive the surgery they need sooner and to improve their quality of life.

In 2009-10, the department continued to work with the states and territories to improve access to elective surgery through the Elective Surgery Waiting List Reduction Plan. The plan aims to reduce the number of patients waiting longer than the clinically recommended time for surgery by improving efficiency and capacity in public hospitals. Stages one and two provided funding for system and infrastructure improvements. Stage three commenced in July 2009 and provided facilitation and reward payments for states and territories that met specific performance targets. Stage three will end on 31 December 2010.

Improving Access to Public Dental Services

Commonwealth Dental Health Program
Through the Commonwealth Dental Health Program, the Australian Government intended to provide funding to the state and territory governments for about one million additional public dental visits over three years. The planned closure of the old Medicare Chronic Disease Dental Scheme did not proceed in 2009-10 with the consequence that the Commonwealth Dental Health Program was not implemented. The Senate did not support the closure of the old scheme and the Government was unable to put in place the necessary subordinate legislation to close the scheme, with the consequence that funding for the program was not available.
Closing the Gap — Indigenous Dental Services in Regional and Rural Areas
In 2009-10, the department finalised agreements and implementation plans for infrastructure with New South Wales and the Northern Territory. The Northern Territory agreement provided funding to replace an existing four-wheel-drive dental vehicle based in Alice Springs and the New South Wales agreement provided funding for a mobile dental van serving Narooma and nearby communities. In addition, the department provided funding to New South Wales for fixed and mobile dental equipment for an Aboriginal Medical Service in Orange and the surrounding region for patients through a ‘hub and spoke model’.

Improving Health Care Services in North-West Tasmania

The Australian Government provides funding through an agreement with the Tasmanian Government for the operation and management of the Mersey Community Hospital at Latrobe, to improve health care services for people in the north-west region of Tasmania. In 2009-10, the department met regularly with officers from the Tasmanian Department of Health and Human Services and the hospital, to monitor the delivery of the health care services being provided at the hospital. The hospital continues to provide all of the core services that are outlined in the agreement. The agreement also provides for expansion of the range of services provided at the hospital and services have been expanded in the areas of endoscopy, elective cataract surgery and urology. The department also monitors activity through analysis of information provided regularly by the Tasmanian Government.

In 2009-10, funding was provided to the Tasmanian Government to improve health care services for rural Tasmanian patients through the Tasmanian Patient Transport initiative. In 2009-10, several projects were completed, including upgrades to Queenstown Airport, the purchase of patient transfer and lifting equipment for Wynyard Airport, and an upgrade to the Spur Wing accommodation complex in Launceston which will also improve health care services.

2 Available at www.myhospitals.gov.au.

3 The National Health and Hospital Reform Commission’s final report A Healthier Future for all Australians was part of the major health reform undertaken in 2009-10. For further information on health reform, please refer to the Secretary’s Review.

4 International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification, Seventh Edition.

5 Australian Refined Diagnosis Related Group (AR-DRG), available at: www.health.gov.au/internet/main/publishing.nsf/Content/Casemix-1.

6 Available at www.health.gov.au/internet/main/publishing.nsf/Content/sooph10.


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Performance Information for Outcome 13

Program 13.3: Deliverables

Qualitative Deliverables

Qualitative Deliverable: Timely production of evidence-based policy research:

Data provided through the Public Hospitals and Information Program will be analysed and published in reports by the Australian Institute of Health and Welfare, the COAG Reform Council, the Report on Government Services, and the State of Our Public Hospitals report. The states and territories will be able to use this information to improve health service delivery. The data will also inform the Australian Government about where resources are most effectively targeted.

Analysis by the department of data provided as part of The Heads of Agreement for the management, operation and funding of the Mersey Community Hospital with the Tasmanian Government will seek to improve health services in the north-west region of Tasmania. The data will also inform the Australian Government as to whether Tasmania is meeting its obligations to continue to provide the agreed core clinical activities at the hospital.
Result: Deliverable met.
On 30 June 2010, the department published the seventh State of Our Public Hospitals June 2010.7 The 2010 report, presented public hospital performance in 2008-09 with comparisons of private hospitals and chapters on hospital use by Aboriginal and Torres Strait Islander people and on hospital maternity services.

Regular data has been provided by the Tasmanian Government on the operation of the Mersey Community Hospital and the services provided. The hospital continues to provide all of the core services that are outlined in the agreement. The agreement also provides for the expansion of services provided at the hospital. Services have been expanded in the areas of endoscopy, elective cataract surgery and urology.
Qualitative Deliverable: Regular stakeholder participation in program development, through such avenues as regular meetings and conferences. In addition: the department will consult with the states and territories and private sector, which are key stakeholders in program development and data production, seeking collaboration across all levels of government and with input from appropriate health care experts.
Result: Deliverable met.
The department worked with consumers, industry and all state and territory governments towards improving the provision of acute care hospital services and dental services by ensuring that policy directions reflect, where appropriate, the broader concerns of the health sector. Consultation was achieved through the annual Australian Health Care Agreement Data Meeting; regular National Partnership Agreement Implementation Steering Committee and its working groups; the Emergency Department/Activity Based Funding and Subacute Care Measurement Working Group; and monthly Elective Surgery Waiting List Reduction Plan Working Group.

Quarterly working groups conducted through the Private Hospital Working Group and the Hospital Casemix Protocols, represented by states and territories and key stakeholders from the private sector, to negotiate private hospital data changes, change management rules and streamline operational activities.
Improving Health Care Services in North-West Tasmania
Qualitative Deliverable: A North West Health Services Network Advisory Group has been established by the Tasmanian Government to meet the obligation in the Mersey Community Hospital Agreement to enable consumers and other stakeholders to provide input into the direction and development of health services for the Mersey Community Hospital and the north-west region of Tasmania.
Result: Deliverable met.
In 2009-10, the department participated in quarterly meetings of the North West Health Services Network Advisory Group.

7 Available at www.health.gov.au/internet/main/publishing.nsf/Content/sooph10.


Quantitative Deliverables

Quantitative Deliverable: Percentage of variance between actual and budgeted expenses.
2009-10 Target: ≤0.5% 2009-10 Actual: -4.1%
Result: Deliverable not met.
All program deliverables were substantially met in 2009-10, although some delays in implementation occurred due to the expansion of health reform strategies under the National Health and Hospitals Network Agreement. The Hospital Accountability and Performance Program and some aspects of activity-based funding were affected. However, overall agreed timeframes are still expected to be met.
Reform of and Access to Public Hospital Services
Quantitative Deliverable: Percentage expansion of state and territory subacute service provision.
2009-10 Target: 5% 2009-10 Actual: Data will be available by December 2010
Result: Deliverable cannot be reported.
Data to determine whether this deliverable was met or not met will not be available until December 2010. In their published progress reports covering the first six months of the National Partnership Agreement on Health and Hospital Workforce Reform, all states and territories reported that overall, implementation is on track against their plans and against the agreed annual service growth targets.

Program 13.3: Key Performance Indicators

Qualitative Key Performance Indicator

Improving Health Care Services in North-West Tasmania
Qualitative Indicator: The provision of safe and sustainable hospital services for the people in the north-west region of Tasmania can be measured by the ongoing effective management and operation of the Mersey Community Hospital. Under the agreement between the Australian Government and the Tasmanian Government, Tasmania is funded to manage and operate the Mersey Community Hospital. The effectiveness of this agreement will be measured by the ongoing provision of the services specified in the agreement.
Result: Indicator met.
The Mersey Community Hospital continues to operate in accordance with the agreement between the Australian Government and the Tasmanian Government to ensure that people in the north-west region of Tasmania have access to safe, appropriate and sustainable health care services. The hospital continues to provide all of the core services that are outlined in the agreement and the agreement also provides for expansion of the range of services provided at the hospital. Services have been expanded in the areas of endoscopy, elective cataract surgery and urology.

Quantitative Key Performance Indicator

Improving Access to Public Dental Services
Quantitative Indicator: Number of additional public dental visits delivered by the states and territories above agreed baseline. Measured by a reduction in state and territory public dental waiting list for priority groups assisted (Commencement date subject to Senate decision).
2009-10 Target: 166,5008 2009-10 Actual: Nil
Result: Indicator not met.
The planned closure of the Medicare Chronic Disease Dental Scheme did not proceed in 2009-10. The Senate did not support the closure and the government was unable to put in place the necessary subordinate legislation to close the scheme, with the consequence that funding for the Commonwealth Dental Health Program is not presently available.

8 Data caveat: A target of 1 million additional visits has been set over 36 months, but year-by-year breakdowns are subject to negotiations with individual jurisdictions.


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Outcome 13 – 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 13.1: Blood and Organ Donation Services
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)  9,784  9,370 ( 414)  13,554
Special appropriations

 

 

 

 
National Health Act 1953 – Blood Fractionation, Products and Blood Related Products – to National Blood Authority  548,056  548,056  -  613,409
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)  5,926  6,093  167  8,729
Revenues from other sources  315  245 ( 70)  320
Unfunded depreciation expense1  -  -  -  129
Operating loss / (surplus)  -  3  3  -
Total for Program 13.1  564,081  563,767 ( 314)  636,141
Program 13.2: Medical Indemnity
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)  250  247 ( 3)  157
Special appropriations

 

 

 

 
Medical Indemnity Act 2002  100,900  26,215 ( 74,685)  115,409
Unfunded Expenses2  2,200  - ( 2,200)  -
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)  2,959  3,269  310  4,358
Revenues from other sources  157  132 ( 25)  160
Unfunded depreciation expense1  -  -  -  65
Operating loss / (surplus)  -  2  2  -
Total for Program 13.2  106,466  29,865 ( 76,601)  120,149
Program 13.3: Public Hospitals and Information
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)  82,027  78,643 ( 3,384)  121,779
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)  17,018  17,553  535  25,732
Revenues from other sources  919  706 ( 213)  932
Unfunded depreciation expense  -  -  -  377
Operating loss / (surplus)  -  8  8  -
Total for Program 13.3  99,964  96,910 ( 3,054)  148,820
Outcome 13 Totals by appropriation type
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)  92,061  88,260 ( 3,801)  135,490
Special appropriations  648,956  574,271 ( 74,685)  728,818
Unfunded Expenses  2,200  - ( 2,200)  -
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)  25,903  26,915  1,012  38,819
Revenues from other sources  1,391  1,083 ( 308)  1,412
Unfunded depreciation expense1  -  -  -  571
Operating loss / (surplus)  -  13  13  -
Total Expenses for Outcome 13  770,511  690,542 ( 79,969)  905,110
Average Staffing Level (Number)  172  172  -  221

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


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