Outcome 10 – Health System Capacity and Quality

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Outcome Strategy

This chapter reports on the major activities undertaken by the department during the year, reporting against each of the major activities and performance indicators published in the Outcome 10 chapter of the 2010-11 Health and Ageing Portfolio Budget Statements (PB Statements) and the 2010-11 Health and Ageing Portfolio Additional Estimates Statements (PAES). It also includes a table summarising the estimated and actual expenditure for this Outcome.

Outcome 10 was managed in 2010-11 by the Acute Care Division, the Ageing and Aged Care Division, the Mental Health and Chronic Disease Division, the Portfolio Strategies Division, the eHealth Division, and the Regulatory Policy and Governance Division. The department’s state and territory offices also contributed to the achievement of this Outcome.

Program Name	Program Objectives in 2010-11
Program 10.1: Chronic Disease – Treatment	Improve the management of chronic diseases, such as asthma, diabetes, cardiovascular and musculoskeletal disease. Closing the gap in Indigenous health outcomes. Improve detection, treatment and survival outcomes for people with cancer through infrastructure support.
Program 10.2: eHealth Implementation	Provide national leadership in electronic health (eHealth) to improve health system standards and infrastructure. Promote the use of Healthcare Identifiers to improve safety and quality outcomes for health care providers and consumers. Support the design and development of a personally controlled electronic health record system to increase the availability of health care information for consumers and health care providers when and where it is needed across the healthcare system.
Program 10.3: Health Information	Contribute to the strategic development of health and ageing policies and programs to benefit the Australian health system and the population.
Program 10.4: International Policy Engagement	Improve health outcomes in Australia by contributing strategically and effectively as a member of the global community to international health and ageing issues and to bilateral and regional initiatives.
Program 10.5: Palliative Care and Community Assistance.	Improve palliative care services through increased support, training, adoption of a national approach, encouraging the use of quality medicines and research to improve evidence-based care.
Program 10.6: Research Capacity	Improve health and medical research capacity. Improve safety and quality in health care through national collaboration.
Program 10.7: Health Infrastructure	Invest in major health infrastructure programs that will support the objectives of reform of the Australian health and hospital system.

Major Achievements

• Progressed implementation of 85 projects funded under the Health and Hospitals Fund Rounds One and Two, whilst also supporting the assessment of 237 compliant applications for funding under the Health and Hospitals Fund Regional Priority Round, which resulted in funding for 63 projects totalling $1.33 billion.
• Allocated approximately 24 million Healthcare Identifiers to improve the communication of health information between healthcare providers and consumers.
• Set-up 12 eHealth lead sites to improve patient service delivery.
• Supported the introduction of accredited software testing facilities to ensure the safe use of the Healthcare Identifiers for Australians.
• Supported the work program of agreed National Safety and Health Service Standards by providing strategic advice to the Minister for Health and Ageing.
• Developed a new three year Plan of Action with the Chinese Ministry of Health to guide cooperation between Australia and China on health issues of strategic importance to both countries.
• Updated the National Palliative Care Strategy and received endorsement by Australian Health Ministers to help ensure a nationally consistent and coordinated approach to palliative care for patients, their families and carers.
• Supported the roll-out of Tackling Smoking and Healthy Lifestyle Teams in the first 20 of 57 regions nationally. This exceeded targets for training health workers in the delivery of Chronic Disease Self-management sessions and was completed under the National Partnership Agreement for Closing the Gap in Indigenous Health Outcomes.
• Assisted the establishment of the Australian Commission on Safety and Quality in Health Care as a permament body.
• Advised on and assisted with the amalgamation of Cancer Australia and National Breast and Ovarian Cancer Centre (NBOCC), which was completed on 30 June 2011. All cancer stakeholders now have one Australian Government agency to work with regardless of cancer type, and the Government has a strengthened Cancer Australia with greater capacity to build on its expertise in cancer control.

Challenges

• Managing the transition of the Australian Commission on Safety and Quality in Health Care from the Department of Health and Ageing to an independent authority, without significant disruption to the work of the Commission.
• Managing a large and diverse portfolio of capital works projects funded by the Health and Hospitals Fund to ensure the effective implementation and monitoring of the projects through funding and reporting arrangements with non-government agencies and the states and territories.
• Ensuring there is an appropriately skilled workforce to deliver quality palliative care.

Program 10.1: Chronic Disease – Treatment

Improve Chronic Disease Management

Monitoring

The department will continue to fund the AIHW monitoring centres in 2011-12. The centres will provide critical data in informing the Government’s reform agenda and addressing the burden of disease associated with increasing rates of chronic disease.

Qualitative KPI:	Improved chronic disease surveillance and monitoring.
2010-11 Reference Point:	Best practice analysis of trends and patterns in health information systems and the resultant delivery of work plan items.
Result: Indicator met.
Through agreed annual work plans, the department was able to direct the AIHW in preparing and publishing data-based publications and online data and information summaries relating to the prevention, management and treatment of arthritis and musculoskeletal conditions, asthma and linked respiratory conditions, cardiovascular disease, chronic kidney disease, and diabetes. Eleven publications focusing on these five chronic diseases were released by the AIHW in 2010-11. The department also funded the AIHW to continue work relating to the National Diabetes Register (NDR), which contains records of people in Australia who commenced using insulin to treat their diabetes after 1 January 1999, and who have provided consent to have their records included on the Register. In addition, the department funded the South Western Sydney Local Health Network to oversee the Australian National Diabetes Information Audit and Benchmarking (ANDIAB) project, which undertakes data collection and reporting on the clinical management, patient education and self-care activities, of people with diabetes for the purposes of clinical audit and monitoring change in specialist diabetes services across Australia. The department has funded ANDIAB on eight occasions since 1998, with stage 7 of the project having been completed in December 2010, and stage 8 commencing in January 2011 (this stage will complete in December 2012).

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Asthma Management

Qualitative KPI:	Asthma Management Program reduces the personal, social and economic impact of asthma and linked chronic respiratory conditions.
2010-11 Reference Point:	An evaluation of the program scheduled for completion in June 2011 concludes that program reduces the impact of asthma and linked chronic respiratory conditions.
Result: Indicator substantially met.
The department funded the University of Wollongong to evaluate the four-year program from 2009-10 to 2012-13, including a mid‑term review in 2011 and final report in 2013. Outcomes from the mid-term review undertaken in 2011 will inform future considerations of the program. The department specified an ongoing program of evaluation activities to inform the mid-term review. The evaluation activities for the program have been delivered as per the agreed schedule, with the mid-term review in 2011 nearing completion. Outcomes from the mid-term review will inform future considerations of the program to assist in reducing the impact of asthma and linked chronic respiratory conditions.

Arthritis and Osteoporosis

Closing the Gap in Indigenous Health Outcomes

Qualitative Deliverable:	Cross-sector engagement of Healthy Lifestyle Workers Program with nutrition support and other preventative programs.
2010-11 Reference Point:	Healthy Lifestyle Workers are able to provide and/or refer Aboriginal and Torres Strait Islander peoples to local nutrition and physical activity programs and resources.
Result: Deliverable met.
Organisations employing Healthy Lifestyle Workers are funded to support those workers through Certificate III training in identified courses as well as other training specific to their role of promoting activity, food nutrition and other healthy lifestyle approaches in Indigenous communities. Healthy Lifestyle Workers are undertaking external training such as the ‘Living Strong’ and ‘Good Quick Tukka’ programs and linking in with organisations such as the Heart Foundation and the National Rugby League (NRL) to ensure they are resourced to identify opportunities for healthy activities. Healthy Lifestyle Workers also provide a range of local nutrition and physical activity programs including in schools and organising healthy community days offering a broad range of information and exercise experiences.
Quantitative Deliverable:	Number of new Healthy Lifestyle Workers employed.
2010-11 Target:	42	2010-11 Actual:	30
Result: Deliverable substantially met.
The majority of Healthy Lifestyle Workers have been employed, however local labour market conditions posed challenges for host organisations in recruiting staff. The first national workshop of host organisations and workers was held in Canberra in December 2010 to provide induction training and build networks across this new national workforce.
Qualitative KPI:	Increased awareness and engagement of Indigenous communities in chronic disease prevention.
2010-11 Reference Point:	Levels of awareness and engagement on positive chronic disease prevention activity in Indigenous communities as reported by Healthy Lifestyle Workers.
Result: Indicator substantially met.
Healthy Lifestyle Workers report good participation in healthy living activities including physical activity such as walking groups, Zumba and touch football and nutrition activities such as healthy cooking groups and community gardening. Healthy Lifestyle Workers have actively promoted health checks contributing to a significant increase in participation.
Quantitative KPI:	Number of health professionals trained in chronic disease self‑management support.
2010-11 Target:	100	2010-11 Actual:	130
Result: Indicator met.
The department funded the Flinders Human Behaviour and Health Research Unit, Flinders University, South Australia to develop and pilot a specialist Chronic Disease Self-Management (CDSM) support training program, building on the existing Flinders Program, designed for delivery to Indigenous Australians in a range of settings and circumstances. The program was piloted in Far North Queensland, SA and NSW. Training is offered to health workers who are servicing large numbers of Indigenous patients, such as Aboriginal Health Workers and nurses who are based at Aboriginal Community Controlled Health Services, or state and territory controlled health services. One hundred and thirty Aboriginal Health Workers, practice nurses and doctors were trained in 2010-11. To assist with sustainability a ‘Train the Trainer’ model has been developed to increase the pool of accredited trainers, particularly in Aboriginal Medical Services (AMSs). The department has also funded a remote CDSM project in the Pilbara and Kimberley regions of WA. With support from BHP Billiton the University of WA will evaluate this initiative.

Improve Detection and Treatment of Cancer

Cancer Australia

Cancer Centres

In 2010-11, the department 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 2010-11, Heidelberg House was demolished and construction of the new centre commenced. Occupancy of the centre is planned for late 2012.

Prostate Cancer Research

Youth Cancer Networks

Breast Care Nurses

COAG Improving Cancer Care initiative

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Whole of Program Performance Information

Program 10.2: eHealth Implementation

National eHealth Leadership

In 2010-11, the department continued to support the development of national standards for the safe transfer of electronic prescriptions through NEHTA and Standards Australia. These standards will improve the long-term capacity, quality and safety of Australia’s health care system through reducing the need to re-key prescriptions. The standards will also provide direction and certainty to industry, health care providers andthe community to create electronic medication management systems.

The department successfully negotiated contracts to establish 12 eHealth lead implementation sites in 2010-11. These sites will deploy national eHealth infrastructure and specifications in real world health care settings, build stakeholder support behind the national PCEHR system and demonstrate the tangible outcomes and benefits of eHealth projects.

In addition, through the eHealth Support Officer Program, the department worked with the Divisions of General Practice Network and state based organisations to increase the adoption of eHealth by general practices and primary health care providers nation-wide.

On 30 November and 1 December 2010, the department conducted a National eHealth Conference in Melbourne. The conference allowed GPs, health professionals, allied health workers, consumers and vendors to gain an increased understanding of eHealth by demonstrating its benefits through presentations and group discussions. The conference also provided participants with an understanding of the design and development of the PCEHR system.

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Promote the Use of Healthcare Identifiers

In 2010-11, the department worked to introduce the Healthcare Identifiers Act 2010, the Healthcare Identifiers (Consequential Amendments) Act 2010 and the Healthcare Identifiers Regulations 2010. These regulations allow all Australians, health care professionals and healthcare provider organisations to be assigned with an HI. Since 1 July 2010, the department has worked with Medicare Australia (the operator of the HI Service) to make available approximately 24.0 million HIs to healthcare consumers; 528,300 HIs to healthcare professionals and 170 HIs to healthcare organisations.

Qualitative Deliverable:	HIs available to health care providers and consumers for use in the transfer of health information.
2010-11 Reference Point:	HIs available to providers and consumers from July 2010 following passing of legislation.
Result: Deliverable met.
From July 2010, healthcare consumers and providers can access HIs by contacting Medicare Australia by phone.103 Healthcare consumers can also access their HI through the Medicare Australia website.104
Qualitative KPI:	Support provided to health care professionals to access the HI Service.
2010-11 Reference Point:	Health care providers able to access and use the HI Service in a timely manner.
Result: Indicator substantially met.
Take-up of HIs by healthcare providers will occur when providers are able to access HIs through their practice software. A delay in establishing a software testing process meant that software vendors could only submit their products for testing from June 2011. Once software has passed testing it can be made available to healthcare providers. From July 2010, healthcare consumers and providers could access HIs by contacting Medicare Australia by phone. Healthcare consumers could also access their HI by using Medicare Australia’s Online Services.
Quantitative KPI:	Percentage of Australians whose HI has been activated.
2010-11 Target:	10%	2010-11 Actual:	100%
Result: Indicator met.
On 1 July 2010 Medicare Australia assigned HIs to all healthcare consumers enrolled in Medicare and those who held a Department of Veterans’ Affairs Treatment Card.
Quantitative KPI:	Number of Individual HIs utilised by providers.
2010-11 Target:	2.2m	2010-11 Actual:	2.2m
Result: Indicator met.
Approximately 2.2 million Individual HI searches were conducted between December 2010 and January 2011 by the Australian Capital Territory Department of Health as part of testing of the HI Service.

The department developed HI resource information in 2010-11 such as a guide for healthcare providers using the HI Service and a consumer information brochure. This information is available from the Medicare Australia website¹⁰⁵.

During 2010-11, the department funded the Federal Privacy Commissioner to undertake regulatory oversight of the HI Service. The Privacy Commissioner is responsible for investigating potential acts of misuse of HIs. The commission completed the first compliance audit of the HI Service in May 2011 to ensure that privacy protections are being appropriately implemented.

Qualitative Deliverable:	Appropriate use of, and access to, HIs ensured.
2010-11 Reference Point:	Ministerial Council oversight sought as required and funding allocated to Federal Privacy Commissioner for investigation of complaints in a timely manner.
Result: Deliverable met.
The department funded the Federal Privacy Commissioner to conduct regulatory oversight of the HIs Service. The Privacy Commissioner completed a compliance audit of Medicare Australia in May 2011.

In June 2011 the department, in collaboration with NEHTA, jurisdictions, Medicare Australia and the information communication and technology industry, introduced testing for software that supports the use of HIs. This process tests for clinical safety, privacy and information security, and will help ensure the safe adoption of HIs by the healthcare sector.

The department worked in conjunction with NEHTA on the PCEHR eHealth sites and a number of jurisdictions to adopt HIs. The lessons learned from the sites and the jurisdictional projects have been shared with other implementers of HIs. The adoption of HIs will improve the accuracy of health information matching and reduce the risk of adverse events from mismatched information.

Quantitative Deliverable:	Number of general practices provided with incentives to promote the use and uptake of eHealth.
2010-11 Target:	4,300	2010-11 Actual:	4,278
Result: Deliverable met.
Participation in the Practice Incentive Payment eHealth Incentive continued to increase in 2010-11, with 84% (4,215 practices) of practices receiving payment in February 2011, compared with 79% (3,830 practices) in May 2010.

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Support the Design and Development of a Personally Controlled Electronic Health Record System

In August 2010, the department, in partnership with NEHTA, contracted three eHealth lead implementation sites to test key elements of the PCEHR system in community settings. These sites are located in: the Hunter Urban Division of General Practice, New South Wales; GP Partners Limited, Brisbane, Queensland; and Melbourne East General Practice Network Limited, Victoria. The primary care sector, through these sites, can now exchange critical health care information with hospitals, pharmacies and aged care facilities.

In June 2011, the department contracted an additional nine eHealth lead sites to build upon the work of the first three lead sites. In 2011-12, these nine eHealth sites will reach up to 30% of the Australian population. These sites will target a number of important cohorts, including mothers and newborns, the aged, those with chronic disease, people with disabilities, war widows, and Indigenous populations. Through these sites, the department will provide coverage to rural and regional communities in South Australia, Northern Territory and Western Australia.

The nine additional sites are: Calvary Hospital, Australian Capital Territory; Fred IT Group Geelong, Victoria; the Mater Misericordiae Health Service, Brisbane; Brisbane South Division, Queensland; Northern Territory Department of Health and Families; Department of Health and Human Services, Tasmania; St. Vincent’s and Mater Health Sydney, New South Wales; Medibank Private (national); and New South Wales Health.

Additionally, the department will deploy a broad set of functions across all 12 sites to help shape the development of systems infrastructure required for the PCEHR system. The broad functions will include discharge summaries and provide the capacity to incorporate lessons learnt through this testing phase. These sites cover around 500,000 consumers across 600 GP practices.

Qualitative Deliverable:	Design and develop infrastructure to support a PCEHR system.
2010-11 Reference Point:	Implementation plan agreed by Health Ministers, infrastructure agreed and legislation requirements identified.
Result: Deliverable substantially met.
The department has developed an implementation plan for the PCEHR system and engaged in ongoing consultations with jurisdictions through Australian Health Ministers Advisory Council sub committees.

Whole of Program Performance Information

Qualitative Deliverable:	Produce relevant and timely evidence-based policy research.
2010-11 Reference Point:	Relevant evidence-based policy research produced in a timely manner.
Result: Deliverable met.
In February 2011, the department engaged McKinsey Pacific Rim, Inc to undertake research into the eHealth readiness of Australia’s allied health and medical specialists sectors. The report will inform the take-up of HIs, and the development of the PCEHR system. The report will help shape future strategies for change and adoption of eHealth tools and services.
Qualitative Deliverable:	Stakeholders participate in program development through a range of avenues.
2010-11 Reference Point:	Stakeholders participated in program development through avenues such as regular consultative committees, conferences, stakeholder engagement forums, surveys, submissions on departmental discussion papers and meetings.
Result: Deliverable met.
In 2010-11, the department funded a national eHealth Conference bringing together industry, healthcare providers, consumers and state and territory governments to facilitate a community wide discussion on the implementation and adoption of eHealth nationally. During 2010-11, the department consulted nationally to provide consistent information on the PCEHR system and sought stakeholder views to help shape the system’s design, governance and implementation planning. In April 2011, the department conducted a public consultation of the PCEHR system, including bilateral discussions with targeted stakeholder groups. The concept of operations articulates the key design principles of the PCEHR system and the proposed characteristics to stimulate informed discussion by consumer, clinicians and information communication technology stakeholder groups, which will inform the final design.
Quantitative Deliverable:	Percentage of variance between actual and budgeted expenses.
2010-11 Target:	<_0.5%	2010-11 Actual:	4.0%
Result: Deliverable not met.
The administered expenses for Program 10.2 overspent by 4.0%. The variance was due to the timing of engagement of key delivery partners contracted prior to 30 June 2011.

Program 10.3: Health Information

Strategic Development of Health and Ageing Policies

Australia’s Health Ministers’ Advisory Council

Further, the Council continued its focus on health workforce issues, considering matters relating to: the addition of the professions of Aboriginal and Torres Strait Islander Health Practice, Chinese Medicine, Medical Radiation Practice, and Occupational Therapy to the National Registration and Accreditation Scheme; the development of National Board Registration Standards; and the development of a national training plan for doctors, nurses and midwives.

Qualitative Deliverable:	Manage the Australian Government’s contribution toward the annual AHMAC budget.
2010-11 Reference Point:	Containment of overall budget within agreed parameters.
Result: Deliverable met.
The overall cost-shared budget was contained within the agreed budget principles as approved by the Australian Health Ministers’ Conference on 22 April 2010.
Qualitative Deliverable:	Facilitate collaborative planning, information sharing and innovation with other jurisdictions to ensure activities undertaken by AHMAC and its principal committees contribute to supporting the Australian Health Ministers’ Conference in providing leadership on national health issues.
2010-11 Reference Point:	Australian Government priorities are reflected in the annual AHMAC work plan.
Result: Deliverable 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.
Quantitative KPI:	Containment of AHMAC overall budget within agreed budget parameters.
2010-11 Target:	$1.8m	2010-11 Actual:	$1.8m
Result: Indicator met.
The overall cost-shared budget was contained within the agreed budget principles as approved by the Australian Health Ministers’ Conference on 22 April 2010. This indicator has been in line with estimates for the years: 2008-09 – $1.709m; 2009-10 – $1.746m; and 2010-11 – $1.798m.

Community Sector Support Scheme

Qualitative Deliverable:	Provide national secretariat support to peak community organisations through the Community Sector Support Scheme.
2010-11 Reference Point:	National secretariat support provided to a number of peak community organisations through the Community Sector Support Scheme.
Result: Deliverable met.
The department supported the secretariat activities of 18 peak community organisations through the Community Sector Support Scheme.
Qualitative KPI:	Peak community organisations provide input to policy and program development and delivery.
2010-11 Reference Point:	Achievement of agreed plans and targets by funded organisations within agreed timeframes.
Result: Indicator met.
The 18 organisations funded under the Community Sector Support Scheme in 2010-11 provided community perspectives into the 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.

National Health Surveys

Whole of Program Performance Information

Program 10.4: International Policy Engagement

Facilitate International Engagement on Global Health Issues

In 2010-11, 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 links with health counterparts in the region to promote good governance in Pacific health systems. The relationship between the Chinese Ministry of Health and the department is formalised by a Memorandum of Understanding (MoU). This MoU is implemented by Plans of Action and a new three year Plan of Action was signed in April 2011 during a Ministerial visit to Beijing for a Health Policy Dialogue. The Plan of Action 2011-14 will guide cooperation between Australia and China on health issues of strategic importance to both countries. Such regional relationships are important to Australia because of the increasingly cross-border nature of diseases and disease control.

Qualitative Deliverable:	Provide leadership in addressing regional and global health policy challenges.
2010-11 Reference Point:	Contribute to, and participate in, a range of international forums on health issues.
Result: Deliverable met.
The department made a significant contribution to multilateral organisations, such as the WHO, OECD and APEC, on international health policy issues. 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 provide leadership in addressing regional and global health policy challenges through its participation in a number of high level forums. In 2010-11, the department promoted Australia’s international leadership in health policy through its role as: chair of two meetings of the OECD Health Committee; chair of the 2010 annual Pacific Senior Health Officials Network meeting; and vice-chair of the WHO Western Pacific Regional High-Level Meeting on Non-communicable Diseases.
Quantitative Deliverable:	Number of meetings of the Pacific Senior Health Officials Network attended by department representatives.
2010-11 Target:	1		2010-11 Actual:		1
Result: Deliverable met.
In 2010-11, the department co-chaired, and provided secretariat support for, the 2010 annual Pacific Senior Health Officials Network meeting held in Port Vila, Vanuatu. The department also chaired the annual network steering committee meeting in 2011. This meeting provided strategic direction for the network.
Quantitative Deliverable:	Number of WHO governing body meetings attended by department representatives.
2010-11 Target:	7		2010-11 Actual:		7
Result: Deliverable met.
The department attended the key WHO governing body meetings for 2010-11. These were the 2011 World Health Assembly, two Executive Board meetings, two Programme, Budget and Administration Committee meetings, the IARC Governing Council meeting and the 2010 Western Pacific Regional Committee meeting. The department also managed the WHO Fellowships Program and attended WHO technical meetings.
Quantitative Deliverable:	Number of OECD Health Committee meetings attended by department representatives.
2010-11 Target:	3	2010-11 Actual:		3
Result: Deliverable met.
In 2010-11, the department chaired two OECD Health Committee meetings and participated in the 2010 OECD Health Ministerial Meeting.
Quantitative Deliverable:	Number of APEC Working Group meetings attended by department representatives.
2010-11 Target:	2	2010-11 Actual:		2
Result: Deliverable met.
In 2010-11, the department participated in two APEC Working Group meetings.
Quantitative Deliverable:	Number of international health delegations visits facilitated by the department.
2010-11 Target:	20-25	2010-11 Actual:		28
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 AusAID, to facilitate meetings with the department for overseas delegates. Meetings in 2010-11 included two visits by the Regional Director of the WHO Western Pacific Regional Office.

Quantitative Deliverable:		Number of Health and Ageing Portfolio representatives attending major international meetings.
2010-11 Target:		12-20	2010-11 Actual:	14
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.
Qualitative KPI:	Promote Australia’s leadership in global health policy challenges.
2010-11 Reference Point:	Support 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 2011 World Health Assembly, the department coordinated across its program areas and worked with external agencies to ensure that a consistent whole-of-department and whole-of-government position was formed on key agenda items and on international health policy developments. The department coordinated with other Australian Government departments which share policy responsibility for international health issues, in particular AusAID and the Department of Foreign Affairs and Trade. Following each major meeting, the department informed relevant program areas and agencies of the outcomes to ensure consistency in the implementation of international health policy. Where appropriate, the department participated in Inter-Departmental Committees to ensure a consistent message on Australia’s international health policy was promoted at all relevant international events, such as the Commonwealth Heads of Government Meeting.
Quantitative KPI:	Number of cooperative agreements with overseas health ministries.
2010-11 Target:	5-7		2010-11 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.

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Whole of Program Performance Information

Program 10.5: Palliative Care and Community Assistance

Improve Palliative Care

National Palliative Care Strategy

Community Access to Palliative Care

Qualitative Deliverable:	Provide support for a specialist palliative care website and community organisations to provide consumers with information about palliative care and community palliative care services.
2010-11 Reference Point:	The CareSearch website provides information to palliative care patients, their families, health workers and researchers.
Result: Deliverable met.
The Caresearch website106 continues to provide up-to-date, evidence-based information about palliative care to patients, their families and carers as well as researchers and palliative care specialists.
Qualitative KPI:	Increased palliative care information is available to patients living in the community, their families and care workers.
2010-11 Reference Point:	A wider range of information about palliative care services and research is available from the CareSearch website.
Result: Indicator met.
In 2010-11, the department developed new resources for health professionals and carers including additional web pages on the practicalities of caring (aimed at consumers/carers) and additional pages for health professionals on managing nausea, bowel obstruction and mental illness.
Quantitative KPI:	Number of times the CareSearch website is accessed.
2010-11 Target:	350,000	2010-11 Actual:	534,450
Result: Indicator met.
The number of times the Caresearch website107 was accessed exceeded the expected target as a result of additional and expanded information available to health professionals and carers.
Quantitative KPI:	Average number of monthly visits to the palliative care information website.
2010-11 Target:	25,000	2010-11 Actual:	43,000
Result: Indicator met.
The average number of monthly visits to the palliative care information website exceeded the expected target and demonstrates the importance of the information available to the community on the website.
Quantitative KPI:	Number of times the national directory of palliative care services is accessed.
2010-11 Target:	40,000	2010-11 Actual:	32,000
Result: Indicator substantially met.
The number of times the national directory of palliative care services was accessed was lower than expected. In 2011-12 the department will work with the operator of the national directory, Palliative Care Australia, to ensure that it is updated, promoted and meets community needs.

Access to Quality Palliative Care

Quantitative Deliverable:	Number of health professionals participating in clinical placements through the Program of Experience in the Palliative Approach.
2010-11 Target:	150	2010-11 Actual:	155
Result: Deliverable met.
The department funded 155 placements of health professionals in specialist palliative care agencies in 2010-11.
Quantitative Deliverable:	Number of universities that incorporate palliative care into their undergraduate curricula.
2010-11 Target:	75	2010-11 Actual:	91
Result: Deliverable met.
A total of 91 university health courses reported that they were using specially developed palliative care materials as part of their curricula or were moving to implement the resources. A further 30 university courses were reviewing the materials for possible future use.
Quantitative Deliverable:	Number of research grants, doctorate scholarships and postdoctoral fellowships funded.
2010-11 Target:	36	2010-11 Actual:	36
Result: Deliverable met.
The targeted number of grants, scholarships and fellowships funded under the Palliative Care Research Program has been met. These grants, scholarships and fellowships were originally awarded under Round 3 of the Palliative Care Research Program.

Palliative Care Guidelines and Service Standards

Qualitative Deliverable:	Community aged care services receive information about, and training in using, a palliative approach in care delivery.
2010-11 Reference Point:	Community aged care services receive copies of the Guidelines for a Palliative Approach for Aged Care in the Community Setting and have access to relevant training.
Result: Deliverable not met.
The Guidelines for a Palliative Approach for Aged Care in the Community Setting became available in June 2011. These guidelines are distributed on request. The department is currently in the process of developing a complementary training package to support the implementation of the guidelines.
Qualitative Deliverable:	Palliative care agencies use benchmarking and national service standards to improve palliative care quality.
2010-11 Reference Point:	The palliative care outcomes collaboration and national standards assessment project offer free benchmarking and standards services to palliative care agencies.
Result: Deliverable met.
In 2010-11, the department funded free benchmarking and national standards assessment services which were used by a majority of palliative care agencies. A total of 144 agencies used or agreed to use the benchmarking services and 148 agencies used or agreed to use the assessment services.
Quantitative Deliverable:	Number of states and territories where palliative care services use national service standards.
2010-11 Target:	7		2010-11 Actual:	7
Result: Deliverable met.
The number of palliative care services using national service standards is currently estimated to represent about 85% of all palliative care services in Australia.
Qualitative KPI:	States and territories have palliative care outcomes collaboration benchmarking services in place.
2010-11 Reference Point:	Eight jurisdictions having palliative care collaborations in place.
Result: Indicator met.
In 2010-11, the department funded the delivery of benchmarking services to palliative care agencies in all states and territories. A majority of palliative care agencies were estimated to have used these services over the period.
Qualitative KPI:	Community aged care services use palliative care guidelines to inform the care they provide to clients.
2010-11 Reference Point:	Specialist palliative care training material is developed for community aged care services.
Result: Indicator met.
In 2010-11, the department provided over 4,500 copies of the Guidelines for a Palliative Approach in Residential Aged Care to individuals and organisations including community aged care services. The department has also commenced work on the development of a complementary training package to support the implementation of the Guidelines for a Palliative Approach for Aged Care in the Community Setting.
Quantitative KPI:	Number of community aged care services receiving information and training in palliative care.
2010-11 Target:	100	2010-11 Actual:		>100
Result: Indicator met.
Of the 4,500 copies of the Guideline for a Palliative Approach in Residential Aged Care distributed, the department estimates that at least 100 community aged care services utilised this resource. The Guidelines for a Palliative Approach for Aged Care in the Community Setting is also available and distributed on request.

Access to Palliative Care Medicines

Qualitative Deliverable:	Stakeholders are consulted about the appropriateness and availability of palliative care medicines to people living in the community.
2010-11 Reference Point:	The Palliative Care Medicines Working Group provides advice on improving access to palliative care medicines in the community, particularly in relation to the group of medicines to be considered and strategies to be implemented.
Result: Deliverable substantially met.
The Palliative Care Medicines Working Group ceased operation in December 2010, as the group had met its terms of reference. The department will continue to receive advice about the appropriateness and availability of palliative care medicines through the Palliative Care Working Group and the Palliative Care Clinical Studies Collaborative.
Qualitative KPI:	The community continues to have access to high quality palliative care medicines.
2010-11 Reference Point:	The Palliative Care Medicines Working Group provides advice to the department regarding access to appropriate medicines.
Result: Indicator not met.
The Palliative Care Medicines Working Group ceased operation in December 2010, as the group had met its terms of reference. The community will continue to have access to high quality palliative care medicines through the Palliative Care Schedule of the Pharmaceutical Benefits Scheme.
Quantitative KPI:	Percentage of multi-site drug trials progressed and completed through the palliative care clinical studies collaborative within agreed timeframes.
2010-11 Target:	100%	2010-11 Actual:	100%
Result: Indicator met.
The department continued to fund the Palliative Care Clinical Studies Collaborative for five clinical research trials to be continued during 2010-11, with one trial reaching completion. The drug trials are being undertaken across a number of clinical research sites across Australia. The timeframes for trials that are yet to be completed have been extended due to delays in obtaining ethics approval and in recruiting patients into the trials.

Whole of Program Performance Information

Program 10.6: Research Capacity

Improve Research Capacity

The Commission will play a key part in making improvements to Australia’s quality of health care by:

• developing national standards for clinical safety and quality;
• developing a national system for health service accreditation;
• improving patient safety by reducing harm caused by preventable errors;
• effectively managing health care resources arising from unnecessary or ineffective treatment; and
• giving independent and informed advice to all health care providers and health care services consumers.

Whole of Program Performance Information

Program 10.7: Health Infrastructure

Health and Hospitals Fund

The Government has provided funding for 85 health infrastructure projects in the first two funding rounds of the HHF. These projects span three critical areas: the fight against cancer; translational research and research workforce infrastructure; and improvement and modernisation of the hospital system. A list of the funded projects is located on the department’s website.¹⁰⁸

In September 2010 the Government announced a Regional Priority Round which closed on 3 December 2010. The funding round focused on providing capital funding to projects in regional communities to support upgrades to regional health infrastructure, expansions to regional hospitals and to help support the clinical training capacity of regional hospitals. The department received 239 applications for funding with a combined total of more than $5.3 billion. The Regional Priority Round resulted in funding for
63 projects totalling $1.33 billion over 5 years.

The department aims to ensure that funding recipients deliver the infrastructure projects in accordance with original specifications so that the expected health facilities and resultant health benefits can be realised. In order to achieve this, in 2011-12, the department will continue to work with state and territory governments, non-government organisations, universities and medical research institutes to progress the projects. Funding recipients are required to report against key performance milestones as detailed in individual project agreements. The department makes progress payments on the successful completion of the milestones outlined in each funding agreement.

Under the Nation-building Funds Act 2008, an independent, expert advisory board appointed by the Minister for Health and Ageing assesses applications for health infrastructure funding. The Board advises the Minister whether proposals for funding satisfy the HHF Evaluation Criteria, having regard to guidelines issued by the Minister. In 2010-11, the department provided administrative support to the Board in its consideration of the Regional Priority Round applications.

Qualitative Deliverable:	Review of funded project performance against agreed milestones.
2010-11 Reference Point:	Project milestones reviewed in accordance with individual funding agreements.
Result: Deliverable met.
The department received all progress reports from contracted projects in the appropriate timeframe during 2010-11. Each report identified the progress that had been made on each project and demonstrated how activities had met the milestones outlined in the agreement.
Quantitative Deliverable:	Percentage of payments progressed within agreed timeframes.
2010-11 Target:	95%	2010-11 Actual:			100%
Result: Deliverable met.
In 2010-11, the department met all procedural and process deadlines to ensure that all payments were progressed within the agreed timelines.
Qualitative KPI:	Provision of appropriate and timely support to the Health and Hospitals Fund Advisory Board.
2010-11 Reference Point:	Advisory Board members satisfied with support provided.
Result: Indicator met.
In February 2011, the Chair of the HHF Advisory Board advised the Minister that the Board was satisfied with the level of support received from the department. The department supported the Board in assessing applications for the Regional Priority Round. The department also implemented the Board’s recommendation to establish a strengthened compliance and monitoring framework for HHF funded projects.
Qualitative KPI:	Submission of progress reports by funded organisations in accordance with individual funding agreement.
2010-11 Reference Point:	Progress reports submitted by organisations funded through the Health and Hospitals Fund.
Result: Indicator met.
All funded organisations submitted progress reports within the timeframes specified in their agreements or, where circumstances warranted, as agreed with HHF project managers and senior officers.
Quantitative KPI:	Percentage of progress reports that meet agreed requirements.
2010-11 Target:	100%		2010-11 Actual:	88%
Result: Indicator substantially met.
The department received and accepted the progress reports from contracted projects during 2010-11, the majority of which met agreed requirements. The remaining reports were received in 2010-11 but not accepted as meeting the agreed requirements. The department is in consultation with organisations to finalise the outstanding reports.

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Whole of Program Performance Information

Outcome 10 – Financial Resources Summary

	(A) Budget Estimate1 2010-11 $’000	(B) Actual 2010-11 $’000	Variation (Column B minus Column A) $’000
Program 10.1: Chronic Disease - Treatment
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	42,632	40,003	(2,629)
Special Accounts			-
Health and Hospitals Fund Health Portfolio Special Account	329,684	202,648	(127,036)
Departmental Outputs
Ordinary Annual Services (Annual Appropriation Bill 1)	5,576	5,595	19
Revenues from other sources (s31)	161	150	(11)
Unfunded depreciation expense	120	161	41
Operating loss / (surplus)	-	-	-
Total for Program 10.1	378,173	248,557	(129,616)
Program 10.2: eHealth Implementation
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	125,109	130,094	4,985
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	11,424	11,463	39
Revenues from other sources (s31)	331	307	(24)
Unfunded depreciation expense	247	330	83
Operating loss / (surplus)	-	1	1
Total for Program 10.2	137,111	142,195	5,084
Program 10.3: Health Information
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	7,792	7,785	(7)
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	224	225	1
Revenues from other sources (s31)	6	6	-
Unfunded depreciation expense	5	6	1
Operating loss / (surplus)	-	-	-
Total for Program 10.3	8,027	8,022	(5)
Program 10.4: International Policy Engagement
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	14,386	12,716	(1,670)
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	19	20	1
Revenues from other sources (s31)	1	1	-
Unfunded depreciation expense	-	1	1
Operating loss / (surplus)	-	-	-
Total for Program 10.4	14,406	12,738	(1,668)
Program 10.5: Palliative Care and Community Assistance
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	28,562	27,525	(1,037)
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	2,770	2,779	9
Revenues from other sources (s31)	80	74	(6)
Unfunded depreciation expense	60	80	20
Operating loss / (surplus)	-	-	-
Total for Program 10.5	31,472	30,458	(1,014)
Program 10.6: Research Capacity
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	20,357	19,406	(951)
to Safety and Quality in Health Care Special Account	(5,500)	(5,545)	(45)
Special Accounts
Health and Hospitals Fund Health Portfolio Special Account	114,300	99,700	(14,600)
Safety and Quality in Health Care Special Account	13,517	9,960	(3,557)
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	2,447	2,455	8
Revenues from other sources (s31)	71	66	(5)
Unfunded depreciation expense	53	71	18
Operating loss / (surplus)	-	-	-
Total for Program 10.6	145,245	126,113	(19,132)
Program 10.7: Health Infrastructure
Administered Expenses
Special Accounts
Health and Hospitals Fund Health Portfolio Special Account	339,052	385,691	46,639
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	1,179	1,184	5
Revenues from other sources (s31)	34	32	(2)
Unfunded depreciation expense	25	34	9
Operating loss / (surplus)	-	-	-
Total for Program 10.7	340,290	386,941	46,651
Outcome 10 Totals by appropriation type
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	238,838	237,529	(1,309)
to Safety and Quality in Health Care Special Account	(5,500)	(5,545)	(45)
Special Accounts	796,553	697,999	(98,554)
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	23,639	23,721	82
Revenues from other sources (s31)	684	636	(48)
Unfunded depreciation expense	510	683	173
Operating loss / (surplus)	-	1	1
Total expenses for Outcome 10	1,054,724	955,024	(99,700)
Average Staffing Level (Number)	155	157	2
1 Budgeted appropriations taken from the 2011-12 Health and Ageing Portfolio Budget Statements and re-aligned to the 2010-11 outcome structure.

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¹⁰³ Telephone on: 1300 361 457.
¹⁰⁴ Available at: www.medicareaustralia.gov.au
¹⁰⁵ Available at: www.medicareaustralia.gov.au/provider/health-identifier/index.jsp
¹⁰⁶ Available at: www.caresearch.com.au
¹⁰⁷ Available at: www.caresearch.com.au
¹⁰⁸ Available at: www.health.gov.au/HHF

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