Outcome 13 – Acute Care

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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 13 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 13 was managed in 2010-11 by the Acute Care Division, the Regulatory Policy and Governance Division and the Transition Office.

Program Name	Program Objectives in 2010-11
Program 13.1: Blood and Organ Donation Services	Support a nationally coordinated approach to organ and tissue donation for transplantation. Support access to an adequate, safe, secure and affordable supply of blood and blood products, through policy advice and funding contribution to the National Supply Plan and Budget as set out in the National Blood Agreement.
Program 13.2: Medical Indemnity	Ensure stability for the medical indemnity insurance industry. Ensure insurance products are affordable for doctors. Support accessible and affordable insurance products for midwives.
Program 13.3: Public Hospitals and Information	Design and implement far-reaching reforms, including negotiating a new National Health Reform Agreement on National Health Reform and revising the National Partnership Agreement on Improving Public Hospital Services (NPA IPHS). Continue to implement and monitor the ongoing programs under the National Partnership Agreement on Hospital and Health Workforce Reform (NPA HHWR) and the National Partnership Agreement on the Elective Surgery Waiting List Reduction Plan (NPA ESWLRP). Improving the collection of performance data to increase our knowledge about hospital performance and reporting and to sharpen public accountability. Promote and improve public access to dental services. Ensure patients in north western Tasmania, have continued access to health care and other support services, through the Commonwealth’s agreement with Tasmania for the management, operation and funding of the Mersey Hospital.

Major Achievements

• Launch of the MyHospitals website ¹²⁶ on 10 December 2010 by the Minister for Health and Ageing. MyHospitals is the first website to publish nationally consistent hospital-level performance information.
• States and territories commenced nearly 80 projects with Commonwealth funding (20 of which have now been completed) in 43 public hospitals across Australia, under the Taking Pressure off Public Hospitals initiative.
• Approved Implementation Plans for the NPA IPHS which includes the delivery of improved access to elective surgery and subacute care services and reduce/shorten waiting times in emergency departments.
• Conducted negotiations leading to the Australian Government signing a new agreement with the Tasmanian Government to continue the management and operation of the Mersey Community Hospital, which will ensure patients in north western Tasmania continue to receive high quality, safe and integrated hospital services.
• Developed a four year Clinical Services Plan for the National Cord Blood Collection Network to improve access to matched transplants from cord blood.

Challenges

• Finalising a nationally consistent method for measuring growth in subacute care by August 2011, which is necessary to measure performance against the new subacute beds and services targets under the NPA IPHS.
• Ensuring sufficient units of cord blood are collected from Indigenous Australians and other ethnically and culturally diverse communities to meet targets for Australia’s public cord blood collection network.
• Managing the implementation of the Commonwealth Dental Health Program (CDHP) as the planned closure of the previous government’s Medicare Chronic Disease Dental Scheme did not proceed in 2010-11, with the consequence that funding for CDHP was not available.

Program 13.1: Blood and Organ Donation Services

Improve Australians’ Access to Organ and Tissue Transplants

The department also funded 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 2010-11, 33 units were released for Australian patients and 99 units for international patients. The network facilitated the importation of 19 cord blood units from international registries, for transplantation into Australian patients for whom a suitably matched unit was not available from within the Australian inventory.

Quantitative Deliverable:	Number of banked cord blood units.
2010-11 Target:	Total: 2,379 Indigenous: 129	2010-11 Actual:	Total: 1,880 Indigenous: 74
Result: Deliverable substantially met.
In 2010-11, both the total number of cord blood units and the number collected from Indigenous donors were below targets. Total collections overall were below target due to staff shortages and budget pressures. The target for Indigenous donors has historically been challenging as only donations from the Royal Darwin Hospital collection centre are included. Under the new Clinical Services Plan collection processes will now target donations from Indigenous mothers at all Network centres. The department will work with the Network in 2011-12 to implement the Clinical Services Plan based on a revised budget and ensure that appropriate targets for Indigenous, ethnically diverse and total donations are met.

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The department supported the development of a new four-year Clinical Services Plan for the Network. The plan describes new cord blood collection and banking strategies to increase the proportion and number of high cell count units and units collected from Indigenous Australians and other ethnically and culturally diverse donors. Implementation of the plan will increase the likelihood of a compatible unit being available for Australian patients requiring a cord blood transplant.

The department continued to fund the construction of a state-of-the-art facility for the Donor Tissue Bank of Victoria. When completed, Australians will have improved access to high quality tissue grafts for transplantation.

Support Access to Blood and Blood Products

The department managed four research projects considering the factors driving Australia’s increasing demand for blood and blood products and the gaps in current knowledge. These projects are assisting the department to develop future strategies for better forecasting and demand management while focussing on improving patient safety and clinical outcomes.

The department continued to assist people with haemophilia, von Willebrand disease and related inheritable disorders, by funding the Haemophilia Foundation of Australia (HFA) for activities such as advocacy, education, and best practice advice on treatment. After reviewing the HFA’s operations, the department provided funding to assist the particular needs of younger people with bleeding disorders, particularly to assist the HFA to develop strategies to better respond to the needs of this group.

The department continued to provide funding, through the Health and Hospitals Fund, to the Australian Red Cross Blood Service to substantially complete construction of a new blood processing site in Melbourne, serving Victoria and Tasmania. 100% of funding has now been provided. The site will improve the efficiency and long-term capacity of the Blood Service to produce quality blood products for the Australian community.

Quantitative Deliverable:	Percentage of the total contribution, made by the Australian Government, to the approved National Supply Plan and Budget.
2010-11 Target:	63%	2010-11 Actual:		63%
Result: Deliverable met.
This was achieved through contribution by the Australian Government to 63% of the National Supply Plan and Budget.
Quantitative KPI:	Number of applications for funding of new blood products assessed within target timeframe.
2010-11 Target:	80%	2010-11 Actual:	Not applicable
Result: Not applicable.
No applications were referred for assessment during 2010-11. The implementation of the project was delayed due to extensive internal consultations and with the National Blood Authority and the MSAC Executive. Implementation of the project is now expected to occur in 2011-12 financial year.

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Whole of Program Performance Information

Program 13.2: Medical indemnity

Ensure Stability of the Medical Indemnity Insurance Industry

In 2010-11, the department continued to ensure the stability of the industry through regulation and ongoing monitoring of the operations and activities of medical indemnity insurers.

Qualitative Deliverable:	Publish reports by the Australian Institute of Health and Welfare on medical indemnity.
2010-11 Reference Point:	Timely provision and analysis of data.
Result: Deliverable met.
The department worked closely with the Australian Institute of Health and Welfare and other Medical Indemnity Data Working Group stakeholders to assist in the publication of two reports on medical indemnity claims.

Keep Premiums Affordable for Doctors

Ensure Availability of Professional Indemnity Insurance for Eligible Midwives

In 2010-11 the department managed the contract with MIGA in conjunction with Medicare Australia. In the period to 30 June 2011 there were no claims made.

Qualitative Deliverable:	An appropriate professional indemnity insurance product is available.
2010-11 Reference Point:	Product is available to eligible midwives from 1 July 2010.
Result: Deliverable met.
Eligible privately practising midwives were able to purchase Commonwealth supported professional indemnity insurance from MIGA from 1 July 2010.
Quantitative Deliverable:	Percentage of eligible midwife applicants covered under the Midwife Professional Indemnity Scheme.
2010-11 Target:	100%	2010-11 Actual:	100%
Result: Deliverable met.
All eligible privately practising midwives who applied for professional indemnity insurance through MIGA were offered cover.

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.
The department provided policy advice on emerging trends in the medical indemnity industry to the Australian Government in a timely manner based on analysis and monitoring of qualitative data on medical indemnity trends and issues.
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 meetings, conferences and stakeholder engagement.
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 Deliverable:	Percentage of variance between actual and budgeted expenses.
2010-11 Target:	≤0.5%	2010-11 Actual:	-47.4%
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.

Program 13.3: Public Hospitals and Information

In 2010-11, the department, in collaboration with the states and territories continued to manage the relevant components of the National Health Reform Agreement, the National Partnership Agreement on Hospital and Health Workforce Reform (NPA HHWR), the National Partnership on Elective Surgery Waiting List Reduction Plan (ESWLRP) and the introduction of new major reforms including implementation of the revised National Partnership Agreement on Improving Public Hospitals (NPA IPHS).

Program 13.3 also aims to improve public access to dental services and health care services in north-western Tasmania, and to support improvement to the information available on hospital performance reporting and accountability.

Emergency Departments

Elective Surgery

Elective Surgery performance measures were introduced in 2010 as part of National Health Reform, similar to those for Emergencies Departments. Through the NPA IPHS the department has administered and managed the program of funding to states and territories, to build system capacity to work towards meeting these new measures and to improve patient access to elective surgery within the clinically recommended times.

Qualitative Deliverable:		Elective surgery data reported on state and territory departments of health websites.
2010-11 Reference Point:		Elective surgery data publicly available in a timely manner.
Result: Deliverable substantially met.
In 2010-11 as part of the NPA ESWLRP, a number of states and territories reported on elective surgery performance in public hospitals through their websites. States and territories have committed to maintaining effort in elective surgery and report on a quarterly basis.
Quantitative KPI:	Percentage of public hospital elective surgery patients seen within clinically recommended times.
2010-11 Target:	N/A		2010-11 Actual:	N/A
Result: N/A
In 2010-11, elective surgery activities under the NPA IPHS were focused on the planning and establishment of projects to increase the percentage of public hospital elective surgery patients seen within clinically recommended times. Annual targets for achieving this increase are set out in the NPA, with the first round of state and territory performance data to be assessed against these targets by the department in early 2012. An Expert Panel was established as a result of agreement at the February 2011 COAG meeting to review the mechanisms through which elective surgery and emergency department targets and the National Access Guarantee are to be implemented and applied. The Panel provided its final report to COAG on 30 June 2011. Targets for emergency departments and elective surgery in the NPA IPHS were changed following the Expert Panel’s recommendations.
Quantitative KPI:	Number of elective surgery procedures undertaken.
2010-11 Target:	624,813		2010-11 Actual:	659,685
Result: Indicator met.
Under Stage Three of the Elective Surgery Waiting List Reduction Plan, states and territories are eligible to receive up to $300 million in facilitation and reward funding to improve the delivery of elective surgery and reduce the number of patients waiting longer than the clinically recommended times. As a result, the target for elective surgery procedures was exceeded by 34,872.129
Quantitative KPI:	Percentage increase in the volume of elective surgery performed across Australia.
2010-11 Target:	3.4%		2010-11 Actual:	5.2%
Result: Indicator met.
In 2010-11, the aim under Stage Three of the Elective Surgery Waiting List Reduction Plan was to increase the volume of elective surgery admissions across Australia and improve management of waiting lists, in particular overdue patients. States and territories were rewarded for achieving set targets under this stage, with the percentage increase exceeding the 2010-11 targets.
Qualitative Deliverable:		Meet the Commonwealth obligations under the National Partnership Agreement on Hospital and Health Workforce Reform implementation requirements.
2010-11 Reference Point:		Requirements are finalised as agreed in the National Partnership Agreement.
Result: Deliverable met.
Funding of $750 million was provided in 2009 to reform and improve the functioning of emergency departments so that by 2012-13, 80% of emergency department presentations are seen within clinically recommended triage times as recommended by the Australian College of Emergency Medicine. A further measure is the requirement that by 2013-14, 95% of hospitals with an emergency department, report to the non-admitted emergency department care national minimum data set collection. The department continues to monitor progress of the projects funded under these initiatives as reflected in state and territory annual reports, which are published on each state and territory government’s website.130 Under the NPA HHWR, the Australian Government worked in close collaboration with state and territory governments, to monitor ongoing progress with implementation of subacute care and emergency department initiatives.

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Subacute Care

In 2010-11, the department also managed the introduction of the New Subacute Beds Guarantee initiative under the NPA IPHS, which aims to deliver 1,316 new subacute beds and bed equivalent services throughout Australia, over the life of the Agreement.

The New Subacute Beds Guarantee contributes to increasing the efficiency of the health care system by ensuring patients are treated in the most appropriate settings, which reduces the pressure on public hospitals and in particular, public hospital emergency departments.

Quantitative KPI:	Number subacute beds and bed equivalent services delivered by states and territories under the NPA IPHS.
2010-11 Target:	329 new subacute beds or bed equivalent services.	2010-11 Actual:	Data will be available in November 2011.
Result: Cannot be reported.
A nationally consistent method to measure growth in subacute care was not finalised in 2010-11. The methods enables the conversion of bed equivalent services to bed numbers to allow for comparative reporting under this measure. Due to the delay, the reporting used to measure this deliverable will apply from November 2011.

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Improve Performance Reporting and Accountability

The website has been well received by the public and media. In the seven months since its launch MyHospitals has had a total of 265,123 visits. As at 30 June 2011, the website included information for 769 public hospitals and 211 private hospitals. Additional information will be added in the future providing patients with comparable information about the quality and safety of hospitals.

The department also worked with states and territories under the NPA IPHS to improve data collections and reporting on emergency department presentations, elective surgeries, subacute care and for non-admitted patients.

Qualitative Deliverable:	Data development work, including creation of a new non-admitted outpatient care national minimum data set, to enable national reporting of performance.
2010-11 Reference Point:	Non-admitted outpatient care national minimum data set implemented by 30 June 2011.
Result: Deliverable met.
This deliverable was substantially met in the form of a patient level non-admitted outpatient care data set specification which was endorsed by the Health Reform Initiative Group for implementation from 1 July 2011. It is envisaged the data collection will be implemented as a national minimum data set in the future once data coverage issues are addressed under the ‘Activity Based Funding’ elements of the National Health Reforms.
Qualitative Deliverable:	Release of average cost of procedures in public and private hospital activity.
2010-11 Reference Point:	National Hospital Cost Data Collection 2010 released by June 2011.
Result: Deliverable not met.
This deliverable was not met during 2010-11 because the cost data is being realigned to meet the needs of the ‘Activity Based Funding’ component of the National Health Reforms. The information is expected to be available in early 2012.

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Improve Access to Public Dental Services

Commonwealth Dental Health Program

Closing the Gap— Indigenous Dental Services in Regional and Rural Areas

Improve Health Care Services in North-West Tasmania, and Support Other Services

Whole of Program Performance Information

Outcome 13 – Financial Resources Summary

	(A) Budget Estimate1 2010-11 $’000	(B) Actual 2010-11 $’000	Variation (Column B minus Column A) $’000
Program 13.1: Blood and Organ Donation Services
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	12,865	10,504	(2,361)
Special appropriations
National Health Act 1953 - Blood Fractionation, Products and Blood Related Products - to National Blood Authority	613,409	608,868	(4,541)
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	11,055	10,844	(211)
Revenues from other sources (s31)	327	307	(20)
Unfunded depreciation expense	262	331	69
Operating loss / (surplus)	-	1	1
Total for Program 13.1	637,918	630,855	(7,063)
Program 13.2: Medical Indemnity
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	157	154	(3)
Special appropriations
Medical Indemnity Act 2002	108,700	58,610	(50,090)
Midwife Professional Indemnity
(Run-off Cover Support payment) Act 2010	5,000	-	(5,000)
Midwife Professional Indemnity
(Commonwealth Contribution) Scheme Act 2010	1,709	-	(1,709)
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	4,204	4,124	(80)
Revenues from other sources (s31)	124	117	(7)
Unfunded depreciation expense	100	126	26
Operating loss / (surplus)	-	-	-
Total for Program 13.2	119,994	63,131	(56,863)
Program 13.3: Public Hospitals and Information
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	95,098	78,455	(16,643)
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	29,526	28,960	(566)
Revenues from other sources (s31)	872	820	(52)
Unfunded depreciation expense	700	883	183
Operating loss / (surplus)	-	2	2
Total for Program 13.3	126,196	109,120	(17,076)
Outcome 13 Totals by appropriation type
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	108,120	89,113	(19,007)
Special appropriations	728,818	667,478	(61,340)
Unfunded Expenses	1,709	-	(1,709)
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	44,785	43,928	(857)
Revenues from other sources (s31)	1,323	1,244	(79)
Unfunded depreciation expense	1,062	1,340	278
Operating loss / (surplus)	-	3	3
Total expenses for Outcome 13	885,817	803,106	(82,711)
Average Staffing Level (Number)	281	271	(10)
1 Budgeted appropriations taken from the 2011-12 Health and Ageing Portfolio Budget Statements and re-aligned to the 2010-11 outcome structure.

¹²⁶ Available at: www.myhospitals.gov.au
¹²⁷ AIHW Australian Hospital Statistics 2009-10, p98.
¹²⁸ Assessment period (twelve months ending 31 December 2011) data will be available by March 2012.
¹²⁹ Under the ESWLRP, performance data is calculated on a calendar year basis – the figures provided above represent performance in the 2010 calendar year (as per assessment periods 2 and 3 of the ESWLRP). These figures were utilised to calculate 2010-11 reward funding payments. Data for January to June 2011 has not been publicly released and is still subject to assessment by Health Ministers.
¹³⁰ Available at: www.pc.gov.au/gsp/national-partnership/hospital-health-agreement

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