Outcome 13 - Acute Care

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Improved access to public hospitals, acute care services and public dental services, including through targeted strategies, and payments to state and territory governments

Major Achievements

• Assisting the Departments of the Prime Minister and Cabinet and the Treasury in the drafting, negotiation and finalisation of the National Health Reform Agreement, agreed by COAG on 2 August 2011.
• Implementation of the National Emergency Access Target and National Elective Surgery Target on 1 January 2012.
• Working with all states and territories to develop a common national legislative scheme to establish the National Health Funding Pool, the Administrator of the National Health Funding Pool and the National Health Funding Body.
• New information on Staphyloccocus Aureus bacteraemia blood infections, hospital hand hygiene rates, cancer services and cancer surgery waiting times added to MyHospitals website.

Challenges

• The National Partnership Agreement on the Expansion of Multi-Purpose Services to establish 286 new subacute beds did not proceed in 2011-12 and was identified as savings in the 2012-13 Budget.
• Managing the National Partnership Agreement on Improving Public Hospital Services in a changing fiscal environment where there is pressure on state health budgets, particularly in Tasmania.
• 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.

Outcome Strategy

Outcome 13 aims to improve the efficiency of, and access to, public hospitals and acute care services by delivering major reforms through the Council of Australian Governments (COAG) National Health Reform Agreement, and National Partnership Agreements on Hospital and Health Workforce Reform, Improving Public Hospital Services, Elective Surgery Waiting List Reduction Plan and Health Infrastructure. The Department worked to achieve this Outcome by managing initiatives under the programs outlined below.

Program 13.1: Blood and Organ Donation Services

Program 13.1 aims to support a nationally coordinated approach to organ and tissue donation for transplantation and support access to an adequate, safe, secure and affordable supply of blood and blood products.

Improve Australians’ Access to Organ and Tissue Transplant

In 2011-12, the Department continued to assist the implementation of reforms aimed at establishing Australia as a world leader in organ and tissue donation, by providing advice and governance support to the Australian Organ and Tissue Donation and Transplantation Authority. The reforms aim to achieve a significant and lasting increase to the number of life-saving and life-transforming transplants for Australians through the introduction of nationally consistent donation processes and systems in hospital settings, supported by dedicated donation specialists, together with a nationally coordinated approach to community and professional awareness and education.

The Department continued to fund the Australian Bone Marrow Donor Registry to maximise the chance of a suitable donor match, either in Australia or overseas, for a patient needing a bone marrow, cord blood or peripheral blood stem cell transplant. In 2011-12, the Registry undertook 648 donor searches on behalf of Australian patients, with 271 Australian patients with leukaemia or other life-threatening haematological or immune system diseases receiving a bone marrow, peripheral blood or cord blood transplant. Through the Bone Marrow Transplant Program, the Department approved financial assistance for 192 patients in Australia, for the costs of obtaining and transporting bone marrow or stem cells from international donors.

To be eligible for appropriate treatment, Australians in need of a bone marrow, cord blood or peripheral stem cell transplant will require a suitably matched donor. The Australian Bone Marrow Donor Registry (ABMDR) will search its registry for a suitable match. If a match is not found in Australia, the ABMDR will search international registries. In 2011-12, 139 Australians accessed treatment through the Australian Bone Marrow Donor Registry and 146 Australians accessed treatment through international registries. Australia provided 85 bone marrow, cord blood or peripheral blood stem cell donations to overseas recipients.

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 2011-12, 51 Australian patients received single or double cord blood unit transplants, utilising 38 cord blood units from the Australian inventory. The Network imported 27 cord blood units from international registries for those patients for whom a suitably matched unit was not available from within the Australian inventory. In addition, 52 units were exported to international patients.

  Indigenous: 129  Indigenous: 94

In 2011-12, a total of 1,835 cord blood units were collected of which 1,025 remain subject to regulatory clearance therefore they have not been included in the banked figure (810). The number of cord blood units collected overall, including from Indigenous donors, was below target. This was due to several factors including staff turnover, delays in recruitment in cord blood banks, delayed implementation of anticipated regulatory changes that would reduce processing times, and delayed execution of funding agreements due to extended negotiations with jurisdictions.

Collection and banking activities reached full capacity once new funding arrangements came into effect from November 2011. Cord blood banks increased collection activities for the remainder of 2011-12. Taking into account the 6 month cord blood unit testing period, the results of these efforts are expected to be realised in increased banking numbers in 2012-13.

Historically, the target for Indigenous donors has been challenging. Implementation of the new collection strategies that target donations from Indigenous mothers at all Network centres should assist in increasing the number of Indigenous donors.

The Department supported the National Cord Blood Collection Network in implementing a four-year Clinical Services Plan (2011-12 to 2014-15) to increase the number, quality and genetic diversity of cord blood units collected in Australia.

Collection and banking strategies were fully implemented, including: establishing revised collection criteria for Indigenous cord blood units across all collection centres; strengthening activity in catchment areas with genetic diversity; and determining cord blood unit minimum cell count thresholds. These activities will increase the likelihood of a compatible unit being available for Australian patients from within the Australian inventory.

In 2012-13, additional efforts will focus on engaging dedicated education officers to communicate with ethnically diverse communities and align testing and banking procedures with expected regulatory changes.

Support Access to Blood and Blood Products

The Department continued to support access to an appropriate, affordable and quality blood supply, by delivering the Australian Government’s contribution of 63 per cent of the funding to the blood sector through the National Blood Agreement, providing governance support to the National Blood Authority (NBA), and chairing and membership of the Jurisdictional Blood Committee (JBC).

The Department continued to work with the JBC to develop strategies for better forecasting and demand management.

The Australian Government contributed 63% of the approved National Supply Plan and Budget, with state and territory governments providing the remaining 37%.

Health Ministers agreed to the 2012-13 National Supply Plan and Budget on 27 April 2012.

The Department continued to contribute to the Hepatitis C Litigation Settlement Scheme, which provides a contribution to the out-of-court settlement costs for eligible individuals who contracted Hepatitis C as a result of a blood transfusion in Australia between 1985 and 1991.

In 2011-12, the Department continued to work with the states and territories (through the JBC), the NBA, and the Medical Services Advisory Committee (MSAC) to implement the health technology assessment framework for blood and blood products. This will help to ensure that patients get access to blood products that have been proven to be safe, effective and cost-effective.

The MSAC has not yet received proposals. Appropriate referral pathways and assessment methods continue to be developed.

Whole of Program Performance Information

The Department continued to provide high quality and timely advice to Ministers on organ and tissue donation and blood issues based on evidence-based policy research.

The Department worked with state and territory governments and sector representatives to improve access to blood and blood products and organ and tissue transplants by ensuring that policy directions consider the perspectives of all stakeholders. The Department consulted stakeholders through regular meetings of the JBC, the National Cord Blood Collection Network (AusCord) Management Committee and the Australian Organ and Tissue Donation and Transplantation Authority State Medical Director committee meetings.

The majority of expenditure is for the National Blood Supply Plan and Budget which is demand driven.

Program 13.2: Medical Indemnity

Program 13.2 aims to ensure the stability of the medical indemnity insurance industry, ensure that indemnity insurance products are affordable for doctors, and ensure indemnity insurance is available for midwives.

Indemnity Insurance Fund

The Indemnity Insurance Fund (the Fund)¹³⁶ was established in August 2011, consolidating existing programs that support medical indemnity. The programs included under the Fund are: the Premium Support Scheme; the High Cost Claims Scheme; the Run-off Cover Scheme; the Incurred-but-not-reported Scheme; the Exceptional Claims Scheme; the Midwife Professional Indemnity (Commonwealth Contribution) Scheme; and the Midwife Professional Indemnity Run-off Cover Scheme.¹³⁷

The objective of the Fund is to streamline administrative processes, cut red-tape and improve program efficiency of existing Government schemes.

Medical indemnity insurance is a specialised form of professional indemnity cover that provides surety to medical practitioners and their patients in the events of an adverse incident. Affordable and stable medical and professional indemnity insurance translates to stable fees for patients, and allows the medical workforce to focus on the delivery of high quality medical services.

In 2011-12, the Department continued to administer these schemes with the assistance of the Department of Human Services and contracted medical insurers.

Stakeholders were advised of implementation arrangements. The legislation enabling the programs consolidated under the Fund has remained unchanged and the programs continue to operate unaffected.

The Department released operational guidelines for the Fund on 14 November 2011. The guidelines are available on the Department’s website.

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. The reports present data on both public and private sector medical indemnity claims and an analysis of claim trends over time.

The Department administers a number of schemes (such as the Premium Support Scheme and the Run-off Cover Scheme) designed to maintain and improve premium affordability for medical practitioners.

All eligible doctors, who applied, received a premium subsidy.

All medical indemnity insurers who have a PSS contract with the Commonwealth meet the Australian Prudential Regulation Authority’s Minimum Capital Requirement.

This is a reduction from the 2,194 doctors who received a premium subsidy in 2010-11. A reduction in the number of doctors receiving a premium subsidy under the Premium Support Scheme is a positive outcome, as it indicates that medical indemnity premiums are affordable.

Privately practising midwives require insurance to meet the requirements of the Government’s National Registration and Accreditation Scheme. The Australian Government has contracted an insurer, Medical Insurance Group Australia (MIGA), to provide professional indemnity insurance to eligible midwives, ensuring that women and their families can access midwifery care. Indemnity insurers are reluctant to offer professional indemnity insurance to midwives, as the small potential premium pool and potentially high risk exposure means it is not commercially viable.

All eligible privately practising midwives who applied for professional indemnity insurance through MIGA were offered cover.

Eligible privately practising midwives were able to purchase Commonwealth supported professional indemnity insurance from MIGA.

Whole of Program Performance Information

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 and quantitative data on medical indemnity trends and issues.

The Department had regular meetings with the Department of Human Services and the Australian Government Actuary as well as bilateral and multilateral consultations with medical indemnity insurers and other stakeholders to ensure that the medical indemnity program continued to meet its policy objectives. Departmental representatives attended several relevant industry conferences and forums.

While the deliverable was not met, the program objectives were substantially met. Generally speaking, 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

Program 13.3 aims to design and implement far-reaching reforms, including implementation of the Council of Australian Governments’ National Health Reform Agreement to improve patient access to public hospital services. The program also aims to improve hospital performance reporting and accountability; increase efficiency and capacity in public hospitals; improve public access to public dental services; and improve health care services in Tasmania.

National Health Reform

The Department in collaboration with the Departments of the Prime Minister and Cabinet and Treasury and states and territories developed the Council of Australian Governments (COAG) National Health Reform Agreement (the Agreement), which sets out the shared intention of the Commonwealth, states and territories to work in partnership to improve health outcomes for all Australians and ensure the sustainability of the Australian health system. This Agreement was entered into on 2 August 2011.

As part of the Agreement, the Department worked collaboratively with the states and territories in 2011-12 to establish the Independent Hospital Pricing Authority (the Pricing Authority) to determine the national efficient price of public hospital services, and the National Health Performance Authority (the Performance Authority) to drive performance improvement through public reporting of the performance of hospitals, Local Hospital Networks and primary health care services.

The Department also worked closely with all states and territories to develop common national legislation to jointly establish the Administrator of the National Health Funding Pool. The Commonwealth’s legislation, the National Health Reform Amendment (Administrator and National Health Funding Body) Act 2012 (which amended the National Health Reform Act 2011), commenced on 25 June 2012. This legislation also established the National Health Funding Body to assist the Administrator in carrying out its statutory functions.

Prior to the legislation establishing the Pricing Authority, an interim Pricing Authority was established as an Executive Agency, under section 65 of the Public Service Act 1999, by the Governor-General in Council on 17 August 2011, with effect from 1 September 2011. Establishing the interim Pricing Authority was required under the Agreement to provide continuity in the transitioning from the interim to the statutory Pricing Authority.

On 1 September 2011, the then Minister for Health and Ageing appointed an Acting Chief Executive Officer (CEO) of the interim Pricing Authority with responsibility for the establishment and day-to-day administration of the interim Pricing Authority.

The legislation to establish the Pricing Authority as a permanent statutory authority took effect on 15 December 2011. On 16 December 2011, the Minister for Health appointed an Acting CEO pending appointment of a permanent CEO of the Pricing Authority. The Minister appointed a Chair, Deputy Chair and non-titled members of the Pricing Authority for a period of five years commencing on 1 February 2012.

The National Health Reform Agreement, agreed by the Council of Australian Governments in August 2011, revised the 1 July 2011 establishment date contained in the Heads of Agreement – National Health Reform, to require that the National Health Performance Authority be established ‘as soon as possible’. The legislation establishing the Performance Authority took effect on 21 October 2011.

The then Minister for Health and Ageing appointed a Chair and Deputy Chair of the Performance Authority for a period of five years commencing on 1 November 2011. Additionally, five ordinary members of the Performance Authority were appointed for a period of five years commencing on 1 January 2012. On 1 February 2012, the Minister for Health appointed an Acting Chief Executive Officer (CEO) of the Performance Authority pending the appointment of a permanent CEO. The inaugural substantive CEO took up the position on 1 June 2012.

Responsibility for this deliverable sits with the National Health Performance Authority.

The Performance and Accountability Framework was agreed out of session by COAG in late 2011. Responsibility for the Hospital Performance and Health Community Reports sits with the National Health Performance Authority.

Increasing Efficiency and Capacity in Public Hospitals

The National Partnership Agreement on Improving Public Hospital Services (NPA IPHS) commits up to $3.4 billion to states and territories over eight years between 2010 and 2018. These funds will help to improve emergency department treatment times, reduce the length of elective surgery waiting lists and increase subacute care services.

Funding of $775m was allocated during 2011-12 to support the delivery of initiatives with 98% of the allocations paid to states and territories on satisfactory reporting of progress.

Emergency Departments

From 1 January 2012, the National Emergency Access Target (NEAT) was introduced following COAG acceptance of Expert Panel recommendations. The NEAT requires that 90 per cent of patients leave the emergency department within four hours of presentation, either by admission, transfer to another hospital, or discharge. The target is designed to drive the whole-of-hospital changes that are required to improve emergency patients’ access to care. The Department is monitoring state and territory progress towards achievement of the targets. Reward payments will be payable to those states and territories that achieve agreed interim targets.

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. Improving elective surgery performance is important in helping more patients receive the surgery they need sooner and to improve their quality of life.

As part of the revised NPA IPHS, COAG accepted recommendations from the Expert Panel to implement a new elective surgery target to replace the National Access Guarantee. The National Elective Surgery Target (NEST) is comprised of two complementary parts: the NEST aims to increase the number of patients who receive their elective surgery within clinically recommended times to 100 per cent and, by 2017, to reduce to zero the number of patients who have already waited longer than the clinically recommended time.

Measurement of the NEAT and NEST commenced on 1 January 2012, with performance assessed on a calendar year basis, so results will not be available until 2013.

Measurement of the NEST commenced on 1 January 2012, with performance assessed on a calendar year basis, so results will not be available until 2013.

Subacute Care

The NPA IPHS provides for more than 1,300 new subacute beds to be established in hospital and community settings nationally from 2010-11 to 2013-14. These additional subacute beds will ensure patients have better access to the subacute services they need, including rehabilitation, palliative care, psychogeriatric care, subacute mental health care and geriatric evaluation and management, in the most appropriate setting. Improved access to subacute services will assist better integration of care across the acute, primary and aged care sectors and deliver better patient health outcomes, functional capacity and quality of life.

Data on the number of additional beds in 2011-12 will not be available until November 2012. While there were initial delays in finalising a nationally consistent method for measuring the increase in the number of subacute care beds, all states and territories have now agreed to the method. States and territories are on track to meet or exceed the National Partnership Agreement subacute care bed targets over the life of the Agreement.

States and territories are on track to achieve agreed growth targets. Many of the services are being provided outside hospitals as most states and territories increase their outpatient and community-based subacute services. States and territories are able to allocate and distribute their funding based on identified needs and gaps in subacute care within their respective jurisdictions.

Hospital Data

Responsibility for this transferred to Independent Hospital Pricing Authority.

The Australian Institute of Health and Welfare undertook a study to develop a revised Private Hospital Establishment Collection dataset and sought to trial this in a cross-section of private hospitals. During the study it became clear that there was not strong industry support for substantial changes to the current dataset or collection arrangements, managed by the Australian Bureau of Statistics, and the study was terminated.

Improve Public Hospital Accountability and Management

MyHospitals Website

In 2011-12, the Department funded the Australian Institute of Health and Welfare to develop the MyHospitals website to publish nationally consistent hospital-level performance information. The MyHospitals website is designed to better inform the community about hospitals by making it easier for people to access information about how individual hospitals are performing.

The MyHospitals website provides nationally consistent, hospital-level performance information for public and private hospitals, such as waiting times for emergency department services and elective surgery in public hospitals, as well as information on hospital acquired staphylococcus infections, hand hygiene rates and cancer surgery waiting times data. It also contains useful profile information such as hospital bed numbers, accreditation status, location details with a map, and a list of clinical and specialist services offered.

The website has been well received by the public and media. Since its launch in December 2010 MyHospitals has had more than 835,000 visits.

The National Health Performance Authority (the Performance Authority) will take responsibility for the MyHospitals website during 2012-13 and it will become the online vehicle for reporting on the performance of individual hospitals and Local Hospital Networks.

Local Hospital Networks

Local Hospital Networks will directly manage public hospital services and functions to decentralise public hospital management and increase local accountability. Local Hospital Networks will engage with the local community and local clinicians, incorporating their views into the day-to-day operational planning of hospitals, particularly in the areas of safety and quality of patient care.

Under the National Health Reform Agreement, states and territories, as health system managers, are responsible for the establishment of Local Hospital Networks (LHNs). During 2011-12, LHNs were established in NSW, Victoria, SA and ACT. Implementation in the remaining jurisdictions took place on 1 July 2012.

All states and territories have established their LHNs by 1 July 2012, as required under the National Health Reform Agreement. The Performance Authority was legislatively established on 21 October 2011, and since late 2011 has been developing core operating documents, including its data plan and strategic plan. The Performance Authority has indicated that it anticipates releasing the first of its Hospital Performance Reports late in the 2012 calendar year.

National Lead Clinicians Group

The National Lead Clinicians Group provides high level leadership, advice and expertise on national clinical issues to the Australian Government. The group seeks to improve and foster clinical best practice and collaborative ways of working across disciplines and sectors.

The National Lead Clinicians Group (LCG) was established on 29 September 2011 and has held three official meetings.

The 2012-13 Budget introduced the Lead Clinicians Groups Streamlined Initiative. This initiative discontinued the establishment of local LCGs and aims to strengthen clinical leadership and engagement at all levels by:

• enhancing the role of the National LCG, through its Terms of Reference, to promote improved clinical engagement;
• establishing a National Clinicians’ Network to promote clinical leadership and engagement by sharing successful local arrangements for integrated care and related issues across all levels through state and national forums; and
• funding capacity building activities, by providing funds to the Australian Medicare Local Alliance to work with Medicare Locals to improve local clinical leadership and engagement across sectors.

Improve Access to Public Dental Services

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 which was contingent on the closure of the Medicare Chronic Disease Dental Scheme (discussed in Outcome 3 – Access to Medical Services). Since the closure of the Medicare Chronic Disease Dental Scheme did not proceed in 2011-12, the Commonwealth Dental Health Program was not implemented.

In the 2012-13 Budget, the $290m allocated for this measure was redirected over the forward estimates towards delivering foundational activities to improve oral health.

In 2011-12, the Department funded mobile dental equipment and infrastructure for rural and regional Indigenous communities. The objective of this program is to provide and assess the effectiveness of mobile dental equipment and services in communities where dental services and facilities are scarce.

Pilot projects for 2011-12 have been implemented.

Improve Health Care Services in Tasmania

The Australian Government provides funding through an agreement with the Tasmanian government for the continuing management and operation of the Mersey Community Hospital at Latrobe, to improve health services for people in the north-west region of Tasmania.

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 are able to access safe, appropriate and sustainable health care services.

Analysis of the data provided to the Department under the Heads of Agreement confirmed that the agreed services were provided.

Whole of Program Performance Information

The Department provided high quality and timely evidence-based research and analysis to inform the Australian Government within the time frames required. Also, under the NPA IPHS states and territories provided satisfactory progress reports to receive 98% of the 2011-12 allocation to increase access to elective surgery and emergency department services as well as increasing subacute care beds.

The Chair and various members of the National Lead Clinicians Group were invited to present at various meetings, conferences and discussions throughout the year. Presentations were made to a varied range of clinical groups, across national, state and local levels, in many jurisdictions.

Delays in establishing the Independent Hospital Pricing Authority and the National Health Performance Authority impacted on a number of projects, resulting in an underspend. This will not impact on the Authorities achieving their outcomes.

Outcome 13 – Financial Resources Summary

1. Departmental appropriation combines ‘Ordinary annual services (Appropriation Bill 1)’ and ‘Revenue from independent sources (s31)’.
2. ’Expenses not requiring appropriation in the current year’ is made up of depreciation expense, amortisation, make good expense and audit fees. This estimate also includes approved operating losses – please refer to the departmental financial statements for further information.

135. On 1 July 2011, Medicare Australia was integrated into the Department of Human Services.
136. In the 2011-12 Budget the Australian Government announced the consolidation of 159 whole or part Health and Ageing programs within 18 flexible Funds. The Indemnity Insurance Fund is one of the 18 Funds that came into operation from 1 July 2011. The establishment of flexible Funds will, over time, reduce red-tape for funding recipients in line with the National Compact, provide increased flexibility to government to respond to emerging health and ageing issues, and deliver better value for money and evidence-based funding.
137. A full list of activities consolidated into each Fund is provided at Part 3.6: Activities Consolidated to Establish Flexible Funds.
138. Applications for a premium subsidy can still be made until 30 June 2013.

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