Outcome 13: Acute Care > Outcome Performance Report

Major Achievements

• Extended the terms and conditions of the 2003–08 Australian Health Care Agreements to 30 June 2009, and provided an additional $500 million in 2007–08 to the states and territories to relieve pressure on public hospitals. The Department also contributed to policy development for the new health care agreements.
• Implemented the Elective Surgery Waiting List Reduction Plan in collaboration with the states and territories, to reduce the backlog of patients waiting longer than clinically recommended for elective surgery.
• Managed the Mersey Community Hospital and entered into negotiations for the ongoing management and administration of the facility to ensure that safe and sustainable hospital services are delivered to the northwest region of Tasmania.
• Provided significant policy input and direction to the Business Study of the efficiency and effectiveness of the Australian Red Cross Blood Service as a member of the Expert Advisory Committee, and developed for Health Ministers a strategy to implement its recommendations.

Challenge

• Continued low rates of organ and tissue donation in Australia. In 2007, Australia’s rate of organ donation for transplantation declined to a rate of 9.4 donors per million population with only 198 deceased organ donors.dvisory Committee, and developed for Health Ministers a strategy to implement its recommendations.Top of page

Key Strategic Directions for 2007–08 – Major Activities

Supporting the Provision of Free Public Hospital Services

Australian Health Care Agreements

The Australian Health Care Agreements are bilateral agreements between the Australian Government and each State and Territory Government. Through the agreements, the Australian Government provides significant funding to assist the states and territories to deliver free public hospital services to the community.

In 2007–08, the Department administered $9.7 billion to the states and territories under the 2003–08 Australian Health Care Agreements. A major achievement was the provision of an additional $500 million to help relieve pressure on public hospitals, and the extension of these arrangements from 30 June 2008 to 30 June 2009. The extension of the agreements has enabled significant policy development to be undertaken with the states and territories for the new National Health Care Agreements.

Under the 2003–08 Australian Heath Care Agreements, the Department received data from all states and territories, which it analysed and published in the State of Our Public Hospitals, June 2008 Report. The 2008 report, based on data collected in 2006–07, represents the most current information available. Key findings are in the Highlights from the State of Our Public Hospitals June 2008 Report section of this chapter.

Elective Surgery Waiting List Reduction Plan

In 2007–08, the Department worked with the states and territories to implement the first two stages of the Elective Surgery Waiting List Reduction Plan.Top of page

A total of $150 million has been provided for an immediate national blitz on elective surgery waiting lists in 2008 and plans have been approved for the expenditure of a further $150 million over two years to make systemic improvements to Australia’s hospital system.

This initiative will reduce the number of people waiting longer than clinically recommended for surgery by providing financial incentives to improve elective surgery capacity in public hospitals, and by making states and territories more accountable for their performance and rewarding them for better outcomes.

States and territories have committed to maintaining effort in elective surgery and other areas of public hospital service provision and will report on a quarterly basis. As part of the plan, states and territories will report on elective surgery performance in public hospitals through their websites, so that patients can make informed decisions about their own health care, based on individual hospital results.

Improved Hospital Care for Older Patients

A focus in the year was on improving the capacity of hospitals to provide more appropriate care for older people, and to improve services to help older Australians to access residential aged care when they need it.

Some older patients in public hospitals no longer require acute hospital care, but experience delays in obtaining more appropriate forms of care such as rehabilitation, palliative care or residential aged care. The Department continued to work with the states and territories to improve outcomes for older public patients at the hospital-aged care interface, through the continuation of the Long Stay Older Patients Initiative and the Pathways Home Program.

States and territories used the funding available to put in place a number of new initiatives during the year, such as improved hospital or rehabilitation facilities, or hospital avoidance or early discharge programs.Top of page

Highlights from the State of Our Public Hospitals June 2008 Report

In 2006–07, more people were admitted to Australian public hospitals than in any previous year. Public hospital admissions increased to almost 4.7 million, while private hospital admissions also increased to more than 2.9 million. There were more than 39.4 million non admitted patient services. In 2006–07, more than 556,770 patients had elective surgery in public hospitals with a median wait of 32 days. Nationally, more than 84 per cent of elective surgery patients were seen within the recommended time. In 2006–07, emergency departments handled more than 6.7 million services across Australia in public hospitals. The public hospital workforce continued to grow, with more than 234,000 full-time staff employed in public hospitals in 2006–07. There was an increase in salaried medical officers, nurses, diagnostic and other health professionals, administration staff and personal care staff during this period. In 2006–07, Indigenous Australians made up 2.5 per cent of the population but accounted for approximately 6 per cent of public hospital admissions. As well, 4.3 per cent of patients treated by emergency departments nationally were Indigenous people. Indigenous Australians seeking elective surgery had a median waiting time of 34 days – two days more than the rest of the population.

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Ensuring the Safe Supply of Blood and Blood-related Products

In 2007–08, the Department continued to collaborate with State and Territory Governments and the National Blood Authority to ensure Australia’s blood supply was safe, sustainable and affordable, and that Australian patients received the fresh blood and blood products they need.

Safe Blood and Blood-related Products

Funding was provided to the Australian Red Cross Blood Service to implement universal bacterial testing for platelets to improve the safety of fresh blood products. In addition, the Department contributed to the development of the first clinical criteria for the use of intravenous immunoglobulin in Australia, which were rolled out nationally in March 2008. The criteria identify the conditions and circumstances for which the use of intravenous immunoglobulin is appropriate, and those that will be funded under the National Blood Agreement.

Improving Collection and Donation Rates

To support Australia’s policy of self-sufficiency in sourcing adequate blood components and plasma from voluntary donations to meet clinical demand, increased funding was provided to the Australian Red Cross Blood Service to boost plasma collections from 329 tonnes in 2006–07 to 350 tonnes in 2007–08.

The Department also continued to work with the Australian Red Cross Blood Service and the National Blood Authority on implementing the recommendations from the 2006 review of Australia’s plasma fractionation arrangements, which addressed the need for improving the rates of blood donation in Australia.

2009 has been designated the ‘Year of the Blood Donor’. The Australian Red Cross Blood Service received $2.2 million to support this initiative. The Department also worked with the organisation to develop a range of community activities that will celebrate blood donors; enhance awareness of the value of, and the need for, blood donors; and help recruit new donors.

Review of the Australian Red Cross Blood Service

The Australian Government contributes 63 per cent of the national blood service costs and the State and Territory Governments contribute the remaining 37 per cent. In 2007–08, the Department participated actively as a member of the Expert Advisory Committee overseeing an independent business study of the organisation’s effectiveness and efficiency to inform future funding arrangements. The final report of the ARCBS Business Study was finalised in January 2008 and a response and implementation strategy to the recommendations of the report was agreed by the Australian Health Ministers’ Conference in July 2008.

Focus on Long-term and Sustainable Increases in Organ and Tissue Donation Rates

Organ and tissue transplantation is a highly successful treatment that transforms the lives of individuals and their families. However Australia has a longstanding shortage of organs for transplantation. In 2007, the national rate of organ donation declined to 9.4 donors per million population, with only 198 deceased organ donors. The Department worked to address this issue through initiatives that will increase and sustain organ and tissue donation rates.

Support for the National Clinical Taskforce on Organ and Tissue Donation

The Department provided secretariat and funding support for the research, consultations and deliberations of the National Clinical Taskforce on Organ and Tissue Donation, which was established by the Government in October 2006, to provide advice on ways to improve the rate of safe, effective and ethical organ and tissue donation for transplantation in Australia.

The taskforce delivered its report containing 51 recommendations for reform to the Government in February 2008. The report Think Nationally, Act Locally and Support Evidence is available on the Department’s website.

New Governance Arrangements

The Department also led the implementation of new governance arrangements for the organ and tissue donation and transplantation sectors. In December 2007, all Australian Health Ministers agreed to establish a new joint committee as the primary source of advice to governments and to drive and oversee workable national reforms. The Cognate Committee on Organ and Tissue Donation and Transplantation brings together senior government decision makers, key clinical experts and the community sector.

The committee met for the first time in April 2008 and commenced work on a number of practical reform initiatives. The committee replaced both the Intergovernmental Committee on Organ and Tissue Donation and the former peak non-government body for the sector, Australians Donate.

Organ Donation Promotion

The Department provided funding to Transplant Australia, Zaidee’s Rainbow Foundation and a number of State and Territory Governments to promote organ donation and encourage people to register on the Australian Organ Donor Register. The Department also supported Australian Organ Donation Awareness Week 2008 and ran a national poster and poetry competition to promote organ and tissue donation.

On 2 July 2008, the Government proposed a world’s best practice reform package of national initiatives to improve Australians’ access to life saving and transforming transplants. This $151.1 million package will introduce to Australia a coordinated, consistent approach and systems spearheaded by a new independent national authority. The package reflects international and national experience and best practice and builds on the recommendations of the National Clinical Taskforce and the work of the Cognate Committee on Organ and Tissue Donation and Transplantation.

Improved Acute Care Information

The Department uses acute care data provided by the states and territories to inform government policy, monitor hospital services, assist in improving performance, inform the allocation of resources, and enable public reporting of hospital activity. This data is also important for any move to a more nationally consistent approach to activity based funding for services provided in public hospitals. Further, the Australian Refined Diagnosis Related Groups classification system (version 6.0), the basis of acute care data, is being updated by the Department and will be published in November 2008.

In 2007–08, the Department completed assessments of the current arrangements through the Hospital Information and Performance Program Review and the National Hospital Cost Data Collection Review. The reviews’ recommendations are informing improvements in Australians’ access to timely, meaningful information about hospital services and the costs associated with those services, in particular through improved information on emergency department and outpatient activity.

The Department also collaborated with the states and territories on outpatient, allied health and emergency department services data to assist in the collection of detailed information on these patients, to enable the development of nationally consistent data in these areas.

In October 2007, the Department released the Emergency Triage Education Kit, which provides nurses with tools to improve national consistency in the application of the Australasian Triage Scale; helping patients to receive timely and consistent assessment, and intervention based on clinical urgency. This kit was well received by nurses and has been recognised internationally.

Funding Public Hospital Services at the Mersey Community Hospital

The Australian Government announced in August 2007 its intention to ensure the provision of hospital services at Mersey Community Hospital at Latrobe, Tasmania. The Government assumed ownership and operational responsibility for the hospital on 23 November 2007. The Department has managed the hospital since that time, and successfully engaged in processes to secure the ongoing management and administration of the facility, ensuring that safe and sustainable hospital services are delivered to the northwest region of Tasmania. The Commonwealth has engaged the Tasmanian State Government to manage and operate the hospital, while the Commonwealth continues to own and fund the hospital. The new arrangement will start from September 2008.