Online version of the 2012-13 Department of Health and Ageing Annual Report

Outcome 10: Health System Capacity and Quality

Improved long-term capacity, quality and safety of Australia's health care system to meet future health needs, including through investment in health infrastructure, international engagement, consistent performance reporting and research

Page last updated: 29 October 2013

Major Achievements

  • Implemented the Personally Controlled Electronic Health Record (PCEHR), allowing for more effective and efficient health information for consumers and their health care providers.
  • Progressed implementation of the 221 projects funded under the four rounds of the Health and Hospitals Fund, which is providing nation-building health infrastructure. As of 30 June 2013, work had begun on 164 projects, of which 53 had been completed.
  • More than 3,400 women and their families received support from the McGrath Foundation Breast Care Nurses Program.
  • The CanTeen Youth Cancer Networks model was fully established in 2012-13, providing specialised cancer care to adolescents and young adults in every state and territory.

Challenges

  • Managing the large and diverse portfolio of capital works projects funded by the Health and Hospitals Fund and ensuring that community benefits are fully realised.
  • Improving consumer safety by managing the increasing volume of unwanted medicines being returned under the National Return and Disposal of Unwanted Medicines program.
  • Coordinating and managing partners and stakeholders to build and deliver the National Prescribing and Dispense Repository and the Child eHealth Record in a timely and successful manner.
  • Continuing to embed safety and quality into the Australian health system to improve patient care outcomes, maximise patient safety and enhance accountability.

Performance

This is a doughnut chart and a table that summarises the results for all deliverables and key performance indicators in outcome 10 during 2012-13. The results show that 72.7% were met compared with 78.3% in 2011-12, 18.2% were substantially met compared with 13.3% in 2011-12 and 9.1% were not met compared with 8.4% in 2011-12.

72.7% MET

18.2% SUBSTANTIALLY MET

9.1% NOT MET

Period Met Substantially met Not met
2012-13 72.7% 18.2% 9.1%
2011-12 78.3% 13.3% 8.4%

Programs contributing to Outcome 10

Outcome Strategy

Outcome 10 aims to improve the long-term capacity of Australia’s health care system with a particular emphasis on quality and safety. In 2012-13, the Department worked to achieve this Outcome by managing initiatives under the programs outlined below.

Program 10.1: Chronic disease – treatment

Program 10.1 aims to improve detection, treatment and survival outcomes for people with cancer.

Improve detection, treatment and survival outcomes for people with cancer

Cancer Centres

The Department continued to monitor the construction of 24 regional cancer centres funded under the Health and Hospitals Fund (HHF) at a total cost of $653 million. This national network will dramatically improve access and support for cancer patients, their carers and families in rural and regional Australia. Of these 24 projects, nine projects are finalised, 14 are under construction and one project is in the design phase. The final project is expected to be contracted in 2013-14.

In addition, $19 million was allocated from the Better Access to Radiation Oncology Budget measure for the Alan Walker Cancer Care Centre in Darwin, which was officially opened in January 2010. This will result in a national network of 25 regional cancer centres.

Additionally, three nationally significant cancer centre projects funded under the HHF aim to improve cancer outcomes for all Australians:

  • The Kinghorn Cancer Centre in Sydney, completed in August 2012, has a focus on rapidly translating research findings into clinical application for the prevention, diagnosis and treatment of individual cancer patients.
  • The Chris O’Brien Lifehouse at Royal Prince Alfred Hospital in Sydney, expected to start providing services in late 2013, will be an Australian centre of excellence as an integrated cancer research and treatment facility.
  • The Victorian Comprehensive Cancer Centre in Melbourne, is expected to open in late 2015 and bring together a critical mass of cancer experts to drive world-class innovation in cancer treatment through translating research discoveries.

Youth Cancer Network

The Department has worked with CanTeen to establish the Youth Cancer Networks Program which is delivering better models of care for adolescents and young adults diagnosed with cancer.

BreastScreen Cancer Infrastructure

In 2012-13, the Department provided funding of $120 million to BreastScreen Australia to install new digital technology to replace existing analogue mammography technology used to detect breast cancer. The majority of these upgrades are now in place with the final units to be installed and operational in 2014. This will ensure that women in Australia are screened using the best available technologies, including electronic transfer of mammography images from remote locations to major cities for analysis.

The Department funds McGrath breast care nurses to provide information, care, practical and emotional support to women diagnosed with breast cancer, their families and carers.

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Program 10.2: eHealth implementation

Program 10.2 aims to provide national eHealth leadership and develop systems to provide eHealth services.

Provide national eHealth leadership

The eHealth Memorandum of Understanding (MOU) recognises that the Commonwealth and all states and territories have a mutual interest in developing a national eHealth capability that will lead to significant improvements in the quality and delivery of health care. The MOU, which is underpinned by national specifications, standards, services and infrastructure, commits parties to interim priorities and current investment, including to the National E-Health Transition Authority (NEHTA). The Department managed the development of the MOU, overseen by the eHealth Working Group (EHWG).

NEHTA is funded to manage the COAG eHealth work program by all jurisdictions under the Australian Health Ministers’ Advisory Council (AHMAC) cost shared formula. The Commonwealth and each jurisdiction have individual funding arrangements with NEHTA to undertake this work. The Commonwealth also has a separate funding agreement in place with NEHTA for the PCEHR work stream.

NEHTA is an effective way for the Commonwealth, states and territories to work together to develop strong foundations for a national eHealth system. The focus is on operation of priority solutions that are already being implemented by parts of the health sector, and development of key standards for medication management and diagnostics.

Develop systems to support a national eHealth system

The PCEHR system has been up and running since 1 July 2012. By 30 June 2013, almost 400,000 consumers had registered for an eHealth record. This number climbed to more than 500,000 consumers registered by mid July. Government support, provided by the Practice Incentive Program eHealth incentive (ePIP), has helped more than 96% of Australian practices get the information technology they need for eHealth, with more than 4,300 health care organisations participating, by 30 June 2013.

In the 2012-13 Budget, more than $233.7 million over two years was allocated for eHealth. This included $161.6 million to operate the eHealth record system, $4.6 million to maintain privacy safeguards and $67.4 million as the Commonwealth’s share of joint funding with the states and territories for the NEHTA work program. This investment builds on $467 million over two years allocated in 2010 to build the complex national infrastructure for the national eHealth records system.

Provide eHealth services

In 2012-13, the Department continued delivery of the NBN Enabled Telehealth Pilots Program, funding nine pilot projects. These projects deliver high quality health care services to people in their homes and community hubs via the National Broadband Network (NBN). The focus of the program is on aged care, cancer care and palliative care.

In delivering the program, the Department manages individual funding agreements for each of the nine projects. This includes assessment of deliverables, risk management, governance and comprehensive stakeholder communications, which includes close liaison with the Department of Broadband, Communications and the Digital Economy.

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Program 10.3: Health information

Program 10.3 aims to provide support to the Australian Health Ministers’ Advisory Council and support maternity services reform.

Provide support to the Australian Health Ministers’ Advisory Council

The Australian Health Ministers’ Advisory Council (AHMAC) provides support to the Standing Council on Health (SCoH) by advising it on strategic issues relating to the coordination of health services across the nation and, as applicable, with New Zealand.

Throughout 2012-13, the Department worked to progress key areas of focus for AHMAC and SCoH, including national health reform, health workforce, eHealth, safety and quality, and continued implementation of the Australian National Breastfeeding Strategy, the Aged Care Reform package, and the Fourth Mental Health Plan. Also during 2012-13 SCoH finalised the Primary Health Care Strategic Framework and the National Tobacco Strategy. The Commonwealth’s priorities were also progressed through the work programs of AHMAC’s six Principal Committees.

Support maternity services reform

During 2012-13, the Department undertook a number of significant activities under the National Maternity Services Plan to address the four key priorities of the Plan – access, service delivery, workforce and infrastructure. These activities included:

  • re-launch of the Pregnancy, Birth and Baby online service (pregnancybirthbaby.org.au);
  • providing scholarships to midwives to undertake the Nursing and Midwifery Board of Australia’s approved prescribing courses under the Nursing and Allied Health Scholarship and Support Scheme;
  • extensive consultation with relevant medical and midwifery groups and consumers relating to legislation on collaborative arrangements;
  • evaluation of the Improving Maternity Services Budget Package; and
  • continued work with the Australian Institute of Health and Welfare to develop a comprehensive, nationally consistent approach to maternal and perinatal mortality data collection.

The Department also worked with states and territories, though the Maternity Services Inter-Jurisdictional Committee, to implement actions under the National Maternity Services Plan. There has been considerable progress in developing a Birthing on Country service delivery model which aims for Indigenous women to give birth in their communities giving the baby a spiritual, physical and social connection to the land. This has the potential to improve health outcomes for Aboriginal and Torres Strait Islander mothers and babies.

Breastfeeding

Breastfeeding helps protect infants against a number of conditions, including diarrhoea, respiratory and ear infections, and obesity and chronic diseases later in life. Breastfeeding also benefits a mother’s own health by reducing the risks of breast cancer, ovarian cancer, type 2 diabetes and osteoporosis.

To increase breastfeeding rates, the Department continues to fund the Australian Breastfeeding Association to run the National Breastfeeding Helpline. The helpline, 1800 MUM 2 MUM81, is staffed by Australian Breastfeeding Association volunteers right across Australia and provides free, confidential breastfeeding advice and support, 24 hours a day.

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Program 10.4: International policy engagement

Program 10.4 aims to facilitate international engagement on global health issues.

Facilitate international engagement on global health issues

The Department engages in multilateral, regional and bilateral international health fora to help protect and advance the health of the Australian population, and to help fulfill Australia’s responsibility as an advanced country to contribute to improving global and regional public health.

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Program 10.5: Research capacity and quality

Program 10.5 aims to improve research capacity and improve safety and quality in health care.

Improve research capacity

Improve Safety and Quality in Health Care

The Department continues to assist the Australian Commission on Safety and Quality in Health Care (the Commission) in leading and coordinating improvements in safety and quality in Australian health care by identifying issues and policy directions, and recommending priorities for action. The priority areas for 2012-13 included the national safety and clinical standards, formulation and implementation of national accreditation schemes and national data set development.

The Commission continued its work to embed safety and quality into the Australian health system to improve patient care outcomes, maximise patient safety and enhance accountability.

The Department, in conjunction with state and territory governments, also supported the Australian Health Service Safety and Quality Accreditation Scheme, which began on 1 January 2013. The Scheme aims to enhance safety and quality through a nationally consistent approach to health care accreditation.

The Department engaged the Commission to coordinate Australia’s participation in an OECD study investigating unwarranted variations in clinical care across a specific set of procedures including caesarean section, cardiac catheterisation, knee arthroscopy and hysterectomy. The results will be used to develop future initiatives to improve best practice. The Department will examine this evidence to explore referral behaviours of GPs and community-based specialists and expand the work through implementing the 2013-14 Budget measure that provides revised and more targeted arrangements for Commonwealth safety and quality initiatives.

Health and Hospitals Fund

Of the 12 medical research infrastructure projects that began in 2009-10 under the HHF, six are complete with the remainder to be finalised before the end of 2015. The centres cover areas such as mental health, neurological disorders, child health and Indigenous health. The projects aim to improve community health through discovering new treatments and translating new research findings into improved treatment.

Health and Medical Research

In May 2011, the Minister for Mental Health and Ageing announced a major independent review of health and medical research in Australia. The Review focused on optimising Australia’s capacity to produce world class health and medical research to 2020.

Maintain effective health surveillance

To develop effective health policy and programs, researchers and policy makers must have access to current information. The Department funds a range of activities to collect and publish data and statistics on topics such as injuries, drug use and communicable and chronic disease.

For example, in 2012-13, the Department implemented the first stages of a Human Papilloma Virus (HPV) surveillance system. This included a serosurvey83 to establish baseline levels of HPV infection in males, genotyping84 of HPV in the Indigenous population, and extension of a genital warts surveillance program in rural and remote communities.

The Department also continued to fund the Vaccine Preventable Diseases Surveillance Program. Reporting of nationally consistent, high quality data on vaccine preventable diseases allows national monitoring, analysis and timely reporting of data to inform immunisation policy. Information from this program provides national data on the vaccination status of cases and tracks the serogroups85 causing disease, particularly among children.

This information is used by expert groups such as the Australian Technical Advisory Group on Immunisation to evaluate the effectiveness of the National Immunisation Program. The provision of genotype data associated with outbreaks of measles in Australia contributes to the evidence of Australia having eliminated endemic transmission of this disease. High quality measles data also contributes to the wider goal of measles elimination in the WHO Pacific Region.

High Risk Implantable Medical Devices

The Department aims to improve patient safety through enhanced post-market surveillance of high risk implantable medical devices, including facilitating contact with patients affected by safety concerns of such devices.

In 2012-13, the Department engaged the Commission to consult stakeholders including consumers, clinicians and industry on how best to respond to the challenges posed to patient safety by high risk implantable medical devices. The report informed the development of the 2013-14 Budget measure. This measure announced that two national registers are to be established which aim to help monitor and report to the TGA on the performance of specific high risk implantable devices. Additionally, the measure will establish a national protocol to facilitate contact with patients with a high risk implantable device, in the event of a serious safety risk associated with their device.

Monitor the use of diagnostics, therapeutics and pathology

Through the Quality Use of Diagnostics, Therapeutics and Pathology Fund, the Department continued to assist the National Prescribing Service (NPS) and the National Return and Disposal of Unwanted Medicines (NatRUM) program to improve the quality use of medicines and medical services by health professionals and consumers.

In 2012-13, the NPS continued to run the four year Generic Medicines are an Equal Choice campaign to increase consumers’ understanding that generic medicines are of equivalent quality, safety and efficacy to popular brand medicines. In 2012-13, the NPS also continued its work to address antibiotic resistance in Australia. This involved a campaign targeted at health professionals to provide the latest evidence and equip them with tools to encourage more informed clinical decisions when they are deciding whether to prescribe antibiotics. It also involved a campaign to increase consumer awareness of issues surrounding antibiotic resistance.

The NPS continued important work through Rational Assessment of Drugs and Research and Australian Prescriber publications to provide independent, evidence based information to health professionals and consumers regarding new therapeutics, including expert advice and intervention design. The Department, with the assistance of the NPS, continued to implement the Post-Market Monitoring program, which began in June 2011. This program monitors medicines use in clinical practice through research and evidence based assessment and aims to improve patient safety and the quality use and cost effectiveness of medicines.

The Department continued to promote evidenced based pathology and diagnostic imaging services through ongoing funding of the NPS. The Department funded a range of projects to improve pathology and diagnostic imaging referral quality and consistency, including the introduction of education and quality assurance programs for health professionals and consumers and introduction of peer feedback programs amongst practitioners. This additional support and information will help doctors request services that are the most beneficial for patients.

The NatRUM program was established to reduce accidental childhood poisoning, medication misuse and toxic releases into the environment. Consumers can return unwanted or out-of-date medicines to any pharmacy. Medicines are destroyed in an environmentally friendly manner using high-temperature incineration.

The volume of unwanted medicines collected under the NatRUM program has increased steadily since the program began in 1998. In 2000-01, the collection totalled 235,267 kilograms, rising to more than 600,000 kilograms in 2012-13. The Department continues to work with NatRUM on long-term strategies to improve the sustainability of the program. This will ensure that increasing demand for collection services into the future is met.

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Program 10.6: Health infrastructure

Program 10.6 aims to invest in major health infrastructure.

Invest in major health infrastructure

Health and Hospitals Fund

The HHF was established in January 2009 and forms part of the broader nation-building infrastructure program. HHF investments underpin major improvements in efficiency, access and outcomes of health care through renewal and refurbishment of acute and primary care facilities, medical technology equipment and major medical research facilities and projects.

The Department worked with the funding recipients to continue to progress projects. While infrastructure projects often take several years to complete, some projects are now finalised and community benefits are being realised.

The 85 projects funded under HHF Rounds One and Two span four critical areas – the fight against cancer; translational research; research workforce infrastructure; and the modernisation of the hospital system. Forty-two of these 85 projects have now been completed, with 17 finalised in 2012-13.

Under the two regional priority rounds of the HHF, funding was awarded for 139 projects to establish new or improved health facilities in regional communities that aim to close the gap in health outcomes between major metropolitan areas and regional areas of Australia. Eleven of these 139 projects have now been completed, with 10 finalised in 2012-13.

In 2013-14, the Department will continue to work with the states and territories, non-government organisations, universities and medical research institutes to progress these projects. The Department will pursue negotiations for the remaining projects with a view to finalising agreements with successful applicants.

Outcome 10 – Financial Resource Summary

Program (A) Budget Estimate 2012-13
$’000
(B) Actual 2012-13
$’000
Variation (Column B minus Column A)
$’000
Program 10.1: Chronic Disease - Treatment 1
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1) 3,026 3,031 5
Special Accounts
Health and Hospital Fund Health Portfolio Special Account 211,642 222,628 10,986
Departmental Outputs
Departmental Appropriation 3 4,138 4,085 ( 53)
Expenses not requiring appropriation in the current year 4 125 205 80
Total for Program 10.1 218,931 229,949 11,018
Program 10.2: e-Health Implementation
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1) 68,636 68,160 ( 476)
Non cash expenses 2 18,309 18,309 -
Departmental Expenses
Departmental Appropriation 3 18,263 18,288 25
Expenses not requiring appropriation in the current year 4 503 840 337
Total for Program 10.2 105,711 105,597 ( 114)
Program 10.3: Health Information
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1) 32,561 33,097 536
Departmental Expenses
Departmental Appropriation 3 1,590 1,593 3
Expenses not requiring appropriation in the current year 4 49 83 34
Total for Program 10.3 34,200 34,773 573
Program 10.4: International Policy Engagement
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1) 14,912 14,728 ( 184)
Departmental Expenses
Departmental Appropriation 3 18 18 -
Expenses not requiring appropriation in the current year 4 1 1 -
Total for Program 10.4 14,931 14,747 ( 184)
Program 10.5: Research Capacity and Quality 1
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1) 28,764 28,543 ( 221)
Special Accounts
Health and Hospital Fund Health Portfolio Special Account 36,205 36,191 ( 14)
Departmental Expenses
Departmental Appropriation 3 9,204 10,694 1,490
Expenses not requiring appropriation in the current year 4 178 524 346
Total for Program 10.5 74,351 75,952 1,601
Program 10.6: Health Infrastructure 1
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1) - 12,000 12,000
Special Accounts
Health and Hospital Fund Health Portfolio Special Account 466,244 470,455 4,211
Departmental Expenses
Departmental Appropriation 3 3,224 3,170 ( 54)
Expenses not requiring appropriation in the current year 4 97 158 61
Total for Program 10.6 469,565 485,783 16,218
Outcome 10 Totals by appropriation type
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1) 147,899 159,559 11,660
Non cash expenses 2 18,309 18,309 -
Special Accounts 714,091 729,274 15,183
Departmental Expenses
Departmental Appropriation 3 36,437 37,848 1,411
Expenses not requiring appropriation in the current year 4 953 1,811 858
Total expenses for Outcome 10 917,689 946,801 29,112
Average Staffing Level (Number) 194 204 10
  1. This program includes National Partnerships paid to state and territory governments by the Treasury as part of the Federal Financial Relations (FFR) Framework.
  2. 'Non cash expenses' relates to the depreciation of computer software.
  3. Departmental appropriation combines 'Ordinary annual services (Appropriation Bill 1)' and 'Revenue from independent sources (s31)'.
  4. 'Expenses not requiring appropriation in the budget 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.

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