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Department of Health

2013-14 Statement of Priorities Agreement between Minister for Health and The Royal Children’s Hospital

The Royal Children’s Hospital

Statement of Priorities 2013-14 2

Contents Background 3 Policy directions 3

Part A: Strategic overview 5 Mission statement 5 Service profile 5 Strategic planning 5 Strategic priorities 6

Part B: Performance priorities 9 Financial performance 9 Access performance 9 Service performance 10

Part C: Activity and funding 11

Part D 12

Accountability and funding requirements 13

Signature 13



Background Statements of Priorities (SoP) are key accountability agreements between Victorian public health services and the Minister for Health. The annual agreements facilitate delivery of or substantial progress towards the key shared objectives of financial viability, improved access and quality of service provision. The content and process for preparation and agreement of the annual Statement of Priorities is consistent with sections 65ZFA and 65ZFB of the Health Services Act 1988 (Vic).

Statements of Priorities are consistent with the public health services’ strategic plans and aligned to government policy directions and priorities.

A Statement of Priorities consists of four parts:

• Part A provides an overview of the service profile, strategic priorities and deliverables the health service will achieve in the year ahead.

• Part B lists the key financial, access and service performance priorities and agreed targets.

• Part C lists funding and associated activity.

• Part D forms the service agreement between each health service and the state of Victoria for the purposes of the National Health Reform Agreement (NHRA).

The mechanisms used by the Department of Health to formally monitor health service performance against the Statement of Priorities are outlined in the Victorian Health Service Performance Monitoring Framework 2013-14 Business Rules.

Policy directions The Victorian Health Priorities Framework 2012–2022 (VHPF) sets out the following 5 key outcomes the health system should strive to achieve by 2022:

• People are as healthy as they can be (optimal health status)

• People are managing their own health better

• People enjoy the best possible health care service outcomes

• Care is clinically effective and cost-effective and delivered in the most clinically effective and cost-effective service settings

• The health system is highly productive and health services are cost-effective and affordable

It also articulates seven priorities which reflect the Government’s policy ambition to build a strong health system for all Victorians. The focus is on: • developing a system that is responsive to people’s needs • improving every Victorian’s health status and experiences • expanding service, workforce and system capacity • increasing the system’s financial sustainability and productivity • implementing continuous improvements and innovation • increasing accountability and transparency • making better use of e-health and communications technology

These priorities are fundamental to Part A of the SoP and require address by health services.



Government commitments Victoria has long been a leader in driving efficient health services. The Government’s commitment to quality and efficiency will build an affordable health system for the long term ensuring that Victoria is well placed to address future challenges associated with a growing and ageing population, and greater rates of chronic and complex health conditions. In this context, the department will work with service partners to build a health system that is integrated and responsive to the changing needs of the community. Specific commitments made by the Government in 2013-14 relate to:

• Growing essential hospital services including capacity for critical care and elective surgery across the system

• Implementing mental health reforms, supporting mental health initiatives and growing mental health services

• Boosting alcohol and drug services, including alcohol prevention programs and specific alcohol and drug awareness campaigns

• Improving cardiovascular disease health outcomes and reducing readmission and disease progression rates through better management and support for people with chronic heart failure

• Training our future health workforce by providing additional clinical training positions for undergraduates, postgraduates and rural GP proceduralists

• Establishing a Health Innovation and Improvement Fund to support improvements in efficiency, quality, safety and patient centred care

• Implementing an infection prevention and control strategy to improve patient outcomes and reduce the cost burden of health associated infections in Victorian public health services

• Improving health outcomes for Aboriginal Victorians through the provision of culturally appropriate service options

• Increasing support for older people and younger people with a disability through the Home and Community Care (HACC) program to assist them to remain in their home

• Meeting the needs of refugees and asylum seekers through the provision of timely intervention and preventative care in primary care settings in high settlement areas of Victoria

• Improving health literacy about maternity care through the development of consumer information and piloting of a statewide parenting kit

• Increasing the availability of information for senior Victorians to support them to live independently in their own home for longer

• Boosting community health services, particularly in growth areas

• Reducing preventable disease in support of Victoria’s Healthy Together Community Strategy and via various public health initiatives

• Supporting telehealth projects that will improve co-ordination and care for patients, and support the delivery of care closer to where people live

• Supporting additional health capital projects and infrastructure improvements including the Werribee Mercy Hospital Mental Health expansion, The Waurn Ponds Community Hospital and Northern Hospital expansion



Part A: Strategic overview Mission statement Mission The Royal Children’s Hospital improves the health and wellbeing of children and adolescents through leadership in healthcare, research and education. Vision The Royal Children’s Hospital, a GREAT children’s hospital, leading the way. Values Unity: We work as a team and in partnership with our communities Respect: We respect the rights of all and treat people the way we would like them to treat us Integrity: We believe that how we work is as important as the work we do Excellence: We are committed to achieving our goals and improving outcomes

Service profile

The Royal Children’s Hospital (RCH) is the major specialist paediatric hospital in Victoria and also provides specialist care for children from Tasmania, southern New South Wales, and other states around Australia. The RCH has been providing outstanding care for Victoria's children and their families for over 140 years. The RCH is the designated state-wide major trauma centre for paediatrics in Victoria. The RCH delivers the state-wide Paediatric, Infant and Perinatal Emergency Retrieval (PIPER) service and is a National Funded Centre for paediatric heart transplantation, paediatric liver transplantation (in collaboration with Austin Health), Norwood procedure and staged surgical palliation for hypoplastic left heart syndrome and paediatric lung transplant (in collaboration with Alfred Health). In its role as a leading paediatric teaching centre, the RCH is affiliated with the University of Melbourne and has links with other universities. The RCH has a strong commitment to research. The Murdoch Childrens Research Institute, which is based at RCH, is a leading institute in paediatric research. RCH also leads a number of state-wide services including:

• Victorian Paediatric Rehabilitation Service (with Monash Health, Bendigo Health, Eastern Health and Barwon Health)

• Victorian Paediatric Palliative Care Program (with Monash Health and Very Special Kids) • Victorian Forensic Paediatric Medical Service (with Monash Health and Victorian Institute of

Forensic Medicine) • Victorian Infant Hearing Screening Program

Strategic planning

The Royal Children’s Hospital strategic plan can be read at www.rch.org.au/strategic_plan



Strategic priorities The Victorian Government’s priorities and policy directions are outlined in the Victorian Health Priorities Framework 2012-2022.

In 2013-14, The Royal Children’s Hospital will contribute to the achievement of these priorities by:

Priority Action Deliverable

Developing a system that is responsive to people’s needs

Implement formal advance care planning structures and processes that provide patients with opportunities to develop, review and have their expressed preferences for future treatment and care enacted.

Develop advance care planning screening process for long-stay patients in paediatric and neonatal intensive care services.

Conduct advance care planning screening for 75% of long-stay patients in paediatric and neonatal intensive care services.

Complete development of parent resource, Caring Decisions: A handbook to assist parents in advance care planning for a child with a life-limiting condition. Evaluate acceptability and usefulness of parent resource, Caring Decisions: A handbook to assist parents in advance care planning for a child with a life-limiting condition.

Contribute to area-based planning initiatives that consider health care across the care continuum.

Develop a plan for delivery of secondary and tertiary paediatric services across the north-west region in collaboration with local secondary hospitals and regional providers.

In partnership with other local providers, apply existing service capability frameworks to maximise the use of available resources across the catchment.

Complete planning, in collaboration with RMH and RWH, for the implementation of Parkville Pathology Service. Explore feasibility of developing a coordinated approach to clinical support service delivery within Parkville precinct.

Work and plan with key partners and service providers to respond to issues of distance and travel time experienced by some rural and regional Victorians.

Increase telehealth activity by 10%. Extend regional oncology outreach and shared care program (including use of telehealth) to regional services.

Improving every Victorian’s health status and experiences

Improve thirty-day unplanned readmission rates.

Reduce the rate of unplanned re-admission within 30 days by 10%.

Collaborate with key partners such as Medicare Locals, community health services and other providers to support local implementation of the Victorian Health and Wellbeing Plan 2011-2015.

Explore feasibility of establishing general paediatric outpatient services at a local community health service.

Pilot a new model for delivery of a multidisciplinary autism assessment clinic with connections to community-based services.




Optimise alternatives to hospital admission.

Develop and pilot a new model of care for children with medical complexity (CMC).

Ensure service coordination, discharge planning and referral processes support effective care transition.

Pilot electronic transmission of discharge summaries to general practitioners.

Improve the rate of discharge summary completion within 48 hours by 10%.

Use consumer feedback to improve person and family centred care and patient and patient experience.

Use social media as a means of gathering consumer feedback and use this information to improve the patient experience.

Contribute to the provision of additional dental services to achieve the targets, milestones and objectives of the National Partnership on Treating More Public Dental Patients.

Implement agreed increased target for National Partnership Agreement.

Expanding service, workforce and system capacity

Build workforce capability and sustainability by supporting formal and informal clinical education and training for staff and health students, in particular inter-professional learning.

Ensure appropriate level of life support training is completed by 100% of junior medical staff and 100% of clinical nursing / allied health staff.

Implement and evaluate the Senior Medical Staff Leadership Development Program.

Work collaboratively with the department on service and capital planning to develop service and system capacity.

Improve access to neonatal services by commissioning two additional neonatal intensive care cots in January 2014.

Develop and implement a workforce immunisation policy that builds capacity and aligns with national guidelines, including reference to employment screening and staff immunisation assessment.

Convert existing processes into an integrated workforce immunisation procedure.

Integrate immunisation records with HR information systems to improve knowledge of workforce immunisation status.

Increasing the system’s financial sustainability and productivity

Reduce variation in health service administration costs.

Complete the review of corporate information technology systems.

Identify opportunities for efficiency and better value service delivery.

Improve access to MRI services by delivering an additional 300 MRI episodes per annum.

Implementing continuous improvements and innovation

Develop and implement improvement strategies that optimise access, patient flow, system coordination and the quality and of hospital services.

Define ‘Great Care’ and measures of success in the new RCH strategic plan (2013-18).




Support change and innovation in practice where it is proven to deliver more effective and efficient health care.

Implement ‘Good to Go’ across the organisation to deliver improvements in patient access and throughput. Develop Melbourne Children’s Clinical Trials Centre.

Increasing accountability & transparency

Prepare for commencement of proposed new mental health legislation in 2014.

Employ a Mental Health Act Implementation Officer to assist the mental health team to understand the legislative changes.

Implement changes to procedures and practices to facilitate compliance with the proposed new mental health legislation in 2014.

Prepare for the National Safety and Quality Health Services Standards, as applicable

Achieve level three (i.e. leader in improvement) on the Department of Health’s Improvement Capability Quotient. Introduce display of ward-based quality improvements and outcomes.

Increase transparency and accountability in reporting of accurate and relevant information about the organisation’s performance.

Launch Social Media Strategy.

Commence publishing performance data on the internet. Complete implementation of Victorian Integrated Non-Admitted Health Minimum Dataset (VINAH) Project.

Improving utilisation of e-health and communications technology.

Maximise the use of health ICT infrastructure.

Deliver tender process to select a vendor for supply of electronic medical record.

Trial, implement and evaluate strategies that use e-health as an enabler of better patient care

Implement queuing system to optimise patient flow and patient experience at Specialist Clinics appointments. Work with service partners to achieve goals of Paediatric Clinical Network telehealth strategic initiative.



Part B: Performance priorities Financial performance Key performance indicator Target

Operating result

Annual operating result ($m) 0

WIES (1) activity performance

Percentage of WIES (public & private) performance to target 100

Cash management

Creditors < 60 days

Debtors < 60 days

Access performance Key performance indicator Target

Emergency care

Percentage of ambulance transfers within 40 minutes 90 NEAT - Percentage of emergency presentations to physically leave the emergency department for admission to hospital, be referred to another hospital for treatment, or be discharged within four hours (July – December 2013) 75 NEAT - Percentage of emergency presentations to physically leave the emergency department for admission to hospital, be referred to another hospital for treatment, or be discharged within four hours (January – June 2014) 81 Number of patients with a length of stay in the emergency department greater than 24 hours 0

Percentage of Triage Category 1 emergency patients seen immediately 100 Percentage of Triage Category 1 to 5 emergency patients seen within clinically recommended times 80

Elective surgery

Percentage of Urgency Category 1 elective patients treated within 30 days 100 NEST - Percentage of Urgency Category 2 elective surgery patients treated within 90 days (July – December 2013) 80 NEST - Percentage of Urgency Category 2 elective surgery patients treated within 90 days (January – June 2014) 88 NEST - Percentage of Urgency Category 3 elective surgery patients treated within 365 days (July – December 2013) 94.5 NEST - Percentage of Urgency Category 3 elective surgery patients treated within 365 days (January – June 2014) 97

Number of patients on the elective surgery waiting list (2) 3,124

Number of Hospital Initiated Postponements (HiPs) per 100 scheduled admissions 8

(1) WIES is a Weighted Inlier Equivalent Separation. (2) The target shown is the number of patients on the elective surgery waiting list as at 30 June 2014. Includes only competitive elective

surgery initiatives that have been allocated at the time of signing of this agreement.



Service performance Key performance indicator Target

Elective surgery (1)

Number of patients admitted from the elective surgery waiting list – quarter 1 1,877




Critical care

Paediatric ICU Number of days below the agreed minimum operating capacity (2) 0 Neonatal ICU Number of days below the agreed standard and flexible operating capacity (3) 0

Quality and safety

Health service accreditation Full compliance

Cleaning standards Full compliance

Health care worker immunisation - influenza 75

Hand Hygiene (rate) 70

SAB rate per occupied bed days (4) < 2/10,000 Victorian Hospital Experience Measurement Instrument (5)

(January to June 2014) Full compliance

People Matter Survey Full compliance

Newborn

Percentage of eligible newborns screened for hearing deficit > 97

(1) Includes only competitive elective surgery initiatives that have been allocated at the time of signing of this agreement. (2) The agreed minimum operating capacity is 19 ICU equivalents. (3) The standard operating capacity and flex capacity is 13-15, increasing to 15-17 as at 1 January 2014. (4) SAB is staphylococcus aureus bacteraemia. (5) The target for the Victorian Patient Satisfaction Monitor is the Overall Care Index (OCI) which comprises six categories. (6) The Consumer Participation Indicator is a category of the Victorian Patient Satisfaction Monitor. (7) The Victorian Health Experience Measurement Instrument (VHEMI) will succeed the VPSM as the instrument for measuring patient

experience.



Part C: Activity and funding

Funding type Activity Budget ($'000) Acute Admitted WIES Public 34,507 $146,077 WIES Private 11,064 $35,724 WIES (Public and Private) 45,571 $181,801

WIES TAC 451 $1,717

WIES TOTAL 46,022 $183,518

Acute non-admitted Emergency Services $16,168

Specialist Clinics $34,621

Subacute & Nonacute Admitted Rehab Public 4,334 $2,046 Subacute & Nonacute Other Other specified funding $5,189

Subacute non-admitted Victorian Artificial Limb Program $309

Health Independence Program $5,812

Subacute non-admitted Other $10,689

Aged Care HACC $18

Mental Health and Drug Services Mental Health Inpatient 6,349 $4,012 Mental Health Ambulatory 31,000 $11,298 Mental Health Service System Capacity $789

Drug Services $167

Primary Health Community Health / Primary Care Programs 1,988 $178 Community Health Other $575

Other Transplants Paediatric Heart $2,827

Transplants Paediatric Lung $204

Transplants Paediatric Liver $1,273

Other specified funding $66,283

Total Funding $345,974



Part D In 2012-13, the Commonwealth Government reduced funding to Victorian health services by $107 million. The Commonwealth Government decision to return funding of $107 million to Victorian hospitals and health services in 2012-13 was a one-off Commonwealth payment, leaving an ongoing Commonwealth shortfall in promised funding of $368 million over the next three years. In 2013-14, the impact is $99.5 million less than promised.

Period: 1 July 2013– 30 June 2014

Estimated

National Weighted Activity Units

Total Funding

Provisional Commonwealth

Percentage

Activity Based Funding 64,865 313,020,048 34.47% Other Funding 25,500,553 Total 338,520,601

If the Commonwealth government returns funding of $99.5 million this financial year, Royal Children's Hospital budget will increase by $3.31 million. Note:

• Provisional Commonwealth Contribution Percentage is subject to change following state-wide adjustments (i.e. cross border patient flows).

• Activity loadings are included in the Estimated National Weighted Activity Units (i.e. Paediatric, Indigenous, Remoteness, Intensive Care Unit, Private Patient Service Adjustment, and Private Patient Accommodation Adjustment).

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