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City of Ballarat

Health Sector Capability and Gap Analysis Report

July 2010

www.sedconsulting.com.au

City of Ballarat Health Sector Analysis Report

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Contents

DISCLAIMER ......................................................................................................................................... 7

EXECUTIVE SUMMARY ........................................................................................................................ 8

Key issues ........................................................................................................................................................................... 8

Advocacy and leadership .................................................................................................................................................... 8

Investment and development.............................................................................................................................................. 9

Workforce ............................................................................................................................................................................... 9

The role of governments ............................................................................................................................................. 10

Recommendations ...................................................................................................................................................... 10

Advocacy and leadership .................................................................................................................................................. 10

Investment and development............................................................................................................................................ 11

Workforce ............................................................................................................................................................................. 11

Conclusion ..................................................................................................................................................................... 12

BACKGROUND ................................................................................................................................... 13

DEFINITION ......................................................................................................................................... 13

Sub-sectors ..................................................................................................................................................................... 13

METHODOLOGY ................................................................................................................................. 13

OVERVIEW OF HEALTH SECTOR IN BALLARAT ............................................................................ 14

Key health service providers ...................................................................................................................................... 14

Ballarat Health Services ....................................................................................................................................................... 14

St John of God Health Care ............................................................................................................................................... 14

Ballarat Community Health Centre .................................................................................................................................... 15

Central Highlands Primary Care Partnership ..................................................................................................................... 15

UFS Dispensaries ................................................................................................................................................................... 16

Ballarat and District Division of General Practice ............................................................................................................. 16

Private Practitioners ............................................................................................................................................................. 16

Ballarat and District Nursing and Health Care .................................................................................................................. 16

Ambulance Victoria ............................................................................................................................................................ 17

Department of Human Services ......................................................................................................................................... 17

Department of Health ......................................................................................................................................................... 17


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University of Ballarat ............................................................................................................................................................. 17

Australian Catholic University .............................................................................................................................................. 17

Other Universities .................................................................................................................................................................. 17

City of Ballarat ...................................................................................................................................................................... 17

LITERATURE REVIEW ........................................................................................................................ 18

Sector overview and literature review summary ................................................................................................... 20


ECONOMIC ANALYSIS ....................................................................................................................... 21

Local expenditure and domestic imports ............................................................................................................... 23

Value of the sector ...................................................................................................................................................... 25

Economic analysis summary ...................................................................................................................................... 26


HEALTH SECTOR WORKFORCE....................................................................................................... 27Capacity and sustainability ....................................................................................................................................... 27

Age profile ............................................................................................................................................................................ 28

Education and skills .............................................................................................................................................................. 30

Occupations......................................................................................................................................................................... 32

Health sector workforce summary ............................................................................................................................ 36


CONSULTATIONS ............................................................................................................................... 37

Consultation process ................................................................................................................................................... 38

CONSULTATION FINDINGS ............................................................................................................... 39

Healthcare and accessibility ..................................................................................................................................... 39

Strengths ............................................................................................................................................................................... 39

Weaknesses .......................................................................................................................................................................... 40

Opportunities ........................................................................................................................................................................ 41

Threats ................................................................................................................................................................................... 41

Enablers ................................................................................................................................................................................. 41

Commentary ........................................................................................................................................................................ 41

Recommendation ............................................................................................................................................................... 42


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Providers and practitioners ......................................................................................................................................... 42

Strengths ............................................................................................................................................................................... 42

Weaknesses .......................................................................................................................................................................... 42

Opportunities ........................................................................................................................................................................ 42

Threats ................................................................................................................................................................................... 43

Enablers ................................................................................................................................................................................. 43

Commentary ........................................................................................................................................................................ 43

Recommendation ............................................................................................................................................................... 44

Workforce and development .................................................................................................................................... 44

Strengths ............................................................................................................................................................................... 44

Weaknesses .......................................................................................................................................................................... 44

Opportunities ........................................................................................................................................................................ 45

Threats ................................................................................................................................................................................... 45

Enablers ................................................................................................................................................................................. 45

Commentary ........................................................................................................................................................................ 45

Recommendation ............................................................................................................................................................... 45

Business and organisation ........................................................................................................................................... 46

Strengths ............................................................................................................................................................................... 46

Weaknesses .......................................................................................................................................................................... 46

Opportunities ........................................................................................................................................................................ 46

Threats ................................................................................................................................................................................... 47

Enablers ................................................................................................................................................................................. 47

Commentary ........................................................................................................................................................................ 47

Recommendation ............................................................................................................................................................... 47

Infrastructure and logistics .......................................................................................................................................... 47

Strengths ............................................................................................................................................................................... 47

Weaknesses .......................................................................................................................................................................... 47

Opportunities ........................................................................................................................................................................ 48

Threats ................................................................................................................................................................................... 48

Enablers ................................................................................................................................................................................. 48

Commentary ........................................................................................................................................................................ 48

Recommendation ............................................................................................................................................................... 48

Wellness and lifestyle ................................................................................................................................................... 49

Strengths ............................................................................................................................................................................... 49

Weaknesses .......................................................................................................................................................................... 49

Opportunities ........................................................................................................................................................................ 49

Threats ................................................................................................................................................................................... 49


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Enablers ................................................................................................................................................................................. 49

Commentary ........................................................................................................................................................................ 49

Recommendation ............................................................................................................................................................... 49

Consultations summary ............................................................................................................................................... 50

THE ROLE OF GOVERNMENTS ......................................................................................................... 51

RECOMMENDATIONS SUMMARY ..................................................................................................... 52

Advocacy and leadership ......................................................................................................................................... 52

Investment and development ................................................................................................................................... 52

Workforce ...................................................................................................................................................................... 53

CONCLUSION ..................................................................................................................................... 53

APPENDIX 1: CONSULTATIONS....................................................................................................... 54

APPENDIX 2: KEY HEALTH SERVICE PROVIDERS IN THE BALLARAT REGION ......................... 63

APPENDIX 3: LITERATURE REVIEW ................................................................................................ 66

APPENDIX 4: ECONOMIC DATA ....................................................................................................... 84

APPENDIX 5: HEALTH SECTOR WORKFORCE DATA .................................................................... 92

Tables Table 1: Learnings and implications from sector overview and literature review .................................................... 20 Table 2: Economic performance of health and community services 2007-2010 ..................................................... 22 Table 3: Local health sector expenditure trends ...................................................................................................... 23 Table 4: Key imported domestic products and services .......................................................................................... 25 Table 5: Job creation impacts .................................................................................................................................. 25 Table 6: Economic analysis summary ..................................................................................................................... 26 Table 7: Workforce analysis summary .................................................................................................................... 36 Table 8: Consultation list ......................................................................................................................................... 37 Table 9: Consultation analysis summary ................................................................................................................. 51

Figures Figure 1: Output - all sectors - 2007-2010 ............................................................................................................... 21 Figure 2: Health sector economic indicators 2007-2010 ......................................................................................... 22 Figure 3: Local expenditure by sector by health ...................................................................................................... 23 Figure 4: Domestic imports by the health and community services sector ............................................................. 24 Figure 5: Local expenditure versus domestic imports by sector ............................................................................. 24


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Figure 6: Employment - all sectors -2001 2006 ....................................................................................................... 27 Figure 7: Age profile comparison of the Ballarat workforce ..................................................................................... 28 Figure 8: Age profile comparison of the health sector workforce ............................................................................ 29 Figure 9: Age profile of all Ballarat industry sectors ................................................................................................ 29 Figure 10: Mature age workforce profile comparison .............................................................................................. 30 Figure 11: Younger workforce profile for Ballarat .................................................................................................... 30 Figure 12: Education profile comparison ................................................................................................................. 31 Figure 13: Education and qualifications across Ballarat industry sectors ............................................................... 31 Figure 14: Occupation comparison .......................................................................................................................... 32 Figure 15: Occupations across all Ballarat industry sectors .................................................................................... 33 Figure 16: Gender comparison of the Balarat workforce ......................................................................................... 33 Figure 17: Health sector male to female by age groups .......................................................................................... 34 Figure 18: Health sector male to female by education / qualification ...................................................................... 34 Figure 19: Health sector male to female by occupation .......................................................................................... 35 Figure 20: Male to female incomes in the health sector .......................................................................................... 35


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Disclaimer

The Ballarat Health Sector Analysis Report has been prepared specifically for the City of Ballarat the

client. The Ballarat Health Sector Analysis Report and its contents are not to be referred to, quoted or

used by any party in any statement or application, other than the City of Ballarat, without written

approval from SED Consulting.

The information contained in this document has been gained from anecdotal evidence and research.

It has been prepared in good faith and in conjunction with the City of Ballarat. Neither SED Consulting,

nor its servants, consultants, agents or staff shall be responsible in any way whatsoever to any person in

respect to the Report, including errors or omission therein, however caused.

SED Consulting - Central and Western


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Executive summary

The City of Ballarat has commissioned this review to ascertain the capabilities and capacity of the

health sector to meet the health and well-being needs of a growing population in and around Ballarat.

The conduct of the review recognises the importance and value of the health sector and its associated

interests and the important contribution that it makes to the socio-economic development of the

community.

The review has included an overview of key health service providers and support services in the Ballarat

region; consideration of health policy and strategies at local, state and national levels; analysis of

economic and workforce data relating to the Ballarat community and the health and community

services sector; and a qualitative analysis based on a series of consultations with key health sector

stakeholders in Ballarat.

In broad terms, this review has shown that the sector is strongly positioned to provide high quality health

and community care services which meet the diverse needs of the Ballarat community. The review has

not highlighted significant, current gaps in service provision or key sector capabilities. Notwithstanding

this statement, the review has revealed some emerging and potentially important issues and

opportunities for the sector and community leaders to consider in relation advocacy and leadership,

investment and development, workforce development and planning and associated promotion of the

expertise and capabilities within the health and community services sector.

Key issues

Advocacy and leadership

Structural changes in the funding of health services by governments are anticipated to address a range

of current and future health service provision issues. The progress and outcome of these new structures

will not be known for some time, and with imminent elections, the health reform and policy may be

subject to further revision and reform which cannot be anticipated at this time. However, the

recognition that these issues are of critical importance is accepted across governments and we can

therefore expect that programs and policy will be developed to address and mitigate them.

Effective and responsive strategic planning that recognises the importance of corporate, clinical,

academic, information and personal governance in healthcare is critical to the success of all

healthcare organisations and practices in Ballarat. Ultimately, the health, safety and wellbeing of

individuals and the community of Ballarat will depend on the alignment and achievement of these

strategic goals. The City of Ballarat, Ballarat community, healthcare providers and educators can work

together to improve healthcare delivery, outcomes and lifestyle in Ballarat.

The City of Ballarat has a role in providing leadership to support the role of Ballarat, its community and

region in the development, implementation and evaluation of the outcomes of new models of

healthcare tailored to the needs and expectations of our community. The City of Ballarat must


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recognise and accept its important leadership and advocacy role in planning, developing,

coordinating and enhancing healthcare in Ballarat.

Investment and development

The development and advancement of healthcare in Ballarat will depend on the adoption of new, best

practice models of healthcare delivery and ensuring that Ballarat has access to and benefits from the

latest and most advanced diagnostic, therapeutic, interventional and surgical technologies.

Information and communications technology (ICT) is a strong sector in the Ballarat economy and offers

significant opportunities to better integrate healthcare across Ballarat. Indeed, effective healthcare ICT

can render the concept of a health precinct redundant by linking patients, practitioners, and

healthcare providers electronically and facilitating the delivery of quality healthcare services in the

home, community or workplace.

In order to support the potential of these flexible, ongoing investments, future sector opportunities will

not only be focussed on bricks and mortar developments, but also increasingly on technology based

delivery, shared services programs for organisations and providers, and delivery of more home-based

services.

Import replacement opportunities (and associated investment attraction) may exist for the key products

and services currently imported by the health sector. Specialised manufacturing may need to be

supported by an investment business case due to potential high level of capital investment that would

be required.

The City of Ballarat can encourage healthcare providers, universities, local industries and government to

foster translational research and development in quality improvement, service delivery, information

technology, needs assessment, social health and clinical practice throughout Ballarat.

Workforce

Like nearly all sectors in Ballarat, the health and community services sector has shown good economic

performance of the past few years. This has been driven by increased service demand, workforce

growth and associated increases in funding and revenue streams. This continued growth, mainly

demand driven, will impose pressures on the existing workforce and the overall capacity of the sector to

meet demand. In addition, funding of public sector health services will undoubtedly become more

competitive. Innovative solutions to workforce attraction and investment will need to be identified and

implemented by the sector.

Ballarat will increasingly become a location of choice for people seeking the health care they require

and desire. It is also likely that the need to provide health services into the wider catchment region will

also increase as neighbouring communities increase their populations. A key issue will be how this

increased demand will be met especially as the population ages. In addition, with an ageing workforce

profile and increased competition for workers in an increasingly tightening labour market, a further key


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issue for the sector is where it will source its required workforce. The development of required skills and

qualifications by the sector within the sector may present opportunities for accessing an appropriately

skilled workforce and assist with workforce attraction and retention activities

How the sector manages its ageing workforce will become of increasing strategic importance. This will

include workforce and employment structures to retain skills within the workforce for as long as possible.

In addition, the potential loss of employers may exacerbate / negate workforce attraction efforts.

Career path development for female workers and attracting highly qualified female professionals may

be avenues for the sector to consider with the profile of the sectors workforce presenting a growing

proportion of female workers. This process may also need to be supported by innovative and flexible

employment structures.

The City of Ballarat, along with other healthcare organisations and agencies in Ballarat, should also

consider specifically targeting young health professionals who have grown up or trained in Ballarat and

the Grampians Region to encourage them to stay on or return to Ballarat on completion of their training.

The role of governments

The Federal and State Government have the lead roles in setting policy and strategy for the provision of

health and community services. This is undertaken through close liaison and co-operation with the

sector and through assessments of current and future needs of communities. These processes of health

service provision and the structures under which this occurs has been subject to significant review by

Federal and State governments over recent months. At the time of this report, the final outcomes of

these reforms to health service provision were subject to the results of the upcoming Federal election, to

be held in August 2010. In addition, the State Victoria was also due to hold state election later in 2010.

Therefore, it was felt that to provide stated positions on the roles of Federal and State government in

relation to health care provision would not be appropriate at this time.

For local government, the role can be more easily articulated, although it should be noted that the

range and level of heath and community service by individual local councils will vary. In essence, local

governments role is to provide broad advocacy and leadership on the health and well-being needs of

its community, based on an understanding of the structures and strategic thinking of its health service

providers. This involves co-operative planning, vision setting, investment and development facilitation

and identify where it can support the sector in terms of workforce attraction and retention.

Recommendations

Advocacy and leadership

The City of Ballarat should work with the health and education sectors to advocate for the attraction of

ongoing and additional medical training dollars to the region.


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The City of Ballarat has a role in providing leadership to support the role of Ballarat, its community and

region in relation to new models of healthcare, tailored to the needs and expectations of the

community.

Consideration should be given to the establishment of timely briefings with targeted health sector

decision makers to support health related strategic planning, vision setting, and dialogue between

healthcare organisations in Ballarat and surrounding districts.

The City of Ballarat must recognise and accept its important leadership and advocacy role in planning,

developing, coordinating and enhancing healthcare in Ballarat.

Investment and development

The City of Ballarat should work with the regional health sector to identify opportunities for integrating

primary health care services through the utilisation of the regions strengths and capacities in eHealth

and ICT. Where gaps in support ICT infrastructure and/or service solutions exist, opportunities to attract

investment and leverage and build regional expertise should be explored.

In partnership with the sector, the City of Ballarat should identify tangible import replacement avenues

and for increasing local spend. These opportunities should focus on existing or the development of

potential supply / expertise within the region whilst also identifying opportunities for attracting new

investment.

The City of Ballarat can encourage healthcare providers, universities, local industries and government to

foster translational research and development in quality improvement, service delivery, information

technology, needs assessment, social health and clinical practice throughout Ballarat.

To support health sector investment and development, the City should consider providing a health

sector facilitation contact within the organisation. A major role of this position will be to assist and guide

business and investment enquiries through Council processes.

Workforce

Opportunities exist for the City of Ballarat to work in partnership with health and community services

providers to provide integrated marketing for workforce attraction and retention. In particular, the City

can provide motivational materials and welcome packages for use by the sector as part of their

recruitment campaigns.


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The importance of workforce planning based around the current and future demographic of the sector

workforce should be advocated and supported by the City of Ballarat.

The City of Ballarat, along with other healthcare organisations and agencies in Ballarat, needs to

specifically target young health professionals who have grown up or trained in Ballarat and the

Grampians Region to encourage them to stay on or return to Ballarat on completion of their training.

Conclusion

The City of Ballarat must recognise and accept its important leadership and advocacy role in planning,

developing and enhancing healthcare in Ballarat. There is the potential to have Ballarat recognised as

a leading centre of healthcare practice, eHealth, learning, research, health promotion and wellness

and to build an evidence-base for healthcare improvements and outcomes that can support health

reform locally, state-wide and nationally. This positioning may also provide the City, the sector and

wider economy with opportunities to attract investment and provide for innovative product and service

development opportunities within local and regional businesses.


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Background

The City of Ballarat commissioned this review of the health sector in the immediate Ballarat region in

order to ascertain the capabilities and capacity of the sector to meet the health and well-being needs

of a growing population. The City recognises the importance and value of the health sector and its

associated interests and the important contribution it make to the socio-economic development of the

community.

Ballarats health, well-being and community services sectors are growing rapidly and are the regions

second largest employer, employing over 15% of the workforce or nearly 6,000 people. Many health

services are located in Ballarat but also provide care to a large regional catchment.

The principal purpose of this report is to provide an overview of the health sector including relevant

community services, and to present recommendations and guidance to further the development of the

sector by exploring current capabilities, identifying current gaps and a review of current policy and

strategic direction.

Definition

The Australian Bureau of Statistics (ABS) defines the health and community services sector as being units

mainly engaged in providing human health care and social assistance. Units engaged in providing

these services apply common processes, where the labour inputs of practitioners with the requisite

expertise and qualifications are integral to production or service delivery. There are six industry sub-

divisions for health under the Australian and New Zealand Standard Industrial Classification (ANZSIC)

2006 coding system.

Sub-sectors

Hospitals and Nursing Homes

Medical and Dental Services

Other Health Services

Veterinary Services

Child Care Services

Community Care Services

To the meet the requirements of this project and following discussions with the project managers, the

key sub-sectors of hospitals, medical and other health services were the focus of this review.

Methodology

The core methodology employed to develop this report included:

Interviews with key health service providers;

A desktop review of key health service providers and support services in the Ballarat region;

A desktop review of health policy and strategies at local, state and national levels; and


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Analysis of economic and workforce data relating to the wider Ballarat economy and the health

and community services sector in particular.

Overview of health sector in Ballarat

Ballarat plays an important regional role in the provision of health and community services. The Ballarat

community has access to a range of healthcare facilities, including two major hospitals, a day

procedure complex, over 100 general medical practitioners and more than 1,000 public and private,

hospital, nursing and hostel beds. Ballarat Health Services (public hospital) and St John of God Health

Care (private hospital) are located in central Ballarat. Both hospitals serve regional catchments and

are leaders in research and development in areas of psychiatry, nursing, allied health, eHealth, and

clinical medicine.

Key health service providers

A high level review of key providers in Ballarat was undertaken. Although the listing does not include all

health and community service providers in Ballarat, the following provides a summary of the main

providers of health care and allied services in our community. A more detailed profile can be found in

Appendix 2: Key health service providers in the Ballarat region. Annual reports and strategic plans for

most of these organisations are available through their respective web-sites.

Ballarat Health Services

Ballarat Health Services (BHS) is the largest regional hospital and the principal referral hospital in the

Grampians regions. BHS provides a comprehensive range of general and specialist care including:

Acute care;

Sub-acute care;

o Aged Care

o Rehabilitation

o Palliative Care

Residential care;

Emergency services;

Community care;

Psychiatric services;

Outpatients and ambulatory services.

BHS also provide community-based psychiatric services in Horsham, Stawell, Ararat and Bacchus Marsh.

St John of God Health Care

The national St John of God Health Care organisation operates 14 hospitals in Australia and New

Zealand, including St John of God Ballarat which recently underwent a $65m redevelopment. A new

ward block, Emergency Department, cardiac and vascular catheter laboratory and outpatient

rehabilitation facility were commissioned as part of the redevelopment.

As St John of Gods largest Victorian hospital, and the states largest regional private hospital, it plays an

important role in improving access to health services for communities across its wide geographic

catchment.


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Ballarat Community Health Centre

Ballarat Community Health provides services across four sites in Ballarat: Sebastopol, the City centre,

East Ballarat and Wendouree. Outreach services and clinics are also provided at a range of locations

throughout the Central Highlands. The organisations mission is to create opportunities and supportive

environments which empower people to develop healthy lifestyles and prevent or manage illness.

Ballarat Community Health Services include the following:

Alcohol & Drug Services

Chronic disease management

Mental Health Services

Community Health Nursing

Counselling Services

Central Highlands Primary Care Partnership

The Central Highlands Primary Care Partnership (CHPCP) encompasses four local government

municipalities, including the City of Ballarat, Golden Plains Shire, Hepburn Shire and Moorabool Shire in

the Central Highlands region. The CHPCP is a voluntary alliance of 36 health, local government, welfare

and human service agencies working collaboratively with the community and other agencies to

improve the health and well-being of the Central Highlands community:

Ballan and District Health and Care

Ballarat and District Aboriginal Co-Op

Ballarat & District Division of General Practice

Ballarat Community Health Centre

Ballarat and District Nursing and Healthcare

Ballarat Health Services

Ballarat Hospice Care Inc

Bluearth

Centacare

Central Highlands General Practice Network

Central Highlands Sports Assembly

Child and Family Services Ballarat

City of Ballarat

Department of Human Services Ballarat

Department of Veterans Affairs Ballarat

Djerriwarrh Health Services

Glastonbury Child and Family Services

Golden Plains Shire Council

Grampians Integrated Cancer Service

Hepburn Health Service

Hepburn Shire Council

Hesse Rural Health Service

Karden Disability Support Foundation

McCallum Disability Service

Moorabool Shire Council

PINARC

Salvation Army Karinya

Southern Cross Care (Vic)

St John of God Health Care

United Way Ballarat

Uniting Care

University of Ballarat

Vision Australia Foundation

Womens Health Grampians

UFS Dispensaries

UFS Dispensaries is a not-for-profit, community based organisation running thirteen pharmacies, two

pharmacy depots, a Medical Centre, a gift shop and a well-being centre throughout Western Victoria.

Services include, Baby Club, Maternal & Child Health Nurse, Home Medication Reviews, Methadone

Program, Healthcare Equipment Sales & Hire, Weight Management Programs, and NDSS.

Ballarat and District Division of General Practice

Ballarat and District Division of General Practice Inc. (BDDGP) is one of 100 divisions of general practice

across Australia - currently 29 in Victoria. Ballarat and District Division of General Practice represents 118

GPs in the local area. BDDGP covers a geographic area of 7,300 square kilometres and a catchment

population of approximately 122,000 people. The catchment includes the city of Ballarat and the

outlying towns of Daylesford, Creswick, Clunes, Skipton and Ballan. BDDGP currently employs

approximately 12.6 EFT staff working across a range of programs.

Projects and programs run by BDDGP in 2008/2009 included, GP Well Being Program; Mental Health

Program; Mental Health Support for Drought Affected Communities initiative; Aged Care Access

Initiative; Continuing Professional Development; Nursing in General Practice and Immunisation Program;

GP Training; Rural Palliative Care Project; and Primary Care Integration.

Private Practitioners

General practitioners, specialist doctors, nurses, allied health professionals, dentists and a wide range of

other practitioners operate private practice businesses in and around Ballarat. These include solo

practitioners, group practice and corporatised practices. The BDDGP is the peak representative body

for the regions general practitioners. Specialist medical practitioners are represented by their College

specialty societies and associations.

Ballarat and District Nursing and Health Care

Ballarat and District Nursing and Health Care (BDNH) is the largest home nursing agency in the

Grampians region and is one of only two independent HACC funded home nursing providers in Victoria.

The core services offered by BDNH include:

Nursing & Home Support Services;

BDNH Podiatry;

Footsteps to Fitness: building community awareness of the health benefits of walking, access to

walking groups and walking options in the Ballarat and surrounding areas; and

Grampians HACC Training: BDNH play a coordinating role in organising training and professional

development for the full range of health and community services professionals working within the

Home and Community Care (HACC) Program.


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Ambulance Victoria

Ambulance Victoria is responsible for pre-hospital emergency medical care and patient transport and

the majority of non-emergency patient transport (NEPT) services for the Victorian population.

Ambulance Victoria currently has 250 ambulance branches strategically located throughout Victoria.

Ambulance Service Victoria (ASV), based in Ballarat, manages ambulance services throughout regional

and rural Victoria. On July 1st, 2008, ASV was integrated with the Metropolitan Ambulance Service to

form Ambulance Victoria.

Department of Human Services

The Victorian Government Department of Human Services, through its Grampians regional office in

Ballarat, oversees the delivery of disability, child protection, youth justice, housing, health and

community services for 216,000 people who live in the region.

Department of Health

The Victorian Governments Department of Health works with the community to provide better access to

health, aged care and mental health and drug services. This is done through managing the public

hospital system, developing health infrastructure in rural and metropolitan Victoria, pursuing

opportunities for partnership with the primary care sector and other governments, public health

interventions, and implementing major health initiatives such as the Victorian Cancer Action Plan.

University of Ballarat

The University of Ballarats School of Nursing works in partnership with health care providers in Ballarat to

offer innovative programs for nurses, midwives, aged care practitioners and other health professionals.

Australian Catholic University

The Ballarat Campus (Aquinas) offers Bachelor of Nursing / Bachelor of Paramedicine courses as well as

graduate and postgraduate courses in midwifery and nursing research.

Other Universities

Deakin University, the University of Melbourne, the University of Notre Dame and Latrobe University all

provide health professional training and clinical placements in Ballarat.

City of Ballarat

The City of Ballarat provides a range of health and community services to the Ballarat community.

These include maternal and child health, immunisation, meals on wheels, family support programs, child

care and play groups and aged in house support programs.


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Literature review

A review of key health strategy and policy was completed with a more detailed analysis of this review

contained in Appendix 3: Literature Review. The review aimed to highlight the key drivers of health

sector development and the issues supporting or constraining this growth and development particularly

within Ballarat.

Whilst many health service providers are located within the Ballarat region, according to the Ballarat

Health Services Strategic Service Plan and Model of Care (2006) their catchment area spreads across 12

local government areas and covers 20% of the State. The Ballarat Health Sector therefore acts as a

central point for regional services spanning a wide area of the Victorian population.

Ballarats health and community services sector is the second highest employing industry in Ballarat

(behind retail trade) employing 5,829 people, or 15.4% of Ballarats workforce (Economic Strategy 2010-

2014). Ballarat is served by a skilled and committed group of medical practitioners representing most

medical specialties including general practice, internal medicine (physicians), aged care and

rehabilitation, anaesthetics, surgery, obstetrics and gynaecology, paediatrics, psychiatry and

emergency medicine.

The Ballarat Health and Community services industry is progressive, adding value through the use of

technology in remote health care and imaging, and is closely linked with the education sector through

medical and clinical schools. The industry also utilises Ballarats information and communications

technology capabilities, with many health providers and ICT firms forming partnerships in order to aid, for

example, the management of health information systems. The City of Ballarat eHealth Capability Study

(2009) highlights these developments and opportunities.

Along with highlighting the key strength and capabilities of the Ballarat Health Sector, the literature also

emphasises a number of current and emerging challenges presented to the industry. These main

challenges include the growing and aging of the population, and skill shortages.

According to the Ballarat Health Services Strategic Service Plan and Model of Care (2006), the

population within Ballarats catchment is projected to increase to 239,856 persons by 2016, which

represents an increase of 0.7% per annum, over this time period. Ballarats own population is expected

to grow by 15, 716 person over the same time period, an annual increase of 1.1% per year1. In addition,

the proportion of people over 70 years of age in the region is expected to increase significantly over the

next 20 years. These trends, along with a steady national increase in the demand for elective surgeries,

will present significant and ongoing growth in the demand for primary and allied health services.

However it appears that problems with capacity are beginning to emerge with the Economic Strategy

2010-2014 highlighting the capacity issues faced by the Ballarat Austin Radiology Oncology Centre.

1 Source: id population forecasts - http://forecast.id.com.au/Default.aspx?id=210&gid=10&pg=30011


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The literature proposes a number of strategies to combat these issues. For example, Rural Directions for

a Stronger, Healthier Victoria (2009), suggests that the region needs to continue to transform service

provision and develop flexible service models to meet community needs. Consolidating health and

community services, according to the Economic Strategy 2010-2014, as a strategic service sector for

Ballarat and surrounding regions is the key to meeting growing demands generated by population

growth. The Central Highlands Regional Strategy (2010) advises that in order to meet this growing

demand, particularly for aged persons, more home-based health services will be required to alleviate

strain on the hospitals.

Another major challenge presented to Ballarat Health Services is the ability to attract and retain

appropriately qualified health professionals including senior and junior medical staff, general and

specialised nurses and allied health professionals. According to the Grampians Region Nurse

Recruitment Five-year Plan (2006), there were approximately 4,300 nurses (3,350 FTE) living and working

in the Grampians region in 2005. This report also cites that nurse numbers are expected to decline as

health services located in larger rural towns or near major regional cities experience difficulties in

attracting and retaining nurses. Furthermore, the supply of nurses is also expected to decrease due to

an ageing workforce.

The literature suggests that there is a lack of graduate and experienced nurses interested in working in

rural areas. Similarly, it appears that practicing in rural areas is also not attractive to many doctors.

These trends have prompted the development and implementation of strategies aimed at attracting

Division 1 and 2 nurses, and qualified general practitioners and their families to the Ballarat region (See

the Grampians Region Nurse Recruitment Five-year Plan and the GP Recruitment Kit). These strategies

aim to promote Ballarat and build its reputation in order to become a preferred location for medical,

nursing and allied health clinicians as well as clinical placements for medical students (Economic

Strategy 2010-2014 pg 19). In the May 2009 budget, the Federal Government announced incentive

schemes to encourage doctors to relocate to regional and rural areas. Direct incentives range from

$15,000 for relocation to regional areas up to $120,000 for very remote areas.

The Ballarat health sector provides an array of services for the health and wellbeing of its community.

But in the face of emerging challenges, it is the consolidation of existing services, continual innovation,

and the ability to attract qualified medical professionals to the region that will sustain the level of

capabilities required to meet the health service demands brought upon by the growing, ageing

population.


Page 20 of 94

Sector overview and literature review summary

Learnings Implications

Ballarat has access to a high

range of public and private

medical services supported by

extensive expertise, technology

and support care services.

Ballarat will increasingly become a location of choice for people

seeking the health care they require and desire. It is also likely that

the need to provide health services into the wider catchment

region will also increase as neighbouring communities increase their

populations. A key issue will be how this increased demand will be

met especially as the population ages.

Many of the key health service

providers (St John of God, BHS,

UFS) have attracted or

undertaken investment to

increase health service

provision.

The importance of delivering investment in health services is

recognised by the public and private sector. In order to support

the potential of flexible, ongoing investments will not only be

focussed on bricks and mortar developments, but also

increasingly on technology based delivery, shared services

programs for organisations and providers, and delivery of more

home-based services.

Certain occupations and in

particular nursing, appear to be

reaching a level of criticality of

supply. The drain of medical

staff from rural areas into larger,

regional centres and the ageing

of the workforce are expected

to further impact on service

capacity, particularly in rural

areas.

Direct intervention by governments through initiatives such as

relocation incentive schemes, and broader promotion opportunities

aimed a medical professionals may address some shortages in

some areas. However, relocation decisions made by professionals,

particularly those with partners and / or families are also influenced

by supporting lifestyle, liveability, partner careers and other

considerations associated with relocation which may not be

directly or adequately addressed by some of these intervention

initiatives.

In summary, the literature

particularly highlights issues

around the consolidation of

existing services, continual

innovation and staff attraction

and retention. This last issue is

being impacted by an ageing

workforce and a growing and

ageing population.

Structural changes in the funding of health services by governments

are anticipated to address some of these health service provision

issues. The progress and outcome of these new structures will not

be known for some time, and with imminent elections, the health

reform and policy may be subject to further revision and reform

which cannot be anticipated at this time. However, the

recognition that these issues are of critical importance is accepted

across governments and we can therefore expect that programs

and policy will be developed to address and mitigate them.

Table 1: Learnings and implications from sector overview and literature review

Health Sector Analysis Report

Recommendations

The City of Ballarat should work with the regional health sector to i

primary health care services through the utilisation of the regions strengths and capacities in

and ICT. Where gaps in support ICT infrastructure and/or service solutions exist, opportunities to attract

investment and leverage and build regional expertise should be explored.

Opportunities may exist for the City of Ballarat to work in partnership with health and community services

providers to provide integrated marketing for workforce attraction and


recruitment campaigns.

Economic analysis

An analysis of the economic performance of the health sector was completed using REM

economic modelling data for the City of Ballarat. The following provides

data provided in Appendix 4: Economic data

Figure

The health and community services sector is the fifth most important sector in terms of output (total

revenues) and demonstrates a 50.2% growth in output from $455.6

except agriculture show output growth over the same period of time.

health services and community services, health services

2010). Health services has grown slightly

to 2010 period.


The City of Ballarat should work with the regional health sector to identify opportunities for integrating

primary health care services through the utilisation of the regions strengths and capacities in

ICT. Where gaps in support ICT infrastructure and/or service solutions exist, opportunities to attract

tment and leverage and build regional expertise should be explored.


providers to provide integrated marketing for workforce attraction and retention. In particular, the City


An analysis of the economic performance of the health sector was completed using REM

economic modelling data for the City of Ballarat. The following provides an analysis summary with full

Appendix 4: Economic data.

Figure 1: Output - all sectors - 2007-2010


.2% growth in output from $455.6m in 2007 to $684.2 in 2010.

except agriculture show output growth over the same period of time. Within the two sub

health services and community services, health services account for 87.5% of total output ($598.1m in

2010). Health services has grown slightly more than community services at a rate of 53.3% over the 2007

Page 21 of 94

dentify opportunities for integrating

primary health care services through the utilisation of the regions strengths and capacities in eHealth

ICT. Where gaps in support ICT infrastructure and/or service solutions exist, opportunities to attract


retention. In particular, the City


An analysis of the economic performance of the health sector was completed using REMPlan

analysis summary with full


m in 2007 to $684.2 in 2010. All sectors

Within the two sub-sectors of

account for 87.5% of total output ($598.1m in

more than community services at a rate of 53.3% over the 2007


Although output is a measure of a sectors performance, due to the service nature of the sector and the

significant government funding it receives and high level sector policy

problematic to make commentary in relation to the economic performance for this sector.

and community services sector is a growth industry in terms of both outputs and employment

may increase competition within the sector for funding and difficulties in attracting and retaining health

sector workers in an increasingly tightening labour market.

The following table and figure shows the performance of the health sector

economy between 2007 and 2010 using key REMPlan indicators.

performed on par with the wider Ballarat economy against the key indicators.

Table 2: Economic performance of health and community services 2007

Figure 2: Health sector economic indicators 2007

The health has shown positive performance across the key indicators. There has been significant growth

in local expenditure by the sector (that is spend by the sector within the Ballarat municipality) and

good growth in wages and salaries and value add.

significant variances in wages within the sector, average wages and salaries within the sector has grown

from $59,000 per person employed to $75,160 per person, an increase of 27.4%.

!"#$

"%!"

&'"!"

! " #



significant government funding it receives and high level sector policy structures, it is somewhat

problematic to make commentary in relation to the economic performance for this sector.

and community services sector is a growth industry in terms of both outputs and employment

in the sector for funding and difficulties in attracting and retaining health

sector workers in an increasingly tightening labour market.

shows the performance of the health sector and the wider Ballarat

using key REMPlan indicators. It shows that the health sector has

performed on par with the wider Ballarat economy against the key indicators.

$ #

%

&

'

%

'#

conomic performance of health and community services 2007-2010

: Health sector economic indicators 2007-2010



good growth in wages and salaries and value add. Whilst acknowledging that there will be some


from $59,000 per person employed to $75,160 per person, an increase of 27.4%.

&'"!" (! %#!)" &'

!)!#$%!*+

(! %#%+ " ,!$$

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Page 22 of 94


structures, it is somewhat

problematic to make commentary in relation to the economic performance for this sector. The health

and community services sector is a growth industry in terms of both outputs and employment and this

in the sector for funding and difficulties in attracting and retaining health

and the wider Ballarat

It shows that the health sector has

&

##



Whilst acknowledging that there will be some


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+

+


Local expenditure and domestic imports

The health sector purchases just over $87m of local products and services within the Ballarat economy.

Figure 3 shows that the key sectors purchased from are property and business services and

manufacturing. The main services purchased from property and business services are legal, accounting,

marketing and business management services and scientific research, technical and computer serv

From manufacturing, the health sector chiefly purchase

chemical and chemical products.

Figure

Further analysis of the local expenditure trends

and services at the following level from the following key sub sectors ($ spend +$5m in 2010).

Sector

Property & business services

Communication services

Wholesale trade

Finance & insurance

Other machinery & equipment

Personal & other services

Total

Table

%'#(#

)


mestic imports


ors purchased from are property and business services and


marketing and business management services and scientific research, technical and computer serv

From manufacturing, the health sector chiefly purchases other machinery and equipment and

Figure 3: Local expenditure by sector by health

Further analysis of the local expenditure trends shows that health and community services buys good


2007 ($m) 2010 ($m) $

$9.6 $22.2 $12.6

$3.2 $9.2 $5.9

$2.3 $7.9 $5.6

$2.5 $7.1 $4.6

$2.2 $6.3 $4.1

$2.9 $5.9

$22.7 $58.6 $35.8

Table 3: Local health sector expenditure trends

%'#(#

)

Page 23 of 94


ors purchased from are property and business services and


marketing and business management services and scientific research, technical and computer services.

s other machinery and equipment and

shows that health and community services buys good


$ ($m) %

$12.6 132%

$5.9 185%

$5.6 238%

$4.6 181%

$4.1 187%

$3 104%

$35.8 158%

+


The health and community services sectors imports a total of $59.4m of product and services, and of this,

$53.6m is imported from within Australia.

majority of domestic imports followed by property and business services.

Figure 4: Domestic imports by the

A comparison was also made of local expenditure versus domestic imports by sector by the health

sector. This was undertaken in order to ascertain where the greatest opportunity may exist for import

replacement and associated investment attraction.

Figure 5: Local expenditure versus domestic imports by sector

* ((#

)

%'#)# (



$53.6m is imported from within Australia. Figure 4 shows that manufactured products comprise th

majority of domestic imports followed by property and business services.

: Domestic imports by the health and community services sector



ociated investment attraction.

: Local expenditure versus domestic imports by sector

* ((#

)

%'#)# (

&'!) -+ !"%'%+ "

Page 24 of 94


manufactured products comprise the



* ((#

)


Page 25 of 94

Figure 5 shows that manufacturing is the only sector where imported products are greater in value than

products purchased locally by the health sector. Table 4 provides an analysis of the key sub-sectors

within manufacturing and property and business services and shows that the health and community

services sectors imports the following products and services.

Product / sector Value

Photographic and scientific equipment $10.7m

Medicinal and pharmaceutical products $6.2m

Legal, accounting, marketing and business management services $4m

Other business services $3.4m

Paper containers and products $3m

Table 4: Key imported domestic products and services

The two main manufactured products would appear to be highly health sector specific and specialised.

Investment attraction within these supply chains would need to a very robust business case due to the

potentially high level of development investment required. The property and business services imported

would appear to be areas which local Ballarat companies could increase supply to the health sector.

Value of the sector

Research and analysis undertaken by the Council as part of the ED2014 shows that property and

business services, health and community, manufacturing and ICT are among the economic drivers of

the local economy. Table 3 would appear to further support this thinking with key support sectors of

health including those identified sectoral economic drivers. It would also appear to support the premise

that growth sectors within the local economy both support and derive benefit from each other.

Another indicator of the value of the sector is analysing the impacts on job creation within the sector on

the wider economy. As noted, the health workforce has grown by 16.5% over a five-year period. If this

trends continues, we can estimate that the workforce will grow by at least a further 1,000 employees

over the next 5 years. Using impact modelling, Table 5 shows the multiplier of this employment growth.

Direct Effect

Industrial Flow On

Effect

Consumption Flow On

Effect Total Type 1 Multiplier

Type 2 Multiplier

Output ($M) $117.4 $21.7 $76.2 $215.3 1.185 1.834

Employment (Jobs) +1,000 71 338 1,409 1.071 1.409

Wages and Salaries ($M) $75.2 $5.7 $21.6 $102.5 1.076 1.363

Value Added ($M) $92.2 $9.7 $35.3 $137.2 1.105 1.487

Table 5: Job creation impacts


Page 26 of 94

The table shows that 1,000 jobs created within the health and community services sector leads to a

further 71 jobs created within the sector and 338 in other industry sectors. These would be mainly in retail

(125), property and business services (38), manufacturing and education (29 each).

In addition, the economic flow-ons include an increase in overall output within the economy of $215.3m,

additional wages and salaries of $102.5m and a further $137.2m in value-add within the economy.

These multiplier effects would be similar to like job creation within education, retail and personal and

other services sectors. When compared to multiplier effects within other sectors such as manufacturing,

professional and business services, and communication services, the health and community services

sector impacts are relatively low. This is in part due to the lower levels of local intra-sector linkages of the

health sector and its public service delivery rather than commercial product profile.

Economic analysis summary

Learnings Implications

Like nearly all sectors in Ballarat,

the health and community services

sector has shown good economic

performance of the past few years.

This has been driven by increased

service demand, workforce growth

and associated increases in

funding and revenue streams.

This continued growth, mainly demand driven will impose

pressures on the existing workforce and the overall capacity of the

sector to meet demand. In addition, funding of public sector

health services will undoubtedly become more competitive.

Innovative solutions to workforce attraction and investment will

need to be identified and implemented by the sector.

Growth in the health sector has

important economic flow on

benefits to the wider Ballarat

economy.

Although an important driver within the local economy, these flow

on benefits are not as high as similar growth impacts from within

other sectors. In addition, local expenditure by the sector within

Ballarat is relatively low apart from property and business services

and manufacturing. This may present opportunities for increasing

expenditure by health within other sectors.

Key imports by the health sector

appear to be within specialised

manufacturing and property and

business services.

Import replacement opportunities (and associated investment

attraction) may exist for the key products and services currently

imported by the health sector. Specialised manufacturing may

need to be supported by an investment business case due to

potential high level of capital investment that would be required.

This high wage sector provides

significant value to the local

economy.

Provides a competitive advantage for the sector in relation to

workforce attraction and retention and employment generation

in other sectors.

Table 6: Economic analysis summary


Recommendations

In partnership with the sector, the City of B


potential supply / expertise within the region whilst also identifying opportunities for attract

investment.

Health sector workforce

Capacity and sustainability

Helath and community services is the second most important employment sector after retail trade and

accounts for 15.5% of workforce, employing 5,829 people. The workforce has grown by 16.5% between

2001 an 2006 (ABS Census data periods), an increase of 82

continue at the same rate, it can be estimated that there will be approximately 6,790 employed in the

sector in 2011. The City of Ballarat Economic Strategy 2010

will be 10,941 people working in the sector. Within the two sub

people which represents 13.5% of the total Ballarat workforce and 80% of the total sector workforce.

The REMPlan workforce modelling system uses ABS Census d

workforce is Ballarat at that time was 37,708 people working in Ballarat.

presented are based on this figure.

Figure

The following provides a summary of the key workforce characteristics and profiling of the workforce.

More in-depth workforce data is provided in


In partnership with the sector, the City of Ballarat should identify tangible import replacement avenues


potential supply / expertise within the region whilst also identifying opportunities for attract



2001 an 2006 (ABS Census data periods), an increase of 824 employees. Should this employment trend


sector in 2011. The City of Ballarat Economic Strategy 2010-2014 (ED2014) estimates that by 2026, there

e 10,941 people working in the sector. Within the two sub- sectors, health services employ 4,543


The REMPlan workforce modelling system uses ABS Census data from 2006 which shows that the total

workforce is Ballarat at that time was 37,708 people working in Ballarat. Sector workforce figures

Figure 6: Employment - all sectors -2001 2006


depth workforce data is provided in Appendix 5: Health sector workforce data

+

Page 27 of 94

allarat should identify tangible import replacement avenues


potential supply / expertise within the region whilst also identifying opportunities for attracting new



4 employees. Should this employment trend


2014 (ED2014) estimates that by 2026, there

sectors, health services employ 4,543


ata from 2006 which shows that the total

Sector workforce figures


Appendix 5: Health sector workforce data.

./"

./"


Age profile

Using REMPlan data sets, Figure 7 presents the overall age profile of the Ballarat workforce compared to

state and national profiles.

Figure 7: Age profile

There are some differentials between the age profile of the Ballarat workforce and state and national

profiles. Ballarat has a slightly higher proportion of workers aged under 24 years, but this profile then

declines between the years of 25 and 44 years. Thi

age group. Workers aged between 45 and 54 years is slightly higher in Ballarat than elsewhere and

slightly lower in the 55 to 74 years age groups. The data shows that 47% of the workforce in Balla

aged between 35 and 54 years. However, when we look at the age profile comparisons within the

health and community services sector, we see a different profile as presented in

0 0 0

, - "


presents the overall age profile of the Ballarat workforce compared to

: Age profile comparison of the Ballarat workforce

e are some differentials between the age profile of the Ballarat workforce and state and national


declines between the years of 25 and 44 years. This may indicate a loss of workers from the region in this


slightly lower in the 55 to 74 years age groups. The data shows that 47% of the workforce in Balla


health and community services sector, we see a different profile as presented in Figure

0 0 0 0 0 1 2!

, - "

Page 28 of 94

presents the overall age profile of the Ballarat workforce compared to

e are some differentials between the age profile of the Ballarat workforce and state and national


s may indicate a loss of workers from the region in this


slightly lower in the 55 to 74 years age groups. The data shows that 47% of the workforce in Ballarat is


Figure 8.

1 2!

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3%#

,%'%

3%#

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Figure 8: Age profile comparison of the health sector workforce

The 15 to 34 age groups are lower in the Ballarat health sector workforce than elsewhere.

profile then increases with nearly 32% of the health sector workforce in Ballarat aged between 45 and

54 years compared to 28.7% for Victoria and 29.1% for Australia as a whole. The workforce then

becomes slightly younger than elsewhere from 55 ye

made of the age profile of the workforce

Figure 9

The data shows that the health sector has the second highest proportion of workers

groups, and the fourth oldest workforce across all industry sectors in

defined in Figure 10.

0 0 0

, - "

$ "


: Age profile comparison of the health sector workforce

The 15 to 34 age groups are lower in the Ballarat health sector workforce than elsewhere.

profile then increases with nearly 32% of the health sector workforce in Ballarat aged between 45 and

54 years compared to 28.7% for Victoria and 29.1% for Australia as a whole. The workforce then

becomes slightly younger than elsewhere from 55 y