Transcript Presentation heading (Arial 26 pt) white

National Service Planners Forum:
Toward sustainable system wide
service planning
Sue Brennan
Manager, Strategic Planning & Asset Management
7 April 2011
Context, challenges and initiatives
Context
A lot has happened in Victoria – and elsewhere – since we last
met
• Departmental restructure – Health Department
• National Health Reform – marks 1 and 2
• Federal Election
• State Election (Victoria and others)
• New Government
Concurrently, our endeavours to plan well have continued
The growth keeps on coming
Victoria’s
population
projected to
2030
Service Planning is dynamic and multi faceted –
a basic representation of Victoria’s approach
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WOG Planning
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DH Policy and Strategy
Program Planning
Service System Planning
Health Service Planning
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Health service planning is part of whole of
government planning
Department of Health engages with state’s population, land use, urban and
transport planners and other groups, to inform where services and assets will
be required
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challenges include early land purchase/allocation, how to plan for a mixed
health model; can integrated infrastructure create value
The Victorian government has committed to a new plan for Metropolitan
Melbourne (~ 2 years to prepare) –
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impact of location, nature and balance between in fill and expanded
boundaries, on health planning
Victorian health specific initiative – development of transport distribution
model
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This uses transport system modelling techniques to distribute health
activity across hospitals according to travel time. Can model different
hospital size, location and service mix to inform where the
services/capacity, should go
Plans and commitments for health
State government commitment to Health Services Plan 2022
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Metropolitan health plan
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Rural and Regional health plan
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Capital works plan
State government commitment to 800 additional beds in first term and further
800 in second term; election commitments; upcoming budget
National health reform
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Many issues still being worked through including performance
requirements
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Strong focus on enhanced sub acute and elective and emergency
services with related asset development (336 beds)
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System wide approach including redesign projects to improve performance
Commonwealth Health and Hospitals Fund
Forecasts and trends inform service planning –
what services are needed into the future?
2011 Inpatient Forecast Model close to finalisation
Continued decline in LOS –
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All (multiday and same day) - 3.19 days (from 3.23)
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Multiday – 6.10 (from 6.23)
Increase in projected beddays (3% per annum to 2009-10 - 2021-22)
Highest areas of forecast % increase in separations:
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Acute multiday: emergency medical and endoscopy
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Acute sameday: renal dialysis, chemotherapy and endoscopy
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Sub acute
In growth areas of Melbourne (north, west and south-east) and major
regional centres
Average length of stay
Length of stay by age, based on 2010 forecast
(08-09 data)
10.00
9.00
8.00
7.00
6.00
5.00
4.00
3.00
2.00
1.00
0.00
0-14
15-44
45-69
70-84
85+
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Capacity planning – what assets are needed to
deliver services?
Gap in skills and information base –
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Can forecast and analyse service need, articulate changing models of
care and plan for mitigation and management of demand (with limits in
terms of quantifying impact)
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Service planning needs to be combined with an understanding of existing
assets, their utilisation/occupancy, length of remaining functional life etc,
to be effective
Victorian initiatives - examples
Recent bed census of physical capacity
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Will round out information base
Review of service benchmarks related to functional spaces
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No longer aligned with practice (in at least some cases).
Project under definition
Service and capacity planning – renal dialysis
How to manage high growth forecast
Models of care (eg)
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increase home based treatment & peritoneal dialysis
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End of life care (conservative pathways)
Capacity planning
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Analyse occupancy/utilisation of existing chairs – variable; not fully occupied
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Calculate throughput according to different shift models eg 2/3 per day
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Able to accommodate significant projected growth through better use of
existing capacity; saves capital not recurrent
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Policy issues – eg rural access
Governance & funding models
Mitigating and managing demand – prevention,
diversion/substitution, efficiency
Medical patients
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Promotion & prevention of chronic disease – long term impact (note
recent suggested obesity decline in young children)
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Better management of chronic disease in the community – unrealised
potential (eg re-presentations to emergency departments and
readmission to hospital) – timely access to care and advice within
integrated system
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Efficient use of hospital care – focus on short stay models, eg up to 72
hours. Gains in reducing length of stay. No system wide picture yet
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Maximising use of our resources - scope for better understanding of
interaction between acute and sub acute services (important for
jurisdictions growing their sub acute to consider)
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Better measurement and benchmarking of performance and the impact of
models of care and new initiatives
Area based planning - Modelled Bed Growth By Planning
Area and Hospital Supply/Resident Demand from 2008/09
to 2021/22 (Base Case – No Policy Change)
700
Growth for Hos pi tal Suppl y
Growth For Res i dent Dema nd
600
500
400
200
100
Ea s tern
Northern
Peni ns ul a
Southern
Wes tern
Wyndham
Western
Growth Area
Inner West
South East
Growth Area
Middle
South East
Inner South
Peninsula
Northern
Growth Area
Inner North
Diamond
Valley
Yarra Valley
Inner East
0
Dandenong
Ranges
Beds
300
Area and Health Service (entity, campus, clinical
stream) planning
All data analysed on area basis, eg flows; projected growth
Need to move increased capacity closer to home
Increased focus on plans for areas/corridors/sub regions and
entity wide plans for health services with a large geographic
base
Gives the umbrella view into the future which then drops down
service planning by campus and service level according to
priorities (driven by settlement patterns, service growth, fabric,
sequencing), and capital planning
Significant work underway across all major health services, by
geographic service and capital planning and capital
development teams within DH
Linking service planning to asset and site
planning for a system wide plan
Site planning
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analysis of sites to ensure major sites can accommodate projected
medium term service growth; longer term – what land/sites do we
need?
Scale of asset base
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drivers of replacement/expansion cost are square metreage (itself
driven by increasing standards) and escalating construction costs.
Are we managing those best for the future?
Improving asset information management to support decision making
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Integrating data about asset condition, obsolescence and
remaining functional life to help prioritise and sequence asset
replacement
Planning sustainable service growth aligning capital and recurrent
funding scenarios
Future opportunities and risks
Key opportunity
• Improve our long term planning, evidence base and
scenario development across domains – eg service,
asset, capital and recurrent funding projections – to
underpin service development and asset investment
decisions and maximise their effectiveness
Key risk
• Investment combined with model of care and efficiency
innovations will be insufficient to maintain a high
performing health system which provides high quality
contemporary health care