Health Reform and Children:

NSW Perspective

Prof Les White AM DSc

NSW Chief Paediatrician

October 2012

2

An integrated National Health and Hospitals Network

- Organisational elements

National Health Reform

April 2010 – COAG (not WA) signed the National

Health and Hospitals Reform Agreement

February 2011 – Commonwealth and all State &

Territory Governments agreed to a new Heads of

Agreement, providing in principle commitment

August 2011 – Release of new Health Reform

Agreement, finalising the in-principle Agreement

Ch 2: Nurturing a Healthy Start to Life (Recs 22-26)

Key Elements of the Health Reform Agreement

New funding arrangements:

– National Funding Pool

– Activity based funding (ABF) from 1 July 2012

– C‟th shares efficient growth costs 50/50 by 2017.

New National Performance Standards – including:

– Four hour National Access Target for ED

– National Access Guarantee for Elective Surgery.

National Safety and Quality Standards

Medicare Locals (commenced 1 July 2011).

Maintaining focus on local management &

governance.

Role of the States

The Agreement confirms the crucial role of the States,

as system managers for the public health system,

including:

– System-wide public hospital service planning and

performance

– Purchasing of public hospital services

– Planning, funding, and delivering capital

– Planning, funding (with the Commonwealth) and

delivering teaching, research and training

New National Bodies

• National Hospital Performance Authority -Performance and Accountability FrameworkAccountability

• National Funding BodyTransparency

• Independent Hospital Pricing AuthorityPricing

• Australian Commission on Safety and Quality in HealthcareStandards

• Health Workforce AustraliaWorkforce

• National Preventative Health AuthorityPrevention

National approach to efficient prices

Activity based funded (ABF) for public hospital services

will flow from the national pool to State accounts and

then to LHDs

A national system of ABF commenced from 1 July 2012

Funding will flow directly to State Governments for

(a) Block funded hospitals services and

(b) Teaching, training and research in public hospitals

ABF update: August 2012

National Efficient Price Determination

- Appendix B; Table 1 (all AP‟s)

NWAU = $4,808 / NSW = $4,471

Price weight adjustment hierarchy

Education / Information

- National; IHPA

- NSW: ABF Bulletin

Web resources; Resource Kit

Roadshow; Discussions

National & NSW paediatric agenda

Reviews, changes, new DRG version

ABF update: August 2012

Chapter 5 Adjustments

5.2 Precedence of Adjustments

To avoid doubt, Adjustments have the following order of

precedence of application:

a) Paediatric Adjustment (55, 25, 20%); then

b) any Remoteness Area Adjustment (8.7, 15.3, 19.4%)

and/or Indigenous Adjustment; then

c) ICU Adjustment (not ICU DRG‟s); then

d) Private Patient Service Adjustment; then

e) Private Patient Accommodation Adjustment.

National Efficient Price Determination 2012-2013

Special Commission of Inquiry

Special Commission of Inquiry into Acute Care Services in NSW Public

Hospitals

Extensive consultation: written submissions; hospital visits; evidence

from patients, community, clinicians; peak bodies; conferences

Final report made 139 recommendations – three refer to NSW Kids

– Create a new state-wide authority (R.9)

– Coverage - all paediatric inpatient facilities in all hospitals,

community activities (prevention, early intervention and ongoing

specialist)

– Publish a state-wide strategic service delivery plan for child and

youth services (R.10)

– Investigate the need for a new kids hospital (R.11)

Special Commission of Inquiry

“It concerns me that in NSW there is currently a lack of coordination of

paediatric and young person’s health care in public hospitals throughout

the state.”

“.. what is required is a single state-wide authority that provides for the

full range of medical care for children and young people. ..”

“Every child in NSW, regardless of where they live and of their

circumstances, should have access to the best health care both in

community (child health services) and hospital (paediatric services)

settings”

Peter Garling SC

Initial Achievements

Sydney Children‟s Hospitals Network (Randwick and

Westmead) established

Maternity, Child and Young People‟s Health Branch

Appointment of a Chief Paediatrician, Senior Clinical

Advisor Child Health and Senior Clinical Advisor Child

Protection

Establishment of the Children and Young People's

Health Program Council

“Children First & Forem

“Children First & Foremost”

Chief Paediatrician for NSW

Advocate for the health and wellbeing of children

Clinician leadership; System wide engagement

Promote and facilitate the NSW Kids and Families strategy

Liaise with Local Health Districts, Specialty Networks,

Pillars and MoH branches

Engage beyond NSW Health

Progress networks across spectrum of children‟s health

Rural / remote priorities

NSW Public Health System

Local Health Districts

Specialty Networks: Sydney Children‟s Hospital Network;

Forensic Mental Health Network; St Vincent‟s Health Network

Four Pillars: Health Education and Training Institute; Agency for

Clinical Innovation; Bureau of Health Information; Clinical

Excellence Commission

MH Commission; NSW Cancer Institute

Other Public Health Organisations: Justice Health; Ambulance;

Health Support Services; Health Infrastructure; eHealth NSW

NSW Ministry of Health (Governance Review)

Local Health Districts (7 Rural & Regional)

Local Health Districts (8 Metro)

NSW Child Health Network Coverage

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Level 4

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Comprehensive Model of Child Health & Wellbeing

and

Establishing a new authority for NSW children, young

people and their families

Child Health Network Forum announcement

NSW Kids Expert Group established

Future Governance Arrangements for Children and Young Peoples Health Services NSW report released and NSW Kids and Families announced

Garling

recommendations

On 22 July 2011 The Hon Jillian Skinner MP Minister for Health

and Minister for Medical Research opened the NSW Child

Health Network Forum (Sydney) by emphasising the need for

safe and appropriate care of children in all situations

The Minister asked the Director-General and the Ministry of

Health to devise a NSW Kids Plan, which is closer to the intent

of the Garling Recommendations.

“NSW needs a long term system wide approach to the

delivery of child and young people‟s health services and

paediatric care.” (The Hon Jillian Skinner MP 20 August 2011)

Minister announces commitment to a statewide approach to

the health and wellbeing of children

• Appointed by Director-General, Ministry of Health in September 2011

• Established to review progress on implementation of the Garling

recommendations, and advise the Minister and Director-General on a „preferred

governance structure and other elements required for the effective delivery of a

strategy for children and young person‟s health services throughout the state‟

• Targeted consultation with key stakeholders, building on previous consultation

• Considered a range of models and their applicability in new NSW Health

Governance

• The Expert Group Report made a range of recommendations, including a Board

governed statutory health corporation structure

• The Minister for Health accepted all of the Expert Group recommendations,

endorsed by NSW Cabinet

• The Report can be viewed at www.health.nsw.gov.au/nswkids

Expert Group

Establishment of NSW Kids and Families announced

NSW Kids and Families, a new statutory health corporation, to be

established under the Health Services Act 1997 and to commence on

1 July 2012

Champion the health interests of children and young people whether

they are at home, in the community or in or out of hospital

Includes health services for mothers & babies, children, young

people, parents and families

NSW Kids and Families will have a Board chaired by The Hon Ron

Phillips and have the following members: Clinical Professor David

Bennett AO, Ms Ann Brassil, Mrs Christine Corby OAM, Dr Susie

Piper, Professor Graham Vimpani AM and Emeritus Professor

William Walters AM. Standing invitees: Dr Christine Bennett (SCHN)

and Prof Les White AM (Chief Paed)

Relationship to NSW Health Governance Including Sydney Children’s Hospitals Network (Randwick and Westmead)

NSW Kids & Families

CE appointed; staff to be drawn from MCYH Branch and 3 other

Organisational structure finalised – 4 teams: Maternity and Child

Health; Paediatric Health Care; Youth Health and Wellbeing; and

Child Protection and Violence Prevention / Response

Work plan and immediate priorities will be determined – mid

November onwards

Consultation on longer term strategic direction during 2012-2013;

coherence with broader State and NSW Health Plans

Interface with: Pillars, LHD‟s, SCHN, Medicare Locals, Ministry,

Government agencies, will be critical to INFLUENCE outcomes

Longitudinal and system-wide perspectives

NSW KIDS AND FAMILIES

Purpose Statement (second draft following staff feedback)

PURPOSE

NSW Kids and Families will champion world class health outcomes

and services for children and families of NSW through consultation,

evaluation, innovation and the development of shared knowledge.

ROLE

To provide leadership to the NSW Health system on strategies

which deliver outstanding child and family healthcare services and

give every child the best chance of fulfilling their potential as citizens

of NSW.

NSW KIDS AND FAMILIES

Purpose Statement (2nd draft following staff feedback)

WHO: Brings together expertise and resources from within NSW

Health to focus knowledge, effort and action for the health

benefit of families and health care provision located in NSW

HOW: By working collaboratively with the Ministry and agencies

within NSW health, other government departments, primary

health care providers, non-government organisations,

communities and families to develop evidence based practice

in service of LHDs, Sydney Children‟s Hospitals Network and

other providers responsible for delivering health care services

to children and their families

NSW KIDS AND FAMILIES

Purpose Statement (2nd draft following staff feedback)

WHAT:

Develop and support the implementation of evidence- based policies, guidelines

and practices that reduce risk and improve the quality and continuity of

healthcare delivery

Reduce the prevalence and health impact of violence and neglect on

individuals, families and the communities in which they live

Stimulate applied research and support uptake of new programs and innovative

models of health care delivery

Design and monitor service standards and evaluate impact on health outcomes

Build the capacity of healthcare workers, communities, parents and carers to

promote and protect the health and wellbeing of mothers, babies, children and

young people

Provide expert advice in relation to the health, wellbeing and healthcare of

mothers, babies, children, young people and their families