Adelaide Hills (Mount Barker, Mount Pleasant, Gumeracha, Strathalbyn)
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Adelaide Hills
(Mount Barker, Mount Pleasant, Gumeracha,
Strathalbyn)
10 Year Local Health Service Plan
2011 – 2020
Mount Pleasant District Hospital
Gumeracha District Soldiers’ Memorial Hospital
Mount Barker District Soldiers’ Memorial Hospital
Strathalbyn and Districts Health Services
Adelaide Hills Community Health Service
Country Health SA Local Health Network
110 Year Local Health Service Plan
Adelaide Hills Country Health Services
2011 - 2020
Table of Contents
1. Executive Summary ....................................................................................................... 3
2. Catchment summary...................................................................................................... 8
3. Needs Analysis summary............................................................................................ 11
4. Local implications of Statewide plans........................................................................ 15
5. Planning Principles...................................................................................................... 16
6. Service Delivery Plan ................................................................................................... 17
6.1 Core Services to be Sustained ............................................................................... 17
6.2 Strategies for new / expanded services .................................................................. 24
7. Key Requirements for Supporting Services............................................................... 33
7.1 Safety and Quality .................................................................................................. 33
7.2 Patient Journey ...................................................................................................... 34
7.3 Cultural Respect..................................................................................................... 35
7.4 Engaging with our community................................................................................. 36
7.5 Local Clinical Networks .......................................................................................... 37
8. Resources Strategy ..................................................................................................... 38
8.1 Workforce............................................................................................................... 38
8.2 Infrastructure .......................................................................................................... 40
8.3 Finance .................................................................................................................. 41
8.4 Information Technology .......................................................................................... 42
8.5 Risk Analysis .......................................................................................................... 43
9. Appendix ...................................................................................................................... 44
9.1 Leadership Structure .............................................................................................. 44
9.2 Methodology........................................................................................................... 44
9.3 Review Process...................................................................................................... 45
9.4 Glossary ................................................................................................................. 46
Date: 8 August 2011
21. Executive Summary
“We acknowledge this land as the traditional lands for the Peramangk people and that we respect
their spiritual relationship with their country. We also acknowledge the Peramangk people as the
custodians of the Adelaide Hills region and that their cultural and heritage beliefs are still as important
to the living Peramangk people today.”
The Hills Area is east of the capital city of Adelaide in South Australia with Mount Barker 33
kilometres, Strathalbyn 56 kilometres, Mount Pleasant 54 kilometres and Gumeracha 36 kilometres
from Adelaide. There are four Hospitals and a Community Health Service in the Hills Area including
Mount Barker District Soldiers’ Memorial (DSM) Hospital, Strathalbyn and District Health Service,
Gumeracha District Soldiers’ Memorial (DSM) Hospital and Mount Pleasant District Hospital. Adelaide
Hills Community Health Service (AHCHS) is a multidisciplinary agency providing a diverse range of
community health preventative, early intervention, health promotion, better care in the community and
hospital avoidance / GP Plus health service programs.
The Hills catchment area extends to Kersbrook and Springton to the north, Lobethal and Stirling to the
west, Callington and Palmer to the east, and Ashbourne and Milang to the south. The resident
population for the Hills Area Hospitals is 60, 690 (DPLG, Population Projections 2011). The resident
population incorporating the total catchment for Adelaide Hills Community Health Service is 84,548.
People from Aboriginal and Torres Strait Islander backgrounds comprise 0.7% of the population
catchment, compared with 1.7% of the total South Australian (SA) population. There are 439 people
who have identified themselves as Aboriginal in the last ABS Census. The Peramangk people are the
original custodians of the land in the Hills Area.
Over the past 10 years the District Council of Mount Barker (DCMB) has been the fastest growing non
coastal Council within Australia, averaging 3% growth per annum1. The Hills Area is one of the
fastest growing populations in South Australia with the conservative projected population estimated to
increase to 81,639 by the year 2021. The Country Health SA Local Health Network (CHSALHN)
projected population for the broader Adelaide Hills Community Health Service catchment is estimated
to increase to 105,758 by the year 2021. However the SA Department of Planning and Local
Government2 sets a population growth target of 20,300 by 2024, for the combined population of the
townships of Mount Barker, Littlehampton and Nairne, leading to a population of approximately
40,000 people. This is a doubling of the existing population for that area3. This 10 Year Local Health
Service Plan recommends the same approach to planning health services for the Hills Area and the
Mount Barker and Strathalbyn districts in particular.
The Hills Area 10 year Health Service Plan reflects consultation between the Adelaide Hills Health
Advisory Council, the Adelaide Hills Division of General Practice and the existing Country Health SA
health units, namely Adelaide Hills Community Health Service, and Mt Pleasant, Gumeracha, Mt
Barker and Strathalbyn Hospitals. The plan is about providing services closer to home for the Hills
Area residents and providing better care in the community resulting in hospital avoidance. The overall
vision supported within the plan is that in 10 years time (2020) 80% of the hills area population have
access to services that meet 80% of their health care needs within the hills area. This will mean in
real terms a transition of primary and secondary services across the region. It will require Mt Barker
DSM Hospital to provide a new range of services aligned with statewide plans so that only patients
requiring highly specialised or complex care will need to access this type of care in Adelaide. These
services will be supported by rehabilitation services at Strathalbyn Health Services, integrated closely
with statewide rehabilitation directions and an Integrated Health Care Centre at Mt Barker built on the
Hospital Grounds and linked to services throughout the hills area. Existing services provided at Mt
Pleasant Hospital are to continue and an expanded role in bowel screening program to be
investigated. Existing services at Gumeracha Hospital are to continue. Adelaide Hills Community
1
The District Council of Mount Barker (2009). Council Submission to the Draft 30 Year Plan for Greater Adelaide.
2
SA Department of Planning and Local Government (2009). Planning the Adelaide we all want: Progressing the 30 Year
Plan for Greater Adelaide.
3
SA Department of Planning and Local Government (2009). Planning the Adelaide we all want: Progressing the 30 Year
Plan for Greater Adelaide.
3Health Service is to have an expanded role in collaboration with all key stakeholders within the
Integrated Health Care Centre. A GP Plus Super Clinic has been supported by the federal Minister for
Health, the Hon. Nicola Roxon who has pledged up to $7 Million seeding funding to the Adelaide Hills
Division of General Practice. The Division and Hills Area Health Advisory council support the building
of the GP Plus Centre at Mt Barker on the Hospital Grounds.
Through this vision, priority needs identified through the needs analysis process which informed the
planning process will be addressed.
ENHANCED PRIMARY HEALTH CARE
• Partnerships and collaboration across organisations such as those evidenced within the SA
Inner Country Health Network will result in better health outcomes for the population
• Increased flexible funding arrangements that support changing models of care and enable
greater provision of outpatient, day patient and community based care is enabled through
effective partnerships to maximise expertise and funding streams.
• Strengthened primary and community based care and transition services to and from hospital
via the Better Care in the Community initiative (incorporates self managed care for chronic
disease).
• Funded early intervention, illness (disease) prevention and health promotion initiatives.
• Redesigned aged care support infrastructure to support GP Plus initiatives.
“A high quality and effective acute care system depends, in part on robust primary health care,
community care and post acute care services being in place” (SA Health Submission to the National
Health and Hospitals Reform Commission)
LINKED PUBLIC TRANSPORT SYSTEM FOR THE HILLS AREA
It is essential to the success of the above vision that an integrated public transport system connecting
townships between Mt Pleasant, Gumeracha and Strathalbyn to Mt Barker is developed.
INCREASED CAPACITY TO CARE FOR LOCAL POPULATION
Clinical Governance to support the local General Practitioners will be enhanced by the
implementation of the Integrated Health Care Centre. This will enable access to both residential and
visiting specialist care, recruitment and retention of a skilled health care workforce, training capacity in
the areas of obstetrics, anaesthetics and procedures for local GPs. It will also provide opportunity for
building links to tertiary health services and utilising e-health technology.
Increased AND redesigned disability support.
Increased access to timely mental health specialist care.
Utilisation of e-health technology.
Ensure that emergency department in each hospital is appropriate to the population health needs of
the immediate community
Importance of partnerships with General Practice and future developments in Commonwealth health
reform, such as Medical Local networks.
HEALTH PROMOTION
Support the provision of opportunities for exercise eg. sporting fields / clubs and healthy lifestyle
support.
4Key Recommendations:
PROVIDING SERVICES CLOSER TO HOME:
1. Liaise with Adelaide Health Service (formerly Central Northern Adelaide Health Service and
Southern Adelaide Health Service) to address opportunities to provide local access to services
instead of travelling to metropolitan services.
a. Identify the services that are more appropriately accessed throughout the Adelaide Hills
Service catchment based on the changing health needs of the population in the
catchment and work to repatriate services into the Hills
b. Identify the services that will continue to be accessed in metropolitan Adelaide as Mt
Barker expands its role in line with statewide plans.
c. Explore a medical link between Royal Adelaide Hospital Emergency Department (ED)
and Mount Barker DSM Hospital ED in the first instance, building capacity for
collaboration regarding more complex inpatient management in the future.
2. Implement an Integrated Health Care Centre at Mount Barker (IHCC). The IHCC will deliver:
• Increased opportunities for provision of specialist services
• Development of multidisciplinary care models
• Enabled early intervention and prevention strategies
• Enabled health promotion strategies
• Increased mental health workforce
• Integrated private and public allied health services
• Enhanced midwifery and early childhood intervention services
• Development of an aboriginal health strategy
• Creation of an ideal environment for medical and allied health education at
undergraduate and post graduate level
3. Develop an Orthopaedic Post Acute Rehabilitation service at Strathalbyn and District Health
Service based on best practice and with metropolitan rehabilitation services as aligned with the
Statewide Rehabilitation Plan.
4. Develop an Arthroplasty Clinic at Mt Barker
5. Resource surgical services across the Hills Area to meet population health demand.
6. Resource the maternity services at Mt Barker Hospital to meet population health demand in the
redeveloped Maternity services (allocation announced at CHSALHN HAC in 2010 by Minister Hill.
7. Improve and enhance services to Aboriginal people by working with other service providers to
improve accessibility
8. Recruitment and retention of a skilled workforce across disciplines and infrastructure to support
best practice service delivery models to ensure future models of care are provided in a quality
safety framework.
ENHANCED PRIMARY HEALTH CARE
The area health service will work closely with strategic partners including the Adelaide hills
Division of General Practice to enhance Primary Health Care.
9. Increase access to and services for early intervention for children and youth.
10. Develop an Early Childhood and Family Centre integrated closely with other service providers.
11. Increase hospital avoidance by greater integration with the aged care sector to ensure streamlined
services, adequate provision of aged care beds, community care packages and health care
services for older people at home.
12. Implement the Health Service Framework for Older People 2009 – 2016 as a priority. Establish a
Level 4 Older People’s Health Services including inpatient Geriatric Evaluation and Management
or ‘GEM’ teams and support across the Hills area.
13. Introduce a flexible suite of ambulatory community and hospital based services with multiple
access points to be available to older people, and include day rehabilitation programs and
rehabilitation in the home.
14. Consider mobile support teams for aged care and mental health needs.
15. Provide a Level 4 Palliative Care Service as described in the Palliative Care Services Plan 2009-1
16. Source physicians for the Hills, Southern Fleurieu, and Kangaroo Island (HSFKI) cluster; to
increase access to specialist care locally. There would be a combination of resident and visiting
services.
517. Increase models that support changing models of care and enable greater provision of outpatient,
day patient, and community based care regardless of age.
18. Ongoing cultural awareness program for all health service providers. Cultural respect will improve
with the continuation of a dedicated education program for all staff and community as well as
engagement and consultation with culturally and linguistically diverse (CALD) communities.
19. Ongoing engagement with the Aboriginal community and implement a local strategy for Improving
Aboriginal health; including breaking down service delineation barriers
20. Implement a men’s health program.
LINKED PUBLIC TRANSPORT SYSTEM FOR THE HILLS AREA
21. The Hills Area Health Advisory Council and Country Health SA seek a review of the current public
transport system with a view to increased access to rehabilitation, outpatient departments,
ambulatory centres, community and acute services across the Hills Area.
22. Improve access to health care by innovation in transport including a ‘bee-line’ (free scheduled
transport) concept for residents over 65 years or who need public transport to access health care.
It is acknowledged that health services in Adelaide will continue to be an option for care,
recognising personal networks, historic connections and individual choice, particularly for people
residing in the North of the catchment.
INCREASED CAPACITY TO CARE FOR LOCAL POPULATION
23. Implement a formal local clinical governance structure that evidences links with the statewide
clinical networks.
24. Increase access to diagnostic results.
INCREASED AND REDESIGNED DISABILITY SUPPORT.
INCREASED ACCESS TO TIMELY MENTAL HEALTH SPECIALIST CARE.
25. Establish, strengthen and continue collaborations that are currently happening across the Hills,
Southern Fleurieu and Kangaroo Island Cluster.
26. Improve mental health services by clear links to tertiary visiting services, strong governance and
implementation of a local 24/7 on call service response capability within the local service
networks.
27. Work with DASSA and strengthen links with Divisions of General Practice (Adelaide Hills Division
of General Practice (AHDGP)), general practitioners (GPs), and nurse practitioner programs.
Implement training of health providers in the use of screening and brief intervention tools; training
of GP prescribers; DASSA community pharmacy program links to local pharmacies; partnerships
across health, alcohol, tobacco and other drugs (ATOD) and mental health services.
28. Explore local models of care to better manage people, who are affected by alcohol and other
drugs, including those experiencing co-morbidity.
29. Implement a Youth Centre.
UTILISATION OF E-HEALTH TECHNOLOGY.
30. The patient journey will be improved by the Implementation of e-health.
31. ICT capacity is built in to all capital works redesign and care modelling:
a. Access to e-health is essential to meet current and future models of care.
b. ICT connectivity at outreach centres across the Hills Area.
c. CHSALHN has equity of access to e-health with metropolitan health services and units
within CHSALHN have equity of access.
d. Education program for all staff relative to their role to support e-health, including visiting
GPs and specialists.
ENSURE THAT EMERGENCY DEPARTMENT IN EACH HOSPITAL IS APPROPRIATE TO THE
POPULATION HEALTH NEEDS OF THE IMMEDIATE COMMUNITY
32. Build the Emergency Department capacity at Mount Barker and Strathalbyn – including capital
works to redesign the Emergency Departments to meet current Australian Standards.
6HEALTH PROMOTION
33. Ensure that the community is engaged in the ongoing review and implementation of the 10 Year
Health Service Plan.
34. Improve aged care with strong health promotion programs, providing opportunity to reduce social
isolation, and a workforce development strategy that focuses on the development of aged care
specific or blended nurse practitioner roles.
35. Continue effective community engagement to ensure that the Hills Area community is health
literate and supports consumer / volunteer / carer programs
36. Advocate for increase funding for the public dental service to meet population demand.
The Hills Area Health Advisory Council acknowledge the importance of reviewing the plans and
progress annually as needs change in the future. The Plan provides a framework to move forward
in a planned and forward thinking way. It sets out strategic directions over the next 10 years and
implementation steps will need to be established annually to describe how they will be achieved –
addressing the highest priorities first.
72. Catchment summary
Introduction
The Hills Area Health Services catchment has a population of approximately 53,200 residents living
within four local government areas including Adelaide Hills, Alexandrina, Barossa and Mount Barker.
The catchment area encompasses key townships including Gumeracha, Mount Barker, Mount
Pleasant, Strathalbyn, Birdwood, Echunga, Kersbrook, Lobethal, Macclesfield, Meadows, Milang,
Mount Torrens, Oakbank, Nairne, Springton and Woodside (refer map below). Four hospital and
health services provide services to the community situated in the Gumeracha, Mount Barker, Mount
Pleasant and Strathalbyn. The Mount Barker and Gumeracha Hospitals and Health Services are
located approximately 32-39 kilometres from Adelaide, and the Mount Pleasant and Strathalbyn
Hospitals are located approximately 54-56 kilometres from Adelaide.
Source: www.atlas.sa.gov.au
Population
The resident population for the catchment is 60, 690 (DPLG, 2011). People from Aboriginal and
Torres Strait Islander backgrounds represent 0.7% of the catchment population compared with 3.1%
across country South Australia. The traditional owners of the land throughout the Hills catchment are
the Peramangk people. Approximately 2.9% of the population speak a language other than English at
home, compared with 3.9% across country South Australia.
The proportion of people aged 0-14 for the catchment area is 20.5%, compared with 18.5% across
total SA. The proportion of people aged 15-64 for the catchment area is 65.6% compared with 63.8%
across country SA and 66.1% across total SA. The proportion of people aged 65-84 for the
catchment area is 12.2% compared with 13.9% across country SA and 13.4% across total SA. The
proportion of people aged over 85 years for the catchment area is 1.8% compared with 2.0% across
total SA. It is estimated that the total population of the Hills Area Health Services catchment has
increased by approximately 7,000 persons in the five year period between 2006 and 2011.
8Based on Planning SA data (high stable projections), the population is expected to increase by
approximately 7% over the next 10 years. This prediction is below the growth identified by the Mount
Barker District Council and the Greater Adelaide Plan. It is also important to note that from 2004 to
2009, Statistical Local Areas such as Mount Barker Central, Strathalbyn district and the Adelaide Hills
North/Balance have grown by 19%, 11% and 3% respectively (2009 ABS Estimated Resident
Population). The fertility rate across the catchment ranges between 1.83 in the Adelaide Hills - North
Statistical Local Area (SLA) to 2.21 in the Barossa - Barossa SLA (encompassing the Mount Pleasant
catchment). This compares with 1.82 for South Australia. The average indirect standardised death
rate for the Hills Area Health Services catchment ranges from 4.8 in the Mount Barker - Balance SLA
to 7.3 in the Mount Barker – Central SLA. This compares with 6.1 for South Australia.
Information sourced from the South Australian Tourism Commission for 2007 indicates that for the
Adelaide Hills (which includes Mount Barker and Gumeracha but excludes Strathalbyn) and Fleurieu
Peninsula (which includes Strathalbyn, Yankalilla and Victor Harbor) there is a significantly high
number of overnight and same day visitors, most of which are aged between 45-64 years of age. The
Tour Down Under attracts more than 7,000 visitors to the area. Other major events include Classic
Adelaide and the Bay to Birdwood.
Table 1: Hills Area Health Services Population
Country
Cluster* Cluster* SA total
No. % SA
No. % %
%
Total Population 60,690 98,235
Males 30,186 49.7% 48,662 49.5% 50.5% 49.4%
Females 30,504 50.3% 49,573 50.5% 49.5% 50.6%
0-14 years of age 12,431 20.5% 18,403 18.7% 20.4% 18.5%
15-24 years 7,502 12.4% 10,908 11.1% 11.4% 13.3%
25-44 years 15,052 24.8% 22,183 22.6% 25.1% 26.7%
45-64 years 17,208 28.4% 27,997 28.5% 27.3% 26.1%
65-84 years 7,394 12.2% 16,236 16.5% 13.9% 13.4%
85 years and over 1,102 1.8% 2,507 2.6% 1.8% 2.0%
ATSI** 379 0.7% 681 0.9% 3.1% 1.7%
CALD (Speaks a language
1,558 2.9% 2,360 2.8% 3.9% 12.2%
other than English at home)**
*Adelaide Hills, Fleurieu and KI Cluster total
Source: Projected population by age and sex – SLAs in South Australia, 30 June 2011, Department of Planning and Local Government
**Source: 2006 ABS Census
Socioeconomic factors
On the basis of Australian Bureau of Statistics’ measures of remoteness, the Hills Area Health
Services catchment has been identified as inner regional which indicates reasonable proximity to
service centres including Adelaide when compared with other country locations. However transport for
health care consumers remains a barrier to better care in the community despite the existing public
infrastructure including regular bus services between major centres in the region and between the
region and Adelaide. Despite the close proximity to Adelaide, the public transport system across the
Hills Area is insufficient to meet the community needs, especially when needing to access health care
services.
The socioeconomic status for most of the catchment area is similar to or higher than country SA and
total SA averages. A relatively low socioeconomic status is observed in several collection districts
9within the Mount Pleasant catchment, and Strathalbyn. For most of the catchment area, the median
individual, family and household incomes are consistent or higher than the state average. Strathalbyn
and parts of the Mount Pleasant catchments are slightly lower than the state average. Aboriginal
people living in Strathalbyn have been identified as a special needs population since they have come
into the area from elsewhere with little family support.
Based on data which monitors the trends of diseases, health related problems, risk factors and other
issues across major regional areas, the Hills Mallee Southern region demonstrates similar levels of
risk factors for alcohol consumption, obesity, blood pressure, cholesterol, physical inactivity and
smoking when compared with country South Australia overall. The prevalence of chronic disease for
persons aged 16 years and over in the Hills Mallee Southern region demonstrates a slightly lower
prevalence of diabetes and a slightly higher prevalence of existing mental illness when compared to
country and total South Australia.
Health care and social assistance makes up 11.9% of total employment across the Hills Area Health
Services catchment, with manufacturing making up to 10.5%, retail trade 10.0%, education and
training 8.7%, and construction 8.5%. Located just 20 minutes drive east of Adelaide, the Hills Area
region offers easy road access to the eastern states and metropolitan Adelaide. The key industry
sectors in the Adelaide Hills region are wine production, beef and dairy cattle, vegetable growing, fruit
orchards and tourism. Significant extractive mineral operations contribute significantly to the economy
of the region and state. The region has the potential to be the site of new mining ventures, for
example the Angas Prospect near Strathalbyn has significant diamond, copper, lead and silver
deposits.
103. Needs Analysis summary
Methodology used to identify community needs
Community consultation is fostered through a number of formal and informal stand alone and ongoing
forums.
Previous formal community and network engagement in service planning for the Hills Area has
included:
• Northern Adelaide Hills Health Service (NAHHS) - survey to ascertain the Torrens Valley
community’s knowledge, use and perception of the NAHHS sites and its services.
• Review of the pressures impacting on delivery of health services in the Mount Barker and
surrounding areas.
• Gumeracha Community Association Public Survey.
• Alexandrina Council Feedback Report ‘Have Your Say’ consultation on the Draft Community
Strategic Plan 2009-2013.
• Council submission to the draft 30 Year Plan for Greater Adelaide.
• Local Liaison Group (Mental Health Memorandum of Understanding).
• Local Councils - Population planning projections.
• Hills Area Health Advisory Council Annual General Meeting.
• Hills Area Positive Aging Taskforce.
• Hills Area Palliative Care Strategic Planning Group.
• Hills Area Aboriginal Services Forum.
• SA Inner Country Network Local Alliance.
• Hills Area Better Care in the Community Committee.
• Hills Area Pandemic Planning – Influenza (HAPPI).
• Mount Barker District Soldiers Memorial Hospital 2009-10 Business Planning Session.
• Strathalbyn and District Health Service Emergency Department questionnaire.
Ongoing community engagement and collaboration will occur with a diverse range of stakeholders in
the future.
From mid January 2010 a dedicated CHSALHN Planning Officer liaised and consulted with both
internal and external stakeholders including staff, clinicians, local government, statewide service
providers and other key groups. All information from community, staff and key stakeholder
consultations was reviewed and utilised to inform the 10 Year Local Health Service Plan. Leakage
data from the Hills Area to metropolitan health units and outpatient clinics was obtained and analysed.
The Hills Area Health Advisory Council (HAHAC) has considered the consultation outcomes.
The 10 Year Health Service Plan has been considered by the cluster Director HSFKI, cluster
Executives and the local HAHAC for review and endorsement.
Summary of Needs Analysis Key Issues
Community Health Promotion and Prevention Programs
• A need to re-orientate care whenever possible to an ambulatory/hospital avoidance/GP Plus
model of care.
• South Australia’s Strategic Plan 2007–2016 informs the health reform agenda for South
Australia and includes goals for the community to stay healthy, with a focus on preventing
illness through improving lifestyle.
Community Health and GP Plus Services
• The provision of an Integrated Health Care Centre (IHCC) (GP Plus Centre) has community,
key stakeholder and health service staff support and would assist to deliver the integrated care
required for the growing population in the Hills4 The Great Expectations report5 and recent
4
Adelaide Hills Division of General Practice (2009). Mount Barker Integrated Health Care Centre (proposal)
11operational assessment of paediatrics in the Adelaide Hills6 identifies the IHCC as an integral
part of a service delivery model for the future.
• Capital works to enable future models of care are needed at Mount Barker and Strathalbyn
Hospital and AHCHS:
o 5,857 community health episodes of treatment provided in the metropolitan area (an
additional 11% to treatments provided locally). In the last three financial years leakage
to metropolitan community health services has increased by 14%.
• The GP Plus Health Care Strategy 2007 is the overarching primary health care and out-of-
hospital strategy for South Australia.
• Increase ambulatory care for chemotherapy, transfusions, orthopaedic follow up, post acute
care and rehabilitation.
• Transport to and from the metropolitan area is problematic for the ageing and young
populations.
Emergency Services
• There is a higher than national average rate of car accidents in the Hills Area.
• The close proximity to Adelaide, predicted population growth, high community priority on a 24
hour emergency service at Mount Barker and across the Hills, and lack of access to local GPs
impact on emergency service capacity at both Mount Barker and increasing demand at
Strathalbyn. This highlights the need for strengthening emergency services.
• The Mount Barker DSM Hospital ED requires capital works to provide improve the
environment for staff and in particular meet mental health care needs and GP after hours
medical clinic needs
• There is a strong community desire to maintain the EDs at all Hospitals in the Hills area. The
emergency departments provide a core service to both people residing in the catchment and
also the many tourists who travel through the area.
Acute Inpatient Care
• 42% of catchment area acute medical care is being provided locally.
• In the last three financial years leakage to metropolitan public hospitals has increased by 14%
for medical episodes, 13% ‘other episodes, and 11% for surgical episodes.
• 674 chemotherapy treatments are performed in the metropolitan area from catchment.
• 468 renal dialysis admissions to metropolitan area from the catchment.
• There is a strong community desire to maintain the acute services at all Hospitals in the Hills
area.
Elective Surgical
• 22% of catchment area surgery is being performed locally.
• 100% of local emergency surgery is being performed in the metropolitan area.
• There is a need to explore the existing theatre complex capacity at Mount Barker to meet
increased elective surgery demand.
Maternal and Birthing Services
• 37% of women in the Hills cluster birth at Mount Barker Hospital, which is a decrease from
40% in 2001. The maternity ward was redeveloped in 1990 to accommodate 150 births per
annum however the number of births has grown to 350 per annum. The maternity service at
Mount Barker DSM Hospital requires capital works and the introduction of contemporary
midwifery models of care to meet current and future population birthing and family
needs7 8 9.Capital works funding was committed for this in the last election.
• More contemporary models of care (eg. Midwifery Led Care) may contribute to improving
recruitment and retention of midwives.
5
Hoorenman and O’Shea (2007). Great Expectations: A Review of the pressures impacting on delivery of health services to
Mount Barker and surrounding districts.
6
Country Health SA (2009). Paediatrics in the Adelaide Hills: Operational assessment.
7
Hoorenman and O’Shea (2007). Great Expectations: A Review of the pressures impacting on delivery of health services to
Mount Barker and surrounding districts.
8
Wright, D. (2009). Midwife Models Project: Report to the Midwifery Models Project Steering Committee.
9
HASSELL (2009). Mount Barker Maternity Ward Feasibility Update.
12Medical Specialist Services
• Staff and community identified specialist care needs locally, particularly access to respiratory
physician, paediatrician, geriatrician, cardiology, chemotherapy, oncology, orthopaedic,
general physician and allied health. Access to psychiatrist and other specialist support for
mental health is required in the Northern Hills area. This lack of access to specialists limits the
capacity to provide care in the local hospitals and contributes to a negative patient journey and
increased leakage to metropolitan hospitals.
Mental Health
• Clinicians identified the need to explore the opportunity to provide a better environment to
meet mental health and associated co-morbidity needs.
• Young people identified mental ill-health as a major issue including depression, stress, anxiety
associated with bullying and issues at home.
• Clinicians and stakeholders recognised delays in transporting patients to approved treatment
centres impacts on local health and police services and the need for support to manage
violent patients.
• The community and clinicians identified the need for greater clarification about how to access
the services.
• Aboriginal people are accessing mental health services in the cluster at less than optimal
level.
• The Country Model of Care has been based on recognition of the need to reform the health
care system concepts of ‘Right Care, Right Time, Right Place, Right Person/Team’.
Rehabilitation
• Clinicians have identified the opportunity for the provision Orthopaedic Post Acute
Rehabilitation services at Strathalbyn and District Health Service, integrated with key
directions identified in the Framework for Older People 2009-16 and the Statewide
Rehabilitation Plan.
Respite Services
• There is a strong community desire to maintain respite at Mt Barker, Strathalbyn, Gumeracha
and Mount Pleasant Hospitals.
Aged Care
• Statewide planning notes that health care, rehabilitation, primary health care providers and
aged care residential services integration is essential for the Hospitals and AHCHS to meet
the health care needs of the elderly into the future10.
• As the majority of health care for older people occurs in primary health care settings, the GP
Plus Strategy is integral to the SA Health Service Framework for Older People, and provides
the context for many of the strategies described in this Health Service Plan.
• The Model of Care to meet the needs of the aged is described in the Health Service
Framework for Older People 2009-1611.
• Clinicians identified the need for a pro-active system that enables outreach into the aged care
facilities to facilitate early intervention, health promotion, rehabilitation, palliative care, early
discharge from acute care and hospital avoidance.
• Burden of disease statistics for the HSFKI cluster indicates that dementia is noticeably higher
in the cluster than the national average.
• Based on current trends and policy it is likely that there will be a shift in demand away from
low-level residential care and towards community care over the next 10 to 15 years — in
addition to the projected growth resulting from population ageing12.
• As people live longer and with advances in medicine it is expected that individuals will live
longer with disability and will be more likely to benefit from rehabilitation. Evidence indicates
10
SA Health (2009). Health Service Framework for Older People 2009-16: Improving Health and Wellbeing Together
11
SA Health (2009). Health Service Framework for Older People 2009-16: Improving Health and Wellbeing Together
12
The Allen Consulting Group (2007). The Future of Community Care: Report to the Community Care Coalition, Melbourne.
13that perhaps as much as half of the functional decline associated with ageing is the result of
disuse and can be reversed by exercise aimed at increasing the fitness of older people.
Palliative Care
• 299 palliative care treatments were performed in the metropolitan area (community health).
• The SA Palliative Care Services Plan13 projects a significant increase in demand for end of life
care and outlines an expectation that a significant portion of this demand will be managed by
GPs, community health, community and residential aged care providers.
Clinical Support Services
• Clinicians and stakeholders have identified the need for access to ultrasound equipment for
maternity services and increase in hours to radiology services.
• Key focus around the implementation of new health technology concepts in line with SA Health
ICT direction including e- health, electronic decision support tool and electronic referral tools.
Youth Services
• The Youth Advisory Committee (YAC-RAP) has identified young people’s mental health as
needing more of a focus by services, particularly in the areas of depression, anxiety, eating
disorders, self-harm and suicide prevention. There are gaps in current services for children
and youth as identified in AHCHS Child, Youth, and Families Services Development
Proposal14
• Young people have identified mental health as a major issue including depression, stress,
anxiety associated with bullying and issues at home.
Drug and Alcohol Services
• Clinicians and stakeholders have identified that there remains significant unmet demand for
drug dependence treatment, particularly from those who are primarily heroin users, as well as
the increasing number of people dependent on prescription opioids.
• ATOD and mental illness admissions comprise a significant proportion of hospital A&E or
admission episodes and has been identified as an issue previously in needs assessments.
People with ATOD and mental illness co-morbidity often have high and complex health issues
and may be at high risk of mortality.
• Clinicians and stakeholders identified the opportunity for the use of screening tools such as
ASSIST to help identify substance use as a cause of the presenting illness.
• Clinicians and stakeholders identified the need to increase the capacity of GPs who are
permitted to prescribe Suboxone and dispensing pharmacies to meet demand, and for
capacity building in the early identification and treatment intervention of ATOD problems
among primary health care services15.
Early Childhood
• Extract from Operational Assessment of Paediatrics in the Adelaide Hills:
‘Given the growth, demographic make up of the population and perceived benefits from a local
service, concentration of the population, future facility developments and ability to recruit
specialists ….the location of the Adelaide Hills paediatric services is recommended to be at
Mount Barker’.
13
SA Health (2009). Palliative Care Services Plan 2009-2016.
14
Adelaide Hills Community Health Service (2009). Child, Youth, and Families Service Development Proposal
15
DASSA
144. Local implications of Statewide plans
Strategy for Planning Country Health Services in SA
The Strategy for Planning Country Health Services in South Australia, endorsed in December 2008,
builds on the vision in South Australia’s Health Care Plan 2007-2016, South Australia’s Strategic
Plan, and the SA Health Aboriginal Cultural Respect Framework and sets out how to achieve an
integrated country health care system so that a greater range of services are available in the country,
meaning fewer country residents will need to travel to Adelaide for health care.
The Strategy identifies the need for significant changes to achieve a sustainable health system that
addresses the contemporary challenges facing the health system. The main factors contributing to an
increasingly unsustainable health system include the ageing population, increasing prevalence of
chronic diseases, disability and injury, poorer health of Aboriginal people and people of lower
socioeconomic status, and increasing risks to society from communicable diseases, biological threats,
natural disasters and climate change.
Health services located in areas in close proximity to Adelaide (peri-urban sites) including Mount
Barker, Gawler and Victor Harbor are subject to urban growth and have a rural mode of service
delivery. These services’ catchment areas extend into designated country areas and services will be
jointly planned across both country and metropolitan areas. This approach aims to support the
services to expand as their rural catchment grows, with the advantages of being relatively close to
metropolitan services.
A number of Statewide Clinical Service Plans have been developed or are currently under
development providing specific clinical direction in the planning of services. Interpreting these plans
for country South Australia and specific health units is an important element of the planning process
for Country Health SA. The enabling factors which are demonstrated across the statewide clinical
plans include:
• Multi-disciplinary teams across and external to the public health system.
• Patient focused care.
• Care as close to home as possible.
• Teaching and research integrated in service models.
• Integrated service model across the continuum of care.
• Streamlining access to specialist consultations.
• Increasing use of telehealth.
• Improving Aboriginal health services.
• Focus on safety and quality.
• Recruiting and developing a workforce to meet future service models.
• Engaging closely with consumers and community.
• Developing the infrastructure to meet future service models.
• Clinical networking and leadership.
• Connect local patients with pathways to higher level care needs.
• Reduce progression to chronic disease for at risk populations.
Strategies within the Statewide Clinical Service Plans which support the achievement of local needs
have been integrated through the 10 Year Local Health Service Plans.
155. Planning Principles
The Strategy for Planning Country Health Services in South Australia set out important principles
which have been used to guide the local planning which include:
1. Focusing on the needs of patients, carers and their families utilising a holistic care
approach.
2. Ensuring sustainability of country health service provision.
3. Ensuring effective engagement with local communities and service providers.
4. Improving Aboriginal health status.
5. Contributing to equity in health outcomes.
6. Strengthening the IT infrastructure.
7. Providing a focus on safety and quality.
8. Recognising that each health service is part of a total health care system.
9. Maximising the best use of resources.
10. Adapting to changing needs.
166. Service Delivery Plan
6.1 Core Services to be Sustained
Service Category Service Description Target Group Directions over next 10 years
Community Health Local Area: • Over 45 All Sites:
Promotion and • Access to chronic disease self • Children and youth • Ongoing staff development in the delivery of services that respond to
Prevention management programs, • People with diabetes community demand including:
Programs Domiciliary Care, Aboriginal • Aboriginal people o Post acute management
health, community nursing and • Carers o Palliative care
midwifery services, drug and o Expansion of staffing capacity to address ageing workforce issues
alcohol services, community • Continue with qualified diabetes resource
mental health (adult and child), • HAHAC to work with the community to resource an Aboriginal
counselling and allied health Community House
services. • HAHAC to source a bus for use by Aboriginal communities for events /
District: funerals, medical appointments
• Specialised chronic disease • HAHAC to work with Local Council and Housing SA to address the lack
practitioners eg. diabetes of public housing for Aboriginal people
educators, chemotherapy • Increase resources to meet increasing population demand for early
• Diabetes management, women’s intervention strategy implementation including allied health
health, Aboriginal health, early • Continue to engage the community and key stakeholders to support
learning for families team, youth carers:
program, o SA Carers Support Model
Carers Support Program: o HACC service agreements
• Commonwealth Respite and o Positive Aging Taskforce 10 Year Plan
Carelink Centre South and East o Carers support groups
Country (Carers SA)
• Hills Carer Wellness Centre which Mount Barker
is auspiced by Carers Link in the • Work with partners to implement a Youth Centre to respond to youth
Barossa mental health needs and a large number of disengaged youth from
school, significant youth issues
• See section 6.2 for new services
Outpatient Care District: • People with cancer Mount Barker
• Chemotherapy • People with a clinical • Establishment of an Outpatient Department Cancer Oncology and
• High level provision of post acute need that does not Chemotherapy clinic with specialists who would consult and supervise
and hospital avoidance services require a hospital the administration of the more toxic drugs that are not administered at a
admission local level currently
• Implement a designated ambulatory care centre for chemotherapy,
transfusions, post acute assessment and rehabilitation assessment
• Develop common approach to packages of care that are criteria driven
17Strathalbyn, Mount Pleasant and Gumeracha Hospitals
• Provide services to clients in the community using existing hospital staff.
AHCHS and Hospitals collaborate to provide outreach services in the
community using this model
Allied Health • Local access to broad range of Clients across the All Sites
allied health services (eg. continuum of care • Development of allied health assistant roles eg. reorienting services to
physiotherapy, occupational use professional skills appropriately
16
therapy, social work, speech • Re-orienting services to promote independence and early intervention
pathology, podiatry, dietician) • Partnerships - shared leadership of a broad range of health and human
• services at the local level to deliver on specified impacts and outcomes
• Practice standards - agreed minimum standard of service coordination
practice
Emergency Services • Mount Barker, Strathalbyn, All people All Sites
Gumeracha and Mount Pleasant • Nurse led emergency care overnight
24 hour service 7 days a week • Ensure ongoing education program and up skilling for nursing staff in
• first line emergency management
• Introduce aged care specialist nurses into the ED to facilitate hospital
avoidance for the elderly
Mount Barker
• Using current facilities, explore alternative models of care in provision of
emergency services notably at Mt Barker
• Capital works business case to meet service demand, address deficits
and control risks at Mount Barker Hospital:
o Establish separate space for agitated patients or grieving families
Establish physical infrastructure to manage presenting patients and
improve facilities for staff to safely manage agitated or violent clients
• Work towards capacity for emergency surgery in Mount Barker
Acute Inpatient Care • Local area services at all Hills Area community All Sites:
hospitals • Maintain access to acute inpatient care
• District services for surgical,
birthing, chemotherapy at Mount Mount Barker DSM Hospital:
Barker • Increase capacity to admit and treat more complex medical conditions,
• Level one surgery at Strathalbyn to improve the patient journey
• Day procedural surgery at Mount • Increased capacity is linked to the IHCC initiative
Pleasant • Paediatric Step Down Unit linked to increased maternity services and
IHCC
16
Chronic Disease Action Plan for South Australia 2009-2018
17
Stepping up Report, Social Inclusion Report
18• Explore possibility of expanded service for youth and young adults with
17
mental health / drug and alcohol co-morbidities
Elective Surgical • Local area services at Mount Hills Area community Mount Barker DSM Hospital:
Barker and Strathalbyn • Ensure that infrastructure and resourcing meet the elective surgery
• District services including joint demand for the Hills Area
replacement at Mount Barker • Explore the possibility of providing all inpatient surgery at Mount Barker,
• Procedural and scope services at appropriately funded by the elective surgery strategy; with Strathalbyn a
Mount Pleasant (linked to national Centre for Orthopaedic Post Acute Rehabilitation, supporting the
bowel screening program) increased surgical demand across the Hills Area
• Explore the feasibility of 23 hour day surgery clinic and stand alone day
surgery suite into the future
• Explore the possibility of a team to support the national bowel screening
program across the Hills supported by Mount Barker and Mount
Pleasant District Hospitals (high prevalence of cancer in the Hills area)
Mount Pleasant District Hospital:
• Continue and expand procedural day surgery only; particularly for
screening and monitoring for bowel cancer (could service the Hills,
some of the Barossa and the near Murray Mallee area eg. Mannum)
Strathalbyn and District Health Service:
• Utilise existing theatre resources for up to level 1 day surgery until
Mount Barker builds capacity to meet demand in the Hills Area
Maternal and Local Area Services: Pregnant women, All Sites
Birthing Services • Antenatal and postnatal care foetus and infants in the • Resource community midwifery to meet demand – particularly the large
• Shared Care Programs Hills Area proportion of women returning to the Hills Area after birthing in
18
• Access to community midwifery metropolitan health units
services and parenting programs
District Services: Mount Barker DSM Hospital:
• Low risk, single birth, theatre and • Build birthing capacity to 600 births each year and enable a step down
staffing for caesarean sections 24 nursery for neonates who no longer need to be at the Women’s and
hours a day, 7 days a week Children’s Hospital for ongoing care
• Service is supported by one • Encourage the introduction of a Midwifery Led Model to compliment the
obstetric specialist, 5 GP existing Shared Care Model as it taps into a sustainable workforce in the
obstetricians and 4 GP recruitment/employment of direct entry midwives
anaesthetists
Medical Specialist Local area services • People with cancer All Sites:
Services • District Services • People who need Liaise with Adelaide Health Service (formerly Central Northern
• There are no resident medical palliation Adelaide Health Service and Southern Adelaide Health Service) to
specialists • People with a mental address opportunities to provide local access to medical specialist
health issue or services instead of travelling to metropolitan services
illness
18
Standards for Maternal and Neonatal Services in South Australia 2009
19• People over 65 Mount Barker
• People with a • Building and implementing an Integrated Health Care Centre at Mount
respiratory condition Barker will increase access to medical and other specialists eg.
• Children o Access to a visiting oncologist
o Access to a visiting palliative care specialist
o Increase access to visiting mental health specialists
o Increase access to visiting geriatric specialists
o Access to a visiting respiratory physician
o Access to a visiting paediatrician
Mental Health Local area services People of all ages and All Sites
• Community based care across the continuum of • Identify clear links to tertiary visiting services
Primary mental health care care who have a mental • Inclusive leadership and governance
• Shared care management with health issue or illness • See section 6.2 for new services
local GP
• Local admissions for mental
health 24 hour 7 day/week
emergency mental health service
by telehealth
District area services
• Visiting psychiatrists in Mt Barker
• Local private psychologist in Mt
Barker
Resident mental health nurses in Mt
Barker
Rehabilitation • Inpatient immediate post • People who have Strathalbyn District Hospital
operative rehabilitation for joint orthopaedic • Work in collaboration with the Hills area to develop a Orthopaedic Post
replacement and other procedures, Acute Rehabilitation service at Strathalbyn and District Health Service
orthopaedic surgery at Mount including based on best practice and with metropolitan rehabilitation services as
Barker and Strathalbyn arthroplasty aligned with the Statewide Rehabilitation Plan
• Transitional Care Packages are • People over 65 • See section 6.2 for new services
available
• community and home based
rehabilitation support, centre
based day therapy, multi-
discipline outpatient rehabilitation
and aquarobics / tai chi classes
20Respite Services Local area services All people requiring All Sites
• Access to domiciliary care respite • Strengthen partnerships with current providers of respite services
• Access to residential care • Improved access to day centres to provide support for carers
• Volunteer programs • Explore opportunities to increase respite options to avoid hospital
• Organised in home respite admission
• No access to higher level acuity / • Continue existing links to the community eg. respite in residential care
disability care
• Strathalbyn Hospital to provide
programmed respite care, other
health units to provide emergency
respite only
Aged Care • Mount Barker Hospital is a Over 65 All Sites
casemix funded Hospital for acute • Explore infrastructure needs to meet consumer expectations
care only • Implement minor capital works to meet the needs of in house
• Strathalbyn, Gumeracha and Transitional Care Packages (TCP)
Mount Pleasant District Hospitals • Increase EACH and EACH-D packages to meet population health
have aged care beds with a mix demand in the Hills Area
of commonwealth and state • Undertake more detailed analysis to clarify HACC accessibility and
funding priorities to build community confidence in the service
• Local Area services for • Redesign care to meet the outcomes as specified in the Health Service
19
community management, Framework for Older People 2009
including aged care assessment • Plan to build capacity for people with dementia to access dementia
20
is provided by Adelaide Hills services across the Hills Area
Community Health Service Mount Pleasant District Hospital
• Regional services including • Develop space for day activities in line with current required standards
psycho-geriatric support are • See section 6.2 for new services
available
• Day Care Dementia Service
• Willow Fern Community Respite
House (Southern Cross)
overnight and day activities
19
Health Services Framework for Older People 2009-2016
20
South Australia’s Dementia Action Plan 2009-2010
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