south western sydney area health servicetable 49 sydney south west area health service, employed...

LE OF SYDNEY SOUTH WEST

A HEALTH PROFI

A status report describing the population, their health and the services provided for ydney South West Area Health Service

S

June 2005

The Sydney South West Area Health Service would like to encourage wide distribution of this plan and

an may be made without seeking permission. However, any reference made to formation contained within this plan must be done so with acknowledgment to the Sydney South West

ISBN: 1 74079 0634

Health Service Planning Report No: 01/

Health Service Planning

Sydney South West Area Health Service Locked Bag 7017, Liverpool BC NSW 1871

Telephone: (02) 9828 5755; Facsimile: (02) 9828 5962

photocopies of this plinArea Health Service.

2005

For additional copies:

A Health Profile of Sydney South West – June 2005

TABLE OF CONTENTS

1. EXECUTIVE SUMMARY ....................................................................................................................... 4

2. BACKGROUND ..................................................................................................................................... 6

3. DEMOGRAPHY ..................................................................................................................................... 7

4. HEALTH OF THE POPULATION ........................................................................................................ 11

4.1 MATERNAL AND INFANT HEALTH.............................................................................................. 11

4.2 MORTALITY................................................................................................................................... 16

4.3 MORBIDITY AND RISK FACTORS............................................................................................... 18

4.3.1 Cancer............................................................................................................................... 18 4.3.2 Communicable Diseases .................................................................................................. 21 4.3.3 Health Risk Factors........................................................................................................... 21

4.4 HEALTH PROTECTION BEHAVIOURS ....................................................................................... 23

5. HEALTH UTILISATION........................................................................................................................ 25

5.1 HOSPITALISATION PATTERNS FOR SSWAHS RESIDENTS ................................................... 25

5.2 ACTIVITY PROFILE OF SSWAHS HOSPITALS .......................................................................... 29

5.3 PATTERNS OF HOSPITAL USE BY AGE GROUP...................................................................... 32

5.4 PUBLIC/PRIVATE PATIENT MIX AT SSWAHS HOSPITALS ...................................................... 35

5.5 EMERGENCY DEPARTMENT ACTIVITY..................................................................................... 36

6. CLINICAL SERVICE PLANS ............................................................................................................... 39

6.1. THE WAY FORWARD 2004-2008................................................................................................ 39

6.1.1 Methodology of The Way Forward 2004-2008.................................................................. 39 6.1.2 Projected Activity from The Way Forward 2004-2008 ...................................................... 40 6.1.3 Key Findings and Recommendations of The Way Forward 2004-2008 ........................... 40 6.1.4 Service Configuration as indicated in The Way Forward 2004-2008................................ 41 6.1.5 Current Status of The Way Forward 2004-2008 ............................................................... 44

6.2 THE RESOURCE TRANSITION PROGRAM................................................................................ 46

6.2.1 Methodology...................................................................................................................... 46 6.2.2 Projected Activity............................................................................................................... 47 6.2.3 Service Configuration as indicated in the RTP ................................................................. 48 6.2.4 Current Status of the RTP................................................................................................. 49

7. HEALTH SERVICES............................................................................................................................ 51

7.1 ACUTE HOSPITALS...................................................................................................................... 51

7.2 SELECTED SPECIALTY AND STATEWIDE SERVICES ............................................................. 51

7.3 MENTAL HEALTH SERVICES...................................................................................................... 53

7.4 AGED CARE AND REHABILITATION SERVICES ....................................................................... 54

7.5 PRIMARY AND COMMUNITY HEALTH SERVICES .................................................................... 54

7.6 ORAL HEALTH SERVICES........................................................................................................... 55

8. HEALTH WORK FORCE ..................................................................................................................... 56

9. FUTURE DIRECTIONS ....................................................................................................................... 58

APPENDIX A – PROFILE OF THE LOCAL GOVERNMENT AREAS IN SSWAHS.................................. 60

APPENDIX B-TREND DATA FOR KEY INPATIENT ACTIVITY VARIABLES AT SSWAHS HOSPITALS61

- 1 -


Tables and Figures Table 1 Population Characteristics by LGA – 2001 Census and Projected 7 Table 2 Population Aged Structure by LGA – 2001 Census 8 Table 3 Population Projection from 2001 to 2016 by Age for SSWAHS 8 Table 4 Family Household Structure 9 Table 5 Socioeconomic Indicators 9 Table 6 Index of Relative Socio – Economic Disadvantage 10 Table 7 Maternal and Early Childhood Indicators 11 Table 8 Number of births to mothers aged less than 20 years by LGA, 1999 – 2003 12 Table 9 Confinements by Place of Birth – resident Demand 2002 13 Table 10 Confinements by maternal Aboriginality & Country of Birth - Resident Demand 2002 13 Table 11 Confinements by Duration of Pregnancy at First Antenatal Check – Resident Demand 2002 14 Table 12 Confinements by Delivery Type – Resident Demand 2002 14 Table 13 Confinements by Delivery Type and Hospital 15 Table 14 Births by Birthweight – Resident Demand, 2002 15 Table 15 Births by Gestational Age and Hospital – 2002 16 Table 16 NICU Registration in NSW and ACT 2002 16 Table 17 Deaths, Death Rates by LGA – Males, 1998 – 2002 17 Table 18 Deaths, Death Rates by LGA – Females, 1998 – 2002 17 Table 19 Death Rates by LGA and cause of death 2000 – 2002 18 Table 20 Number of cancers and crude incidence for the common cancers by LGA, Males 1998 – 2002 19 Table 21 Number of cancers and crude incidence for the common cancers by LGA, Females 1998 – 2002 19 Table 22 Number of cancers and crude incidence for the common cancers, Males and Females combined, 1998 – 2002 20 Table 23 Age-standardised cancer incidence rates (per 100,000 population) by gender, 1998 – 2002 20 Table 24 Annual average crude notification rates (per 100,000 population) for selected communicable disease by LGA, January 2000 – November 2004 21 Table 25 Current daily or occasionally cigarette and any alcohol risk drinking behaviour by gender, persons aged 16 years and over, 2002 – 2003 22 Table 26 Confinements by Number of Cigarettes Smoked in the Second Half of Pregnancy – Resident Demand, 2002 22 Table 27 Prevalence of selected health status by gender, persons aged 16 years and over, 2002 – 2003 22 Table 28 Overweight and obesity, fruit and vegetable intake and adequate physical activity by gender, persons aged 16 years and over, 2002 – 2003 23 Table 29 Immunisation rates by LGA, children aged 12 – 15 months, 2003 – 2004 23 Table 30 Breast cancer screening, women aged 50 – 69 years, July 2002 to June 2004 26 Table 31 Biennial cervical screening rates by LGA, women aged 20 – 69 years, 1 January 2001 – 31 December 2002 24 Table 32 Place of Acute Inpatient Treatment for SSWAHS resident aged 16+years 2002 – 2003 25 Table 33 Place of Acute Inpatient Treatment for Residents’ LGA aged 16+years 2002 – 2003: Separations 26 Table 34 Place of treatment for Eastern Zone residents (age 16+yr) by SRG 2002/2003: Separations 26 - 27 Table 35 Place of treatment for Western Zone residents (age 16+yr) by SRG 2002/2003: Separations 38 - 29 Table 36 Acute Inpatient Activity in Hospitals 2002 – 2003 All Ages 29 Table 37 Acute Inpatient Activity 2002 – 2003 Aged 0 – 15 Yrs Separations 30 - 31 Table 38 Acute Inpatient Activity 2002 – 2003 Age 16+years Separations 31 - 32 Table 39 Age Group Profile for Acute Inpatient Activity 2002 – 2003 All Ages 32 - 33 Table 40 Trends in patients requiring admission to wards through Emergency Departments 33 - 34 Table 41 Snapshot of Aged patients in SSWAHS Hospitals 34 Table 42 Acute Inpatients 2002/2003 All Ages (including Unqualified Babies) Beddays By final Payment Status 35

- 2 -


Table 43 Emergency Department Activity 2002 – 2003 36 Table 44 Emergency Department Attendances and Access Block 2003 – 2004 37 Table 45 Medicare Claiming GPs within General Practice Division Boundaries 1997/98 – 1998/99 38 Table 46 Eastern Zone Projected change in Acute Hospital Activity – 1994/95 – 2006 47 Table 47 CSAHS Flow Indicators 1994/95 to 1997/98 (Cost Weighted Separations)* 50 Table 48 Bed Numbers at SSWAHS Hospitals 51 Table 49 Sydney South West Area Health Service, employed persons (head count), by occupation (based on award category), sex and selected age group, June 2005 56 -57 Figure 1 Total Confinements by maternal Age – resident Demand 2002 12 Figure 2 Confinements by Delivery Type, 2002 14 Figure 3 Place of Acute Inpatient Treatment for Eastern Zone Residents Aged 16+yr: Separation 25 Figure 4 Place of Acute Inpatient Treatment for Western Zone Residents Aged 16+yr: Separation 25 Figure 5 Acute Inpatient Separations 2002 – 2003 (all) 32 Figure 6 Seps by Aged Group 33 Figure 7 Acute inpatients 2002- 2003 All Ages (including Unqualified Babies) Beddays by Final

Payment Status 35 Figure 8 Total Emergency Attendances 2003/04 36 Figure 9 ED Attendance 2003 – 2004: By Triage Category 37 Figure 10 Medicare Claiming GPs within General Practice Division Boundaries 1997/98 – 1998/99 38 Figure 11 Projected Changes in Eastern Zone Numbers 48

- 3 -


1. Executive Summary This report describes the newly created Sydney South West Area Health Service (SSWAHS), its people, their health status, their use of health services and the health services that are provided for them by SSWAHS. Sydney South West (SSW) covers a land area of 6380 square kilometers and has a current population of approximately 1.33 million, representing 20% of the NSW population. With areas of both substantial new land release for residential development and medium density urban infill, SSWAHS is one of the fastest growing parts of the State and its population is projected to increase by up to 300,000 people by 2030, a 22% increase. SSWAHS is characterized by its multicultural character, with 39% speaking a language other than English at home. A high proportion of new migrants to Australia choose to settle in Sydney South West, including refugees. In addition to the influx of new migrants to the area, the population grows by around 19,000 new births per annum. In some parts of the Area, notably Canterbury, Liverpool and Bankstown, birth rates are between 2.09 to 2.16, considerably above the State average of 1.79 and this trend is projected to continue with young families expected to comprise a large proportion of new residential developments. There are 266,000 children under the age of 15 representing 20% of the total population. At the other end of the age range, there are 180,000 people over the age of 65, representing 17% of the population. There are large numbers of elderly people in some of the SSW Local Government Areas with over 24,000 people over the age of 65 in Bankstown and around 18,000 in both Fairfield and Canterbury. Hospital data indicates that people over the age of 65 years are responsible for 45% of all acute hospital beddays. The number of people aged over 65 years is projected to increase by 45% by 2016 at which time they will represent 13% of the total population. Sydney South West has some of the poorest communities in the State, characterized by a large number of recent migrants, significantly higher unemployment and a high proportion of families dependent on welfare. Such areas include Fairfield, the fourth most disadvantaged LGA in NSW as ranked by the SEIFA Index, and Canterbury and Liverpool, which are both in the lowest quartile. The age standardized death rates for SSW residents are higher than the state average for both males (721.8 per 100,000 vs 709) and females (457 per 100,000 vs 443). Residents of SSW generate 165,700 public hospital admissions per annum. These admissions account for a total of 659,000 beddays, which is equivalent to 2000 beds at 90% occupancy. The majority of these admissions (83%) were within acute public hospitals in Sydney South West. The major outflows were to the former South Eastern Sydney AHS (15,500 admissions) accounting for a further 9.3% of total admissions. Acute hospitals within Sydney South West have a capacity of 2,500 overnight acute beds and 270 same day beds and provide 203,000 separations per annum. These hospitals also receive 256,000 emergency department attendances per annum, with Liverpool and Royal Prince Alfred hospitals having two of the five busiest emergency departments in the State. A total of 22,434 staff are employed by Sydney South West Area Health Service.

- 4 -


The proposed South West growth area centered around Bringelly and Leppington will increase the population of SSWAHS by around 250,000 -300,000 people by 2030, creating demand for a substantial expansion in health service capacity in the Western Zone of SSWAHS. In order to plan the services required to meet this additional population demand, SSWAHS is embarking on a clinical service planning process. The development of an Area-wide Clinical Services Plan based on the latest population projections and projections of acute hospital activity to 2016 and beyond is the next step in the process of operationalising The Way Forward Health Network Plan recommendations. The development of the Clinical Services Plan will then drive, in turn, the required Asset Strategic Planning for the Western Zone of SSWAHS.

- 5 -


2. Background On 27 July 2004, The Hon Morris Iemma, Minister for Health, announced the amalgamation of Area Health Services (AHS) across NSW, including formation of the new Sydney South West Area Health Service (SSWAHS), combining the previous Central Sydney and South Western Sydney Area Health Services. The amalgamated Areas come into being as legal entities from 1 January 2005 with existing Areas continuing in legal force until that time. The estimated resident population in 2004 was 1.33 million, projected to increase to 1.52 million in 2016. SSWAHS will be the most populous of the amalgamated Area Health Services. This document provides an overview of key demographic, health status and health utilization data relating to SSWAHS.

It should be noted that recent local governmenCanada Bay Council (formerly Concord and DCouncil (formerly Sydney and South Sydney).contained in this document in relation to these There are a range of data sources used in this • FlowInfo Version 5.1 • Health Wiz Version 6.2.9 • Department Of Health (DOH) Revised Pop• Australian Bureau of Statistics (ABS) Regio• Emergency Department Information System In Sydney South West Area Health Service (Central Sydney Area Health Service (CSAHS)(SWSAHS) are referred to as the easter

-

Where meaningful and available, data ispresented at the Local Government Area(LGA) level, in order of LGAs from the innercity to urban fringe areas, as follows: Eastern Zone: • City of Sydney (part) • Leichhardt • Marrickville • Ashfield • Burwood • Strathfield • Canada Bay • Canterbury Western Zone: • Bankstown • Fairfield • Liverpool • Campbelltown • Camden • Wollondilly • Wingecarribee

t amalgamations have resulted in the creation of rummoyne) and changes to the City of Sydney

Depending on the data source used, references LGAs may vary.

document including:

ulation Projections (June 2003) nal profiles Census 2001 (EDIS)

SSWAHS) the two former area health services, and South Western Sydney Area Health Service n zone and the western zone respectively.

6 -


3. Demography

The estimated population of SSWAHS is 1.33M in 2004 (representing 20% of the total population of NSW). This is projected to increase to 1.52M in 2016, due to the planned release of land in the South West corridor and urban consolidation in the Inner West. Table 1 provides a brief demographic profile of the SSW area. SSWAHS is the most ethnically diverse health area in Australia, with 39% of people speaking a language other than English at home, most notably in Fairfield and Canterbury, with over 60% of the population not speaking English at home. There are considerable variations between LGAs in the proportions of the population identifying as Aboriginal (highest in South Sydney and Campbelltown)

Table 1: Population characteristics by LGA – 2001 Census and Projected Aboriginal identified

% Language other than

English spoken at

home (2001 census) (2001

census)

Projected Population LGA Population 2001

No. % 2001 pop

2006 2011 2016

Sydney (part) 32,698 61 0.19% 27 37,808 41,301 45,555South Sydney (part) 25,813 1,134 4.39% 21.8 29,455 33,855 38,593Leichhardt 50,450 631 1.25% 15.6 51,700 52,320 52,700Marrickville 76,770 983 1.28% 38.6 76,230 75,880 78,700Ashfield 40,540 205 0.51% 43.5 42,130 42,730 42,720Burwood 30,590 113 0.37% 52.7 32,180 34,160 35,960Strathfield 29,450 93 0.32% 53.7 33,940 37,680 41,160Canada Bay 62,350 228 0.37% 30.3 67,000 73,890 78,610Canterbury 137,520 664 0.48% 62.2 139,730 142,100 144,080Eastern Zone 486,181 4,112 0.85% 39.1 510,173 533,916 558,078Bankstown 172,030 1,303 0.76% 46.2 174,990 177,850 180,060Fairfield 189,020 1,118 0.59% 66 191,920 193,350 191,460Liverpool 159,070 2,038 1.28% 43.7 175,670 197,440 225,590Campbelltown 150,160 3,602 2.40% 19.4 154,310 164,050 179,280Camden 45,450 525 1.16% 8.5 54,630 69,020 83,030Wollondilly 38,460 577 1.50% 5.1 42,210 45,510 47,840Wingecarribee 42,760 497 1.16% 4.2 46,070 48,970 51,740Western Zone 796,950 9,660 1.21% 38.9 839,800 896,190 959,000SSWSAHS 1,283,132 13,772 1.07% 39 1,349,973 1,430,106 1,517,078NSW 6,578,980 134,888 2.05% 19 6,872,530 7,164,950 7,434,050

Source:2001 ABS Census DIPNR population projections 2004 The age structure of SSWAHS reflects a combination of the generally older Eastern Zone structure and younger Western Zone structure. LGAs with the highest proportion of younger people (0-14) are in Camden, Campbelltown and Liverpool. LGAs with the highest proportion of older people (85+) are in Ashfield, Burwood and Strathfield. (See Table 2)

- 7 -


Table 2: Population Age Structure by LGA – 2001 Census

Populat

n growth, the most substantial growth is occurring in the older ge groups. The population of people aged 65 and over is projected to increase by 45% in the

AHS

Source: DIPNR Population Projections (2004)

2001 15-44 45-64 65-84 85+(census) years years years years

Sydney (part) 32,698 2,705 8.27% 21,519 65.81% 6,148 18.80% 2152 6.58% 174 0.53%South Sydney (part) 25,813 2,673 10.36% 15,596 60.42% 4,861 18.83% 2,473 9.58% 210 0.81%Leichhardt 50,450 6,450 12.78% 27,660 54.83% 11,460 22.72% 4,270 8.46% 610 1.21%Marrickville 76,770 10,820 14.09% 41,870 54.54% 16,240 21.15% 6,940 9.04% 900 1.17%Ashfield 40,540 6,170 15.22% 19,580 48.30% 8,640 21.31% 5,090 12.56% 1,060 2.61%Burwood 30,590 5,080 16.61% 14,400 47.07% 6,700 21.90% 3,830 12.52% 580 1.90%Strathfield 29,450 5,480 18.61% 13,160 44.69% 6,700 22.75% 3,570 12.12% 540 1.83%Canada Bay 62,350 10,000 16.04% 28,760 46.13% 14,480 23.22% 8,050 12.91% 1,060 1.70%Canterbury 137,520 27,720 20.16% 62,530 45.47% 29,550 21.49% 15,950 11.60% 1,770 1.29%Eastern Zone

486,181 77,098 15.86% 245,075 50.41% 104,779 21.55% 52,325 10.76% 6,904 1.42%Bankstown 172,030 36,450 21.19% 74,490 43.30% 36,750 21.36% 22,250 12.93% 2,090 1.21%Fairfield 189,020 41,890 22.16% 87,370 46.22% 41,260 21.83% 17,080 9.04% 1,420 0.75%Liverpool 159,070 39,470 24.81% 77,290 48.59% 30,630 19.26% 10,730 6.75% 950 0.60%Campbelltown 150,160 38,690 25.77% 69,800 46.48% 32,330 21.53% 8,590 5.72% 750 0.50%Camden 45,450 11,850 26.07% 21,210 46.67% 8,910 19.60% 3,070 6.75% 410 0.90%Wollondilly 38,460 9,740 25.33% 16,810 43.71% 8,820 22.93% 2,820 7.33% 270 0.70%Wingecarribee 42,760 9,760 22.83% 15,750 36.83% 10,710 25.05% 5,840 13.66% 700 1.64%

Western Zone 796,950 187,850 23.57% 362,720 45.51% 169,410 21.26% 70,380 8.83% 6,590 0.83%

SSWAHS 1,283,131 264,948 20.65% 607,795 47.37% 274,189 21.37% 122,705 9.56% 13,494 1.05%NSW 6,578,980 1,344,810 20.44% 2,861,870 43.50% 1,513,180 23.00% 766,620 11.65% 92,500 1.41%

% %LGA 0-14 years % % %

Source: DIPNR ion Projections (2004) In terms of the projected populatioa15 years from 2001 to 2016, and the over 85 population, who are substantial users of acute hospital services, is projected to almost double over the same period. Table 3: Population Projections from 2001 to 2016 by Age for SSW Age Group 2001 2006 2011 2016 Total change 01- % chan

4 89,787 87,091 86,316 88,601 -1,187ge 01-16

-1.32% 5-9 89,703 87,264 86,958 87,300 -2,403 -2.68%10-14 85,458 89,340 89,130 89,648 4,191 4.90%15-19 87,812 90,917 95,825 96,620 8,808 10.03%20-24 94,415 100,016 105,362 111,309 16,894 17.89%25-29 109,907 104,859 112,037 119,126 9,219 8.39%30-34 109,929 114,864 113,278 121,285 11,356 10.33%35-39 106,854 109,961 116,224 116,268 9,414 8.81%40-44 98,879 105,271 109,808 116,240 17,361 17.56%45-49 86,668 97,345 104,192 109,058 22,390 25.83%50-54 80,006 84,041 94,610 101,330 21,325 26.65%55-59 59,057 75,008 79,449 89,328 30,272 51.26%60-64 48,459 54,910 69,742 74,125 25,666 52.96%65-69 40,378 44,152 50,782 64,423 24,045 59.55%70-74 36,408 35,883 40,088 46,678 10,270 28.21%75-79 28,662 30,696 30,902 35,153 6,491 22.65%80-84 17,257 21,901 24,102 24,924 7,666 44.42%85+ 13,494 16,452 21,302 25,664 12,169 90.18%Total 1,283,132 1,349,973 1,430,105 1,517,077 233,946 18.23%

0-

- 8 -


SSWAHS contains significant variations between LGAs in the characteristics of family households. LGAs with the highest proportion of single family households are in Camden, Wollondilly and Liverpool. The highest proportion of multiple family households are in Fairfield, Liverpool and Bankstown. The highest proportion of lone person and group households are in South Sydney, Leichhardt and Marrickville. (See Table 4)

Table 4: Family Household Structure % of Households LGA Population

2004 (est) No.

House-holds Single Family

Multiple Family

Lone Person

Group Average House-

hold Size Sydney (part) 14,067 4,506 (est.) 48.3 0.4 36.2 15.1 2.0 South Sydney (part) 42,738 17,377 (est.) 41.9 0.5 44.5 13.1 1.8 Leichhardt 66,196 25,835 56.2 0.5 33.0 10.3 2.1 Marrickville 77,275 27,940 58.5 1.6 30.0 9.9 2.3 Ashfield 41,363 14,436 62.8 1.5 28.8 6.8 2.4 Burwood 31,796 9,931 67.7 2.2 23.6 6.5 2.7 Strathfield 31,408 9,035 73.0 2.4 20.8 3.8 2.9 Canada Bay 66,090 22,198 69.3 1.4 23.9 5.4 2.5 Canterbury 138,497 43,455 72.3 2.5 21.9 3.2 2.8 Eastern Zone 509,430 174,713 60.3 1.4 30.1 8.2 2.3 Bankstown 176,761 53,397 75.7 2.6 19.6 2.0 2.9 Fa ,184 53,341 79.3 4.2 14.3 2.0 3.2 irfield 189Liv erpool 167,505 46,807 80.4 2.7 15.0 2.0 3.1Ca 0 mpbelltown 152,975 45,195 80.1 1.8 15.3 2.2 3.Ca .0 mden 51,055 13,985 83.2 1.3 13.5 2.0 3Wo 0 llondilly 41,050 11,796 82.0 1.6 14.8 1.7 3.Wi 5 ngecarribee 44,996 14,546 74.1 1.0 23.1 2.1 2.We 0 2.6 16.3 2.0 3.0 stern Zone 823,526 239,067 79.SSWAHS 1,332,956 413,780 70.5 2.1 22.6 4.8 2.7 NS 2,828 71.5 1.3 23.4 3.8 2.6 W 6,769,213 2,23

Source: N gional Profile 2004, ABS. SW Re Population density is significantly higher in inner city LGAs (Le Sy shcompared to suburban areas (Strathfield, Bankst Fa a an fringe

ee, Woll . Cam ltown nks and Wollondillyst proportion of t re l in th me five rs ago.

, South Sydney, Leich Ashfi arric and mden have highestrtion of newly settled resid The h prop ns in ed a mod are in Sydney, Sydney, Leichha Marric

outh West has some o oores unit the S , ch terise recents, high unemployment a h pro of fa s dep ent elfare

As with the highest pro f the p ion b Cent k cu ers a airfield,town, Canterbury, Marric nd As Mea xable me west i airfield,

y, Campbelltown and Liverpool. (See Table 5)

Socioeconomic Indicators

ichhardirfield)

t, Southnd urb

dney, A field) areas own,

(Camden, Wingecarribhe highe

ondilly) Fairfield, pbel , Ba town have t popula ion who we iving e sa LGA yea

t

Sydney hardt, eld, M kville Ca he propo ents. ighest ortio rent ccom ation South rdt and kville. Sydney S f the p t comm ies in tate arac d by migrant nd a hig portion milie end on w . The LG portion o opulat eing relin stom re F Banks kville a hfield. n ta inco is lo n F Canterbur

Table 5: LGA Popn.

Density Persons /

% Livin

km2

g in same LGA 5 years ago

% in rented

dwelling

P ublic housingtenant

households1

Centrelink Income Support

Customers2

Centrelink Customers

Mean Taxable

as % 2004 Income popn. $

Sydney (part) 4,586.8 14.7 50.4 399 (est.) 1,571 (est) 11.2 51,435 South Sydney (part)

5,068.2 39.4 52.9 2,980 (est.) 9,209 (est) 21.5 47,740

Leichhardt 5,007.9 51.5 44.2 2,385 10,755 16.2 55,107 Marrickville 4,630.4 57.1 40.5 828 17,779 23.0 39,212 Ashfield 4,871.0 56.2 38.0 193 8,784 21.2 41,065 Burwood 4,296.2 59.0 33.3 350 6,321 19.9 40,948

- 9 -


LGA Popn. % % in Public housing Centrelink Centrelink Mean Density

Persons / km2

Living in same LGA 5

rented dwelling

tenant households1

Income Support

Customers2

Customers as % 2004

popn.

Taxable Income

$ years ago

Strathfield 2,124.4 60.1 31.1 541 5,122 16.3 43,280 Canada Bay 3,206.1 62.4 26.9 763 10,180 15.4 49,947 Canterbury 4,074.6 67.6 34.4 3,213 35,023 25.3 34,239 Eastern Zone 4,118.8 N/A 40.4 11,652 104,744 20.56 44,304 Bankstown 2,256.7 74.1 26.4 6,431 45,121 25.5 35,688 Fairfield 1858.0 78.5 28.8 4,665 55,129 29.1 33,185 Liver 3 .2 2 pool 535. 61 30. 4,867 35,188 21.0 35,592 Campbelltown 8 0 482.5 75.9 30.3 6,99 30,72 20.1 35,581 Camden 8 237.8 58.5 17.8 35 6,009 11.8 39,282 Wollondilly 15.2 13.7 142 .1 37,884 70.2 6,605 16Wingecarribee 16.2 7 19.7 382 8,754 19.5 40,582 69.Western Zone 129.2 N/A 26.9 23,843 187,526 22.8 35,740 SSWAHS 214.7 N/A 33.2 35,495 292,270 21.9 39,610 NSW 8.3 69.4 27.5 125,401 1,474,412 21.8 41,623

1Includes ho2

useholds r and those not. e pension, disability support pension, wance, parenting p ngle, youth allowa udy, carer uble orphan pension, ex nal circumstances, mob llowance rt matu al parenting

ered, p wance ess a ce, special benefit, widow allowance, wife n a eiving more ayme are o nted once he main p type. SW Region 2004,

sus da ABS de socio-economic disadvantage which economic indicators suc w inc lo ational

t, high loym nd jobs in relati nskill pations into a single index eflecting overall socio-economic disadvantage. The lower the value the more

ed an is compared to other areas. The median SEIFA value for Australia is Table 6 sh ach of the SS As according to their SEIFA value and ranking.

Ind Rela Soc onom adva

eceiving rental subsidyIncludes ag

, doNewstart allo ayment si

, nce, aust

paymentpayment partn

ceptio, sickn

ility a Newsta re agepensio

lowance, nd widow class B.artner allo llowan

People rec than one p nt type nly cou using t aymentSource: N al Profile ABS. From cen ta, the has veloped an index of brings together a range of socio- h as lo ome, w educattainmen unemp ent a vely u ed occufigure rdisadvantag area 1,000. ows e W LG

Table 6: ex of tive io-Ec ic Dis ntage LGA SEIFA Value1 NS king W ran

Sydney (part) 1,0 137 09.5 South Sydney (part) 993.3 121 Leichhardt 1,061.1 162 Marrickville 980.6 94 Ashfield 1,025.7 147 Burwood 1,024.8 145 Strathfield 1,051.2 160 Concord 1,059.5 161 Drummoyne 1,069.5 166 Canterbury 950.4 37 Bankstown 968.9 72 Fairfield 905.1 4 Liverpool 955.5 47 Campbelltown 963.6 62 Camden 1,051.2 159 Wollondilly 1,028.4 150 Wingecarri 1,029.4 151 bee

1 1996 data2 t) to 188 (lo n al On the basis of this inde GAs in SSWAHS with socio-economic disadvantage greater than the State median, in order of ranking, are Fairfield, Canterbury, Liverpool, Bankstown and Marrickville. Fairfield has the fourth highest level of disadvantage of all 188 NSW LGAs. Key population parameters for the LGAs of SSWAHS are summarised at Appendix A “Profile of the Local Government Areas in SSWAHS”.

. Ranked 1 (highes west) based o l LGAs in NSW.

x, the L

- 10 -


4 ealth of the ulation A detailed epidemiological profile of SSWAHS has been prepared and is available through the SSWAHS Centre for Research, Evidence Management and Surveillance. This section provides

ey summary resented in t report.

4.1 Maternal and Infant Health

en) with significantly lower fertility rates in the inner ity suburbs of the Eastern Zone (Sydney, South Sydney, Leichhardt, Canada Bay,

Marrickville). Infant mortality rates are generally equivalent to or below the State average with the exception of Campbelltown and Wollondilly. (See Table 7) The average age of mothers is increasing each year, with the predominant age group being women aged 30-34 years. There are a range of co-morbidities associated with the increase in maternal age including hypertension and gestational diabetes. Increased morbidity and co-morbidity is also associated with the increasing numbers of women able to participate successfully in in-vitro fertilization (IVF).

Table 7: Maternal and Early Childhood Indicators

. H Pop

some of the k data p tha

Sydney South West contains areas with some of the highest fertility rates in NSW. Residents of Sydney South West gave birth to 19,234 babies in 2002, over 22% of all births in NSW. SSWAHS combines higher fertility rates in LGAs further from the inner city (Canterbury, Liverpool, Bankstown, Campbelltown, Camdc

LGA Births 2002

Fertility Rate 2000-20021

Infant Deaths 2000-022

Infant Mortality Rate 2000-20023

Sydney (part) 114 0.79 1 4.5 South Sydney (part) 389 0.96 6 4.4 Leichhardt 1,027 1.32 9 3.2 Marrickville 1,065 1.41 15 4.6 Ashfield 495 1.42 6 3.9 Burwood 381 1.43 5 4.8 Strathfield 282 1.40 3 4.6 Canada Bay 858 1.40 8 3.4 Canterbury 2,206 2.12 35 5.1 Eastern Zone to 31/12/04 6,817 N/A 88 N/A Bankstown 2,671 2.09 32 4.1 Fairfield 2,692 1.93 36 4.3 Liverpool 2,988 2.16 43 4.9 Campbelltown 2,254 2.00 46 6.7 Camden 832 1.99 10 4.4 Wollondilly 528 1.97 9 5.7 Wingecarribee 452 2.01 3 2.1 Western Zone to 31/12/04 12,417 N/A 179 N/A SSWAHS from 1/1/05 N/A N/A 267 N/A NSW 86,568 1.79 1,302 5.0

1 The sum of age-specific fertility rates (live births at each age of mother per female estimated resident population of that age). The

rate represents the number of babies born to a woman throughout her reproductive life. 2 Death of a live-born child who dies before reaching his/her first birthday. 3 The number of deaths of children under one year of age in one calendar year per 1,000 live births in the same calendar year Source: NSW Regional Profile 2004, ABS.

- 11 -


Average maternal age is higher in the Eastern Zone, with 64% of mothers aged 30 or more. In s than 30.

.4%). However, Campbelltown and in rr rtion of births to women under the age of 20

yea %

the Western Zone 55% of mothers are aged les Women under 20 have been identified as belonging to a high risk category from a psycho-social perspective, as evidence indicates a greater potential for mental health issues, domestic violence and/or isolation. Overall, the proportion of births to women under the age of 20 years

as lower in SSWAHS (3.6%) compared to NSW (4wW geca ibee had a significantly higher propo

rs (7.6 and 4.9% respectively). Figure 1: Source: NSW Public Health Bulletin Supplement: NSW Mothers and Babies, 2002 Department of Health

Total Confinements by Maternal Age - Resident Demand 2002

500060007000

tage

EZWZ

0100020003000

Perc

en

4000Total

EZ 134 618 1575

12-19 20-24 25-29 30-34 35-39 40-44 45+

2493 1428 318 12

WZ 562 2240 4136 3721 1547 309 7

Total 627 19696 2858 5711 6214 2975

Age Group (Years)

Ta ber of births to mothers aged less than 20 years LGA, 1999-200ble 8: Num by 3

LG

Number of birth

A

s to mothers aged under 20

years % Mean number Total number of

births (1999-2003) of

birth/year As 23 0.9 2,587 517 hfield Ba 505 3.7 13,476 2,695 nkstown Bu 18 1.0 1,718 344 rwood Ca 89 2.5 3,589 718 mden Ca n 906 7.6 11,846 2,369 mpbelltowCa 353 3.1 11,283 2,257 nterbury Co 12 0.7 1,710 342 ncord* Dr 10 0.4 2,223 445 ummoyne* Fa 488 3.4 14,244 2,849 irfield Le 5 1.1 4,637 927 ichhardt 3 Liv 58 4.0 14,629 2,926 erpool 2 Marrickville 121 2.2 5,481 1,096 South Sydney 68 3.1 2,173 435 Strathfield 22 1.5 1,438 288 Sydney Inner 4 0.7 567 113 Wingecarribee 126 4.9 2,567 513 Wollondilly 123 4.3 2,879 576 SSWAHS 3,503 3.6 97,047 19,409 NSW 18,909 4.4 4,33,488 86,698 Source: NSW MDC 1999-2003, HOIST, Epidemiology and Surveillance Branch, NSW Department of Health. *Now amalgamated as Canada Bay

- 12 -


The following tables (9-16) – provide a profile of confinements, birth weights, perinatal outcomes, gestational age & Neonatal Intensive Care Unit (NICU) registration for SSWAHS.

Table 9: Confinements by Place of Birth - Resident Demand 2002

Hospital Birth Centre

Planned Birth Centre-

Hospital Admission

Planned Home Birth

Planned Home Birth-

Hospital Admission

Born Before Arrival

TOTAL

No. % No. % No. % No. % No. % No. % No. % Eastern Zone

6,035 91.7 390 5.9 128 1.9 5 0.1 - 0.0 21 0.3 6,579 100.0

W stern 12,272 98.0 183 1.5 18 0.1 6 0.0 1 - 46 eZone

0.4 12,526 100.0

SSWAHS TOTAL

07 95.8 573 3.0 146 0.8 11 0.1 1 0.0 67 0.4 19,105 10018,3 .0

Source: Source: NSW Public NSW Mothers and Babies, 2002 Department of Health

verwhelming majority (96%) of births for re ent est o pital. her proportion of mothers p ning to g birth in birth es (8% compared to 1.6%)

ts of the Eastern Zone cts great roximity to entres at hos such as ince Alfred Hospital (RPAH nd the R Hospital for en, Randwick.

Confinements by rnal Ab inality & C of Birth – Resident Demand 2002

Health Bulletin Supplement:

The o sid s of Sydney South W ccur in hosThe hig lan ive centrfor residen refle er p Birth C pitals Royal Pr ) a oyal Wom Table 10: Mate orig ountry

Eastern Zone W TOTestern Zone AL

Cultural Background No % No % No % Aboriginal & Torres Strait Islander 1.1 0.7 165 0.9 73 92 Non-Aboriginal & Torres Strait Islander 6504 98.9 1 99.2 18,935 99.12,431 English Speaking 4 61.1 60.5 11,58 .7 4,01 7,568 2 60Central & South America 4 1.3 2.0 33 .8 8 254 8 1Melanesia, Micronesia & Polynesia 0 3.0 4.0 704 20 504 3.7Southern Europe 6 2.2 2.4 449 .4 14 303 2Western Europe & Northern Europe 7 0.9 0.5 114 5 57 0.6Eastern & Russia, Central Asian & Baltic States 0.9 0.6 135 .7 56 79 0Middle East, Europe, & Africa 6 7.5 10.6 1,819 49 1,323 9.5South East Asia 2 9.2 14.9 2,4 .9 60 1,869 71 12North East Asia 9 10.0 2.5 9 65 312 71 5.1Southern Asia 258 3.9 243 2 501 2.6 TOTAL 6,572 100.0 12,512 100.0 19,084 100.0Source: NSW Public Health Bulletin Supplement: NSW Mothers and Babies, 2002 Department of Health

In 2002 there were 165 births for women identifying as Aboriginal or Torres Strait Islander

sident in Sydney South West, representing around 1% of all births. Around 40% of all births speaking country of

en e Middle East and Africa account for a further 10% of all deliver re rowing proportion. The proximity of Villawood De C ultin sig mb ths for women from refugee families.

reto residents of Sydney South West are to women who have a non-English birth. Wom born in Asia comprise 18% of total mothers. Women from th

ies and g in a

present a gnificant nutention entre is res er of bir

- 13 -


Table 11: Confinements by Duration of Pregnancy at First Antenatal Check – Resident Demand, 2002

Weeks 0-19 20 - plus Not Stated TOTAL No % No % No % No % East Zone 5,556 84.5 975 14.8 48 0.7 6,579 ern 100.0Wes .2 2,623 20.9 113 0.9 12,526 tern 100.0 Zone 9,790 78SSWAH 3 3,598 18.8 161 0.8 19,105 100.0 S 15,346 80.Source: NSW Public Health Bulletin Supplement: NSW es t of He Mothers and Babi , 2002 Departmen alth

It is recommende or a first ante l check at 10-12 wee enab a first scan and es 4-16 weeks. It is noted that 15% and 21Easte are presen r ir a 0 Howe these would be enrolled in al d ith G Table ery Type - nt a 2

d that women present f nata ks, lingtimated date of confinement at 1 % of women from the

rn and Western Zones, respectively, ting fo their f st check fter 2 weeks or more. ver a proportion of antenat share care w their P.

12: Confinements by Deliv Reside Dem nd, 200

Normal Forceps Vaccum V E e aginal lectiv Emergency

Vaginal Extraction Breech Caesarean Caesarean N ot Stated

TOTAL

No % No % No % No % No % No % No % No %

Eastern Z 219 3.3 620 9.4 2 4. 100.0 one 3,953 60.1 4 0.4 933 1 2 827 12.6 3 0.0 6,579

Western Z 70.4 261 2.1 973 7.8 7 1,3 2. 100.0 one 8,821 0 0.6 70 1 6 1,031 8.2 - - 12,526

SSWAHS 2,774 66.9 480 2.5 1,593 8.3 9 2 5 100.0 TOTAL 1 4 0.5 2,303 1 .1 1,858 9.7 3 0.0 19,10

Source: NSW Public Health Bulletin Supplement: NSW Mothers and Babies, 2002 Department of Health Figure 2:

Confinements by Delivery Type, 2002

70

80

0

10

20

30

40

50

60

Normal Vaginal Forceps VaccumExtraction

Vaginal Breech Elective Ceasar. EmergencyCeasar.

Delivery Type

Per

cent

age EZ WZ

Two-thirds of all births for women from Sydney South West are normal deliveries. The rate of Caesarean births in 2002 was 22%, with 44% of these emergency caesareans. The higher Caesarean rates for Royal Prince Alfred Hospital (RPAH) and Liverpool Hospital, indicated below, reflect the tertiary role of these maternity units. Both hospitals receive women with co-morbidities and expected complicated births.

- 14 -


ConfinementsTable 13: by Delivery Type and Hospital

Normal Fo Vacuum Vaginal Elective Emergencrceps y Vaginal Extraction Breech Caes n area Caesarean

TOTAL

No. % No. No. % No. % N % No. % No % o. % RPAH 62.3 63 100.0 2,198 1.8 325 9.2 24 0.7 468 13.3 452 12.8 3,530

Canterbu 7 70.6 33 100.0 ry 1,01 2.3 119 8.3 1 0.1 145 10.1 125 8.7 1,440

Bankstow 1,760 100.0 n 1,335 75.9 22 1.3 133 7.6 11 0.6 151 8.6 108 6.1

Fairfield 1,422 77.8 18 1.0 145 7.9 6 0.3 146 8.0 90 4.9 1,827 100.0

Liverpool 2,194 74.0 33 1.1 198 6.7 26 0.9 273 9.2 241 8.1 2,965 100.0

Campbelltown 1,943 74.5 18 0.7 134 5.1 13 0.5 276 10.6 223 8.6 2,607 100.0

Bowral 386 63.1 22 3.6 90 14.7 6 1.0 59 9.6 49 8.0 612 100.0

Total - Public 10,495 71.2 209 1.4 1,144 7.8 87 0.6 1,518 10.3 1,288 8.7 14,741 100.0

Syd SW Priv 565 54.6 40 3.9 164 15.9 5 0.5 159 15.4 101 9.8 1,034 100.0 TOTAL all Hosp 1 1.6 8 0 7 9 8.8 15,775 100.0 1,060 70.1 249 1,308 .3 92 .6 1,67 10.6 1,38Source: NSW Public Health Bulletin Supplement: NSW Mothers and Babies, 2002 Department of Health NB Camden closed ies du ng 2002, d lo m o 005.

gh 5 grams or more is seen as optimal b st i 0 . firt r m g

o during preg t can be a s

hed less than 1,500 rams at birth (see Table 14)

Births by Birthweight - Resident Demand, 2002

to deliver ri ue to redeve pment. Ca den Delivery cl sed March 2

A birthwei t of 2, 00 y ob etric ans. In 20 2, 6 6% o all resident b hs we e below 2,500 grams. There are a nu ber of reasons for low birthwei ht, such as smoking, alcohpredictor of health issue

l and othe later in life

r drug use . Medical advance is continuing to enable smaller and more

nancy. Low birth weigh

premature babies to survive. At this time, 265 babies, or around 1%, weigg

. Table 14:

Eastern Zone Western Zone SSWAHS Birthweight (grams) No % No % No %

Less than 500 15 0.2 33 0.3 48 0.2 500-999 27 0.4 73 0.6 100 0.5 1000-1499 45 0.7 72 0.6 117 0.6 1500-1999 102 1.5 156 1.2 258 1.3 2000-2499 230 3.4 539 4.2 769 4.0 2500-2999 1,066 15.9 2,064 16.3 3,130 16.1 3000-3499 2,453 36.6 4,618 36.4 7,071 36.4 3500-3999 2,043 30.5 3,722 29.3 5,765 29.7 4000-4499 615 9.2 1,217 9.6 1,832 9.4 4500+ 103 1.5 203 1.6 306 1.6 Not stated 7 0.1 10 0.1 17 0.1 TOTAL 6,706 100.0 12,698 100.0 19,404 100.0 Source: NSW Public Health Bulletin Supplement: NSW Mothers and Babies, 2002 Department of Health

he majority (93%) of babies had a gestational age of 37 weeks or greater. Around 2% of all

Tbirths in SSWAHS hospitals were for gestations less than 32 weeks. The majority of these were at Royal Prince Alfred and Liverpool hospitals, reflecting their tertiary status. These hospitals have level 3 Neo Natal Intensive Care Units (NICUs) and therefore receive both higher risk pregnancies and babies transferred from other hospitals (See Table 15).

- 15 -


Table 15: Births by Gestational Age and Hospital - 2002

Gestational Age (weeks) 20 - 31 32 - 33 34 - 36 37+ TOTAL % % % No % No %No No No RPAH 2 4 8 2 5 3 0 622 00.015 .2 0 .2 180 .0 ,21 88.6 3, 1Canterbury 4 0. 3. 1, 0 0.3 3 0.2 45 1 398 96.4 1,45 10 0Total Easte n 3 8 4 4, 2rn Zo e 156 .1 3 1.6 225 .4 608 90.9 5,07 100.0Bankstown 3 0 .3 3 1, 5 0 1 .7 5 0 56 .2 701 95.8 1,77 10 .0Fairfield 0 .2 3 1, 7 07 .4 3 0 59 .2 768 96.2 1,83 10 .0Liverpool 117 3 5 .9 5 2, 4 0..9 7 1 160 .3 680 88.9 3,01 10 0Campbellto 9 0 .2 2 4. 2, 0wn 1 .7 6 0 1 6 8 489 94.3 2,640 10 .0Bowral 1 0.2 - 2 3 596 96.1 0 3 .7 620 100.0Total Western Zone 157 1.6 7 0.7 424 4.3 9,234 93.4 9,886 1 100.0Sydney SW t 3 0 0 4 4 5 0 Priva e .3 - 9 .7 993 95.0 1,04 10 .0

TOTAL Hospitals 316 2.0 1.0 698 16,003154 4.4 14,835 92.7 100.0

Source: NSW Public Health Bulletin Supplement: NSW Mothers and Babies, 2002 Department of Health

small proportion of births required a stay in the neo-natal intensive care unit. A There were 408

NICU confinements for Sydney South West births in 2002 (see Table 16).

Table 16: NICU Registrations in NSW and ACT 2002

Area of Residence Actual No. % Total Total NSW & ACT Live Births

Registrants per 1,000 live

births Easter e n Zon 134 6.7% 6,727 19.9Weste Zone 274 13.7%rn 12,916 21.2TOTAL NSW & ACT 00 90,22 22.22,003 1 .0% 6

Source: N Bulleti ot 2 Depa

4.2 Mortality During 199 re were 3 aths r m d de fem per year (7,376 deaths per year in total) HS or males, th al ath was 616 per 100,000 population and for fe t w 6 p 0 ula ble The age-standardised death rate for SSWAHS ma 70 S les). For females, th ardised ra SW wa for m The age-standardise SSWAHS wa gni high han W f les (Table 21). The mortality rate for males h S HS SW s s tly females. For males e in the

ner west LGAs of Leichhardt, South Sydney, Ashfield, Marrickville and Burwood and to a

SW Public Health n Supplement: NSW M hers and Babies, 200 rtment of Health

8-2002, the 897 de fo ales an 3479 e a u

aths for alesin SSWA . F nn crude de ratemales i as 54 er 100, 00 pop tion (Ta s 20 & 21).

les was 721.8 ((44

9.0 for N W maale age-stand

for te for S AHS s 457.0 3.2 NSW fe es).

d rate females, in bot

s siSWA

ficantly and N

er t, wa

for NSignifican

emahigher than for

age standardised death rates are significantly higher than the NSW averaginlesser extent in Campbelltown, Camden and Liverpool.

- 16 -


Table 17: Deaths, Death Rates, by LGA - Males, 1998-2002

Age-standardised rate per 100,000 pop LGA

Number of deaths

Crude rate per 100,000 pop Rate Lower 95% CI U I pper 95% C

Ashfi 947 83 .6 7.3eld 945.0 2.1 779 88Ban 3,128 5 69 2kstown 741. 3.1 668.7 718.Burw 671 900.3 79 5ood 4.7 735.5 857.Camden 510 1 74 2481. 7.3 681.8 817.Cam 1,569 423.3 77 8pbelltown 6.0 734.7 818.Can 2,236 651.9 64 5terbury 6.0 619.4 673.Concord* 450 0 63 6681. 8.6 580.7 700.Drum 600 738.8 59 2moyne* 7.2 550.0 647.Fair 2,457 521.4 69 0field 3.0 664.9 722.Leic ,180 6 91 0hhardt 1 778. 3.6 861.4 968.Live 1,707 446.5 72 5rpool 2.0 685.9 759.Marrickville 1,377 705.8 817.8 774.4 862.9Sou 757 7 86th Sydney 733. 2.7 800.6 928.3Stra 737.5thfield 567 794.2 678.8 623.7 Sydney 69 249.5 437.3 329.7 566.0Wingecarribee 793 777.3 670.3 623.8 719.3Wollondilly 464 489.6 678.8 616.5 745.4SSWAHS 19,482 616.0 721.8 711.6 732.1NSW 1,16,614 724.0 709.1 705.0 713.2Note: Data are re d by year of death. Numbers for 2002 include an estimate of the small nporte umber of deaths that were registered in 2003, data for

hich were not available at the time of production. Death rates were age-adjusted using the Australian population as at 30 June 1991. Upper and lower its of the 95 per cent confidence interval for the point estimate are shown. Crude death rates were calculated based on ABS estimated resident

n 1Source: AB OIST, E v h, . * Amalgamated as Canada Bay

For females age standardised death rates are higher than the NSW average (in order of magnitude) in the LGAs of Ashfield, Campbelltown, Camden, Liverpool, Leichhardt, South Sydn o ly.

Tab es, by LGA - Females, 1998-2002

wlimpopulatio 998-2002.

S mortality data 1997-2002, H pidemiology and Sur eillance Branc NSW Department of Health

ey, Marrickville, Fairfield and W llondil

le 18: Deaths, Death Rat

Age-standardised rate per 100,000 pop LGA

Number of deaths

Crude rate per 100,000 pop Rate Lower 95% CI Upper 95% CI

Ashfield 1185 1149.2 517.3 483.3 552.7Bankstown 2722 635.0 435.9 419.2 453.1Burwood 585 760.4 422.9 386.4 461.8Camden 560 516.6 511.6 468.1 557.8Campbelltown 1409 372.9 512.7 485.6 540.8Canterbury 1919 559.2 402.0 383.7 421.0Concord* 467 685.2 425.7 385.5 468.8Drummoyne* 568 637.5 343.8 314.2 375.3Fairfield 2148 456.2 467.7 448.1 488.0Leichhardt 968 591.9 504.1 471.2 538.6Liverpool 1555 414.1 507.7 482.4 533.9Marrickville 1107 579.0 485.1 455.7 515.8South Sydney 499 537.6 498.7 454.9 545.5Strathfield 550 750.1 417.3 380.1 457.0Sydney 46 188.4 333.3 235.3 455.4Wingecarribee 732 688.6 414.0 383.0 446.7Wollondilly 372 399.7 444.7 400.1 492.9SSWAHS 17392 545.8 457.0 450.1 464.0NSW 107555 658.2 443.2 440.5 446.0

- 17 -


Note: Data are re d by year of death. Numbers for 2002 include an estimate of the small number of dwhich were not av t the time of production. Death rates were age-adjusted using the Australian popu

porte eaths which were registered in 2003, data for ailable a lation as at 30 June 1991. Upper and lower

limits of the 95 per cent confidence interval for the point estimate are shown. Crude mated resident population 1998-2002. Source: A tality data 1 IS ce B SW D .

Bay

r causes of d are circulato eases, ca s, injury/poisoning and respiratory s. These compri bout 80% of aths in both SSWAHS and NSW. The four major

of death are the same for both males and females. Deaths due to cancer, ning and re ory diseases higher a males. The proportion of female

e to injury/poisoning is about half that for males (4% vs. 8.5%).

hows variations by LGA in death rates by major disease categories.

9: Death ra y LGA and cause of death - 2000-2002

death rates were calculated based on ABS esti

BS morted as Canada

997-2002, HO

T, Epidemiology and Surveillan ranch, N epartment of Health*Amalgama The majo eath ry dis ncerdisease se a all decausesinjury/poiso spirat were mongdeaths du Table 19 s

Table 1 tes bCauses o h (rate)1f DeatLGA

Malignant All Heart Disease

Cerebro Respiratory Neoplasms Vascular System

Accidents Intentional Assault A es ll Causof DeatSelf Harm h

Sydney (part) 124.0 76.5 43 18.2 6.3 0.9 416.2 30.5 .7 South Sydney (part) 213.8 197.8 54 31.1 15.2 5.8 787.0 63.9 .9 Leichhardt 1 190.7 76 19.4 13.3 1.9 756.5 89.5 88.2 .4 Marrickville 1 209.3 73 27.3 9.5 1.9 748.9 73.3 93.9 .8 Ashfield 169.9 203.4 79 29.6 15.2 3.2 817.1 109.0 .3 Burwood 166.6 196.0 59 18.6 7.3 1.1 699.6 75.5 .6 Strathfield 180.7 164.9 52.5 21.0 3.4 4.5 649.671.0 Canada Bay 175.3 159.5 64.9 41.5 22.5 8.2 0.0 594.4 Canterbury 164.0 162.7 54.8 48.9 22.2 11.0 1.4 600.8 Eastern Zone N/A N/A N/A N/A N/A N/A N/A N/A Bankstown 178.7 183.1 61.4 63.8 16.8 8.9 1.6 663.2 Fairfield 184.3 175.1 84.0 50.4 19.1 8.8 2.8 668.1 Liverpool 182.8 196.8 65.4 63.2 28.9 6.9 2.2 697.2 Campbelltown 195.5 215.4 70.3 77.0 25.4 13.4 1.6 753.6 Camden 190.5 197.4 109.5 57.8 18.6 10.0 1.5 726.9 Wollondilly 188.2 206.3 78.6 52.9 29.0 9.2 1.8 694.3 Wingecarribee 167.8 165.5 78.3 52.0 26.4 10.9 0.0 628.4 Western Zone N/A N/A N/A N/A N/A N/A N/A N/A SSWAHS N/A N/A N/A N/A N/A N/A N/A N/A NSW 184.7 177.5 68.0 57.3 23.9 11.1 1.6 669.4

1direct standar death rate, cause of death being the disease or injury that initiated thdized e train of morbid events leading directly to death. Cause of death is classified according to ICD-1 2002, with the rate per 1000,000 of the mid-yea onSource: egional Profile 2004, ABS.

orbidity an sk factor

1 Cancer

cidence data obtained the NSW cer Registr ugh HOIST, epartment and a resented fo five-year d 1998-200

th males and females, the crude incidence rate 1,000,000 p tion for all cancers er in SSWAHS ales: 409.0; Females: 344.5) compared to NSW (Males: 499.5;

s: 412.6) (Table 24). Crude incidence rates for both male females com d nted in Table 2

ortion of the co on cancers percentage of all cancer nder and LG e ted in Tables 22 & 23. In SSWA s, prostate cancer is the most common cancer

up about 23% of all cancer, whereas in females, breast can the most co n nd makes up about 28% of all cancers. The fi are similar SW.

0. Based upon deaths for the period 2000-r 2001 populati .

NSW R 4.3 M d ri s

4.3. Cancer in were from Can y thro NSWHealth D re p r the perio 2. For bo per opulawere low (MFemale s 23 & s and bineare prese 5. The prop mm as a by ge A arpresen HS maleand makes cer is mmocancer a gures for N

- 18 -


Table 20: Number of cancers and crude incidence for the common cancers by LGA, Males, 1998-2002

LGA Colorectal Lung Melanoma ProstateOther All

Cancers Cancers Crude incidence rate per

100,000 pop Ashfield 50 64 42 103 211 470 469.0

Bankstown 279 284 182 559 857 2,161 512.3

Burwood 55 46 18 70 178 367 492.4

Camden 48 45 47 72 165 377 355.7

Campbelltown 121 137 120 224 482 1,084 292.5

Canterbury 229 206 108 327 653 1,523 444.0

Concord* 60 41 25 96 139 361 546.3

Drummoyne* 62 50 51 111 188 462 568.9

Fairfield 247 256 75 354 722 1,654 351.0

Leichhardt 98 92 56 152 293 691 455.9

Liverpoo 121 162 65 1,138 297.7l 264 526

Marrickville 112 106 59 168 367 812 416.2

South Sydney 61 71 29 85 230 476 461.4

Strathfield 57 36 2 90 163 372 6 521.1

Sydney 6 9 13 35 674 242.3

Wingecarribee 54 6 187 191 58687 7 574.4

Wollondilly 43 34 4 85 132 335 1 353.5

SSWAHS 1,7 ,693 1,01 2,960 5,532 12,936 36 1 5 409.0NSW 11,2 8,59 19,103 32,304 80,455 73 9,180 5 499.5Source: NSW Central Cancer R ata, Epidem and Su ce Bra SW De ent of H .

as Canada Bay

21: Number nce d cr incide for omm cance by LFemales -20

egistry d HOIST, iology rveillan nch, N partm ealth

* Amalgamated

Table of ca rs an ude nce the c on rs GA, , 1998 02

LGA Colorectal Lung Melanoma Breast CerOthe

vixr

CancersAll

Cancers Crude i ence rncid ate

per 1 00 pop00,0 Ashfield 64 29 27 422 40 118 12 172 9.3Bankstown 252 31 109 16 391 409 38 739 78 1.4Burwood 42 23 16 85 5 106 277 360.1Camden 47 25 46 107 9 143 377 347.8Campbelltown 105 87 117 317 27 430 1083 286.6Canterbury 163 72 62 333 26 550 1206 351.4Concord* 41 18 16 90 4 125 294 431.4Drummoyne* 51 22 34 146 8 176 437 490.4F irfield 181 105 70 396 49 628 1429 303.5aLeic 40 69 180 16 232 609 372.4hhardt 72 Liverpool 135 82 64 295 22 448 1046 278.6Marrickville 78 46 29 185 16 285 639 334.2South Sydney 34 45 22 88 9 159 357 384.6Strathfield 50 18 16 91 4 128 307 418.7Sydney 7 3 3 11 0 15 39 159.7Wingecarribee 68 21 42 140 6 188 465 437.4Wollondilly 30 18 30 103 4 127 312 335.2SSWAHS 1,420 785 772 3,094 255 4,651 10,977 344.5NSW 9,445 4,625 6,069 19,172 1,339 26,771 67,421 412.6Source: NSW Central Cancer Registry data, HOIST, Epidemiology and Surveillance Branch, NSW Department of Health. * Amalgamated as Canada Bay

- 19 -


Table 22: Number of cancers and crude incidence for the common cancers, males and females combined, 1998-2002

A Colorectal Lung Melanoma Breast Cervix Prostate Other

Cancers All

Cancers LG

Crude incidence rate

per 100,000 pop

Ashfield 114 93 69 118 12 892 103 383 438.7

Bankstown 531 415 291 412 38 3,839 559 1,593 451.4

Burwood 97 69 34 85 5 70 644 284 425.2

Camden 95 70 93 109 9 72 754 306 351.7

Campbelltown 226 224 237 320 27 2,167 224 909 289.5

Canterbury 392 278 170 335 26 2,729 327 1,201 397.7

Concord* 101 59 41 91 4 96 655 263 487.9

Drummoyne* 113 72 85 147 8 899 111 363 527.9

Fairfield 428 361 145 397 49 3,083 354 1,349 327.2

Leichhardt 170 132 125 180 16 1,300 152 525 412.6

Liverpool 256 244 129 298 22 2,184 264 971 288.2

Marrickville 190 152 88 185 16 1,451 168 652 375.6

South Sydney 95 116 51 88 9 85 833 389 425

Strathfield 107 54 42 94 4 90 679 288 469.2

Sydney 13 12 7 12 0 13 106 49 203.6

Wingecarribee 155 75 109 141 6 1,051 187 378 504.5

Wollondilly 73 52 71 103 4 85 647 259 344.4

SSWAHS 3,156 2,478 1,787 3,115 255 23,913 2,960 10,162 376.6NSW 20,718 13,805 14,664 19,333 1,339 19,103 58,914 1,47,876 455.8Source: NSW Central Cancer Registry data, HOIST, Epidemiology and Surveillance Branch, NSW Department of Health. *Amalgamated as Canada Bay The age-st ardised incidence of colorectal cancer, melanoma and prostate cancer in males

tly lower in SSWAHS thand

was significan an NSW. However, males in SSWAHS had a significantly higher age-standardised incidence of lung cancer compa NS a

ardised in r l er s ntly lower in S A than N . g an cervi canc tes in females in

were similar o NSW

Age-sta rd canc inc nce tes 10 0 populationgender, 1998-2002

red to W (T ble 26). The age- in females wastand cidence of colo ectal cancer, me anoma and breast canc

significa SW HS SW Lun d cal er raSSWAHS to th se in .

Table 23: nda ised er ide ra (per 0,00 ) by

All

Cancers Colo al rect

Lung

Melanoma

Breast

Cervical

Prostate

Males

SSWAHS Age-standardised incidence rate per

ulation 449.4 61. 60.3 - 100,000 pop 4 34.1 - 107.3

Lower 95% CI 441.6 58. 57.4 - 5 32.0 - 103.4

Upper 95% CI 457.3 64.4 63.3 - 36.3 - 111.3

NSW Age-stand100,000 p

ardised incidence rate per opulation 471.9 66.3 54.2 5 - 0.2 - 113.5

Lower 95% CI 468.6 65. 53.1 - 1 49.2 - 111.9

Upper 95% CI 475.2 67. 55.4 - 6 51.3 - 115.1

Females

SSWAHS Age-standardised incidence rate per 100,000 population 322.9 41.6 23.8 22.9 92.3 7.6 -

Lower 95% CI 316.8 39.4 22.1 21.3 89.0 6.7 -

Upper 95% CI 329.1 43.8 25.5 24.5 95.6 8.6 -

- 20 -


NSW

Age-standardised incidence rate per 100,000 population 340.8 45.9 23.2 32.6 .7 7.4 100 -

Lower I 95% C 338.2 44.9 22.5 31.7 99.2 7.0 -

Upper 95% CI 343.4 46 23.9 1 - .8 33.4 02.1 7.9 Source: NSW

Central Cancer istry data, HOIST, Epidemiology a NSW ment of h.

Commu able seases

rates for mu ble dis es were obtained fro he N out les Heant. The crude notification rates presented are for s ted un diseas

are the ann vera s of noti tion om J uary 2 0 to O er 20

notification ra osis pat B, he titis C, AIDS, rrho d syphher for SSW c ared to W le 2 The ificati tes epatitis

in SSWAHS for NSW. The highestLG were Sydney, Strathfield, Canterbury

ield. Fairfie ad highest notific n rat or hepatitis B reas th Sydnhest notific n r or hepa C, A S, go rrhoe nd sy s.

Annual average crude fica rate (per selectcomm cabl iseases y LGA, January 2000 ovem 2004

Reg nd Surveillance Branch, Depart Healt

4.3.2 nic Di Notification com nica eas m t ew S h Wa lth Departme elec comm icable es only and ual a ge fica s fr an 00 ctob 04. Crude tes for tubercul , he itis pa gono ea an ilis were hig AHS omp NS (Tab 4). not on ra for h B, AIDS, gonorrhoea and syphilis were about twice that notification rates for tuberculosis among SSWand Fairf

AHS atio

As e fld h the whe Sou ey

had the hig atio ate f titis ID no a a phili

Table 24: noti tion s 100,00 population) for ed uni e d b -N ber

LGA Tu lobercu sis Hepatitis He s patitiC

AIDS Gonorrhoea Syphilis B

Ashfield 14.9 122.4 114.1 0.9 29.2 18.7 Bankstown 8.1 178.5 113.4 0.4 10.0 25.5 Burwood 10.5 126.5 73.8 3.7 13.1 10.2 Camden 1.0 30.3 45.4 0 4.3 4.2 Campbelltown 7.3 51.1 137.7 0.3 5.9 13.0 Canterbury 18.4 157.2 96.3 1.6 17.2 15.0 Concord* 7.3 59.7 56.7 2.1 13.2 7.0 Drummoyne* 3.6 35.9 56.3 2.1 23.1 10.8 Fairfield 18.4 255.6 140.6 0.8 15.7 29.2 Leichhardt 5.0 42.2 111.4 4.3 44.5 19.3 Liverpool 9.3 104.4 128.5 0.6 13.1 20.3 Marrickville 13.0 106.2 174.7 6.8 83.3 35.9 South Sydn 11.9 109.4 426.3 30.7 344.0 103.5 eyStrathfield 30.7 169.9 74.7 1.4 19.3 13.7 Sydney 30.2 221.5 170.5 6.5 133.1 62.7 Wingecarribee 0 77.8 9.3 0.5 1.6 7.0Wollondilly 1.3 11.5 52.0 0.5 2.1 3.7 SSWAHS 11.2 105.4 45.5 23.5 120.6 3.7 NSW 6.0 56.9 20.1 10.7 111.4 1.8

Source: GODSEND, New South Wales Health Department (Accessed November 2004)

Health Risk Factor

e were no significant differences in smoking rates for both males and females between AHS, the males smoking rate was 24.4% and the female smoking

.

drinking behaviour, oth m an males, less common i SSWAHS compared to NSW. For males, the prevale lcohol risk drinking behaviour in SSWAHS

%, which was significantly lower than the prevalence for NSW (41.3%). For females, risk drinking behaviour was not significantly different between

%) and NSW (27

* Amalgamated as Canada Bay

4.3.3 s TherSSWAHS and NSW. In SSWrate was 19.3% Alcohol risk for b ales d fe was n

nce of awas 35.2the prevalence of alcohol SSWAHS (25.1 .7%).

- 21 -


Table 25: Current daily or occasionally cigarette smoking and any alcohol risk drinking behaviour b gender, persons aged 16 ears an over, 2 02-2003 y y d 0

Males Female No. Prevalence (%) 95% CI No. Prevalence (%) 95% CI

Current daily/occasionally smoking SSWAHS 1243 24.4 22.0 7 19. 4 –– 26.8 169 3 17. 21.2 NSW 10665 23.2 22.4 – 24.0 14965 18.6 18.0 – 19.3 Any alcohol risk drinking behaviour SSW 37.8 1697 25.1 23.0 – 27.2 AHS 1243 35.2 32.5 – NSW 10665 41.3 40.4 – 42.3 14965 27.7 26.9 – 28.4 Source: NSW Health Survey 2002 & 2003 (HOIST). Centre for Epidemiology and Research, NSW Department of Health.

Table 26: Confinements by Number of Cigarettes Smoked in the Second Half of Pregnancy - Resident Demand, 2002 None 1-10 per day > 10 per

day Smoked-

amount not stated

Not Stated TOTAL

No. % No. % No. % No. % No. % No. % Eastern Zone

6,106 92.8 318 4.8 152 2 2 0 1 - 6,579 100.0

Western 10,785 86.1 847 6.8 842 6.7 51 0.4 1 - 12,526 100.0 Zone SSWAHS 16,891 88.4 1,165 6.1 994 5.2 53 0.3 2 0.0 19,105 100.0 Source; NSW Publi For m ther e t asthma, diabetes/high blood sugar h blo ssu hig ood chole l betw SSWAHS and NSW (Table 27). For ales ver, t val of curre thma high blood pressure were significantly lower in HS c red SW (Tab ). No at for high blood pressure and high blood choles , data rom t 2002 NSW alth Su y only and hence the smaller sample size.

Ta Prevalence elec alth s by nder, per aged ears and over, 2002-2003

c Health Bulletin Supplement: NSW Mothers and Babies, 2002 Department of Health

ales, e were no significant o

differencesr

in th prevalence of curren, hig d pre e and h bl stero een fem howe he pre ence nt as and

SSWA ompa to N le 27 te thterol are f he He rve

ble 27: of s ted he statu ge sons 16 y

Males Female No. Prevalence

% 95% CI No. Prev alence

% 95% CI

C sthma urrent aS 1243 8.8 7.2 – 1 7 .4 9.9 – 12.9SWAHS 0.3 169 11N 10665 9. 8.5 – 5 .5 3.0 – 14.1SW 1 9.6 1496 13 1D gh blood sugaiabetes/Hi r SSWAHS 1243 7. 6.4 – 09 9.4 169 6.6 5.4 – 7.8NSW 10616 9.8 9.2 – 10.3 14921 7.8 7.4 – 8.3High blood pressure SSWAHS .5 21.0 – 27.9 873 22.3 19.6 – 25.1593 24NSW 25.9 – 28.3 7223 27.4 26.3 – 28.45187 27.1High blood cholesterol SSWAHS 454 27.3 23.2 – 31.4 631 30.1 26.5 – 33.7NSW 3900 26.9 25.5 – 28.3 5208 28.0 26.8 – 29.3

S

ource: NSW Health Survey 2002 & 2003 (HOIST). Centre for Epidemiology and Research, NSW Department of Health.

nts of vegetables, for both males and females, was ignificantly lower in SSWAHS compared to NSW.

For both males and females, prevalence of obesity/overweight was significantly lower in SSWAHS compared to NSW and the prevalence of adequate physical activity was significantly higher in males for SSWAHS compared to NSW. The consumption of adequate amounts of fruit was no different for both males and females in SSWAHS compared to NSW. The consumption of recommended amous

- 22 -


Table 28: Overweight and obesity, fruit and vegetable intake and adequate physical activity by gender, persons aged 16 years and over, 2002–2003

Males Female N Prevalence

(%) 95% CI N Prevalence

(%) 95% CI

Overweight/obesity SSWAHS 1243 51 54.4 7 3.6 48.8 – 169 38.2 5.9 – 40.6 NSW 10664 55.7 54.8 – 56.7 14963 42.7 42.0 – 43.5 Adequate p l activity hysicaSSWAHS 12 52 55.0 7 343 .2 49.4 – 169 41.0 8.6 – 43.3 NSW 10665 48.1 47.1 – 49.0 14965 39.7 38.9 – 40.5 Adequate fruit intake SSWAHS 1243 43.0 40.3 – 45.8 1697 52.3 49.9 – 54.7 NSW 10665 39.7 38.7 – 40.6 14965 53.6 52.8 – 54.4 Adequate vegetable intake SSW HS 1243 0.0 11.6 21A 1 8.3 – 1697 23.4 .4 – 25.4 NSW 10665 3.9 14.5 27 1 13.2 – 14965 28.0 .3 – 28.7

Source: NSW Health Survey 2002 & 2003 (HOIST). Centre f emiolo NSW Department of Health.

ea r ti e i

im at ov e 20 4 e o ned m Inf ti seN a e en he re ta rte th Au l ild

or Epid gy and Research,

4.4 H

lth P otec on B hav ours

Data for munis ion c erag for 03/0 wer btai fro the ec ous Di ases Branch, SW He lth D partm t. T se a da repo d to e stra ian Ch hood Immunisation Register by immunisation providers. In SSWAHS, the percentage of children fully immunised by the age of 15 months ranged from 75% to 94% (Table 29). For SSWAHS as a whole the immunisation coverage rate was 91% and for NSW it was 90%.

Table 29: Immunisation rates by LGA, children aged 12-15 months, 2003-2004 LGA % Fully Immunised Ashfield 87Bankstown 93Burwood 88Camden 94Campbelltown 91Canterbury 90Concord* 92Drummoyne* 92Fairfield 90Leichhardt 90Liverpool 90Marrickville 90South Sydney 87Strathfield 90Sydney 75Wingecarribee 87Wollondilly 93SSWAHS 90NSW 91

Source: Infectious Diseases Branch, NSW Department of Health, 2004. * Amalgamated as Canada Bay Data for breast cancer screening were from BreastScreen NSW. In the two year period July 2002 to June 2004, breast cancer screening was undertaken by 45.8% of SSWAHS women aged 50 to 69 years compared to 51.9% for NSW (Table 30). The percentage for SSWAHS was significantly lower than for NSW as a whole.

- 23 -


Table 30: Breast cancer screening, women aged 50-69 years, July 2002 to June 2004 No. Screened % Screened 95% CI SSWAHS 53,135 45.8 45.5-46.2NSW 343,8 51 7-5250 .9 51. .1

Note: Only screenings done by BreastScree ncluded. Data provided by BreastScreen NSW.

Data for biennial cervical cancer s in e tained fr he N cal Screening Program & NSW Pap Test ist cal Repo 02. T ng r nificantly th r N Table 31 eichh en and Wingecarribee had the highest s in S S wher shfie ld and Canterbury had the lowest screening rates.

T ervical screening rates by LGA, women aged 20-69 years, 1 Janua 1–31 Dec r

n NSW i

creen g rates w rStatisti

e ob om t SW Cervi Reg er, Annual rt 20 he screeni

ates for SSWAHS were sig lower an that fo SW ( ). L ardt, Camdcreen g rates in SWAH eas A ld, Strathfie

able 31: Biennial cry 200 embe 2002

LGA No. % 95% CI Ashfield 6,680 49.5 48.7 – 50.3Bankstown 25,595 55.3 54.9 – 55.8Burwood 4,863 53.3 52.2 – 54.3Camden 7,689 66.2 65.3 – 67.0Campbelltown 21,572 52.8 52.3 – 53.3Canterbury 21,307 52.4 51.9 – 52.9Canada Bay 11,943 60.9 60.2 – 61.6Fairfield 29,400 55.6 55.2 – 56.0Leichhardt 15,279 66.3 65.7 – 66.9Liverpool 23,777 57.0 56.5 – 57.4Marrickville 14,481 54.9 54.3 – 55.5South Sydney 6,896 59.0 58.1 – 59.9Strathfield 4,285 51.9 50.8 – 53.0Sydney 2,269 61.2 59.6 – 62.7Wing 64.3 63.4 – 65.2ecarribee 6,858Wollondilly 59.5 – 61.45,835 60.35S 2,,08,721 56.5 56.3 – 56.6SWAHS N 807,597 60.7 60.6 – 60.8SW

Sou rvical Screening Program & NSW Pap Te egister, Annual Statistical Report 2002. Westmead Hospital, Sydney, 200

rce: NSW Ce st R3.

- 24 -


5. Health Utilisation 5. italisati erns fo W sidents

1 Hosp on patt r SS AHS re

g tables profile the hospitalisation patterns for residents within SSWAHS.The followin

Table 32: Place of Acute Inpatient Treatment for SSWAHS residents age 16+years 2002/03

Area of Residence

Area of Hospital

Seps Beddays Cost Wtd Seps*

% Seps

% Beddays

%Cost Wtd Seps*

Av. Cost Wtd Sep*

Eastern Zone 50,247 209,284 68,162 74% 68% 70% 1.36 SESAHS 10,741 40,178 13,837 14% 13% 14% 1.29 Western Zone 3,370 13,072 4,438 4% 4% 5% 1.32 NSAHS 1,304 4,531 1,879 2% 1% 2% 1.44 WSAHS 1,292 4,304 1,632 2% 1% 2% 1.26

E

O 922 1% 1% 1% 1.22

astern Zone

ther 758 2,616 Eastern Zone 67,712 273,985 90,870 87% 89% 93% 1.34

Western Zone 77,997 30 ,365 80% 77% 1.25 9,332 97 80% Eastern Zone 6,369 2 ,273 6% 8% 1.61 4,875 10 6% WSAHS 5,799 ,007 6% 6% 1.38 21,909 8 6% SESAHS 4,785 17 ,309 5% 6% 1.53 ,517 7 5%

Western Zone

Other 3,073 11,245 ,022 3% 3% 1.31 4 3% Western Zone 98,023 384,878 126,976 100% 100% 100% 1.30

S 1

Figure 3 Figure 4

As indicated in the above pie charts 74% of Eastern Zone residents aged greater than 16 are treated in Eastern Zone hospitals, with 16% flowing to the former SESAHS and 5% flowing to the Western Zone. Similarly, in the Western Zone 80% of residents aged greater than 16 years of age are receiving their inpatient hospital care within Western Zone hospitals with 6% flows into the Eastern Zone and also to the former WSAHS.

ource: NSW Health FlowInfo V5.

PlaceZon

of Acute Inpatient Treatment foresidents Age 16+yr: SEPARA

WSAHS2%

Other1% NSAHS

2%

SWSAHS5%

S

Eastern TIONSe R

SESAH16%

CSAHS74%

Place of Acute Inpatient Treatment for Western esidents Age 16+yr: SEPARATIONS

Other3% SESAHS

5%

WSAHS6%

CSAHS6%

S

Zone R

WSAHS80%

- 25 -


Tab 3: Place of Acute Inple 3 atient Treatment by Residents' LGA age 16+years 2002/03: Separations

Area f oResidence LGA EASTERN ZONE WESTERN ZONE SESAHS WSAHS Other

Grand Total

Sydney (part) 30% 0% 66% 0% 3% 100%South Syd (part) 57% 1% 38% 0% 3% 100%L 83% 1% 10% 1% 5% 100%eichhardt Marrickville % 13% 3% 82 2% 1% 100%As 87% 3% hfield 1% 8% 2% 100%Burwood % 3% 3% 10 85 3% 6% 0%Strathfield % 7% 2% 1080 5% 5% 0%Canada Bay % 3% 5% 1085 1% 6% 0%

E

y % 2% 2% 10

astern Zone

Canterbur 65 14% 18% 0%Eastern Zone 74% 5% 16% 2% 3% 10 0%

Bankstown % 9% 2% 10 14 67% 8% 0%Fairfield 5% 10% 2% 1080% 3% 0%Liverpool 5% 4% 4% 1083% 5% 0%Campbelltown 3% 2% 2% 10 88% 4% 0%

Western Zone

Camden 2% 3% 10090% 3% 2% %Wollondilly 3% 78% 4% 3% 12% 100%

W 7% 100%ingecarribee 3% 81% 5% 3% Western Zone 6% 80% 5% 6% 3% 100%SSWAHS 34% 49% 9% 4% 3% 100%Source: NSW Health FlowInfo V5.1

At the LGA level, significant flows outside of the resident zone are confined to LGAs where

ere are natural referral links to hospitals in close proximity over the border eg. 66% of Sydney sidents and 38% of South Sydney residents flowing to SESAHS, 32% of Canterbury residents

owing either to the Western Zone or SESAHS and 14% of Bankstown residents flowing to the astern Zone.

able 34: Place of treatment for Eastern Zone residents (age 16+yr) by SRG 2002/03: Separations

threflE

T

Se ice Related Group rv Eastern Zone SESAHS Western Zone NSAHS WSAHS Other SRG total % outflow

Obstetrics 6,116 1,206 255 94 195 37 7,903 23%

Non Subspecialty Surgery 4,034 750 239 121 123 90 5,357 25%

Cardiology 4,095 513 230 67 58 75 5,038 19%

Orthopaedics 3,445 746 330 132 98 97 4,848 29%

R 49 31 55 4,35espiratory Medicine 3,465 561 189 0 20%

Gynaecology 2,776 666 176 100 165 25 3,908 29%

Neurology 2,450 387 131 53 38 45 3,104 21%

Non Subspecialty Medicine 2,435 356 100 44 61 36 3,032 20%

Diagnostic GI Endoscopy 2,131 446 258 64 30 20 2,949 28%

Gastroenterology 2,223 400 149 40 36 47 2,895 23%

Urology 2,030 479 272 24 33 15 2,853 29%

Haematology 1,735 351 135 13 9 6 2,249 23%

- 26 -


Se rourvice Related G p Eastern Zone SESAHS Western Zone NSAHS WSAHS Other SRG total % outflow

Immunology and Infec 59 18 50 22 1,80tions 1,164 487 0 35%

Op 71 hthalmology 768 806 23 14 7 1,689 55%

Interventional Cardio 1,111 228 79 5 5 6 1,5logy 4 4 32 27%

Plastic and Reconst 980 210 77 4 8 19 1,4ructive Sx 1 0 07 30%

Drug and Alcohol 850 257 41 4 2 40 1,2 3 1 52 32%

Upper GIT Surgery 935 187 87 1 10 6 1,2 6 41 25%

Neurosurgery 836 212 61 2 33 8 1,1 2 72 29%

Colorectal Surgery 864 166 90 1 6 8 1,1 5 49 25%

Medi 91 156 48 1 5 1,0cal Oncology 7 7 2 19 22%

Endocrinology 81 135 26 4 14 9 7 16 76 20%

Vascular Surgery 746 119 54 24 2 9 16 61 22%

Ear, Nose and Throa 44 169 35 18 11 8t 5 78 55 36%

Renal Medicine 58 186 40 16 9 8 5 7 16 32%

Psychiatry - Acute 342 75 15 14 32 13 491 30%

Cardiothoracic Surgery 299 97 9 8 - 4 14 27 30%

Pain Management 343 52 8 6 7 4 7 23 19%

Rheumatology 245 100 17 8 1 1 372 34%

Breast Surgery 290 46 16 3 5 - 360 19%

Dermatology 238 47 11 12 17 3 328 27%

Head and Neck Surgery 165 44 22 9 9 2 251 34%

Unallocated 169 30 12 3 5 2 221 24%

Tr %acheostomy 161 25 18 10 4 3 221 27

Rehabilitation 29 4 19 2 10 52 6 51%

Dentistry 34 11 4 47 1 1 9 64%

Extensive Burns 23 2 1 1 - 27 15%

Maintenance 12 2 3 - 17 29%

Transplantation 8 2 1 2 - 13 38%

Unqualified Neonate 3 3 - 6 50%

Grand Total 50,247 10,741 3,370 1,304 1,292 758 67,712 26%Source: NSW Health FlowInfo

residentof significan mer SESAHS for mainl

logy, g ol, u nos e , nongery. There are also flo s for immunology and infections t

l referrals for HIV/AIDS treatment.

V5.1

At the Enhanced Service Related Group (ESRG) level for Eamount of flow activity in ESRGs

astern Zone s, the highest y t volume is to the for

district level work in ophthalmo dru and alcoh rology, diag tic ndoscopy -subspecialty surgery and plastic surthe former SESAHS mos

w o t probably representing natura

- 27 -


Table 35: Place n 1 0Separations

of treatment for Western Zone reside ts (age 6+yr) by SRG 2 02/03:

Western Zon Eastern Zone WSAHS SES Other Grand Total% ouService Related Group e AHS tflow

555 655 12%399 189 Obstetrics 12,915 14,713

205 375 14%192 247 Cardiology 6,224 7,243

496 353 386 367 Orthopaedics 5,264 6,866 23%

y 432 517 Non Subspecialty Surger 5,104 330 337 6,720 24%

459 582 23%290 148 Gynaecology 5,004 6,483

y 260 198 169 131Diagnostic GI Endoscop 5,387 6,145 12%

232 290 131 167 Respiratory Medicine 5,206 6,026 14%

515 239 404 102 31%Urology 2,802 4,062

232 249 Gastroenterology 3,325 103 117 4,026 17%

ne 207 315 Non Subspecialty Medici 2,788 144 131 3,585 22%

169 202 19%107 182 Neurology 2,884 3,544

398 136 167 55 Haematology 1,892 2,648 29%

Interventional Cardiology 177 192 188 78 1,743 2,378 27%

121 104 64 61 2,22Upper GIT Surgery 1,878 8 16%

177 194 Plastic and Reconstructive Surgery 1,649 114 73 2,207 25%

135 133 133 49 Immunology and Infections 1,627 2,077 22%

161 59 59 1,954 43%552 Ophthalmology 1,123

121 52 64 24 Colorectal Surgery 1,647 1,908 14%

42 91 65 91 Drug and Alcohol 1,299 1,588 18%

162 78 66 26 Medical Oncology 954 1,286 26%

149 72 119 72 33%Neurosurgery 849 1,261

120 91 89 31 27%Vascular Surgery 891 1,222

112 110 105 75 35%Ear, Nose and Throat 752 1,154

Renal Medicine 829 98 90 71 35 1,123 26%

Endocrinology 727 111 72 51 30 991 27%

110 42 58 18 71Cardiothoracic Surgery 487 5 32%

Breast Surgery 463 61 45 30 1 600 23%

Psychiatry - Acute 440 40 26%39 25 50 594

Head and Neck Surgery 266 45 49 48 19 427 38%

Dermatology 301 35 31 10 12 389 23%

Rheumatology 252 66 28 34 4 384 34%

Unallocated 284 44 22 17 13 380 25%

Tracheostomy 197 23 38 24 15 297 34%

Pain Management 178 44 24 8 17 271 34%

- 28 -


Service Rela roup ted G Western Zone Eastern Zone WSAHS SESAHS Other Grand Total% outflow

Dentistry 7 21 7 23 15 98 6 37%

Unqualified Neonate 142 - 142 0%

2 17 18 Rehabilitation 84 6 34% 127

Extensive Burns 18 21 3 43 5 60%

Transplantation 20 6 4 3 33 100%Maintenance 24 1 - 4% 25

Grand Total 77,997 6,369 5,799 4,785 3,073 98,023 20% Source: NSW Health FlowInfo V5.1 A est sid igh amou f flo RG f significant volume is to the Eastern Zone and the former WSAHS. Significant flows to the E orthop ma log euros ery, surgery a ant f th d b of a tertiary referral nature, but still significant flows in non-tertiary work. Significant flows to the former WSAHS are in non-s a terv nd er cardiology ery o ty of wh epre ent ice and local s. 5 file HS als The followin ile the acute SSWAHS. I Appendix B provides trend data fo ctivity variables for the f S

Table 36: in Hospitals 2002/3 All Ages (Excluding renal dialysis & chemotherapy, as counting patterns changed during this period)

t the ESRG level for W ern Zone re ents the h est nt o w activity in ES s o

astern Zone are in aedics, hae tology, uro y, n urg cardiothoracic nd ENT, with a signific proportion o is workloa eing

ubspecialty surgery, gyn ecology, in entional a oth , plastic surg andbstetrics, the majori ich would r sent pati cho referral network

.2 Activity Pro of SSWA Hospit

g tables prof inpatient activity for hospital within r some key inpatient a

n addition, hospitals o

SWAHS.

Acute Inpatient Activity

Separa s tion

Hospital All Day only

Cases Beddays Cost Wtd

Seps * Av LOS (days) excl day only

Av Cost Wtd Sep *

RPAH 49,642 26 72,918 2. 18,2 209,123 6.1 02 IRO 2,270 639 10,574 6,282 6.1 3.67 CRGH 27,092 0 40,231 2. 11,69 119,874 7.0 24 Canterbury 14,512 3,923 50,441 14,644 1.20 4.4 Eastern Zone 93,516 34,478 390,012 134,075 6.0 1.98 Bankstown 25,099 17 29,809 1. 8,5 99,898 5.5 53 Fairfield 16,073 4,087 56,588 16,568 4.4 1.20 Liverpool 34,389 48 52,040 1. 9,0 161,539 6.0 86 Campbelltown 19,251 18,669 1.07 3,035 66,298 3.9 Camden 8,937 90 5,453 0. 6,6 15,868 4.1 96 Bowral 5,931 05 3,599 0. 3,5 9,901 2.6 86

Western Zone 109,680 34,882 410,092 126,138 5.0 1.45 SSWAHS 203,196 69,360 800,104 260,214 5.5 1.68 * Discounted for private paSource: NSW Health Flowinfo

tients

V5.1

- 29 -


F

igure 5

A c u te In p a t ie n t S e p a ra t io n s 2 0 0 2 /3 (a ll

1 0 ,0 0 0

1 5 ,0 0 0

2 0 ,0 0 0

2 5 ,0 0 0

3 0 ,0 0 0

3 5 ,0 0 0 )D a y o n ly O v e r -n ig h t (s )

5 ,0 0 0

- R P A R P A H In s t R h m &

O rthC o n c or d C a n t e r b u r y B a n k s to w n F a ir f ie ld L iv e r p o o l * C a m p b e l lt o w n C am d e n B o w r a l

Hospitals with the highest volume of activity are RPAH, Liverpool and CRGH in that order. These hospitals also treat the most complex cases as measured by average cost weight, including IRO, which provides major orthopaedic joint replacement surgery. The percentage of activity undertaken on a day only basis tends to be higher across the Western Zone as compared to the Eastern Zone.

Table 37 : Acute Inpatient Activity 2002/03 Aged 0 – 15 yrs Separation (Descending order total separations)

SRG RPAH IRO CRGH Canter-bury

Banks-town

Fair-field

Liver-pool

Camp-belltown

Cam- den

Bowral Grand Total

Unqualified Neonate 3,229 1,404 1,548 1,346 2,443 2,020 305 505 8,167

Non Subspecialty Med 470 28 419 508 496 787 1,166 102 255 3,314

Qualified Neonate 302 2 97 426 637 374 583 16 135 2,171

Respiratory Medicine 239 13 202 352 216 409 440 27 112 1,556

Non Subspecialty Sx 147 42 198 162 116 371 494 50 113 1,306

Orthopaedics 187 4 186 30 104 131 457 302 31 84 1,191

Immu

Infect

127 1 85 nology and

ion

9 103 165 249 301 29 67 914

Ear, N 7 ose & Throat 86 125 110 48 343 297 7 44 849

Perinatology 378 371 371

Plasti 27 1 c & Reconstr Sx 28 26 33 127 89 10 19 304

Neurology 43 6 20 38 32 63 112 8 29 264

Urology 20 2 12 26 13 65 62 1 13 166

Denti 1 stry 187 17 5 9 3

Ophth 24 1 5 5almology 1 35 37 0 4 131

Drug 17 2 23 3and Alcohol 16 19 21 7 10 10 120

Derm 7 1 17atology 12 15 36 51 6 1 126

Gastr 8 6 23 40oenterology 12 15 24 2 13 117

Haem 4 5 2 74 atology 4 19 23 1 2 4

Unall 8 3 6 53 1 2 73 ocated 2

Neuro 2 13 34 47 surgery 12

Endocrinology 3 1 2 5 1 17 23 1 6 53

Cardiology 2 5 5 5 5 14 1 30

Rheumatology 1 1 3 3 2 11 13 2 31

Renal medicine 2 6 3 2 9 11 25

Psychiatry – Acute 2 3 1 8 11 1 2 26

Gynaecology 4 3 6 1 3 8 2 20

Diagnostic GI

Endoscopy

2 2 6 1 7 2 1 5 22

Pain Management 2 1 2 4 4 11 2 21

- 30 -


Head & Neck Sx 3 1 2 7 3 12

Colorectal Surgery 3 1 3 2 1 1 2 2 8

Upper GI Surgery 1 2 1 7 8 T

Obste 2 3 1 3 1 5 trics

Medic 4 al Oncology 3 1 2 1

Breast 4 Surgery 1 3

Extensive Burns 1 2 1 3

Vascu 2 lar Surgery 2 1 1

Other 1 3 2 3 2

Grand Total 5,362 6 171 2,986 3,628 3,315 6,336 6,234 612 1,433 21,558

Highest 2nd highest 3rd highest Source: NSW Heal Ther a higher l o ctiv r en on cti ela

Th ludes significant activity m ow non- pec me neator edicine and immunology a infe s and at Liverpool in orthop ic

surge nd u ology PA as sig can tivity in neonatology and eflec the rtiar ICU ilities hat and Canterbury has significant for c ren.

Acu npa ent A ivit 02/3 16+ s S ration(Descending order total separations)

th FlowInfo V5.1

e is leve f a ity fo childr across the Western Z e, refle ng r tive demography. is inc at Ca pbellt n in subs ialty dici , surgery, respir y m nd ction aed s, ENT, plastic ry a r . R H h nifi t acperinatology r ting te y N fac at t sitedental activity hild

Table 38: te I ti ct y 20 Age yr epa s

HOSPITAL SRG RPAH IRO Con-

cord Canter- Banks- Fair- Liver- Camp-

belltown

Cam-den

Bowral Grand bury town field pool Total

Renal Dialysis 10,191 9, 6 20,043 39,620 38 *

Obstetrics 6,558 8 1,787 2,165 2,489 4,856 2,970 386 722 21,941

Orthopaedics 2,050 1,394 1,816 1,018 1,661 1,188 1,948 756 517 367 12,715

Non Subspecialty Sx

3,225 266 920 1,767 1,085 563 327 12,530 17 2,235 1,125 1,

Cardiology 2,448 1 1,705 1,247 1,640 1,085 1,652 1,457 591 390 12,216

Respiratory med 2,462 6 1,675 844 1,674 776 1,551 1,123 429 162 10,702

Gynaecology 3,883 1 295 791 894 918 1,820 760 869 386 10,617

Diag GE Endoscopy

1,683 5 1,374 641 1,956 565 1,697 71 1,433 475 9,900

Gastroenterology 1,718 6 1,332 496 1,095 569 919 520 343 288 7,286

Urology 1,383 2 1,880 507 1,196 489 672 293 576 128 7,126

Neurology 1,766 16 1,420 462 834 442 992 549 272 169 6,922

Non Subspec Med 1,869 10 1,293 480 814 540 693 578 311 136 6,727

Haematology 1,149 13 1,870 116 1,036 107 664 154 108 127 5,344

Interventional Card 1,716 998 67 260 96 1,488 94 16 4,735

Plastic & Reconstr Sx

1,358 13 826 167 435 209 545 91 529 96 4,269

Upper GIT Surgery 647 1 656 277 549 355 605 493 68 52 3,703

Immunol, & Infections

864 4 750 254 424 244 473 412 143 123 3,691

Colorectal Surgery 748 741 168 534 321 431 212 314 101 3,570

Ophthalmology 765 1 840 24 400 14 617 19 217 104 3,001

Neurosurgery 1,175 95 571 208 845 2,894

Drug & Alcohol 745 312 204 152 706 249 241 84 68 2,761

Medical Oncology 998 12 542 93 440 56 369 86 114 22 2,732

Vascular Surgery 773 4 665 82 282 67 569 107 35 16 2,600

Endocrinology 423 322 687 116 179 137 260 141 59 39 2,363

ENT 556 1 410 174 218 45 342 244 20 35 2,045

Renal Medicine 504 1 386 90 355 80 325 98 56 24 1,919

Cardiothoracic Sx 850 78 26 515 1,469

- 31 -


HOSPITAL SRG RPAH IRO Con-

cord Canter-

bury Banks-town

Fair-field

Liver-pool

Camp-belltow

n

Cam-den

Bowral Grand Total

Breast Surgery 305 219 58 121 66 177 82 58 8 1,094

Psychiatry – Acute 184 2 237 95 108 42 103 150 24 62 1,007

Chemotherapy 33 6 652 220 24 52 9 996

Rheumatology 104 279 128 30 128 34 94 31 18 8 854

Pain Management 284 55 187 48 60 40 42 27 26 7 776

Dermatology 217 1 169 38 73 57 78 38 82 11 764

Unallocated 281 2 125 6 66 31 165 16 30 15 737

Head & Neck Sx 224 136 13 97 25 175 22 8 1 701

Tracheostomy 237 113 1 74 2 158 10 595

Dentistry 18 70 94 18 10 210

Rehabilitation 34 35 7 29 14 40 10 7 176

Extensive Burns 132 3 18 1 154

Transplantation 63 63

Maintenance 10 5 8 5 2 13 43

Grand Total 54,501 2,270 36,959 11,526 21,680 12,734 48,079 12,940 8,374 4,507 213,568

Source: NSW Health FlowInfo V5.1

Highest 2nd highest 3rd highest For adults, highest activity for most ESRGs is at RPAH, followed by either Liverpool or CRGH and in some instances Bankstown. 5.3 Patterns of hospital use by age group Table 39: Age Group Profile for Acute Inpatient Activity 2002/3 All Ages

Age Group (years)

Seps 0-14 15-44 45-64 65-79 80+ Grand Total

% 0-14yrs % 65+yrs

RPA H

5,362

22,338

14,894

13,857

3,415

59,866 9% 29%

IRO

6

414

739

882

235

2,276 0% 49%

Concord

171

7,256

10,088

12,764

6,851

37,130 0% 53%

Canterbury

2,986

4,791

2,464

2,489

1,782

14,512 21% 29%

Bankstown

3,628

6,637

5,313

6,448

3,293

25,319 14% 38%

Fairfield

3,315

5,815

2,897

2,778

1,268

16,073 21% 25%

Liverpool

6,336

14,863

15,142

14,885

3,230

54,456 12% 33%

Campbelltown

6,234

6,884

2,725

2,132

1,277

19,252 32% 18%

Camden

612

3,178

2,493

1,755

951

8,989 7% 30%

Bowral

1,433

2,127

1,025

928

427

5,940 24% 23%

TOTAL

30,083

74,303

57,780

58,918

22,729

243,813 12% 33%

Beddays

RPA H

24,352

62,109

53,639

59,028

20,219

219,347 11% 36%

IRO

11

1,096

2,818

5,350

1,305

10,580 0% 63%

Concord

219

15,366

27,596

48,580

38,515

130,276 0% 67%

Canterbury

7,272

10,854

6,918

11,501

13,896

50,441 14% 50%

- 32 -


Bankstown

10,503

16,253

16,905

32,791

23,666

100,118 10% 56%

Fairfield

9,483

15,578

9,561

13,628

8,338

56,588 17% 39%

Liverpool

19,394

43,659

47,218

51,883

19,452

181,606 11% 39%

Campbelltown

17,545

18,340

10,086

11,890

8,440

66,301 26% 31%

Camden

1,152

4,163 3,321

3,695

3,589

15,920 7% 46%

Bowral

3,197

3,534

1,273

1,343

563

9,910 32% 19%

SSWAHS

93,128

190,952

179,335

239,689

137,983

841,087 11% 45%Source: NSW Health FlowInfo V5.1 There is significant use of hospital facilities by aged people at CRGH and to a less marked extent at Liverpool. At CRGH there are twice the number of patients aged 80+ to that treated at RPAH or Liverpool. Liverpool has the highest number of patients treated aged 65-79, followed by RPAH and CRGH. Figure 6 (overleaf) depicts this pattern. Figure 6

Seps by Age Group

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

RPA H IRO Concord Canterbury Bankstown Fairfield Liverpool Campbelltown Camden Bowral

80+65-7945-6415-440-14

The following tables 40 & 41 profile the patterns of hospital utilisation by patients in the older (70+) age groups.

Table 40: Trends in patients requiring admission to wards through Emergency Departments

Separations ALOS (days) Hospital 99-00 00-01 01-02 02-03 03-04 99-00 00-01 01-02 02-03 03-04

Patients aged 80+ RPAH 1,492 1,766 1,696 1,797 1,757 6.36 6.72 7.61 8.03 8.55 Concord 2,351 2,563 2,760 2,841 2,855 9.56 9.64 10.15 9.73 10.05 Canterbury 1,132 1,151 1,261 1,467 1,474 7.19 7.98 8.16 8.97 8.53 Bankstown 1,794 1,858 1,900 1,971 2,184 8.45 8.94 9.43 9.55 10.99 Fairfield 669 711 712 803 833 8.06 8.22 8.48 7.85 8.19 Liverpool 1,216 1,398 1,247 1,221 1,371 8.93 8.80 8.95 9.36 10.22 Campbell town

594 641 652 621 800 7.28 7.87 7.31 6.76 7.96

Camden 185 249 231 219 163 7.11 8.25 8.31 4.67 4.27 Bowral 362 278 78 78 382 6.86 7.91 2.59 2.59 6.76 SSWAHS 9,795 10,615 10,537 11,018 11,819 8.13 8.46 8.84 8.82 9.37

- 33 -


Patients aged 70-80 RPAH 2,307 2,348 2,311 2,348 2,241 7.54 7.62 8.40 8.12 8.72 Concord 2,240 2,332 2,273 2,297 2,100 8.82 9.37 8.77 8.58 8.65 Canterbury 1,008 1,003 1,117 1,126 1,123 6.74 6.46 6.72 6.64 6.98 Bankstown 2,235 2,135 2,123 1,981 1,924 7.95 8.42 8.92 6.18 9.37 Fairfield 860 967 927 1,022 1,038 7.36 6.97 7.35 7.06 6.89 Liverpool 2,024 2,082 1,936 1,807 1,933 9.47 9.10 9.21 9.82 9.53 Campbell town

749 823 824 809 896 6.81 6.70 6.77 6.09 6.95

Camden 161 194 209 188 162 6.53 5.77 5.73 3.27 3.66 Bowral 369 321 112 111 395 5.54 6.16 3.11 2.74 5.45 SSWAHS 11,953 12,205 11,832 11,689 11,812 7.98 8.07 8.24 8.07 8.30 Source: NSW Health FlowInfo V5.1 Overall, separations for patients aged 80+, admitted through the emergency departments, have been increasing at all hospitals as has the length of stay of these patients (with the exception of Camden where role changes have changed the composition of patients within this category). The impact is less marked for patients aged 70-80, with the numbers being seen remaining relatively steady and a mixed variation in length of stay, although increased length of stay has been experienced in this age cohort at the larger hospitals, RPAH and Liverpool.

Table 41: Snapshot of aged patients in SSWAHS Hospitals

Patients Receiving Care Patients Awaiting Care

Hospital Acute Rehab Palliative

Maintenance or GEM or

Psychogeriatric Respite

Residential Care

Placement

Other Hospital

Services or Assessment

Family or home

support RPA H/IRO 153 8 5 7 - 6 10 4 Concord 149 26 1 11 1 11 7 9 Canterbury 55 1 5 - - 3 1 1 Balmain 30 21 1 8 2 4 4 1 Bankstown 136 35 2 7 - 4 4 1 Fairfield 34 - - 2 - - - 1 Braeside - 20 12 13 - 2 - 1 Liverpool 103 6 7 23 - 1 6 2 Campbelltown 39 - - 2 - 1 4 2 Camden 7 18 6 2 - 4 1 1 Bowral 18 - - 1 - 1 1 -

SSWAHS 724 135 39 76 3 37 40 23 Source: Census of Older People in Public Hospitals, NSW Health, at midnight Tuesday 29 June 2004. Each year a snapshot survey of older patients in hospital is undertaken during winter. The 2004 survey indicated that across SSWAHS there were 37 patients on this day who were ready for discharge but awaiting residential care placement. A further 73 patients were not receiving active treatment because they were either awaiting services from other hospitals (often rehabilitation), assessment as to placement options, family decisions or the organization of

who would benefit from transitional care in either setting or in the community. SSWAHS has applied to the Commonwealth for increased

transition care places in both hospital and community settings in each of the Eastern and Western Zones. Increased rehabilitation beds have also been sought under the Sustainable Access Program to address the deficit in availability of this service.

home support. These are the types of patients a ward

- 34 -


5.4 Public/private patient mix at SSWAHS hospitals

Table 42 Illustrates the mix of public /private separations by Hospitals

Table 42: Acute Inpatients 2002/3 All Ages (including Unqualified Babies) Beddays By Final Payment Status

Payment Status

Hospital DVA Non-

Chargeable Other Private Unqual Neonate

Hospital Total

% Non-charge-

able %

Private RPAH 6,073 156,094 10,124 35,691 11,365 219,347 71% 16% IRO 513 6,799 176 3,092 - 10,580 64% 29% CRGH 14,831 95,394 3,223 16,828 - 130,276 73% 13%

Canterbury 3,011 39,505 1,039 2,782 4,104 50,441 78% 6%

Eastern Zone 24,428 297,792 14,562 58,393 15,469 410,644 73% 14%

Bankstown 6,435 80,606 2,070 7,198 3,809 100,118 81% 7% Fairfield 1,197 48,329 1,848 2,109 3,105 56,588 85% 4% Liverpool 5,187 152,351 8,203 10,112 5,753 181,606 84% 6% Campbelltown 2,877 53,481 1,787 3,037 5,119 66,301 81% 5% Camden 832 13,831 44 382 831 15,920 87% 2%

Bowral 259 6,416 342 1,698 1,195 9,910 65% 17%

Western Zone 16,787 355,014 14,294 24,536 19,812 430,443 82% 6%

SSWAHS 41,215 652,806 28,856 82,929 35,281 841,087 78%

Source: NSW Health FlowInfo V5.1 Figure 7 Acute Inpatients 2002/3 All Ages (including Unqualified Babies) Beddays

By Final Payment Status

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

RPAH IRO CRGH Canterbury Bankstown Fairfield LiverpoolCampbelltown Camden Bowral

Unqual NeonatePrivateOtherNon-ChargeableDVA

Source: NSW Health FlowInfo V5.1 There is a much higher level of chargeable private patients in the Eastern Zone hospitals as compared to Western Zone hospitals. CRGH has a higher level of chargeable DVA patients due to the continuing links with the veteran community forged during the time, over a decade ago, when CRGH was a Commonwealth controlled repatriation hospital.

- 35 -


5.5 Emergency Department Activity The following tables 44 & 45 profile activity within the Emergency Department for each hospital within SSWAHS. Triage categories are described as follows:

1. Immediately life threatening 2. Imminently life threatening 3. Potentially life threatening 4. Potentially serious’ 5. Less urgent

Table 43: Emergency Department activity 2002/3 Triage Category

Hospital AttendancesCase-Weighted

Attendances Average Wtd Attendance 1 2 3 4 5

RPAH 44,297 46,662 1.05 494 4,321 18,137 12,816 5,820 CRGH 24,186 25,622 1.06 199 1,514 6,929 10,193 4,272 Canterbury 24,873 25,303 1.02 191 1,636 9,834 9,053 687 Eastern Zone 93,356 97,587 1.05 884 7,471 34,900 32,062 10,779

Bankstown 31,348 34,059 1.09 262 2,116 17,330 8,621 266 Fairfield 26,285 26,804 1.02 168 2,039 10,516 10,698 1,340 Liverpool 45,555 49,386 1.08 583 3,336 22,384 14,620 1,432 Campbelltown 32,698 35,652 1.09 339 2,971 16,932 8,799 1,030 Camden 10,778 10,633 0.99 42 768 4,307 4,389 816 Bowral 16,527 15,819 0.96 44 603 4,461 9,061 1,461 Western Zone 163,191 172,353 1.06 1,438 11,833 75,930 56,188 6,345

SSWAHS 256,547 269,940 1.05 2,322 19,304 110,830 88,250 17,124 Source: NSW Health FlowInfo V5.1 Figure 8 Total Emergency Attendances 2003/04

-

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

45,000

50,000

55,000

RPAH CRGH Canter bur y Bankstown Fai r f ield Liver pool Campbel l town Camden Bowr al

Attendances

Case-Weighted Attendances

- 36 -


Figure 9 ED Attendances 2003/4: by Triage Category

-

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

45,000

RPAH CRGH Canterbury Bankstow n Fairfield Liverpool Campbelltow n Camden Bow ral

54321

Table 44: Emergency Department Attendances and Access Block 2003/04 Triage 11 Triage 22 Triage 33 Triage 44 Triage 55Hospital Attend. No. % <

2 mins

No. % < 10

mins

No. % < 30

min

No. % < 60

min

No. % < 120 min

Access Block

%6

RPAH 44,297 494 100 4,321 60 18,137 36 12,816 53 5,820 82 45 CRGH 24,186 199 100 1,514 92 6,929 64 10,193 64 4,272 86 51 Canterbury 24,873 191 100 1,636 73 9,834 40 9,053 41 687 85 48 Eastern Zone 93,356 884 100 7,471 69 34,900 42 32,062 53 10,779 84 48 Bankstown 31,348 262 100 2,116 100 17,330 64 8,621 61 266 86 34 Fairfield 26,285 168 100 2,039 93 10,516 67 10,698 76 1,340 93 33 Liverpool 45,555 583 100 3,336 80 22,384 45 14,620 51 1,432 84 27 Campbelltown 32,698 339 100 2,971 73 16,932 52 8,799 59 1,030 91 32 Camden 10,778 42 100 768 83 4,307 82 4,389 88 816 97 44 Bowral 16,527 44 100 603 91 4,461 72 9,061 76 1,461 96 3 Western Zone 163,191 1,438 100 11,833 85 75,930 57 56,188 65 6,345 91 29 SSWAHS 256,547 2,322 100 19,304 79 110,830 52 88,250 61 17,124 87 N/A Metropolitan 1,112,020 N/A 100 N/A 74 N/A 56 N/A 61 N/A 83 37

1 Immediately life threatening 2 Imminently life threatening3 Potentially life threatening 4 Potentially serious 5 Less Urgent 6 % not admitted within 8 hours of active treatment commencing. Source: NSW Health Emergency Department Performance Reports

The emergency departments at RPAH and Liverpool are by far the busiest in SSWAHS and amongst the busiest in the State. Overall, ability to meet the benchmarks for time taken to see patients within the various triage categories, is higher in the Western Zone than the Eastern Zone. Access block, which reflects the ability to admit emergency department patients to ward beds within a reasonable time, is more of a problem in the Eastern Zone hospitals than in the Western Zone.

- 37 -


Table 45: Medicare Claiming GPs within General Practice Division Boundaries 1997/98-1998/99.

Table 45 identifies GPs within the Division boundary who bulk bill and the associated population GP Division Medicare Claiming GPs

within Division Boundary

Estimated Population within GP Division

Boundary

Population per Medicare Claiming

GP Central Sydney 986 315,171 319 Canterbury 262 140,450 536 Eastern Zone 1,248 455,621 365 Bankstown 324 148,026 456 Fairfield (Health Service Inc.) 378 211,909 560 Liverpool 217 129,564 597 Macarthur 298 200,287 672 Southern Highlands 74 41,516 561 Western Zone 1,291 731,302 566 SSWAHS 2,539 1,186,923 467 NSW 12,578 5,927,907 471

Figure 10

0

200

400

600

800

1,000

1,200

1,400

Central Sydney Canterbury Eastern Zone Bankstown Fairfield HealthService Inc.

Liverpool Macarthur SouthernHighlands

Western Zone

GP Division

No. Medicare-claiming GPs

Population / Medicare-claiming GP

Source: Health Wiz 9.6.2, Commonwealth Department of Health and Aged Care. As data on GP availability is derived from billing data, there are difficulties in accessing up to date data. Nevertheless it is not considered that the relative availability of general practitioners is likely to vary significantly over the relative short term. There are seven Divisions of General Practice in SSWAHS with the Central Sydney Division being by far the largest. In terms of GP numbers per head of population, availability is highest in the Central Sydney Division and second highest in Bankstown, with Canterbury, Fairfield, Liverpool and Southern Highlands being fairly similar and least availability in Macarthur.

- 38 -


6. Clinical Service Plans 6.1. The Way Forward 2004-2008 The South Western Sydney Health Network: The Way Forward 2004 – 2008 (‘the Plan’) is the clinical services strategy of the former SWSAHS. The Plan outlines broad directions for the provision of hospital and health services in the Western Zone over the next four years. It was developed in 2004 by the former SWSAHS Clinical Strategy Group, comprising 16 senior clinicians across the Area. The Plan sets out clearly defined roles for hospital facilities across the Western Zone of SSWAHS, and identifies enhanced service levels across the Area to cater for the health needs of the changing and growing population in South Western Sydney. In addition, the Plan provides for the networking of services to facilitate better coordination and collaboration between hospital facilities across the Area. In developing the Plan, the Clinical Strategy Group (CSG) aimed to: • create area-wide services with multi-campus delivery, • define complementary roles/centres of expertise for each hospital, • create SWSAHS as a single teaching Area, • cross-appoint all clinical staff, • ensure stronger hospital – to – primary care connections are in place and • boost the training and quality of staff. The Plan focuses on achieving significant improvements in health outcomes for the people of South Western Sydney by: • improving patient access to tertiary and secondary services locally with a target of 85% self-

sufficiency, • improving patient access to appropriate care levels in a network of services, • ensuring safety and quality through improved clinical leadership and registrar cover, • establishing clear directions for each clinical service across SWSAHS. Under the Plan, key improvements include: • improved treatment capacity to improve local access to acute facilities, • safer, well staffed and improved triage performance in Emergency Departments across the

Area with increased physical capacity to absorb growth, • a reduction in the transfer of critically ill people out of SWSAHS, • increased ICU bed numbers in accordance with the state average, • improved performance for surgical long waits, • boost to renal dialysis capacity, • extra transitional care beds for nursing home patients, • improved weekend and out-of-hours medical officer cover at all hospital facilities across

SWSAHS.

6.1.1 Methodology of The Way Forward 2004-2008 In November 2003, a Clinical Strategy Group comprising 16 senior clinicians was established to coordinate the development of the Plan. The CSG considered the following key drivers of change in developing the Plan:

• patient safety and medical coverage; • cohesion of hospital’s roles in the current sector management structure; • the adequacy of the hospital-community interface throughout the Area; • equity of access;

- 39 -


• seamless transfers of acute patients; • cross accreditation and appointment of clinicians; • clinical governance; • education and training; and • research.

The population profile of South Western Sydney and the fact that it is one of the fastest growing areas in Australia also informed the deliberations of the CSG. Critical to the development of the Plan was the involvement of clinicians at all levels of the health service. The CSG considered over 60 clinical service submissions from clinicians across the Area. Over 500 staff members including doctors, nurses, allied health staff, health planners and administrators contributed to the development of the Plan. Members of the local community also contributed to the process. A Draft Plan was circulated to clinicians, staff and members of the community for comment. The Minister for Health, the Hon Morris Iemma MP, launched the final Plan in June 2004.

6.1.2 Projected Activity from The Way Forward 2004-2008 In developing the Plan and formulating its recommendations, the CSG relied on health service activity data to determine existing patterns of utilization and need, and used activity projections to identify future need. The CSG examined health service activity data for the period 2002/03 for over 60 health service categories. This data was gleaned from various data sources including the NSW Department of Health’s Flowinfo Version 5.1, and the Area Health Services’s own Performance Indicator Reports. This data was then used to profile inpatient activity in all hospitals across the Area, for each health service category. These profiles included separations and bed occupancy rates, the top ten diagnostic related groups and treatment locations for local residents, and flows for each health service category. In addition, projected hospital activity for each respective health service category was identified for 2006 and 2011. This data was based on the NSW Department of Health’s Activity Projections Plus Interventions (APPI) which uses current service utilization data and population projections to project resident demand for health services.

6.1.3 Key Findings and Recommendations of The Way Forward 2004-2008 The Plan provides the foundation and direction for how hospital and health services will be further developed in South Western Sydney over the next four years, and will provide for ongoing sustainability into the future. The Plan provides for the following:

• a new clinical management structure for SWSAHS staff to provide enhanced clinical leadership;

• increased numbers of medical, nursing and allied health cover in critical areas such as emergency, intensive care and after hours inpatient care;

• appointment of medical staff across a number of hospitals so that care can be provided at the most appropriate site;

- 40 -


• Area-wide co-ordinated services rather than services considered on a hospital-by- hospital basis;

• a significant strengthening of the partnership between hospitals and the community sector to ensure that patients receive ongoing care in the community after discharge and avoid unnecessary hospitalization;

• a single phone-call system for inter-hospital acute patient transfer supported by a centralized area-wide system for safely transporting patients;

• clearly delineated roles for each hospital; • increased training of clinical staff; • additional academic appointments; • moving forward with planning for a new health research institute for South Western

Sydney; and • to expedite detailed planning for the Liverpool Hospital Stage Two Capital Works

Program.

6.1.4 Service Configuration as indicated in The Way Forward 2004-2008 The development of clinical services across hospitals in the Western Zone of SSWAHS will be complementary as follows:

• Liverpool Hospital will continue to be the tertiary referral hospital for the Western Zone, providing a comprehensive range of high-level emergency, medical, surgical, mental health, maternity, paediatric and newborn services. Research infrastructure will also be centred at Liverpool Hospital and it will maintain its leading role as the academic centre for the Western Zone.

• Bankstown Hospital will continue as a principal referral hospital operating its services

mostly at Level 5. Bankstown will be the centre for plastic surgery and colorectal surgery, and with Liverpool, be a major provider of upper gastro-intestinal surgery, urology and Level 6 gastroenterology.

• Campbelltown Hospital will progressively develop towards principal referral hospital

status operating its services mostly at Level 5. Sub-specialty capabilities in medicine and surgery will be developed. It will be the centre for academic general medicine and a lead site for Western Zone in paediatrics and ambulatory care. It will be a major centre for colorectal surgery and adult and adolescent acute and non-acute mental health.

• Fairfield Hospital will continue as a major metropolitan hospital operating its

emergency, medical, surgical, obstetric and paediatric services mostly at Level 4. It will be the centre for elective orthopaedic surgery and elective short stay, day only, low risk surgery. With Braeside Hospital, it will develop as the centre for rehabilitation.

• Camden Hospital will maintain a complimentary role with Campbelltown Hospital,

offering rehabilitation, palliative care, urgent care and an extensive day surgery program with ambulatory care.

• Bowral Hospital will operate as a rural general hospital with more defined links to

Campbelltown Hospital, as the latter develops. It will be linked with all the Area units to enable access for Wingecarribee residents to Level 5 and 6 services available at other Western Zone hospitals. It will offer elective and emergency services to adults and children for medical, surgical and obstetric care.

The Plan outlines a range of comprehensive recommendations to enhance the operation of over 60 clinical service groups across the Area. In particular, the plan identifies a series of strategies

- 41 -


for 18 priority clinical groupings. These priority clinical groupings, and their respective key strategies, are as follows:

• Cancer Services - an integrated Area Cancer Service will be developed; - medical oncology will be enhanced at Campbelltown, Liverpool and Bankstown

Hospitals; - increased capacity in chemotherapy and radiation therapy at Liverpool and

Campbelltown Hospitals; - two linear accelerators for Campbelltown Hospital and replacement of older

linear accelerator at Liverpool Hospital; - enhancement of cancer research across the Area.

• Emergency Department Services - enhanced Emergency Department services across the Area, managed as an

integrated network; - appointment of a Chair in Emergency Medicine; - additional senior medical, nursing and allied health staff appointed to Emergency

Department’s across the Area to manage the growth in demand; and - increased senior medical cover and dedicated triage staff appointed at Bowral.

• Intensive Care Services

- increased intensive care beds and high Dependency beds across the Area; - establish an Area coordinated Acute Care Response Unit with a single phone call

system for the transfer of seriously ill patients; and - an area intranet program will be implemented to monitor ICU/HDU bed

availability.

• Aged Care, Aged Care Psychiatry, Transitional Care and Rehabilitation Services - Increased aged care beds to meet the acute, sub-acute and transitional cares

needs of aged care patients; and - Enhanced Aged Care Psychiatry and dementia services.

• Palliative Care Services

- Increased Palliative Care beds across the Area; and - Implementation of a centralized Palliative Care intake system.

• Cardiology and Cardiothoracic Surgery Services

- A pacemaker and defibrillator service established at Bankstown and Liverpool Hospitals;

- Improved access to interventional cardiology, with Liverpool Hospital as the centre;

- Enhanced non-invasive services at Fairfield, Campbelltown and Bowral. - Elective thoracic surgery at Bankstown and Liverpool Hospitals.

• Mental Health Services

- Enhanced acute, non-acute and community –based mental health services across the Area;

- Major inpatient centres developed at Liverpool, Bankstown and Campbelltown Hospitals; and

- Enhanced prevention programs.

• Maternal and Perinatal Services - Maternal and perinatal services across the Area developed in accordance with

the recommendation of the external review conducted by Professor David Henderson Smart;

- 42 -


- Enhanced medical, nursing and allied health staff across the Area; - Increased neonatal intensive cares beds and special care nursery beds; and - Appointment of a Professor of Obstetrics.

• Anaesthetics / Pain Services

- Appointment of an Academic Chair as Director of Anaesthetics with an interest in obstetrics anaesthesia;

- Implementation of preoperative assessment clinics to triage bookings to the appropriate role delineated facility;

- Review operating theatre utilization; and - Enhanced Area Pain Services at Liverpool Hospital.

• Diabetes Services

- Enhancement of diabetes services across the Area, including diabetes educators and allied health staff;

- A Centre for Diabetes established in Macarthur; - Multidisciplinary teams established across the Area; and - Area Diabetes Register established.

• Emergency and Trauma Surgery / General Surgery / Vascular Surgery /

Neurosurgery Services - Emergency, urgent general surgery and neurosurgery services enhanced across

the Area; - A Research Centre for short stay and day only surgery established at Fairfield

Hospital; - Academic Chair in Trauma and Emergency Surgery appointed;

• General Medicine Services

- Area Professor of General Medicine appointed at Campbelltown Hospital; and - Additional general medicine physician appointed to Bowral Hospital.

• Neurology Services

- Enhancement of specialised medical, nursing and allied health staff; and - Increased resources to improve access to acute and chronic neurological

services.

• Paediatric Services - Increased 24 hour medical cover; - Paediatric Emergency Medicine Units established; - Ambulatory Care Unit established at Bankstown Hospital; and - Enhancement of community based paediatric services.

• Radiology and Imaging Services

- Radiology and nuclear medicine services enhanced across the Area; - Expansion of Picture Archiving Communication Information System across the

Area; and - Enhanced ultrasound services across the Area.

• Renal Medicine Services

- Expansion of Campbelltown Hospital’s Renal Dialysis Service; - Satellite dialysis services provided at Bowral Hospital; and - Ultrasound services will be enhanced to promote skill development and training

opportunities.

- 43 -


• Respiratory Medicine Services - Improved access to respiratory medicine across the Area; - Increased specialist medical and nursing staff across the Area; and - Respiratory Function Laboratory and a Sleep Disorder and Respiratory Failure

Service provided at Liverpool Hospital.

• Rheumatology Services General rheumatology and metabolic bone disease clinic progressively provided at Bankstown, Fairfield, Campbelltown and Bowral Hospitals.

6.1.5 Current Status of The Way Forward 2004-2008

The implementation of the Plan is well underway with many of the 389 recommendations already in place. Area-wide clinical services have been formed to create a single service, multi-campus health care delivery system across the Western Zone of SSWAHS. Clinical Directors have been appointed to lead the newly created Area-wide services including Cardiovascular Services, Complex and Primary Care Services, Child, Youth and Family Services, Gastroenterology and Liver Services, Critical Care Services, Surgical Services and Allied Health and Clinical Support Services. Over $2.3 million has been injected into facilities across the Area to reduce the long wait list of surgery patients. An additional 39 registrars have been appointed to work across the Area, commencing January 2005. Other achievements under the Plan include the following:

Liverpool Hospital

Recruitment of Clinical Academics in: o Ophthalmology o Rheumatology o Emergency Medicine o Midwifery

Recruitment underway for Clinical Academics in: o Surgery o Obstetrics o Radiation Oncology

Additional ICU beds (2) Establishment of the Golden Phone- Acute Care Response Unit Recruitment underway for additional NICU (1) and special care nursery beds (4) Enhanced Emergency Department staffing- staff specialists (2), nursing staff Establishment of the Liverpool/Campbelltown ICU Network Establishment of a Liverpool/Campbelltown Emergency Department Network Increased utilisation of Liverpool as a centre for high risk pregnancies Additional registrars

o Emergency (3) o ICU (3) o Cardiology (1) o Gastroenterology (1) o Anaesthetics (1) o Oncology (1) o Haematology (1)

Recruitment of additional registrars in 2006 in: o Cardiology (1) o Respiratory (1) o Obstetrics (2)

- 44 -


Recruitment of 1.5 FTE additional respiratory physicians Increased access to high cost cancer drugs Cardiology networking between hospitals in western zone with development of shared

policies and procedures, 10 cardiology network beds (SAP funding), increase interventional cardiology including insertion of defribulators, refurbishment of cardiac catheter lab

Reconfiguration of wards into home wards underway with establishment of complex medical beds

Increased endoluminal procedures Commencement of interventional radiology procedures including neuro-coiling Increased beds:

o 4 PECC beds o 14 high dependency mental health beds o 10 23 hour short stay surgical beds (SAP funding) o 20 complex medical meds (SAP funding) o 10 cardiology networking beds (SAP funding)

Improved physician training with the recruitment of Director of Physician Training, Clinical Superintendent

Refurbishment of the Emergency Department Completed Development of the Mental Health building to be completed by the end of 2005.

Bankstown Hospital Intensive Care has been boosted at Bankstown Hospital to support Fairfield Hospital with appointment of additional VMO specialists and registrars to the Intensive Care Unit (ICU) to enable daily cover of the High Dependency Beds at Fairfield Hospital and transfer to Bankstown of ICU patients. An additional fully equipped bed for critically ill patients is now operational. Nursing home beds, transitional care services and community care packages have been enhanced at Bankstown Hospital to facilitate the early discharge of patients from hospital.

Fairfield Hospital Fairfield Hospital’s critical care capacity has been boosted through development of a network with Bankstown Hospital. This arrangement includes daily rounds by trained intensivists and a full roster of junior medical staff in intensivist training programs. The Emergency Department has expanded senior medical cover with a roster of VMO emergency physicians and increased overnight cover. A staff specialist in paediatrics has been appointed with direct links to Emergency and a brief to lead the development of a paediatric EMU model for Fairfield. A staff specialist in Obstetrics and Gynaecology has been appointed with a focus on the quality and education needs of this area. Cardiology services have been enhanced with the appointment of a staff specialist cardiologist allowing for improved use of non interventional cardiology especially for emergency patients. An additional registrar has been appointed in General Surgery allowing for the establishment of a 24/7 on call roster. An additional 20 beds have been approved under the Sustainable Access Plan to allow Fairfield to develop a greater role in sub acute geriatric and rehabilitation medicine as planned in The Way Forward. Bowral Hospital The Bowral Hospital’s Emergency Department Nursing Triage Program has been enhanced and staff appointed. Campbelltown and Camden ICU cover is now being provided by staff specialists on rotation from Liverpool Hospital. Seven additional Medical Registrars have been appointed to the Campbelltown and Camden Hospitals and a staff specialist along with a Registrar has been appointed to the Neurology Department. A specialist cardiology service is now operational with a roster of four cardiologists working to develop the hospital as a centre of excellence in heart failure. Liverpool Hospital has opened a designated ICU bed to cater for patients being transferred from Campbelltown Hospital.

- 45 -


6.2 The Resource Transition Program The Resource Transition Program (RTP) was developed by Central Sydney Area Health Service (CSAHS) in 1996 to proactively address both the reduction in budget required by the Resource Distribution Formula (RDF) and the major reconfiguration of health service infrastructure in order to enable the Area to provide quality health services into the 21st century. The Resource Transition Program was developed as a managed program of capital works to enable the Area to achieve the transition in shifting resources to areas of population growth. The aim of the RTP was to introduce a new model of patient care characterised by the following: • an Area-wide approach to the development and organization of clinical services; • consolidation of overnight beds into wards of efficient size (30 beds); • collocation of critical care beds and operating theatres on one “hot floor”; • provision of perioperative day treatment facilities; • organisation of inpatient activities according to Clinical Groupings with sharing of beds.

6.2.1 Methodology Demand parameters considered included the overall population needs of both the local catchment and the broader Statewide catchment for referral services at RPAH and CRGH, taking into account the projected decline in patient inflows as a result of new hospital developments in the growth areas. The future projected activity levels assumed a reduction in patient flows from neighbouring area health services commensurate with the expansion of acute hospital capacity in those Areas. The supply factors considered included the future anticipated operating budget for CSAHS, the projection of continued increases in productivity (measured in increased day only activity and reduced length of stay), and the recognition of certain ‘givens’ in terms of recent investment decisions (eg Canterbury and Balmain hospital redevelopments). The NSW Health Service Research Group (HSRG) provided projection data to 2006 for both resident demand and service supply. This data subsequently became the basis for the APPI projections now used Statewide. These projections are based on demographic projections of population growth and change in composition, and trends in acute hospital activity parameters ie separation rates, overnight length of stay (LOS) and the proportion admitted on a day only (DO) basis for around 30 Service Related Groups (SRGs). The total number of inpatient separations to be provided in NSW in 2006 were then modelled as to the location of treatment. The HSRG model utilises existing usage patterns to allocate these resident separations to the public sector Area Health Services and to private hospitals. The impact of additional service capacity created by current or proposed hospital expansions in the growth areas such as at St George, Gosford, Liverpool and Nepean Hospitals was factored into the activity projections for CSAHS hospitals. Clinical services planning also took account of: • population growth and ageing, with the ageing being of most impact in CSAHS; • technological change leading to an increasing range of conditions that can be treated on a

day only, ambulatory care or community care basis; • changing patterns of disease including increasing prevalence of cardiac disease and some

cancers, increasing care requirements for chronic and degenerative diseases with population ageing and the impact of newer emerging viral illnesses such as Hepatitis C and HIV/AIDS;

- 46 -


• diminishing funding for CSAHS as budgets are reduced towards RDF target shares. The projections were critically reviewed and validated by all clinical departments through a comprehensive consultative planning phase of the Resource Transition Program. Each Clinical Grouping in the Area completed a detailed Service Delivery Plan to 2006.

6.2.2 Projected Activity As a result of projected increases in day only separations (from 44% in 1994/95 to 52% in 2006), the total number of separations in 2006 were projected to increase by 30% to 149,000. This compared with a 40% projected growth in separations for the State as a whole, indicating the impact of projecting for a reduction in patient flows to Central Sydney within the RTP. Table 47 indicates, by Clinical Grouping, the projected increase in acute inpatient separations and reduction in beddays.

Table 46: Eastern Zone Projected Change in Acute Hospital Activity – 1994/95, 2006

Separations Bed Days Clinical Grouping 1994/95 2006

(projected) % Change 1994/95 2006

(projected) % Change

General, Geriatric and Rehab. 10323 11443 10.85% 104460 87450 -16.28%

Cardiovascular 23335 35573 52.44% 95391 99654 4.47%

Bone and Joint 10146 13024 28.37% 67248 57625 -14.31%

Cancer Services 18619 21798 17.07% 65577 61603 -6.06%

Women’s and Children’s Health 15696 17563 11.89% 69880 43950 -37.11%

Neurosciences 6819 8139 19.36% 38512 28060 -27.14%

Respiratory and Critical Care 7602 9235 21.48% 29321 24309 -17.09%

Gastroenterology and Liver 14812 19298 30.29% 60849 46015 -24.38%

TOTAL 107352 136073 26.75% 531238 448666 -15.54% Note: Excludes Mental Health and Population Health and Drug and Alcohol clinical groupings As a result of a decrease in average length of stay projected from 4.9 days to 3.3 days by 2006, total acute beddays were projected to decrease by around 15%, enabling an 18% reduction in bed capacity. The total number of public acute beds in Central Sydney was projected to decrease by 21% from 1,940 in 1994 to 1,350 in 2006, as illustrated in Table 50.

- 47 -


- 48 -

Figure 11: Projected Changes in Eastern Zone Bed Numbers

6.2.3 Service Configuration as indicated in the RTP

Roles for the acute facilities within CSAHS as indicated in the RTP were as follows: RPAH will be a major centre providing referral and district acute services to a catchment that includes the local area, the whole State of NSW, as well as interstate and overseas patients. Projected activity in 2006 of 66,874 inpatients with an average length of stay of 3.19 days, significantly below the 3.3 days projected for CSAHS as a whole. Around 52% of inpatients will be treated on a day only basis. A total of 213,541 inpatient bed days are projected. CRGH will continue as a major acute care teaching hospital providing a range of tertiary and district level services to it’s local community and veterans across NSW who choose to continue receiving their care at the hospital. Projected activity in 2006 of 45,849 separations with an average length of stay of 3.48, which is higher than the 3.25 days projected for the Area as a whole, reflecting CRGH’s continuing role in geriatric care, including the care of aging veterans. Around 51% of inpatients will be treated on a day basis. A total of 159, 652 inpatient bed days are projected. Canterbury Hospital will continue to provide a range of district level services to its local community, including obstetrics and paediatrics. Projected activity in 2006 of 15,843 separations with an average length of stay of 3.7 days, which is higher than the 3.25 days projected for the Area as a whole, reflecting the geriatric and general medicine component to operate at the hospital. It is expected that over 40% of inpatients will be treated on a day basis. A total of 58,900 inpatient bed days are projected. The Tresillian family care service is collocated on the Canterbury Hospital site. Balmain Hospital will be continuing to provide general, geriatric and rehabilitation medicine services to essentially a local catchment population, along with transfers from RPAH and CRGH where the services of an acute care teaching hospital are no longer required. Projected activity in 2006 of 2,228 separations with an average length of stay of 12.43 days, reflecting the longer stay geriatric and rehabilitation nature of the services offered. There will be no planned day stay patients at Balmain. A total of 27,702 inpatient bed days are projected.

0

1

2

3

4

Thou

sand

s

Beds

1991 1996 2001 2006

Acute Care Mental Health Aged and Disabled

CSAHS - Changes in Bed Numbers1991 - 2006


A free standing joint replacement/rheumatology unit, the Institute of Rheumatology and Orthopaedics (IRO) was established on the RPAH campus with dedicated wards and operating theatres, to replace the ageing Rachel Forster Hospital. Projected activity in 2006 of 4,413 separations with an average length of stay of 5.55 days, reflecting the complexity of orthopaedic joint replacement surgery and longer stay rheumatology patients who will be treated. Around 25% of patients will be treated on a day basis. A total of 24,505 inpatient bed days are projected. The maintenance dialysis treatment and training places at Dame Edith Walker were projected to expand to 40, to meet the expected 7% p.a. increase in demand for maintenance dialysis over the next decade. A major reconfiguration of Mental Health services was proposed with the development of a mental health precinct at Concord RGH to enable the provision of acute mental health care from modern purpose built facilities making best use of the proximity to the diagnostic and medical services located on the general hospital campus for mental health patients. The development of mental health services at Concord RGH will enable the relocation of acute adult and psychogeriatric and rehabilitation services from outmoded building stock at Rozelle Hospital. A feature of the new precinct will be the provision of an acute adolescent mental health unit. Thomas Walker Hospital (Rivendell) will continue to provide 30 adolescent psychiatry beds on the present site. Rivendell will continue to provide a tertiary referral service for adolescents and their families across NSW as well as services to the local adolescent population through the network of community and mental health services in Central Sydney. Planned Sub Acute and Non Acute Service Configuration The RTP strategy for Aged and Disabled Care was to develop localised services where the full range of care is coordinated under one team serving the local area. Partnership arrangements with non-government providers were pursued to develop specific purpose residential care facilities at Croydon to meet gaps in services available in the private sector. The bed licences for this facility came from within the stock of beds generated with the progressive closure of public nursing homes at Braeside, Glebe Annex and Loreto. The special purpose residential care facility requires supplementation from Area funds. Aged Care Assessment Teams will operate in the Eastern, Western and Canterbury sectors with geriatric and rehabilitation beds available locally at Balmain/RPAH, Concord RGH and Canterbury hospitals respectively. Community Health Services Community health services in CSAHS in 1996 were dispersed across a number of different locations within the Area in a variety of rented and non-purpose built premises. The RTP strategy in respect of community health was to collocate community health teams wherever possible in order to promote collaboration across the different teams (early childhood, child and family, mental health, drug health, aged care and community nursing). Consequently, in 2005 when work is completed at Croydon and Camperdown, and with the exception of aged care, the majority of Eastern sector (old CSAHS) community health services will be based at the new Croydon Health Centre and the majority of Eastern sector services will be based at Marrickville and the King George V building in Camperdown. The majority of Canterbury community health services are based on the Canterbury Hospital site.

6.2.4 Current Status of the RTP The majority of building works associated with the RTP have been completed or are nearing completion, with the exception of mental health.

- 49 -


The RTP is still current in that the Service Delivery Strategy that guided the reconfiguration of health infrastructure within CSAHS has not altered. Over the intervening years since 1996 the Health Services Planning Unit has been regularly monitoring service activity levels against those projected in the RTP. As indicated in Table 50, the patient flow patterns for CSAHS have remained relatively stable over the seven-year period ending 2003/04.

Table 47: CSAHS Flow Indicators 1996/97 to 2003/2004 (Cost Weighted Separations)*

Year Inflows as % of CSAHS Activity

Outflows as % of CSAHS Resident

Activity

Tertiary Inflows as % of Inflows

General Outflows as % of

Outflows 1996/97 49.2% 29.4% 31.7% 62.5%

1997/98 49.7% 29.1% 32.3% 63.4%

1998/99 48.2% 27.5% 31.8% 64.6%

1999/00 47.5% 26.1% 30.7% 64.7%

2000/01 47.5% 26.7% 33.3% 62.4%

2001/02 47.0% 27.1% 34.0% 63.6%

2002/03 47.0% 28.2% 34.5% 65.4%

2003/04 47.5% 29.9% 34.6% 68.6%

• Discounted for private patient separations, excludes psychiatric and non-acute patients. The broad strategy for flows management within CSAHS was to: • Expect some reversal of non-tertiary flows from growth areas, despite experience that such

inflows have stayed at historic levels despite investment in the growth areas; • Minimise outflows, particularly general flows (defined as all non-tertiary flows excluding

flows from border localities close to hospitals in other Areas - general flows are considered to be more amenable to change than other flows);

• Continue to provide tertiary referral services for patients flowing to CSAHS hospitals. Table 50 indicates steady progress in this direction with a decrease in inflows (from around 49% to around 47%), outflows remaining at 25 to 29% of resident activity and an increase in the proportion of inflows that are tertiary (around 32% to around 35%).

- 50 -


7. Health Services

7.1 Acute Hospitals In November 2004 NSW Health commissioned consultants to undertake a survey of bed numbers across NSW, to provide a baseline for Sustainable Access planning and standardize the methodology for counting beds. This survey identified baseline bed numbers at SSWAHS hospitals as at Table 51. These numbers will vary over time as capital redevelopments proceed and resources are identified to enable additional beds to be opened. Table 48: Bed Numbers at SSWAHS Hospitals

Acute Overnight Beds Facility Treat- ment Chairs

Same Day Beds

Mental Health Beds

State-wide Specia-lty

Med-ical

Sur-gical

ICU CCU/HDU2

Obs- tetric

Paeds

Re- hab

Pall. Care

Total Over night

Total Hospital

RPAH 40 63 40 163 214 151 59 23 65 10 538 681 IRO 11 20 23 43 54 Concord 30 68 84 188 96 9 24 24 349 447 Canterbury 4 7 74 29 10 32 10 24 179 190 Balmain 7 52 26 78 85 Rozelle Bankstown 3 17 30 160 84 13 16 20 14 20 327 377 Fairfield 1 13 58 50 18 29 12 167 181 Liverpool 39 52 34 165 171 141 24 23 61 25 461 586 Braeside Campbell-town

17 16 36 81 42 8 29 33 30 223 292

Camden5 4 9 27 2 14 20 10 73 86 Bowral 7 2 34 10 12 10 66 75 Total6 138 270 40 1079 616 113 155 266 111 90 34 2504 3054

1 includes neonate intensive care beds 2 includes neonate special care nursery beds 3 liver and renal transplant beds 4 extensive burns beds 5 brain injury rehabilitation unit Source: DOH bed survey/audit November 2004, with exception of local data for Rozelle, Bowral, Braeside.

7.2 Selected Specialty and Statewide Services A number of Statewide and Selected Specialty Services are provided from facilities within the new Sydney South West Area Health Service. The following services are recognised Statewide and Selected Specialty Services. A NSW Health Department Working Group is currently developing a method for these services. Bone Marrow Transplant Units Bone marrow transplants can be either autologous where the patient has previously donated their own bone marrow or allogeneic where the donor is a tissue matched related or unrelated donor. Autologous transplantation is undertaken at RPAH and Liverpool hospitals and more recently at CRGH. Allogeneic transplantation is also undertaken at RPAH. Overall, around 40 bone marrow transplants are undertaken at RPAH p.a., around 20 at Liverpool and around 10 at CRGH. Brain Injury Rehabilitation Unit The Brain Injury Unit at Liverpool Hospital is one of three adult inpatient units in NSW. The Unit provides inpatient rehabilitation and non-inpatient care from a purpose built 16 bed facility staffed by medical, nursing and allied health staff.

- 51 -


Cardiac Surgery and Interventional Cardiology Cardiac surgery is provided at RPAH and Liverpool Hospital. Interventional cardiology services including angipoplasty, stenting and implantation of cardiac defibrillators are available at RPAH, CRGH and Liverpool. RPAH and Liverpool both have 3 catheterisation laboratories and CRGH has 2. Cochlear Implants Adult cochlear implants are provided at RPAH. In 2003/04 28 procedures were performed. Some patients experience a long wait before they can benefit from this surgery, with the average waiting time recorded for this procedure being 7.3 months. Intensive Psychiatric Care Unit Rozelle Hospital currently provides Intensive Psychiatric Care for the Southern Mental health network. Intensive psychiatric care in the Western Zone is primarily networked with Cumberland Hospital, Westmead. Interventional Neuroradiology (INR) RPAH is one of two sites in the State for provision of Cerebrovascular Embolisation (CVE), one of the more complex and expensive INR procedures performed in NSW. Endovascular coiling is now considered the optimal treatment for specific cerebral aneurysms. Around 100 INR procedures p.a. are undertaken at RPAH. Currently no services are provided in the Western Zone. The Way Forward 2004-2008 recommends the development of an interventional neuroradiology service at Liverpool Hospital. NSW Health has recently commissioned a consultant to provide an options paper on the future service delivery of cerebrovascular embolisation services in NSW. Liver Transplant Unit The Liver Transplant Unit at RPAH is the sole adult unit for NSW and currently provides transplants for around 50 recipients per annum. In addition a further 12 or so transplants are provided for children at The Children’s Hospital at Westmead. Service provision for liver transplants is constrained by the availability of donor organs. Magnetic Resonance Imaging (MRI) There are a total of 3 public MRIs in SSWAHS. Located at RPA (1992) Liverpool (2002) and Concord (2005). A number of private MRIs are also located within SSWAHS. Positron Emission Tomography (PET) There are currently only two public (Medicare eligible) Positron Emission Tomography (PET) machines in NSW. Both of these services are located within SSWAHS. The PET at RPAH was the first of two publicly funded services in Australia established in the early 1990s. Recently RPAH has installed a mini cyclotron to improve service efficiencies with the production of isotopes. In 2002, Liverpool Hospital won a Commonwealth tender to establish another public PET service in NSW. A third machine for NSW is planned at Westmead Hospital. Neonatal Intensive Care Units There are two neonatal intensive care units (NICUs) in SSWAHS. Both are level 5 NICUs. RPAH has a total 32 cots and Liverpool 24 cots. The number of neonatal ventilated beds at Liverpool Hospital has recently been increased as a result of a statewide enhancement for neonatal services. Radiation Oncology There are currently 5 linear accelerators at RPAH whilst radiation oncology is provided across two sites in the Western Zone. There are three linear accelerators at Liverpool and two at Campbelltown Hospital. The second linear accelerator at Campbelltown Hospital commenced operations in April 2005.

- 52 -


Renal Transplant Unit The Renal Transplant Unit at RPAH and is one of six centres providing adult renal transplants. Both cadaveric and living donor transplants are provided. There were 64 renal transplants undertaken in 2003/04. The Report of the Greater Metropolitan Services Implementation Group 2001 recommended that in the event that levels of renal transplantation in NSW approach 220 per year, Liverpool Hospital be considered as the next center for transplantation. In 2003/04 there were 178 renal transplants undertaken in NSW. Severe Burns Unit The Severe Burns Unit at Concord RGH is part of a networked Statewide Burns service across Concord RGH, Royal North Shore Hospital and Sydney Children’s Hospital at Westmead. Trauma Units Two of the six adult Major Trauma Units within NSW are located in SSWAHS, at Liverpool and RPAH. The Liverpool Trauma Unit is second busiest in NSW in total volume of trauma presentations. The Liverpool Emergency Department is currently being partly refurbished and rebuilt for a total of $9.1M. The new emergency unit will have a total of 65 treatment spaces including 5 resuscitation bays.

7.3 Mental Health Services Eastern Zone Existing Eastern Zone inpatient mental health capacity includes:

o Supra regional tertiary services – 24 bed child/adolescent service at Rivendell (Monday-Friday) and 4 eating disorders beds at RPAH;

o 10 adult intensive mental health care and observation beds at Rozelle; o 20 observation beds (10 at RPAH, 10 at Rozelle) o 96 acute adult mental health beds (30 at RPAH, 66 at Rozelle); o 26 older adult acute beds at Rozelle (+2 respite beds); o 40 adult non-acute rehabilitation beds at Rozelle; o 10 older adult extended care beds at Rozelle (remaining veterans funded under long-

standing arrangement with DVA); o 27 older adult psychogeriatric nursing home beds at Croydon - to be supplemented by

remaining 13 Innovative Pilot Pool Project (IPPP) beds in 2005. Western Zone Existing Western Zone mental health capacity includes:

o 90 acute beds for adults (Bankstown 30 beds, Campbelltown 30 beds and Liverpool 30 beds). A new 50 bed mental health facility is currently being developed on the Liverpool Hospital site. This will increase Liverpool’s capacity by 20 beds.

o 6 bed adolescent mental health unit (Gna Ka Lun) located at Campbelltown. The Unit also includes a day unit for tertiary level care.

o Non-acute patients are admitted to Bowral under the care of a GP physician in collaboration with the Wingecarribee mental health service.

o Fairfield Community Health Centre (Carramar) provides newly built accommodation for adolescent and adult community mental health services and the Fairfield/Liverpool Youth Health Team (FLYHT).

o A 20 bed non acute mental health unit is being built at Campbelltown hospital

- 53 -


7.4 Aged Care and Rehabilitation Services Aged care and rehabilitation services focus usually on older people (and their carers) with high level needs that may be acute or chronic and that may be manifested by physical disability, mental disability, care, accommodation and support issues, multiple medical problems and polypharmacy. Services are also offered to some younger adults with a disability and high support needs. The range of services offered include:

o Acute inpatient beds in geriatrics and general medicine; o Beds for patients who are confused or behaviourally disturbed; o Sub acute rehabilitation beds; o Ambulatory clinics including day hospitals; o Community and home based assessment, therapy and support (ACAT, home based

therapy); o Frail aged day care; o Dementia specific day care; o Short and long term brokerage services; o Transport to and from some services; o Carer support and respite; o Nurse consultancy support; o Links with emergency departments through Aged Care Service Emergency Teams

(ASET). Eastern Zone There are three sectors with each offering their own inpatient, ambulatory and domiciliary services:

o Western sector based at CRGH providing services mainly to Ashfield, Burwood, Canada Bay and Strathfield residents;

o Eastern sector based at Balmain and RPAH and some services at Glebe, Marrickville and Newtown, providing services mainly to Leichhardt, Marrickville, Sydney (part), South Sydney (part) residents;

o Canterbury sector based at Canterbury Hospital, providing services mainly to Canterbury residents.

Western Zone Aged Care services across the Western Zone are provided in accordance with an integrated service model combining Aged Care and rehabilitation, with formal collaboration with Aged Care Psychiatry. Services are provided across the continuum of care and include community services such as Aged Care Assessment Teams (ACAT), acute inpatient services, subacute services, nursing home liaison, day care and respite services. Services are delivered by multidisciplinary teams in the community, providing assessment, intervention and education, either in the client’s home, in outpatient settings or in group situations. Cross-cultural education services are delivered across the Western Zone with the assistance of the Reslink (Dementia) Program and bilingual workers. Four Aged Care Assessment Teams operate across the Western Zone. They are the Bankstown, Liverpool/Fairfield, Macarthur and Wingecarribee. Aged Care Assessment Teams (ACATs) are a fundamental component of aged care services.

7.5 Primary and Community Health Services Primary health care providers are the most visible and utilized part of the health care system, and generally the first point of contact for people seeking help with their health. Primary health care services provided across SSWAHS include primary health nursing and palliative care, child

- 54 -


and family nursing, chronic and complex care, generalist counseling services for individuals and families, sexual assault counseling, allied health services such as speech therapy, occupational therapy, social work, podiatry, nutrition and psychology, health promotion and community development, youth health services, Aboriginal Health and Multicultural Health services. These services are delivered in a variety of settings across SSWAHS, including the home, outreach centres and community health centres. Across SSWAHS there are 20 community health centres operating at Redfern, Camperdown, Marrickville, Croydon, Canterbury, Bankstown, Bowral, Cabramatta, Campbelltown, Fairfield, Hoxton Park, Ingleburn, Liverpool, Miller, Moorebank, Narellan, Prairiewood, Rosemeadow, Tahmoor and Yagoona. Primary health care services are also delivered in other SSWAHS facilities including youth health centres, family care cottages, and primary heath nursing clinics, some of which are located in schools. Primary health care services across SSWAHS often collaborate with a range of other service provides at the local level in the coordination and care of individual patients and clients. Key collaborators include general practitioners, other government departments, non-government organizations, educational facilities and local governments.

7.6 Oral Health Services Oral Health Services across SSWAHS provide emergency and some routine dental outpatient care including denture services to eligible patients across the Area. Oral Health Services receive specific project funding from the NSW Department of Health, which is quarantined for the provision of dental services. The outpatient Oral Health Program is provided to Health Care Card holders and Pensioner Concession Card holders and their dependents. Commonwealth Seniors Health Card Holders are also eligible to receive the Service. In the Eastern Zone oral health services are provided through the Sydney Dental Hospital, which in addition to providing general emergency and routine services is a major referral centre for tertiary oral health management. Dental clinics are also provided at RPAH, CRGH and Canterbury Hospitals and from 2004, a family dental clinic has been available at Croydon Community Health Centre, replacing single-chair isolated clinics located mainly on school grounds. Most Oral Health Clinics in the Western Zone are provided in Community Health Centres. Some Clinics are provided at Fairfield and Liverpool hospitals, the Cartwright Public School and the Bankstown North Public School. The Service has contractual agreements with private dental practitioners and dental prosthetists for the provision of emergency dental care to eligible patients and consumers under the Oral Health Fee for Service Scheme and Pensioner Denture Scheme.

- 55 -


8. Health Work Force The health workforce is defined as the workforce that provides health care to the people of SSWAHS; ranging from workers with no formal qualifications providing support in home based settings through to highly qualified specialists working in technology intensive super-acute hospitals. This definition is the national definition adopted in the National Health Workforce Strategic Framework (Health Ministers, 2004). SSWAHS has a large and diverse workforce. As at June 2005, it is estimated there were a total of 22,082 people employed by SSWAHS. By major occupation grouping, nurses are by far the largest component of the SSWAHS workforce. In June 2005, there were 9,898 nurses in SSWAHS, which represents 45% of the total SSWAHS workforce. The SSWAHS workforce is predominantly female (74%) and has a comparatively young age profile, with 45.6% aged under 35 years and only 13.5% aged over 55 years. SSWAHS will be developing a workforce plan for its workforce over the next decade. This plan will link into the clinical service plan and will be undertaken following completion of the service plan. The following table provides a broad profile of the SSWAHS and details employed persons by main occupation category. This information was current as at June 2005. A more detailed workforce profile will be provided in the SSWAHS workforce plan, which will include a more comprehensive breakdown of some of the more general occupation categories listed in the following table. Table 49 Sydney South West Area Health Service, employed persons (head count), by occupation (based on award category), sex and selected age group, June 2005 Occupation Female

Head count

Male Head count

Total Head count

% female

% under 35 yrs

% over 55 yrs

NURSING Assistants in Nursing 690 155 845 81.7 72.4 4.7Clinical Nurse Consultants 195 43 238 81.9 61.8 13.4Clinical Nurse Specialists 939 103 1042 90.1 70.0 13.6Enrolled Nurses 1037 194 1231 84.2 55.4 11.3Enrolled Nurses - Trainees 150 43 193 77.7 79.2 1.5Nurse Educators 94 19 113 83.1 47.8 6.2Nurse Managers 144 30 174 82.8 39.7 29.9Nursing Unit Managers 274 49 323 84.8 48.6 17.6Nurse Practitioners 9 1 10 90.0 60.0 20.0Registered Nurses 5042 687 5729 88.0 64.5 9.6Total 8,574 1,324 9,898 86.6 63.9 10.2

MEDICAL Career Medical Officers 52 64 116 44.8 9.5 23.3Clinical Academics 7 49 56 12.5 1.8 51.8Interns 71 71 142 50.0 84.5 0.0Medical Administrators 4 8 12 33.3 8.3 8.3Medical – Temporary/Agency 84 205 289 29.1 55.0 2.1Registrars 275 445 720 38.2 63.5 0.8Resident Medical Officers 201 149 350 57.4 81.4 0.3Specialists 172 436 608 28.3 6.6 15.0Total 866 1427 2293 37.8 46.8 7.0

ALLIED and COMPLEMENTARY HEALTH Audiologists 2 2 4 50.0 0.0 50.0Chiropodists 5 5 10 50.0 20.0 10.0

- 56 -


Occupation Female Head count

Male Head count

Total Head count

% female

% under 35 yrs

% over 55 yrs

Dietitians 91 2 93 97.8 52.6 9.7Occupational Therapists 186 13 199 93.5 71.4 3.0Orthoptists 7 0 7 100.0 57.1 28.6Physiotherapists 209 64 273 76.6 58.9 5.5Podiatrists 9 0 9 100.0 77.8 11.1Psychologists 182 57 239 76.2 39.7 12.9Social Workers 298 38 336 88.7 37.3 15.5Speech Pathologists 100 2 102 98.0 75.5 2.0Total 1090 183 1273 85.6 52.0 9.5 OTHER Aboriginal Health Co-ordinators 23 7 30 76.7 26.7 6.7Anaesthetic Technicians 14 17 31 45.2 32.3 3.2Biomedical Engineers 0 8 8 0.0 0.0 37.5Clerical Staff 1925 189 2114 91.1 25.3 17.9Computer Staff 61 136 197 31.0 27.9 8.6Dental Officers 316 93 409 77.3 28.9 13.0Engineers 2 36 38 5.2 2.6 36.8Health Education Officers 323 147 470 68.7 24.2 14.7Health Service Managers 392 225 617 63.5 17.3 15.7Hospital Administrative Staff 1686 1234 2920 57.7 16.3 26.2Hospital Pharmacists 97 29 126 77.0 34.1 15.1Hospital Pharmacy Assistants 16 8 24 66.7 29.2 8.3Interpreters 78 18 96 81.3 3.1 36.4Librarians / Library Officers 23 2 25 92.0 20.0 24.0Medical Records Librarians 52 10 62 83.9 58.1 0.0Radiographers / Therapists 374 221 595 62.9 47.9 8.1Research Officers 29 10 39 74.4 56.4 5.1Scientific Officers 215 157 372 57.8 20.8 16.1Technical Aides / Assistants 146 37 183 79.8 18.6 26.2Tradesmen, incl. apprentices 6 161 167 3.6 18.0 37.7Wardspersons 44 51 95 46.3 45.2 8.4Total 5822 2796 8618 67.6 23.3 19.6

TOTAL 16,352 5,730 22,082 74.0 45.6 13.5

- 57 -


9. Future Directions Following the completion of “The Way Forward” which outlines the strategic direction for hospital facilities in the Western Zone, SSWAHS, the next step is an asset strategic planning process incorporating Liverpool Hospital Stage II and other physical enhancement of capacity required to meet the needs of burgeoning population growth expected in the South West Corridor of Sydney. Asset strategic planning must be driven by clear and detailed service plans that outline the roles and future activity levels of hospitals in South Western Sydney. “The Way Forward” provides the framework for this planning and the next phase of service planning that is required to build on this framework must incorporate: • The use of recently released population projections that identify the impact of accelerated

land release in the South West Growth Centre (Bringelly); • Extrapolation of acute inpatient activity projections to 2016 taking into account these

revised population projections; • Consideration of the various physical infrastructure options in the development of additional

hospital and health service capacity to meet projected population needs; • Allocation of projected Clinical Service workloads to hospital facilities and development of

detailed hospital service plans that will support detailed facility planning. Clinical Services Plans for SSWAHS, 2005-2016 Accordingly, the next step is to develop an Areawide Clinical Services Plan that will provide the level of information required to evaluate different options in the development of additional health infrastructure in the Western Zone and to enable the development of detailed facility plans for Liverpool Hospital Stage II and other required facility enhancements. As noted in The Way Forward and other previous planning documentation such as the South Western Sydney Strategic Resource Plan, 2001 and the Master Development Control Plan for Liverpool, June 2001, a second stage capital program to expand Liverpool Hospital is a high priority. NSW Health has recognised the importance of increasing capacity at Liverpool Hospital by accelerating the planning for Liverpool Stage II.

However the implications of accelerated land releases at Bringelly-Leppington, revised population growth figures, and the development of the newly formed Sydney South West Area Health Service (SSWAHS) highlights the need to plan services and physical assets beyond 2011. In order to provide the required platform for physical asset planning for hospitals and community services in the Western Zone, detailed service plans for each of the clinical services are required at a hospital level that outline projected inpatient admission numbers by specialty, average length of stay, day only activity, non-inpatient clinics etc and community health service activity. In addition, a number of clinical services will require planning on a combined SSWAHS basis to take account of high cost infrastructure and/or specialised workforce issues.

The emphasis for further planning is on the Western Zone due to the pressing demands of accelerated population growth in the Bringelly area, as the Eastern Zone has a current capital asset strategy, the Resource Transition Program (RTP). Substantial population growth due to medium density urban consolidation in inner and middle ring suburbs will require review of hospital capacity in the Eastern Zone also.

It has been agreed with NSW Health that detailed clinical service planning will be completed by September 2005. This will include both hospital and community services. A crucial step in the

- 58 -


development of area wide clinical services plans requires the development of acute activity projections to 2016 and beyond.

From March 2005 Clinical Planning Groups will be established for the broad range of health services in SSWAHS. Each Planning Group will be provided with the 2016 acute activity projections for their relevant services and any other planning data developed to date. Clinical Planning Groups will be established for each of the following services: • Cancer • Cardiovascular • Renal • Surgical • Medical including ambulatory care • Gastro and Liver • Women’s • Child Youth and Family • Critical Care • Trauma • Aged and Rehabilitation • Mental Health • Drug Health • Oral Health • Community Health • Population Health • Research In addition a further group will review Models of Care, looking at possible change in methods of delivering health care and providing direction on future models of care for Sydney South West Area Health Service which will inform the way in which services may be configured in physical terms. The task for each Planning Group is to review service projections and guiding assumptions, produce and sign –off on a Clinical Service Plan that identifies future activity levels, models of care and an allocation of this service activity to hospital and other facility locations. These Plans are the starting point for the development of Hospital Service Plans.

- 59 -


- 60 -

APPENDIX A – Profile of the Local Government Areas in SSWAHS

Profile of the Local Government Areas in SSWAHS1

Sydn

ey

Sth

Sydn

ey

Leic

hhar

dt

Mar

rickv

ille

Ash

field

Bur

woo

d

Stra

thfie

ld

Can

ada

Bay

Can

terb

ury

Ban

ksto

wn

Fairf

ield

Live

rpoo

l

Cam

pbel

ltow

n

Cam

den

Wol

lond

illy

Win

geca

rrib

ee

NSW

Land area km2 6.7 17.8 12.9 16.5 8.3 7.2 13.9 19.8 33.6 76.8 101.7 305.4 312.2 201.3 2,556.6 2,688.8 801,353.2Population 30/06/97 16,501 81,788 61,341 79,469 41,483 29,806 27,635 57,213 139,032 165,682 189,308 131,205 148,624 35,333 35,264 38,069 6,276,961

Population 30/06/02 30,653 90,230 64,349 76,515 40,362 30,702 29,452 63,571 136,673 173,207 188,711 163,310 150,489 47,818 38,944 43,476 6,634,110 % Change 85.8% 10.3% 4.9% -3.7% -2.7% 3.0% 6.6% 11.1% -1.7% 4.5% -0.3% 24.5% 1.3% 35.3% 10.4% 14.2% 5.7%Aged <=14 2,631 7,801 8,004 10,732 6,167 5,056 5,364 10,091 27,292 36,659 41,004 40,110 37,844 12,315 9,635 9,786 1,338,710Aged 15-44 20,213 55,714 35,465 41,403 19,354 14,367 13,078 29,381 61,776 74,734 86,565 79,095 69,598 22,238 16,898 15,881 2,872,659Aged 45-64 5,529 17,840 14,614 16,506 8,794 6,842 6,883 14,872 29,660 37,243 42,213 31,977 33,301 9,522 9,205 11,029 1,547,649Aged 65+ 2,280 8,875 6,266 7,874 6,047 4,437 4,127 9,227 17,945 24,571 18,929 12,128 9,746 3,743 3,206 6,780 875,092Popn Density/km2 4,582.6 5,063.4 5,003.0 4,626.1 4,866.4 4,292.2 2,122.4 3,203.1 4,070.8 2,254.6 1,856.3 534.8 482.0 237.6 15.2 16.2 8.3

Births 01/02 206 828 934 1,060 504 337 284 783 2,111 2,562 2,518 2,775 2,161 747 500 474 83,039Crude birth rate 6.7 9.2 14.5 13.8 12.5 11.0 9.6 12.3 15.4 14.8 13.3 17.0 14.3 15.6 12.8 11.0 12.5Deaths 01/02 78 563 364 486 440 227 223 388 793 1,178 951 643 565 208 183 310 45,394Crude death rate 2.5 6.2 5.7 6.3 10.9 7.4 7.6 6.1 5.8 6.8 5 3.9 3.8 4.3 4.7 7.2 6.8Building approvals - new dwelling units 01/02 1,662 2,652 256 269 241 337 250 571 299 1,013 626 1,523 766 490 405 498 49,282

Index of Relative Socioeconomic Advantage/Disadvantage 2001 1,138.4 1,123.9 1,159.0 1,067.9 1,083.8 1,060.9 1,082.5 N/A 964.8 972.0 915.4 978.0 969.5 1,042.9 1,003.1 N/A 1,015.3Unemployment no. June 02 579 3,551 1,438 2,872 1,316 843 771 975 3,955 5,337 8,178 4,593 8,539 1,156 1,127 599 201,286Unemployment rate % 5.0 6.3 3.3 5.7 5.0 4.9 5.0 2.6 6.2 7.0 8.5 6.6 9.9 5.4 5.5 3.0 6.1Age pensioners no. 917 6,253 4,594 6,375 4,430 3,171 2,419 6,042 13,510 18,733 16,040 10,551 7,463 2,300 2,668 4,051 601,465Disability Support pensioners no. 830 4,593 1,908 2,937 1,126 760 557 1,161 4,549 5,545 6,627 5,115 4,755 713 987 1,306 217,165Newstart allowance no. 692 4,087 1,458 3,075 925 606 523 677 3,967 4,905 9,117 5,113 4,405 572 627 748 178,699

Newstart % long-term 46.9 53.1 49.9 54.0 52.4 52.6 49.3 45.4 52.3 55.6 60.9 56.9 51.2 42.1 52.4 49.0 58.8Parenting payment-single no. 236 1,118 803 1,314 516 317 254 492 2,746 3,690 5,485 4,013 5,700 951 814 914 141,472Youth allowance no. 342 1,632 1,067 1,818 633 524 529 636 3,063 4,158 6,340 3,522 3,325 521 512 596 124,441Other no. 398 1,912 925 2,260 1,154 943 840 1,172 7,188 8,090 11,520 6,874 5,072 952 997 1,139 211,170Total on income support no. 3,415 19,595 10,755 17,779 8,784 6,321 5,122 10,180 35,023 45,121 55,129 35,188 30,720 6,009 6,605 8,754 1,474,412Average taxable income 01/02 $51,435 $47,740 $55,107 $39,212 $41,065 $40,948 $43,280 $49,948 $34,239 $35,688 $33,185 $35,592 $35,581 $39,282 $37,884 $40,079 $41,623Wage and salary earners 00/01 21,108 43,068 31,908 34,580 17,924 12,451 10,913 27,618 50,274 63,169 65,048 61,203 62,917 21,210 15,055 14,566 2,534,813New passenger motor vehicle sales 01/02 6,038 5,017 2,275 1,866 1,474 1,846 1,963 1,884 2,132 3,941 4,337 4,133 3,016 1,198 809 1,140 190,7211 For LGAs only partly covered by SSWAHS, data refers to all of the LGA.Source: Australian Bureau of Statistics National Regional Profile , Commonwealth of Australia, 2004

Population

Population Dynamics

Socioeconomic Factors


- 61 -

APPENDIX B- Trend Data for Key Inpatient Activity Variables at SSWAHS Hospitals Table B1: Acute Inpatient Activity in Hospitals 1996/7–2002/3: SEPARATIONS (includes unqualified neonates)

[excluding renal dialysis and chemotherapy, as counting patterns changed during this period] Hospital 1996/7 1997/8 1998/9 1999/2000 2000/1 2001/2 2002/3 2003/04RPAH 53,794 51,735 50,261 50,790 49,660 49,357 49,642 45,065IRO 1,384 2,076 2,270 2,185Rachel Forster 2,481 2,431 2,473 2,155 441 CRGH 31,485 31,900 30,457 30,014 28,866 28,221 27,092 24,503Canterbury 7,400 7,449 12,824 14,030 14,281 14,796 14,512 15,053EASTERN ZONE to 1/1/05 95,160 93,515 96,015 96,989 94,632 94,450 93,516 86,766Bankstown 25,996 27,928 27,082 25,581 25,305 24,662 25,099 24,717Fairfield 16,297 15,662 15,831 16,261 16,682 15,457 16,073 16,289Liverpool 29,074 32,697 34,865 34,102 34,083 33,532 34,389 35,620Campbelltown 19,868 19,459 22,433 24,235 23,672 20,401 19,251 19,634Camden 7,925 7,737 4,937 1,914 2,281 5,517 8,937 8,895Bowral 6,447 6,859 7,120 7,411 7,336 5,882 5,931 7,847

Western zone to 1/1/05 105,607 110,342 112,268 109,504 109,359 105,451 109,680 112,736

new SSWAHS 200,767 203,857 208,283 206,493 203,991 199,901 203,196 199,502


Table B2: Acute Inpatient Activity in Hospitals 1996/7–2002/3: BEDDAYS [excluding renal dialysis and chemotherapy, as counting patterns changed during this period] Financial Year of Separation

Hospital 1996/7 1997/8 1998/9 1999/2000 2000/1 2001/2 2002/3 2003/04

RPAH 239,213 227,947 226,028 213,046 204,857 206,539 209,123 210,890

IRO 7,345 10,780 10,574 10,539

Rachel Forster 16,279 15,160 14,246 12,582 2,372 CRGH 139,313 140,143 130,824 131,804 125,298 123,769 119,874 116,579

Canterbury 29,562 31,607 45,977 47,960 47,647 48,256 50,441 51,955

EASTERN ZONE to 1/1/05 424,367 414,857 417,075 405,392 387,519 389,344 390,012 389,963

Bankstown 117,731 110,809 104,953 98,494 100,850 102,692 99,898 107,323

Fairfield 56,221 51,829 51,721 53,202 55,833 54,580 56,588 56,510

Liverpool 134,648 149,290 155,071 158,380 158,465 158,643 161,539 170,570

Campbelltown 57,169 54,232 61,137 65,804 66,778 65,875 66,298 69,437

Camden 23,575 22,179 14,734 5,757 6,784 10,884 15,868 17,258

Bowral 20,641 20,204 19,368 19,232 18,112 10,197 9,901 18,574

Western zone to 1/1/05 409,985 408,543 406,984 400,869 406,822 402,871 410,092 439,672,

new SSWAHS 834,352 823,400 824,059 806,261 794,341 792,215 800,104 829,635

- 62 -


- 63 -

Table B3 : Acute Inpatient Activity in SSWAHS Hospitals All Ages 1996/7 - 2003/4: COST WEIGHTED SEPARATIONS* (DISCOUNTED)

(excluding unqualified babies, renal dialysis and chemotherapy) Hospital 1996/97 1997/98 1998/99 1999/2000 2000/01 2001/02 2002/03 2003/04 RPAH 75,198 73,300 72,212 70,290 71,256 72,130 71,392 65,336 Inst. Rheum. Orthop. 4,303 6,293 6,282 5,581 Rachel Forster 6,167 6,178 6,299 6,399 1,386 CRGH 44,988 45,535 43,550 43,630 41,916 39,620 40,231 38,450 Canterbury 8,930 9,264 13,017 13,810 13,556 13,845 13,985 13,036 EASTERN ZONE to 31/12/04 135,282 134,277 135,077 134,129 132,416 131,888 131,890 122,403 Bankstown 28,224 30,614 29,687 29,103 29,394 29,599 29,073 29,657 Fairfield 14,521 14,412 14,595 14,881 15,572 15,161 15,921 15,896 Liverpool 36,184 44,451 48,576 50,332 49,675 49,604 50,869 53,094 Campbelltown 15,600 15,749 18,068 19,634 19,539 17,935 17,730 17,691 Camden 6,464 5,995 3,881 1,445 1,650 3,588 5,310 5,083 Bowral 5,722 6,005 5,893 5,942 5,459 3,429 3,425 5,977 Western zone to 31/12/04 106,715 117,226 120,699 121,337 121,289 119,317 122,328 127,398 SSWAHS from 1/1/05 241,998 251,503 255,776 255,466 253,705 251,205 254,218 249,801 * discounted for private patients


- 64 -

Table B4: Acute Inpatient Activity in SSWAHS Hospitals All Ages 1996/7 - 2003/4: AVERAGE LOS EXCLUDING SAMEDAY CASES (days)

(excluding unqualified babies, renal dialysis and chemotherapy) Hospital 1996/97 1997/98 1998/99 1999/2000 2000/01 2001/02 2002/03 2003/04 RPAH 6.3 6.3 6.4 6.1 6.0 6.3 6.4 6.8 Inst. Rheum. Orthop. 6.6 6.6 6.1 6.4 Rachel Forster 8.3 8.2 7.5 7.3 6.6 CRGH 6.7 6.8 6.9 6.9 7.1 7.2 7.0 7.2 Canterbury 5.3 5.6 4.8 4.5 4.3 4.3 4.6 4.6 EASTERN ZONE to 31/12/04 6.4 6.4 6.3 6.1 6.0 6.3 6.2 6.5 Bankstown 6.2 5.4 5.5 5.4 5.8 6.0 5.8 6.5 Fairfield 4.4 4.2 4.1 4.1 4.3 4.6 4.6 4.7 Liverpool 6.0 5.9 5.9 6.2 6.0 6.2 6.4 6.5 Campbelltown 3.9 3.8 3.8 3.8 3.9 4.1 4.1 4.3 Camden 4.3 4.2 4.4 5.3 5.4 5.4 4.3 4.2 Bowral 4.6 4.1 3.9 3.8 3.8 2.7 2.6 3.8 Western zone to 31/12/04 5.2 5.0 5.0 5.0 5.1 5.3 5.3 5.5 SSWAHS from 1/1/05 5.8 5.6 5.6 5.5 5.5 5.7 5.7 5.9


- 65 -

Table B5: Acute Inpatient Activity in SSWAHS Hospitals All Ages 1996/7 - 2003/4: AVERAGE COST WTD SEP* EXCLUDING SAMEDAY CASES

(excluding unqualified babies, renal dialysis and chemotherapy) Hospital 1996/97 1997/98 1998/99 1999/2000 2000/01 2001/02 2002/03 2003/04 RPAH 1.99 2.03 2.06 2.02 2.11 2.23 2.20 2.15 Inst. Rheum. Orthop. 3.87 3.89 3.67 3.41 Rachel Forster 3.09 3.26 3.26 3.71 3.89 CRGH 2.04 2.08 2.16 2.17 2.23 2.17 2.24 2.26 Canterbury 1.55 1.59 1.38 1.31 1.28 1.27 1.31 1.18 EASTERN ZONE to 31/12/04 2.00 2.05 2.03 2.00 2.05 2.10 2.10 2.04 Bankstown 1.45 1.48 1.50 1.56 1.65 1.68 1.63 1.72 Fairfield 1.15 1.19 1.18 1.19 1.20 1.26 1.29 1.30 Liverpool 1.62 1.75 1.83 1.94 1.90 1.93 2.01 2.02 Campbelltown 1.05 1.10 1.11 1.12 1.13 1.14 1.15 1.12 Camden 1.14 1.12 1.14 1.22 1.15 1.19 1.04 0.98 Bowral 1.26 1.24 1.21 1.21 1.14 0.94 0.93 1.20 Western zone to 31/12/04 1.35 1.43 1.46 1.52 1.53 1.56 1.57 1.58 SSWAHS from 1/1/05 1.65 1.71 1.72 1.74 1.76 1.80 1.81 1.78 * discounted for private patients

south western sydney area health servicetable 49 sydney south west area health service, employed...

Documents