THE NEW WOMEN S AND CHILDREN S HOSPITAL

Transcription

1 THE NEW WOMEN S AND CHILDREN S HOSPITAL Special Grand Round 27 August 2018 Jim Birch, Chair, nwch Taskforce

2 Acknowledgment of Country We would like to acknowledge this land that we meet on today is the traditional lands for the Kaurna people and that we respect their spiritual relationship with their country. We also acknowledge the Kaurna people as the custodians of the Kaurna land, and that their cultural and heritage beliefs are still as important to the living Kaurna people today.

3 Introduction and Purpose > What progress has been made; Reference Groups active Reaching a conclusion on major clinical and health services planning Site options analysis underway Progressing on lessons learned (RAH and interstate) and international learning > Scenario modelling process undertaken with the Taskforce. > Today building the preferred scenario what it is, assumptions, constraints and opportunities

4 Context 2019 nwch Taskforce High level planning High level consultation Decision enabler focused Business case development Decision Point - nwch Service Planning Additional analysis Service level models of care Broad consultation Facility Planning Translates service planning into design outcome Broad consultation

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6 Population Projections Children and Adolescents > Population projections indicate that the yr age group is projected to grow at a higher rate than the 0-14 age group across SA. Age Male / Female / Totals Change % Growth 0-14 Females 148, , , ,213 11,566 8% Males 155, , , ,306 12,396 8% Total , , , ,550 23,977 8% Females 51,271 51,131 54,859 57,759 6,488 13% Males 53,101 53,750 56,869 60,380 7,279 14% Total , , , ,139 13,767 13% Grand Total , , , ,658 37,729 9% > Almost all the growth is projected to be in Adelaide / Outer Adelaide > Highest growth for 0-14 and is projected in similar geographic areas (see next slide). 6

7 Population Population Growth Growth, Years years Hospital Name Lyell McEwin Hospital Royal Adelaide Hospital Flinders Medical Centre Women s and Children s Hospital The Queen Elizabeth Hospital 7

8 Population Projections - Females > Population projections for all women across South Australia are summarised below. Age Change % Growth , , , ,213 11,566 8% ,271 51,131 54,859 57,759 6,488 13% , , , ,567 24,136 9% , , , ,700 67,611 18% All Females 864, , , , ,801 13% Over 95% of the female population growth is projected to be in Adelaide / Outer Adelaide. For 0-44s highest population growth is projected in Playford, north/ west Adelaide, Mt Barker similar to previous slide. For 44+ highest growth is projected in similar areas. Also significant growth south of Adelaide (Onkaparinga / South Coast, Victor Harbor) 8

9 Definitions > For the purposes of this modelling exercise only, the following definitions have been applied for analysis: > Paediatric is defined as 0-14 (excl. neonates) > Adolescent is defined as (ie. up to 18). 9

10 Who Accesses Services Locally Across SA? This table refers to the percentage of residents being treated in their own LHN, otherwise known as self sufficiency. It is dependent on the level of services provided locally i.e. the clinical service capability of the hospitals in the area. Not all hospitals or regions can be, or are expected to be, 100% self-sufficient. Service % CALHN Residents at CALHN / WCHN % NALHN Residents at NALHN % SALHN Residents at SALHN % CHSALHN Residents at CHSASLHN Paediatric 94% 35% 59% 49% Adolescent 93% (91% WCHN, 2% CALHN) 28% 46% 55% Gynaecology 87% 52% 81% 63% Obstetrics 88% 72% 94% 74% Neonates 86% 57% 88% 33% 10

11 Total Inpatient Activity at WCH by Separations and Bed-days, 2016/17 awaiting 17/18 data 35,000 30,000 25,000 20,000 15,000 10,000 Separations Beddays 5,000 0 Paed and Adol Medical Paed and AdolPaed and Adol Surgical / Procedural Mental Health and Drug and Alcohol Neonates Gynaecology Obstetrics - Vaginal Obstetrics - Caesarean Obstetrics - Other 11

12 Scenarios As agreed with the Taskforce, a number of scenarios were reviewed and considered. 1. Status Quo - projected activity to 2031/32 from endorsed planning tools. 2. Centralising paediatric and adolescent surgical services at WCH. 3. Ambulatory services not modelled 4. Centralising high complexity low volume paediatric and adolescent and women s services at WCH with WCHN to retain high volume low complexity work for its catchment. 5. SALHN / NALHN / CHSALHN providing a greater volume of paediatric and adolescent medical services for their local catchments, cognisant of service capability. 6. A higher volume of low risk deliveries provided at Mt Barker, Gawler, and Victor Harbour. 7. Impact of a shift of birthing activity away from the private sector to the public sector. Key Outcome What to model in a final preferred scenario that will have a discernible impact on the future size/scope of WCH. 12

13 Scenario 1 Status Quo > The Acute Inpatient Modelling Tool (AIM) is the endorsed SA Health planning tool for projected inpatient activity > Importantly, the status quo projection does not assume no future changes to models of care. The AIM tool provides projections based on: the historical trend of separations current utilisation of services and current referral patterns projected population growth Possible length of stay projections 13

14 Scenario 1 Status Quo > The AIM tool groups admitted activity into SRGs (Service Related Groups) and ESRGs (Enhanced Service Related Groups) as per the example below for Obstetrics services. SRG ESRG DRG 31 Obstetrics 114 Ante-natal Admission O66A ANTENATAL&OTH OBS ADM, MAJC O66B ANTENATAL&OTH OBS ADM, MINC 115 Vaginal Delivery O02A VAGINAL DELIVERY +OR PR, MAJC O02B VAGINAL DELIVERY +OR PR, MINC O60A VAGINAL DELIVERY, MAJC O60B VAGINAL DELIVERY, INTC O60C VAGINAL DELIVERY, MINC 116 Caesarean Delivery O01A CAESAREAN DELIVERY, MAJC O01B CAESAREAN DELIVERY, INTC O01C CAESAREAN DELIVERY, MINC 117 Post-natal Admission O61A POSTPART&POST ABORTN -OR, MAJC O61B POSTPART&POST ABORTN -OR, MINC 14

15 Scenario 1 Status Quo > There are some limitations with the AIM tool that mean that the projections must be interpreted with caution: Lag in availability (using 16/17 data as base year) The tool only allows analysis of broad age groups (eg 0-14,15-44 etc.). The National Mental Health Service Planning Framework is utilised to inform planning for mental health services across South Australia. When informing infrastructure planning, clinical input must be applied to the outputs generated (e.g. to treatment spaces calculated on the basis of planning benchmarks). 15

16 Scenario 1 WCH Status Quo Analysis 30,000 25,000 20,000 15,000 10,000 5,000 0 Paediatric and Adolescent Separations Obstetrics Gynaecology Neonates 2016/ / / /32 Projected growth in separations overall about 15% over 15 years. 60,000 50,000 40,000 30,000 20,000 10,000 0 Paediatric and Adolescent Beddays Obstetrics Gynaecology Neonates 2016/ / / /32 Less growth in terms of bed days due to decreasing ALOS (continuing trends overnight ALOS decreased by 0.5 days at WCH between 2012/13 and 2016/17). 16

17 Scenario 1 WCH Status Quo Analysis > WCH overnight average length of stay projections from the Acute Inpatient Modelling Tool Specialty Grouping 2016/ / / /32 Change Paed and Adol Medical Paed and Adol Surgical / Procedural Gynaecology Obstetrics - Other Obstetrics - Vaginal Obstetrics - Caesarean

18 Scenario 1 Recommendations > Tool limitation noted by Taskforce need to apply clinical input in interpretation, particularly as related to built infrastructure. > Vaginal delivery ALOS due to concern with large projected reduction and increasing complexity of patient cohorts, flatten ALOS from 2021/22 at 2.3 days. It was noted that the overnight ALOS for all vaginal deliveries at Flinders Medical Centre was 2.4 days in 2016/17. 18

19 Scenario 2 Paediatric and Adolescent Surgical > The Scenario: Centralising paediatric and adolescent surgical activity at WCH. > Background 69% of paediatric surgical / procedural services and 49% of adolescent surgical / procedural services were provided at WCH in 16/17 in SA. Approximately 12% of separations were at FMC, 3% were at LMH for 0-17s. Highest volume services provided outside WCH were primarily dental (extractions), orthopaedics, general (appendectomies, circumcisions), ENT (T&As, grommets, nasal procedures). > Methodology Analyse paediatric surgical services being performed outside WCH and model the potential impact of centralisation. 19

20 Scenario 2 Paediatric and Adolescent Surgical (cont d) > Surgical / procedural patient flow (%) by age and hospital, SA, 2016/17 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% % WCH % FMC % RAH % Other 20

21 Scenario 2 - Recommendation > There does not appear to be inappropriate paediatric surgery being undertaken in centres outside of WCH. > We want to continue providing services as close to home as possible where it is safe and appropriate to do so. > Opportunities for enhanced clinical networks in the future. > Taskforce Recommendation maintain the status quo (do not model future changes in where patients access paediatric surgical services). 21

22 Scenario 4 High Complex, Low Volume > The Scenario: Centralising high complexity low volume paediatric and adolescent and women s services at WCH with WCHN to retain high volume low complexity work for its catchment. > Methodology: Define high complex, low volume services all specialist services (e.g. cardiology, cancer, renal) and only complex DRGs of other services. Measure the potential impact of centralising some or all of these services at WCH. 22

23 Scenario 4 Context In-Scope High Complex Low Volume Services > Types of paediatric and adolescent services being performed outside of WCH. For paediatrics Respiratory infections Ear infections Gastro Various other (injuries, infections, viral illnesses etc.) For adolescents Mental health Appendectomy Drug and alcohol Various other (injuries, infections, viral illnesses etc.) Approximately 85% of the in-scope activity performed outside of WCHN is emergency (ie. not elective). 23

24 Scenario 4 - Recommendation > A significant volume of these services are emergency (hence there is a more limited ability to affect where patients access the service). > It is difficult to define high complex low volume particularly for services like birthing. > We want to continue providing services as close to home as possible where it is safe and appropriate to do so. > Taskforce Recommendation Maintain the status quo (do not model changes in where patients access these services). 24

25 Scenario 5 General Paediatric/ Adolescent Medicine > The Scenario: SALHN / NALHN / CHSALHN providing a greater volume of paediatric and adolescent medical services for their local catchments, cognisant of service capability. > Background 54% of public paediatric and 52% of public adolescent admitted medical services were provided at WCH across SA in 2016/17. Self-sufficiency of LHNs in 2016/17 for medical services:. Paediatrics - CHSALHN 52%, NALHN 44% and SALHN 63%.. Adolescents - CHSALHN 58%, NALHN 34% and SALHN 48%. > Methodology Define general medicine (minor / intermediate complexity services) Model potential impact of increasing self-sufficiency at CHSALHN, NALHN and SALHN. 25

26 Scenario 5 Context In-Scope General Medicine Services > Approximately 4,500 paediatric separations and 755 adolescent separations were in-scope general medical services in 2016/17 for residents of SALHN / NALHN / CHSALHN at WCH. > What types of general medical services are provided to residents of SALHN / NALHN / CHSALHN at WCH? For paediatrics General viruses, allergic reactions, infections. Gastro Respiratory disease/ infections Ear infections Injuries For adolescents Poisoning / toxic effects of drugs Gastro General viruses, allergic reactions, infections. 65% of in-scope general medical activity for paediatric / adolescent patients at WCH was emergency (ie. not elective) Issue take out DRGs that may be assigned to Paed Med but are complex 26

27 Scenario 5 - Recommendation > The major population growth for children is projected in the north. > NALHN has a lower self-sufficiency (ie. a number of NALHN residents receive admitted services at WCH). > We want to continue providing services as close to home as possible where it is safe and appropriate to do so. > Taskforce Recommendation - Model an increase in self-sufficiency for general medical services that are already provided in NALHN. > The modelling accounts for the future supply of paediatric medical services in response to population growth, service need and the delivery of safe, quality care, consistent with the approved clinical service capability level of service at each facility. 27

28 Scenario 6 Low Risk Deliveries > The Scenario: A higher volume of low risk deliveries provided at Mt Barker, Gawler, and Victor Harbour. > Background Mount Barker and Gawler Hospitals see approximately 500 births per year South Coast District Hospital sees approximately 100 births per year. > Methodology Calculate the potential impact of increasing the volume of low risk birthing services provided to local residents at Mt Barker, Gawler and South Coast District Hospitals. 28

29 Scenario 6 - Recommendation > Very minimal impact on WCH (less than 1 bed equivalent). > Local planning decision at these locations in CHSALHN, reliant on workforce. > Taskforce Recommendation maintain the status quo in the modelling. 29

30 Scenario 7 Private Birthing Shift to Public > The Scenario: Impact of a shift of birthing activity away from the private sector to the public sector. > Background: Trends in birthing admissions, public vs. private hospitals. Public / Private 2012/ / / / /17 Public 15,502 15,456 15,398 15,604 15,351 Private 4,705 4,522 4,394 4,193 3,975 Grand Total 20,207 19,978 19,792 19,797 19,326 % Public 76.7% 77.4% 77.8% 78.8% 79.4% % Private 23.3% 22.6% 22.2% 21.2% 20.6% > Methodology Model the potential impact of a 25% and a 50% shift from the private sector to the public sector for birthing services. 30

31 Scenario 7 - Recommendation > Trends across Australia in terms of shifts from private to public. > Likelihood of government intervention in coming years in terms of policy / regulation in some way if trends continue. > Locally, there is a continued risk of partial market failure. > Taskforce Recommendation - Model a 25% shift from private to public for birthing services. 31

32 Questions 32

33 Next Steps > Complete a high level service statement for the WCH > Integrate with work in progress on clinical support services > Finalise inpatient and ambulatory care requirements based on projected activity and clinical input > Complete high level schedule of accommodation to inform early spatial planning, costing etc. (see next slide) > Other Taskforce work continues > Further detailed work post Taskforce dependent on decision-making. 33

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