Primary Health Network Core Needs Assessment. November 2017

Primary Health Network Core s Assessment November 2017 This template must be used to submit the Primary Health Network s (PHN s) s Assessment report to the Department of Health (the Department) by 15 November 2017 as required under Item E.5 of the PHN Core Funding Schedule under the Standard Funding Agreement with the Commonwealth. This template should include the needs assessment of primary health care after hours services. Name of Primary Health Network North Coast When submitting this s Assessment Report to the Department of Health, the PHN must ensure that all internal clearances have been obtained and the Report has been endorsed by the CEO. Page 1

Section 1 Narrative Process North Coast Primary Health Network (NCPHN) has reviewed and extended its March and November 2016 s Assessments to arrive at a more detailed understanding of the health and service needs on the North Coast of NSW in preparation for the 2017-18 planning process. November 2017 update The s Assessment completed in March 2016 has been reviewed and extended to ensure it includes the most current and relevant health and service data available. In some instances, evidence has been removed from the needs assessment where local health statistics now indicate a rate or result that is better (i.e., healthier) than the state or national result. New data has also been added to most sections within this s Assessment, deepening and expanding on NCPHN s understanding of health and service needs. In early 2018, the results of this s Assessment will be published on the NCPHN website alongside 20 updated fact sheets detailing need in the region. In addition, the NCPHN will publish a Comprehensive s Assessment using all available health and service data on our website in mid- 2018. Note, secure data made available from the Department of Health and other organisations will not be included in this publicly-available publication. Further developmental work The March and November 2016 NCPHN s Assessment processes identified a range of health and health system issues to be addressed. We examined health and health system needs through a triangulation of improved health statistics, service mapping and survey results, which provided a solid basis for assessing need. We further investigated appropriate approaches to addressing the identified needs through more in depth consideration of evidence based approaches. However, continued research, analysis and improved data are required to enable NCPHN to best target each issue and inform continued co-designing of services, projects and programs that achieve the desired outcomes rather than focussing solely on outputs. To this end some opportunities, priorities and options reflect the need to continue developing an evidence-informed approach. For our next s Assessment (2018), we have initiated discussion with Local Health Districts and other social-sector organisations from the region in order to develop a shared process and product that can inform more coordinated, needs-driven health planning within the North Coast region Page 2

Overview of March 2016 s Assessment In March 2016 North Coast Primary Health Network (NCPHN) implemented the following processes and structures to complete the initial assessment of needs: 1. Establishment of an oversight committee 2. Focus groups with community members 3. Interviews with clinicians 4. Community survey (the largest local community needs assessment survey undertaken to date) 5. Service provider survey (the largest local service provider needs assessment undertaken to date) 6. Service mapping and collation of health and service statistics 7. Public presentations and roundtables with key stakeholders 8. Communication of health needs to stakeholders 1. Establishment of an oversight committee The below schema represents the various committees, structures and processes used to consult and gain input into the March 2016 s Assessment. Stakeholders were invited to join the s Assessment Oversight Committee (NAOC) in December 2015. NAOC met three times throughout the s Assessment process, and provided advice on the s Assessment process and scope. Membership of NAOC includes senior representatives from each Local Health District, Aboriginal Health Partnership groups (AMSs), Clinical Councils, Divisions of General Practice, the North Coast Allied Health Association and community representatives. Page 3

NCPHN s three clinical councils and two key community advisory groups were significantly engaged in the March 2016 s Assessment process. Members took lead roles and provided advice on NAOC, focus group, survey and workshop activities. 2. Focus Groups with community members More than 60 community members participated in focus groups with one focus group held in each of the 12 Local Government Areas. Four focus groups were attended by people with experience of mental health services, four were attended by people aged over 65 years, two were attended by Aboriginal men, and the remaining two were attended by Aboriginal women. The content of the community focus groups was used to inform the community survey instrument. 3. Interviews with Clinicians NCPHN staff conducted focus groups and interviews with more than 60 clinicians. More than half of these were General Practitioners, and at least two clinicians were interviewed in each Local Government Area. The content of the interviews was used to inform the content of the service provider survey. 4. Community Survey The community survey was disseminated over a two-week period online and in hard copy. Partnerships were formed with 34 Non-Government Organisations who agreed to offer support to hard-to-reach groups to complete the survey. Only those over the age of 15 were surveyed. The profile of the 2,420 community members surveyed was as follows: 12.8% of respondents identified as Aboriginal and/or Torres Strait Islander (n=306, Aboriginal population rate >15 years is 3.4%); 12.8% of respondents identified as Lesbian, Gay or Bisexual (n=294); 19.6% of respondents identified as health care card holders (n=475, population rate is 22%); 37.2% of respondents identified as having private health insurance (population rate is 51%); 21.7% identified as experiencing mental health challenges (n=526); and 6% identified as having challenges with alcohol and other drugs (n=144). 5. Service Provider Survey The service provider survey was disseminated online over a two-week period. The profile of the 1,250 service providers surveyed was as follows: Most respondents were based in a public hospital (n=289), Non-Government Organisation (n=196), or General Practice (n=172) or in Allied Health private practice (n=94); Other respondents were from the disability sector, education, Aboriginal health organisations, government, and employment agencies; and Most respondents were nurses (n=322), Allied Health Professionals (n=289), Service Managers (n=99), Case Managers (n=96) and General Practitioners (n=86). 6. Service mapping and collation of health and service statistics In 2016, a desktop service mapping exercise was undertaken focussed on General Practice, Allied Health, mental health and Alcohol and Other Drug (AOD) services. In addition to this, in 2017 a service mapping exercise was undertaken that focused entirely on dementia services. All available data sources were interrogated for local health information. Page 4

The following diagram represents the various data sources used in the NCPHN s Assessment. 7. Public presentations and roundtables with key stakeholders The findings of the health statistics analysis, service mapping and survey results were presented to community members and service providers at public sessions in Coffs Harbour on 14 March 2016 and Lismore on 17 March 2016. Following each of these sessions, a roundtable workshop session was held, each attended by approximately 70 service providers, clinicians and community members. In these sessions, the identified needs were prioritised and potential solutions generated. Further community presentations were delivered in May 2016 in Tweed Heads, Goonellabah, Grafton, Coffs Harbour and Port Macquarie. 8. Communication of health needs to stakeholders To detail the findings of the needs assessment in a publicly accessible format, a series of 20 fact sheets and booklets were created. Final versions of these are available on the NCPHN website (http://ncphn.org.au/needs-assessment-2016/). Page 5

Additional Data s and Gaps While the annual NCPHN s Assessment is informed by a wide range of national, state and local data sources, we are limited in our ability to fully understand the health status and service access of some populations in our community due to a lack of available data at a local level. Access to available Commonwealth and State localised, timely data for the following population groups and health issues would facilitate better understanding and analysis of health needs and service gaps in our region. Aboriginal health data In addition to the data already provided to PHNs from the Department of Health, we request access to OCHRE Streams data. This data would provide PHNs a detailed understanding of local Aboriginal Health issues. Health and NDIS data for people with a disability NCPHN requests access to Department of Health and NDIS data for people with a disability. Data from the NDIS rollout across the NCPHN region would provide key service information around the number of people accessing NDIS-funded services, the types of services they are accessing and assist us to determine potential gaps in local service provision. MBS and PBS data In addition to the data already provided to PHNs from the Department of Health, we request access to more detailed Medicare Benefits Scheme and Pharmaceutical Benefits Scheme utilisation including; the utilisation rate per item and per group by SA3 with State and National comparison, breakdown by Aboriginality and age. Workforce and service dynamics In addition to the allied health workforce data already provided to PHNs from the Department of Health (Health Workforce Australia data), we request access to comparable specialist data which would assist in understanding service access. Furthermore, any data sources to assist PHNs on system and service efficiency and effectiveness would greatly assist in understanding health system capacity and capability development needs. Page 6

Section 2 Outcomes of the health needs analysis Outcome of the health needs analysis ABH_D(a) High proportion of Aboriginal and/or Torres Strait Islander people Around 5.0% of the NCPHN region s population identify as Aboriginal and/or Torres Strait Islander, compared to 2.9% in NSW and 2.8% across Australia. Australian Bureau of Statistics, 2016. Census of Population and Housing. [Online] Available at: http://www.abs.gov.au/ [Accessed September 2017]. In 2015, life expectancy at birth across the North Coast PHN region was 82.0 years, which is lower than the NSW average of 82.9 years. In the Kempsey LGA, life expectancy was 82.0 years and 82.7 years for residents of the Lismore LGA. The percentage of Aboriginal or Torres Strait Islanders in Kempsey LGA (11.6%) and Lismore (5.0%) are higher than the NSW percentage of 2.8%. Aboriginal Health ABH_D(b) Lower rates of life expectancy in regions with high proportions of Aboriginal and Torres Strait Islander people Centre for Epidemiology and Evidence, 2017. Life expectancy. [Online] Available at: http://www.healthstats.nsw.gov.au/indicator/bod_lexbth/bod_lexbth_lgamap. [Accessed October 2017] In 2015, life expectancy at birth for females in Kempsey (83.9), Lismore (84.4), Richmond Valley (84.8), Clarence Valley (84.9) & Bellingen (84.9) LGAs were lower than the NSW rate for females (85.0). The percentage of Aboriginal or Torres Strait Islanders in Kempsey LGA (11.6%) Lismore (5%), Richmond Valley (7.2%), Clarence Valley (6.3%) & Bellingen (3.5%) are higher than the NSW percentage of 2.9%. Centre for Epidemiology and Evidence, 2017. Life expectancy. [Online] Available at: http://www.healthstats.nsw.gov.au/indicator/bod_lexbth/bod_lexbth_lgamap. [Accessed October 2017] In 2015, life expectancy at birth for males in Kempsey (79.6 years), Lismore (80.1), Richmond Valley (80.4), Clarence Valley (80.5), Bellingen (80.5), Nambucca (80.7) and Coffs Harbour (80.7) LGAs were lower than the NSW rate for males (80.9). The percentage of Aboriginal or Torres Strait Islanders in Kempsey LGA (11.6%) Lismore (5%), Richmond Valley (7.2%), Clarence Valley (6.3%) & Bellingen (3.5%), Nambucca (7.6%) and Coffs Harbour (5%) are higher than the NSW percentage of 2.9%. Centre for Epidemiology and Evidence, 2017. Life expectancy. [Online] Available at: http://www.healthstats.nsw.gov.au/indicator/bod_lexbth/bod_lexbth_lgamap. [Accessed October 2017] Page 7

Cross Reference: See 2017 NCPHN Mental Health s Assessment MH_D(f) According to the Australian Health Ministers Advisory Council: - 53% of Indigenous Australians reported that they had been a happy person all or most of the time in the previous four weeks compared with 61% of non-indigenous Australians. - 51% of Indigenous Australians reported that they had felt so down in the dumps nothing could cheer them up at least some of the time over the same period compared with 37% of non-indigenous Australians. - The Indigenous rate of high/very high psychological distress was 2.6 times the rate for non-indigenous adults. Aboriginal Health ABH_D(c) Lower rates of social and emotional wellbeing among Aboriginal and/or Torres Strait Islander people - Indigenous women (39%) were significantly more likely than Indigenous men (26%) to report high/very high levels of psychological distress. Australian Health Ministers Advisory Council, 2017, Aboriginal and Torres Strait Islander Health Performance Framework 2017 Report, AHMAC, Canberra. Aboriginal and Torres Strait Islander Health Performance Framework 2017 Report. [Online] Available at: https://www.pmc.gov.au/sites/default/files/publications/2017-health-performance-framework-report_0.pdf [Accessed October 2017]. In 2015-16, the rate of hospitalisation for mental disorders for Aboriginal and Torres Strait Islander people in Northern NSW was 3,028.3 per 100,000 people. Across the Northern NSW region, Aboriginal people were 2.6 times more likely to be hospitalised for mental disorders compared to non-aboriginal people (1,147.5). In 2015-16, the rate of hospitalisation for mental disorders for Aboriginal and Torres Strait Islander people in Mid North Coast was 2,453.7 per 100,000 people. Across the Mid North Coast region, Aboriginal people were 1.3 times more likely to be hospitalised for mental disorders compared to non-aboriginal people (1,855.1). Centre for Epidemiology and Evidence, 2017. Hospitalisations by Aboriginality, Local Health District, category of cause and year. [Online] Available at: http://www.healthstats.nsw.gov.au/indicator/bod_hos_cat/atsi_hos_lhn_cat_comparison [Accessed October 2017]. Page 8

Data cannot be published. ABH_D(c) continued Lower rates of social and emotional wellbeing among Aboriginal and/or Torres Strait Islander people University of Queensland, 2017. National Mental Health Service Planning Framework (NMHSPF): NMHSPF standard reports for North Coast PHN. Report provided to NCPHN Directly. Not publicly available. During the three year period 2011 to 2013, there were over 4,500 separations at acute mental health units in Northern NSW, and 10% of these (444 separations) were for patients identifying as Aboriginal. Aboriginal people in Northern NSW were 2.5 times more likely to be admitted to an acute Mental Health Unit within Northern NSW than the non-aboriginal population. Aboriginal Health Northern NSW Local Health District, 2015. Northern NSW Integrated Aboriginal Health and Wellbeing Plan 2015-2020 Vol. 2 [Online]. Available at: http://nnswlhd.health.nsw.gov.au/blog/2015/07/30/northern-nsw-integrated-aboriginal-healthwellbeing-plan-2015-2020/ [Accessed October 2017]. Cross Reference: See 2017 NCPHN Mental Health s Assessment MH_D(g). ABH_D(d) High rates of self-harm hospitalisations, particularly among 15-24 year olds In 2015-16, the rate of intentional self-harm hospitalisations for Aboriginal people aged 15-24 years in NSW was 752.7 per 100,000 population. This figure was more than double the rate of non-aboriginal 15-24 year olds (314.7) across NSW. In addition, the rate for 15-24 year old females (1009.2) was close to double the rate for males (510.2). Centre for Epidemiology and Evidence, 2017. Intentional self-harm; hospitalisations. [Online] Available at: http://www.healthstats.nsw.gov.au/indicator/men_suihos/men_suihos_atsi?&topic=suicide&topic1=topic_men&code=men_ sui%20inj_dth_cat%20inj_hos_cat [Accessed November 2017]. Page 9

In 2016, 16.9% of adults living in the NCPHN region were current smokers, which is higher than the NSW level of 15.0%. Data is not available for the rate of smoking among the Aboriginal population of the NCPHN region; however in 2015, 39.7% of Aboriginal people in NSW smoked which is significantly higher than for the rate of 15% for the whole of NSW. Aboriginal Health ABH_D(e) Higher rate of smoking and hospitalisations attributed to smoking for Aboriginal and/or Torres Strait Islander people ABH_D(f) Higher rates of Alcohol attributable hospitalisations of Aboriginal and/or Torres Strait Islander people Centre for Epidemiology and Evidence, 2016. Health Statistics New South Wales: Current smoking by Primary Health Network, persons aged 16 years and over, NSW 2002 to 2016 [Online] Available at: http://www.healthstats.nsw.gov.au/indicator/beh_smo_age/beh_smo_phn [Accessed September 2017]. The rate of hospitalisations attributed to smoking amongst Northern NSW Aboriginal residents (1,800 per 100,000 Aboriginal people) is significantly higher than for non-aboriginal residents (550 hospitalisations per 100,000 people). Northern NSW Local Health District, 2015. Northern NSW Integrated Aboriginal Health and Wellbeing Plan 2015-2020 Vol. 2 [Online]. Available at: http://nnswlhd.health.nsw.gov.au/blog/2015/07/30/northern-nsw-integrated-aboriginal-healthwellbeing-plan-2015-2020/ [Accessed September 2017]. In 2015, 45.8% of Aboriginal mothers on the North Coast smoked during their pregnancy. This is higher than the NSW rate for Aboriginal mothers at 45% and much higher than the rate of non-aboriginal mothers at 12.2%. Centre for Epidemiology and Evidence, 2016. Health Statistics New South Wales: Smoking in pregnancy [Online] Available at: http://www.healthstats.nsw.gov.au/indicator/mab_smo_cat/mab_smo_cat_atsi_phn_snap [Accessed November 2017]. Alcohol attributable hospitalisations were 12% higher in Northern NSW (737 admissions per 100,000 people in 2010/11) compared to the NSW average (655 admissions per 100,000 people). In 2011/12 Aboriginal residents of Northern NSW were 3.1 times more likely than non-aboriginal residents to have an alcohol attributed hospitalisation. From 1998/99 to 2011/12 alcohol attributable hospitalisations in both non-aboriginal and Aboriginal residents in Northern NSW increased by around 60%. This steady increase over time in Northern NSW is more than double the increase in alcohol-attributable hospitalisations compared to all NSW for the same time period. Northern NSW Local Health District, 2015. Northern NSW Integrated Aboriginal Health and Wellbeing Plan 2015-2020 Vol. 2 [Online]. Available at: http://nnswlhd.health.nsw.gov.au/blog/2015/07/30/northern-nsw-integrated-aboriginal-healthwellbeing-plan-2015-2020/ [Accessed September 2017]. Page 10

Indigenous Australians are more likely to abstain from drinking alcohol than non-indigenous Australians (28% compared with 22% respectively). However, among those who did drink, a higher proportion of Indigenous Australians drank at risky levels. Australian Institute of Health and Welfare 2014. National Drug Strategy Household Survey detailed report, 2013. Drug statistics series no. 28. Cat. No. PHE 183. Canberra: AIHW. Aboriginal Health ABH_D(f) continued Higher rates of Alcohol attributable hospitalisations of Aboriginal and/or Torres Strait Islander people In 2014, the percentage of Aboriginal adults in NSW who consumed more than two standard drinks on a day when consuming alcohol (44.1%) was significantly higher than the 2014 NSW average (29.8%). Centre for Epidemiology and Evidence, 2016. Health Statistics New South Wales: Alcohol drinking in Adults [Online] Available at: http://www.healthstats.nsw.gov.au/indicator/beh_alc_age/beh_alc_atsi [Accessed September 2017]. In 2014-15, the rate of alcohol attributable hospitalisations among Aboriginal people in NSW was 1,390.1 per 100,000 Aboriginal persons, compared to 639.4 per 100,000 people for the non-aboriginal population. As with previous years, rates of hospitalisation for males was much higher than for females. Data is not currently available for this measure at a PHN level. Centre for Epidemiology and Evidence, 2014. Health Statistics New South Wales: Alcohol Attributable Hospitalisations by Aboriginality. [Online] Available at: http://www.healthstats.nsw.gov.au/indicator/beh_alcafhos/beh_alcafhos_atsi_trend [Accessed September 2017]. ABH_D(g) Higher rates of hospital admission of Aboriginal and/or Torres Strait Islander people Data cannot be published. (Mid North Coast Local Health District, 2016. Restricted data request). Page 11

From 2001/02 to 2010/11 there was a 23% increase in hospital admissions for Northern NSW non-aboriginal residents while the increase for Northern NSW Aboriginal residents was substantially larger at 38%. The increase in Aboriginal admissions during this 10 year period was primarily driven by a threefold increase in admissions amongst males (200% increase) while admissions for Aboriginal females decreased by 14%. Aboriginal Health ABH_D(g) continued Higher rates of hospital admission of Aboriginal and/or Torres Strait Islander people Northern NSW Local Health District, 2015. Northern NSW Integrated Aboriginal Health and Wellbeing Plan 2015-2020 Vol. 2 [Online]. Available at: http://nnswlhd.health.nsw.gov.au/blog/2015/07/30/northern-nsw-integrated-aboriginal-healthwellbeing-plan-2015-2020/ [Accessed January 2016]. The rate of hospitalisation of non-aboriginal people was 33,758.1 per 100,000 persons in Northern NSW and 36,673.5 in Mid North Coast, less than half the rate that Aboriginal and Torres Strait Islander people were hospitalised in the NCPHN region (90,474.6). Centre for Epidemiology and Evidence, 2016. Health Statistics New South Wales: Hospitalisations by Aboriginality and Primary Health Network, All causes [Online]. Available at: http://www.healthstats.nsw.gov.au/indicator/bod_hos_cat/atsi_hos_phn_cat_comparison [Accessed September 2017]. Page 12

Rates of potentially preventable hospitalisations for all types of conditions are higher on the North Coast (2,567.1 per 100,000 persons) compared to the NSW rate (2,126.3). When the data is examined for Aboriginal and non-aboriginal people, it is evident that Aboriginal people living in Northern NSW have a rate of hospitalisation for all conditions (7,067.4 per 100,000 Aboriginal persons) and on the Mid North Coast (6854.8) that is significantly higher than the rate for Aboriginal people living in NSW (5,223.8). Department of Health, 2016. Potentially preventable hospitalisations by Aboriginality and Local Health District. [Online] Available at: http://www.healthstats.nsw.gov.au/indicator/bod_acshos/atsi_acshos_lhn_snap [Accessed September 2017]. Aboriginal Health ABH_D(h) Higher rates of potentially preventable hospitalisations of Aboriginal and/or Torres Strait Islander people Rates of potentially preventable hospitalisations for chronic conditions are higher on the North Coast (1,070.1 per 100,000 persons) compared to the NSW rate (922.3). When the data is examined for Aboriginal and non-aboriginal people, it is evident that Aboriginal people living on the Mid North Coast have a rate of hospitalisation for chronic conditions (4,605.9 per 100,000 Aboriginal persons) that is significantly higher than the rate of Northern NSW (3474.6)and NSW for Aboriginal people (2,767.5). Department of Health, 2016. Potentially preventable hospitalisations by Aboriginality and Local Health District. [Online] Available at: http://www.healthstats.nsw.gov.au/indicator/bod_acshos/atsi_acshos_lhn_snap [Accessed September 2017]. Rates of potentially preventable hospitalisations for acute conditions are higher on the North Coast (1,316.5 per 100,000 persons) compared to the NSW rate (1,072.1). When the data is examined for Aboriginal and non-aboriginal people, it is evident that Aboriginal people living in Northern NSW have a rate of hospitalisation for acute conditions (3,293.7 per 100,000 Aboriginal persons) that is significantly higher than the rate of Mid North Coast (2,036.2)and NSW for Aboriginal people (2,169.1). ABH_D(i) Higher rate of hospitalisation of Aboriginal and/or Torres Strait Islander people attributed to high body mass Department of Health, 2016. Potentially preventable hospitalisations by Aboriginality and Local Health District. [Online] Available at: http://www.healthstats.nsw.gov.au/indicator/bod_acshos/atsi_acshos_lhn_snap [Accessed September 2017]. The rate of hospitalisations attributed to high body mass amongst Northern NSW Aboriginal residents is significantly higher than for non-aboriginal residents. In 2011/12 the rate of hospitalisations for Aboriginal people was 1,075 per 100,000 people, 2.8 times higher than the rate for Northern NSW non-aboriginal people. (Northern NSW Local Health District, 2015. Northern NSW Integrated Aboriginal Health and Wellbeing Plan 2015-2020 Vol. 2 [Online]. Available at: http://nnswlhd.health.nsw.gov.au/blog/2015/07/30/ northern-nsw-integrated-aboriginal-healthwellbeing-plan-2015-2020/ [Accessed September 2017]). Page 13

Aboriginal Health ABH_D(j) Higher rates of chronicdisease-related dialysis hospital admissions of Aboriginal and/or Torres Strait Islander people ABH_D(k) Higher rates of chronicdisease-related diabetes hospital admissions of Aboriginal and/or Torres Strait Islander people In 2015-16, rates of dialysis among Aboriginal and/or Torres Strait Islander people living across the NCPHN region are significantly higher than rates of dialysis among both Aboriginal NSW residents and are over 8 times the rate recorded for non- Aboriginal people. The region with the highest rate of dialysis among Aboriginal people is Mid North Coast with a rate of 47,733.9 hospitalisations per 100,000 Aboriginal people. The Northern NSW region had a rate of 41,284.5 hospitalisations per 100,000 Aboriginal people. In comparison, the rate of dialysis hospitalisation among non-aboriginal people in the NCPHN region (4,004.7 per 100,000 persons) is slightly lower than the state average of 4,050.2 dialysis hospitalisations per 100,000 people. Centre for Epidemiology and Evidence, 2016. Health Statistics New South Wales: Hospitalisations for Dialysis by Aboriginality, by LHD [Online] Available at: http://www.healthstats.nsw.gov.au/indicator/bod_hos_cat/atsi_hos_lhn_cat [Accessed September 2017]. In Northern NSW in 2011/12, hospitalisation rates for diabetes were 472 per 100,000 for Aboriginal people and 120 per 100,000 for non-aboriginal people, nearly a fourfold difference. Northern NSW Local Health District, 2015. Northern NSW Integrated Aboriginal Health and Wellbeing Plan 2015-2020 Vol. 2 [Online]. Available at: http://nnswlhd.health.nsw.gov.au /blog/2015/07/30/northern-nsw-integrated-aboriginal-healthwellbeing-plan-2015-2020/ [Accessed September 2017]. Over the past 10 years there has been a significant increase in hospitalisation rates for diabetes for Aboriginal people, from 591 per 100,000 people in 2001/02, to 936 per 100,000 people in 2009/10. There has been no significant change in the difference in rates between Aboriginal and non-aboriginal people between 2001/02 and 2009/10. Northern NSW Local Health District, 2015. Northern NSW Integrated Aboriginal Health and Wellbeing Plan 2015-2020 Vol. 2 [Online]. Available at: http://nnswlhd.health.nsw.gov.au /blog/2015/07/30/northern-nsw-integrated-aboriginal-healthwellbeing-plan-2015-2020/ [Accessed September 2017]. 44.8% of Aboriginal respondents reported diabetes as one of the top 5 serious health concerns in their community (n=306), compared to 15.2% of non-aboriginal respondents (n=2,083). North Coast Primary Health Network, 2016. Primary Health s Survey, unpublished. Page 14

Aboriginal Health ABH_D(l) Higher rates of respiratory hospital admissions of Aboriginal and/or Torres Strait Islander people ABH_D(m) Higher rates of cardiovascular diseaserelated hospital admissions of Aboriginal and/or Torres Strait Islander people ABH_D(n) Higher rates of circulatory disease hospital admissions of Aboriginal and/or Torres Strait Islander people The rate of hospitalisation for respiratory problems for Aboriginal and Torres Strait Islander people in 2015-16 in Northern NSW was 4,340.1 per 100,000 people and 4,631.3 in Mid North Coast per 100,000 people. These rates are much higher than the NSW rate for Aboriginal and Torres Strait Islander people of 3,770.9 per 100,000 people. Centre for Epidemiology and Evidence, 2016. Health Statistics New South Wales: Hospitalisations by Aboriginality and Primary Health Network, Respiratory diseases [Online]. Available at: http://www.healthstats.nsw.gov.au/indicator/bod_hos_cat/atsi_hos_phn_cat_comparison [Accessed September 2017]. In 2011/12 the rate of hospitalisations for cardiovascular disease in Northern NSW was 3,312 per 100,000 Aboriginal people and 1,637 per 100,000 non-aboriginal people. The difference is significant, with Aboriginal people twice as likely to be hospitalised for cardiovascular disease in Northern NSW. Northern NSW Local Health District, 2015. Northern NSW Integrated Aboriginal Health and Wellbeing Plan 2015-2020 Vol. 2 [Online]. Available at: http://nnswlhd.health.nsw.gov.au/blog/2015/07/30/ northern-nsw-integrated-aboriginal-healthwellbeing-plan-2015-2020/ [Accessed September 2017]. In 2015/16, the rate of hospitalisation for circulatory diseases was higher for Aboriginal people in the NCPHN region (3,705.8 per 100,000 Aboriginal persons) compared to the rate for NSW Aboriginal persons (2,900.0). When the data is examined at an LHD level, it is evident that Northern NSW has a higher rate (3,890.7) compared to the Mid North Coast (3,499.2). Centre for Epidemiology and Evidence, 2016. Health Statistics New South Wales: Hospitalisations for Circulatory Diseases by Aboriginality and [Online] Available at: http://www.healthstats.nsw.gov.au/indicator/bod_hos_cat/atsi_hos_lhn_cat [Accessed September 2017]. ABH_D(o) Higher rates of hospitalisations of Aboriginal and/or Torres Strait Islander people for infectious diseases The rate of hospitalisation for infectious disease for Aboriginal and Torres Strait Islander people in 2015-16 in Northern NSW was 1,235.1 and 733.9 in Mid North Coast per 100,000 Aboriginal persons. In comparison, the rate of hospitalisation for non- Aboriginal people was 665.8 in Northern NSW and 495.6 in Mid North Coast per 100,000 people. Centre for Epidemiology and Evidence, 2016. Health Statistics New South Wales: Hospitalisations for Infectious Diseases by Aboriginality and LHD [Online] Available at: http://www.healthstats.nsw.gov.au/indicator/bod_hos_cat/atsi_hos_lhn_cat [Accessed September 2017]. Page 15

Aboriginal Health Health of Older Persons ABH_D(p) Higher rates of hospitalisations of Aboriginal and/or Torres Strait Islander people for injury and poisoning ABH_D(q) Higher rates of hospitalisations of Aboriginal and/or Torres Strait Islander people for skin diseases ABH_D(r) Higher rates of infant mortality AC_D(a) High proportion of older people In 2015-16, rates of injury and poisoning hospitalisations among Aboriginal people in Northern NSW were much higher at 5,317.0 per 100,000 people than the rate across both the Mid North Coast (4,261.5 per 100,000 people); and the State rate for Aboriginal people which is reported as 4,239.5 per 100,000 Aboriginal people. While rates of hospitalisation for injury and poisoning among non-aboriginal people were much lower, they were again highest in Northern NSW (3,309.0 per 100,000 people) compared to the state average of 2,452.5 per 100,000 people. Centre for Epidemiology and Evidence, 2016. Health Statistics New South Wales: Hospitalisations for injury and poisoning by Aboriginality and LHD [Online] Available at: http://www.healthstats.nsw.gov.au/indicator/bod_hos_cat/atsi_hos_lhn_cat [Accessed September 2017]. In 2015-16, rates of skin disease hospitalisations among Aboriginal people in Northern NSW (1,331.9 per 100,000 people) and in the Mid North Coast (1,168.3) are much higher than the state average (986.8 per 100,000 Aboriginal people). These rates are much higher for Aboriginal people on the North Coast NSW, compared to the rates for non-aboriginal people in Northern NSW (660.0) and on the Mid North Coast (553.0 per 100,000 non-aboriginal people). Centre for Epidemiology and Evidence, 2016. Health Statistics New South Wales: Hospitalisations for skin diseases by Aboriginality and [Online] Available at: http://www. healthstats.nsw.gov.au/indicator/bod_hos_cat/atsi_hos_lhn_cat [Accessed September 2017]. Whilst the infant mortality rate for Aboriginal babies is not available aggregated at a local level, the rate across NSW is higher for Aboriginal infant mortality at 4.4 deaths per 1,000 compared to 3.4 for non-aboriginal infants. Across the NCPHN region, the rate of infant mortality (for all babies) across the NNSWLHD was 5.5 deaths per 1,000 births, and across the MNCLHD was 5.6 deaths per 1,000 births. The rate for both regions was therefore higher than the NSW rate of 4.0 deaths per 1,000. Centre for Epidemiology and Evidence, 2016. Health Statistics New South Wales: Infant mortality. [Online] Available at: http://www.healthstats.nsw.gov.au/indicator/bod_infdth/bod_infdth_atsi_trend [Accessed November 2017]. More than 22% of the NCPHN region s population is aged 65 years or over, compared to around 16% in NSW and 15% in Australia. Australian Bureau of Statistics, 2011. Census of Population and Housing: Quickstats. [Online] Available at: http://www.abs.gov.au/ [Accessed September 2017]. Page 16

Out of the 94 state electoral districts in the state of NSW, the NCPHN region has three of the top five for estimated dementia prevalence in 2016: Tweed, Oxley (Coffs Harbour) and Port Macquarie. Tweed has the highest prevalence of dementia in NSW with an estimated 1,842 individuals living with dementia. Alzheimer s Australia and Deloitte Access Economics, 2014. Dementia Prevalence in NSW by SED: Ranking SED by 2016 Prevalence. Data Request. [Accessed March 2016]. When projected rates of dementia are mapped for the period 2011-2050, the regions of Tweed, Ballina, Clarence, Oxley (Coffs Harbour), and Port Macquarie are expected to grow between 97% and 122%. Health of Older Persons AC_D(b) Higher rates, prevalence and impact from dementia Alzheimer s Australia, 2016. Dementia Prevalence in New South Wales by State Electoral Division, Data Request. [Obtained 4 March 2016]. In 2013-14, the North Coast PHN region recorded a rate of mental health overnight hospitalisations for dementia at 47 hospitalisations per 100,000 persons compared to the national rate of 45. When compared with other regional Primary Health Networks, the North Coast rate of 47 per 100,000 persons was higher than the regional rate of 42 hospitalisations per 100,000 persons. Australian Institute for Health and Welfare, 2016. Healthy Communities: Hospitalisations for mental health conditions and intentional self-harm in 2013 14 [Online] Available at: http://myhealthycommunities.gov.au/our-reports/mental-health-andintentional-self-harm/september-2016/explore-the-data [Accessed September 2017]. In 2013-14, the North Coast PHN region recorded a rate of bed days for mental health overnight hospitalisations for dementia at 474 bed days per 100,000 persons compared to the national rate of 765 bed days. When compared with other regional Primary Health Networks, the North Coast rate of 474 bed days per 100,000 persons was much lower than the regional rate of 658 bed days for dementia hospitalisations per 100,000 persons. Australian Institute for Health and Welfare, 2016. Healthy Communities: Hospitalisations for mental health conditions and intentional self-harm in 2013 14 [Online] Available at: http://myhealthycommunities.gov.au/our-reports/mental-health-andintentional-self-harm/september-2016/explore-the-data [Accessed September 201]. Page 17

In 2013-14, the North Coast PHN region recorded a rate of non-specialised care hospitalisations for dementia at 45 hospitalisations per 100,000 persons compared to the national rate of 39. When compared with other regional Primary Health Networks, the North Coast rate of 45 per 100,000 persons was higher than the regional rate of 38 hospitalisations per 100,000 persons. Australian Institute for Health and Welfare, 2016. Healthy Communities: Hospitalisations for mental health conditions and intentional self-harm in 2013 14 [Online] Available at: http://myhealthycommunities.gov.au/our-reports/mental-health-andintentional-self-harm/september-2016/explore-the-data [Accessed September 2017]. Health of Older Persons AC_D(b) continued Higher rates of dementia When the 2013-14 data for mental health overnight hospitalisations for dementia is presented by Statistical Area Level 3 (SA3), it is evident that the regions of Port Macquarie (73 hospitalisations per 100,000 persons) and Kempsey-Nambucca (65 per 100,000) had the highest rates on the North Coast. Australian Institute for Health and Welfare, 2016. Healthy Communities: Hospitalisations for mental health conditions and intentional self-harm in 2013 14 [Online] Available at: http://myhealthycommunities.gov.au/our-reports/mental-health-andintentional-self-harm/september-2016/explore-the-data [Accessed September 2017]. Whilst Port Macquarie (73 per 100,000) and Kempsey-Nambucca (65 per 100,000) regions have higher than the national rate of hospitalisations (45 per 100,000 people) for dementia, all areas within the NCPHN region have lower than the national number of bed days per 100,000 people for dementia. Australian Institute for Health and Welfare, 2016. Healthy Communities: Hospitalisations for mental health conditions and intentional self-harm in 2013 14 [Online] Available at: http://myhealthycommunities.gov.au/our-reports/mental-health-andintentional-self-harm/september-2016/explore-the-data [Accessed September 2017]. In 2014-16 four of the 12 LGAs in the NCPHN region had significantly higher rates of dementia hospitalisations for persons aged 65 and over than the NSW rate of 1,711.0: Nambucca (3,065.6), Bellingen (2,862.5), Coffs Harbour (2,420.5) & Tweed (2,248.6). Centre for Epidemiology and Evidence, 2017. Dementia Hospitalisations. [Online] Available at: http://www.healthstats.nsw.gov.au/indicator/bod_dementhos/bod_dementhos_lgamap. [Accessed October 2017] Page 18

AC_D(c) Community concern about family violence among older persons 44.2% of community survey respondents aged 65+ reported family violence as one of the most serious health concerns in their local community (n=457). North Coast Primary Health Network, 2016. Primary Health s Survey, unpublished. The rate of hospitalisation of persons aged 75 years and older for coronary heart disease on the North Coast (3,203.5 per 100,000 older persons) is slightly higher than the NSW rate (3,075.2). When this data is examined by Local Health District (LHD), the Mid North Coast has a higher rate (3,440.9) than both the Northern NSW LHD (3,013.9) and the NSW rate (3,075.2). Over the past five years, there has been a gradual decline in the hospitalisation rate at both a State and local level for this age group. Health of Older Persons AC_D(d) Higher rates of chronic disease among older persons Centre for Epidemiology and Evidence, 2016. Health Statistics New South Wales: Coronary heart disease hospitalisations by age. [Online] Available at: http://www.healthstats.nsw.gov.au/indicator/cvd_chdhos/cvd_chdhos_lgamap [Accessed September 2017]. In 2015-16 the rate of hospitalisations for females aged 75+years in the NNSW LHD region (1392.5) per 100,000 population was higher than the NSW rate (1,089.9). The rate of hospitalisations for all persons aged 75+ in NNSW LHD Region (1,412.6) was higher than the NSW rate (1,262.2). Centre for Epidemiology and Evidence, 2017. Stroke hospitalisations. [Online] Available at: http://www.healthstats.nsw.gov.au/indicator/cvd_strhos/cvd_strhos_lhn_snap. [Accessed October 2017]" When 2015-16 hospitalisation data for Chronic Obstructive Pulmonary Disease (COPD) is examined among those aged 65 years and over, it is evident that the North Coast rate at 1,737.5 per 100,000 older persons is higher than the NSW rate of 1,462.0. When the data is further examined at an LHD level, it is specifically the Mid North Coast rate of 1,911.2 that is driving this rate. When the data trend is examined for the period 2001-02 to 2015-16, it is evident that the Mid North Coast rate overtook the NSW rate in 2007-08 and has been consistently higher since then. Centre for Epidemiology and Evidence, 2016. Health Statistics New South Wales: Chronic obstructive pulmonary disease hospitalisations by age. [Online] Available at: http://www.healthstats.nsw.gov.au/indicator/res_copdhos/res_copdhos_lhn_snap [Accessed September 2016]. Page 19

Health of Older Persons AC_D(e) Higher rates of fall-related injury hospitalisations for people 65+ years PH_D(a) Higher rates of fair or poor self-assessed health PH_D(b) Higher rates of hospitalisation In 2015-16 the rate per 100,000 population of fall related injury hospitalisations for people aged 65 + years was higher in NNSW (3,188.1) and NCPHN (3,035.0) than the NSW rate of 2,995.1. Centre for Epidemiology and Evidence, 2017. Fall related injury hospitalisations. [Online] Available at: http://www.healthstats.nsw.gov.au/indicator/inj_falloldhos/inj_falloldhos_lhn_snap. [Accessed October 2017] The NCPHN region has a higher proportion of adults with fair or poor self-assessed health at (16.4%). At an LGA level, it becomes clear that the regions of Kyogle (20.5%), Kempsey (19.1%), Tenterfield (19.2%), Richmond Valley (18.7%), Clarence Valley (17.6%), Nambucca (17.6%), Bellingen (17.3%), Tweed (16.5%), Lismore (16.2%), Coffs Harbour (16.1%),and Port Macquarie-Hastings (15.4%) have higher proportions of fair or poor self-assessed health, compared to both the state (14.3%) and national (14.8%) figures. Public Health Information Development Unit (PHIDU), 2016. Social Health Atlases of Australia: Local Government Areas. [Online] Available at: http://phidu.torrens.edu.au/social-health-atlases/data#social-health-atlas-of-australia-primary-healthnetworks [Accessed September 2017]). The rate of hospitalisation for all causes is higher in the NCPHN region, compared to the NSW rate. When rates are examined at an LGA level, it is evident that 9 of the 12 LGAs in the NCPHN footprint recorded a rate higher than the NSW rate of 35,043 per 100,000 persons, including (in order from the highest rate): Kempsey; Richmond Valley; Clarence Valley; Lismore; Coffs Harbour; Port Macquarie; Ballina; Kyogle and Nambucca. Centre for Epidemiology and Evidence, 2016. Health Statistics New South Wales: Hospitalisations for all causes. [Online] Available at: http://www.healthstats.nsw.gov.au/indicator/bod_projhos/bod_hos_lgamap [Accessed September 2017]. In 2015-16, 14.4% of adults from the NCPHN region were admitted to any hospital in the preceding 12 months, which was higher than the Australian rate of 12.7%. Australian Institute of Health and Welfare, 2017. Patient experiences in Australia. [Online] Available at: https://www.myhealthycommunities.gov.au/our-reports/australians-experiences-with-primary-health-care-updates/june- 2017 [Accessed October 2017]. Page 20

PH_D(c) Higher rates of potentially preventable hospitalisations PH_D(d) Higher rates of potentially avoidable deaths PH_D(e) Higher rates of socioeconomic disadvantage and low rates of education attainment across NCPHN region Of the 12 LGAs that make up the NCPHN footprint, nine LGAs recorded a rate of potentially preventable hospitalisations that were significantly higher than the State average, including: Ballina, Clarence Valley, Coffs Harbour, Kempsey, Kyogle, Lismore, Nambucca, Richmond Valley and Tweed. The highest rates overall were evident in the LGAs of Richmond Valley (3,143.5 per 100,000 persons), Kempsey (3,117.3) and Kyogle (3,038.8), compared to the NSW rate of 2,126.3 per 100,000 persons. Centre for Epidemiology and Evidence, 2016. Health Statistics New South Wales: Hospitalisations for all causes. [Online] Available at: http://www.healthstats.nsw.gov.au/indicator/bod_acshos/bod_acshos_lhn_snap [Accessed September 2017]. NCPHN has the second highest rate (131.4) per 100,000 of potentially avoidable deaths for people aged under 75 years in NSW (105.9). The LGA of Kempsey (138) is significantly higher than the NSW rate (105.9). Centre for Epidemiology and Evidence, 2017. Potentially avoidable deaths. [Online] Available at: http://www.healthstats.nsw.gov.au/indicator/bod_avodth/bod_avodth_phn_trend. [Accessed October 2017]. The Socio-Economic Indexes for Areas (SEIFA) score of disadvantage ranks Australian communities level of disadvantage compared to one another. With a national median score of 1000, communities with a score greater than 1000 are considered more advantaged than communities with a score less than 1000. When the SEIFA Disadvantage score of the 12 Local Government Areas that make up the NCPHN region are examined, it is evident that our region is more socio-economically disadvantaged than the National median, with scores in our region ranging from 880 in Kempsey to 989 in Ballina. Public Health Information Development Unit (PHIDU), 2016. Social Health Atlases of Australia: Local Government Areas. [Online] Available at: http://phidu.torrens.edu.au/social-health-atlases/data#social-health-atlas-of-australia-primary-healthnetworks [Accessed September 2017]. All NCPHN LGAs except Byron scored below the state average of 1,000 on the Index of Education and Occupation, with Clarence Valley, Kempsey, Nambucca and Richmond Valleys falling significantly below the NSW average, implying there may be low levels of literacy across the region. Australian Bureau of Statistics, 2017. Census of Population and Housing: Socio-Economic Indexes for Areas (SEIFA), Australia, 2011. [Online] Available at: http://www.abs.gov.au/ausstats/abs@.nsf/detailspage/2033.0.55.0012011?opendocument. [Accessed September 2017]. Page 21

Population Health PH_D(f) Low levels of health literacy The latest available data show that 41% of Australians aged 15 74 had a level of health literacy that was considered to be adequate or above (adequate). People living in more disadvantaged areas and areas outside major cities, and people with poorer self-assessed health status, were more likely to have lower health literacy. Australian Institute for Health and Welfare, 2012. Australia's Health 2012 [Online] Available at: http://www.aihw.gov.au/publication-detail/?id=10737422172&tab=3 [Accessed September 2017]. Page 22

To date, evidence around the level of health literacy among community members has not been aggregated at a local level. The following national research indicates how socio-demographic factors impact on an individual s level of health literacy. Consistent with other literacy domains (prose and document literacy, numeracy and problem solving), health literacy generally increased from the 15 to 19 years age group up to the 35 to 39 years age group, and then generally decreased for those aged 40 years and over. Ageing causes physical, psychological and social change, and dependence on health care services and personal health care often increases. In such circumstances, the ability to effectively care for oneself, interact and communicate with health services, requires a reasonable level of health literacy 83% of those aged 65 to 74 years did not achieve Level 3 or above on the health literacy scale. It is important to note that the steep decline in the older age groups may also be associated with the lower education levels of these older cohorts, and may not necessarily be associated with a decline in health literacy over time for any individuals... PH_D(f) continued Low levels of health literacy "Both males and females achieved similar levels of health literacy overall, with 40% and 41% respectively achieving skill Level 3 or above. When examined by age, 48% of females aged 15 to 44 years achieved a health literacy of Level 3 or above, compared to 43% of males in the same age group. In contrast, 35% of males aged 45 and over achieved a health literacy Level 3 or above, compared to 32% of females of the same age"... "All literacy domains, including health literacy, were found to have similar relationships with characteristics such as educational participation and attainment. For example, those respondents who had completed a greater number of years of formal education achieved higher literacy scores across all literacy domains. Completing Year 12 is also associated with achieving higher health literacy levels. Among people who had completed Year 12 or equivalent, 58% achieved Level 3 or above, and if a non-school qualification was also completed, 61% achieved Level 3 or above. In comparison, if Year 12 was completed but a non-school qualification was not completed, 50% achieved a health literacy Level 3 or above"... "There were no outstanding differences in skill levels for health literacy between the states and territories of Australia. The exception to this was the Australian Capital Territory, where there were significantly more people at skill Level 3 or above (56%) than other states and territories. The proportions at skill Level 3 or above in the other states and territories ranged from 43% in Western Australia to 37% in the Northern Territory and Tasmania. This is consistent with the findings for the other literacy domains". Australian Bureau of Statistics, 2006. 4233.0 Health Literacy Australia. [Online] Available at:http://abs.gov.au/ausstats/abs@.nsf/detailspage/4233.02006?opendocument [Accessed September 2017]. Page 23