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Prof. Les White - Health Reform & Children: NSW Perspective
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Prof. Les White - Health Reform & Children: NSW Perspective


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A presentation given by Prof. Les White at the CHA 2012 Conference, The Journey.

A presentation given by Prof. Les White at the CHA 2012 Conference, The Journey.

Published in: Health & Medicine

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  • 1. Health Reform and Children: NSW Perspective Prof Les White AM DSc NSW Chief Paediatrician October 2012
  • 2. 2
  • 3. An integrated National Health and Hospitals Network- Organisational elements
  • 4. National Health Reform April 2010 – COAG (not WA) signed the National Health and Hospitals Reform Agreement February 2011 – Commonwealth and all State & Territory Governments agreed to a new Heads of Agreement, providing in principle commitment August 2011 – Release of new Health Reform Agreement, finalising the in-principle Agreement Ch 2: Nurturing a Healthy Start to Life (Recs 22-26)
  • 5. Key Elements of the Health Reform Agreement New funding arrangements: – National Funding Pool – Activity based funding (ABF) from 1 July 2012 – C‟th shares efficient growth costs 50/50 by 2017. New National Performance Standards – including: – Four hour National Access Target for ED – National Access Guarantee for Elective Surgery. National Safety and Quality Standards Medicare Locals (commenced 1 July 2011). Maintaining focus on local management & governance.
  • 6. Role of the States The Agreement confirms the crucial role of the States, as system managers for the public health system, including: – System-wide public hospital service planning and performance – Purchasing of public hospital services – Planning, funding, and delivering capital – Planning, funding (with the Commonwealth) and delivering teaching, research and training
  • 7. New National Bodies • National Hospital Performance Authority - Accountability Performance and Accountability Framework Transparency • National Funding Body Pricing • Independent Hospital Pricing Authority • Australian Commission on Safety and Standards Quality in Healthcare Workforce • Health Workforce Australia Prevention • National Preventative Health Authority
  • 8. National approach to efficient prices Activity based funded (ABF) for public hospital services will flow from the national pool to State accounts and then to LHDs A national system of ABF commenced from 1 July 2012 Funding will flow directly to State Governments for (a) Block funded hospitals services and (b) Teaching, training and research in public hospitals
  • 9. ABF update: August 2012 National Efficient Price Determination - Appendix B; Table 1 (all AP‟s) NWAU = $4,808 / NSW = $4,471 Price weight adjustment hierarchy Education / Information - National; IHPA - NSW: ABF Bulletin Web resources; Resource Kit Roadshow; Discussions National & NSW paediatric agenda Reviews, changes, new DRG version
  • 10. ABF update: August 2012Chapter 5 Adjustments5.2 Precedence of AdjustmentsTo avoid doubt, Adjustments have the following order ofprecedence of application: a) Paediatric Adjustment (55, 25, 20%); then b) any Remoteness Area Adjustment (8.7, 15.3, 19.4%) and/or Indigenous Adjustment; then c) ICU Adjustment (not ICU DRG‟s); then d) Private Patient Service Adjustment; then e) Private Patient Accommodation Adjustment.National Efficient Price Determination 2012-2013
  • 11. Special Commission of InquirySpecial Commission of Inquiry into Acute Care Services in NSW PublicHospitals Extensive consultation: written submissions; hospital visits; evidence from patients, community, clinicians; peak bodies; conferences Final report made 139 recommendations – three refer to NSW Kids – Create a new state-wide authority (R.9) – Coverage - all paediatric inpatient facilities in all hospitals, community activities (prevention, early intervention and ongoing specialist) – Publish a state-wide strategic service delivery plan for child and youth services (R.10) – Investigate the need for a new kids hospital (R.11)
  • 12. Special Commission of Inquiry“It concerns me that in NSW there is currently a lack of coordination ofpaediatric and young person’s health care in public hospitals throughoutthe state.”“.. what is required is a single state-wide authority that provides for thefull range of medical care for children and young people. ..”“Every child in NSW, regardless of where they live and of theircircumstances, should have access to the best health care both incommunity (child health services) and hospital (paediatric services)settings” Peter Garling SC
  • 13. Initial Achievements Sydney Children‟s Hospitals Network (Randwick and Westmead) established Maternity, Child and Young People‟s Health Branch Appointment of a Chief Paediatrician, Senior Clinical Advisor Child Health and Senior Clinical Advisor Child Protection Establishment of the Children and Young Peoples Health Program Council
  • 14. “Children First & Forem“Children First & Foremost”
  • 15. Chief Paediatrician for NSW Advocate for the health and wellbeing of children Clinician leadership; System wide engagement Promote and facilitate the NSW Kids and Families strategy Liaise with Local Health Districts, Specialty Networks, Pillars and MoH branches Engage beyond NSW Health Progress networks across spectrum of children‟s health Rural / remote priorities
  • 16. NSW Public Health System Local Health Districts Specialty Networks: Sydney Children‟s Hospital Network; Forensic Mental Health Network; St Vincent‟s Health Network Four Pillars: Health Education and Training Institute; Agency for Clinical Innovation; Bureau of Health Information; Clinical Excellence Commission MH Commission; NSW Cancer Institute Other Public Health Organisations: Justice Health; Ambulance; Health Support Services; Health Infrastructure; eHealth NSW NSW Ministry of Health (Governance Review)
  • 17. Local Health Districts (7 Rural & Regional)
  • 18. Local Health Districts (8 Metro)
  • 19. NSW Child Health Network Coverage
  • 20. Comprehensive Model of Child “Acute” and other Health & Wellbeing hospital care Child protection needs Developmental needs Level5/6 Level 4and Level 1-3 Population: universal and 10 healthcare
  • 21. Establishing a new authority for NSW children, youngpeople and their families Future Governance Arrangements for Children and NSW Kids Young Peoples Expert Group Health Services established NSW report released and NSW Kids and Child Health Network Families Forum announcement announced Garling recommendations
  • 22. Minister announces commitment to a statewide approach tothe health and wellbeing of children On 22 July 2011 The Hon Jillian Skinner MP Minister for Health and Minister for Medical Research opened the NSW Child Health Network Forum (Sydney) by emphasising the need for safe and appropriate care of children in all situations The Minister asked the Director-General and the Ministry of Health to devise a NSW Kids Plan, which is closer to the intent of the Garling Recommendations. “NSW needs a long term system wide approach to the delivery of child and young people‟s health services and paediatric care.” (The Hon Jillian Skinner MP 20 August 2011)
  • 23. Expert Group• Appointed by Director-General, Ministry of Health in September 2011• Established to review progress on implementation of the Garling recommendations, and advise the Minister and Director-General on a „preferred governance structure and other elements required for the effective delivery of a strategy for children and young person‟s health services throughout the state‟• Targeted consultation with key stakeholders, building on previous consultation• Considered a range of models and their applicability in new NSW Health Governance• The Expert Group Report made a range of recommendations, including a Board governed statutory health corporation structure• The Minister for Health accepted all of the Expert Group recommendations, endorsed by NSW Cabinet• The Report can be viewed at
  • 24. Establishment of NSW Kids and Families announced NSW Kids and Families, a new statutory health corporation, to be established under the Health Services Act 1997 and to commence on 1 July 2012 Champion the health interests of children and young people whether they are at home, in the community or in or out of hospital Includes health services for mothers & babies, children, young people, parents and families NSW Kids and Families will have a Board chaired by The Hon Ron Phillips and have the following members: Clinical Professor David Bennett AO, Ms Ann Brassil, Mrs Christine Corby OAM, Dr Susie Piper, Professor Graham Vimpani AM and Emeritus Professor William Walters AM. Standing invitees: Dr Christine Bennett (SCHN) and Prof Les White AM (Chief Paed)
  • 25. Relationship to NSW Health Governance Including Sydney Children’s Hospitals Network (Randwick and Westmead)
  • 26. NSW Kids & Families CE appointed; staff to be drawn from MCYH Branch and 3 other Organisational structure finalised – 4 teams: Maternity and Child Health; Paediatric Health Care; Youth Health and Wellbeing; and Child Protection and Violence Prevention / Response Work plan and immediate priorities will be determined – mid November onwards Consultation on longer term strategic direction during 2012-2013; coherence with broader State and NSW Health Plans Interface with: Pillars, LHD‟s, SCHN, Medicare Locals, Ministry, Government agencies, will be critical to INFLUENCE outcomes Longitudinal and system-wide perspectives
  • 27. NSW KIDS AND FAMILIESPurpose Statement (second draft following staff feedback)PURPOSENSW Kids and Families will champion world class health outcomesand services for children and families of NSW through consultation,evaluation, innovation and the development of shared knowledge.ROLETo provide leadership to the NSW Health system on strategieswhich deliver outstanding child and family healthcare services andgive every child the best chance of fulfilling their potential as citizensof NSW.
  • 28. NSW KIDS AND FAMILIESPurpose Statement (2nd draft following staff feedback)WHO: Brings together expertise and resources from within NSW Health to focus knowledge, effort and action for the health benefit of families and health care provision located in NSWHOW: By working collaboratively with the Ministry and agencies within NSW health, other government departments, primary health care providers, non-government organisations, communities and families to develop evidence based practice in service of LHDs, Sydney Children‟s Hospitals Network and other providers responsible for delivering health care services to children and their families
  • 29. NSW KIDS AND FAMILIESPurpose Statement (2nd draft following staff feedback)WHAT: Develop and support the implementation of evidence- based policies, guidelines and practices that reduce risk and improve the quality and continuity of healthcare delivery Reduce the prevalence and health impact of violence and neglect on individuals, families and the communities in which they live Stimulate applied research and support uptake of new programs and innovative models of health care delivery Design and monitor service standards and evaluate impact on health outcomes Build the capacity of healthcare workers, communities, parents and carers to promote and protect the health and wellbeing of mothers, babies, children and young people Provide expert advice in relation to the health, wellbeing and healthcare of mothers, babies, children, young people and their families