SWSML_PopHNA.pdf - ` Population Health Needs Assessment for the Communities of South Western Sydney and the Southern Highlands November 2014 This report

SWSML_PopHNA.pdf - ` Population Health Needs Assessment for...

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Unformatted text preview: ` Population Health Needs Assessment for the Communities of South Western Sydney and the Southern Highlands November 2014 This report was developed by South Western Sydney Medicare Local and the Planning Unit of South Western Sydney Local Health District. Wide distribution of this Plan is encouraged. It may be reproduced in whole or part for study or training purposes subject to inclusion of an acknowledgement of source. It may not be reproduced for commercial usage or sale. Photocopies may be made without permission; however, any reference made to information contained within this Plan must be done so with acknowledgment to the South Western Sydney Medicare Local. ISBN: 978‐0‐646‐94128‐8 Information about the status of data included within this report is available from: South Western Sydney Medicare Local Telephone: 1300 179 765 Facsimile: (02) 4625 9466 South Western Sydney Local Health District Planning Unit 8738 5755 Population Health Needs Assessment for the Communities of South Western Sydney and the Southern Highlands Foreword It has been just over 12 months since the release of the Population Health Needs Assessment for the Communities of South Western Sydney – Initial Report, and significant progress has been made. Recognizing the striking diversity of South Western Sydney, we’ve strengthened our engagement with population groups whose particular needs may not have been fully explored during our first round of consultation. To this end, we actively sought to engage the people and service providers among the Aboriginal community, culturally and linguistically diverse communities, young people, aged people and people living with severe and persistent mental illnesses. Throughout this process, I have been encouraged by the honest and constructive reflections that our communities have shared with us about the state of health in South Western Sydney. I have found people from all walks of life to be very generous with their time and experience, and it is because of this that our needs assessment work is possible. It is feedback like this that strengthens our resolve to actively address the needs of our diverse area. You may notice some significant changes from this version to the last. As a result of community feedback we have added to our initial 10 priority areas, Aboriginal Health, Aged Care and Culturally and Linguistically Diverse communities. We’ve also utilised this time to further refine our strategies for addressing the now 13 priority areas. This involved an extensive literature review and consultation with field experts and the community. In each case, the aim is to ensure that we drive quality interventions supported by evidence to optimise possible benefit to the community. I would like to extend my sincere gratitude to the executive and staff of the South Western Sydney Local Health District (SWSLHD) for all of their support. In particular, the contributions of the SWSLHD’s Planning Unit, who partnered with us to jointly develop our needs assessment. Without their support and expertise, this product would not have been possible. During this process, the Australian Government has undertaken significant review of the health sector. One subsequent outcome is the decision to lapse funding to Medicare Locals and redirect this to contracts for larger Primary Health Networks. Despite these announcements, we still felt it important to deliver a high quality needs assessment with a long-term perspective. This will allow all our stakeholders, including the Primary Health Network that will service South Western Sydney, to use and effectively apply this resource and meet the needs of the local community. We therefore trust that this work is our legacy in making a tangible contribution to the health landscape of South Western Sydney and extend a heartfelt thank you to all involved. “It is good to have an end to journey toward; but it is the journey that matters, in the end.” - Ernest Hemingway Regards, Dr Matthew Gray Chair, South Western Sydney Medicare Local Population Health Needs Assessment for the Communities of South Western Sydney and the Southern Highlands Table of Contents Executive Summary .............................................................................................................................. 5 1. Background ................................................................................................................................. 8 2. The Region ................................................................................................................................ 13 3. South Western Sydney Communities ..................................................................................... 15 4. The Health of Local Communities ........................................................................................... 21 5. Priority Populations .................................................................................................................. 31 6. Health Care Services ................................................................................................................ 45 7. Factors Affecting Health Care ................................................................................................. 55 8. Directions to Improve the Health of Local Communities...................................................... 67 Priority Area 1 Mental Health ............................................................................................. 68 Priority Area 2 Overweight and Obesity ........................................................................... 69 Priority Area 3 Tobacco Control ........................................................................................ 69 Priority Area 4 Chronic Disease: Diabetes and Cardiovascular Disease ................... 70 Priority Area 5 Cancer ........................................................................................................ 71 Priority Area 6 Pregnancy and the Early Years .............................................................. 72 Priority Area 7 Strengthen Prevention .............................................................................. 73 Priority Area 8 Advocacy .................................................................................................... 73 Priority Area 9 Information ................................................................................................. 74 Priority Area 10 Workforce ................................................................................................... 75 Priority Area 11 Aboriginal Health ....................................................................................... 76 Priority Area 12 Aged Care .................................................................................................. 77 Priority Area 13 Culturally and Linguistically Diverse Communities .............................. 78 9. The Next Steps .......................................................................................................................... 79 10. Appendices................................................................................................................................ 80 Appendix A Terms of Reference of the Steering Committee ................................... 80 Appendix B Sources of Information ............................................................................. 82 Abbreviations ...................................................................................................................................... 84 References ........................................................................................................................................... 86 Population Health Needs Assessment for the Communities of South Western Sydney and the Southern Highlands Executive Summary South Western Sydney covers the south western suburbs of metropolitan Sydney and extends south to the Southern Highlands, an area of 6,243 square kilometres. It includes the seven Local Government Areas (LGAs) of Bankstown, Camden, Campbelltown, Fairfield, Liverpool, Wingecarribee and Wollondilly. South Western Sydney Medicare Local was established in 2012 by the Australian Government as the key body for integrated, quality primary health care services in South Western Sydney. It is a requirement for Medicare Locals to assess the needs of their region in order to develop locally focussed solutions. The Needs Assessment process commenced in late 2012 with data collection, consultation and literature review, to develop an interim report. The outcomes were fed back to the community in 2013 and work to develop a more complete picture of the health of South Western Sydney was undertaken. The result is this Population Health Needs Assessment report, which aims to provide a better understanding of the health status of local communities. This Needs Assessment provides an overview of the demographic and health characteristics of the communities which reside in South Western Sydney; the health services available, how they are used, how they work together to meet patient needs and the workforce that provides health care. An estimated 875,763 people live in South Western Sydney, predominantly in the more densely populated areas of Bankstown, Fairfield, Liverpool and Campbelltown. It has a relatively young profile, with 21% of residents under 15 years of age and a further 15% in the 15-24 year age range. The region has experienced considerable growth which extends across all LGAs. High fertility rates and new urban development are the major sources of growth. Substantial growth is projected over the next 10 -20 years, driven by the urban development in the South West Growth Centre (in Camden and Liverpool), new developments in Wollondilly and urban infill in established areas. At the same time, the aged population which is currently relatively small will grow by 45%. South Western Sydney is characterised by its diversity. There is a large Aboriginal community of 13,070 people and 36% of residents were born overseas. In Fairfield LGA 74% of residents speak a language other than English at home while in Bankstown, Liverpool and Campbelltown LGAs 60%, 55% and 30% of residents speak a language other than English at home, respectively. There are pockets of considerable disadvantage with Fairfield, Liverpool, Bankstown and Campbelltown amongst the most disadvantaged LGAs in metropolitan Sydney. Approximately 9% of residents live in metropolitan fringe LGAs of Wingecarribee and Wollondilly, many in smaller towns and rural properties. The disadvantage of geographical isolation is accentuated by relatively poor public transport and high dependence on private transport. It is also an issue for people in new housing estates and in locations of greater socioeconomic disadvantage, such as public housing estates. National and state surveys indicate that on a range of measures the health of residents in South Western Sydney is poorer than for NSW as a whole. 79% of South Western Sydney residents consider their health to be very good, good or excellent (compared with 82% of NSW residents); 12.9% report high or very high levels of psychological distress (compared to 10.3% for NSW); 44% report adequate levels of physical activity; 51% report eating the recommended daily fruit intake; 19% are current smokers; 20% drink at risky levels; and 21% report they are obese. The trends indicate that demand for health care in the future will grow. | 5 Population Health Needs Assessment for the Communities of South Western Sydney and the Southern Highlands Health data on mortality and morbidity also indicates patterns of concern: Cardiovascular disease is the most common cause of death and the reason for a large proportion of hospitalisations. Rates were particularly high in Campbelltown. The death rate and hospitalisations due to diabetes were higher than the state average, and were particularly high in Fairfield. 14.8% of people in NSW treated for chronic kidney disease (CKD) reside in South Western Sydney. Rates of CKD are higher than NSW for all LGAs except Camden and Wollondilly. In the years 2004-2006, there were 16,609 cases of cancer with mortality rates higher than the NSW rate. Participation in early detection programs such as breast and cervical cancer screening is well below the NSW target. There were 16,123 hospitalisations related to respiratory disease in 2012-13. The rate of hospitalisations for Aboriginal people was well above the local rate. Injury and poisoning is the leading cause of death for people under 45 years. Common causes of injury related death are suicide (25%), motor vehicle accidents (17%) and falls (12%). Schizophrenia and major affective disorders are the major reasons for a mental health admission to hospital. The region has the 2nd highest number of notifications for Hepatitis B in NSW, with notifications particularly high in Fairfield and Bankstown. SWS also has the 4th highest number of notifications for Hepatitis C. 46% of residents report a long term health condition i.e. the 5th highest level of any metropolitan region. Both infant mortality and child mortality rates are higher in Campbelltown LGA than other LGAs in South Western Sydney, and are higher than the NSW state averages. Only 56% of women attend their first antenatal visit before 14 weeks and 15.3% report smoking during pregnancy. Children in Bankstown, Campbelltown, Fairfield and Liverpool have higher levels of developmental vulnerability in two or more domains than the NSW average. Rates of potentially avoidable deaths in Bankstown and Campbelltown and preventable hospitalisations in Campbelltown, Wingecarribee and Bankstown are above the NSW average. The region has a number of communities which experience poorer health. For example, on a range of indicators the health of Aboriginal people in South Western Sydney is poorer than that of other local residents. Other people at heightened risk include those with mental health conditions, intellectual or physical disabilities; carers; people from non-English speaking backgrounds; people in contact with the criminal justice system; people living in public housing estates or in rural areas; people with drug and alcohol problems; people who are homeless; and children who are in care or in families with child protection issues. Primary and specialist health services prevent and treat health problems. Issues identified through the needs assessment process include: General practitioner (GP) headcount to population ratios range from 1 GP for 568 residents in Wingecarribee to 1 GP per 2,200 residents in Wollondilly. Practice nurses who increase access to health care and follow-up are predominantly used by practices in Wingecarribee and Campbelltown LGAs. The relatively high levels of bulk billing by GPs in the region improves access however cost is a significant barrier for access to medical specialists, dental services, allied health services and when filling a prescription. Although after hours GP services operate across the region, more than half of the after-hours presentations were through Emergency Departments (ED). Waiting times are a barrier particularly to medical specialists and allied health and for some dental services. This reflects an underdeveloped private sector in parts of the region and gaps in | 6 Population Health Needs Assessment for the Communities of South Western Sydney and the Southern Highlands public outpatient services. Waiting times for planned surgery meet the NSW target for all surgery types except non-urgent surgery and waiting times for ED are below the NSW target. Information about specialist services, referral processes, waiting times and service criteria is poorly developed and deficits in verbal communication and information sharing hamper transfer of care and service provision. Many primary healthcare providers are reluctant to adopt meaningful use of the ehealth record system within their practices. This affects the availability of the system to the population of South Western Sydney. Knowledge and use of the Medicare Australia Practice Incentive Program (PIP) by GPs is varied. Use of brief intervention tools, health checks and health plans such as the Diabetes Cycle of Care requires attention. Targeted programs such as Connecting Care and sustained home nurse visiting programs are well utilised and well regarded. There are considerable gaps and inequities in some specialist health and community services including mental health, rehabilitation, health promotion and immunisation. The increased demand for health related transport in particular is not considered sustainable. The demographic and health profile of local communities means that a broader range of responses is required including outreach and targeted service provision and a stronger focus on prevention The General Practice workforce is ageing, particularly in Fairfield where there are a large number of solo practices. With significant projected growth and ageing of local communities, planning for growing the primary care workforce is critical. The Needs Assessment identifies thirteen priority areas for immediate attention: Mental health; Overweight and Obesity; Tobacco; Chronic Disease - Diabetes and Cardiovascular Disease; Cancer; Pregnancy and the Early Years; Strengthening prevention; Advocacy; Information: Workforce; Aboriginal Health; Aged care and Culturally and Linguistically Diverse Communities. Strategies have been identified to address these priorities, including a strong focus on information sharing about the findings from this Needs Assessment. To support the information provided in this Report, a supplementary data report entitled Health Indicators for the Communities of South Western Sydney and the Southern Highlands has been produced. The supplementary report brings together publically available information about the health and other characteristics of local communities in South Western Sydney and the Southern Highlands. It is anticipated that this will be a useful resource for health professionals, local agencies and the broader community. Where possible, data is reported at an LGA level. Please note that in some circumstances, the most recently available statistics are only at whole region level. The most recent statistics are contained within this report, for LGA level statistics for the previous reporting period, please refer to the supplementary report. | 7 Population Health Needs Assessment for the Communities of South Western Sydney and the Southern Highlands 1. Background As part of the Australian Government’s National Health Reform agenda, sixty one Medicare Locals were established across Australia to work with local primary health care providers, such as general practitioners (GPs), Local Health Districts and communities to ensure that patients receive “the right care in the right place at the right time” and to help reorient the health system away from acute hospital based care. Medicare Locals were established with the following national strategic objectives: South Western Sydney Medicare Local 1. Improving the patient journey through developing integrated and coordinated services Vision: To be the principal 2. Provide support to clinicians and service providers to organisation which delivers an improve patient care effective & innovative 3. Identification of the health needs of local areas and development of locally focussed and responsive integrated primary health care services system for the residents of our 4. Facilitation of the implementation and successful region. performance of primary health care initiatives and programs Mission: To enhance and 5. Be efficient and accountable with strong governance connect primary health care so and effective management residents and patients achieve better health outcomes. South Western Sydney Medicare Local Ltd. (SWSM...
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