Dr Simon Towler Chief Medical Officer WA Department of Health

1. Dr Simon Towler Chief Medical Officer WA Department of Health

2. MAKING THE DATA SPEAK! Just who is listening? What is your vantage point!

3. Improving 21st Century Health systems Safe: avoid preventable injury from care Effective: services based on scientific knowledge Patient centered: respectful, responsive care Timely: reducing waiting and harmful delays Efficient: avoid waste (equipment, supplies, ideas) Equitable: no variation due to ethnicity, gender, age, etc Institute of Medicine

4. London Healthcare “A Framework for Action” 1/ Services focused on individual needs and choices Provision should, wherever possible, be tailored to the particular needs of each individual. Patients should feel in control of their care and be able to make informed choices.

5. London Healthcare “A Framework for Action” 2/ Localise where possible, centralise where necessary Routine healthcare should take place as close to home as possible. More complex care should be centralised to ensure it is carried out by the most skilled professionals with the most cutting edge technology.

6. London Healthcare “A Framework for Action” 3 (a) Truly integrated care and partnership working, maximising the contribution of the entire workforce. Better communication and co-operation is needed – between urgent and planned care, between health and social care – to stop people from falling through the gaps.

7. London Healthcare “A Framework for Action” 3(b)Truly integrated care and partnership working, maximising the contribution of the entire workforce. Care should be multidisciplinary bringing together the valuable contributions of practitioners from different disciplines. The NHS should be committed to working in partnership with other organisations, including local government and the voluntary and private sectors.

8. London Healthcare “A Framework for Action” 4/ Prevention is better than cure. Health improvement, including proactive care for people with long-term conditions, should be embedded in everything the NHS does. Close working with local authority partners is needed to help people stay mentally and physically healthy.

9. London Healthcare “A Framework for Action” 5/ A focus on health inequalities and diversity. ….., the most deprived areas of London, with the greatest health needs, need better access to high-quality healthcare.

10. London Healthcare “A Framework for Action” Partnerships to improve health. The NHS has often made the mistake of thinking it can change healthcare outcomes on its own. It cannot. The NHS must work with its partners – the London boroughs, the Greater London Authority and the Mayor’s Office, the voluntary and private sectors, and the higher education sector – to implement this Framework.

11. Improving 21st Century Health systems • Different viewpoints of what constitutes these outcomes • The patient • Carers and families • Medical practitioners • Other health professionals • Management • Politicians Health information is being used by all these groups! It is influencing their ideas about their own healthcare experience! What is the quality of that information? What is the depth of their understanding? How is that information feeding back into the system?

12. MJA Volume 190 March 2009 Elshaug et al Title:Identifying existing health care services that do not provide value for money “If governments, the professions and the community really want and expect a “better” health system, then it is time to start asking questions about resource allocation, in a spirit of transparency, with an explicit statement of values, and supported by a systematic and evidence-based framework. The answers have the potential to enhance the sustainability and quality of health care.”

13. Health expenditure as % GDP Institute of Medicine

14. Advances in medical technology have brought large benefits but have also been a major driver of increased health spending in recent years. In many cases, increased expenditure on new medical technologies reflects improved treatment and a significant increase in the number of people treated. Productivity Commission Report

15. Productivity Commission Report • This report identified that advances in medical technology have been a major driver of the growth in real health care expenditure and estimated that the cost of technological change contributed 1.9 per cent to the annual growth in real health care expenditure of 5.3 per cent, or 36 per cent of the annual growth in real health care expenditure from 1992-93 to 2002-03.

16. Population Growth Sept 2005 - Sept 2007* WA is the fastest growing State in the nation

17. GP workforce in WA Case study 1 2005-06 WA Metro GP FWE’s 11% less than the national average WA Rural GP FWE’s 16% less than the national average

18. You can imbed commercial videos or your own video movie in any slide ... Distribution of General Practice in Perth PERTH H H H FREMANTLE H ROCKINGHAM H ARMADALE KELMSCOTT MANDURAH/PEEL H Pink dots are GP Practises H

19. Population growth to 2016 Rockingham 27000 additional people by 2016 30% growth

20. You can imbed commercial videos or your own video movie in any slide ... Distribution of General Practice in Perth ROCKINGHAM H

21. Population growth to 2016 Cockburn 25000 additional people by 2016 30% growth

22. You can imbed commercial videos or your own video movie in any slide ... Distribution of General Practice in Perth COCKBURN ROCKINGHAM H

23. What are GP’s doing? BEACH data suggest that in the 12 months 2001–02, people in Australia spent on average 83 minutes with a GP per head of population. This compares with about 56 minutes per head in New Zealand and about 30 minutes in the United States during the same period.

24. What are GP’s doing? BEACH The extent to which this affects health outcomes for the populations is as yet unclear. However, considering this high use of general practice care, information about the problems dealt with and how they are managed by GPs is essential.

26. Improving health systems 2nd 1st 2nd

27. Improving health systems

37. GP attendances have remained relatively stable, ED attendance (metro) growing at 6.2% per annum)

38. GP Services

40. Rates of ED presentation by area of residence (2004/05) 0 – 150 presentations per 1000 population 310 - 402 presentations per 1000 population

41. Public hospital activity is growing faster than the population

42. WA: Population Growth

43. AVERAGE LENGTH of STAYBy AGE GROUP and SEX

44. SEPARATIONS per 1000 POPULATION by USUAL RESIDENCE

45. Malcolm (1994): “the overriding problem of hospitals, as organisational entities, is that they fragment the continuum of care, the delivery of integrated services which should be inclusive of both hospital as well as community-based care”.

47. Upstream Downstream Secondary Hospitals

48. SEPARATIONS per 1000 POPULATION by INDIGENOUS STATUS and AGE GROUP

49. Indigenous Australians as percentage of all population, by region

50. Deloitte Ross Tohmatsu 1991 • The major weakness evident in the Western Australian health system is a lack of integration across its component agencies. • Planning has been isolated from clinical expertise and consequently implementation of plans and recommendations has been difficult