NSW Perspective Dr Mary Foley Secretary, NSW Health

1. NSW Perspective Dr Mary Foley Secretary, NSW Health

2. NSW HEALTH SYMPOSIUM Health System SustainabilityNSW Health’s approach to developing a patient centred healthcare system for the 21st CenturyDr Mary FoleySecretaryJune 2014

3. Health System Sustainability • Health systems are constantly evolving • NSW Health performs very well • Evidence that health expenditure contributes to economic growth by building healthier, more productive communities

4. Bureau of Health Information – Healthcare in focus 2013

6. Health systems at an inflexion point • Three key challenges: • Increasing demand - More good things we can do for people of all ages • Improving quality by reducing waste, adverse events and unwarranted clinical variation • Joining the dots for the patient - imperative for integrated care

7. Grattan Institute Report – Budget pressures on Australian Governments, (John Daley, April 2013)

8. McKeon Review Report - Strategic Review of Health and Medical Research: Final Report February 2013

9. Achieving better health outcomes for patients by: • Integrating acute and primary care • Working with others to meet the patient’s needs • Harnessing eHealth and mobile technology

10. NSW STATE HEALTH PLANTowards 2021 Delivering Innovation – The Directions Direction One - Keeping People Healthy Supporting people to live healthier, more active lives and reducing the burden of chronic disease Direction Two – Providing World-Class Clinical Care Providing timely access to safe, quality care in hospitals, Emergency Departments and the community Direction Three – Delivering Truly Integrated Care Creating a connected health system, so that patients get the care they need, where and when they need it, by connecting State health services with other health services

11. NSW STATE HEALTH PLANTowards 2021 Making it Happen – The Strategies Strategy One – Supporting and Developing our Workforce Helping the ‘heart and hands’ of NSW Health deliver first class, patient centred care within the CORE values framework Strategy Two – Supporting and Harnessing Innovation Creating the evidence base for better models of care and translating research into new devices, drugs, therapies and procedures to deliver improved healthcare Strategy Three – Enabling eHealth Improving digital connectivity for a smart networked health system in hospitals, in the community, into the future Strategy Four – Designing and Building Future – Focused Infrastructure Improving facilities and equipment to support the delivery of care

13. Commonwealth Budget 2014/15 • We are back to the drawing board on Commonwealth/State arrangements for funding • Commonwealth funding of growth in utilisation of public hospitals, using ABF, will continue for the next three years • The growth guarantee has gone and the Commonwealth’s share of growth will reduce from 2017/18 • The Commonwealth has put us on notice that they intend to revisit the funding arrangements for health through the White Papers on Federation and Tax

14. Commonwealth Funding to NSW Under NHR Agreement 12,000m 10,000m 691m 8,000m 631m 631m 477m 391m 6,000m 184m 4,000m 2,000m 0m 2012 - 13 2013 - 14 2014 - 15 2015 - 16 2016 - 17 2017 - 18 2018 - 19 2019 - 20 SPP Base SPP Annual Growth Share of $16.4b

15. Commonwealth Funding to NSW Under NHR Agreement 12,000m 10,000m 691m 8,000m 631m 631m 477m 391m 6,000m 184m 4,000m 2,000m 0m 2012 - 13 2013 - 14 2014 - 15 2015 - 16 2016 - 17 2017 - 18 2018 - 19 2019 - 20 SPP Base SPP Annual Growth Share of $16.4b

16. Commonwealth Funding to NSW Under NHR Agreement 12,000m 10,000m 691m 8,000m 631m 631m 477m 391m 6,000m 184m 4,000m 2,000m 0m 2012 - 13 2013 - 14 2014 - 15 2015 - 16 2016 - 17 2017 - 18 2018 - 19 2019 - 20 SPP Base SPP Annual Growth Share of $16.4b

17. NSW Budget 2014/15 • $18.7 billion an increase of $929 million or 5.2% - $300 million for increased patient volumes • 80,000 extra ED admissions • 40,000 extra patient admissions • $220 million to fill the gap left by expiring NPAs – NPA substitute funding by NSW brings the growth in funding to 7% • Almost $1.3 billion for capital works • Other enhancements for medical research, preventive health and eHealth

18. Funding Model • All LHDs receive significant growth funding in 2014/15 – indexation and funding for more patients and services • The funding model has been further refined in consultation with LHDs: • ABF growth for all LHDs will be funded at the full State price. • A portion of transition grants for acute and ED streams will be used to fund more patient care. • The main driver of activity growth will be population change (weighted for age), adjusted for a range of other factors.

19. In NSW we are pursuing our own reform journey • Governance Reform: Supporting devolution • and local decision making about patient care • and healthy communities • Funding & Performance:Establishing a • transparent funding and performance • framework which empowers local • boards and management, clinicians, • patients and communities; rolling • out data analytical tools to help • clinicians and managers improve care

20. In NSW we are pursuing our own reform journey • New service models:Developing new service models to meet changing demand and growth pressures, working in partnership with other providers • Safe, sustainable health care: Ensuring high quality, driving innovation, using evidence, reducing waste and unwarranted variation for better patient outcomes

21. What next? • Continue to improve our core business – • keeping people healthy and out of hospital & • providing world class clinical services • Develop our focus on: • Integrated Care – working closely with primary • health care, influence the arrangements for • primary health networks, develop effective • relationships between EDs and General Practice • Rural Health –looking forward to the Rural Health Plan which will improve access for rural patients

22. What next? • Mental Health – developing and implementing a whole of government response to the Mental Health Commission’s draft Strategic Plan for Mental Health in New South Wales • Children, Young People and Families in NSW – strategic plan to launch later in 2014 • Leadership – further develop our leadership capacity across the system – HETI online, Essentials of Care, Clinical Redesign School, Clinical Leadership Program, embedding the CORE Values • Pursue our enabling strategies – eHealth, Workforce, Research Innovation and delivering Infrastructure

23. Foundations for a sustainable health system “The health system’s … building blocks alone do not constitute a system, any more than a pile of bricks constitute a functioning building. It is the multiple relationships and interactions among the blocks – how one affects and influences the others, and it is in turn affected by them – that converts these blocks into a system.” de Savigny D, Taghreed A, eds. ‘Systems thinking for health systems strengthening’. Alliance for Health Policy and Systems Research. Geneva, World Health Organization, 2009.