Needs Assessment Snapshot. East Gippsland Local Government Area

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1 Needs Assessment Snapshot East Gippsland Local Government Area June

2 Introduction This snapshot includes East Gippsland specific information included in the Gippsland PHN Needs Assessment for the Gippsland region, which was developed between November 2015 and March The regional needs assessment forms the foundation for the Gippsland PHN priorities for See the Gippsland PHN website for the regional context and information about the Needs Assessment and priorities The Needs Assessment incorporated three main components; A Brief Population Health Profile which identifies health issues in Gippsland based on quantitative sources of information and allows a comparison of Gippsland and its six Local Government Areas (LGA) with other PHNs and/or Victoria and Australia. Measures of demography, social status, health behaviours and risk factors, health conditions and status and service use / access are included. This document is available on the Gippsland PHN web site Qualitative data from an analysis of existing reports documenting views of consumers and other stakeholders in Gippsland related to health. Qualitative data derived from 69 interviews with key stakeholders (professionals). The methodology is described in more detail in Appendix 1 (overview) and more information about the qualitative methods can be found in the Needs Assessment Qualitative Report (June 2016). This document is available from the Gippsland PHN web site Please note, information about East Gippsland is also available from the following sources: Gippsland Health Online; East Gippsland Council web site; East Gippsland Primary Care Partnership; The DHHS Health and Wellbeing planning guides 2

3 What the Brief Population Health Profile tells us about East Gippsland The following information about East Gippsland notes key information or differences compared to other Gippsland Local Government Areas, Gippsland as a whole, or Victoria / Australia. Population East Gippsland has a population of 44,611 (2016) which will increase to 47,016 in 2021 and 52,242 in 2031; an annual growth rate of 1.1% ( ). This is lower than the Gippsland rate of 1.4% and Victorian rate of 1.7% % of the East Gippsland population are aged 60 years or older; 39.9% are years; and 26.9% are 24 years and under. The proportion of people aged 60 years or older is the highest in Gippsland (27.3%) and much higher than Victoria (20.6%). 1 There are 2,692 people in East Gippsland with a profound or severe disability. 3 East Gippsland s population density of 2.0 people per square km is low compared to Gippsland (6.3) and Victoria (24.8) % of the population identify as Aboriginal and/or Torres Strait Islander (1,351 people); high compared to Gippsland (1.8%) and Victoria (0.8%). 2 East Gippsland has a fertility rate of 2.4 children per woman; the highest of Gippsland LGAs and higher than Victoria (1.8). 2 East Gippsland has a teenage fertility rate (live births by mothers <19 years) of 23.3; higher than Gippsland (20.8) and over double the Victorian rate (10.4). 2 Socio-economic information Disadvantage The SEIFA measure of socio economic disadvantage for East Gippsland is 958; the second lowest in Gippsland and low compared to Victoria (1010). (Note: a low score means more disadvantage). 2 Income, employment and housing The equivalised median income of $798 is lowest in Gippsland; and lower than Victoria ($1,216). 2 East Gippsland has 759 age pension recipients per 1,000 eligible population; high compared to Gippsland (750) and Victoria (694) % of year old East Gippsland residents receive an unemployment benefit; high compared to Gippsland (7.2%) and Victoria (4.9%) % of children under 15 are in jobless families; high compared to Gippsland (16.6%) and Victoria (12.7%) % of East Gippsland families have a low income or are welfare dependent; similar to Gippsland (10.8%), but high compared to Victoria (8.7%) % of the East Gippsland population (16-64 years) receive the disability support pension; high compared to Gippsland (8.8%) and double the Victorian rate (5.3%). 3 Rental stress is common in East Gippsland (30% of households) compared to Gippsland (28%) and Victoria (25%). 2 Other socio-economic information 17% of school leavers participate in higher education; low compared to Gippsland (19%) and Victoria (36%). 2 28% of people over 15 years are volunteers; higher than Gippsland (25%) and Victoria (19%). 2 3

4 20% of the East Gippsland population live within 800m of public transport; lower than Gippsland (35%) and much lower than Victoria (74%) % of the East Gippsland population ran out of food at least once in the past 12 months; similar to Gippsland (6.8%) and high compared to Victoria (4.6%). 2 Crime East Gippsland has a crime rate of 8,251 total offences per 100,000 ( ); higher than the Victorian rate (7,490). 11 East Gippsland has 2,304 family incidents per 100,000; the second highest rate in Gippsland, and much higher than Victoria (1,129). 11 East Gippsland has 868 family incidents where children are present per 100,000; the second highest rate in Gippsland and over double the Victorian rate (388). 11 East Gippsland has 64.2 alcohol related family violence incidents per 10,000 population ( ); the second highest in Gippsland and more than double the Victorian rate (26.7). 6 The rate of substantiated child abuse is 15.5 per 1,000 population ( ); high compared to Gippsland (13.8) and Victoria (6.7). 2 Bairnsdale was included among the top seven regional Significant Urban Areas in Victoria with the greatest increase in drug use and possession incidents between 2011 and Causes of death/disability The top cause of death in East Gippsland is malignant cancer, followed by cardiovascular disease, chronic respiratory diseases, un-intentional injuries and neurological and sense disorders. 4 The top five causes of disability in order are neurological and sense disorders, mental disorders, malignant cancers, chronic respiratory disease and cardiovascular disease. 4 East Gippsland has a significantly higher rate of premature deaths (0-74 years) for males (351 per 100,000, age-standardised) compared to Australia (299). 3 The rate for specific conditions was also significantly higher than Australia for: 3 o lung cancer; 27 compared to Australia (21) o COPD; 12 compared to Australia (8) The alcohol related death rate in East Gippsland is 2.5 per 10,000 (2012); high compared to Victoria (1.5). 6 Health status Male life expectancy is 78.4 years and female is 83.3 years; lower than Victoria at 80.3 and 84.4 years respectively. 2 18% of people in East Gippsland report fair or poor self-assessed health; high compared to Gippsland (15%) and Victoria (16%). 2 28% of people in East Gippsland report high blood pressure; high compared to Victoria (24%) % of adults in East Gippsland report heart diseases; high compared to Gippsland (7.0%) and Victoria (6.9%) % of people in East Gippsland report osteoporosis; higher than Gippsland (5.3%) and Victoria (5.3%). 2 14% of people in East Gippsland report high or very high psychological distress; higher than Gippsland (12%) and Victoria (11%) % of adults report poor dental health; high compared to Victoria (5.6%). 2 There were 1.9 pertussis notifications per 1,000 (2013); high compared to Gippsland (1.6) and Victoria (0.8). 2 4

5 East Gippsland had a low rate of chlamydia; 2.2 notifications per 1,000 people compared to Gippsland (3.3) and Victoria (3.5%). 2 East Gippsland had 774 malignant cancers diagnosed per 100,000 people; high compared to Gippsland (631) and Victoria (522). 2 East Gippsland has 99 unintentional injuries treated in hospital per 1,000 people; higher than Gippsland (94) and Victoria (59). 2 East Gippsland has 4.7 intentional injuries treated in hospital per 1,000 people; higher than Victoria (3.1). 2 East Gippsland has 170 asthma admissions to hospital per 1,000 people for year olds; very high compared to Victoria (87). 2 East Gippsland has 45 alcohol related ambulance attendances per 10,000 people ( ); high compared to Victoria (34). 2 East Gippsland has 18.5 alcohol related emergency department attendances per 10,000 people ( ); high compared to Victoria (13.8). 2 East Gippsland has 10.8 alcohol and drug treatment clients per 1,000 people ( ); high compared to Gippsland (9.3) and Victoria (5.8) % of the East Gippsland population (or 1,232 people) are predicted to have dementia by 2020; the highest rate in Gippsland and much higher than Victoria (1.6%). 5 Children 9.1% of babies in East Gippsland were low birth weight babies; the highest rate in Gippsland and higher than Victoria (6.6%) % of children are developmentally vulnerable on two or more domains; high compared to Gippsland (11.7%) and Victoria (9.5%) % of children have emotional or behavioural problems at school entry; high compared to Victoria (4.3%). 2 19% of children have speech or language problems at school entry; high compared to Gippsland (17%) and Victoria (14%). 2 East Gippsland has the highest rate of children attending 3 year old maternal and child health checks at 78%, compared with 66% for Gippsland and 64% for Victoria % of children under 15 are in jobless families; high compared to Gippsland (16.6%) and Victoria (12.7%). 3 The rate of children in out of home care is 8.3 per 1,000 population in East Gippsland; lower than Gippsland (9.9) but high compared to Victoria (4.6). 2 30% of East Gippsland adolescents report being bullied; the highest rate in Gippsland and much higher than Victoria (18%). 2 Health behaviours 27% of East Gippsland adult males are smokers; the highest rate in Gippsland (21%); and much higher than Victoria (18%). 2 45% participate in bowel cancer screening; higher than Victoria (36%). 2 59% of females years participate in breast screening; higher than Victoria at 55%. 2 13% of adult East Gippsland residents consume alcohol at least weekly at levels likely to cause harm; higher than Gippsland (11%), and Victoria (9%). 2 Service use / access East Gippsland has 4.3 GP attendances per person; low compared to Gippsland (5.6) and Victoria (5.5). 2 5

6 East Gippsland has 0.13 after-hours GP attendances per person; low compared to Gippsland (0.15) and Australia (0.31). 2 East Gippsland has a GP practice open for hours in the after-hours period located in Lakes Entrance and GP operated Urgent Care Centres in Orbost and Omeo. There is a very high rate of HACC clients aged 0-69 years in East Gippsland at 419 per 1,000 target population, compared to Gippsland (221) and Victoria (142). 2 The rate of HACC clients aged 70 or more is also high at 554 per 1,000 target population, compared to Gippsland (513) and Victoria (408). 2 East Gippsland has 556 hospital inpatient separations per 1,000 population; high compared to Gippsland (455) and Victoria (420). 2 12% of inpatient separations for East Gippsland residents are in a private hospital, very low compared to Gippsland (20%) and Victoria (39%). 2 East Gippsland has 416 emergency department presentations per 1,000 population, high compared to Gippsland (380) and Victoria (259). 2 East Gippsland has 207 primary care type presentations to the emergency department per 1,000 people; high compared to Gippsland (188), and Victorian (108). 2 East Gippsland has 18.5 alcohol related emergency department presentations per 10,000 people; high compared to Victoria (13.8). 6 The ambulance call out rate of 20 per 1,000 people in East Gippsland (Code 3 low acuity) is high compared to Gippsland (18) and Victoria (8). 8 East Gippsland has 1,341 acute and vaccine-preventable potentially preventable hospitalisations (per 100,000 people); high compared to Gippsland (1,288) and Victoria (1,325). 7 East Gippsland has 293 cellulitis potentially preventable hospitalisations (per 100,000 people); high compared to Gippsland (249) and Victoria (237). 7 Workforce East Gippsland have lower than Victorian numbers of registered professionals per 1,000 population of: o Dentists 0.43 (Victoria 0.59) 9 o Medical specialists 0.18 (Victoria 1.31) 9 o Medical radiation practitioners 0.39 (Victoria 0.52) 9 o Occupational therapists 0.55 (Victoria 0.66) 9 o Physiotherapists 0.57 (Victoria 1.11) 9 o Pharmacists 0.80 (Victoria 1.09) 9 o Registered nurses 9.13 (Victoria 10.18) 9 o Podiatrists 0.14 (Victoria 0.36) 9 o Psychologists 0.43 (Victoria 1.02) 9 o Midwives 0.95 (Victoria 1.05) 9 There are higher than Victorian numbers of registered professionals per 1,000 population of; 9 o Enrolled nurses 4.69 (Victoria 3.11). 9 There are similar numbers of registered professionals per 1,000 population of; 9. o GPs 1.18 (Victoria 1.22) 9 o Optometrists 0.23 (Victoria 0.25) 9 6

7 Medical practices Rates presented here are prescriptions dispensed / investigations / procedures per 100,000 population (age standardised rate). Mental health treatment plans by GPs were less common in East Gippsland compared to other Gippsland LGAs at 3,986 per 100,000 population (age-standardised rate) and low compared to Victoria (4,769). 7 Prescribing rates for under 17 year olds (age standardised rate per 100,000 people) were high for: o ADHD medications; 15,654 compared to Victoria (7,789) 7 o Anti-depressants; 14,159 compared to Victoria (7,789) 7 o Anti-psychotics; 2,751 compared to Victoria (1,774) 7 Prescribing rates for year olds were high for: o Anti-depressant medications; 137,244 compared to Victoria (99,774) 7 o Anti-psychotic medications; 30,255 compared to Victoria (19,663) 7 Prescribing rates for year olds were high for: o Asthma medications; 32,164 compared to Victoria (19,496) 7 Prescribing rates for people 65 years or over were low for: o anxiolytic medications; 27,500 compared to Victoria (42,664) 7 o antipsychotic mediations; 22,625 compared to Victoria (31,763) 7 o anticholinesterase medications; 9,079 compared to Victoria (14,027) 7 Antimicrobial dispensing was low in East Gippsland; 104,988 compared to Victoria (129,607), but specific antibiotics varied: 7 o Amoxycillin; low at 17,735 compared to Victoria (28,347) o Amoxycillin clavulanate; low at 11,434 compared to Victoria (17,267) o Quinolone; high at 1,276 compared to Victoria (1,141). 7

8 What the Qualitative Data tells us about East Gippsland Information about the qualitative methodology is in Appendix 1 (overview) and more detailed information is in the Needs Assessment Qualitative Report (June 2016). This document is available from the Gippsland PHN web site Existing Reports Consumer input Themes from a consumer perspective for East Gippsland were identified based on six reports incorporating results of over 600 consumers. Service gaps was the most identified theme, with half of these relating to children. Access to services and health workforce shortages also featured in the top three, both themes relating to geographical challenges within the catchment. Table 1. Consumer themes identified in reports for East Gippsland, including a count of number of times mentioned. Theme Service Gaps (Autism spectrum disorder specialists (2), Childcare, Parenting, GP, Specialists, Interpreters, Internet, Respite and Social Support, Early Intervention) Count 10 Access to Services (access to services identified as an issue, e.g. geography, transport) 6 Health Workforce Shortage (refers to an ongoing shortage of health workers (non GPs) in a catchment or part of a catchment) 5 Attitudes (includes attitudes and values of health professionals such as racism, judging, dismissive comments, ageism, lack of compassion, shaming) 3 Information About Health Services (includes references to need for or quality of information about health care services) 3 Community Connectedness Healthy eating Service quality Affordability Bullying Health Workforce Training Mental health Physical activity Built Infrastructure School Bullying Education Employment Transport 2 1 8

9 Existing Reports Other Stakeholders The themes emerging from other stakeholders perspectives for East Gippsland were identified based on five reports. The number of times each theme was identified is listed in Table 2. The key theme for other stakeholders was service gaps, mainly relating to services for children. This was similar to the consumer perspective outlined above, as was the second most common issue of Access to Services. As with most other Gippsland LGA s, Community Connectedness also ranked highly. Table 2. Other stakeholder themes identified in reports for East Gippsland, including a count of number of times mentioned. Theme Service Gaps (Low Cost Services, Parenting of Infants (2), Special Needs Children (2), Paediatric Speech therapy, Childcare - remote (2), Pre School, Child Mental health - remote, Infant Mental Health, GPs, Specialist Mental health (2), Paediatricians (2), Psychologists, Early Intervention services for children, Respite care for carers of special needs children, Support for Independent Living) Access to Health Services (access to services identified as an issue with no specific explanation, e.g. geography, transport) 6 Count 19 Community Connectedness (refers to social participation, social isolation, being part of a community) For people with a disability who are not connected with the mainstream community, loneliness and isolation is a problem across all ages. 5 Healthy Eating (refers to any comments relating to food access, food quality, food safety) 3 Social and economic determinants of health (includes income, education and employment) 3 Health Workforce shortage (refers to an ongoing shortage health workers (non GPs) in a catchment or part of a catchment) 2 Attitudes Physical Activity Information on Health Services Coordination ehealth GP workforce shortage Collaboration Service Quality Built infrastructure Funding models Service Integration Transport Safety 2 1 9

10 Results of Stakeholder Interviews Seventeen interviews were conducted with professionals in East Gippsland. The top health issues identified were diabetes, chronic disease (not specified), mental health, drug and alcohol use and heart disease (Table 3). There were many service gaps identified, most commonly involving access to mental health professionals and paediatrics. Collaboration, relationships and partnerships were identified as something that is working well along with integrated care between GPs and allied health professionals. Table 3. Themes identified in interview data for East Gippsland, including a count of number of times mentioned. What are the top three health issues? Count Diabetes 11 Chronic disease (not specified) 7 Mental health 7 Drug /Alcohol Alcohol is number one issue -Alcohol fuelled town. Young age exposure to undesirable situations (drug seeking). 6 Heart Disease 6 Aged care 3 Chronic Obstructive Pulmonary Disease 2 Smoking 2 Family violence 2 General Welfare Issues Children's Health Multiple Complex Needs Eye And Ear Osteoporosis Disability Pensions Physical Inactivity Asthma Obesity Asthma Healthy diet Public violence 1 10

11 What are the top three health service gaps? Mental Health Mental health access - access and waiting times are an issue 7 Paediatricians 4 Psychiatrists Affordable mental health. Access to psych - expensive and outside income affordability so patients do not present. 3 Psychologists 3 Transport 3 Dementia 3 Medical imaging X-ray patients have to travel 2 hours 3 Workforce general 3 Care coordination Social work Diabetes Education Colonoscopy Paediatric Speech Pathology Practice Nurse Allied Health Gynaecologist Lack of Culturally Appropriate Holistic Services Chemotherapy Post baby care Autism Spectrum disorder treatment services Adolescent health services Culturally appropriate holistic services 2 1 What is working well for health? Collaboration, relationships and partnerships Collaboration is extra important to use resources well. Connectedness and partnership with services visiting area 6 Integrated care between GPs and Allied Health 6 Activity Groups Passionate /well skilled staff Visiting Services After-hours access to GPs for workers Transport and drivers for Indigenous clients Community controlled ACCHO Provision of MCH to Indigenous families Telehealth opportunities Man cave

12 Personal rapport with patients Services to at risk groups Agility of health services Steady workforce Palliative care in the home What is not working well for health? Mental health Mental health service area has very limited resources and people fall through the gaps. Coordination between services difficult and some services not available locally Psychologist/Counsellor who is able to provide bulk billing service to low income population. Cannot currently afford and won t attend. Health Workforce Shortage practices have closed appointment books to new patients Lack of funding for General Practices Access to funding for practice improvements Care coordination for patients with complex care needs 3 Alcohol and Other Drug education, support and programs 3 Access due to geography 2 Expectation of younger people - do not see any opportunities - so leave town community Communication of service availability Access to Physicians and Diabetes specialist and educator Mainstream services needing more Indigenous specific services and training Range of services to high care Dementia patients Wish list for health Increased funding for general holistic care coordination Gym/hydrotherapy pool in town so that population can access - currently nothing to do. School children, and larger population could use gym. Would assist with current social isolation issues. Employment opportunities. Dismal opportunities for income - low socio, mental health issues, drug seeking cycle. (2 similar ones) No cancers Access to X-ray Increased GP workforce to cope with patient presentations Stable GP workforce GP commitment to community and not seen as transient/locum Subsidised maintenance program delivery for elderly - not all patients are able to work and fix their homes/maintain etc.. More clinical resources - building improvements. GP recruitment - workforce shortage/succession planning Ready access to services for patients - travel/distance is issue. Providing population with access/opportunities for physical activity. Would also assist in social isolation and improved communication. A supportive environment to promote good health

13 Improved communication within the Health Service system to provide good and accurate information about what service is available and where. Additional bulk funding requiring less administration and more direct service delivery. Additional funding for general services rather than "high risk groups" The population to be able to live well. Social inclusion. Behaviour change -lifestyle factors Access; geographically & economically Additional comments Provide the community with access to activities for social inclusion and time out from technology - watching TV, computers and ipads. The town needs to start communicating and getting active. People need to take responsibility for their own health - the best model would be a preventative model. This could happen through education. Find avenues of support for practice Good relevant education for Practice nurses, they deliver the care to patients and need access to up to date information and education. Education should not be at lunch time - after 6pm is preferable. Bairnsdale is good location, Traralgon not suitable. Access to specialist services and sustainability of current staff. Consumer engagement - knowing where to go for services. Very complex Community support - 'Life Coach' access Having programs meeting the needs of the community We have yet to address climate change through a health services lens. Health services not prepared, e.g. for weather extremes affecting older and vulnerable people. Access and communication between services! 13

14 References 1. Victoria In Future 2015; /victoria-in-future Local Government Area Profiles Datasheet 2013, Department of Health and Human Services, Victoria, includes data from various sources, 3. Social Health Atlas of Australia; Data by Primary Health Network, published by Public Health Information Development Unit, November 2014; 4. Gippsland Health and Demographic Snapshot, Gippsland Health Online 5. Access Economics: Projections of dementia prevalence and incidence in Victoria : Department of Health Regions and Statistical Local Areas. 6. Turning Point; 7. National Health Performance Authority, 8. Ambulance Victoria data, using POLAR Explorer for the analysis (January 2016) 9. AIHW National Health Workforce Dataset, oject%2fexpenditure%20and%20economics%2freports&reportname=health%20workforce&appswi tcherdisabled=tr and population estimates for SA3 in Gippsland based on Victoria in Future Crime Statistics Agency, Sutherland P and Millsteed M, Briefing Copy - Recorded drug use and possession crime in metropolitan, regional and rural Victoria, Victoria Police LEAP, ; 14

15 Appendix 1 Methodology for Gippsland PHN Needs Assessment 2016 Gippsland PHN formed an internal Steering Committee for the Needs Assessment and invited comments from local representatives of the Monash School of Rural Health and the Department of Health and Human Services. The following components formed part of the needs assessment: A Brief Population Health Profile was produced to identify health issues in Gippsland based on reliable sources of information which allowed a comparison of Gippsland and its six Local Government Areas (LGA) with other PHNs and/or Victoria and Australia. Measures of demography, social status, health behaviours and risk factors, health conditions and status and service use / access were included. This document can be accessed via the Gippsland PHN web site. The service needs analysis included an overview of workforce and service provision by LGA, based on information available on web sites. It was identified that additional work is required to accurately describe available service options and coordination. A desktop analysis of existing reports including consumer and/or other stakeholder input on health issues from local organisations in Gippsland was undertaken. A letter was also sent to stakeholders requesting their assistance in identifying relevant reports. In total, 35 reports including consumer input and 46 reports including other stakeholder input were included in the analysis, representing LGAs, health services, non-government organisations and consumers across the PHN catchment. Reports were read and relevant consumer and stakeholder material was cut and pasted into separate documents. A qualitative analysis was undertaken by two independent reviewers using slightly different methodology (one using a combination of the techniques of pawing, word repetitions, and compare/contrast, while the other used a combination of cutting-and-sorting, word repletion and repetition-in-context). Key themes were developed and compared, arriving at a common set with agreed definitions and a count against each. Limitations to some of this data are acknowledged, such as an over-representation by local government reports, bias introduced by the authors since the analysis was not based on raw data and incomplete coverage of geographical areas and population groups. However, an important benefit of this analysis was the recognition of existing work and considerable efforts to include consumer input and engagement of key stakeholders. Semi-structured interviews were held with 69 key stakeholders representing general practice, health services, bush nursing centres, Aboriginal community-controlled organisations, local and state government organisations and non-government organisations. Stakeholders were invited to be interviewed based on their role, employer and geographical location to achieve broad representation. Direct experience with key population groups (including aged, children, young people and Indigenous people) or priority areas such as mental health was also considered. A set of seven open-ended questions was used as the basis for the interviews and responses were recorded by each of the five interviewers. A qualitative analysis of themes was undertaken using similar methods to those described under desktop analysis above. Assessment and triangulation of information from each component was undertaken in order to identify priorities. Initially, a modification of the method described in the guidelines provided by the Department was applied. The identified potential priorities were provided to the Gippsland PHN Clinical Council and interviewed key stakeholders who ranked them. Subsequently, additional triangulation incorporating the ranking results and measures of the size, severity and changeability of the issue and a measure of the PHNs role in addressing the potential priority was conducted. Resulting draft priorities were then distributed to the Steering Committee, the 15

16 Gippsland PHN Clinical Councils and interested stakeholders who provided information about suggested options to address them. Throughout the process of the needs assessment, it has been a priority to engage stakeholders as much as possible and to build relationships for future partnerships. This focus has affected the time available for in depth data analysis. However, the rich data gathered during interviews and through the Clinical Councils has been very valuable and possible partnership options have been identified, ensuring a strong position for Gippsland PHN for the future. Decisions about how to best capture consumer views in a short time frame warrant some additional comment. Initial plans included adding direct input from specific population groups after identifying gaps. However, after undertaking a desk top analysis of existing reports, it was found that a considerable body of information derived from consultations with thousands of consumers in Gippsland existed. In addition, it was identified that there was a risk that the quality of consumer input would be compromised if we chose, within short time lines, to undertake consumer surveys, or consultations without input from the Community Advisory Committee which was not yet operational. Therefore, it was decided that broad consumer input would be undertaken during , ideally in collaboration with municipal planners to ensure a coordinated approach. For the 2016 Needs Assessment, consumer views were obtained directly and indirectly from key groups including; - the Indigenous sector, including specific Alcohol and Other Drug input and via representation on the Gippsland Aboriginal Health Advisory Committee, - the mental health sector, including PIR consumer representatives and PIR Advisory Group input and input from the Gippsland Mental Health Alliance, and - the Gippsland Catchment Planning for AOD and Mental Health Community Support Services consumer and carer focus groups and the Gippsland Alcohol and Drug Service Providers Advisory group. 16