Biruu.Health. Department of Health. Shire-wide service plan For health services in the Macedon Ranges Shire

Department of Health Biruu.Health Shire-wide service plan For health services in the Macedon Ranges Shire In Partnership with Flynn Health Consulting Version 5.0: 15 October 2013

Contents 1 Executive Summary... 3 1.1 Background... 3 1.2 Findings... 3 1.3 Service plan objectives... 4 1.4 Service redevelopment options... 4 1.5 Recommendations and implementation... 6 1.6 Next steps... 7 2 Background... 8 2.1 Methodology... 8 3 About the catchment... 9 3.1 Demographics... 9 3.2 Health status of the community... 10 3.3 Mental health status of the community... 12 3.4 Socioeconomic status of the community... 13 4 Policy and planning context... 15 4.1 National Health Reform... 15 4.2 Living Longer Living Better, Australian Government Aged Care National Framework: 2012... 15 4.3 Victorian health priorities framework 2012-22: Rural and regional health plan... 16 4.4 Planning context... 16 4.5 Macedon Ranges Shire Council: Council Plan 2013 to 2017... 17 5 About the Macedon Ranges Shire health services... 18 5.1 Kyneton District Health... 19 5.2 Macedon Ranges Health... 20 5.3 Cobaw Community Health Service... 20 5.4 Macedon Ranges Shire Council... 21 5.5 Windarring... 21 5.6 Service partners... 22 5.7 Residential aged services... 23 6 Stakeholder consultations... 24 6.1 Summary of discussion... 24 6.2 Summary of community members comments... 24 6.3 Relationships between service providers... 24 6.4 Changing government requirements... 25 6.5 Service gaps and duplications... 26 6.6 Palliative care... 27 6.7 Sub-acute service model... 27 7 Service system requirements... 28 7.2 Service configuration... 29 7.4 Service volumes: aged services... 31 8 Service redevelopment... 32 8.1 Redevelopment objectives... 32 8.2 Options for service configuration... 33 9 Recommendations and Implementation... 37 9.1 Recommendations... 37 9.2 Next steps... 37 Appendix 1 People consulted... 39 Appendix 2 Data methodology... 41 Appendix 3 Acute services forecasts for Macedon Ranges Shire... 43 Medical services... 43 Surgical services... 46 Births... 49 Chemotherapy, radiotherapy and dialysis... 49 Same day scope procedures... 51 Emergency and urgent care services... 52 Appendix 4 Community-based services... 55 Kyneton District Health... 55 Macedon Ranges Health... 56 Macedon Ranges Shire Council... 57 Cobaw Community Health Service... 58 Version # Date Comment 1.0 20 May 2013 First draft for discussion by Project Control Group 2.0 12 June 2013 Second draft for discussion by Project Control Group 3.0 19 July 2013 Third draft for discussion: includes executive summary 4.0 23 August 2013 Fourth draft for discussion 4.1 9 Sept 2013 Editorial changes: AMcL and Biruu 4.2 30 Sept 2013 Changes to clarify recommendations 5.0 15 Oct 2013 Final draft, following endorsement in principle by Advisory Group 9 Oct 13 Disclaimer: Please note that, in accordance with Company policy, Biruu is obliged to advise that neither the Company, employee or sub-contractor undertakes responsibility in any way whatsoever to any person or organisation (other than the Client) in respect of information in this report, including any errors or omissions therein, arising through negligence or otherwise however caused. This document file name: Service Plan_Macedon Ranges Shire 5_0.docx Department of Health Page 2 of 58

1 Executive Summary Biruu.Health This Service Plan provides a strategic direction for three health and wellbeing services located in the Macedon Ranges Shire, approximately one hour s drive north of Melbourne in the Loddon Mallee Region. The Plan was commissioned by the Victorian Department of Health, and was supported by an Advisory Group including representatives of the Department, plus the three health and wellbeing services to be included in the Plan: Kyneton District Health Cobaw Community Health Service Macedon Ranges Health. In recognition of the strong interrelationships between organisations in the Shire, key service partners were invited to participate in the Advisory Group: Windarring and the Macedon Ranges Shire Council. The assistance of the organisations is gratefully acknowledged. Note that during the service planning project, the Advisory Group agreed to make some changes to the scope of the project. The main change was to consolidate the service planning reports, to include: A single Shire-wide health services plan describing a new service system to be jointly created by the existing service providers (this report) A dedicated plan for Kyneton District Health which complements the recommendations in this Plan, describes its role as a key health services provider in the Shire, and supports the completion of the Kyneton District Health master plan. 1.1 Background Macedon Ranges Shire had a population in 2011 of about 43,000 people. The largest community in Macedon Ranges Shire is Gisborne 1. The Shire is one of Victoria s 14 identified peri-urban local government areas, where the environmental and lifestyle benefits of smaller communities are matched with the challenges arising from high population growth. The Shire has three main town centres (Kyneton, Romsey and Gisborne) and four smaller ones, along with a number of small villages, and the dispersed population presents unique geographical service issues. The Service Plan is based on detailed consultation with community and organisational stakeholders, analysis of demographic and service delivery data, and a series of detailed discussions with the health and wellbeing service providers. 1.2 Findings Changes in the policy and planning environments have had significant impacts on the confidence and sustainability of the health and wellbeing service providers in Macedon Ranges Shire. Consequently this Service Plan documents some service redevelopments that are currently underway, while exploring options consistent with government policy for long-term change to make the service system sustainable in Macedon Ranges Shire. Some existing redevelopments have taken place in response to changes in Australian Government approaches to hospital and health service planning and management, including: Proposals for two primary care and community health facilities, one co-located with Kyneton District Health and the other with Macedon Ranges Health on the Gisborne campus. Funds for the two facilities were made available under the Health and Hospital Fund Closure by Kyneton District Health s residential aged care facility (the Thomas Hogan Wing) during July 2013, in response to new market drivers and in consultation with the Department of Health Reconsideration of service boundaries, particularly in response to the establishment of the Macedon Ranges and North West Melbourne Medicare Local which is responsible to drive strategies to improve the delivery and coordination of primary health services in a catchment from Macedon Ranges Shire to suburbs in inner-city Melbourne Redevelopment of Bendigo Health, which will increase its capacity over time to provide a greater range and volume of tertiary-level acute services and to support a health and wellbeing service system across Loddon Mallee Region 1 2011 Local government area profiles, Department of Health Modelling, GIS and Planning Products Department of Health Page 3 of 58

Changes to the role of local government, with new Victorian legislation mandating the preparation of community health and wellbeing plans which include health promotion, and new funding made available by the Australian Government for local governments health promotion programs and strategies through the Healthy Communities initiative The development of the National Disability Insurance Scheme, which will over time change the relationship between people and their service providers by giving people more control over the range of services they will use and the way in which they will receive them. These system-wide changes take place against a backdrop of service system challenges in Macedon Ranges Shire: The population is spread across a large area with no major population centre and poor natural transport links between the eastern and western parts of the Shire There is significant population growth in the parts of the Shire that are closest to Melbourne and to the main train and road transport links along the western spine, while the population in other areas is on average becoming older There is a number of small health and wellbeing services in the Shire, with larger State-wide and/or national public and private organisations starting to compete for roles with the Shire and the subregion. The small health and wellbeing services in the Shire believe they will over time become unsustainable as they have difficulty competing with larger service providers who have better scale economies and as the costs of compliance and accountability continue to increase While the Shire as a whole is not disadvantaged with comparison to other communities in Victoria, there are communities and individuals with poor access to employment, education, transport and health services. Innovative service models are needed to address the needs of these people and to provide integrated health and wellbeing solutions within and outside the Shire Kyneton District Health has had difficulties meeting community demand for some of the lowcomplexity health services that should be expected, including urgent care services, low-risk maternity services and low-complexity medical and surgical interventions. On the other hand, some of its services have suffered from low occupancy, and it appears the health service configuration is not well aligned with community need. 1.3 Service plan objectives The health and wellbeing services in Macedon Ranges Shire have agreed a number of objectives for service redevelopment. Within the context of government policy and consistent with health and wellbeing service demand, the agencies seek to find options that deliver: 1 Responsiveness: to make accessible throughout the region a system of person-centred health and wellbeing services 2 Suite of services: to create a suite of services and pathways that respond appropriately to the range of health and wellbeing needs within the community 3 Local engagement: to connect the health and wellbeing service system within the Macedon Ranges communities and contribute to the strength of local economies 4 Sustainability: to create a platform for investment in the long-term growth of the health and wellbeing service system in the Shire. To maximise efficiency and strengthen the health and wellbeing service infrastructure in the Shire. 1.4 Service redevelopment options In considering options, we have defined three types of health and wellbeing services: Hospital-based services that should be provided in only one location within the Shire. These services are provided in the Macedon Ranges Shire by Kyneton District Health and its acute and sub-acute partners Community-based services that should be provided in three areas across the Shire to maximise access (Kyneton, Gisborne and Lancefield/Romsey). These are mainly primary health services, community health services, some aged services and mental health services Department of Health Page 4 of 58

Universal services, which should be available throughout the Shire in people s homes, in community settings and online. These are health promotion and disease prevention services, aged services, disability services and related services such as education and transport. We have considered three options for the redevelopment of a health and wellbeing service system in Macedon Ranges Shire: No change option: where service locations, service models and organisational arrangements remain largely unchanged, except where individual agencies make internal changes Collaboration option: the three health services would create a vehicle which provided organisational and back-of-house services, in order to create scale economies and reduce the managerial and administrative duplication in the Shire Transformation option: create a new service system based on an understanding of the communities needs and create organisational arrangements that suit the new service models. 1.4.1 Option 1: no change Under this option, the existing group of health and wellbeing service providers continues to seek opportunities to improve their efficiency and to provide a wider suite of responsive services. However, many of the existing problems will not be able to find a solution under this option, particularly: The duplication of managerial and governance effort across the Shire The inefficient use of physical infrastructure The fragmentation of services and difficulties in finding appropriate pathways for people The risk that policy and program changes made by Government reduce the viability of the services, rather than achieving their desired effects. 1.4.2 Option 2: collaboration Under this option, the health and wellbeing services in the Shire (and others if the model were to be attractive) would create or engage an independent entity which would provide shared organisational services: personnel management, resource management, compliance, fundraising and so on. Each service provider would agree to engage the services of the management entity, but would retain its own identity and service profile. 1.4.3 Option 3: service transformation This is the preferred option, which is most able to deliver the service planning objectives. Under this option, a health and wellbeing service system is created, which brings together: A consolidated provider of community-based and universal services that would have a physical location in each of Kyneton, Gisborne and Lancefield/Romsey, and would provide a network of universal services across the Shire and beyond. Note the Woodend Children s Hub would provide another location for family and children s services in the Shire Some individual agencies who would partner with the consolidated provider to create the transformed service system: Kyneton District Health, Windarring, Macedon Ranges Shire Council and the Macedon Ranges. Over time, these organisations may decide to merge with the consolidated organisation and/or transfer service responsibilities to it Health and wellbeing service partners within the Shire and beyond, who provide networked services such as mental health services, sub-acute services, trauma services and other clinical services. There are other organisations who may wish to participate in the service system such as providers of education, transport, community welfare and family services. The role of the consolidated provider of community-based and universal services would be modified to include the existing roles of the organisations who join to create the organisation, as well as some new roles. The consolidated provider would operate as: Information provider: one of the key service enhancements sought by stakeholders is increased access to information which would assist people to manage their own health and wellbeing, and to access appropriate services when needed Department of Health Page 5 of 58

Fund-holder: by holding funds for service delivery within the catchment, the organisation can direct resources to areas of greatest need and seek alternative low-complexity responses for individuals with specific needs Pathway manager: the organisation would be responsible to equitably provide accessible points of entry to the service system, assisting people to access Shire-based, universal and/or other services to meet their needs. People s pathways may or may not include services provided within the Macedon Ranges Shire. Operating as a pathway manager, the consolidated provider would ensure Shire residents had access to regional and networked services such as mental health services, aged services, alcohol and drug services, and highly-specialised acute health services Service provider: the organisation would be responsible to bring together existing non-acute health and wellbeing services, as well as identifying opportunities for service enhancement and expansion. The service model would be based on the existing services provided within the Shire, although the consolidated provider aims to increase its service offerings by participating in service development and funding rounds managed by the Victorian and Australian Governments such as the Aged Care Approvals Round, National Disability Insurance Scheme arrangements, and primary care enhancements funded by the Medicare Local. 1.5 Recommendations and implementation The following recommendations are made to support service system transformation: That the three existing health and wellbeing service providers develop a Memorandum of Understanding which commits them to continue working together toward the proposed service system redevelopment. The Memorandum of Understanding should be based on the objectives described in Section 1.3, above, and should support an eventual process by which some of the organisations join under common governance That the Department of Health endorse the redevelopment objectives and commit to assisting the transformation process That other partners are invited to participate in the transformation process. In the first instance the other invited partners would be Windarring and Macedon Ranges Shire Council. Other partners will be identified over time The service partners develop a common system and platform for the service entry functions: information, referrals, pathway management Create an integrated health promotion, primary, community and acute service system based on the principle of subsidiarity (that services that are effectively provided by the least complex organisation should not be provided by more-complex organisations) and partnership. The service system would depend on partnerships between agencies, and the devolution of roles and responsibilities to the most locally-based organisations That the service partners continue to identify new sources of funding and new service delivery options so as to increase the suite of health and wellbeing services available to service users. This is likely to become the main mechanism for service system growth in the Shire. The following recommendations are made to support organisational reconfiguration: That the service partners identify a strategy to allocate existing resources and/or seek additional resources to establish a new service delivery base in the eastern part of the Shire (Romsey and Lancefield area). Models for this service delivery base may include physical locations and colocations, and/or virtual service delivery platforms That the service partners determine a fund-holding strategy, under which they would hold funds to purchase packages of primary care services for Macedon Ranges Shire residents. The cooperation and assistance of the Macedon Ranges and North Western Melbourne Medicare Local will be needed in order to develop appropriate referral pathways for general practitioners and primary care providers. The service partners may also hold funds for regional and networked services such as mental health services, aged services and others That the service partners continue to develop models for information technology-enabled health service delivery, in partnership with VeRSI, University of Melbourne and La Trobe University and others Department of Health Page 6 of 58

That the service partners endorse the service configuration and service role described in the service plan for Kyneton District Health and all agencies agree to work together during the transformation process to reduce service barriers, eliminate service duplication and extend service delivery platforms across the Shire. 1.6 Next steps Once the Advisory Group has agreed its preferred strategy for service and organisational transformation, a proposal should be presented to the Department of Health seeking endorsement for the strategy and assistance with some elements of the transition process. The following actions are needed: Short term actions: by the end of 2013, the Master Plan for Kyneton District Health needs to be completed. While this is happening and by April 2014 the service partners will develop a Memorandum of Understanding, an innovation strategy, an implementation plan and a communications plan. Opportunities for location of services in the Romsey and Lancefield area are underway, and will continue during the short term Medium-term actions: during 2014, the service partners will need to complete their detailed planning, conduct due diligence and finalise organisational arrangements. The new organisation will need to review its suite of services, develop a plan to enhance the service suite where consistent with its goals and with government policy, and start detailed discussions with service partners Long-term actions: once the new organisational arrangements are in place the service partners can finalise collaboration agreements and identify opportunities to enhance and expand the service suite including through the development of virtual services. The accompanying service plan for Kyneton District Health specifies service volumes for hospital-based services and roles for the primary care service that is to be built during 2014. This will assist the master planners to reconsider the hospital facility and appropriately locate the primary care facility, and will provide a basis for discussions between Kyneton District Health and the Department of Health with regard to an appropriate funding basis for the service profile. Department of Health Page 7 of 58

2 Background Biruu.Health The purpose of this service plan is to provide an overview and strategic direction for health and aged services in Macedon Ranges Shire. There are three health services in scope for the project: Kyneton District Health, Macedon Ranges Health and Cobaw Community Health Service. The Department of Health has engaged Biruu.Health to develop a series of Service Plans that will help the health services in Macedon Ranges Shire to achieve the following: Optimal operational arrangements in order to improve residents access to services, support safety and quality of care and promote a cost-effective and financially sustainable service system in the Shire An appropriate service profile, taking into account demand for health services from the primary catchment, supply of services from relevant other providers within and outside the sub-region, demand forecasts over ten years, and relevant government policies and funding parameters Agreed roles for the health service providers in the sub-region, acknowledging the roles of other service providers, and opportunities for collaboration Strategies for building and strengthening relationships and partnerships between the local service providers An implementation plan for each service provider. Note that during the service planning project, the Advisory Group agreed to make some changes to the scope of the project. The main change was to consolidate the service planning reports, to include: A single Shire-wide health services plan describing a new service system to be jointly created by the existing service providers (this report) A dedicated plan for Kyneton District Health to support completion of its master plan. 2.1 Methodology This service plan is based on a series of consultation meetings with key stakeholders within and outside Macedon Ranges Shire. Community members were given an opportunity to comment on health needs, with a dedicated email address established for the project. A list of people consulted is provided at Appendix 1. A summary of community members comments is provided in Chapter 6 below. The project was commissioned and managed by the Department of Health. The Department established an Advisory Group whose membership is provided in Table 1. Table 1 Advisory Group members Organisation Position Name Department of Health, Loddon Mallee Director Loddon Mallee Region Ann-Maree Conners Region Manager Social and Environmental Annette Toohey Programs Manager, Acute and Aged Services Andrew Kallaur Department of Health, Capital Project Manager, Rural Service Graeme Sheers Projects and Service Planning Planning Manager, Rural Service and Capital David Kaye Planning Cobaw Community Health Service Chief Executive Anne McLennan Macedon Ranges Health Chief Executive Bill Ashby Kyneton District Health Chief Executive Jennifer Gale Windarring Adult Training and Chief Executive Bev Vines Support Service Macedon Ranges Shire Council Director, Community Wellbeing Karen Stevens Information for this service plan is based on publicly available information and datasets provided by the Department of Health Victoria, Macedon Ranges Shire Council and the Macedon Ranges Shire health services, unless otherwise stated. Additional information on the methodology is provided in Appendix 2. Department of Health Page 8 of 58

3 About the catchment Biruu.Health The Macedon Ranges Shire is located approximately one hour s drive north of Melbourne in the Loddon Mallee Region, with a population in 2011 of about 43,000 people. The largest community in Macedon Ranges Shire is Gisborne 2. The Shire is one of the 14 rural and regional peri-urban local government areas, where the environmental and lifestyle benefits of smaller communities are matched with the challenges arising from high population growth. The Shire has three main town centres (Kyneton, Romsey and Gisborne) and four smaller ones, along with a number of small villages, and the dispersed population presents unique geographical service issues. 3.1 Demographics Over the next fifteen years, the population of Macedon Ranges Shire is expected to grow by 1.6 per cent per annum or 27.6 per cent in total, with the Macedon Ranges Shire Balance and Romsey projected to experience the most significant growth (Table 2). By comparison, the state of Victoria is expected to grow by 1.4 per cent per annum during that time period. Table 2 Macedon Ranges Shire estimated population growth 2011 to 2026 Statistical Local Area 2011 2016 2021 2026 Change 2011 to 2026 Per cent growth 2011 to 2026 Growth per annum Macedon Ranges (S) - 9,077 9,460 9,799 10,186 1,109 12.2% 0.8% Kyneton Macedon Ranges (S) - 12,138 13,510 14,757 15,961 3,823 31.5% 1.8% Romsey Macedon Ranges (S) Bal 22,026 24,370 26,722 29,026 7,000 31.8% 1.9% (incl. Gisborne) Total 43,241 47,340 51,279 55,172 11,931 27.6% 1.6% Source: Victoria in Future 2012 By 2026, the number of people aged over 65 years living in Macedon Ranges Shire is forecast to more than double with many older people living outside the major population centres. While this will bring many benefits including new community skills and capacities, it will also present some challenges as the older people are likely to need more health and aged care services, including services in sometimes-remote homes and communities (Figure 1). Figure 1 Macedon Ranges Shire population projections by age group 2011 to 2026 4,500 4,000 3,500 Number of persons 3,000 2,500 2,000 1,500 1,000 500 0 5 year age group Source: Victoria in Future 2012 Year 2011 Year 2016 Year 2021 Year 2026 2 2011 Local government area profiles, Department of Health Modelling, GIS and Planning Products Department of Health Page 9 of 58

3.2 Health status of the community Biruu.Health Several datasets are available which can provide indicators of community health status. Some datasets, such as the Burden of Disease, are not included as they are now outdated. Please refer to the following websites for additional information on the health status and social determinants of health for Macedon Ranges Shire: Department of Health, Health status of Victorians: http://www.health.vic.gov.au/healthstatus/composite/index.htm Macedon Ranges Shire Council, Population profile: http://www.mrsc.vic.gov.au/council_the_region/about_our_region/population_profile CVHA Health and Wellbeing Profile for the Macedon Ranges Shire 2012: http://cvha.com.au/admin/wpcontent/uploads/2013/05/summary-and-issues-mrs-2012-final-may-2013.pdf 3.2.1 Avoidable Mortality Avoidable mortality refers to the number of premature and unnecessary deaths for which effective public health and medical interventions are available 3. Using the rates of avoidable mortality from 2002 to 2006 and the 2011 standardised population, the Macedon Ranges Shire had 249 deaths that could have been avoided (Table 3). Table 3 Total Avoidable Mortality for the Macedon Ranges Shire using the 2011 standard population AM Group Number of deaths Standardised Rate per 100,000 Persons Lower limit of 95% CI Upper limit of 95% CI Unavoidable Mortality 145 86.49 72.19 100.79 Total Avoidable Mortality 249 147.24 128.54 165.94 Primary AM 128.8 76.26 62.77 89.75 Secondary AM 60.65 36.24 26.92 45.56 Tertiary AM 59.55 34.74 25.69 43.79 Notes: CI - Confidence Interval; for privacy, the output is suppressed when less than 5 deaths are reported Source: Victorian Health Information Surveillance System (VHISS), Health Intelligence Unit, Prevention and Population Health Branch, Wellbeing, Integrated Care and Aged Division of the Department of Health Victoria Ischaemic Heart Disease (IHD) and lung cancer were the two most frequent avoidable mortality conditions, with 50 and 29 deaths, respectively, followed by colorectal cancer and suicide with 26 deaths each (Table 4). Table 4 Avoidable Mortality for the Macedon Ranges Shire using the 2011 standard population AM Condition Number of deaths Standardised Rate per 100,000 Persons Lower limit of 95% CI Upper limit of 95% CI Standardised Rate per 100,000 Persons: Victoria Ischaemic Heart Disease (IHD) 50 29.84 21.42 38.26 32.94 Lung cancer 29 16.28 10.26 22.31 22.71 Colorectal cancer 26 15.85 9.63 22.06 13.10 Suicide 26 15.70 9.39 22.01 11.01 Road traffic injury 18 12.35 6.41 18.28 6.95 Breast cancer 18 9.65 5.10 14.19 9.74 Skin cancers 13 6.82 3.07 10.58 3.94 Stroke 8 5.45 1.66 9.24 6.78 Stomach cancer 8 4.80 1.43 8.17 3.90 Chronic Obstructive 6 4.12 0.82 7.41 8.35 Pulmonary Disease (COPD) Diabetes 6 4.09 0.81 7.38 7.80 Alcohol related conditions 6 3.42 0.65 6.20 4.41 Respiratory infections 5 2.93 0.32 5.54 0.75 Hepatitis and liver cancer 5 2.70 0.29 5.12 3.57 Congenital anomalies 5 2.56 0.30 4.81 1.27 Notes: CI - Confidence Interval; for privacy, the output is suppressed when less than 5 deaths are reported Source: Victorian Health Information Surveillance System (VHISS), Health Intelligence Unit, Prevention and Population Health Branch, Wellbeing, Integrated Care and Aged Division of the Department of Health Victoria 3 Health Information Surveillance System (VHISS), Health Intelligence Unit, Prevention and Population Health Branch, Wellbeing, Integrated Care and Aged Division, 11 March 2011 Department of Health Page 10 of 58

3.2.2 Australia Early Development Index (AEDI) In 2012, 636 children in the Macedon Ranges Shire were surveyed for the Australian Early Development Index (AEDI), to show how young children are developing in the Shire s communities. The average age of children surveyed was five years and 10 months old. Five areas of early childhood development were measured, including: physical health and wellbeing, social competence, emotional maturity, language and cognitive skills (school-based) and communication skills and general knowledge. In Australia, 22.0 per cent of children are developmentally vulnerable on one or more domains, and 10.8 per cent of children are developmentally vulnerable on two or more domains 4. Results of the survey indicate that children in the Macedon Ranges community are less developmentally vulnerable than Australian children in general, scoring better across all categories except emotional maturity. Compared with children in Victoria, Macedon Ranges Shire children scored better for social competence, language and cognitive skills (schoolbased) and communication skills and general knowledge (Table 5). Table 5 AEDI Macedon Ranges 2012 community results table Proportion of children developmentally vulnerable (%) Number Macedon of Language Communicat Vulnerable on Vulnerable on Ranges Physical children Social Emotional and cognitive ion skills and one or more two or more community health and surveyed competence maturity skills (schoolbased) knowledge the AEDI AEDI general domains of domains of the wellbeing Australia 289,973 9.3 9.3 7.6 6.8 9.0 22.0 10.8 Victoria 67,931 7.8 8.1 7.2 6.1 8.0 19.5 9.5 Macedon Ranges 636 8.0 7.1 8.8 5.2 6.1 19.1 9.0 Local Community Gisborne & 137 3.8 7.8 8.5 3.8 4.6 16.4 7.8 surrounds Kyneton & 105 2.9 2.9 4.9 1.9 1.9 8.7 2.9 surrounds Lancefield 32 13.8 20.7 17.2 13.8 3.4 34.5 17.2 Macedon 31 3.3 0.0 6.7 0.0 3.3 10.0 3.3 Mt Macedon 26 0.0 4.0 4.0 0.0 4.0 4.0 4.0 New 36 11.1 2.8 5.6 5.6 8.3 19.4 5.6 Gisborne# Newham & 23 22.7 9.1 4.5 13.6 13.6 31.8 18.2 surrounds Riddells Creek 59 6.9 8.6 10.5 6.9 5.2 21.1 8.6 Romsey / 88 16.0 13.6 17.3 12.3 9.9 33.3 21.0 Darraweit Guim Woodend / North 99 10.6 4.3 6.5 2.1 9.6 19.6 7.4 # AEDI data collection is greater than or equal to 60% and less than 80% of the ABS five-year-old population, interpret with caution Source: 2012 Community results table: AEDI Macedon Ranges community, Victoria; Version 1 (February 2013) Legend values Highest proportion Lowest proportion 0.0 = There are no children developmentally vulnerable 4 http://reports.aedi.org.au/community-profile/vic/2012/24130.pdf Department of Health Page 11 of 58

3.3 Mental health status of the community Biruu.Health While there are no definitive data sources supporting an analysis of the mental health status of the community, several indicators are available: a voluntary survey of general practitioners in the Shire, results from the 2008 Victorian Population Health Survey, and people s usage of admitted mental health services. 3.3.1 Macedon Ranges Shire: online general practice survey In March 2013, the Macedon Ranges Shire Council invited local general practices to participate in an anonymous online survey that would help inform the health and wellbeing plan. Twenty-one responses were received, from both individual general practitioners, and from practices answering collectively. General practitioners reported mental health, lifestyle and chronic disease as the top three issues that they spend most of their time talking to patients about (Table 6). Table 6 Survey results: What GPs spend the most time talking to patients about Issue Frequency Mental health 16 Lifestyle including exercise, diet and smoking 12 Chronic disease 9 Overweight/obesity 4 Drug and alcohol 3 Other 13 Source: Macedon Ranges Shire Council health and wellbeing planning: Results from online GP survey (April 2013 release) 3.3.2 Victorian Population Health Survey 2011-2012 The Victorian Population Health Survey is conducted periodically by Department of Health. Preliminary findings 5 indicate that in Macedon Ranges Shire, approximately: 15.3 per cent of the Shire population are current smokers (compared with 15.7 per cent in Victoria), 27.9 per cent are ex-smokers and 56.3 per cent are non-smokers 6.8 per cent of the Shire population complies with both fruit and vegetable consumption guidelines, compared with 5.2 per cent of the Victorian population 33.4 per cent of the Shire population is at low risk of short-term alcohol-related harm (35.8 per cent in Victoria), 54.5 per cent consume alcohol at risky or high risk levels weekly, monthly or yearly (45.3 per cent in Victoria), and only 12.0 per cent are abstainers 85.5 per cent of the Shire population is at a low risk of long-term alcohol-related harm (77.3 per cent in Victoria), and 2.1 per cent are at a high risk of long-term alcohol-related harm (3.3 per cent in Victoria) 3.5 per cent of the Shire population is sedentary, and 29.7 per cent get insufficient time and sessions of physical activity (compared with 5.5 per cent and 26.6 per cent in Victoria, respectively) 54.6 per cent of the Shire population is overweight or obese, compared with 49.8 per cent of the Victorian population Based on the Kessler 10 psychological distress scale, 26.4 per cent of the Shire population is moderately psychologically distressed (21.5 per cent in Victoria) and 6.9 per cent of the population is highly distressed (11.1 per cent in Victoria) 51.1 per cent of the Shire population report having a excellent or very good health status (46.6 per cent in Victoria), 35.7 per cent report having a good health status (37.3 per cent in Victoria) and 13.1 per cent report having a fair/poor health status (15.9 per cent in Victoria). This summary indicates that while the overall health status of Macedon Ranges Shire is better than the Victorian average, there is an underlying level of moderate psychological distress in the community, as well as a relatively high level of risky alcohol use and a larger number of people who have insufficient exercise. 5 Department of Health Victoria, Victorian Population Health Survey 2011-2012: Selected preliminary survey findings Department of Health Page 12 of 58

3.3.3 Acute mental health service delivery For acute inpatient mental health services, 42.9 per cent of Macedon Ranges Shire patients received care at a regional hospital followed by 38.8 per cent in a private hospital in 2011/2012. By 2026/2027, the number of mental health services provided to Macedon Ranges Shire residents at a regional hospital is expected to more than double, with the overall number of services provided by all Victorian health providers in an acute inpatient mental health service projected to increase by 73.4 per cent (Table 7). This demonstrates the networked nature of acute mental health services, which are provided in the southern part of the Loddon Mallee region by Bendigo Health. Table 7 Where Macedon Ranges Shire residents are going for mental health services 2011/2012 projected to 2026/2027 (designated mental health service) Hospital 2011/ 2012 2013/ 2014 2016/ 2017 2018/ 2019 2021/ 2022 2026/ 2027 Difference 2011/2012 to 2026/2027 Per cent change Regional hospital 63 76 88 96 110 136 73 115.8% Private Hospital 57 98 100 100 99 99 42 74.5% Metro Specialist 13 10 11 11 11 13 0-1.5% hospital Metro hospital 13 <5 <5 5 5 7-6 -48.5% Sub regional <5 -<5-100.0% hospital Total 147 189 204 211 226 255 108 73.4% Source: Victorian Admitted Episodes Dataset 2013, Department of Health Projections 3.4 Socioeconomic status of the community The Australian Bureau of Statistics uses census data to produce its Index of Relative Socio-Economic Disadvantage. It is based on a range of census variables considered to reflect levels of disadvantage, including income level, employment status and level of educational attainment. A number of studies have indicated a consistent correlation between low socioeconomic status and poor health. These data are collated to create the Socio-economic Index for Areas. Scores are standardised so that the average score across Australia is 1,000. Scores lower than 1,000 indicate relatively more disadvantaged areas and higher scores indicate relatively less disadvantaged areas. The Index of Economic Resources focuses on the financial aspects of relative socio-economic advantage and disadvantage, by summarising variables related to income and wealth. Financial aspects include the number of owned or rented homes, the amount of rent paid, household income and other economic variables. The Index of Education and Occupation reflects a communities educational and occupational level, including qualifications achieved, number of people undergoing further education, and the number of people in low or high skilled occupations. 6 Table 8 demonstrates that Macedon Ranges Shire is the least disadvantaged Local Government Area within the Loddon Mallee region, with the Shire s major townships all scoring above the average index score of 1,000 for relative socioeconomic disadvantage. Table 8 Index of Relative Socioeconomic Disadvantage 2011 for Local Government Areas Local Government Area Index of Relative Socioeconomic Disadvantage Decile within Victoria* Rank amongst LGAs in Victoria** Index of Economic Resources (Decile)* Index of Education and Occupation (Decile)* Macedon 1,055.1 9 72 10 9 Ranges Shire City of Greater 983.1 4 31 5 6 Bendigo Campaspe 964.1 3 20 5 4 Shire Mildura Rural 935.0 1 5 2 3 6 http://www.abs.gov.au/ausstats/abs@.nsf/lookup/2033.0.55.001main+features100062011 Department of Health Page 13 of 58

Local Government Area City Index of Relative Socioeconomic Disadvantage Decile within Victoria* Rank amongst LGAs in Victoria** Index of Economic Resources (Decile)* Biruu.Health Index of Education and Occupation (Decile)* Swan Hill Rural 949.8 2 10 3 5 City Buloke Shire 967.7 3 22 4 7 Central 904.6 1 2 2 1 Goldfields Shire Mount 983.3 4 32 5 8 Alexander Shire Gannawarra Shire 958.8 3 18 4 4 Loddon Shire 934.1 1 4 3 6 *Note: All areas are ordered from the lowest to highest score, with the lowest 10% of areas given a decile number of 1 and so on, and the highest 10% of areas given a decile number of 10 **Note: All areas are ordered from the lowest to highest score, with the area with the lowest score given a rank of 1 Source: ABS 2033.0.55.001 - Census of Population and Housing: Socio-Economic Indexes for Areas (SEIFA), Australia, 2011 Within Macedon Ranges Shire, Kyneton is the most disadvantaged town with an index score of 961.8, followed by Lancefield with an index score of 978.2 (Table 9). Table 9 Index of Relative Socioeconomic Disadvantage 2011 for Macedon Ranges Shire towns Area Index score Area Index score Gisborne District 1,081.9 Gisborne 1,074.1 Kyneton District Kyneton 961.8 999.8 Malmsbury 990.5 Lancefield District 1,023.4 Lancefield 978.2 Macedon and Mt Macedon Macedon 1,088.6 District 1,093.9 Mount Macedon 1,103.4 Riddells Creek District 1,087.3 Riddells Creek 1,089.4 Romsey District 1,047.5 Romsey 1,034.6 Woodend District Woodend 1,032.8 1,059.8 Tylden 1,026.5 Macedon Ranges Shire 1,055.1 Regional VIC 977.7 Victoria 1,009.6 Australia 1,002.0 Source: Australian Bureau of Statistics, Census of Population and Housing 2011. Compiled and presented in atlas.id using ABS 2033.0.55.001 - Census of Population and Housing: Socio-Economic Indexes for Areas (SEIFA), Australia, 2011 Department of Health Page 14 of 58

4 Policy and planning context The policy and planning context lies in documents and strategies published by the Australian and Victorian Governments, and by the Macedon Ranges Shire Council. All health service planning is now carried out against a background of national reform which aims to improve efficiency, accountability and accessibility of health and aged services. 4.1 National Health Reform The national health reform agenda aims to shift the priority of service delivery away from the hospital system to the primary health system, while implementing a national efficient-pricing mechanism and strengthening local networks of health service providers. This approach has been agreed between the Australian Government and all State and Territory Governments. The key changes include: Establishment of Medicare Locals across Australia, to improve local planning and delivery of primary care services Creation of the Independent Hospital Pricing Authority and a National Health Funding Pool to implement a national activity-based funding approach New national performance targets including emergency department and elective surgery targets Increased funding for aged services and acute and sub-acute services across Australia. The creation of networks of health care organisations and providers with responsibility and accountability for a coordinated response to local needs is a central concept of the health reform agenda. Health care providers will be expected to work together effectively at a local level, with an increasing focus on partnerships and cooperative arrangements between services and opportunities for planning and service delivery to consider the entire continuing of care. 4.2 Living Longer Living Better, Australian Government Aged Care National Framework: 2012 The Living Longer Living Better aged care reform package was publicly announced during April 2012 to provide $3.7 billion over five years, and kick-off a 10 year reform program designed to stream-line aged care services in Australia. While the reform package aims to improve residential care through building more residential aged care facilities, establishing a new Aged Care Financing Authority and improving the Aged Care Funding Instrument, the policy particularly emphasises increasing resources to home-based and community-based aged services and supporting carers. This will be done through increasing the number of Home Care packages, establishing fairer means testing for the Home Care packages, and establishing Customer Directed Care and an integrated Home Support Program. A substantial amount ($1.2 billion) of the funding is directed to strengthening the aged care workforce. The reform package also aims to tackle the dementia epidemic through including a new Dementia Supplement in home and residential care, improving hospital and primary care and overall improving the approach to dementia care. The new aged care framework includes new planning benchmarks for residential aged care places and home-based packages. For the first time, the new benchmarks do not distinguish between levels of care, providing for: 80 residential places per 1,000 population over the age of 70 45 community-based Aged Care Packages per 1,000 population over the age of 70. In addition to the Living Longer Living Better policy framework, the Commonwealth Government also released during August 2012 the Aged Care Financing Authority Interim Operating Framework. This authority was established in order to advise the Government on pricing and financial issues across the aged care sector and ultimately help achieve the Australian Government s objectives for the aged care financing arrangements. In particular, their roles and responsibilities include: Determining pricing policy and subsidy rates Providing independent advice to the Minister for Mental Health and Ageing on pricing policy Approving the fees that aged care providers are permitted to levy, where those fees are regulated by the Aged Care Act 1997 Department of Health Page 15 of 58

Ensuring consumers are informed and supported. 4.3 Victorian health priorities framework 2012-22: Rural and regional health plan The Victorian health priorities framework 2012-22: Rural and regional health plan (the Health Plan) establishes a framework for the planning and development of priorities for health services state-wide by 2022 and sets out the long-term directions and next steps for rural and regional Victoria s health services. The Health Plan recognizes that rural and regional Victoria is sociologically, culturally, economically and spiritually different from metropolitan areas, which affects how health services are delivered and determines the health needs of the population. The Health Plan describes the key health issues experienced by Victoria s rural and regional population, including an ageing population, access to primary, secondary, tertiary and specialist health service providers, the prevalence of chronic diseases, and the availability of community-based services. By 2022, the government aims to provide a health system that is responsive to people s needs and rigorously informed and informative. 4.4 Planning context It is recognised that some services are provided locally by networked and/or regional service providers, working in partnership and consultation with local health services. In Macedon Ranges Shire: Clinical mental health services are provided by the Loddon Campaspe / Southern Mallee Area Mental Health Service (Bendigo Health) Currently non-clinical mental health services are provided by St Lukes Community Support, however the reform of the Psychiatric Disability Support Service system may result in catchment-based changes Home-based aged care services (Community Aged Care Packages and Extended Aged Care at Home) are provided by a number of regional, statewide and national organisations under contract to the Australian Government. There are no sources of reliable information about the actual number of people in Macedon Ranges Shire who receive home-based aged services Renal services are provided by Kyneton District Health under the auspice of the RMH Kidney Care Service Other specialised acute services managed within clinical networks (stroke, cardiac and children s services) are not directly provided within the Shire, although Kyneton District Health is a part of the sub-regional service systems for these services Sub-acute services and specialised inpatient and consulting palliative care services are provided by Bendigo Health and Castlemaine Health. Kyneton District Health provides a community-based palliative care team, and Macedon Ranges Health is funded to provide a sub-regional continence service Specialised alcohol and drug services are provided on a regional basis by Bendigo Community Health Service and Bendigo Health. Loddon Mallee region seeks a systemic approach to the planning and delivery of health services, and has developed a number of regional strategies including: The Regional Diabetes Pathway Project, which provide guidelines for the identification and management of people with pre-diabetes, type 1, type 2 and gestational diabetes The oral health plan, which informs investment, strengthens system integration and increases prevention efforts The community mental health planning and service coordination initiative, which supports implementation of the Victorian Mental Health Reform Strategy at the local level Closing the Gap Implementation Plan, which estimates the Aboriginal population as 3.7 per cent of the Macedon Ranges Shire population. The Shire is serviced by the Bendigo and District Aboriginal Cooperative. The Implementation Plan recommends that health services should be more culturally competent, and should be more willing to hire Aboriginal staff. It recommends greater attention to smoking cessation and awareness programs and detoxification facilities, while recognising the importance of partnerships between Aboriginal and non-aboriginal health services. Department of Health Page 16 of 58