Southern NSW Medicare Local Population Health Sub Regional Profile Pty Ltd ACN 118 337 821 Level 3, 86 Liverpool Street, Sydney, New South Wales, 2000 Phone (02) 9261 3707 Fax (02) 9261 3705 26 July, 2013 Final Version 1
Table of Contents Section Page INTRODUCTION... 1 POPULATION AND COMMUNITY CHARACTERISTICS... 2 2.1 POPULATION CHARACTERISTICS... 2 2.2 BIRTH RATE... 3 2.3 CULTURAL CHARACTERISTICS... 4 2.4 EDUCATION LEVELS... 4 2.5 SOCIO-ECONOMIC CHARACTERISTICS... 4 2.6 EMPLOYMENT... 5 2.7 ABORIGINAL AND TORRES STRAIT ISLANDER COMMUNITY... 6 2.8 HOMELESSNESS... 6 HEALTH RISKS OF THE POPULATION... 7 3.1 HEALTH RISK FACTORS... 7 3.2 ALCOHOL RELATED DOMESTIC VIOLENCE INCIDENCES... 7 3.3 HEALTH SCREENING RATES... 8 3.4 IMMUNISATION... 9 LONG TERM CONDITIONS, CHRONIC DISEASE AND DISABILITY... 12 4.1 PREVALENCE OF CHRONIC DISEASE...12 4.2 MORTALITY...13 4.3 INFECTIOUS DISEASE...14 4.4 DISABILITY...15 HEALTH SERVICE AVAILABILITY... 16 5.1 ACUTE AND DAY SURGERY...16 5.2 GENERAL PRACTITIONER...16 5.3 ALLIED HEALTH...17 5.4 COMMUNITY HEALTH SERVICES...18 5.5 AGED CARE...20 HEALTH SERVICE UTILISATION... 22 6.1 PRIMARY CARE UTILISATION...22 6.2 EMERGENCY...22 6.3 HOSPITAL ADMISSION...22 6.4 AMBULATORY-CARE SENSITIVE ADMISSIONS...23 6.5 HOME AND COMMUNITY CARE...24
APPENDICES APPENDIX A: POSTCODE TO LGA/SLA CORRESPONDENCES APPENDIX B: DATA SOURCES AND LIMITATIONS APPENDIX C: AMBULATORY CARE SENSITIVE CONDITIONS QUERY
1 Introduction (LGA) (pop: 37,991) is located in the southern tablelands of New South Wales (NSW), along the eastern border of the Australian Capital Territory (ACT). This LGA includes the suburbs and villages of Queanbeyan City, Carwoola, Crestwood, Environa, Googang, Greenleigh, Jerrabomberra, Karabar, Queanbeyan East, Queanbeyan West, The Ridgeway, Royalla and Tralee. The Ngunnawal people are the traditional owners of these lands. Queanbeyan City is located just 15 kilometres from Canberra and 250 kilometres south-west of Sydney, close to the junction of the Molonglo and Queanbeyan Rivers. Due to its proximity to Canberra, many residents within this regional centre work within the federal capital while residing in New South Wales. Not only is Queanbeyan the most populous region within the Southern NSW Medicare Local (ML) catchment, but it is anticipated to be one of the fastest population growth areas within all of NSW. Table 1.1 provides general characteristics of the Queanbeyan LGA at a glance. Population^ Indicator Table 1.1: Characteristics of the Queanbeyan LGA at a glance Value LGA Rank within ML Medicare Local NSW 37,991 1 189,415 6,917,656 Population growth forecast (2011 to 2025) # 44.1% 2 28.2% 20.3% % Indigenous persons # 3.0% 2 3.0% 2.5% Average annual household income^ $99,352 2 $74,094 $80,813 Unemployment # 2.12% 6 4.94% 5.7% % English as primary language^ 85.2% 6 94.1% 72.5% Private Health Insurance coverage # 55.8% 2 45.7% 48.2% Broadband internet penetration # 70.9% 2 66.0% 69.9% Source: ^Australian Bureau of Statistics; # Public Health Information Development Unit and Australian Bureau of Statistics Southern NSW Medicare Local Page 1
% of total population 2 Population and community characteristics Headlines A higher proportion of young residents aged 49 and less, compared to the ML Highest birth rate among sub-regions in the ML Average household incomes are higher than the ML average Second highest SEIFA score among the sub-regions in the ML Low rates of homelessness per-capita 2.1 POPULATION CHARACTERISTICS Figure 2.1 shows that the population profile of the Queanbeyan LGA is generally younger than the overall ML population, with a greater proportion of residents aged 49 and less, accounting for 72.9% of the total population. The highest proportion of residents are aged 40 to 49 (16.6%), followed closely by residents aged 30 to 39 (14.9%) and 20 to 29 (14.7%) 1. Within Queanbeyan, there are fewer residents aged 50+ years as compared to the ML catchment overall. Figure 2.1: Population profile (by age) versus ML and state comparators, 2011 9% 8% 7% 6% 5% 4% 3% 2% 1% 0% 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85 years Queanbeyan (C) Southern NSW New South Wales + Source: Public Health Information Development Unit and Australian Bureau of Statistics (2012) Population forecasts for the Queanbeyan LGA to 2025 are provided in Figure 2.2. Population growth is expected to be larger than the broader ML catchment area for all age groups with the largest percentage increase in population in age range75 to 79 (133.5%). Across all age groups combined, population growth in the Queanbeyan LGA is expected to be 44.1% between 2011 and 2025, which is almost double the forecast population growth across both the ML (28.2%) and NSW (20.2%) 2. In real numbers, it is estimated that the population in this catchment will increase to around 70,000, in real numbers, by 2036 making Queanbeyan one of the fastest growing centres in NSW. In addition, the age profile of the population is predicted to shift, with much of the population growth occurring in the 60+ year age range. Large increases in population are expected in new developments at Googong and in the Jerrabomberra Valley due to their proximity to Canberra, with a large percentage of the population living in NSW but working in ACT. 3 1 Public Health Information Development Unit and Australian Bureau of Statistics (2012) 2 ibid. (2012) 3 http://www.qcc.nsw.gov.au/discover-queanbeyan/heritage. Accessed 17 February 2013. Southern NSW Medicare Local Page 2
Births per 1,000 population % populations growth (2011 to 2025) Figure 2.2: Forecast population growth (2011 to 2025, by age) versus ML and state comparators,2011 to 2025 140% 120% 100% 80% 60% 40% 20% 0% 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85 Growth Growth years (all aged + ages) 65+ Queanbeyan (C) Southern NSW New South Wales Source: Public Health Information Development Unit and Australian Bureau of Statistics (2012) 2.2 BIRTH RATE The birth rate in Queanbeyan is the highest in the ML (14.5 births per 1,000 population), followed by Upper Lachlan/Goulburn Mulwaree (11.7 births per 1,000 population) and Yass/Palerang (11.6 births per 1,000 population). The birth rate in this region is higher than both the Southern NSW ML (11.3 births per 1,000 population) and NSW (13.7 births per 1,000 population). 16.0 14.0 12.0 10.0 8.0 6.0 4.0 2.0 Figure 2.3: Comparison of Birth Rates across the ML and state, 2011 0.0 Upper Lachlan /Goulburn Mulwaree Yass Valley/Palerang Queanbeyan Eurobodalla Bega Valley Monaro Southern NSW NSW Source: Australian Bureau of Statistics (2011) Figure 2.4 shows the percentage of births where mothers were aged 15 to 20 years. Although Queanbeyan reports a high proportion of residents within the 20-45 years of age and a higher birth rate than average for the ML and NSW, Queanbeyan has a relatively lower proportion of young mothers (1.0%) compared to the other regions in the ML. Southern NSW Medicare Local Page 3
% of total population % of all births Figure 2.4: Comparison of births with mothers aged 15 to 20 across the ML, FY 2011/2012 1.4% 1.2% 1.0% 0.8% 0.6% 0.4% 0.2% 0.0% Upper Lachlan/ Goulburn Mulwaree Queanbeyan Eurobodalla Bega Valley Monaro Source: Provided by Southern NSW LHD, Data received 12 Feb 2013 2.3 CULTURAL CHARACTERISTICS Figure 2.5 shows that the cultural diversity of the Queanbeyan LGA varies in comparison with the overall cultural profile across the entire ML. Majority (85.2%) of Queanbeyan residents identify English as the primary language spoken at home, which is less than the overall ML percentage (94.1%), but is higher than the NSW percentage (76.5%). Figure 2.5: Primary language spoken at home versus ML and state comparators,2011 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% English Northern Europe Eastern Europe Southern Europe Southern Asia Southeast Asia Eastern Asia Middle East Australian Indigenous Other Queanbeyan Southern NSW New South Wales Source: Australian Bureau of Statistics (2011) 2.4 EDUCATION LEVELS Within the Queanbeyan LGA, 51% of people aged over 15 years have completed Year 12 schooling (or equivalent). 4 Data available from PHIDU indicates that secondary school participation at age 16 is approximately the same in Queanbeyan (79.3%) as the Southern NSW ML overall (79.2%) and slightly lower than across NSW (80.1%). The proportion of school leavers from Queanbeyan that go on to pursue higher education qualifications (18.0%) is higher than the overall ML (14.0%), but is lower than NSW (26.6%). 2.5 SOCIO-ECONOMIC CHARACTERISTICS The Socio-Economic Indexes For Areas (SEIFA) index score for socio-economic advantage and disadvantage in Queanbeyan is 1,051, which places it in the 86 th percentile of Socio-Economic 4 Profile Id: Queanbeyan, (2012), accessed from http://profile.id.com.au/queanbeyan/ Southern NSW Medicare Local Page 4
% of all industry sectors Percentile Advantage and Disadvantage 5 for NSW, and is ranked 2 nd out of the six sub-regions within the Southern NSW ML. 6 Figure 2.6 shows Queanbeyan s relative socio-economic advantage rating within the overall ML. Figure 2.6: Comparison of SEIFA* Advantage and Disadvantage percentiles across the ML, 2011 100 90 80 70 60 50 40 30 20 10 0 Upper Lachlan/ Goulburn Mulwaree Yass Valley/Palerang Queanbeyan Eurobodalla Bega Valley Monaro (Bombala, Cooma-Monaro, Snowy River) Advantage and Disadvantage percentile within NSW Source: Australian Bureau of Statistics (2011) Note*: Mean SEIFA score was used for sub-regions with more than one LGA The distribution of household incomes in Queanbeyan include a greater proportion of households earning high incomes (26.6%), compared to the ML overall, and a smaller proportion of households on lower incomes (14.7%). 7 2.6 EMPLOYMENT An analysis of the jobs held by the residents of Queanbeyan reveal that the top five industry sectors are Public Administration and Safety (27.5%), Construction (9.7%), Retail Trade (9.4%), Health Care and Social Assistance (8.7%) and Professional, Scientific and Technical Services (6.5%). Together, these five industries employ 61.8% of the population, which is higher when compared to the ML (44%) and NSW (43.3%). 30.0% Figure 2.7: Top five Industry Sector of Employment versus ML and state comparators, 2011 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% Public Administration and Safety Construction Retail Trade Health Care and Social Assistance Professional, Scientific and Technical Services Queanbeyan Southern NSW NSW Source: Australian Bureau of Statistics (2011) Unemployment in Queanbeyan (2.1%) is lower than the ML average (4.9%), which reinforces the relatively higher level of household income with a large proportion of the population being Clerical and Administrative Workers (20.2%), Professionals (19.2%) and Managers (13.2%) 8. 5 Australian Bureau of Statistics (2006) 6 Public Health Information Development Unit and Australian Bureau of Statistics (2012) 7 Australian Bureau of Statistics (2011) Southern NSW Medicare Local Page 5
Persons per 1,000 2.7 ABORIGINAL AND TORRES STRAIT ISLANDER COMMUNITY Aboriginal Australians comprise a total of 3.0% of the total population of the Queanbeyan LGA, which is identical to the average for the ML (3.0%) and higher than the average of NSW (2.5%). The Aboriginal population in Queanbeyan is young with almost half of the population (47%) is aged between 0 to 19 and only 2% aged 65 years and older. 9 Although it is widely recognised that the Aboriginal population has poorer access to health care services and poorer overall health status, indicators that describe the health of Indigenous persons at a LGA level were not available for the purposes of this project. Analysis of acute patient-level activity data may help to provide some insight into the health issues facing Indigenous persons in Queanbeyan. 2.8 HOMELESSNESS Figure 2.8 shows that the per-capita rate of homelessness in Queanbeyan (2.7 persons per 1,000) is 18% lower than the ML (3.2 persons per 1,000) and 22% lower than NSW (3.4 persons per 1,000). Queanbeyan overall has a lower per-capita rate of homelessness for all categories compared to the ML. Figure 2.8: Housing and homelessness indicators versus ML and state comparators, 2006 4.0 3.5 3.0 2.5 2.0 1.5 1.0 0.5 - In improvised dwellings, tents or sleeping out Staying temporarily with other households Living in 'severely' crowded dwellings All homeless persons Living in other crowded dwellings Queanbeyan Southern NSW NSW Source: Australian Bureau of Statistics (2006) 8 ibid 9 Public Health Information Development Unit and Australian Bureau of Statistics (2012) Southern NSW Medicare Local Page 6
Population % 3 Health risks of the population Headlines Low overall health risk profile, with a lower prevalence of all risk factors compared to the overall ML Lower incidence of alcohol related domestic violence compared to other sub-regions in the ML Lowest participation rate for health screenings compared to the ML overall 3.1 HEALTH RISK FACTORS Figure 3.1 shows that the health risk profile of Queanbeyan is generally lower than the risk profile of the ML and NSW in terms of the proportion of the population that are smokers, consume risky amounts of alcohol, physically inactive, psychologically distressed or overweight/obese. The proportion of physically inactive persons in Queanbeyan (32.2%) represents the largest difference to the ML (36.6%). Figure 3.1: Health risk factors versus ML and state comparators, 2007-08 40% 35% 30% 25% 20% 15% 10% 5% 0% Smokers Risky alcohol consumption Overweight persons Obese persons Physically inactive persons Psychologically distressed Queanbeyan (C) Southern NSW New South Wales Source: Public Health Information Development Unit and Australian Bureau of Statistics 2007-08 National Health Survey Note: Data represents a mean of age-standardised rates 3.2 ALCOHOL RELATED DOMESTIC VIOLENCE INCIDENCES Although, in real numbers, Queanbeyan has the highest number of reportable incidents of domestic violence, there is a lower percentage of alcohol related domestic violence incidents (46%) when compared across the ML (51% alcohol related incidents), but a higher rate as compared to NSW (39%). Southern NSW Medicare Local Page 7
% screened Total number of domestic violence incidents Figure 3.2: Comparison of alcohol related domestic violence incidences across the ML, Jan-Dec 2011 160 140 120 100 80 60 40 20 0 55% Upper Lachlan/ Goulburn Mulwaree 43% Yass Valley/ Palerang 46% 47% 58% 53% Queanbeyan Eurobodalla Bega Valley Monaro Alcohol related incidents Non-alcohol related incidents Source: NSW Bureau of Crime Statistics and Research, 2011. 3.3 HEALTH SCREENING RATES This section presents the bowel cancer, breast cancer and cervical screening rates in Queanbeyan LGA. 3.3.1 Bowel cancer screening rates Figure 3.3 shows the percentage of people who participated in the National Bowel Cancer Screening Program for each sub-region in the Southern NSW ML. Queanbeyan had the lowest overall rate among the sub-regions (34%), with a higher participation from females (38%) compared to males (30.4%). Figure 3.3: Comparison of bowel cancer screening rates across the ML, 2010 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% Bega Valley Eurobodalla Queanbeyan Upper Lachlan/Goulburn Mulwaree Yass Valley/Palerang Monaro NSW Source: Department of Health and Ageing - Note: 1. Formal publication and reporting of the NBCSP data is undertaken by the Australian Institute of Health and Welfare on behalf of the Department of Health and Ageing. NBCSP data included in this report provided by the Department of Health and Ageing is not part of the formal publication and reporting process for NBCSP data. Note: 2. Cautionary note about small numbers - Due to a larger degree of statistical fluctuation in small numbers, great care should be taken when assessing apparent differences involving small numbers and measures based on small numbers. 3.3.2 Breast cancer screening rates Figure 3.4 shows the biennial participation rate of women aged 50 to 69 who were screened for breast cancer for the period ending 30 June 2012. Queanbeyan had the second highest rate among the subregions (46.2%), however this screening rate is slightly lower than the Upper Lachlan/Goulburn Mulwaree sub-region (48%) despite having a similar population of females in the 50-69 age range and is 8.6% lower than the NSW average overall (50.2%). Southern NSW Medicare Local Page 8
% of women screened % of women screened aged 50-69 Figure 3.4: Comparison of biennial breast cancer screening rates for women aged 50-69 across the ML 60% 50% 40% 30% 20% 10% 0% Bega Valley Eurobodalla Queanbeyan Upper Lachlan/Goulburn Mulwaree Yass Valley/Palerang Monaro NSW Source: Cancer Institute NSW and HOIST database, Period: 01/07/2010 to 30/06/2012 3.3.3 Cervical cancer screening rates Figure 3.5 shows the biennial participation rate of women in the age ranges 20 to 49, 50 to 69 and overall aged 20 to 69 who were screened for cervical cancer for the period ending 30 June 2012. Queanbeyan had a lower participation rate compared to the other sub-regions across all age ranges. Queanbeyan was ranked fourth for the age range 20 to 49 (55.1%), was the lowest for age range 50 to 69 (53.1%) and was second last for the overall age range 20 to 69 (54.6%). The participation rate in Queanbeyan for age range 50-69 was lower (15.4%) than the NSW average. Figure 3.5: Comparison of biennial cervical cancer screening rates for women aged 20-69 across the ML 70% 60% 50% 40% 30% 20% 10% 0% Bega Valley Eurobodalla Queanbeyan Upper Lachlan/Goulburn Mulwaree Yass Valley/Palerang Monaro NSW 20-49 years 50-69 years 20-69 years Source: NSW Pap Test Register, Cancer Institute NSW, HOIST database and NSW Health Survey 2008, Period: 01/07/2010 to 30/06/2012 3.4 IMMUNISATION Figure 3.6 shows the percentage of children who are fully immunised in Southern NSW ML during October to December 2012. Southern NSW ML has a very high rate of children who are fully immunised, with the age range between 24 to 27 months having the highest percentage (93.1%). Southern NSW Medicare Local Page 9
Rate per 1,000 persons % of children whose parents have withdrawn consent for vaccination %of children fully immunised Figure 3.6: Percentage of children fully immunised in Southern NSW ML, Oct to Dec 2012 93.5% 93.0% 92.5% 92.0% 91.5% 91.0% 90.5% 90.0% 89.5% 12-<15 Months 24-<27 Months 60-<63 Months Southern NSW Source: Department of Health and Ageing Figure 3.7 shows percentage of children whose parents have withdrawn consent for them to have vaccinations across the ML. Queanbeyan LGA has the fourth highest rate across the ML in 2011-12 (1.2%) and the lowest rate in 2012-13 (0.2%). Figure 3.7: Percentage of children whose parents have withdrawn consent for vaccination across the ML 5.0% 4.5% 4.0% 3.5% 3.0% 2.5% 2.0% 1.5% 1.0% 0.5% 0.0% Upper Lachlan/Goulburn Mulwaree Yass Valley/Palerang Queanbeyan Eurobodalla Bega Valley Monaro 2011-2012 2012-2013 Source: Department of Human Services, 2011-12 & 2012-13 Figure 3.8 shows the vaccine preventable notification rates for Pertussis per 1,000 persons for Southern NSW and NSW from 2008 to 2012. The data highlights a prolonged period of increased epidemic activity from 2009-2011 with the highest rate being in 2011 (2.5 per 1,000 persons). A high concentration of notifications occurred in children aged 5-14 years during the epidemic period. Figure 3.8: Vaccine preventable Pertussis notification rates per 1,000 for Southern NSW and NSW, 2008 to 2012 3.0 2.5 2.0 1.5 1.0 0.5 0.0 2008 2009 2010 2011 2012 SNSW NSW Source: Public Health Unit covering Murrumbidgee and Southern NSW Local Health Districts, 2008-2012 Note: Only those cases that were notified to the Public Health Unit are included in the analysis and as a result, the data might only represent a small proportion of the actual number of cases and the data is not absolute Southern NSW Medicare Local Page 10
Rate per 1,000 persons Figure 3.9 shows the vaccine preventable notification rates for pneumococcal per 1,000 persons for Southern NSW and NSW from 2008 to 2012. The data reflects a divergence in local notification rates from the comparative NSW rate. A low number of reports in young children (aged 1-4 years) could be seen to reflect a high uptake of vaccine in this cohort, while higher number of cases among older people could be indicative of lower immunisation coverage rates. Figure 3.9: Vaccine preventable Pneumococcal notification rates per 1,000 for Southern NSW and NSW, 2008 to 2012 0.12 0.10 0.08 0.06 0.04 0.02 0.00 2008 2009 2010 2011 2012 SNSW NSW Source: Public Health Unit covering Murrumbidgee and Southern NSW Local Health Districts, 2008-2012 Note: Only those cases that were notified to the Public Health Unit are included in the analysis and as a result, the data might only represent a small proportion of the actual number of cases and the data is not absolute During the reporting period, there were no reported cases of measles, rubella, tetanus or diphtheria and a low level activity of mumps and meningococcal disease, which is consistent with the trend seen in NSW over the period 2008-2012. Southern NSW Medicare Local Page 11
% of total population 4 Long term conditions, chronic disease and disability Headlines Similar prevalence of chronic diseases compared to the ML and NSW averages Low incidence of most cancers, but higher cancer-related mortality per capita compared to both the ML and NSW Higher rate of mortality from preventable causes compared to the ML and NSW average Second lowest suicide rate among other sub-regions in the ML Highest prevalence rate of chlamydia per 1,000 persons compared to the ML High proportion of persons aged 70 years and above requiring assistance with core activities 4.1 PREVALENCE OF CHRONIC DISEASE Figure 4.1 shows that the prevalence of Type 2 diabetes (3.3%), high cholesterol (5.3%), mood disorders (6.8%), circular system diseases (14.7%) and musculoskeletal conditions (29.6%) within Queanbeyan closely mirror those rates across the entire ML. Only the prevalence of the respiratory system diseases (25.7%) is slightly higher. 35% 30% 25% 20% 15% 10% 5% Figure 4.1: Prevalence of selected chronic conditions versus ML and state comparators, 2007-08 0% Type 2 Diabetes High Cholestorol Mood Disorders Circulatory System Diseases Queanbeyan (C) Southern NSW New South Wales Respiratory System Diseases Musculoskeletal Conditions Source: Public Health Information Development Unit and Australian Bureau of Statistics 2007-08 National Health Survey Note: Mood disorders include depression, anxiety, dysthymia and bipolar; Circulatory system conditions include ICD-10-AM codes I00 to I99; Respiratory system diseases include ICD-10-AM codes J00 to J99; Musculoskeletal conditions include ICD-10-AM codes M00 to M99. Note: Data represents a mean of age-standardised rates Figure 4.2 presents the incidence of selected cancers in Queanbeyan, which shows that the incidence of all cancers types are slightly lower than the incidence across the ML. In particular, the incidence of prostate cancer (0.57 cases per 1,000 persons) is significantly lower in Queanbeyan in comparison to the ML (1.03 cases per 1,000 persons) and NSW (0.92 cases per 1,000 persons). Southern NSW Medicare Local Page 12
Cases per 1,000 persons Prevalence per 1.,000 persons Figure 4.2: Incidence of selected cancers per 1,000 persons versus ML and state comparators, 2004 to 2008 1.00 0.80 0.60 0.40 0.20 0.00 Breast Cervix Colon Lung Melanoma Prostate Stomach Queanbeyan Southern NSW NSW Source: Cancer Institute NSW (2010); Note: Incidences reported are crude rates (not age-standardised) 4.2 MORTALITY Figure 4.3 presents mortality rates from chronic conditions in Queanbeyan for persons aged between 0 and 74. Data shows that premature mortality from cancer (1.15 deaths per 1,000 persons) and respiratory system disease (0.19 deaths per 1,000 persons) are higher in Queanbeyan than across both the ML and NSW. These results follow from the higher prevalence of respiratory system diseases and similar prevalence rates to the ML and NSW for cervical, colon and stomach cancers as shown in Figures 4.1 and 4.2, respectively. Despite having a similar prevalence rate for circulatory system diseases to NSW, the premature mortality rate is higher for these conditions (0.63 cases per 1,000 persons) in Queanbeyan than in NSW (0.58 cases per 1,000 persons). Figure 4.3: Premature mortality* from chronic disease (ages 0 to 74 years) and external causes per 1,000 persons versus ML and state comparators, 2003 to 2007 1.40 1.20 1.00 0.80 0.60 0.40 0.20 - Cancer Circulatory system disease Respiratory system disease External causes Queanbeyan (C) Southern NSW New South Wales Source: Public Health Information and Development Unit and Australian Bureau of Statistics (2012). Note: * Premature mortality is defined by PHIDU as mortality occurring prior to 75 years of age; Circulatory system conditions include ICD-10-AM codes I00 to I99; Respiratory system diseases include ICD-10-AM codes J00 to J99; External causes include deaths arising from transport accidents, accidental falls, accidental poisoning, assault and suicide;death rates reported are crude rates (not age-standardised). In line with high rates of premature mortality from chronic diseases, the per-capita rate of avoidable mortality in Queanbeyan (1.09 deaths per 1,000 persons) is 4% higher than the Southern NSW ML (1.05 deaths per 1,000 persons) and is 11% higher than the NSW rate (0.98 deaths per 1,000 persons), as illustrated in Figure 4.4. Southern NSW Medicare Local Page 13
Cases per 1,000 persons Deaths per 1,000 persons Figure 4.4: Avoidable mortality* per 1,000 persons versus ML and state comparators 1.12 1.10 1.08 1.06 1.04 1.02 1.00 0.98 0.96 0.94 0.92 Queanbeyan (C) Southern NSW New South Wales Avoidable mortality Source: Public Health Information and Development Unit and Australian Bureau of Statistics (2012). Note: * Data relates to persons aged from 0 to 74 years where mortality is caused by a number of conditions specified by the Public Health Information Development Unit. A list of ICD codes used as the basis for the calculation of avoidable mortality is available here; Mortality rates reported are crude rates (not age-standardised). In comparison to other regions in the ML, Queanbeyan has a lower suicide rate (0.08 cases per 1,000 persons, ranked 5 th ) and is also slightly lower than the average across the ML (0.10 cases per 1,000 persons) and NSW (0.09 cases per 1,000 persons). Figure 4.5: Premature mortality* from suicide^ and self-inflicted injuring (ages 0 to 74 years) per 1,000 persons across the ML and state comparators, 2003 to 2007 0.16 0.14 0.12 0.10 0.08 0.06 0.04 0.02 0.00 Upper Lachlan/ Goulburn Mulwaree Yass Valley/ Palerang Queanbeyan Eurobodalla Bega Valley Monaro Southern NSW NSW Source: Public Health Information and Development Unit and Australian Bureau of Statistics (2012). Note: * Premature mortality is defined by PHIDU as mortality occurring prior to 75 years of age;death rates reported are crude rates (not agestandardised). Note^: Suicide rates were not available for Yass Valley, Upper Lachlan, Snowy River or Bombala LGAs. 4.3 INFECTIOUS DISEASE Figure 4.6 shows the rate per 1,000 persons for sexually transmitted chlamydia infections across the ML. In Southern NSW, sexually transmitted chlamydia infections are the most frequently notified condition. Queanbeyan has the highest reportable rate among the sub-regions (16.8 per 1,000 persons); a rate 43% higher than Eurobodalla (9.5 per 1,000 persons) and 54% higher than Upper Lachlan/Goulburn Mulwaree sub-region (7.8 per 1,000 persons). In Southern NSW, chlamydia has a higher prevalence rate among age range 15 to 24 and is higher for females than males. Southern NSW Medicare Local Page 14
% of all persons in age group Rate per 1,000 persons Figure 4.6: Prevalence rates of sexually transmitted chlamydiainfections per 1,000 persons across the ML, 2008-2012 18.0 16.0 14.0 12.0 10.0 8.0 6.0 4.0 2.0 0.0 Upper Lachlan/Goulburn Mulwaree Yass Valley/Palerang Queanbeyan Eurobodalla Bega Valley Monaro Source: Public Health Unit covering Murrumbidgeeand Southern NSW Local Health Districts From 2008 to 2012, there have been a total of 60 notifications of gonorrhoea in Southern NSW. Notified cases of syphilis, newly acquired hepatitis B and C are also infrequently reported in Southern NSW. For privacy reasons, the total number of cases has not been included in this report. 4.4 DISABILITY Figure 4.6 shows that Queanbeyan residents aged 70 and above have a much greater need for assistance with core activities than the average compared to the broader ML, and NSW. With strong predicted growth in the number of residents aged 70+ years to 2025, assistance required for aged persons in Queanbeyan has implications for population health needs both now and in the future in terms of the requirement for access to aged care, allied health and rehabilitation services. Figure 4.6: Proportion of persons requiring assistance with core activities* versus ML and state comparators, 2011 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% Less than 50 50 to 59 60 to 69 70 to 79 80+ Age Queanbeyan Southern NSW NSW Source: Australian Bureau of Statistics (2011). Note: * Core activities are defined by the ABS as needing help in one or more of three activity areas of self-care, mobility and communication Southern NSW Medicare Local Page 15
5 Health service availability Headlines There is one public hospital, Queanbeyan Hospital & Community Health Service, which has less than 50 beds Lowest per capita rate of GPs of any sub-region in the ML The number of high-care residential aged care places per 1,000 persons aged 70+ is 65% higher than the ML and 50% higher than NSW 5.1 INPATIENT SERVICES Table 5.1 shows that Queanbeyan has one public hospital, which offers a range of services (e.g. emergency, surgery, medical, maternity and renal). Although there is only one facility within this LGA, many Queanbeyan residents seek acute and day surgery services from the ACT, due to their close proximity to Canberra. Public sector health services Table 5.1: Inpatient facilities in Queanbeyan Health Service Name Service Type Location Queanbeyan Hospital & Community Health Service Public Hospitals Queanbeyan Source: NSW Health Establishment Registration Online (HERO) database 5.2 GENERAL PRACTITIONERS Figure 5.1 shows the GP FTE per 1,000 persons across the sub-regions in Southern NSW ML. Queanbeyan has the second lowest rate of GPs per 1,000 persons in the ML (0.79). Sub-regions with a similar population size (i.e. Eurobodalla, Upper Lachlan/Goulburn Mulwaree) both have much higher GP availability rates per capita. When using 1 GP per 1,133 residents as a benchmark 10,11,12, the availability of GPs appears inadequate to service residents within this region. Importantly, these ratios could be distorted as Queanbeyan residents could be obtaining adequate primary care service from GPs located in Canberra ACT. Unfortunately, data required to report on these potential cross-border flows was unavailable for this report. 10 May J, Jones PD, Cooper RJ, Morrissey M, Kershaw G. (2007) GP perceptions of workforce shortage in a rural setting. The International Electronic Journal of Rural and Remote Health Research, Education, Practice and Policy. http://www.rrh.org.au/articles/subviewaust.asp?articleid=720 11 Wilkinson D. Inequitable distribution of general practitioners in Australia: analysis by state and territory using census data. Australian Journal of Rural Health 2000; 8: 87-93. 12 May J, Morrissey M, Cooper R, Kershaw G. Supporting the rural GP workforce: impact of a managed care practice. In, Proceedings, General Practice & Primary Health Care Conference; 5-7July 2006; Perth, WA; 2006. Southern NSW Medicare Local Page 16
FTE per 1,000 persons GP FTE per 1,000 persons Figure 5.1: Comparison of General Practitioners per 1,000 persons across the ML 1.20 1.00 0.80 0.60 0.40 0.20 0.00 Upper Lachlan/Goulburn Mulwaree Palerang/Yass Valley Queanbeyan Eurobodalla Bega Valley Monaro Source: Provided by Southern NSW Medicare Local, Data received on 27 Feb 2013 5.3 ALLIED HEALTH Figure 5.2 shows the availability of private and NGO allied health practitioners per 1,000 persons in Queanbeyan LGA compared to the ML. Queanbeyan LGA appears to be better serviced for all services provided in the sub-region when compared to the ML. Queanbeyan has a 38% higher per capita rate of physiotherapists (0.39 per 1,000 persons) when compared to the catchment area (0.24 per 1,000 persons) Figure 5.2: Private and NGO allied health practitioners per 1,000 persons in Queanbeyan LGA versus the ML 0.45 0.40 0.35 0.30 0.25 0.20 0.15 0.10 0.05 0.00 Queanbeyan Southern NSW Source: Provided by Southern NSW Medicare Local, Data received on 22 March 2013 Figure 5.3 shows the total Private and Public Mental Health practitioners per 1,000 persons across the sub-regions in Southern NSW ML. Queanbeyan has the highest rate of clinical psychologists (0.65 per 1,000 persons), the second highest rate of social workers (0.30 per 1,000 persons) and the fourth highest rate of psychologists (0.58 per 1,000 persons) in comparison to the other sub-regions. Southern NSW Medicare Local Page 17
FTE per 1,000 persons Figure 5.3: Comparison of Private and Public Mental Health Practitioners per 1,000 persons across the ML 0.80 0.70 0.60 0.50 0.40 0.30 0.20 0.10 0.00 Upper Lachlan/Goulburn Mulwaree Yass Valley/Palerang Queanbeyan Eurobodalla Bega Valley Monaro Clinical Psychology Nurse* Psychology Social Worker Source: Provided by Southern NSW Medicare Local and Southern NSW LHD, Data received on 22 March 2013 Note* Nurse = Mental Health Nurse, Registered Nurse and Enrolled Nurse There are three Aboriginal allied health providers in Queanbeyan as shown below in Table 5.2. Table 5.2: Aboriginal Allied Health Providers in Queanbeyan Allied Health Category Practice Name FTE Aboriginal Health Worker Munjuwa Aboriginal Health, Housing and Community Corporation 0.00 (1xweek) Nursing Munjuwa Aboriginal Health, Housing and Community Corporation 0.00 (1xweek) Optometry Munjuwa Aboriginal Health, Housing and Community Corporation 0.20 (1xquarter) Source: Provided by Southern NSW ML, Received on 7 March 2013 5.4 COMMUNITY HEALTH SERVICES This section presents an analysis of the community services available within the Queanbeyan sub region, including mental health community services. 5.4.1 Community health facilities, services and providers Table 5.3 lists the four community health centres in Queanbeyan including Queanbeyan Community Health Centre; Karabar (Karabar Community Health Centre); Jerrabomberra (Jerrabomberra Community Health Centre) and Bundendore (Bundendore Community Health Centre). Table 5.3: Community health facilities/services in Queanbeyan Health Facility Name Facility Type Location Public sector health services Queanbeyan Community Health Centre Community Health Centre Queanbeyan Karabar Community Health Centre Community Health Centre Karabar Jerrabomberra Community Health Service Community Health Service Jerrabomberra Bungendore Community Health Service Community Health Service Bungendore Source: Provided by Southern NSW LHD, Received on 5 July 2013 In addition, according to the Southern NSW Local Health District, a number of community health sites deliver a range of public programs and services which are determined by: 1. Ministry of Health Community Based Service Streams and 2. General funded community nursing and allied health services. Figure 5.4 shows that there is a full range of child, youth and family services, chronic care, rehabilitation and aged health services, oral health services and priority population health services provided under the Ministry of Health Community Based Service Streams Southern NSW Medicare Local Page 18
Table 5.4: Ministry of Health Community Based Service Streams Child, Youth and Family Services Chronic Care, Rehabilitation and Aged Health Services Oral Health Services Priority Population Services Antenatal and postnatal care Child and Family Health (including Early Childhood Health Services and HealthOne NSW) Immunisation (including infant, adolescent & adult services) Sustaining NSW Families Programs Building Strong Foundations for Aboriginal Children, Families and Communities Out of Home Care Assessments and Coordination Statewide Eyesight for Preschoolers Screening Statewide Infant Screening Hearing Child Protection (including Physical Abuse and Neglect of Children services) Domestic and Family Violence Services Sexual Assault Services Victims of Crime Services Youth Health Services Aged Health (geriatric medicine aged care assessment and transitional aged care) Chronic Care (Connecting Care, other Chronic Care Services, and HealthOne NSW services) Dementia Services Home and Community Care Palliative Care Rehabilitation Services Pain management services Oral health promotion Early Childhood Oral Health Program services Specialist and special needs dental services Dental services for Aboriginal communities and older people Clinical training placements of dental and oral health students Dental services delivered through Justice health services Aboriginal Health Breast Cancer & Cervical Screening Carer Support Services Disability Services Multicultural Health Refugee Health Source: Provided by Southern NSW LHD, Received on 5 July 2013 Table 5.4 shows that there are 34.69 FTE providing Ministry of Health Community Based Service Streams services (in community and hospital) in Queanbeyan LGA: Table 5.4: FTE providing Ministry of Health Community Based Service Streams Home and Comm unity Care Palliati ve Care Aged Service s Emerge ncy Team/A ged to Acute Rehab Care Aged Care Assess ment Team Transiti onal Aged Care progra m Oral Health Women Health Statewide eyesig ht preschool screeni ng Statewide Infant hearing screeni ng Sexual Assault Service s Child Protect ion-on Counse lling Service s Aborigi nal Health Sexual Health Oncolo gy Cancer Care Total 5.67 4.05 1.0 2.72 3.22 8.84 1.25 0.3 0.32 1.05 1.12 2 1.33 0.91 0.91 34.69 Source: Provided by Southern NSW LHD, Received on 26 March 2013 In addition, Figure 5.5 outlines the services that are provided under the General funded community nursing and allied health services. Southern NSW Medicare Local Page 19
Table 5.5 General funded community nursing and allied health services Community Nursing Services Provided both in patients homes and in community health clinic settings Models of service delivery include a mix of generalist, specialist and program funded services Services include chronic disease management, wound care, cardiac and pulmonary rehabilitation, palliative care, diabetes education, tuberculosis, cancer care, palliative care, women s health (cervical screening, breast care and violence prevention), child and family nursing, immunisation, infant hearing and preschool sight tests. A significant number of community-based nursing services are also funded through the Community Health and Home and Community Care (HACC) programs requiring separate reporting on client outputs. Allied Health Services Provided by clinicians employed under identified programs and generalist and specialist services. Provide a mix of hospital in-reach and community based services Services include audiology, allied health assistants, dietetics, occupational therapy, physiotherapy, psychology, social work and speech pathology Source: Provided by Southern NSW LHD, Received on 26 March 2013 Table 5.5 shows that there are 28.68 FTE available in the General funded community nursing and allied health services provided to both inpatient units and the community in Queanbeyan sub-region. Table 5.5: FTE providing General funded community nursing and allied health services Health Services Nursing Dietician Occupational Therapy Physiotherapy Speech Pathology Social Work Psychology Queanbeyan 12.29 1.18 3.68 5.12 2.33 4.08 28.68 Source: Provided by Southern NSW LHD, Received on 26 March 2013 Total 5.4.2 Community mental health services and providers Queanbeyan has one mental health team providing services to the community. The full-time equivalents (FTE) associated with providing community mental health services in Queanbeyan have been included in Figure 5.3. 5.5 AGED CARE This section presents a summary of the available residential aged care facilities and community aged care services available in Queanbeyan. 5.5.1 Residential aged care facilities Table 5.7 shows that Queanbeyan has three residential aged care homes providing a total of 178 high care places and 130 low care places. Table 5.6: Residential aged care facilities in in Queanbeyan Health Facility/Service Name Postcode Care Type* High care places Low care places BCS George Forbes House 2620 Residential 0 85 Queanbeyan Aged Care Facility 2620 Residential 178 0 Warrigal Care Queanbeyan 2620 Residential 0 45 Source: Department of Health and Ageing, 30 June 2012 Note:*Residential = Residential Aged Care, CACP = CACP Aged Care Package, EACH = EACH, MPS = MPSs, ATSI = ATSI, CDC = Consumer Directed Care, Innovative Care Southern NSW Medicare Local Page 20
Places per 1,000 persons aged 70+ 5.5.2 Community aged care services Table 5.8 shows that Queanbeyan also provides community aged care services: one community aged care package service with a total of 40 places and one transition care service with a total of nine places. Health Facility/Service Name TRACKS HOME (Queanbeyan Transitional Aged Care Service) Table 5.7: Community aged care services in Queanbeyan Post code Care Type* Community care places Transition care places 2620 Transition Care 0 9 Warrigal Community Care - Queanbeyan 2620 Community 40 0 Source: Department of Health and Ageing, 30 June 2012 5.5.3 Residential and community aged care places Figure 5.6 shows that the number of per capita residential (high care) places in Queanbeyan is greater than both the ML and NSW. The number of high-care residential aged care places per 1,000 persons aged 70+ in Queanbeyan (69.8 per 1,000 persons) is 41% higher than the ML (41.2 per 1,000 persons) and 35% higher than NSW (45.2 per 1,000 persons). 80.00 70.00 60.00 50.00 40.00 30.00 20.00 10.00 Figure 5.6: Aged care places per 1,000 persons versus ML and state comparators, 2011 - High-care Low-care Community aged care Queanbeyan (C) Southern NSW New South Wales Source: Public Health Information Development Unit and Department of Health and Ageing (2012) Note: Data represents a mean of age-standardised rates Southern NSW Medicare Local Page 21
Number per 1,000 persons 6 Health service utilisation Headlines Higher number of primary care services billed to the MBS per-capita than the ML average for GP health assessments for persons aged 75+ Lower rates of preventable hospitalisation for ambulatory-sensitive conditions than the ML and NSW with top ten avoidable hospital admissions accounting for 5.4% of all admissions Higher rates of care counselling, case management, transport and care coordination HACC services than the ML 6.1 PRIMARY CARE UTILISATION Figure 6.1 shows the number of primary care services per-capita billed to the MBS varied across service types when compared to the ML overall. Of note, the rate of GP health assessments for persons aged 75+ (301.2 cases per 1,000 persons) was 67% higher for when compared to the ML (180.8 cases per 1,000 persons) and 45% higher than NSW (207.7 cases per 1,000 persons). Figure 6.1: Selected primary care services per 1,000 persons, versus ML and state comparators, 2010 400 350 300 250 200 150 100 50 0 45 year old health checks GP health assessments for persons aged 75+ GP Enhanced Primary Care services Practice Nurse services GP Mental Health Care Plans Queanbeyan (C) Southern NSW New South Wales Source: Public Health Information Development Unit and Department of Health and Ageing (2012) Note: Data represents a mean of age-standardised rates 6.2 EMERGENCY During FY2011-12, there were a total of 16,659 presentations to Queanbeyan Health Service 13 of which 10,470 (96.7%) were residents from Queanbeyan LGA. Triage 4 (semi-urgent) and 5 (nonurgent) emergency presentations are those that are classified as could be seen in a GP clinic. At Queanbeyan Health Service, 68.1% of the presentations were classified as triage 4 and 5. 6.3 HOSPITAL ADMISSION In 2010/11 SNSW ML residents had about 62,000 admissions to a hospital. (This excludes admissions for renal dialysis, chemotherapy and unqualified neonates). Please note that data on 13 FirstNet database Southern NSW Medicare Local Page 22
% of all admissions % of all admissions admissions to private facilities in the ACT was not available at the time of this analysis and may impact heavily on analysis of data for Queanbeyan residents. Queanbeyan residents had 9,781 admissions to a hospital in 2010/11 and 2,512 visits for renal dialysis. The top ten reasons for admission are presented in Figure 6.2 and account for 27% of the total number of admissions for Queanbeyan residents. Figure 6.2: Top ten causes for hospital admissions by DRG from residents in Goulburn Mulwaree LGA, 2010/11 4.5% 4.0% 3.5% 3.0% 2.5% 2.0% 1.5% 1.0% 0.5% 0.0% 722 Vaginal Delivery 495 Other Orthopaedics - Surgical 159 Other Gastroenterology 161 Other Colonoscopy 279 Other Non Subspecialty Medicine 111 Chest Pain 219 Other Neurology 829 Other Psychiatry 249 Other Respiratory Medicine 723 Caesarean Delivery Source: Ministry of Health Flow info vs. 11.2, provided by Southern NSW Local Health District, Data received on 27 March 2013 Note: Data excludes Renal Dialysis, Chemotherapy and Unqualified neonates and private hospital data in the ACT Of the total admissions, about 33% of admissions were in hospitals within the SNSW ML, 23% in Private NSW facilities and about 40% to ACT public hospitals as shown below in Figure 6.3. Figure 6.3: Flow of Queanbeyan residents hospital admissions across NSW, ACT and other states/territories, 2010/11 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% A.C.T. SNSW LHD Hospitals Private NSW Sydney LHDs Other LHDs NSW Other States and Territories Source: Ministry of Health Flow info vs. 11.2, provided by Southern NSW Local Health District, Data received on 27 March 2013 Note: Data excludes Renal Dialysis, Chemotherapy and Unqualified neonates and private hospital data in the ACT 6.4 AMBULATORY-CARE SENSITIVE ADMISSIONS Figure 6.4 shows the potentially preventable hospitalisations resulting from Ambulatory-Care Sensitive Conditions (ACSCs). ACSCs are those conditions for which hospitalisation is thought to be avoidable with the application of public health interventions and early disease management, usually delivered in ambulatory setting such as primary care. High rates of hospital admissions for ACSCs may provide indirect evidence of problems with patient access to primary healthcare, inadequate skills and resources, or disconnection with specialist services. 14 ACSC s include vaccine-preventable 14 Victorian Department of Health, http://www.health.vic.gov.au/healthstatus/admin/acsc/index.htm Southern NSW Medicare Local Page 23
% of all admissions of residents in Queanbeyan sub-region Cases per 1,000 persons conditions, selected acute conditions and selected chronic conditions that are modifiable through behaviour modification and lifestyle change. Rates of preventable hospitalisation for ambulatorysensitive conditions in Queanbeyan (17.9 per 1,000 persons) are lower than both the ML overall (25.3 per 1,000 persons) and NSW (23.8 per 1,000 persons). Figure 6.4: Preventable hospitalisations for ambulatory-care sensitive conditions per 1,000 population versus ML and state comparators, 2009-10 to 2011-12 30 25 20 15 10 5 0 Queanbeyan Southern NSW NSW Preventable hospitalisations per 1,000 persons Source: NSW Health Centre for Epidemiology and Evidence (2011); Note: Rates reported are indirectly standardised by age and gender Note: Data represents a mean of age-standardised rates Figure 6.5 shows the top ten avoidable hospital admissions resulting from ACSCs from residents in the Queanbeyan sub-region. Chronic obstructive pulmonary disease (75 episodes, 1.6%) is ranked number one, followed by congestive heart failure (48 episodes, 1.0%) and iron deficiency anaemia (31 episodes, 0.6%). During 2011-12, the top ten avoidable hospital admissions accounted for 5.3% of all admissions. Figure 6.5: Top ten avoidable hospital admissions resulting from ambulatory-care sensitive conditions from residents in Queanbeyan sub-region, FY2011-2012 1.8% 1.6% 1.4% 1.2% 1.0% 0.8% 0.6% 0.4% 0.2% 0.0% Chronic obstructive pulmonary disease Congestive heart failure Iron deficiency anaemia Diabetes complications Angina Pyelonephritis Dehydration Hypertension Influenza and and pneumonia gastroenteritis Dental Conditions Source: Provided by Southern NSW Local Health District, Data received on 6 Feb 2013 6.5 HOME AND COMMUNITY CARE Figure 6.6 shows the profile of Home and Community Care clients in Queanbeyan, compared to the total Southern NSW ML catchment and NSW. Reflective of stronger cultural diversity as compared to the ML overall, the proportion of HACC clients that do not speak English (8%) was higher than the ML (2%). And, while more HACC clients have a carer (18.0%), and a greater proportion of clients live alone (36%) as compared across the ML. Figure 6.6: HACC client profile versus ML and state comparators, 2010-11 Southern NSW Medicare Local Page 24
Instances of care per 1,000 persons % of all HACC clients 45.0 40.0 35.0 30.0 25.0 20.0 15.0 10.0 5.0 - Indigenous clients (as % of total indigenous population) Non-English speaking Clients with a carer Clients living alone Queanbeyan (C) Southern NSW New South Wales Source: Public Health Information Development Unit and Department of Health and Ageing (2012) Note: Data represents a mean of age-standardised rates Figure 6.7 provides a graphical comparison of selected HACC services in Queanbeyan, compared to the ML and NSW. Figure 6.8 shows that HACC clients located in Queanbeyan received a much lower number of allied health care at home, centre based day care and domestic assistance per 1,000 persons, compared to benchmarks at the ML and state levels. However, the number of care counselling, case management, transport and care coordination services provided to Queanbeyan residents per-capita is notably higher than across the ML catchment. Figure 6.7: HACC service profile versus ML and state comparators, 2010-11 10.0 9.0 8.0 7.0 6.0 5.0 4.0 3.0 2.0 1.0 - Allied Health careat home Care counselling Case management Centre based day care Transport Care coordination Domestic assistance Queanbeyan (C) Southern NSW New South Wales Source: Public Health Information Development Unit and Department of Health and Ageing (2012); Note: Rates reported are indirectly standardised by age and gender. Note: Data represents a mean of age-standardised rates Southern NSW Medicare Local Page 25