Significant issues

The WA Country Health Service’s primary responsibility is to provide hospital and related services to the population it serves. The population in regional WA is diverse and expansive and as a result has widely varying health needs.

Health snapshot of country WA

The health status of country people is often poorer than the metropolitan population with a higher rate of illness and co-morbidity, particularly in areas where General Practitioners and other primary health care services are limited or not available. Life expectancy of people living in country WA is less than that of their metropolitan counterparts - 2.5 years less for men and 2.0 years less for women.

The burden of disease is higher in people living in socio-economically disadvantaged areas. In Australia, geographic areas are classed into five levels of disadvantage with level one being the most disadvantaged and level five being the least disadvantaged. Fourteen per cent of WA Country Health Service residents live in the least disadvantaged localities (those classed as level five), whereas 35 per cent of metropolitan residents live in this type of locality. Approximately 41 per cent (217,491) of country residents live in the highest areas of disadvantage (those areas classified as levels one and two).

In contrast, no metropolitan residents live in localities classed as level one and only seven per cent live in localities classed as level two. Addressing this disparity has required the WA Country Health Service to develop new and innovative models to deliver care to country communities. The expansion of telehealth, significant investments in infrastructure and technology and the development of partnerships with other health services and providers is helping us achieve great improvements in access to care.

View video: Telehealthy - An introduction to telehealth in WA (Facebook)

Health snapshot of country WA

• Life expectancy (for births 2010-2012):
  • Metro Perth 83.1yrs vs Country WA 81.1yrs
  • Aboriginal Males 65yrs, Non-Aboriginal Males 80.1yrs. Gap: 15.1 years less
  • Aboriginal Females 70.2yrs, Non-Aboriginal Females 83.7yrs. Gap: 13.5 years less
• 2011- 2015 Deaths from motor vehicle accidents were almost 3x higher for country people than metro people.
• 13,144 Country people are living with cancer
• 12.9% of country Aboriginal women have babies with a low birth weight.
• The infant mortality for Aboriginal babies is 2.8 times more than for non-Aboriginal babies.
• Country people experience higher rates of chronic conditions and many are lifestyle related
• Obesity statistics in 2013-16:
  • 34.6% country residents
  • 27.8% across the State
• More country people drink and smoke at high-risk levels compared with people living in the city.
• Rates are higher in remote communities of:
  • trachoma
  • diarrhoeal disease
  • skin infections
• 43.2% of all potentially preventable hospitalisations in country WA were due to chronic conditions in 2015.
• The rate of diabetes-related hospitalisations in 2017 was greatest in the northern regions of WA:
  • Pilbara region is 1.25x higher than the State Rate
  • Goldfields region is 1.6x higher than the State Rate
  • Kimberley region is 3.2x higher than the State Rate
• Hospitalisationsfor many types of potentially preventable conditions are greater in the Kimberley and other northern WA areas. For example:
  • The hospitalisation rate for respiratory disease is 4x higher in the Kimberley than the State rates.
  • The hospitalisation rate for cardiac failure is 4x higher in the Kimberley than the State rates.
  • The hospitalisation rate for cellulitis is 6.5x higher in the Kimberley than the State rates.

Note: See Appendix 3 for data sources

Current and emerging issues

The WA Country Health Service is the major provider of hospital, health, mental health and aged care services across country WA. It is funded to provide emergency care in hospitals and nursing posts, as well as hospital-based acute services such as general medical, general surgery, mental health, obstetrics, renal dialysis and cancer services. It is also responsible for the provision of maternal and child health, public health, health promotion, chronic conditions services, mental health, drug and alcohol services and sub and post-acute services such as palliative care and rehabilitation.

In country WA, population growth and ageing in many communities is impacting on access to appropriate aged care beds and services. The total number of people aged 70 years and above has increased 21 per cent in the past five years, to more than 44,500. This age group is projected to grow 25 per cent in the next five years. The impact of an ageing population on the demand for health and older adult mental health services is well established. An ageing population changes both the mix and volume of medical procedures and services required.

Primary and aged care services are the primary responsibility of the Australian Government, however the current fee-for-service and consumer-driven funding arrangements mean that the State is often required to fill the gaps. In country WA where service viability often leads to market failure in many communities as a result of higher costs and lower volumes, the WA Country Health Service is required to fill these primary care and aged care service gaps. This ultimately has resulted in fewer GPs, fewer pharmacies and fewer aged care providers per capita in the bush.

The vast spread of the population and the corresponding small population numbers mean that it is challenging to sustain integrated health services across the state. Significant factors driving service demand include changes in population and population demographics, increased availability in the scope of local services and a higher than average burden of disease in Aboriginal and rural populations.

Systemic demographic factors also continue to be a driver, with the ageing regional population affecting residential and community aged care places. Comprehensive health services are required by, and provided to, people living in regional WA. However, limitations to service capability and capacity leads to some consumers not being able to stay in their home towns, especially as their care needs increase or become more specialised. Where this occurs, consumers need to navigate across the healthcare system, often requiring transport, acute, inpatient and outpatient services from metropolitan health services or the non-government sector.

[Photo (PDF only): Derby Mum-to-be Amanda Ogg completes her antenatal classes by telehealth]

Responding to demand and activity complexity

Responding to our communities’ current health needs is challenging and requires us to think innovatively about ways in which the WA Country Health Service can increase the sustainability of our services, and use our finite funding and resources in the most effective way. Initiatives aimed at improving access to services have been implemented and are expected to improve detection of chronic and other health conditions, particularly through the expansion of services available via telehealth.

The WA Country Health Service is building links with primary care providers, child health and development services, as well as building capacity in critical care and rehabilitation services. In addition, a $1.5 billion capital works program is bringing world-class health care closer to home for more people living in regional and remote WA.

Ongoing capital investment is aimed at facilitating higher levels of self-sufficiency within the regions, namely improved access and quality of emergency and primary care and improved inpatient services.

A $300 million capital works program is improving capital infrastructure in 37 towns across the Wheatbelt, Great Southern, Midwest and South West regions. In the Wheatbelt region, Merredin, Narrogin and Northam hospitals are being redeveloped, as well as upgrades to 23 small hospitals and health centres across the region.

[Photo (PDF only): Internal stairwell artwork – Karratha Health Campus: Title: 'A Differing Perspective' Material: digital print on aluminium and laser cut aluminium overlay Leanne Bray (Artist)]

[Photo (PDF only): External Wall artwork Karratha Health Campus: Title: 'Metamorphic Life' Material: High fired porcelain with copper and iron glaze Ian Dowling -Artist, Beth Dowling – Installer, Troy Dowling – Installer]

“Redevelopments such as those happening throughout the Wheatbelt mean that we can continue to offer high quality care to our patients without them having to travel great distances to the city to receive treatment” Sean Conlan Regional Director Wheatbelt.

View video: Young Tayten gets her "normal" life back, thanks for telehealth (Facebook)

[Photo (PDF only): Mural: Title: 'Efflorescence' Material: Paint Pictured - Kyle Hughes Odgers (Artist) Image courtesy of FORM]

Progress towards meeting service demand requirements in 2017-18 included:

• Continued construction of the $207.15 million Karratha Health Campus - the biggest investment in a public hospital ever undertaken in regional WA.
• Construction of the Onslow Health Campus redevelopment. The final stage being scheduled for completion in October 2018.
• Redevelopment of the emergency department at the Collie Health Service and the new $39 million Warren Health Service in Manjimup.
• Completion of the $13 million redevelopment at Harvey Health Service; and the Midwest Cancer Centre.
• Commencement of planning for the $73 million Geraldton Health Campus Stage 1 redevelopment and Midwest mental health service. This investment will deliver a combination of new build and refurbished infrastructure including an expanded emergency department and critical care unit; an acute psychiatric unit; a mental health short stay unit; and essential engineering service upgrades to the existing infrastructure.
• Increased access to the Emergency Telehealth Service, providing patients and staff with state-of-the-art access to high quality emergency and inpatient care.
• Increased access to outpatient and clinical services via telehealth.

Workforce challenges and initiatives

The WA Country Health Service area covers approximately 2.55 million square kilometres. Some of our hospitals and many of our health services and nursing posts are in remote locations and attracting permanent clinical staff to these locations can be difficult.

Key workforce challenges in attracting and retaining clinical staff can at times require innovative or alternate solutions to ensure the uninterrupted provision of medical, nursing and allied health care services within regional areas. Ensuring that we are able to attract and retain a diverse and skilled workforce remains an ongoing and key area of focus for the organisation.

During 2017-18, we implemented innovative staffing models to address regional staff requirements across nursing and midwifery, medical, allied health, mental health and Aboriginal health. This included the continuation of the WA Country Health Service Aboriginal Mentorship Program which now has trained 42 Aboriginal mentors across the state.

Our staff have access to a range of leadership development opportunities which include formal programs offered externally via the Public Sector Commission as well as tailored development coordinated internally. New and aspiring managers have access to an internal management development program that includes ten modules designed to assist existing and aspiring managers to understand and gain knowledge in managing services within the organisation. Over the course of 2017-18 we have also developed a Future Leaders Program which is a tailored program designed to assist staff who aspire to senior roles within the health service to obtain targeted and essential leadership and management development.

Supporting and facilitating learning programs that enable the development and maintenance of professional skills is a key focus for the organisation in attracting and retaining a competent and skilled workforce that is aligned with service needs across disciplines. The WA Country Health Service Learning and Development framework ensures ongoing skills development and learning to support the delivery of safe, high quality and consumer-centred care.

Learning and development across the organisation is facilitated through the Learning and Development Network, an organisation-wide network represented by a range of discipline areas, including the Medical Education Unit, Nursing and Midwifery Services, aged care, allied health, regional staff development educators and learning and development coordinators. Further to this, the management, publication and reporting of training and development achievements and delivery of tailored programs is enabled and supported by an organisation-wide Learning Management System.

In January 2018, the organisation welcomed the second cohort of medical interns who are based at Bunbury and Albany Hospitals. Both hospitals benefit with five interns each, but experience shows that regional Western Australia will be the big winner; doctors who train in the country are more likely to practice in country areas. This is evidenced by the 2017 group of ten interns all choosing to take up employment in country WA as Resident Medical Officers in Albany, Bunbury and Geraldton in 2018.

Working in partnership with key stakeholders, such as the Integrated Rural Training Hubs, in 2017-18 the Medical Education Unit team attended many events aimed at medical students and early career doctors to promote the benefits of working in the country as part of our efforts to attract and retain the rural medical workforce for the future. In addition, the team manages a range of specialist training programs, including the highly successful Community Residency Program (CRP) which continues to be over-subscribed by medical officers seeking the opportunity to gain experience in rural and communitybased health care. In 2018 three new CRP placements were commenced in Esperance, Narrogin and Albany.

Our values in action

Great Southern staff reaching for new heights

Staff in the Great Southern region are working hard to deliver culturally secure health services to improve the lives of Aboriginal people in their local communities. The WA Country Health Service is committed to developing a workforce culture and environment that supports the employment and retention of Aboriginal people to help ‘close the gap’ between Aboriginal patients and other health services.

Having familiar faces within the community to provide a local connection and help reach those who would not normally engage with traditional health services is a key driver.

The Great Southern Aboriginal Health Service is working with staff across the region, supporting those with aspirations to reach new heights in their health careers.

Katanning Aboriginal Health Workers Debbie Yarran and Marie Abrahams are both currently training in a Certificate IV Aboriginal Health Work with the 18-month course providing a mix of online and face-to-face learning in Bunbury.

In the lower Great Southern a trio of staff are embarking on Enrolled Nurse training. Senior Aboriginal Health Worker Chantelle Van Der Brugge and Health Promotion Officer Jye Walker began their training in 2017 and have extensive training and practical blocks under their belts. Albany receptionist Eden Coyne is also undertaking bridging qualifications to enable her to enter the Enrolled Nursing course and is currently at South Regional TAFE completing a Certificate II in Health Services.

While all five admit their communities and colleagues miss them when they are away, the skills they are learning will enable them to provide a greater depth of services for their communities in the long run.

[Photo (PDF only): Health Promotion Officer Jye Walker, Albany receptionist Eden Coyne and Senior Aboriginal Health Worker Chantelle Van Der Brugge]

[Photo (PDF only): New skills will enable staff to provide a greater depth of services for the community]

[Photo (PDF only): Katanning Aboriginal Health Workers Marie Abraham and Debbie Yarran]

Sustainable Health Review

The Sustainable Health Review (SHR) was announced by the State Government in June 2017 to develop a more sustainable health system for Western Australia. The Review, chaired by a panel of experts appointed by the Government of Western Australia, seeks to prioritise the delivery of patientcentred, high quality and financially sustainable healthcare across the State into the future.

In 2017 the panel sought input and received submissions from a range of individuals and organisations. After collecting input from our consumers, clinicians, managers and staff from across our regional areas the WA Country Health Service Board and management have provided a response and recommendations for consideration of the Panel. Input to our submission included insights from our key consumer advisory groups the District Health Advisory Committees.

In its submission, the organisation provided a summary of the significant challenges facing country communities and the critical importance of taking steps to ensure a sustainable health system into the future – one that recognises and enhances the delivery of services to country communities while ensuring the ongoing viability and sustainability of those services such that they are responsive to the needs of country communities into the future. These included strategies to make enhancements to regional aged care, patient transport and ambulance services, investment in digital capacity to ensure access to technology across the state.

Many of the issues raised by the WA Country Health Service have been recognised in the panel’s interim report released in early 2018 highlighting in particular in their preliminary directions a need to develop new ways to support equity in country health and better utilising resources with more care in the community. Telehealth and virtual care has been acknowledged as a key enabler of new models of care in the community and as a means of supporting country health service delivery with areas noted for immediate action including a pilot of the Emergency Telehealth Service model in at least one other specialty in the country and metropolitan area. Further work to be investigated includes developing options for seamless and safe patient movement across the system and more formalised links between metropolitan and country hospitals to better support patient care and professional development for staff.

The valuable insights gathered from our stakeholders throughout the process of developing the WA Country Health Service submission have been gathered to be further utilised in the development of the organisation’s strategic plan beyond 2018.

The panel’s final report is due in late 2018 and we look forward to continuing to work towards the aims of the review.

[Photo (PDF only): Pemberton Emergency Telehealth Service - Marion and Ava Fuge with WACHS Nurse Jess Byers and Dr Mlungisi Mahlangu]

Our values in action

Aboriginal mentorship blazing trails in Kimberley

Since its inception in 2014 the successful WA Country Health Service Aboriginal Mentorship Program (AMP) has supported many Aboriginal staff to study, apply for promotions, undergo training and create career pathways. The program continued this year with two courses held in the Kimberley. The program aims to help build confidence and mentoring support for our Aboriginal staff across the state. Aboriginal staff play a critical role in providing accessible and culturally secure services ultimately to assist in improving health outcomes for Aboriginal people.

In February, eight staff took part in an AMP train the trainer course in Broome, followed by a workshop in Kununurra where 14 staff underwent training to become mentors.

“We are excited about the AMP for the Kimberley.” Aboriginal Health Consultant Jo Gray said, “Tailoring the program for our region has been important in helping us ensure that our Aboriginal workforce feel supported and to increase our staff retention.”

“The Kimberley region has many communities that will benefit from mentoring Aboriginal people to seek employment with the WA Country Health Service in hospital and community settings,” Jo said. “The pressure within diverse health professional roles in the workplace and contributing social and cultural responsibilities in the family and community can be challenging.”

Corporate Aboriginal staff member Johari Bin Demin agreed that mentoring would contribute to retaining Aboriginal staff. “This is especially important in remote areas such as the Kimberley, where the health issues within the Aboriginal population can be both personal and overwhelming for WACHS’s Aboriginal staff.”

Supporting and mentoring Aboriginal staff within our organisation plays a very crucial role in addressing the huge disparity in health outcomes between Aboriginal people and non-Aboriginal people throughout the state. Kununurra course participant Sam Miller said the mentor program had led to better communication within the service about Aboriginal and non-Aboriginal ways. “There is better support for Aboriginal people, someone to go to and talk about issues and understand processes,” she said.

“Through my work I have been mentored and supported so that now I have the confidence to be able to support, mentor and give advice to others. I feel very proud and it’s like my previous hurt is healing.”

[Photo (PDF only). Front (L-R): Bev Stone, Wendy George, Cecilia Rivers, Mareeka Patrick, Aimee Trust, Dr Duy Tran, Sam Miller, Jo Warren; Back: Jo Gray, Nawoola Davey, Sarah Tobias, Johari Bin Demin, Vernon Dann, Nicola Turschwell, Will Morrow, Kate Woods. Supporting and mentoring Aboriginal staff within our organisation plays a very crucial role.]