Online version of the 2013-14 Department of Health Annual Report

Outcome 13: Acute Care

Improved access to public hospitals, acute care services and public dental services, including through targeted strategies, and payments to state and territory governments

Page last updated: 31 October 2014

Major Achievements

  • In 2013-14, the Commonwealth provided more than $13 billion for public hospital services, with the Department leading the way in implementing public hospital funding arrangements.
  • The equivalant of 360,00056 people were treated under the National Partnership Agreement on Treating More Public Dental Patients.

Challenges

  • Continuing to provide national leadership to drive the appropriate use of blood and blood products.

Looking Ahead

In 2014-15, the Department will work with States and Territories to implement changes to public hospital funding arrangements announced in the 2014-15 Budget and negotiate the National Partnership Agreement on Adult Public Dental Services to ensure continued improvement in patient access to public dental services. The Department will also work closely with the National Blood Authority, and the Australian Organ and Tissue Donation and Transplantation Authority, to ensure a smooth transition into a single independent authority by 1 July 2015.

Programmes Contributing to Outcome 13

  • Programme 13.1: Blood and organ donation services
  • Programme 13.2: Medical indemnity
  • Programme 13.3: Public hospitals and information

Divisions contributing to Outcome 13

In 2013-14, Outcome 13 was the responsibility of Acute Care Division and Medical Benefits Division.

Outcome Strategy

Outcome 13 aims to improve access to, and the efficiency of, public hospitals and acute and subacute care services. In 2013-14, the Department worked to achieve this Outcome by managing initiatives under the programmes outlined below.

Programme 13.1: Blood and organ donation services

Programme 13.1 aims to improve Australians’ access to organ and tissue transplants, and support access to blood and blood products.

Improve Australians’ access to organ and tissue transplants

In 2013-14, the Department continued work with the Australian Organ and Tissue Donation and Transplantation Authority to implement reforms aimed at achieving increases in the number of life-saving and life-transforming transplants for Australians. These reforms include the introduction of nationally consistent donation processes and systems in hospital settings, supported by dedicated donation specialists, together with a nationally coordinated approach to community and professional awareness and education. The Department also managed the Supporting Leave for Living Organ Donors Pilot which commenced on 1 July 2013 and is administered by the Department of Human Services.

The Department provides support for these treatments through the Australian Bone Marrow Donor Registry (ABMDR) to maximise the chance of a suitable donor match for a patient needing a HPC transplant. In 2013-14, the ABMDR undertook approximately 660 donor searches on behalf of Australian patients. From this, 301 Australian patients with leukaemia or other life-threatening haematological or immune system diseases received a Hematopoietic Progenitor Cell (HPC) transplant. Australia also provided 43 HPC donations to overseas recipients.

Qualitative Deliverable
Support the Australian Bone Marrow Donor Registry and the National Cord Blood Collection Network to identify matched donors and stem cells for transplant
2013-14 Reference Point
Increased diversity of tissue types of donors and cord blood units available for transplant
Result
Met
Throughout 2013-14, the ABMDR continued recruitment and collection strategies targeting donors from ethnically diverse populations, to improve the prospects of finding a match for a patient from the Australian donor registry or cord blood inventory.
Quantitative KPI
Percentage of legitimate Bone Marrow Transplant Programme applications assessed and approved within three days of receipt
2013-14 Target
100%
2013-14 Actual
100%
Result
Met
The BMTP has assessed and approved 278 applications in 2013-14, to assist eligible Australians requiring a HPC transplant. All applications were assessed and approved within three days of receipt.

The Department also funded the National Cord Blood Collection Network (NCBCN) which collects, processes, banks and releases high quality umbilical cord blood stem cell units to Australian and international transplant centres for patients needing a transplant. In 2013-14, 31 Australian patients received single or double cord blood unit transplants. A total of 20 cord blood units were sourced from the Australian inventory, of which 15 cord blood units were provided to international patients.

Quantitative Deliverable
Number of banked cord blood units
2013-14 Target total
2,379
2013-14 Actual
1,957
Result
Substantially met
2013-14 Target Indigenous
129
2013-14 Actual
101
Result
Substantially met
The number of banked cord blood units: Total – 2010-11 1,880 cord blood units, 2011-12 810 cord blood units, 2012-13 523 cord blood units; Indigenous – 2010-11 74 cord blood units, 2011-12 94 cord blood units, 2012-13 64 cord blood units. The range of cord blood units contained in the Australian cord blood registry is not reflective of Australia’s ethnically diverse population. To address this, there has been a focus on collecting cord blood units from ethnically diverse children. This has increased the genetic diversity in the inventory.

The inventory target of 30,000 cord blood units that was to be available by 30 June 2014 was not reached. At that date, there were 38,385 banked and 28,028 searchable cord blood units57 in the Australian inventory, an achievement of 93 per cent of the target. The refocus on collection of high cell-count cord blood units, and from ethnically diverse children, has slowed the banking quantity but greatly increased its quality and ensured the inventory is better tailored to Australia’s multicultural population.

Support access to blood and blood products

The Department ensured access to affordable and quality blood supply by providing governance support to the National Blood Authority (NBA) and delivering the Commonwealth’s contribution of funding to the blood sector. The Department chaired the Jurisdictional Blood Committee (JBC) and continued to support the development of strategies that supported appropriate blood and blood product use, a reduction in inventory wastage, and better forecasting and demand management across jurisdictions. The Department worked with the NBA, the Australian Commission on Safety and Quality in Health Care (ACSQHC), and States and Territories to develop the Patient Blood Management Collaborative programme and implement stronger governance arrangements for access to funded intravenous immunoglobulin (refer Programme 10.5 for more information).

In 2013-14, the Department continued to support and fund the work of the Haemophilia Foundation of Australia, which provides advocacy, education and best practice advice for people with haemophilia, von Willebrand disease and a range of other heritable clotting disorders.

The Department also contributed to the Hepatitis C Litigation Settlement Scheme, which provides a contribution to the out-of-court settlement costs for eligible individuals who contracted hepatitis C as a result of a blood transfusion in Australia between 1985 and 1991.

Qualitative Deliverable
Effective planning of the annual blood supply through the National Supply Plan and Budget
2013-14 Reference Point
The 2014-15 National Supply Plan and Budget agreed by all Health Ministers in 2013-14
Result
Met
Quantitative Deliverable
Percentage of the total contribution, made by the Australian Government, to the approved National Supply Plan and Budget
2013-14 Target
63%
2013-14 Actual
63%
Result
Met
Qualitative KPI
Improved evidence based policy on funded blood products and services
2013-14 Reference Point
Proportion of applications for assessment of new blood products submitted to MSAC
Result
Met
In 2013-14, the Department continued to work with States and Territory Governments through the JBC, the NBA, and the Medical Services Advisory Committee (MSAC) to implement the health technology assessment framework for blood and blood products.

Programme 13.2: Medical indemnity

Programme 13.2 aims to ensure the stability of the medical indemnity insurance industry so that insurance products for medical professionals are available and affordable.

Ensure the stability of the medical indemnity insurance industry

Medical indemnity insurance is a specialised form of professional indemnity cover that provides surety to medical practitioners and their patients in the event of an adverse outcome arising from medical negligence. Affordable and stable medical indemnity insurance allows the medical workforce to focus on the delivery of high quality medical services.

By subsidising high cost claims and providing a guarantee to cover exceptional claims, the Government ensures that the medical indemnity insurance industry continues to remain stable and secure.

Qualitative Deliverable
Continued participation in the Medical Indemnity National Collection through the Medical Indemnity National Collection Coordinating Committee and the Medical Indemnity data working group
2013-14 Reference Point
Reports published by the Australian Institute of Health and Welfare
Result
Met
Quantitative KPI
Percentage of medical indemnity insurers who have a Premium Support Scheme contract with the Commonwealth that meets the Australian Prudential Regulation Authority’s Minimum Capital Requirement
2013-14 Target
100%
2013-14 Actual
100%
Result
Met

Ensure that insurance products are affordable for doctors

The Department administers a number of schemes – such as the Premium Support Scheme (PSS) and the Run-off Cover Scheme – designed to maintain and improve premium affordability for medical practitioners. Premium support is demand driven, with subsidies paid in response to applications from eligible doctors.

Through the PSS, the Government provides subsidies to assist eligible specialists whose medical indemnity premiums are relatively high in proportion to their income.

Quantitative Deliverable
Percentage of eligible applicants receiving a premium subsidy through the Premium Support Scheme
2013-14 Target
100%
2013-14 Actual
100%
Result
Met
Quantitative KPI
Number of doctors that receive a premium subsidy support through the Premium Support Scheme
2013-14 Target
2,200
2013-14 Actual
1,613
Result
Met
Quantitative KPI – Number of doctors that receive The number of doctors that receive a premium subsidy support through the Premium Support Scheme: 2010-11 2,194 doctors, 2011-12 2,106 doctors, 2012-13 1,847 doctors. In 2013-14, 1,613 doctors received a premium subsidy. This is a significant result, as it shows a continuing decline in the number of doctors seeking subsidy support and indicates that the measures administered by the Department have contributed to ensuring the industry remains stable through affordable premiums.

Ensure availability of professional indemnity insurance for eligible midwives

Privately practising midwives need insurance to meet the requirements of the Government’s National Registration and Accreditation Scheme. Indemnity insurers are reluctant to offer professional indemnity insurance to midwives, as the small potential premium pool and potentially high risk exposure means it is not commercially viable. The Australian Government contracted an insurer, MIGA, to provide professional indemnity insurance to eligible midwives, to ensure that women and their families can access midwifery care.

Quantitative Deliverable
Percentage of eligible midwife applicants covered by the Midwife Professional Indemnity Scheme
2013-14 Target
100%
2013-14 Actual
100%
Result
Met
All eligible privately practising midwives who applied  for Commonwealth-supported professional indemnity insurance through MIGA were offered cover. All eligible privately practising midwives who applied for Commonwealth-supported professional indemnity insurance through MIGA were offered cover.
Qualitative KPI
The continued availability of professional indemnity insurance for eligible midwives
2013-14 Reference Point
Maintain contract with Medical Insurance Group Australia to provide professional indemnity insurance to eligible midwives
Result
Met
Eligible privately practising midwives were able to purchase Commonwealth supported professional indemnity insurance from MIGA.

Programme 13.3: Public hospitals and information

Programme 13.3 aims to increase efficiency and capacity in public hospitals including through improved access to public dental services, and increase support for health services for the Torres Strait.

The Department works with State and Territory health departments and relevant national agencies to support funding, delivery and accountability of public hospital services.

Efficiency and capacity in public hospitals

The intent of the National Partnership Agreement on Improving Public Hospital Services (NPA IPHS) was to contribute to improved public patient access to elective surgery, emergency department and subacute care services.

Qualitative Deliverable
Provide financial contribution to States and Territories to support the delivery of initiatives
2013-14 Reference Point
Payments to States and Territories are made in a timely manner
Result
Met

Subacute Care

Qualitative KPI
Enhanced provision and improved mix of subacute care services in hospital and community settings
2013-14 Reference Point
States and Territories reporting consistently demonstrates enhanced provision and improved mix of services
Result
Met

Elective Surgery

Qualitative KPI
Increase the proportion of elective surgery patients seen within the clinically recommended time
2013-14 Reference Point
Each State and Territory has Met the 2013 targets as agreed with jurisdictions in the National Partnership Agreement on Improving Public Hospital Services58
Result
Not met
The National Elective Surgery Target (NEST) is a calendar year target. Targets for each State and Territory are set out within the NPA IPHS and publicly reported by the COAG Reform Council (CRC). In 2013, the CRC reported that no jurisdiction achieved all of its nine interim targets against the NEST. No jurisdiction achieved all three of its targets under NEST Part 1 (patients being seen within clinically recommended times). The Australian Capital Territory and South Australia were the only jurisdictions to achieve all six of their targets under NEST Part 2 (treating long wait patients).
Quantitative Deliverable
Minimum number of additional elective surgery operations for Tasmania
2013-14 Target
500
2013-14 Actual
633
Result
Met

Emergency Departments

Qualitative KPI
Increase the proportion of emergency department patients seen within the clinically recommended time
2013-14 Reference Point
Each State and Territory has met the 2013 targets as agreed with jurisdictions in the National Partnership Agreement on Improving Public Hospital Services59
Result
Not met
Nationally, the proportion of emergency department patients seen within the clinically recommended time increased from 65.5% in 2012 to 70.9% in 2013. However, no jurisdiction achieved its 2013 target under the National Emergency Access Target (NEAT). Victoria, South Australia, Tasmania, the Australian Capital Territory and the Northern Territory performed at a level below their 2012 target.

Improve access to public dental services

Up to $344 million (over the period 2012-13 to 2014-15) in funding is being provided to States and Territories to deliver public dental services for an additional 400,000 patients through the National Partnership Agreement on Treating More Public Dental Patients. States and Territories use this funding to provide a range of dental services (including preventive and restorative services and dentures), through: the purchase of specialist services; extending opening hours; engaging the private sector; building infrastructure; and expanding the dental workforce.

Qualitative Deliverable
Implement National Partnership Agreement on Treating More Public Dental Patients
2013-14 Reference Point
Commence programme and reporting in a timely manner
Result
Met
The National Partnership Agreement on Treating More Public Dental Patients has been signed by all States and Territories. All jurisdictions have now completed three reporting periods.
Qualitative Deliverable
Implement the Flexible Grants Programme
2013-14 Reference Point
All applications received in 2013-14 are assessed by the Department and recommendations made to the Minister during 2014
Result
Not met
The flexible grants programme was discontinued in the 2014-15 Budget.
Qualitative KPI
Improve access to public dental services for public dental patients
2013-14 Reference Point
Evaluation of the National Partnership Agreement on Treating More Public Dental Patients and associated data to determine if increased access to dental services has occurred
Result
Met
Nationally, the States and Territories are on track to meet the overall objective of treating an additional 400,000 public dental patients. A final evaluation of the National Partnership Agreement on Treating More Public Dental Patients will be conducted with States and Territories on the completion of the Agreement (30 June 2015).
Quantitative KPI
Number of additional public dental patients treated, under the National Partnership on Treating More Public Dental Patients, by the States and Territories above agreed baseline
2013-14 Target
177,778
2013-14 Actual
368,199
Result
Met
Under the Agreement, there is a national target to treat an additional 400,000 public dental patients across Australia over three years. Higher than forecasted activity in 2013-14 made up for a slower than anticipated start to the programme in 2012-13. The States are on track to achieve the overall target by the end of 2014-15.

Outcome 13 – Financial Resource Summary

(A) Budget Estimate1
2013-14
$’000
(B) Actual 2013-14
$’000
Variation (Column B minus
Column A)
$’000
Programme 13.1: Blood and Organ Donation Services2
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)
16,374
14,379
( 1,995)
Special appropriations
National Health Act 1953 – Blood Fractionation, Products and Blood Related Products – to National Blood Authority
716,039
714,411
( 1,628)
Departmental Expenses
Departmental Appropriation3
5,064
5,967
903
Expenses not requiring appropriation in the current year4
238
253
15
Total for Programme 13.1
737,715
735,010
( 2,705)
Programme 13.2: Medical Indemnity
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)
150
199
49
Special appropriations
Medical Indemnity Act 2002
93,902
48,543
( 45,359)
Midwife Professional Indemnity
(Commonwealth Contribution) Scheme Act 2010
410
( 410)
Departmental Expenses
Departmental Appropriation3
335
698
363
Expenses not requiring appropriation in the current year4
15
32
17
Total for Programme 13.2
94,812
49,472
( 45,340)
Programme 13.3: Public Hospitals and Information
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)
108,803
99,151
( 9,652)
Departmental Expenses
Departmental Appropriation3
46,863
47,815
952
Expenses not requiring appropriation in the current year4
13,777
13,730
( 47)
Total for Programme 13.3
169,443
160,696
( 8,747)
Outcome 13 Totals by appropriation type
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)
125,327
113,729
( 11,598)
Special appropriations
810,351
762,954
( 47,397)
Departmental Expenses
Departmental Appropriation3
52,262
54,480
2,218
Expenses not requiring appropriation in the current year4
14,030
14,015
( 15)
Total Expenses for Outcome 13
1,001,970
945,178
( 56,792)
Average Staffing Level (Number)
202
205
3

1 Budgeted appropriations taken from the 2014-15 Health Portfolio Budget Statements and re-aligned to the 2013-14 programme group structure.

2 This programme includes National Partnerships paid to state and territory governments by the Treasury as part of the Federal Financial Relations (FFR) Framework. National Partnerships are listed in this chapter under each programme.

3 Departmental appropriation combines ‘Ordinary annual services (Appropriation Bill 1)’ and ‘Revenue from independent sources (s31)’.

4 ‘Expenses not requiring appropriation in the budget year’ is made up of depreciation expense, amortisation, make good expense and audit fees. This estimate also includes approved operating losses – please refer to the departmental financial statements for further information. Some reclassifications have been made to the Budget estimates to more accurately reflect the allocation of departmental depreciation by outcome.