Integrated Care in NSW Presentation to NSW Rural Health & Research Congress Dubbo, 9 September 2014 Katherine Burchfield Director, Integrated Care Branch NSW Ministry of Health

Why Integrated Care? What does it mean? The NSW Integrated Care Strategy Content 1

Various drivers are placing increasing pressure on our health system 2 Increasing demands on the health system Increased demands from people with complex needs Increased number of people living with chronic diseases Growing and ageing population Reduction in length of stay and productivity targets Increasing specialisation in medicine and nursing Societal changes Rising consumer expectations

The current system is episodic and fragmented, focused on patient outcomes by exception 3 Current system tends to supports short term episodic care rather than long term health and functionality Health promotion Outpatient care close to home Unplanned hospital care Residential aged care Planned inpatient care Planned care at home “Systems designed to treat occasional episodes of care for normally healthy people are being used to deliver care for people who have complex and long term conditions. The result is that they are passed from silo to silo without the system having the ability to co-ordinate different providers” S Dorrell, NHS Health Service Journal, 2011

Why NSW needs integrated care 4 Increase in chronic disease Increase in hospitalisations and GP visits Increase in need for health workforce Increase in need for hospitals Prevalence of chronic disease expected to increase by 15-20% in 2030 Total number of chronic diseases to increase by ~1M (+33%) in 2030 Length of stay has decreased but hospital separations have increased, resulting in an increase in bed days between 2006 and 2011 Number of bed days to increase by 51% to 9.7m in 2030 Number of GP visits to increase by 64% to 56m in 2030 Health workforce required to grow by % by 2030 −36% more nurses −97% more physicians −30% more allied health professionals An additional 10,000 beds or ~114 hospitals will be required in 2030 Ageing population The NSW population is expected to grow by about 1% per annum Over 65s will represent ~20% of the population in 2030 compared to 14% in 2006 Healthcare expenditure for over 65s is two to three times higher than under 65s

Better integration of care will help to achieve a more sustainable health system 5 TodayTomorrow ? Fragmented Episodic Inefficient Unsustainable Integration of care Integrated, sustainable health system

Why Integrated Care? What does it mean? The NSW Integrated Care Strategy Content 6

Care is person centred Care is a seamless continuum Care is effectiveCare is efficient Care is organised for, by and with the person by bringing care to the person’s community or home rather than the person to the care Care is organised across spectrum of care ranging from social and preventative, to primary and acute, through to aged and end-of-life care Care results in the outcomes that are desired by the patient and reflect achieved health status, recovery process and sustainability of health Care makes efficient use of both financial and human resources What is integrated care? Integrated Care meets a person’s needs by providing seamless, effective and efficient care, organised for, by and with the person, from prevention through to end of life. Value-based healthcare 7

Why Integrated Care? What does it mean? The NSW Integrated Care Strategy Content 8

NSW State Health Plan launched in June Three clear directions for the future delivery of healthcare in NSW Direction One: Keeping People Healthy Direction Two: Providing World Class Clinical Care Direction Three: Delivering Truly Integrated Care NSW State Health Plan 9

Jillian Skinner MP Minister for Health Minister for Medical Research MEDIA RELEASE Thursday 20 March 2014 NSW GOVERNMENT COMMITS $120 MILLION TO INTEGRATED HEALTH CARE The NSW Government will spend $120 million over four years to provide seamless care to people in an integrated way - from care in the community to acute care in hospital. Health Minister Jillian Skinner was joined at Parliament House today by community providers including general practitioners (GPs) and non-Government organisations (NGOs) as well as representatives of the primary care sector including pharmacies and private hospitals as she launched the Integrated Care in NSW strategy. Mrs Skinner described the NSW Government’s new focus on integrated care as a transformative step for health care in this state …. Announcement 10

The NSW Integrated Care Strategy has three components 11 Description Goal Integrated Care Demonstrators LHD-led Demonstrators in Western NSW, Central Coast and Western Sydney focused on large-scale transformation of integrated local health systems and testing initiatives prior to extension across the State. Develop system-wide integrated care approaches in three LHDs that are transferrable and scaleable Statewide enablers Focused on information technology infrastructure, outcomes measurement and patient feedback, capacity building and evaluation. Establish key enablers of integrated care benefiting all LHDs and stakeholders Planning and Innovation Fund Investment in individual initiatives and planning at the local level, including extension of successful integrated care approaches from the Demonstrators. Support local planning, collaboration and innovation initiatives Indicative % funding $120M investment over 4 years Implementation will involve partnerships with primary care organisations, NGOs and private providers 42% 27% 31%

The Strategy seeks to build and link on existing initiatives 12

Expected benefits 13 Better patient experience Improved outcomes Less waste Easier navigation of the system Reduced waiting times Increased satisfaction Better patient reported outcomes Improved long term health outcomes Fewer avoidable hospitalisations and ED attendances Less duplication of services/tests

Regional planning for health services and wider determinants of health Move beyond consultation & coordination to true partnerships with primary care, aged care providers, and Aboriginal Community Controlled Health Services (ACCHS) New funding and business models – particularly for community-based health services - that optimise workforce and funding streams Improve IT infrastructure and information flow, including outcomes monitoring and feedback Leverage MPS and service co-location ‘hubs’ Further embed telehealth and m-health Greater use of telephonic solutions eg. HealthDirect Explore the most cost effective pathways for supporting ‘health’ of remote populations Promote prevention and early intervention Consumer/community engagement, health literacy and self management Opportunities in rural NSW 14