Western Sydney Local Health District Research Paper 2022

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Running head: HEALTH CARE
Health care
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Abstract
The paper summarizes a specialist health service planning for paediatric service in
WSLHD to meet the vision of better health services for people in Western Sydney according to
the WLSHD ‘Health Services Plan to 2026’. The essay presents environment scanning of the city
give an overview of the burden of disease, mortality, and morbidity in children group. The needs
assessments identifies gaps in the current care model, and the ongoing service profile shows the
separation rates and patient inflows at the hospital. The above analysis depicts the needs of the
target population and key gaps in current models of care. The paper also gives an overview of the
goals, strategies and key activities of the health service plan to ensure development of the
paediatric health service in Western Sydny

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Table of Contents
Introduction......................................................................................................................................3
Environmental Scan:........................................................................................................................4
Needs Assessment...........................................................................................................................6
Service Profile within LHD:............................................................................................................7
Current inpatient and outpatient activity levels...............................................................................9
Catchment and reverse catchment profiles:.....................................................................................9
Situational Analysis.......................................................................................................................10
Strategic Issues and Priorities........................................................................................................10
Future Services Profile by facility:................................................................................................11
Key goals, objective and strategies:...............................................................................................11
Overarching recommendations and conclusions:..........................................................................12
References:....................................................................................................................................13
Appendix:......................................................................................................................................16

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Introduction
According to the Western Sydney Local Health District (WLSHD) Health Services Plan
to 2026, the core vision of the plan is to develop high-quality health services for the people of
Western Sydney. To ensure that a system is created to respond to community needs, it is
necessary to focus on the development and growth of specialist health services too. This paper
focuses on the specialist health services of paediatric services in WLSHD and aims to develop a
specialist Health Service Plan for Paediatric services in the region. The primary rationale for
paying attention to the paediatric services and outcome is that children are one the priority
people according to the WLSHD Plan to 2026 and strengthening paediatric services and neonatal
care in the district can help to provide the best start to life for children in Western Sydney (NSW
Government, 2018). This specialist health service plan provides an overview of the
environmental scan, needs assessment, service profile, inpatient and outpatient activity levels,
catchment profiles, and situational analysis to effectively identify strategic issues and priorities
for promotion of children's health. The report will propose recommendations for facility
development too.
Environmental Scan:
The health service plan should be aligned to the WSLHD plan to 2026, which sets out
different strategies for the development of health service in hospitals and nursing homes and has
children as one of the priority populations (NSW Government, 2018). The need for growth of
paediatric services and children’s hospital can be understood by the demographic analysis of the
target area. WSLHD is the fastest growing area of the NSW health system, and its population is
expected to increase to 1.3 million by 2031. It is delivering public health care in about 120

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suburbs in the Hills Shire, Blacktown, Cumberland and Parramatta local government areas
(LGAs). It has 51% of females of childbearing age and 68 980 children up to the age of 4 years
(WLSHD, 2019). 4% of the population in Western Sydney consists of Aboriginal and Torres
Strait Islander people who experience poor health compared to the rest of the community. The
population details based on age are illustrated in Figure 1, and tabular representation of children
in WSLHD is given in table 1 (HealthStats NSW, 2016). One of the concerns in the WSLHD is
the prevalence of more significant socioeconomic disadvantage for WSLHD residents compared
to the other NSW population. 50 % of the residents experience chronic disease and the risk of
chronic diseases like diabetes is higher among culturally and linguistically diverse (CALD)
residents of the community (WSLHD, 2018). Socioeconomic disadvantage (SEDs) for WSLHD
residents is an example of poor determinants of health and poor health is also seen because of
poor health literacy, financial burden, poor social status and feelings of disempowerment among
the group. SEDs can have a significant impact on health-related behaviours of a group and
strengthening socioeconomic status is crucial to reduce health damage and differences (Kim et
al., 2018).
Figure 1: Population by age for WLSHD in the year 2016. Source: (HealthStats NSW, 2016).

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Figure 1: Population by age for WLSHD in the year 2016. Source: (HealthStats NSW, 2016).
As the target population for health service plans are children from birth until the age of
18, developing an understanding of the burden of disease in this group can also inform the health
service planning process. Western Sydney is one of the hotspots of diabetes. The weight of
illness in children in the target LSD is understood from the infant mortality rate and the mortality
rate per 1000 births in the area is 2.8 in the year 2017. The number of deaths reported in infant
was 41 (Appendix 2.). The burden of vaccine preventable disease and communicable disease like
influenza, measles and whooping cough was high in children in the area. In addition, burden of
childhood obesity is also a major health concern in the area (NSW, 2017). Hence, increasing
capacity of the paediatric services to improve child health and well-being in the WSLHD is
important.

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Needs Assessment
One of the primary goals of health service planning is to improve health status of target
population by safeguarding health equity and fairness of access to services for the group. The
success of such planning can be seen when this is shaped around the health needs of individuals
and families (Silver, 2018). Hence, needs assessment of the community can help to prioritize
health service needs and identify relevant service directions for the plan. Currently, there are 80
paediatric pathways in Western Sydney. However, based on the review of identified health care
needs in children, it has been found that health needs of children with medical complexity have
not been addressed in Australia. Currently, health system in the country is designed for episodic
care, but limitation is seen in providing adequate support to children and families who are
dealing with chronic coniduons (Altman et al., 2018). In response to the gap in chronic care, a
state wide initiative called the HealthOne was implemented to reduce unavoidable pr preventable
hospitalisation and promote adequate referral to specialist health services. The significance of
this virtual organization was that it focussed on target population group of older people with
chronic illness. The initiative resulted in increased planning and coordination and better
information exchanged between patients and care provided. However, one major limitation of the
initiative was very few referrals to specialised home nursing (McNab & Gillespie, 2015). This
suggests lack of implementation of integrated care model for children and the need for up
gradation of current care models used in paediatric services of WSLHD.
Service Profile within LHD:
The review of current paediatric services in WSLHD and other interlinked facilities are
important to understand areas where service reform is needed. The key facilities available in the
region include the Westmead Hospital, Auburn Hospital, Blacktown hospital, Mount Druitt

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Hospital and the Integrated Community Health Centres. The key services related to pediatric care
available in these hospitals are as follows:
Westmead hospital It is the largest paediatric centre that delivers services to 80, 000 sick and
injured children and it focussed on providing positive care environment to
children (SCHN, 2018).
Auburn Hospital It caters to patient requiring paediatric day only surgery, but outpatient
services exist (Auburn Hospital, 2019).
Mount Druitt Hospital It continues to provide paediatric services specially outpatient services
Blacktown Hospital It mainly provides 24 hours emergency services
The review of immunization services for children in different NSW revealed changes in
immunization coverage in different areas. According to Hendry et al. (2018), the proportion of
children with vaccination delay by 1-3 months for the third dose of the DTPa-containing vaccine
in Western Sydney was 20.6% in Aboriginals and 10.9% in non-Aboriginals. One crucial finding
of the survey was that although gaps in vaccination coverage for aboriginal and non-aboriginal
groups significantly reduced. However, still there remains high proportion of Aboriginal children
with delay in first and third doses of DTPa vaccines. Addressing this disparity is crucial to
promote equity in health outcomes for the residents of Western Sydney. Currently, the WS
Public Health Unit is recruiting Aboriginal Immunisation health care workers (AIHW) to support
aboriginal parents in getting vaccinated on time. The AIHW also get in touch parents with
newborn child to give immunisation related information. In addition, any barrier to addressing
the service is now being met by the indigenous services officer and the Aboriginal Health
Service staff (wslhd.health.nsw.gov.au, 2019).

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Role delineation is a framework that gives an overview of minimum support services
available to deliver care safely. Clinical services fall under seven specialty services in NSW
namely emergency medicine, surgery, child and family health, mental health, aboriginal health
and community health. As the current specialty plan focuses on paediatric health, the child and
family health services will be particularly reviewed Source: (NSW Ministry of Health, 2018).
Table 2 in appendix 3 gives an overview of role delineation service cope and service scope about
child and family health.
According to the role delineation in table 2, core services for paediatric care up to level 5
include adult core services with the capacity to treat children. The level 6 core services include
those services that are mostly provided by specialist’s children's hospital. The critical service
requirements at level 1 include links with maternity services, primary health networks and
referral pathways to the Aboriginal program. Access to allied health services is service
requirements for level 2. At level 3, the main focus is to improve access to facilities that link
with aboriginal mothers and children’s health programs, mental health and drug services and
child protection services. At level 5, the service requirement includes the link with the
community health stream (NSW Ministry of Health, 2018).
The review of current models of care suggests efforts being taken in WS to adapt
integrated models of care. Such models of care can facilitate the transition from one service type
to another and this can be achieved by opening pathways that lead to the development of
integrating service networks and standard protocols. It is a team-based approach to care that
enables the blending of expertise of different health care professionals to improve the health of
the population. As NSW is found to cater to episodic care, integrated care provision is one of the

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best strategies to resolve issues found in the fragmented care system (World Health
Organization, 2016).
Current inpatient and outpatient activity levels
The review of the inpatient and outpatient activity levels at WSLHD for the year 2015-
2016 has been illustrated in table 3 in the appendix. Table 3 lists downs the separations and bed
days for overall services at WS. However, data is available for individual hospitals too. The
number of terminations in Mount Druitt hospital has been 14, 906 and the bed days include 41,
327. In the case of Auburn Hospital, the separation numbers added 20, 422 and the total bed days
were 44, 784. New referrals to child and family health services in WSLHD was 34, 189 and the
numbers of client seen included 77, 228 (WSLHD, 2016). The above data indicates the level of
utilization of health services.
Catchment and reverse catchment profiles:
Within the catchment of Western Sydney, public health care is delivered to million
residents in Sydney. Hospitals in this region have the highest rate of inflows, with about 17,000
separations in 2011-2012. However, the most massive outflow was seen with 26,000 departures
because of a lack of WSLHS’s capacity to treat adult patients. The most recent data available for
Westmead hospital shows a separation rate of 105, 383 in 2017-2018, in Westmead hospital. The
hospital had 317, 581 bed data and the average daily beds were 958. The separation number of
Auburn decreased in 2017, evidenced by 18,816 separations. The separation rate for Blacktown
was 45, 394 (WSLHD, 2018). This data shows patient inflow and outflow rates in the catchment.

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Situational Analysis
The key issues and challenges the plan that can be faced in terms of meeting the health needs
of the WSLHS paediatric population over the next 10 years are as follows:
 Ensuring equity and inclusion to access to health services
 Meeting the health needs of aboriginal children
 Achieving immunization targets for the community
Strategic Issues and Priorities
The key strategies and priorities for the development of paediatric health services
planning at the WSLH includes
 Adaptation of integrated models of care to reduce the gaps related to fragment and
episodic care
 Engage in partnership with community health services to develop strength of
aboriginal people in closing haps in health and life expectancies
 Reducing vulnerabilities for indigenous children
 Enhance early intervention for children with health issues
 Make efforts to improve national immunization targets for aboriginal people
 Reduce the burden of childhood obesity
Future Services Profile by facility:
Future services profile by the facility for WSLHD will be created utilizing the NSW
Paediatric service capability framework. The advantage of this framework is that it defines the
scope of planned activity for each paediatric service. It is designed to optimize paediatric service

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capability by optimizing the care provided within the level of species (NSW Health, 2017). The
key outcomes that are likely to be obtained in the future with an increase in paediatric service
capability are as follows:
 Improvement in service access
 Alignment of services according to contemporary models of care
 Reduction of demands on acute care resources following the integration of services
 Low rate of hospitalizations of children facilitating allocation of resource to early
intervention and prevention activities
 Increase in value of paediatric care
Key goals, objectives and strategies:
Goals Objectives Activities
Adaptation of integrated models
of care
To reduce gaps found in current
models of care
Consultation with key
stakeholders to modify existing
care models
Engage in the community health
partnership
To improve patient access to
services for indigenous people
and facilitate the smooth
transition from one service to
another
Contact aboriginal service and
workforce to give information
regarding health services and
health information
Achieving national immunization
targets for aboriginals
To reduce vulnerabilities for
aboriginal children
Implement immunization
programs and increases access to
immunization service at the local
region of aboriginals

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Increase networking between
paediatric health services
To provide services according to
different levels
Working based on current role
delineation standards
Overarching recommendations and conclusions:
The critical analysis of the environment scan, needs assessments, service profile and
catchment profiles concerning child health or paediatric services in Western Sydney revealed
that the LHD had achieved improvement in mortality rate and immunization rate for children.
However, a delay in immunization for aboriginal children is still an issue. The inflow and patient
outflow rates show an increase in the capacity of hospitals to deal with the problem. However,
due to the presence of fragmented care models, it is recommended to take innovative steps to
adapt the integrated model of care and enhance the capacity of community health services so that
health equity can be maintained.

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References:
Altman, L., Breen, C., Ging, J., Burrett, S., Hoffmann, T., Dickins, E., … Woolfenden, S.
(2018). "Dealing with the Hospital has Become too Difficult for Us to Do Alone" -
Developing an Integrated Care Program for Children with Medical Complexity
(CMC). International journal of integrated care, 18(3), 14. doi:10.5334/ijic.3953
Auburn Hospital. (2019). Auburn Hospital. Retrieved from:
https://www.wslhd.health.nsw.gov.au/Auburn-Hospital
HealthStats NSW (2016). Population by Local Health District. Retrieved from:
http://www.healthstats.nsw.gov.au/Indicator/dem_pop_lhnmap
HealthStats NSW (2017). Infant mortality. Retrieved from:
http://www.healthstats.nsw.gov.au/Indicator/dem_pop_lhnmaphttp://www.healthstats.ns
w.gov.au/Indicator/bod_infdth/bod_infdth_lhn_snap
Hendry, A., Hull, B., Dey, A., Campbell-Lloyd, S., & Beard, F. (2018). NSW Annual
Immunisation Coverage report 2016. Retrieved from:
https://www.health.nsw.gov.au/immunisation/Documents/2017-annual-coverage-
report.pdf
Kim, P., Evans, G. W., Chen, E., Miller, G., & Seeman, T. (2018). How socioeconomic
disadvantages get under the skin and into the brain to influence health development
across the lifespan. In Handbook of life course health development (pp. 463-497).
Springer, Cham.

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McNab, J., & Gillespie, J. A. (2015). Bridging the chronic care gap: HealthOne Mt Druitt,
Australia. International journal of integrated care, 15, e015. doi:10.5334/ijic.2243
NSW Government (2018). Western Sydney Local Health District: About Us. Retrieved from:
https://www.wslhd.health. nsw.gov.au/About-Us/Performance
NSW Health (2017). NSW Paediatric Service Capability Framework. Retrieved from:
https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/GL2017_010.pdf
NSW Ministry of Health (2018). NSW Health Guide to the Role Delineation of Clinical Services.
Retrieved from: https://www.health.nsw.gov.au/services/Publications/role-delineation-of-
clinical-services.PDF
NSW. (2017). child HEALTH & Wellbeing Plan 2016–2021. Retrieved from:
https://www.slhd.nsw.gov.au/pdfs/ChildHealthWellbeingPlan2016-2021.pdf
Silver, R. (2018). Health service public relations: a guide to good practice. CRC Press.
The Sydney Children’s Hospital Network (SCHN). (2018). About The Children's Hospital at
Westmead. Retrieved from: https://www.schn.health.nsw.gov.au/about/about-the-
childrens-hospital-at-westmead
WLSHD (2019). Health Services Plan Growing Good Health in Western Sydney. Retrieved
from: https://www.wslhd.health.nsw.gov.au/ArticleDocuments/511/ WSLHD Health
Services Plan%20-%20overview.pdf.aspx).
World Health Organization (2016). Integrated care models: an overview. Retrieved from:
http://www.euro.who.int/__data/assets/pdf_file/0005/322475/Integrated-care-models-
overview.pdf

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WSLHD (2016). FORGING OUR FRONTIER. Retrieved from:
file:///C:/Users/User00/Downloads/WSLHD_Year_in_Review_2015_16.pdf
WSLHD. (2018). Western Sydney Local Health District. 2017-18 YEAR IN REVIEW.
Retrieved from: file:///C:/Users/User00/Downloads/WSLHD_year-in-review_2017-
18%20(4).pdf
wslhd.health.nsw.gov.au (2019). Aboriginal Health. Retrieved from:
https://www.wslhd.health.nsw.gov.au/Population-Health-Services/Services-and-
Programs/Aboriginal-Health

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Appendix:
1.
Table 1: Number of children in WLSHD in 2016. Source: (HealthStats NSW, 2016).
Age (years) Males Females Total
0-4 37, 490 36, 155 73, 645
5-9 35, 572 33, 306 68, 878
10-14 30, 040 28, 044 58, 083
15-19 30, 671 28, 447 59, 118
2. Infant mortality rate in 2017 for different LSDs (Source: HealthStats NSW 2017).

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3.
Table 2: Role delineation service standards overview.. Source: (NSW Ministry of Health,
2018).
Speciality
services
Standards NPS Ll L2 L3 L4 L5 L6
Child and
Family health
services
Child and family health      
Child Protection Services     
Maternity       
Neonatal       
Paediatric medicine      
Surgery for children     
Youth health     
4.
Table 3: Review of current inpatient and outpatient activity levels at WSLHD

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Number of separations 106, 196
Total bed days 326, 579
Average beds available 1, 024
Number of births in hospital 5, 614
Number of emergency attendance 73, 324
Number of ambulance presentation 24, 260