South Western Sydney LHD: Critical Care Service Plan

This report provides a health service plan for the critical care clinical stream within the South Western Sydney Local Health District (SWS LHD). It begins with an executive summary outlining the need for improved critical care services due to increasing population and changing demographics. The report includes an environmental scan with demographic and health determinant analyses, needs assessments, and data on morbidity and mortality. It details the current service profile within the LHD, catchment and reverse catchment profiles, and a situational analysis identifying strategic issues. The report proposes a future model of care, key goals, objectives, and strategies for the critical care service, followed by conclusions and recommendations. Appendices provide supporting data, including projected population figures and service models. The plan focuses on enhancing capacity and health response times for the local population, particularly through intensive and high dependency care units, emergency departments, pain services, and anaesthetics.

Running head: HEALTH SERVICE FACILITY PLANNING
Health Service Facility planning
Name of the Student
Name of the University
Author’s Note

1HEALTH SERVICE FACILITY PLANNING
EXECUTIVE SUMMARY
South Western Sydney Local Health District (SWS LHD) consists of seven local government
areas and goal of SWS LHD is to increase and enhance the capacity and health response time
for the local population. The purpose of this paper is to present a health service plan (HSP)
for the clinical stream ‘Critical Care’ in SWS LHD area. The increasing population and
changing demographics and environmental condition require more effective healthcare plan
particularly critical care for this area. In this area, the demand for critical care will see an
increase of around 37 % in comparison with today. The higher rate of chronic heart diseases
and other viral diseases are the primary reason for the admittance in critical care in SWS
LHD. These all denotes to the fact that SWS LHD will have a growing demand for adequate
and effective critical care service. The SWS LHD manages three types of health facilities
namely acute, sub-acute and community health facilities. LHD is currently operating
inpatient separations of 195,454 patients. To counter this, a future model of care for critical
care has been provided in this article. Mainly four key medical settings and discipline will be
focussed for these purposes which are intensive and high dependency care units, emergency
departments, pain services and anaesthetics. In this article, the proposed structure of the
critical care service will help to fulfil most the crucial needs of the LHD. It has also been
found that SWSLHD has to increase the health promotional activity through community-
based healthcare service with particular focus in critical care, which can improve their
expansion across the district.

2HEALTH SERVICE FACILITY PLANNING
Table of Contents
1. INTRODUCTION..................................................................................................................4
1.1 Background:.....................................................................................................................4
1.2 Aim:..................................................................................................................................4
1.3Rationale:..........................................................................................................................4
2. ENVIRONMENTAL SCAN.................................................................................................4
2.1 Demographic analysis......................................................................................................4
2.2 Determinants of health.....................................................................................................5
2.3 Burden of Disease data for selected population...............................................................5
2.4 Morbidity and mortality data...........................................................................................6
3. NEEDS ASSESSMENT........................................................................................................6
4. SERVICE PROFILE WITHIN LHD.....................................................................................8
5. CURRENT INPATIENT AND OUTPATIENT ACTIVITY................................................9
6. CATCHMENT AND REVERSE CATCHMENT PROFILE.............................................10
7. SITUATIONAL ANALYSIS INCLUDING STRATEGIC ISSUES AND PROPRIETIES
..................................................................................................................................................10
8. PROPOSED FUTURE MODEL OF CARE........................................................................11
9. PROPOSED KEY GOAL, OBJECTIVES AND STRATEGIES........................................12
10. CONCLUSION AND RECOMMENDATION.................................................................12
REFERENCES.........................................................................................................................14
APPENDICES..........................................................................................................................16

3HEALTH SERVICE FACILITY PLANNING
Appendix1: Projected population of SWSLHD (SWSLHD, 2016).....................................16
Appendix2: Current Service model of Critical care (SWSLHD, 2018)...............................17
Appendix3: Future Service model of Critical care (SWSLHD, 2018)................................18

4HEALTH SERVICE FACILITY PLANNING
1. INTRODUCTION
1.1 Background:
South Western Sydney Local Health District (SWS LHD) was established in the year
2011 during the Australian state health reform. The goal of this reform was to increase and
enhance the capacity and health response time for the local population. This health district
consists of seven local government areas and the approximate coverage area of this health
district is 6,243 km2. South Western Sydney Local Health District has been facilitating this
area with healthcare supports and healthcare premises since the very beginning of their
foundation.
1.2 Aim:
The purpose of this paper is to present a health service plan (HSP) for the clinical
stream ‘Critical Care’. This Population Health Service Plan will present a health service plan
of ‘Critical Care’ for South Western Sydney Local Health District (SWS LHD).
1.3Rationale:
The increasing population and changing demographics and environmental condition
require more effective healthcare plan particularly critical care for this area. Critical Care
provides vital supports to this health service as its helps patient at their most vulnerable
moment. The rationale behind the development of effective and functioning Critical Care
service is to provide timely care and handling the increased demand. Finally, a service profile
with levels and roles will be presented mentioning the strategic goals and objectives.
2. ENVIRONMENTAL SCAN
2.1 Demographic analysis
The South Western Sydney district comprises the urban, rural and semi-rural area
with some valuable national parks and conservation areas. According to Estimated Resident
Population in 2011, this area has the population of 840,602 consisting of Children, young,
Adult, Older population (Watling, 2015: 9). The children population of age group 0 to 14
years is projected as 184,395 in the Census report, which is 22% of the total population. The
young population of age group 15 to 24 years is 120,737, which is 14% of the total
population (Watling, 2015: 11). The adult population with the age of 25 to 70 years is

5HEALTH SERVICE FACILITY PLANNING
468,496 or 56% of the total population. Only 66,976 people are over 70 years old, which is
10% of the total population. With regards to the household structure of this area, 52% of
families are the couple with children (Boonwaat, Fletcher-Lartey&Conaty, 2016:33).
2.2 Determinants of health
Many factors (Social, economic and political) can affect the health of a society. These
factors are educational level, employment status, income level, access to utility services,
social segregation, crime rate and violence behaviour etc. South Western Sydney has a higher
unemployment rate than the overall rate of NSW. The current unemployment rate in this area
is 7.2%, where 26,873 people are unemployed. On the other hand, only 61.1% population are
fulltime employed (Boonwaat, Fletcher-Lartey&Conaty, 2016:34).This high unemployment
rate is directly proportional to the health of the South Western Sydney.Education also plays a
significant role in the health quotient of a society. The education system is average in this
area where 45.6% of the population have completed 12th year or equivalent level education.
23.8% have completed the 10th level or equivalent education (Morgan & Eastwood, 2014:51).
The population of 40.8% do not have 10th level education, which is higher than the NSW
standard. The social diversity of this area is also noticeable. More than 2.4% population are
Aboriginal people and Torres Strait Islanders. Approximately 1.5% population are non-
English speaker where 12.4% people of this area have born overseas (Sina et al., 2018: 43).
Studies have also shown that allocating more budget in social services has reduced the
medical cost of a community. It has shown that this can reduce the prevalence of critical care
needing disease like cancer and mental health (Bradley et al., 2016: 765). High crime rate in a
neighbourhood also increases medical cost of a state.
2.3 Burden of Disease data for selected population
About 16% of children in this area have a chronic condition or disability, such as
asthma, autism, diabetes, physical or intellectual disabilities. The mental health condition of
younger people within the age group of 18 to 25 years is considerably poor than the national
standard (McKay et al., 2012: 49). At the same time, high alcohol consumption is even drug
abuse are also weakening the health condition of this young population. Due to a low level of
physical activity, 27% of the older population is suffering from osteoporosis and arthritis
(Bradd, Travaglia&Hayen, 2017: 22). Apart from that, High blood pressure, vision and
hearing loss and dementia are also common in the older population of this area. About 13%
suicides in this area are attempted by more than 55 years old people due, to the mental health
problem, like Schizophrenia, Bipolar disorder and other conditions.

6HEALTH SERVICE FACILITY PLANNING
2.4 Morbidity and mortality data
There are various types of illness which needs critical care amongst individuals. Most
common of them are respiratory problem, unable to keep blood pressure in check and
infection. These problems need critical care attention. Table 1 presents the major causes of
critical care admission required in the SWSLHD area.
Table1: Morbidity Rate of SWSLHD
Indicator SWSLHD
Viral Upper Respiratory Tract Infection 1657
Fever 1865
Gastroenteritis 1554
Abdominal Pain 1664
Viral disease 2461
Source: (thestatsinstitute., 2013)
Table 2: Mortality Rate and Life expectancy
Indicator SWSLHD
Death from all causes from 2003 to 2006, SMR or Standardised
Mortality Ratio
98.6
Death from all causes from 2005 to 2007, SMR or Standardised
Mortality Ratio
100.8
Life expectancy at birth for male 78.7
Life expectancy at birth for female 83.5
Infant mortality rate 4.4 per 1000 birth
Crude mortality rate 35.47 per 100,000
Source:(South Western Sydney Local Health District, 2013)
3. NEEDS ASSESSMENT
From the above environmental and demographic analysis, it has been clear that in
majority of the population in the SWS LHD comprises of adult (56%) and older generation
(10%).This population is almost two-third of the total SWS LHD population. The higher rate
of chronic heart diseases and other viral diseases clearly indicates that these adult and older
populations have a dire need of effective and adequate intensive critical care amongst them
(Friesen et al., 2014: 5). The proportion of treatment in private hospitals in this area is 27%,

7HEALTH SERVICE FACILITY PLANNING
which is very less than the state level standard and directs to the need of proper critical care
unit in the area of SWS LHD (SWSLHD - Vision and Strategies, 2018).
Figure 1: Growth of demand for critical care in SWSLHD
Source: (South Western Sydney Local Health District, 2013)

8HEALTH SERVICE FACILITY PLANNING
Two-third population of adult and older generation signifies that SWS LHD area will
see a demand for critical care in the near future. Figure 1 depicts this growth demand for
critical care in the area of SWS LHD in the year 2021 -22. From the picture it can be seen
that the demand for critical care will see an increase of around 37 % in comparison with
today. These all denotes to the fact that SWS LHD will have a growing demand for adequate
and effective critical care service. Expected population growth of SWS LHD area in next
five years has been provided in the Appendix 1.
4. SERVICE PROFILE WITHIN LHD
The South Western Sydney Local Health District manages three types of health
facilities namely acute, sub-acute and community health facilities. Each of these facilities
delivers designate services as per the classification system, role delineation, size,
configuration and requirement of local population regulated by the SWSLHD. An overview
of the major health facilities in the District is provided in the Figure 1.
Additionally, current service model for the critical care service in the SWS LHD area
has been provided as a flow chart in the Appendix 2.
Figure 1: SWSLHD Health Facilities and Defined Roles

9HEALTH SERVICE FACILITY PLANNING
Source :( South Western Sydney Local Health District, 2013)
5. CURRENT INPATIENT AND OUTPATIENT ACTIVITY
Current health services of SWSLHD have been grown significantly while providing a
range of services to the community. LHD is currently operating inpatient separations of
195,454 patients (South Western Sydney Local Health District, 2013). At the same time, the
LHD is operation 2.42 million outpatient activities of several services. Inpatient services are
currently operating 40,991 surgical procedures. The outpatient health services include6 acute
care hospitals, 4 affiliated health services, more than 60 community centres and 2,232 bets in
public hospitals (South Western Sydney Local Health District, 2013). For both inpatient and
outpatient, activity the South Western Sydney Local Health District has a formal performance
agreement with the Ministry of health considering the service range and target population.

10HEALTH SERVICE FACILITY PLANNING
6. CATCHMENT AND REVERSE CATCHMENT PROFILE
More than 50% of the activities at Karitane from outside of SWSLHD borders while
reflecting the expanded regional catchment of the service (Kohler et al., 2014). The
requirements of Chemotherapy have been presented based on projected rates of cancer
incidence for catchment populations, which were derived from NSW Cancer Council. In
absence of recently published State NICU plan, NICU beds of Liverpool were shown as
continuous providence o all SWSLHD catchment (SWSLHD - Vision and Strategies, 2018).
The requirements of radiotherapy and chemotherapy have been resented based on incidence
rates of cancer for catchment populations, according to the NSW Cancer Council data. The
adopted approach for implementing this Plan is for developing expansive assumption about
key demand drivers while applying these to the projected catchment population for the
service plan of 2021. The projected activities in 2021 has been declared through utilising the
growth in population cohort as well as the health indicator, which can properly represent the
patient catchment (Stewart, Parter & Maher, 2012: 87). For each SWSLHD facility this has
been under taken by using the geographic area, which can also represent the facility
catchment with more accuracy.
7. SITUATIONAL ANALYSIS INCLUDING STRATEGIC ISSUES AND
PROPRIETIES
In the next ten years, the primary issues that will be faced by Critical Care service of
SWS LHD can be identified as : Population growth, Population ageing, Lack of equity,
emerging therapies, High rates of chronic disease, Complexity of patients, Gaps in key
infrastructure, Limited access to private health services, and a lack of clinical academics to
drive research. From these identified issues, it can be said that the strategic issues and
priorities of SWSLHD are currently based on the significant increase in critical care unit
considering the population growth and ageing as well. Their current strategic planning and
prioritisations suggests that building quality critical care services to a larger group of
pupation is their one of the primary strategies. LHD is also redesigning the services to bring
their critical care service closer to communities for increasing the accessibility (Hope et al.,
2012: 35). Situation can be anticipated and plan can be made accordingly to avoid potential
risks. This can be done by planning in advance for the situation like fluctuations in demand
for critical care, staff disruption, and impact of adverse weather. Additionally, emergency
situation protocol should be reviewed and manoeuvre regularly.

11HEALTH SERVICE FACILITY PLANNING
8. PROPOSED FUTURE MODEL OF CARE
The following Table 3 will depict the future model of care for the critical care unit
and its future directions. Mainly four key medical settings and discipline will be focussed for
this purpose. These four key disciplines are intensive and high dependency care units,
emergency departments, pain services and anaesthetics.
Table 3: Characteristics of future model of care for critical care in SWSLHD Health
Facilities
Emergency
departments
Intensive and high
dependency care units
Anaesthetics Pain services
 Networking
arrangement
and
coordination
between
staff, hospital
and other
resources
 Meeting
NEAT target
and handling
the demand
of increased
pressure
 Application
of team
based care
 Development
of the
resources for
the intensive
care unit by
creating
Critical Care
Taskforce
(CCT)
 Extension and
expansion of
high
dependency
wards like
Respiratory
Non‐Invasive
Ventilation
Unit
 Increased
number of
sedational
procedures
 Involve
nurses in
the minor
sedation
procedures
 Make sure
the
department
is
adequately
staffed.
 Implementation
of NSW
Government
Pain
Management
Plan introduced
in 2012
 Interaction and
collaboration
with third party
insures to
maximise the
work cover.
 Development of
acute pain
management
facilities to
handle
increasing
demand.
Source: (South Western Sydney Local Health District, 2013)