Understanding and assessing demand for health services needs to focus on both need and access (‘demand’) and capacity and capability (‘supply’). We need to understand the trends and future growth in required treatment, predict patient care needs, and align our health system to supply appropriate health services.
This section provides a ‘snapshot’ of the data and evidence that has been used to predict the future demands on our health care services. Further information can be found in the accompanying document “Illawarra Shoalhaven Local Health District Health Care Services Plan 2012-2022: Technical Notes”
Greater attention needs to be paid to the continuum of care, particularly the links between acute care and care in the community. Services need to be provided from cost effective locations that optimise available resources. This is an extraordinarily complex task to address in the Australian health care system.
To understand our future demand for health services, we need to: Understand what is driving the demand across the health continuum Understand how and where demand is expressed
Develop a greater understanding of the socio-demographic influences on the health of our communities To respond to our future demand for health services, we need to:
Ensure there are initiatives to prevent the demand, or ‘pre-empt’ acute onset and manage people more effectively in Primary Health Care settings and through General Practice
Work to move our patients from ‘emergency’ presentation to ‘planned presentation’ and thus allow the health system to improve planning and reduce the cost of treating disease
Increase our understanding of the capacity to supply appropriate services in the primary health care setting and allocate resources accordingly.
Demand is assessed using reported activity in different settings (acute, sub-acute, and ambulatory and primary health care) as well as by considering waiting lists and certain performance results. The historical trends, current (2010/11) distribution of services, and projected growth in demand for each catchment hub were reviewed to identify areas of change over the next 10 years.
Summary of District Socio-demographic profile3
There are three main population centres in the District with the following resident numbers in 2011: Northern Illawarra (Wollongong LGA) 201,728 (52%), Southern Illawarra (Shellharbour LGA and Kiama LGA) 87,961 (23%), and Shoalhaven 98,735 (25%).
3PHIDU Medicare Locals Population Health Profiles Online data, June 2012
Our Population will grow significantly, particularly in the
70+ age cohort. Shoalhaven residents
are the most socio- economically disadvantaged in the
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Each centre has significant projected population growth to 2021, of between 7.8% in Northern Illawarra, and 13.8% in Shoalhaven.
The growth rate in the high demand age cohort of 75+ over the next 10 years is 25.6% (additional 4,106) for North Illawarra, 37.1% (additional 2,233) for South Illawarra, and 38.4% (additional 3,821) in Shoalhaven.
The growth rate for the 0-14 age group is highest in Shoalhaven, at 8.9% (additional 1,523), followed by Wollongong at 7.5% (additional 2,779).
Relative to all District residents, Shoalhaven residents are the most socio- economically disadvantaged, especially in the Nowra area, which also has the highest density of Aboriginal people, the highest level of premature mortality, and the lowest level of private health insurance.
Summary of Historical Trends4
Several acute services are distributed thinly across the District with five EDs and 5 hospitals providing surgical care. There are eight hospitals providing Aged Care and four hospitals providing rehabilitation care. Other acute services are highly concentrated: two acute mental health units and three renal dialysis units.
The acute centres at Wollongong, Shellharbour, Shoalhaven District Memorial and Milton-Ulladulla Hospitals are accessible 24 hours/day, 7 days/ week, and are well located to service the communities with reasonable travel times for emergency care (ie. the maximum travel time for any resident is less than 40 minutes).
In 2010/2011, the District’s hospitals provided 80,922 acute inpatient episodes of treatment (separations), of which Northern Illawarra (Coledale, Bulli and Wollongong Hospitals) accounted for 58.9%, Southern Illawarra (Shellharbour, Port Kembla and Kiama Hospitals) accounted for 15.9%, and Shoalhaven (Shoalhaven District Memorial, David Berry and Milton-Ulladulla Hospitals) accounted for 25.3%.
Private hospitals provided 56,066 separations to District residents in 2010/11, predominantly for diagnostic gastro intestinal endoscopy, rehabilitation, orthopaedics, gastroenterology, and ophthalmology. The District residents use private hospitals less than the state average.
There are high numbers of District residents who receive care in other Local Health Districts (outflows). Residents outflow to access care in high numbers for interventional cardiology, diagnostic gastro intestinal endoscopy, plastic surgery and non-sub-specialty medicine. Re-directing, or attracting, many of the outflows back to the District would increase the local demand, assist in achieving critical mass for services and provide sufficient training opportunities for sub-specialty rosters, thereby providing better access to services locally.
ED presentations at Bulli totalled 5,864 in the 2011/12, 89% of which were Triage Categories 4 or 5. In addition, there were 1,245 planned return presentations to the ED. This total volume appears too low for sustainable medical staffing and diagnostic capability 24 hours/day, 7 days/week.
4FlowInfo Version 11.1
Services are spread across 9 hospitals which provide
acute and subacute inpatient care and mental
health services. There are large numbers of residents accessing care in other Local Health Districts
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Demand for emergency care peaks during the summer months, especially at Shoalhaven District Memorial and Milton-Ulladulla Hospitals, due to tourist visits, where monthly demand can increase by 50% above the background demand level. Variable staffing arrangements are required in the ED and diagnostic services. Demand for services in the Northern Illawarra does not fluctuate in the same way. Mental Health services (acute, sub-acute and non-acute) are concentrated at
Wollongong Hospital (36% of bed-days) and Shellharbour Hospital (64% of bed- days). Shoalhaven residents access Mental Health services at Shellharbour and/or Wollongong hospitals.
In 2010/2011, the District’s hospitals provided 4,720 sub-acute inpatient episodes of treatment (separations). This includes care for Rehabilitation, Aged Care and Palliative Care provided at Coledale, Bulli, Wollongong, Port Kembla, Kiama, David Berry and Shoalhaven District Memorial Hospitals.
Summary of Projected Growth in Services5
While the majority of services are expected to grow over the next 10 years, based on available ‘patient number’ data, it is anticipated that there are a number of services that are expected to have significant growth, which will have a significant impact on the District’s ability to manage the demand for services. The growth in some of these services will be as a result of the District actively pursuing to return some of the outflows back to the District’s hospitals.
The inpatient services that are expected to grow the most and have a significant impact on demand over the next 10 years are:
Geriatric Medicine
Invasive Cardiac Investigative Procedures
Percutaneous Coronary Angioplasty (eg. Stent Implantation) Interventional Cardiology (eg. Pacemaker Implantation) Hip and Knee replacements
Glaucoma and Lens procedures (eg. Cataract) Non-specialty surgery (eg. Hernia, Injury to limb)
With the growth in the ageing population, aged care services are also expected grow significantly over the next 10 years. For patients aged 70+ years, the services that are expected to grow the most and have a significant impact on demand over the next 10 years are:
Hip and Knee replacements
Invasive Cardiac Investigative Procedures
Other Orthopedics (eg. Shoulder Procedures, Connective Tissue Procedures) Glaucoma and Lens Procedures (eg. Cataract)
It is also recognised and supported by the strong view of clinicians that the increasing demand for Dementia Care will have a major impact on our services in future years. It is essential that we plan for this increase and develop robust data collection and reporting mechanisms to support the increasing evidence of demand in this service area.
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