A presentation given by Prof. Les White at the CHA 2012 Conference, The Journey.

1. Health Reform and Children:
NSW Perspective
Prof Les White AM DSc
NSW Chief Paediatrician
October 2012

2. 2

3. An integrated National Health and Hospitals Network
- Organisational elements

4. National Health Reform
 April 2010 – COAG (not WA) signed the National
Health and Hospitals Reform Agreement
 February 2011 – Commonwealth and all State &
Territory Governments agreed to a new Heads of
Agreement, providing in principle commitment
 August 2011 – Release of new Health Reform
Agreement, finalising the in-principle Agreement
 Ch 2: Nurturing a Healthy Start to Life (Recs 22-26)

5. Key Elements of the Health Reform Agreement
 New funding arrangements:
– National Funding Pool
– Activity based funding (ABF) from 1 July 2012
– C‟th shares efficient growth costs 50/50 by 2017.
 New National Performance Standards – including:
– Four hour National Access Target for ED
– National Access Guarantee for Elective Surgery.
 National Safety and Quality Standards
 Medicare Locals (commenced 1 July 2011).
 Maintaining focus on local management &
governance.

6. Role of the States
 The Agreement confirms the crucial role of the States,
as system managers for the public health system,
including:
– System-wide public hospital service planning and
performance
– Purchasing of public hospital services
– Planning, funding, and delivering capital
– Planning, funding (with the Commonwealth) and
delivering teaching, research and training

7. New National Bodies
• National Hospital Performance Authority -
Accountability Performance and Accountability Framework
Transparency • National Funding Body
Pricing • Independent Hospital Pricing Authority
• Australian Commission on Safety and
Standards Quality in Healthcare
Workforce • Health Workforce Australia
Prevention • National Preventative Health Authority

9. National approach to efficient prices
 Activity based funded (ABF) for public hospital services
will flow from the national pool to State accounts and
then to LHDs
 A national system of ABF commenced from 1 July 2012
 Funding will flow directly to State Governments for
(a) Block funded hospitals services and
(b) Teaching, training and research in public hospitals

10. ABF update: August 2012
 National Efficient Price Determination
- Appendix B; Table 1 (all AP‟s)
 NWAU = $4,808 / NSW = $4,471
 Price weight adjustment hierarchy
 Education / Information
- National; IHPA
- NSW: ABF Bulletin
Web resources; Resource Kit
Roadshow; Discussions
 National & NSW paediatric agenda
 Reviews, changes, new DRG version

11. ABF update: August 2012
Chapter 5 Adjustments
5.2 Precedence of Adjustments
To avoid doubt, Adjustments have the following order of
precedence of application:
a) Paediatric Adjustment (55, 25, 20%); then
b) any Remoteness Area Adjustment (8.7, 15.3, 19.4%)
and/or Indigenous Adjustment; then
c) ICU Adjustment (not ICU DRG‟s); then
d) Private Patient Service Adjustment; then
e) Private Patient Accommodation Adjustment.
National Efficient Price Determination 2012-2013

14. Special Commission of Inquiry
Special Commission of Inquiry into Acute Care Services in NSW Public
Hospitals
 Extensive consultation: written submissions; hospital visits; evidence
from patients, community, clinicians; peak bodies; conferences
 Final report made 139 recommendations – three refer to NSW Kids
– Create a new state-wide authority (R.9)
– Coverage - all paediatric inpatient facilities in all hospitals,
community activities (prevention, early intervention and ongoing
specialist)
– Publish a state-wide strategic service delivery plan for child and
youth services (R.10)
– Investigate the need for a new kids hospital (R.11)

15. Special Commission of Inquiry
“It concerns me that in NSW there is currently a lack of coordination of
paediatric and young person’s health care in public hospitals throughout
the state.”
“.. what is required is a single state-wide authority that provides for the
full range of medical care for children and young people. ..”
“Every child in NSW, regardless of where they live and of their
circumstances, should have access to the best health care both in
community (child health services) and hospital (paediatric services)
settings”
Peter Garling SC

16. Initial Achievements
 Sydney Children‟s Hospitals Network (Randwick and
Westmead) established
 Maternity, Child and Young People‟s Health Branch
 Appointment of a Chief Paediatrician, Senior Clinical
Advisor Child Health and Senior Clinical Advisor Child
Protection
 Establishment of the Children and Young People's
Health Program Council

17. “Children First & Forem
“Children First & Foremost”

18. Chief Paediatrician for NSW
 Advocate for the health and wellbeing of children
 Clinician leadership; System wide engagement
 Promote and facilitate the NSW Kids and Families strategy
 Liaise with Local Health Districts, Specialty Networks,
Pillars and MoH branches
 Engage beyond NSW Health
 Progress networks across spectrum of children‟s health
 Rural / remote priorities

19. NSW Public Health System
 Local Health Districts
 Specialty Networks: Sydney Children‟s Hospital Network;
Forensic Mental Health Network; St Vincent‟s Health Network
 Four Pillars: Health Education and Training Institute; Agency for
Clinical Innovation; Bureau of Health Information; Clinical
Excellence Commission
 MH Commission; NSW Cancer Institute
 Other Public Health Organisations: Justice Health; Ambulance;
Health Support Services; Health Infrastructure; eHealth NSW
 NSW Ministry of Health (Governance Review)

20. Local Health Districts (7 Rural & Regional)

21. Local Health Districts (8 Metro)

22. NSW Child Health Network Coverage

24. Comprehensive Model of Child
“Acute” and other
Health & Wellbeing
hospital care
Child protection needs
Developmental needs
Level5/6
Level 4
and
Level 1-3
Population: universal and 10 healthcare

25. Establishing a new authority for NSW children, young
people and their families
Future
Governance
Arrangements
for Children and
NSW Kids Young Peoples
Expert Group Health Services
established NSW report
released and
NSW Kids and
Child Health Network Families
Forum announcement announced
Garling
recommendations

27. Minister announces commitment to a statewide approach to
the health and wellbeing of children
On 22 July 2011 The Hon Jillian Skinner MP Minister for Health
and Minister for Medical Research opened the NSW Child
Health Network Forum (Sydney) by emphasising the need for
safe and appropriate care of children in all situations
The Minister asked the Director-General and the Ministry of
Health to devise a NSW Kids Plan, which is closer to the intent
of the Garling Recommendations.
“NSW needs a long term system wide approach to the
delivery of child and young people‟s health services and
paediatric care.” (The Hon Jillian Skinner MP 20 August 2011)

28. Expert Group
• Appointed by Director-General, Ministry of Health in September 2011
• Established to review progress on implementation of the Garling
recommendations, and advise the Minister and Director-General on a „preferred
governance structure and other elements required for the effective delivery of a
strategy for children and young person‟s health services throughout the state‟
• Targeted consultation with key stakeholders, building on previous consultation
• Considered a range of models and their applicability in new NSW Health
Governance
• The Expert Group Report made a range of recommendations, including a Board
governed statutory health corporation structure
• The Minister for Health accepted all of the Expert Group recommendations,
endorsed by NSW Cabinet
• The Report can be viewed at www.health.nsw.gov.au/nswkids

29. Establishment of NSW Kids and Families announced
 NSW Kids and Families, a new statutory health corporation, to be
established under the Health Services Act 1997 and to commence on
1 July 2012
 Champion the health interests of children and young people whether
they are at home, in the community or in or out of hospital
 Includes health services for mothers & babies, children, young
people, parents and families
 NSW Kids and Families will have a Board chaired by The Hon Ron
Phillips and have the following members: Clinical Professor David
Bennett AO, Ms Ann Brassil, Mrs Christine Corby OAM, Dr Susie
Piper, Professor Graham Vimpani AM and Emeritus Professor
William Walters AM. Standing invitees: Dr Christine Bennett (SCHN)
and Prof Les White AM (Chief Paed)

30. Relationship to NSW Health Governance
Including Sydney Children’s Hospitals Network (Randwick and Westmead)

31. NSW Kids & Families
 CE appointed; staff to be drawn from MCYH Branch and 3 other
 Organisational structure finalised – 4 teams: Maternity and Child
Health; Paediatric Health Care; Youth Health and Wellbeing; and
Child Protection and Violence Prevention / Response
 Work plan and immediate priorities will be determined – mid
November onwards
 Consultation on longer term strategic direction during 2012-2013;
coherence with broader State and NSW Health Plans
 Interface with: Pillars, LHD‟s, SCHN, Medicare Locals, Ministry,
Government agencies, will be critical to INFLUENCE outcomes
 Longitudinal and system-wide perspectives

32. NSW KIDS AND FAMILIES
Purpose Statement (second draft following staff feedback)
PURPOSE
NSW Kids and Families will champion world class health outcomes
and services for children and families of NSW through consultation,
evaluation, innovation and the development of shared knowledge.
ROLE
To provide leadership to the NSW Health system on strategies
which deliver outstanding child and family healthcare services and
give every child the best chance of fulfilling their potential as citizens
of NSW.

33. NSW KIDS AND FAMILIES
Purpose Statement (2nd draft following staff feedback)
WHO: Brings together expertise and resources from within NSW
Health to focus knowledge, effort and action for the health
benefit of families and health care provision located in NSW
HOW: By working collaboratively with the Ministry and agencies
within NSW health, other government departments, primary
health care providers, non-government organisations,
communities and families to develop evidence based practice
in service of LHDs, Sydney Children‟s Hospitals Network and
other providers responsible for delivering health care services
to children and their families

34. NSW KIDS AND FAMILIES
Purpose Statement (2nd draft following staff feedback)
WHAT:
 Develop and support the implementation of evidence- based policies, guidelines
and practices that reduce risk and improve the quality and continuity of
healthcare delivery
 Reduce the prevalence and health impact of violence and neglect on
individuals, families and the communities in which they live
 Stimulate applied research and support uptake of new programs and innovative
models of health care delivery
 Design and monitor service standards and evaluate impact on health outcomes
 Build the capacity of healthcare workers, communities, parents and carers to
promote and protect the health and wellbeing of mothers, babies, children and
young people
 Provide expert advice in relation to the health, wellbeing and healthcare of
mothers, babies, children, young people and their families