anthony proietto, hunter new england local health district: delivering care in nsw
DESCRIPTION
Anthony Proietto, Director of Cancer Services and Cancer Network, Hunter New England Local Health District delivered this presentation at the 2013 Cancer Centres Symposium in Australia. The annual event explores current opportunities and challenges surrounding cancer centre policy, funding, operations, innovations and development. For more information about the annual event, please visit the conference website: http://www.informa.com.au/cancercentressymposiumTRANSCRIPT
About NSW Area 802,000km2
Population 7,232,589 Average Population Density 9/km2
Combined Population : Syd, W’gong, Newc
4,462,892 (62% NSW pop)
Combined Surface Area : Syd, W’gong, Newc
13,090km2
(1.7% NSW surf area) Combined Population Density : Syd, W’gong, Newc
341/km2
Surface Area : Rest NSW 788,910 Population Density : Rest NSW 3.5/km2
Surface Area and Population : Some Comparisons
Country/ Region
Surface Area (Km2)
Population Population Density
Germany 357,127 80,548,000 226 England 130,395 52,234,000 401 France 549,190 65,806,000 120 Spain 505,370 46,704,314 92 Australia 7,741,220 22,906,355 3.0 NSW 802,000 7,232,589 9 HNE 130,000 866,000 6.7
New Cancer Diagnosed in NSW: Actual and Projected
12,490
27,241 29,450
34,958 39,721
45,889 45,245
51,027
0
10,000
20,000
30,000
40,000
50,000
60,000
1990 1995 2000 2005 2010 2015 2016 2021
Incidence & Mortality Variation
LHD Incidence Number
Incidence Rate/100,000
Mortality Number
Mortality Rate/100,000
Metropolitan Local Health Districts Sydney 2299 441.7 879 171.5
SE Syd 4240 501.2 1473 166.5
Rural Local Health Districts Southern 1187 493.4 431 180.7
Western 1511 486.0 581 188.0
Cancer Incidence & Treatment Cost : Increase (%) by Year
Cost of Health Service Increasing cost of Health as a percentage of total NSW expenditure
Year % Total NSW expenditure
2008 28
2017 35
2032 54
Regional Cancer Centres
Centre No of Linacs
North Coast Cancer Institute (Coffs, Lismore, PM) 6
Central Coast 2
North West Regional Cancer Centre 1
Central West 1
Illawarra Shoalhaven 2
Introducing Hunter New England
HNE Local Health District Newcastle to Moree : 504Km or 6.5hrs
Newcastle to Boggabilla: 619Km or 8hrs
Amsterdam to Paris : 428Km
Dieppe to Marseilles : 348Km
HNE Cancer Service
Networked Service since 2007
Represents cancer services across HNE
Supported by Cancer Leadership Committee
Incorporates six clinical streams
Twelve tumour groups
Structure of HNE Cancer Network It is a Hub & Spoke Model Metropolitan Hub Located in Newcastle (John Hunter & Calvary Mater) A Level 6 Service providing :
All major modalities except State-wide and some highly specialised services, Specialist Palliative Care
Structure of HNE Cancer Network
Surgery
Chemotherapy
Radiotherapy
Palliative Care
Other regional services in
Armidale and Taree
Regional Hub: North West Regional Cancer Centre (Tamworth)
Structure of HNE Cancer Network
Outreach Services
Located at Moree, Muswellbrook and Forster
Provide:
Limited surgery
Non-complex chemotherapy
Palliative Care
Projected Cancer Incidence Cancers
Incidence 2007
Incidence 2008
Projected 2016
Projected 2021
Prostate 1167 1235 1704 1914
Colorectal 737 673 877 951
Melanoma 562 599 709 815
Breast 567 563 731 771
Lung 445 469 507 521
All others 1788 1875 1825 2181
Total 5,266 5,414 6,353 7,153 36% increase from 2007 to 2021
Cancer Network Challenges
Large geographical area (130,000Km2)
Account for 14% NSW cancer incidence
Number of solo practitioners in regional centres
Major gaps in some services, eg palliative care, haematology, allied health
Multiple accountabilities – HNE LHD, LCM, CI
Cancer Network Challenges Access to some specialist services (radiotherapy, haematology)
Low levels of radiotherapy utilisation
Supporting rural workforce to manage people with cancer
High Aboriginal and Torres Strait Islander population (20% of NSW)
Out-of-Area Cancer Services Used by Patients from NW Region
% Patients Destination Distance
37 Sydney 8 hours
12 Newcastle 5+
26 Brisbane 6.5
22 North Coast NSW 3+
2008 data
Cancer Network Challenges
Economic issues Accommodation costs Building patient and carer accommodation Distance to treatment centre Limited transport options Investment in Tele-Health options Outreach services
Cancer Network Challenges
Breaking down silos
Partnering with Medicare Local and NGOs
Care integration across facilities and LHDs
Addressing Demand
New Cancer Diagnosed in NSW: Actual and Projected
12,490
27,241 29,450
34,958 39,721
45,889 45,245
51,027
0
10,000
20,000
30,000
40,000
50,000
60,000
1990 1995 2000 2005 2010 2015 2016 2021
HNE Cancer Plan : Goals Redesign cancer services to provide high quality, integrated care Reduce inappropriate variation in patient outcomes Establish effective partnerships and communication with other service providers and community groups Position cancer services for the future Develop a workforce that meets the needs of the future
Possible Strategies Shared Care model with GP and community sector
Integrating care across primary, community and acute services via Health Pathways
Co-ordinated care
Reduce unwanted variation and Closing the Gap
Have the right workforce
Be sustainable
Possible Strategies
Develop network links, eg via telehealth Tailoring service model to local health needs and service capacity Local MDT supported by main oncology service District-wide policies to achieve consistency (eg adoption of eviQ protocols)
Barriers
Inappropriate treatment
Poor co-ordination
Inefficient processes
Administrative complexity
Need to align with the Triple Aim (population health, patient experience, per capita cost)
Barriers
Funding failing to keep pace with service development Challenges of recruiting and retaining staff in regional areas Limited capacity of the non-cancer services to take on additional responsibilities Culture change required to modify traditional roles
The Future : We’re Coming Ready or Not