nathalia district hospital annual report · nathalia district hospital 2013/14 n a t h a l i a d i...

& Quality of Care report 2013/14

Leading our community towards better health

Annual ReportNathalia District Hospital

Contents

Relevant Minister 1

Mission & Vision 1

About Nathalia District Hospital 2

Chair Report 3

Director of Medical Services Report 4

Board Members 5

Attendance at Meetings 5

Senior Officers 6

Organisational Chart 7

Workforce Data 8

Statutory Requirements 9

Summary of Financial Results 12

Statement of Priorities 13

Financial and Service Performance Reporting 15

Highlights for 2013/2014 17

Disclosure Index 18

Annual Financial Report 19

Quality of Care Report 67

INTRODUCTION

In accordance with the Financial Management Act 1994, I am pleased to present the Report of Operations for the Nathalia District Hospital for the year ended 30 June 2014.

Sue Logie Board Chair19 August 2014

Annual Reporting

Nathalia District Hospital reports on its annual performance in two separate documents. This Annual Financial and Performance Report fulfills the statutory reporting requirements to Government by way of an Annual Report and the Quality of Care Report reports on quality, risk management and performance improvement matters. Both documents are presented to the Annual General Meeting and then distributed to the community.

ANNUAL REPORT

VisionLeading our community towards better health.

MissionWorking collaboratively to provide quality health and well-being services for our community

ValuesIntegrity

We engage others in a respectful, fair, and ethical manner, fulfilling our commitments as professionals. We ensure highest degree of dignity, equity, honesty, and kindness.

Accountability We ensure quality patient care, and use resources appropriately in an open and transparent manner.

Collaboration We work as a team in partnership with our staff, our community, and other healthcare providers.

Knowledge

We create opportunities for education and health promotion.

Excellence

We are committed to achieving our goals and improving quality of care by delivering efficient, safe, person-centred, innovative, knowledge-based healthcare.

NATHALIA DISTRICT

HOSPITAL 2013/14

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Nathalia District Hospital was established under the Health Service Act 1988.

Relevant Minister

The responsible Ministers during the reporting period was:

The Honourable David Davis, MLC, Minister for Health and Ageing.

The Honourable Mary Wooldridge, MLA, Minister for Mental Health.

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The Objectives, Functions, Powers and Duties of Nathalia District Hospital are described in the Operational Practices and By-laws of the

organisation.

Established under the Health Services Act 1988, Nathalia District Hospital is the major regional health provider for Nathalia.

Nathalia District Hospital continues to operate under the Department of Health Small Rural Health Services model. This model gives the hospital flexibility to tailor services to meet the changing needs of our community. These programs are reviewed annually in consultation with our community.

The hospital services the residents of Nathalia and District, which encompasses the small townships and districts of Waaia, Barmah, Picola, Kotupna, Bearii and Yalca. It provides a 24-hour urgent care service with a medical practitioner on call, and a range of services within the Acute Care Unit to cater for adults and children. Outpatient services are conducted in Radiology, Pathology, Physiotherapy, Speech Pathology, Occupational Therapy, Dietetics, Palliative Care, Residential Aged Care and Generalist Counselling. Community Health staff and District Nurses provide a wide range of health promotion and domiciliary programs to our community.

About Nathalia District Hospital

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Chair Report

The past 12 months have had management and the Board preparing for the ‘Living Longer Living Better’ Aged Care reforms by the Federal Government. The program introduced from the 1 July 2014 has involved an enormous amount of work by management and the board and I thank them for their commitment and dedication to the task.

Board members and staff have attended several sessions on the new aged care reforms provided by the Victorian Health Association which have been critical for our understanding of the changes, how to best manage them and help drive our strategic planning.

In September 2013, the hospital was awarded accreditation by The National Safety and Quality Health Service (NSQHS) Standards. Congratulations, to our Director of Nursing Leigh Giffard and her staff for managing the process successfully.

We have established a Community Advisory Committee who will assist the hospital to improve our health services to the community.

Bernadette Brooks resigned from her role on the Board. Bernadette served six years on the Board as Board Chair and also represented the hospital on the board of the Moira Healthcare Alliance.

Sadly Marion Hando lost her battle with cancer late last year, she contributed so much to the hospital, as a nurse and then as a member of the Patient Care Review Committee. Our deepest sympathy goes out to her daughters and their families.

We acknowledge the contribution made by Dale Fraser, Chief Executive Officer, Bill Morfis, Executive Director, Planning and Resources and Melissa Bennett from Goulburn Valley Health for their administrative and corporate governance support.

I would like to thank my fellow Board members, staff, volunteers and supporters for their commitment to providing a safe and quality health care service to our community.

Sue Logie

BOARD CHAIR


At the end of this year, I intend to retire as Director of Medical Services (DMS) for the Moira Health Services. It is over ten years since I started as the DMS at Cobram District Health, and then was recruited first to Yarrawonga Health; then Numurkah District Health Service and finally to Nathalia District Hospital. At the time of my appointment to each of the health care services, the only one to have a previous DMS was Nathalia, where the incumbent at Goulburn Valley Health fulfilled that role.

However, there are advantages in having one doctor in the role of Director of Medical Services for the four services. Increasingly, there is a need to unify the training and teaching programs, particularly at a post-graduate medical level. Unless the small health services work together, the individual expertises of the local doctors may not be fully realised. Not only there is a need to unify the teaching programs but there is also value in the four health services coming together once a year to review the credentialing and privileging requirements of the doctors under the chairmanship of the DMS. The important link between the two is the need to assure the various communities that their doctors have maintained their levels of knowledge and competencies. The doctor working in isolation does not have that advantage.

The DMS helps to maintain the links. Nathalia is closer to Shepparton and Yarrawonga is closer to Wangaratta, yet the four health services share much in common.

In my stewardship, with the diffusion of undergraduate education to rural areas through clinical school and university departments of rural health, the small rural hospital becomes a natural repository for the

intellectual capital underpinning good patient care. Dr Peter Poon, who has been a medical stalwart of your community, is a case in point. He is a very good teacher who, with Dr John Drenen, provides the clinical core of expertise upon which such capital can be continually built. This in turn gives confidence to other doctors working in Nathalia.

Finally, my thanks to Mrs Leigh Giffard and her staff – it has always been a warm welcoming environment.

Dr John Best OA Director of Medical Services

Director of Medical Services Report


Board Chair Ms Sue Logie Committees:

• Audit Committee

• Medical Appointments Committee

• Patient Care Review Committee

Deputy Board Chair Mr David McKenzie Committee:


Audit Committee Chair Mr David Vaughan Committees:

• Audit Committee Chair


Ms Bernadette Brooks Committees:

• Audit Committee


• Moira Healthcare Alliance


Mr Kevin Pell Committees:



Ms Kerry-anne Rappell Committee:


Mr Liam Bourke Committees:

• Audit Committee


Attendance at Meetings

JUN JUL AUG SEP NOV DEC JAN FEB MAR APR MAY JUN

Ms. S. Logie (Chair from 1 August 2013)

NM

Ms. B. Brooks NM A A

Mr. D. McKenzie (Chair) A NM

Mr. K. Pell NM

Mr. D. Vaughan A NM

Ms. K. Rappell NM A

Mr. L. Bourke NM A

= In Attendance A = Apology NM = No Meeting

Honorary Solicitors - Dawes & Vary Auditors - Auditor - General Victoria Bank - Bendigo Bank

Board Members


Chief Executive Officer Mr Dale Fraser MBA, FCPA, B. Bus, FHSM

The Chief Executive Officer (CEO) is responsible to the Board of Management for the efficient and effective management of Nathalia District Hospital. The CEO is also the CEO of the Yea & District Memorial Hospital and Goulburn Valley Health. The CEO represents Nathalia District Hospital on a number of State committees.

Chief Finance Officer Mr. Shaun Eldridge (until November 2013) B.Bus (Acc) MBA, CPA

Chief Finance Officer Mr Bill Morfis (from November 2013) BHA (UNSW), MCom (UNSW), CPA

The Chief Financial Officer role has responsibility for the financial management and reporting requirements to the Board of Management, Managers and external bodies including the Department of Health.

Director of Nursing/Manager Ms Leigh Giffard RN, BN, Grad Dip Advanced Nursing (Management), Master of Health Service Management, MRCNA

The Director of Nursing/Manager is responsible for the management of all clinical and non-clinical services within the organisation. This includes Nursing, Hospitality, Maintenance, Allied Health Services and the Nathalia Medical Clinic. Leigh also oversees the operational management of Quality Improvement, Risk Management, Occupational Health and Safety, and Complaints Management. She maintains strong links with the community and its representatives to ensure the services provided by our Hospital meet community needs.

Assistant Director of Nursing Mr Grant Hutchins RN, Bachelor of Public Health, BN

The Assistant Director of Nursing holds a key management and leadership role within the Hospital coordinating the quality of clinical care delivered to our residents and patients. Major responsibilities include Clinical Leadership and Standards of Practice, Nursing Recruitment and Retention, Clinical Risk Management, and Quality Improvement. Grant oversees the placement of nursing, allied health and medical students as well as the ongoing professional development of our own clinical staff. Where necessary, Grant relieves the Director of Nursing/Manager to ensure seamless service delivery.

Director of Medical Services Dr John Best OA MBBS (USyd), FRACP, FRACMA

The Chief Medical Officer has overall professional responsibility for Visiting Medical Officers, biomedical engineering services and medico legal advice. The Chief Medical Officer co-ordinates medical credentialing of VMOs and provides advice to the Board of Management about the appointment of Visiting Medical Officers.

Senior Officers

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Labour Category June Current Month June YTD FTE

2013 2014 2013 2014

Nursing 23.85 22.50 22.96 22.17

Administration & Clerical 2.53 2.79 2.52 2.49

Medical Support 0.00 0.63 0.00 0.49

Hotel & Allied Health Services 11.55 12.40 12.36 12.09

Medical Officers 0.00 0.00 0.00 0.00

Hospital Medical Officers 0.00 0.00 0.00 0.00

Sessional Clinicians 0.05 0.00 0.05 0.04

Ancillary Staff (Allied Health) 1.71 1.11 1.61 1.22

Total 39.69 39.43 39.50 38.50

Nursing 22.50

Hotel & Allied Health Services 12.40

Medical Support 0.63

Administration & Clerical 2.79

Ancillary Staff (Allied Health) 1.11

Workforce Data

Nathalia District Hospital is committed to applying merit and equity principles when appointing staff. The selection processes ensure that applicants are assessed and evaluated fairly and equitably on the basis of the key selection criteria and other accountabilities without discrimination.

All Nathalia District Hospital staff are required to abide by the Code of Conduct, which is based on the Code of Conduct for Victorian Public Sector Employees.


Consultancies

Nathalia District Hospital commissioned three consultancies under $10,000 during the year, at a total cost of $12,298. There were no consultancies commissioned over $10,000.

• Enhar Pty Ltd – Solar Feasibility Study $4,000

• Advanced Environmental Systems – Energy Audit $4,850

• Michael Rhook Health Economics – Residential Aged Care Review $3,448

Advanced Environmental Systems were contracted to conduct an Energy Efficiency Audit on the Hospital. A number of improvements highlighted were actioned, with the effect being a 3% reduction on overall electricity usage. Further improvements are planned to maximise our overall energy efficiency.

Government Advertising

No expenditure was spent on government advertising during 2013/14.

Occupational Health and Safety

Nathalia District Hospital complies with the Occupational Health and Safety (OH&S) Act 2004.

Our focus in 2013-14 was on key organisational OH&S risks that relate to manual handling, slips, trips and falls, and aggression management. Our staff underwent extensive training to ensure these areas were improved to the maximum extent possible. Additional equipment was purchased, and procedures changed to further enhance this effort.

An efficiency review of our policies related to health and safety, and risk management, has been conducted. This rationalisation resulted in 13 policies being combined or withdrawn, and our overall OH&S Management System being further streamlined.

Key Performance Indicators exist across a range of OH&S services, including:

Topic No. of KPIs Results

Fire and Emergency 8100% of staff completed competency in fire and emergency training – an increase of 6% on previous year.

Manual Handling 599% of staff completed competency in manual handling, and increase of 5%. One manual handling incident that resulted in time lost.

Infection Control 9 The external cleaning audit of this site meet the requirements.

Safe Chemical Management

4All non-clinical staff completed chemical safety competency. 98% of chemicals had current material safety data sheets.

Radiation Safety 2 Achieved all outcome measures in this area.

Waste Management 3 Achieved all outcome measures in this area.

Security 5An increase in the number of aggressive clients detected, staff have received further training.

Noise 3 Achieved all outcome measures in this area.

Contractor Management 4 All contracts have been reviewed during the year.

Statutory Requirements


Compliance with Building Act

Nathalia District Hospital remains compliant with the building and maintenance provisions of the Building Act 1993 – Guidelines issued by the Minister for Finance for publicly owned buildings.

During 2013-14, the following have been undertaken: Regulation 1209 & 1215 – Annual Essential Safety Measures Report.

Occupancy Permits and Certificates of Final Inspection

Nathalia District Hospital Occupancy Permits and Certificates of Final Inspection are all current.

Building Works

No new Occupancy Permits and Certificates of Final Inspection were issued.

Essential Safety Measures

We comply with building standards and regulations, with all works completed in 2013-14 according to the Building Act 1993, the Building Code of Australia, Standard for Publicly Owned Buildings 1994 and relevant statutory regulations.

All essential safety measures have been maintained, so far as is practicable, in accordance with the Building Regulations 2006 as is recorded in the Annual Essential Safety Measures Report. Essential Safety Measures Reports are prepared annually for properties owned by Nathalia District Hospital to confirm that all of the essential safety services are operating as required.

We ensure works are inspected by independent building surveyors and maintain a register of building surveyors, as well as the jobs they have certified and for which occupancy certificates have been issued.

Fire Audit Compliance

The Nathalia District Hospital Fire Audit is current.

Freedom of Information

The Victorian Freedom of Information Act 1982 provides individuals with the opportunity for consumers to access personal documents held by public hospitals and other government agencies. The designated FOI Officer who manages applications at Nathalia District Hospital is Chief Executive Officer, Mr Dale Fraser.

Under the legislation, all public entities in Victoria must submit an annual return to the Department of Justice regarding FOI activity. Application fees and access charges applied in regard to FOI are done so in accordance with State Government regulations. In 2013/14 the application fee at Nathalia District Hospital was $25.10 per application plus photocopying charges. Two requests were received, both requests related to patients wishing to access their personal medical records.

Protected Disclosure

We comply with the requirements of the Victorian Government’s Protected Disclosure Act 2012.

Neither improper conduct nor the taking of reprisals against anyone who comes forward to disclose such conduct is acceptable to us. We distinguish protected disclosures from something that would be considered a grievance or internal organisational dispute. No disclosures as per the Protected Disclosure Act 2012 were made in the year ended 30 June 2014.

Privacy

We respect the private information that staff, patients and clients entrust to us and are committed to protecting it. We are bound by a strict code of confidentiality and comply with all legislation related to privacy and confidentiality, including the following Victorian Acts:

• Health Services Act 1988

• Information Privacy Act 2000

• Health Records Act 2001

Statutory Requirements continued


Carers Recognition

The Carers Recognition Act 2012 formally acknowledges the important contribution that people in a care relationship make to our community and the unique knowledge that carers hold of the person in their care. The value role of the carer has been actively integrated in the policies and procedures of Nathalia District Hospital.

Competitive Neutrality

We are committed to ensuring that our services demonstrate both quality and efficiency. Competitive neutrality, which supports the Commonwealth Government’s national competition policy, helps to ensure that net competitive advantages which accrue to a government business are offset. We understand the requirements of competitive neutrality and act accordingly.

We support the principles of the Partnerships Victoria policy, which relates to responsible expenditure and infrastructure projects, and the creation of effective partnerships between private enterprise and the public sector.

Victorian Industry Participation Policy

We are committed to ensuring that our participation with Victorian industry is maximised and delivers the highest level of performance for each dollar expended. There were no procurements or projects above $1 million for the 2013-14 year, in accordance with the Victorian Industry Participation Policy Act 2003.

Environmental Performance

The environment is one of our most precious resources, and our Board and staff at Nathalia District Hospital work diligently to minimise our impact upon the environment. In the 2013-14 year a number of measures have been initiated to maximise our environmental sustainability, these include:

• Commissioning and implementation of actions from an energy efficiency audit, resulting in a 3% saving on electricity usage.

• Increased recycling efforts, resulting in a 7% reduction in waste going to landfill.

• Switched garden watering system to a mix of rain water and channel water, reducing town-water usage by 5ML.

• Switched all vehicles to diesel from unleaded, decreasing average fuel consumption from 7.8L/100km to 5.6L/100km.

Additional information

In compliance with the requirements of FRD 22D Standard Disclosures in the Report of Operations, details in respect of the items listed below have been retained by Nathalia District Hospital and are available to the relevant Ministers, Members of Parliament and the public on request (subject to the freedom of information requirements, if applicable):

a. A statement of pecuniary interest has been completed;

b. Details of shares held by senior officers as nominee or held beneficially;

c. Details of publications produced by the Department about the activities of the Health Service and where they can be obtained;

d. Details of changes in prices, fees, charges, rates and levies charged by the Health Service;

e. Details of any major external reviews carried out on the Health Service;

f. Details of major research and development activities undertaken by the Health Service that are not otherwise covered either in the Report of Operations or in a document that contains the financial statements and Report of Operations;

g. Details of overseas visits undertaken including a summary of the objectives and outcomes of each visit;

h. Details of major promotional, public relations and marketing activities undertaken by the Health Service to develop community awareness of the Health Service and its services;

i. Details of assessments and measures undertaken to improve the occupational health and safety of employees;

j. General statement on industrial relations within the Health Service and details of time lost through industrial accidents and disputes, which is not otherwise detailed in the Report of Operations;

k. A list of major committees sponsored by the Health Service, the purposes of each committee and the extent to which those purposes have been achieved;

l. Details of all consultancies and contractors including consultants/contractors engaged, services provided, and expenditure committed for each engagement.


Relevant Financial Information

Summary of Financial Results

Financial Analysis of Operating Revenues and Expenses 2013 2012 2011 2010 2009

Total Revenue 6,227,662 5,848,139 5,620,155 10,504,238 4,019,233

Total Expenses 6,655,300 6,344,655 6,377,494 5,497,230 4,348,046

Net Result for the year (inc. Capital & Specific Items) (427,638) (496,516) (757,339) 5,007,008 (328,813)

Retained Surplus/ (Accumulated Deficit) 3,424,478 3,999,122 4,386,060 5,080,701 264,413

Total Assets 18,010,127 18,053,963 18,227,142 18,904,848 13,752,767

Total Liabilities 1,900,102 1,516,300 1,192,963 1,113,330 968,257

Net Assets 16,110,025 16,537,663 17,034,179 17,791,518 12,784,510

Total Equity 16,110,025 16,537,663 17,034,179 17,791,518 12,784,510

Nathalia District HospitalSummary of Financial Results For the Year Ended 30 June 2014

Significant Changes in Financial Position

Equity and Property, Plant and Equipment have increased during the year due to the revaluation of land and buildings.

Operational & Budgetary Objectives & Factors Affecting Performance

The Board budgeted for a breakeven result in the financial position before capital items and depreciation for the 2013/14 year. The final result for the year was a small deficit before capital items and depreciation. The major factors contributing to the results were the costs associated with supporting clinical operations and shortfalls in revenue associated with staffing movements through the year.

Events subsequent to balance date

Nathalia District Hospital negotiated the sale of the former hospital site in Elizabeth Street during the year, the proceeds realised at settlement in 2013/14.


Statement of Priorities 2013-2014

Action Deliverable Outcome

Implement formal advance care planning structures and processes that provide patients with opportunities to develop, review and have their expressed preferences for future treatment and care enacted.

Complete an education program for clinical staff and community on advanced care planning philosophy.

Develop a system to identify record and meet the identified preferences on the individual client at service contact.

Selected clinical staff have undertaken Advanced Care Planning education.

An information package has been developed for consumers.

Consumers are now asked at first contact to identify if they have completed an Advanced Care Plan.

Work and plan with key partners and service providers to respond to issues of distance and travel time experienced by some rural and regional Victorians.

Resource methods to reduce or manage the cost of transport of patients to the regional centre in Shepparton.

Agreement signed with patient transport to transfer non urgent cases to Shepparton. Items have been placed in the local Redgum Courier encouraging local residents to subscribe to Ambulance Victoria.

Improve thirty-day unplanned readmission rates.

Increase patient satisfaction with the information provided on discharge which supports them managing at home post discharge.

Information given to patients on discharge has been reviewed using feedback from patients about the information which would assist them post discharge.

Deliver care as close to home as possible, when it is safe and effective to do so.

Identify options to support the ongoing provision of medical imaging services in Nathalia.

Funding has been successful to train 3 nurses to undertake nurse led x-ray services.

Build workforce capability and sustainability by supporting formal and informal clinical education and training for staff and health students, in particular inter-professional learning.

Work with Medicare Local to implement a scholarship program that supports the education of nurses to practice as Rural Isolated Practise Endorsed Registered Nurse (RIPERN) practitioners.

Nathalia District Hospital has overseen the distribution of 20 scholarships across 6 health services to support nurses to extend their scope of practice in Urgent Care Centres.

Reduce variation in health service administrative costs

Undertake to review the administrative staffing structure to minimise duplication whilst maintaining service delivery.

A review of the administrative staffing structure has resulted in a single reception area/point of entry for all persons entering the building. Evaluation of the changes is currently being undertaken.

Identify opportunities for efficiency and better value service delivery.

Implement processes to maximise access to the eight Peter Prentice Place community based units.

The eight Peter Prentice Place units have had full occupancy since January 2014.


Action Deliverable Outcome

Support change and innovation in practice where it is proven to deliver more effective and efficient health care

Implement a patient managed discharge plan that gives greater control of outcomes to the patient.

A patient self managed discharge plan has been implemented to assist patients to identify their own needs post discharge and ensure staff work with the patient to achieve their goals.

Prepare for the National Safety and Quality Health Service Standards, as applicable.

Develop and implement policies and procedures to meet the National Standards requirements at Australian Council on Healthcare (ACHS) periodic review in September 2013.

National Standards Review in September 2013 saw Nathalia District Hospital compliant in the Standards with 5 met with merits awarded.

Increase transparency and accountability in reporting of accurate and relevant information about the organisation’s performance.

Introduce a system of informing consumers of the organisation’s performance through a monthly performance report.

An ongoing performance report is available to all patients and residents through a monthly visual display identifying outcomes to all quality audits and activities.

Work with partners to better connect service providers and deliver appropriate and timely services to rural and regional Victorians.

Progressively implement the ‘ConnectingCare’ referral system with the assistance of Primary Care Partnerships.

The ‘ConnectingCare’ referral system has been implemented across the health service.


Financial and Service Performance Reporting

AGED CARE PLACESPublic Sector Residential Aged Care Services (PSRACS)

Campus Number Occupancy level %

High Care 20 99.59

ACUTE

Service Type of activity Activity levels

Medical inpatients Bed days 1,486

Urgent care Presentations 153

Nursing home type patients Bed days 299

Non-admitted patients Occasions of service 5,747

Radiology Number of clients 291

Palliative care Number of clients 9

District nursing Occasions of service 276

Maternity Number of clients 13

Renal dialysis Number of clients 0

Quality and Safety Target 2013-14 actuals

Health Service Accreditation Full compliance Full compliance

Residential Aged Care Accreditation Full compliance Full compliance

Cleaning Standards Full compliance 91.5%

Submission of Data to VICNISS Full compliance Full compliance

Hospital Acquired Infection Surveillance No outliers Full compliance

Hand Hygiene (rate) 70 84.6%

Victorian Patient Satisfaction Monitor (OCI) 73 Insufficient Returns

Consumer Participation Indicator 75 Insufficient Returns

People Matter Survey Full compliance Full compliance

FINANCIAL PERFORMANCEOperating Result Target 2013-14 actuals

Annual Operating result $0 - Balanced Budget $77,283 deficit

Cash Management Target 2013-14 actuals

Creditors <60 days 59 days

Debtors <60 days 25 days


ATTESTATION OF DATA INTEGRITY

I, Dale Fraser, certify that Nathalia District Hospital has put in place appropriate internal controls and processes to ensure that reported data reasonably reflects actual performance. Nathalia District Hospital has critically reviewed these controls and processes during the year.

Dale Fraser Chief Executive Officer 13 August 2014

ATTESTATION FOR COMPLIANCE WITH THE MINISTERIAL STANDING DIRECTION 4.5.5.1 - INSURANCE

I, Dale Fraser, certify that Nathalia District Hospital has complied with Ministerial Direction 4.5.5.1 - Insurance


ATTESTATION OF COMPLIANCE WITH AUSTRALIAN/NEW ZEALAND RISK MANAGEMENT STANDARD

I, Dale Fraser, certify that Nathalia District Hospital has risk management processes in place consistent with the Australian/New Zealand Risk Management Standard (AS/NZS ISO 31000:2009) and an internal control system is in place that enables the executives to understand, manage and satisfactorily control risk exposures. The Audit Committee verifies this assurance and that the risk profile of Nathalia District Hospital has been critically reviewed within the last 12 months.


PRIMARY HEALTH CARE

Service Activity levels by hours of service

Community Health Nursing 1,783

District Nursing 5,967

Dietetics 100

Podiatry 265

Physiotherapy 1,884

Counselling 624

Optometry 82

Occupational Therapy 243

Financial and Service Performance Reporting continued


Highlights for 2013-2014Expansion of the Rural and Isolated Practice Endorsed Registered Nurse (RIPERN) Program at Nathalia

In early 2013 our health service implemented the RIPERN program, aimed at improving patient access to timely, safe and appropriate care in the event that there is no Medical Officer available. Three Registered Nurses had, at that time, successfully completed the training requirements. Since then, with the financial support of GV Medicare Local, an additional two RNs have completed the training, with a further three preparing to undertake the course in 2015.

The RIPERN nurses may administer or supply medicines approved by the Minister for Health, according to the health management protocols contained in the Primary Clinical Care Manual to patients who present in Urgent Care. Following the successful implementation of the program, Nathalia District Hospital was invited to undertake a piece of work in partnership with Numurkah District Health Service, to write guidelines for The Department of Health on nurse led remote operator x-ray services across Victoria. This was successfully completed by December 2013, following which Nathalia District Hospital has recently received funding to support three Registered Nurses to undertake training to allow them to do basic x-rays here at Nathalia. Training will commence in September 2015 to enhance the current RIPERN program.

Partnering with Consumers through the introduction of a Consumer Advisory Committee

Nathalia District Hospital put out an expression of interest in December 2013, inviting interested consumers to form a Consumer Advisory Committee for our health service. This is an important component for Nathalia District Hospital to establish a means of gathering advice and the views of consumers and carers about our health service.

This committee provides advice that will be used by our Board of Management when planning and developing policy. This active committee is advisory to the Board of Management feeding back ideas and issues to the Board through Patient Care Review Committee. It does, however, have no executive authority.

Award for Dr Peter Poon

Dr Poon received the Rural Doctor Award at the Victorian Rural Health Awards held in Melbourne in November 2013, after our health service nominated him in the category of serving more than 35 years or more working in a rural community whilst making an outstanding contribution towards innovation, professional/personal commitment and leadership.

Dr Poon has been providing quality medical services to the small rural community of Nathalia for the past 35 years. A staunch advocate of preventative medicine, his constant aim has been to develop proactive strategies to improve the health and wellbeing of his local community.

Congratulations to Dr Poon, a well deserved recognition.


Disclosure IndexThe annual report of the Nathalia District Hospital is prepared in accordance with all relevant Victorian legislation. This index has been prepared to facilitate identification of the Department’s compliance with statutory disclosure requirements.

Legislation Requirement Page Reference

Ministerial Directions

Report of Operations

Charter and purpose

FRD 22D Manner of establishment and the relevant Ministers 1FRD 22D Objectives, functions, powers and duties 2FRD 22D Nature and range of services provided 2

Management and structureFRD 22D Organisational structure 7

Financial and other informationFRD 10 Disclosure index 18FRD 11A Disclosure of ex-gratia expenses 11FRD 12A Disclosure of major contracts 68

FRD 21B Responsible person and executive officer disclosures 10

FRD 22D Application and operation of Protected Disclosure 2012 11FRD 22D Application and operation of Carers Recognition Act 2012 10FRD 22D Application and operation of Freedom of Information Act 1982 10

FRD 22D Compliance with building and maintenance provisions of Building Act 1993 9

FRD 22D Details of consultancies over $10,000 9FRD 22D Details of consultancies under $10,000 8FRD 22D Employment and conduct principles 12FRD 22D Major changes or factors affecting performance 9FRD 22D Occupational health and safety 12FRD 22D Operational and budgetary objectives and performance against objectives 12FRD 24C Reporting of office-based environmental impacts 11FRD 22D Significant changes in financial position during the year 12FRD 22D Statement on National Competition Policy 11FRD 22D Subsequent events 12FRD 22D Summary of the financial results for the year 12

FRD 22D Workforce Data Disclosures including a statement on the application of employment and conduct principles 8

FRD 25B Victorian Industry Participation Policy disclosures 11FRD 29 Workforce Data disclosures 8SD 4.2(j) Sign-off requirements 22SD 3.4.13 Attestation on Data Integrity 16SD 4.5.5.1 Ministerial Standing Direction 4.5.5.1 compliance attestation 16SD 4.5.5 Risk management compliance attestation 16

Financial Statements

Financial statements required under Part 7 of the FMASD 4.2(a) Statement of changes in equity 25SD 4.2(b) Operating statement 23SD 4.2(b) Balance sheet 24SD 4.2(b) Cash flow statement 26

Other requirements under Standing Directions 4.2SD 4.2(a) Compliance with Australian accounting standards and other authoritative pronouncements 27SD 4.2(c) Accountable officer’s declaration 22SD 4.2(c) Compliance with Ministerial Directions 27SD 4.2(d) Rounding of amounts 29

LegislationFreedom of Information Act 1982 10Protected Disclosure Act 2001 10Carers Recognition Act 2012 11Victorian Industry Participation Policy Act 2003 11


Annual Financial ReportNathalia District Hospital


We certify that the attached financial statements for Nathalia District Hospital have been prepared in accordance with Standing Direction 4.2 of the Financial Management Act 1994, applicable Financial Reporting Directions, Australian Accounting Standards, Australian Accounting Interpretations and other mandatory professional reporting requirements.

We further state that, in our opinion, the information set out in the comprehensive operating statement, balance sheet, statement of changes in equity, cash flow statement and notes to and forming part of the financial statements, presents fairly the financial transactions during the year ended 30 June 2014 and the financial position of Nathalia District Hospital at 30 June 2014.

At the time of signing, we are not aware of any circumstance which would render any particulars included in the financial statements to be misleading or inaccurate.

We authorise the attached financial statements for issue on this day.

Nathalia District Hospital Board member’s, accountable

officer’s and chief finance & accounting officer’s declaration

Bill Morfis Chief Finance & Accounting Officer

Shepparton 19 August 2014

Dale Fraser Accountable Officer


Sue Logie Chairperson



Nathalia District HospitalComprehensive Operating StatementFor the Financial Year Ended 30 June 2014

Note

Total2014

$

Total2013

$

Revenue From Operating Activities 2 5,653,673 5,927,933

Revenue From Non-Operating Activities 2 89,995 96,501

Employee Expenses 3 (4,059,877) (4,181,342)

Non Salary Labour Costs 3 (616,429) (526,811)

Supplies and Consumables 3 (215,517) (262,403)

Other Expenses 3 (929,128) (1,089,233)

Net Result Before Capital & Specific Items (77,283) (35,355)

Capital Purpose Income 2 224,224 203,228

Depreciation 4 (552,499) (592,112)

Finance Costs 3 - -

Expenditure Using Capital Purpose Income 3 (38,545) (2,205)

Share Adjustment in Hume Rural Health Alliance Joint Venture 3 (886) (1,194)

Net Result for the Year (444,989) (427,638)

Other Comprehensive Income Items that will not bereclassified to Net Result

Changes in Physical Asset Revaluation Surplus 13 4,832,736 -

Total Other Comprehensive Income 4,832,736 -

Comprehensive Result For The Year 4,387,747 (427,638)

This statement should be read in conjunction with the accompanying notes


Nathalia District HospitalBalance SheetAs At 30 June 2014

Note

Total2014

$

Total2013

$Current Assets

Cash and Cash Equivalents 5 2,480,340 2,445,130

Receivables 6 193,046 203,269

Other Assets 7 47,313 20,803

Total Current Assets 2,720,699 2,669,202

Non Current Assets

Receivables 6 263,196 173,372

Property, Plant & Equipment 8 19,419,885 15,167,553

Total Non Current Assets 19,683,081 15,340,925

TOTAL ASSETS 22,403,780 18,010,127

Current Liabilities

Payables 9 429,790 522,934

Provisions 10 913,544 912,836

Other Liabilities 12 278,690 288,263

Total Current Liabilities 1,622,024 1,724,033

Non Current Liabilities

Provisions 10 283,984 176,069

Total Non Current Liabilities 283,984 176,069

TOTAL LIABILITIES 1,906,008 1,900,102

NET ASSETS 20,497,772 16,110,025

EQUITY

Property, Plant and Equipment Revaluation Surplus 13a 5,072,713 239,977

General Purpose Surplus 13a 1,268,697 1,179,136

Restricted Specific Purpose Surplus 13a 162,466 162,466

Contributed Capital 13b 11,103,968 11,103,968

Accumulated Surpluses 13c 2,889,928 3,424,478

TOTAL EQUITY 20,497,772 16,110,025

Contingent Assets and Contingent Liabilities 21

Commitments 22



Nathalia District HospitalStatement of Changes in EquityFor the Financial Year Ended 30 June 2014

Note

Property, Plant

& EquipmentRevaluation

Surplus

GeneralPurposeSurplus

RestrictedSpecificPurposeSurplus

Contributed Capital

AccumulatedSurpluses/

(Deficits) Total $ $ $ $ $ $

Balance at 1 July 2012

239,977 1,032,130 162,466 11,103,968 3,999,122 16,537,663

Net Result for the Year

- - - - (427,638) (427,638)

Transfer to Accumulated Surplus

13(a), (c)

- 147,006 - - (147,006) -

Balance at 30 June 2013

239,977 1,179,136 162,466 11,103,968 3,424,478 16,110,025

Net Result for the Year

- - - - (444,989) (444,989)

Transfer to Accumulated Surplus

13(a), (c)

- 89,561 - - (89,561) -

Other Comprehensive Income for the year

13(a) 4,832,736 - - - - 4,832,736

Balance at 30 June 2014

5,072,713 1,268,697 162,466 11,103,968 2,889,928 20,497,772

This Statement should be read in conjunction with the accompanying notes.


Nathalia District HospitalCash Flow StatementFor the Financial Year Ended 30 June 2014

Note

Total2014

$

Total2013

$

Cash Flows from Operating Activities

Operating Grants from Government 3,769,895 4,077,787

Patient and Resident Fees Received 454,118 472,945

Donations and Bequests Received 11,670 63,539

Interest Received 89,818 98,877

Other Receipts 1,306,734 1,213,571

GST Received from ATO 134,515 134,102

Total Receipts 5,766,750 6,060,821

Employee Expenses Paid (3,951,254) (4,086,306)

Non Salary Labour Costs (616,429) (526,811)

Payments for Supplies and Consumables (1,366,982) (1,441,439)

Total Payments (5,934,665) (6,054,556)

Cash Generated from Operations (167,915) 6,265

Capital Grants from Government 131,141 29,264

Other Capital Income 5,075 -

Residential Accommodation Payments Received 125,540 96,703

Expenditure Using Capital Purpose Income (39,431) (3,399)

Net Cash Flow from Operating Activities 14 54,410 128,833

Cash Flows from Investing Activities

Payments for Non Financial Assets (231,445) (65,407)

Proceeds from Sale of Non Financial Assets 221,818 13,105

Net Cash Flow Used Investing Activities (9,627) (52,302)

Net Increase in Cash and Cash Equivalents Held 44,783 76,531 Cash and Cash Equivalents at Beginning of Financial Year 2,156,867 2,080,336

Cash and Cash Equivalents at End of Financial Year 5 2,201,650 2,156,867



Nathalia District Hospital Notes to the Financial Statements 30 June 2014

NOTE 1: SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES

These annual financial statements represent the audited general purpose financial statements for Nathalia District Hospital for the period ending 30 June 2014. The purpose of the report is to provide users with information about the Health Services’ stewardship of resources entrusted to it.

a. Statement of compliance

These financial statements are general purpose financial statements which have been prepared in accordance with the Financial Management Act 1994 and applicable AASs, which include interpretations issued by the Australian Accounting Standards Board (AASB). They are presented in a manner consistent with the requirements of AASB 101 Presentation of Financial Statements.

The financial statements also comply with relevant Financial Reporting Directions (FRDs) issued by the Department of Treasury and Finance, and relevant Standing Directions (SDs) authorised by the Minister for Finance.

The Health Service is a not-for profit entity and therefore applies the additional Aus paragraphs applicable to “not-for-profit” Health Services under the AASs.

The annual financial statements were authorised for issue by the Board of Nathalia District Hospital on 19th August 2014.

b. Basis of accounting preparation and measurement

Accounting policies are selected and applied in a manner which ensures that the resulting financial information satisfies the concepts of relevance and reliability, thereby ensuring that the substance of the underlying transactions or other events is reported.

The accounting policies set out below have been applied in preparing the financial statements for the year ended 30 June 2014, and the comparative information presented in these financial statements for the year ended 30 June 2013.

The going concern basis was used to prepare the financial statements.

These financial statements are presented in Australian dollars, the functional and presentation currency of the Health Service.

The financial statements, except for cash flow information, have been prepared using the accrual basis of accounting. Under the accrual basis, items are recognised as assets, liabilities, equity, income or expenses when they satisfy the definitions and recognition criteria for those items, that is they are recognised in the reporting period to which they relate, regardless of when cash is received or paid.

The financial statements are prepared in accordance with the historical cost convention, except for:

• Non-current physical assets, which subsequent to acquisition, are measured at a revalued amount being their fair value at the date of the revaluation less any subsequent accumulated depreciation and subsequent impairment losses. Revaluations are made and are re-assessed with sufficient regularity to ensure that the carrying amounts do not materially differ from their fair values;

• the fair value of assets other than land is generally based on their depreciated replacement value.

Judgements, estimates and assumptions are required to be made about carrying values of assets and liabilities that are not readily apparent from other sources. The estimates and associated assumptions are based on professional judgements derived from historical experience and various other factors that are believed to be reasonable under the circumstances. Actual results may differ from these estimates.

Revisions to accounting estimates are recognised in the period in which the estimate is revised and also in future periods that are affected by the revision. Judgements and assumptions made by management in the application of AASs that have significant effects on the financial statements and estimates relate to:

• the fair value of land, buildings, infrastructure, plant and equipment, (refer to Note 1(k));

• actuarial assumptions for employee benefit provisions based on likely tenure of existing staff, patterns of leave claims, future salary movements and future discount rates (refer to Note 1(l)).

Consistent with AASB 13 Fair Value Measurement, Nathalia District Hospital determines the policies and procedures for both recurring fair value measurements such as property, plant and



equipment, and financial instruments and for non-recurring fair value measurements such as non-financial physical assets held for sale, in accordance with the requirements of AASB 13 and the relevant FRDs.

All assets and liabilities for which fair value is measured or disclosed in the financial statements are categorised within the fair value hierarchy, described as follows, based on the lowest level input that is significant to the fair value measurement as a whole:

• Level 1 – Quoted (unadjusted) market prices in active markets for identical assets or liabilities

• Level 2 – Valuation techniques for which the lowest level input that is significant to the fair value measurement is directly or indirectly observable

• Level 3 – Valuation techniques for which the lowest level input that is significant to the fair value measurement is unobservable.

For the purpose of fair value disclosures, Nathalia District Hospital has determined classes of assets and liabilities on the basis of the nature, characteristics and risks of the asset or liability and the level of the fair value hierarchy as explained above.

In addition, Nathalia District Hospital determines whether transfers have occurred between levels in the hierarchy by re-assessing categorisation (based on the lowest level input that is significant to the fair value measurement as a whole) at the end of each reporting period.

The Valuer-General Victoria (VGV) is Nathalia District Hospital’s independent valuation agency.

Nathalia District Hospital in conjunction with VGV monitors the changes in the fair value of each asset and liability through relevant data sources to determine whether revaluation is required.

The estimates and underlying assumptions are reviewed on an ongoing basis. Revisions to accounting estimates are recognised in the period in which the estimate is revised if the revision affects only that period or in the period of the revision, and future periods if the revision affects both current and future periods. Judgements and assumptions made by management in the application of AASs that have significant effects on the financial statements and estimates, with a risk of material adjustments in the subsequent reporting period, relate to:

• The fair value of land, buildings, infrastructure, plant and equipment (refer to Note 1(k); and

• Actuarial assumptions for employee benefit provisions based on likely tenure of existing staff, patterns of leave claims, future salary movements and future discount rates (refer to Note 1(l)).

c. Reporting entity

The financial statements include all the controlled activities of Nathalia District Hospital. Its principal address is:

36-44 McDonell StreetNathaliaVictoria 3638.

A description of the nature of Nathalia District Hospital’s operations and its principal activities is included in the report of operations, which does not form part of these financial statements.

Objectives and funding

Nathalia District Hospital’s overall objective is to work collaboratively to provide quality health and well-being services for our community, as well as improve the quality of life to Victorians.

Nathalia District Hospital is predominantly funded by accrual based grant funding for the provision of outputs.

d. Principles of consolidation

Nathalia District Hospital does not control any other entities.

Jointly controlled assets or operations

Interests in jointly controlled assets or operations are not consolidated by Nathalia District Hospital, but are accounted for in accordance with the policy outlined in Note 1(k) Financial assets.

e. Scope and presentation of financial statements

Fund Accounting

Nathalia District Hospital operates on a fund accounting basis and maintains three funds: Operating, Specific Purpose and Capital Funds. Nathalia District Hospital’s Capital and Specific Purpose Funds include unspent capital donations and receipts from fund-raising activities conducted solely in respect of these funds.



Services Supported By Health Services Agreement and Services Supported By Hospital and Community Initiatives

Activities classified as Services Supported by Health Services Agreement (HSA) are substantially funded by the Department of Health and includes Residential Aged Care Services (RACS) and are also funded from other sources such as the Commonwealth, patients and residents, while Services Supported by Hospital and Community Initiatives (H&CI) are funded by Nathalia District Hospital’s own activities or local initiatives and/or the Commonwealth.

Residential Aged Care Service

Nathalia District Hospital’s Residential Aged Care Service operations are an integral part of the entity and shares its resources. An apportionment of land and buildings has been made based on floor space. The results of the two operations have been segregated based on actual revenue earned and expenditure incurred by each operation in Note 2b to the financial statements.

Nathalia District Hospital’s Residential Aged Care does not have a separate Committee of Management and is substantially funded from Commonwealth bed-day subsidies.

Comprehensive operating statement

The comprehensive operating statement includes the subtotal entitled ‘net result before capital & specific items’ to enhance the understanding of the financial performance of Nathalia District Hospital. This subtotal reports the result excluding items such as capital grants, assets received or provided free of charge, depreciation, expenditure using capital purpose income and items of an unusual nature and amount such as specific income and expenses. The exclusion of these items is made to enhance matching of income and expenses so as to facilitate the comparability and consistency of results between years and Victorian Public Health Services. The ‘net result before capital & specific items’ is used by the management of Nathalia District Hospital, the Department of Health and the Victorian Government to measure the ongoing operating performance of Health Services.

Capital and specific items, which are excluded from this sub-total, comprise:

• Capital purpose income, which comprises all tied grants, donations and bequests received for the purpose of acquiring non-current assets,

such as capital works or plant and equipment. It also includes donations of plant and equipment (refer Note 1 (g)). Consequently the recognition of revenue as capital purpose income is based on the intention of the provider of the revenue at the time the revenue is provided.

• Depreciation and amortisation, as described in Note 1 (h);

• Expenditure using capital purpose income, comprises expenditure which either falls below the asset capitalisation threshold or does not meet asset recognition criteria and therefore does not result in the recognition of an asset in the balance sheet, where funding for that expenditure is from capital purpose income.

Balance sheet

Assets and liabilities are categorised either as current or non-current (non-current being those assets or liabilities expected to be recovered/settled more than 12 months after reporting period), are disclosed in the notes where relevant.

Statement of changes in equity

The statement of changes in equity presents reconciliations of each non-owner and owner changes in equity from opening balance at the beginning of the reporting period to the closing balance at the end of the reporting period. It also shows separately changes due to amounts recognised in the comprehensive result and amounts recognised in other comprehensive income.

Cash flow statement

Cash flows are classified according to whether or not they arise from operating activities, investing activities, or financing activities. This classification is consistent with requirements under AASB 107 Statement of Cash Flows.

Rounding

All amounts shown in the financial statements are expressed to the nearest $1 unless otherwise stated.

Minor discrepancies in tables between totals and sum of components are due to rounding.



f. Changes in Accounting Policy

AASB 13 Fair Value Measurement

AASB 13 establishes a single source of guidance for all fair value measurements. AASB 13 does not change when a Health Service is required to use fair value, but rather provides guidance on how to measure fair value under Australian Accounting Standards when fair value is required or permitted. The Health Service has considered the specific requirements relating to highest and best use, valuation premise, and principal (or most advantageous) market. The methods, assumptions, processes and procedures for determining fair value were revised and adjusted where applicable. In light of AASB 13, the Health Service has reviewed the fair value principles as well as its current valuation methodologies in assessing the fair value, and the assessment has not materially changed the fair values recognised.

AASB 13 has predominantly impacted the disclosures of the Health Service. It requires specific disclosures about fair value measurements and disclosures of fair values, some of which replace existing disclosure requirements in other standards, including AASB 7 Financial Instruments: Disclosures.

The disclosure requirements of AASB 13 apply prospectively and need not to be provided for comparative periods, before initial application. Consequently, comparatives of these disclosures have not been provided for 2012-13, except for financial instruments, of which the fair value disclosures are required under AASB 7 Financial Instruments Disclosures.

AASB 119 Employee Benefits

In 2013-14, the Health Service has applied AASB 119 Employee Benefits (Sep 2011, as amended), and related consequential amendments for the first time.

The revised AASB 119 changes the accounting for defined benefit plans and termination benefits. The most significant change relates to the accounting for changes in defined benefit obligation and plan assets. As the current accounting policy is for the Department of Treasury and Finance to recognise and disclose the State’s defined benefit liabilities in its financial statements, changes in defined benefit obligations and plan assets will have limited impact on the Health Service.

The revised standard also changes the definition of short-term employee benefits. These were previously benefits that were expected to be settled within 12 months after the end of the reporting period in which the employees render the related service, however, short-term employee benefits are now defined as benefits expected to be settled wholly within 12 months after the end of the reporting period in which the employees render the related service. As a result, accrued annual leave balances which were previously classified as short-term employee benefits no longer meet this definition and are now classified as long-term employee benefits. This has resulted in a change of measurement for the annual leave provision from an undiscounted to discounted basis.

The change of measurement for annual leave had no significant impact on Nathalia District Hospital’s Financial Statements for 2013-14 and no restatement of the comparative amounts for the 2012-13 year was necessary.

g. Income from transactions

Income is recognised in accordance with AASB 118 Revenue and is recognised as to the extent that it is probable that the economic benefits will flow to Nathalia District Hospital and the income can be reliably measured at fair value. Unearned income at reporting date is reported as income received in advance.

Amounts disclosed as revenue are, where applicable, net of returns, allowances and duties and taxes.

Government Grants and other transfers of income (other than contributions by owners)

In accordance with AASB 1004 Contributions, government grants and other transfers of income (other than contributions by owners) are recognised as income when the Health Service gains control of the underlying assets irrespective of whether conditions are imposed on the Health Service’s use of the contributions.

Contributions are deferred as income in advance when the Health Service has a present obligation to repay them and the present obligation can be reliably measured.

Indirect Contributions from the Department of Health

• Insurance is recognised as revenue following advice from the Department of Health.



• Long Service Leave (LSL) – Revenue is recognised upon finalisation of movements in LSL liability in line with the arrangements set out in the Metropolitan Health and Aged Care Services Division Hospital Circular 05/2013 (update for 2012-13).

Patient and Resident Fees

Patient fees are recognised as revenue at the time invoices are raised.

Private Practice Fees

Private practice fees are recognised as revenue at the time invoices are raised.

Revenue from commercial activities

Revenue from commercial activities such as commercial laboratory medicine is recognised at the time invoices are raised.

Donations and Other Bequests

Donations and bequests are recognised as revenue when received. If donations are for a special purpose, they may be appropriated to a surplus, such as the specific restricted purpose surplus.

Interest Revenue

Interest revenue is recognised on a time proportionate basis that takes in account the effective yield of the financial asset, which allocates interest over the relevant period.

Fair value of assets and services received free of charge or for nominal consideration

Resources received free of charge or for nominal consideration are recognised at their fair value when the transferee obtains control over them, irrespective of whether restrictions or conditions are imposed over the use of the contributions, unless received from another Health Service or agency as a consequence of a restructuring of administrative arrangements.In the latter case, such transfer will be recognised at carrying value.Contributions in the form of services are only recognised when a fair value can be reliably determined and the service would have been purchased if not received as a donation.

h. Expense recognition

Expenses are recognised as they are incurred and reported in the financial year to which they relate.

Employee expenses

Employee expenses include:

• Wages and salaries;

• Annual leave;

• Sick leave;

• Long service leave; and

• Superannuation expenses which are reported differently depending upon whether employees are members of defined benefit or defined contribution plans.

Defined contribution superannuation plans

In relation to defined contribution (i.e. accumulation) superannuation plans, the associated expense is simply the employer contributions that are paid or payable in respect of employees who are members of these plans during the reporting period. Contributions to defined contribution superannuation plans are expensed when incurred.

Defined benefit superannuation plans

The amount charged to the comprehensive operating statement in respect of defined benefit superannuation plans represents the contributions made by the Health Service to the superannuation plans in respect of the services of current Health Service staff during the reporting period.Superannuation contributions are made to the plans based on the relevant rules of each plan, and are based upon actuarial advice.

Employees of the Nathalia District Hospital are entitled to receive superannuation benefits and the Nathalia District Hospital contributes to both the defined benefit and defined contribution plans. The defined benefit plan provides benefits based on years of service and final average salary.

The name and details of the major employee superannuation funds and contributions made by Nathalia District Hospital are disclosed in Note 11: Superannuation.

Depreciation

All infrastructure assets, buildings, plant and equipment and other non-financial physical assets that have finite useful lives are depreciated. Depreciation begins when the asset is available for use, which is when it is in the location and condition necessary for it to be capable of operating in a manner intended by management.



Depreciation is generally calculated on a straight line basis, at a rate that allocates the asset value, less any estimated residual value over its estimated useful life. Estimates of the remaining useful lives and depreciation method for all assets are reviewed at least annually, and adjustments made where appropriate. This depreciation charge is not funded by the Department of Health. Assets with a cost in excess of $1,000 are capitalised and depreciation has been provided on depreciable assets so as to allocate their cost or valuation over their estimated useful lives.

The following table indicates the expected useful lives of non-current assets on which the depreciation charges are based.

Grants and other transfers

Grants and other transfers to third parties (other than contribution to owners) are recognised as an expense in the reporting period in which they are paid or payable. They include transactions such as: grants, subsidies and personal benefit payments made in cash to individuals.

Other operating expenses

Other operating expenses generally represent the day-to-day running costs incurred in normal operations and include:

Supplies and consumables

Supplies and services costs which are recognised as an expense in the reporting period in which they are incurred. The carrying amounts of any inventories held for distribution are expensed when distributed.

Bad and doubtful debts

Refer to Note 1 (k) Impairment of financial assets.

i. Other comprehensive income

Other comprehensive income measures the change in volume or value of assets or liabilities that do not result from transactions.

Net gain/(loss) on non-financial assets

Net gain/(loss) on non-financial assets and liabilities includes realised and unrealised gains and losses as follows:

Revaluation gains/(losses) of non-financial physical assets

Refer to Note 1(k) Revaluations of non-financial physical assets.

j. Financial Instruments

Financial instruments arise out of contractual agreements that give rise to a financial asset of one entity and a financial liability or equity instrument of another entity. Due to the nature of Nathalia District Hospital’s activities, certain financial assets and financial liabilities arise under statute rather than a contract. Such financial assets and financial liabilities do not meet the definition of financial instruments in AASB 132 Financial Instruments: Presentation. For example, statutory receivables arising from taxes, fines and penalties do not meet the definition of financial instruments as they do not arise under contract.

Where relevant, for note disclosure purposes, a distinction is made between those financial assets and financial liabilities that meet the definition of financial instruments in accordance with AASB 132 and those that do not.

The following refers to financial instruments unless otherwise stated.

Categories of non-derivative financial instruments

Receivables

Receivables are financial instrument assets with fixed and determinable payments that are not quoted on an active market. These assets are initially recognised at fair value plus any directly attributable transaction costs. Subsequent to initial measurement, receivables are measured at amortised cost using the effective interest method, less any impairment.

Receivables category includes trade receivables and other receivables, but not statutory receivables.

2014 2013

Buildings 30 to 40 Years 30 to 40 Years

Plant & Equipment 10 Years 10 Years

Medical Equipment 5 Years 5 Years

Computers & Communications 3 Years 3 Years

Furniture & Fittings 5 Years 5 Years

Motor Vehicles 7 Years 7 Years



Financial liabilities at amortised cost

Financial instrument liabilities are initially recognised on the date they are originated. They are initially measured at fair value plus any directly attributable transaction costs. Subsequent to initial recognition, these financial instruments are measured at amortised cost with any difference between the initial recognised amount and the redemption value being recognised in profit and loss over the period of the interest-bearing liability, using the effective interest rate method.

Financial instrument liabilities measured at amortised cost include all of the Health Service’s contractual payables, deposits held and advances received.

k. Assets

Cash and Cash Equivalents

Cash and cash equivalents recognised on the balance sheet comprise cash on hand and cash at bank, deposits at call and highly liquid investments with an original maturity of three months or less, which are held for the purpose of meeting short term cash commitments rather than for investment purposes, which are readily convertible to known amounts of cash and are subject to insignificant risk of changes in value.

Receivables

Receivables consist of:

• contractual receivables, which includes mainly debtors in relation to goods and services and accrued investment income; and

• statutory receivables, which includes predominantly amounts owing from the Victorian Government and Goods and Services Tax (“GST”) input tax credits recoverable.

Receivables that are contractual are classified as financial instruments and categorised as receivables. Statutory receivables are recognised and measured similarly to contractual receivables (except for impairment), but are not classified as financial instruments because they do not arise from a contract.

Receivables are recognised initially at fair value and subsequently measured at amortised cost, using the effective interest method, less any accumulated impairment.

Trade debtors are carried at nominal amounts due and are due for settlement within 30 days from the

date of recognition. Collectability of debts is reviewed on an ongoing basis, and debts which are known to be uncollectible are written off. A provision for doubtful debts is recognised when there is objective evidence that the debts may not be collected and bad debts are written off when identified.

Property, plant and equipment

All non-current physical assets are measured

initially at cost and subsequently revalued at

fair value less accumulated depreciation and

impairment. Where an asset is acquired for no or

nominal cost, the cost is its fair value at the date of

acquisition. Assets transferred as part of a merger/

machinery of government are transferred at their

carrying amount.

More details about the valuation techniques and inputs used in determining the fair value of non-financial physical assets are discussed in Note 8 Property, plant and equipment.

Land and buildings are recognised initially at cost and subsequently measured at fair value less accumulated depreciation and impairment.

Plant, equipment and vehicles are recognised initially at cost and subsequently measured at fair value less accumulated depreciation and impairment.Depreciated historical cost is generally a reasonable proxy for fair value because of the short lives of the assets concerned.

Revaluations of non-current physical assets

Non-current physical assets are measured at fair value and are revalued in accordance with FRD 103E Non-current physical assets.This revaluation process normally occurs at least every five years, based upon the asset’s Government Purpose Classification, but may occur more frequently if fair value assessments indicate material changes in values. Independent valuers are used to conduct these scheduled revaluations and any interim revaluations are determined in accordance with the requirements of the FRDs. Revaluation increments or decrements arise from differences between an asset’s carrying value and fair value.

Revaluation increments are recognised in ‘other comprehensive income’ and are credited directly to the asset revaluation surplus, except that, to the extent that an increment reverses a revaluation decrement in respect of that same class of asset previously recognised as an expense in net result, the increment is recognised as income in the net result.



Revaluation decrements are recognised in ‘other comprehensive income’ to the extent that a credit balance exists in the asset revaluation surplus in respect of the same class of property, plant and equipment.

Revaluation increases and revaluation decreases relating to individual assets within an asset class are offset against one another within that class but are not offset in respect of assets in different classes.

Revaluation surplus is not transferred to accumulated funds on derecognition of the relevant asset.

In accordance with FRD 103E, Nathalia District Hospital’s non-current physical assets were assessed to determine whether revaluation of the non-current physical assets was required.

Prepayments

Other non-financial assets include prepayments which represent payments in advance of receipt of goods or services or that part of expenditure made in one accounting period covering a term extending beyond that period.

Disposal of non-financial assets

Any gain or loss on the sale of non-financial assets is recognised in the comprehensive operating statement. Refer to Note 1(i) – ‘comprehensive income’.

Impairment of non-financial assets

All non-financial assets are assessed annually for indications of impairment, except for:

• assets arising from construction contracts.

If there is an indication of impairment, the assets concerned are tested as to whether their carrying value exceeds their possible recoverable amount. Where an asset’s carrying value exceeds its recoverable amount, the difference is written-off as an expense except to the extent that the write-down can be debited to an asset revaluation surplus amount applicable to that same class of asset.

If there is an indication that there has been a change in the estimate of an asset’s recoverable amount since the last impairment loss was recognised, the carrying amount shall be increased to its recoverable amount. This reversal of the impairment loss occurs only to the extent that the asset’s carrying amount does not exceed the carrying amount that would have been determined, net of depreciation or amortisation, if no impairment loss had been recognised in prior years.

It is deemed that, in the event of the loss or destruction of an asset, the future economic benefits arising from the use of the asset will be replaced unless a specific decision to the contrary has been made. The recoverable amount for most assets is measured at the higher of depreciated replacement cost and fair value less costs to sell. Recoverable amount for assets held primarily to generate net cash inflows is measured at the higher of the present value of future cash flows expected to be obtained from the asset and fair value less costs to sell.

Investments in jointly controlled assets and operations

In respect of any interest in jointly controlled assets, Nathalia District Hospital recognises in the financial statements:

• its share of jointly controlled assets;

• any liabilities that it had incurred;

• its share of liabilities incurred jointly by the joint venture;

• any income earned from the selling or using of its share of the output from the joint venture; and

• any expenses incurred in relation to being an investor in the joint venture.

For jointly controlled operations Nathalia District Hospital recognises:

• the assets that it controls;

• the liabilities that it incurs;

• expenses that it incurs; and

• the share of income that it earns from selling outputs of the joint venture.

Impairment of financial assets

At the end of each reporting period Nathalia District Hospital assesses whether there is objective evidence that a financial asset or group of financial asset is impaired. All financial instrument assets, except those measured at fair value through profit or loss, are subject to annual review for impairment.

Receivables are assessed for bad and doubtful debts on a regular basis. Bad debts considered as written off and allowances for doubtful receivables are expensed. Bad debt written off by mutual consent and the allowance for doubtful debts are classified as ‘other comprehensive income’ in the net result.

The amount of the allowance is the difference between the financial asset’s carrying amount and the present value of estimated future cash flows, discounted at the effective interest rate.



Where the fair value of an investment in an equity instrument at balance date has reduced by 20 percent or more than its cost price or where its fair value has been less than its cost price for a period of 12 or more months, the financial asset is treated as impaired.

In assessing impairment of statutory (non-contractual) financial assets, which are not financial instruments, professional judgement is applied in assessing materiality using estimates, averages and other computational methods in accordance with AASB 136 Impairment of Assets.

l. Liabilities

Payables

Payables consist of:

• contractual payables which consist predominantly of accounts payable representing liabilities for goods and services provided to the Health Service prior to the end of the financial year that are unpaid, and arise when the Health Service becomes obliged to make future payments in respect of the purchase of those goods and services. The normal credit terms for accounts payable are usually Nett 30 days.

• statutory payables, such as goods and services tax and fringe benefits tax payables.

Contractual payables are classified as financial instruments and are initially recognised at fair value, and then subsequently carried at amortised cost. Statutory payables are recognised and measured similarly to contractual payables, but are not classified as financial instruments and not included in the category of financial liabilities at amortised cost, because they do not arise from a contract.

Provisions

Provisions are recognised when the Health Service has a present obligation, the future sacrifice of economic benefits is probable, and the amount of the provision can be measured reliably.

The amount recognised as a liability is the best estimate of the consideration required to settle the present obligation at reporting date, taking into account the risks and uncertainties surrounding the obligation. Where a provision is measured using the cash flows estimated to settle the present obligation, its carrying amount is the present value of those cash flows, using a discount rate that reflects the time value of money and risks specific to the provision.

When some or all of the economic benefits required to settle a provision are expected to be received from a third party, the receivable is recognised as an asset if it is virtually certain that recovery will be received and the amount of the receivable can be measured reliably.

Employee benefits

This provision arises for benefits accruing to employees in respect of wages and salaries, annual leave and long service leave for services rendered to the reporting date.

Wages and salaries, annual leave, sick leave and accrued days off

Liabilities for wages and salaries, including non-monetary benefits, annual leave, and accumulating sick leave are all recognised in the provision for employee benefits as ‘current liabilities’, because the Health Service does not have an unconditional right to defer settlements of these liabilities.

Depending on the expectation of the timing of settlement, liabilities for wages and salaries, annual leave and sick leave are measured at:

• Undiscounted value – if the Health Service expects to wholly settle within 12 months; or

• Present value – if the Health Service does not expect to wholly settle within 12 months.

The liability for long service leave (LSL) is recognised in the provision for employee benefits.

Long Service Leave (LSL)

Unconditional LSL is disclosed in the notes to the financial statements as a current liability, even where the Health Service does not expect to settle the liability within 12 months because it will not have the unconditional right to defer the settlement of the entitlement should an employee take leave within 12 months.

The components of this current LSL liability are measured at:

• Undiscounted value – if the Health Service expects to wholly settle within 12 months; and

• Present value – if the Health Service does not expect to wholly settle within 12 months.

Conditional LSL is disclosed as a non-current liability. There is an unconditional right to defer the settlement of the entitlement until the employee has completed the requisite years of service. This non-current LSL liability is measured at present value.



Any gain or loss followed revaluation of the present value of non-current LSL liability is recognised as a transaction, except to the extent that a gain or loss arises due to changes in bond interest rates for which it is then recognised as an other economic flow.

Termination benefits

Termination benefits are payable when employment is terminated before the normal retirement date or when an employee decides to accept an offer of benefits in exchange for the termination of employment.

The Health Service recognises termination benefits when it is demonstrably committed to either terminating the employment of current employees according to a detailed formal plan without possibility of withdrawal or providing termination benefits as a result of an offer made to encourage voluntary redundancy. Benefits falling due more than 12 months after the end of the reporting period are discounted to present value.

On-costs

Employee benefit on-costs, such as workers compensation and superannuation, are recognised together with provisions for employee benefits.

Superannuation liabilities

Nathalia District Hospital does not recognise any unfunded defined benefit liability in respect of the superannuation plans because the Health Service has no legal or constructive obligation to pay future benefits relating to its employees, its only obligation is to pay superannuation contributions as they fall due.

m. Equity

Contributed capital

Consistent with Australian Accounting Interpretation 1038 Contributions by Owners Made to Wholly-Owned Public Sector Entities and FRD 119 Contributions by Owners, appropriations for additions to the net asset base have been designated as contributed capital. Other transfers that are in the nature of contributions or distributions that have been designated as contributed capital are also treated as contributed capital.

Property, plant & equipment revaluation surplus

The asset revaluation surplus is used to record increments and decrements on the revaluation of non-current physical assets.

General purpose surplus

These are accumulated funds of surplus revenue over expenditure from fund raising activities and community support programs.

Specific restricted purpose surplus

A specific restricted purpose surplus is established where the Health Service has possession or title to the funds but has no discretion to amend or vary the restriction and/or condition underlying the funds received.

n. Contingent assets and contingent liabilities

Contingent assets and contingent liabilities are not recognised in the balance sheet, but are disclosed by way of note and, if quantifiable, are measured at nominal value. Contingent assets and contingent liabilities are presented inclusive of GST receivable or payable respectively.

o. Goods and Services Tax (“GST”)

Income, expenses and assets are recognised net of the amount of associated GST, unless the GST incurred is not recoverable from the taxation authority. In this case, the GST payable is recognised as part of the cost of acquisition of the asset or as part of the expense.

Receivables and payables are stated inclusive of the amount of GST receivable or payable. The net amount of GST recoverable from, or payable to, the taxation authority is included with other receivables or payables in the balance sheet.

Cash flows are presented on a gross basis. The GST components of cash flows arising from investing or financing activities which are recoverable from, or payable to the taxation authority, are presented as an operating cash flow.

Commitments for expenditure and contingent assets and liabilities are presented on a gross basis.


Standard/ Interpretation

Summary Applicable for Annual Reporting periods beginning on

Impact on Public Sector Entity Financial Statements

AASB 9 Financial instruments

This standard simplifies requirements for the classification and measurement of financial assets resulting from Phase 1 of the IASB’s project to replace IAS 39 Financial Instruments: Recognition and Measurement (AASB 139 Financial Instruments: Recognition and Measurement).

1 Jan 2017 The preliminary assessment has identified that the financial impact of available for sale (AFS) assets will now be reported through other comprehensive income (OCI) and no longer recycled to the profit and loss.

While the preliminary assessment has not identified any material impact arising from AASB 9, it will continue to be monitored and assessed.

AASB 10 Consolidated Financial Statements

This Standard forms the basis for determining which entities should be consolidated into an entity’s financial statements. AASB 10 defines ‘control’ as requiring exposure or rights to variable returns and the ability to affect those returns through power over an investee, which may broaden the concept of control for public sector entities.

The AASB has issued an Australian Implementation Guidance for Not-for-Profit Entities – Control and Structured Entities that explains and illustrates how the principles in the Standard apply from the perspective of not-for-profit entities in the private and public sectors.

1 Jan 2014 (not-for-profit entities)

For the public sector, AASB 10 builds on the control guidance that existed in AASB 127 and Interpretation 112 and is not expected to change which entities need to be consolidated.

Ongoing work is being done to monitor and assess the impact of this standard.

AASB 11 Joint Arrangements

This Standard deals with the concept of joint control, and sets out a new principles-based approach for determining the type of joint arrangement that exists and the corresponding accounting treatment. The new categories of joint arrangements under AASB 11 are more aligned to the actual rights and obligations of the parties to the arrangement.


Based on current assessment, entities already apply the equity method when accounting for joint ventures. It is anticipated that there would be no material impact. Ongoing work is being done to monitor and assess the impact of this standard.


p. AASs issued that are not yet effective

Certain new Australian accounting standards have been published that are not mandatory for the 30 June 2014 reporting period.DTF assesses the impact of all these new standards and advises the Health Service of their applicability and early adoption where applicable.

As at 30 June 2014, the following standards and interpretations had been issued by the AASB but were not yet effective.They become effective for the first financial statements for reporting periods commencing after the stated operative dates as detailed in the table below. Nathalia District Hospital has not and does not intend to adopt these standards early.


Standard / Interpretation

Summary Applicable for annual reporting periods beginning on

Impact on public sector entity financial statements

AASB 12Disclosureof Interests in Other Entities

This Standard requires disclosure of information that enables users of financial statements to evaluate the nature of, and risks associated with, interests in other entities and the effects of those interests on the financial statements. This Standard replaces the disclosure requirements in AASB 127 Separate Financial Statements and AASB 131 Interests in Joint Ventures.


The new standard is likely to require additional disclosures and ongoing work is being done to determine the extent of additional disclosure required.

AASB 127 SeparateFinancial Statements

This revised Standard prescribes the accounting and disclosure requirements for investments in subsidiaries, joint ventures and associates when an entity prepares separate financial statements.


Current assessment indicates that there is limited impact on Victorian Public Sector entities. Ongoing work is being done to monitor and assess the impact of this standard

AASB 128 Investments in Associates and Joint Ventures

This revised Standard sets out the requirements for the application of the equity method when accounting for investments in associates and joint ventures.


Current assessment indicates that there is limited impact on Victorian Public Sector entities. Ongoing work is being done to monitor and assess the impact of this standard.


In addition to the new standards above, the AASB has issued a list of amending standards that are not effective for the 2013-14 reporting period (as listed below). In general, these amending standards include editorial and references changes that are expected to have insignificant impacts on public sector reporting. The AASB Interpretation in the list below is also not effective for the 2013-14 reporting period and is considered to have insignificant impacts on public sector reporting.

• AASB 2010-7 Amendments to Australian Accounting Standards arising from AASB 9 (December 2010).

• AASB 2011-7 Amendments to Australian Accounting Standards arising from the Consolidation and Joint Arrangements Standards.

• 2013-1 Amendments to AASB 1049 – Relocation of Budgetary Reporting Requirements.

• 2013-3 Amendments to AASB 136 – Recoverable Amount Disclosures for Non-Financial Assets.

• 2013-4 Amendments to Australian Accounting Standards – Novation of Derivatives and Continuation of Hedge Accounting.

• 2013-5 Amendments to Australian Accounting Standards – Investment Entities

• 2013-6 Amendments to AASB 136 arising from Reduced Disclosure Requirements

• 2013-7 Amendments to AASB 1038 arising from AASB 10 in relation to consolidation and interests of policy holders

• 2013-9 Amendments to Australian Accounting Standards – Conceptual Framework, Materiality and Financial Instruments

• AASB Interpretation 21 Levies.



q. Category groups

Nathalia District Hospital has used the following category groups for reporting purposes for the current and previous financial years.

Admitted Patient Services (Admitted Patients) comprises all recurrent health revenue/expenditure on admitted patient services, where services are delivered in public hospitals.

Aged Care comprises revenue/expenditure from Home and Community Care (HACC) programs and Allied Health and support services.

Primary Health comprises revenue/expenditure for Community Health Services including health promotion and counselling, physiotherapy, speech therapy, podiatry and occupational therapy.

Residential Aged Care comprises those Commonwealth-licensed residential aged care services in receipt of supplementary funding from DH.

Other Services excluded from Australian Health Care Agreement (AHCA) (Other) comprises revenue/expenditure for services not separately classified above, including Public Health Services.

r. Commitments

Commitments for future expenditure include operating and capital commitments arising from contracts. These commitments are disclosed by way of a Note (refer to Note 22) at their nominal value and are inclusive of the GST payable. In addition, where it is considered appropriate and provides additional relevant information to users, the net present values of significant individual projects are stated. These future expenditures cease to be disclosed as commitments once the related liabilities are recognised on the balance sheet.



NOTE 2: REVENUE

Revenue from Operating Activities

HSA2014

$

HSA2013

$

H&CI2014

$

H&CI2013

$

Total2014

$

Total2013

$Government GrantsDepartment of Health 2,687,301 2,897,591 - - 2,687,301 2,897,591 Commonwealth Government:

Residential Aged Care Subsidy 1,148,341 1,176,238 - - 1,148,341 1,176,238 Total Government Grants 3,835,642 4,073,829 - - 3,835,642 4,073,829

Indirect Contributions by Department of HealthInsurance 18,204 8,619 - - 18,204 8,619 Long Service Leave 89,825 70,362 - - 89,825 70,362 Total Indirect Contributions by Department of Health

108,029 78,981 - - 108,029 78,981

Patient and Resident FeesPatient & Resident Fees (Refer Note 2b)

122,619 117,418 - - 122,619 117,418

Residential Aged Care (Refer Note 2b) 347,794 348,207 - - 347,794 348,207 Total Patient and Resident Fees 470,413 465,625 - - 470,413 465,625

Commercial Activities & Specific Purpose FundsMedical Clinic - - 911,782 899,459 911,782 899,459 Caféteria and Catering - - 51,453 52,854 51,453 52,854 Rental Properties - - 24,306 15,936 24,306 15,936 Total Commercial Activities & Specific Purpose Funds

- - 987,541 968,249 987,541 968,249

Donations & Bequests 11,670 12,539 - 51,000 11,670 63,539 Other Revenue from Operating Activities 240,378 277,710 - - 240,378 277,710

Total Revenue from Operating Activities 4,666,132 4,908,684 987,541 1,019,249 5,653,673 5,927,933

Revenue from Non-Operating ActivitiesInterest 434 495 89,561 96,006 89,995 96,501

Capital Purpose IncomeState Government Capital Grants:

Targeted Capital Works and Equipment - - 131,141 22,853 131,141 22,853 Other Capital Grants - - - 6,411 - 6,411

Other Capital Income - - 5,075 - 5,075 -Assets Received Free of Charge (Refer Note 2d)

- - - 75,900 - 75,900

Net Gain on Disposal of Non-Current Assets (Refer Note 2c)

- - (37,532) 1,360 (37,532) 1,360

Residential Accommodation Payments (Refer Note 2b)

- - 125,540 96,704 125,540 96,704

Total Capital Purpose Income - - 224,224 203,228 224,224 203,228

Total Revenue (Refer Note 2a) 4,666,566 4,909,179 1,301,326 1,318,483 5,967,892 6,227,662

Indirect contributions by Department of Health: Department of Health makes insurance and long service leave payments on behalf of Nathalia District Hospital. These amounts have been brought to account in determining the operating result for the year by recording them as revenue and expenses.



NOTE 2A: ANALYSIS OF REVENUE BY SOURCE

AdmittedPatients

2014$

ResidentialAged Care

2014$

Aged Care2014

$

PrimaryHealth

2014$

Other2014

$

Total2014

$

Revenue from Services Supported by Health Service Agreement

Government Grants 1,814,703 1,734,264 254,692 - 31,983 3,835,642 Indirect Contributions by Department of Health

16,223 1,387 594 - 89,825 108,029

Patient and Resident Fees (Refer Note 2b)

59,830 347,794 42,050 20,739 - 470,413

Donations (Non Capital) 10,634 1,036 - - - 11,670 Interest - - - - 434 434 Other Revenue from Operating Activities

102,000 2,700 2,223 15,565 117,890 240,378

Total Revenue From Services Supported By Health Service Agreement

2,003,390 2,087,181 299,559 36,304 240,132 4,666,566

Revenue from Services Supported by Hospital and Community InitiativesCommercial Activities & Specific Purpose Funds

- - - - 987,541 987,541

Donations (Non Capital) - - - - - -Interest - - - - 89,561 89,561 Capital Purpose Income (Refer Note 2)

- - - - 224,224 224,224

Total Revenue From Services Supported By Hospital and Community Initiatives

- - - - 1,301,326 1,301,326

Total Revenue 2,003,390 2,087,181 299,559 36,304 1,541,458 5,967,892




NOTE 2A: ANALYSIS OF REVENUE BY SOURCE

AdmittedPatients

2013$


2013$

Aged Care2013

$

PrimaryHealth

2013$

Other2013

$

Total2013

$

Revenue from Services Supported by Health Service Agreement

Government Grants 1,969,502 1,780,431 282,156 - 41,740 4,073,829 Indirect Contributions by Department of Health

8,503 81 35 - 70,362 78,981

Patient and Resident Fees (Refer Note 2b)

68,732 348,207 26,602 21,905 179 465,625

Interest - - - - 495 495 Donations (Non Capital) 12,289 50 - 200 - 12,539 Other Revenue from Operating Activities

99,273 38,430 1,924 6,637 131,446 277,710

Total Revenue From Services Supported By Health Service Agreement

2,158,299 2,167,199 310,717 28,742 244,222 4,909,179

Revenue from Services Supported by Hospital and Community InitiativesCommercial Activities & Specific Purpose Funds

- - - - 968,249 968,249

Donations (Non Capital) - - - - 51,000 51,000 Interest - - - - 96,006 96,006 Capital Purpose Income (Refer Note 2)

- - - - 203,228 203,228

Total Revenue From Services Supported By Hospital and Community Initiatives

- - - - 1,318,483 1,318,483

Total Revenue 2,158,299 2,167,199 310,717 28,742 1,562,705 6,227,662




NOTE 2B: PATIENT AND RESIDENT FEES RAISED

Total2014

$

Total2013

$Patient and Resident FeesAcute

Inpatients 59,830 68,732 Outpatients 62,789 48,686

Residential Aged Care 347,794 348,207 Total Patient and Resident Fees 470,413 465,625

Capital Purpose Income:Residential Accommodation Payments 125,540 96,704 Total Capital Purpose Income 125,540 96,704

NOTE 2C: NET GAIN(LOSS) ON DISPOSAL OF NON-FINANCIAL ASSETS

Total2014

$

Total2013

$Proceeds from Disposals of Non-Financial AssetsLand 213,636Hume Rural Health Alliance Assets - (77)Motor Vehicles 8,182 13,182 Total Proceeds from Disposal of Non-Financial Assets 221,818 13,105

Less: Written Down Value of Non-Financial Assets SoldLand 249,132Motor Vehicles 10,218 11,745 Total Written Down Value of Non-Financial Assets Sold 259,350 11,745

Net Gain/(Loss) on Disposal of Non-Financial Assets (37,532) 1,360

NOTE 2D: ASSETS RECEIVED FREE OF CHARGE OR FOR NOMINAL CONSIDERATION

Total2014

$

Total2013

$During the reporting period the fair value of assets received free of charge was as follows:

LandElizabeth St, Nathalia, northern block brought to account. - 75,900 TOTAL - 75,900



NOTE 3: EXPENSES

HSA2014

$

HSA2013

$

H&CI2014

$

H&CI2013

$

Total2014

$

Total2013

$

Employee ExpensesSalaries & Wages 3,246,874 3,338,306 269,987 321,666 3,516,861 3,659,972 Long Service Leave 170,521 155,495 14,191 7,404 184,712 162,899 Superannuation 296,989 287,742 24,830 28,384 321,819 316,126 Workcover Premium 33,673 32,330 2,812 3,190 36,485 35,520 Departure Packages - 6,825 - - - 6,825 Total Employee Expenses 3,748,057 3,820,698 311,820 360,644 4,059,877 4,181,342

Non Salary Labour CostsFees for Visiting Medical Officers - 98,149 - 428,662 - 526,811 Agency Costs - Other 98,263 - 518,166 - 616,429 -Total Non Salary Labour Costs 98,263 98,149 518,166 428,662 616,429 526,811

Supplies & ConsumablesDrug Supplies 27,276 40,087 385 190 27,661 40,277 Medical and Surgical Supplies 64,627 83,895 6,193 10,900 70,820 94,795 Food Supplies 113,835 124,310 84 120 113,919 124,430 Pathology Supplies 3,117 2,901 - - 3,117 2,901 Total Supplies & Consumables 208,855 251,193 6,662 11,210 215,517 262,403

Other ExpensesTransfer Pricing (213,430) (105,278) 213,430 105,278 - -Insurance Cost Funded by DH 6,467 387 - - 6,467 387 Administrative Expenses 371,679 423,052 38,118 46,075 409,797 469,127 Domestic Services and Supplies 102,395 107,259 1,082 703 103,477 107,962 Fuel, Light, Power and Water 162,175 161,320 15,317 13,517 177,492 174,837 Motor Vehicle Expenses - 32,161 - - - 32,161 Repairs and Maintenance 79,728 137,968 2,737 2,710 82,465 140,678 Maintenance Contracts 86,220 89,828 570 1,574 86,790 91,402 Patient Transport 5,125 10,397 - - 5,125 10,397 Patient and Client Purchased Services

35,895 43,083 - - 35,895 43,083

Bad and Doubtful Debts 9 - 471 253 480 253 Audit Fees - VAGO Audit of Financial Statements

12,420 12,180 - - 12,420 12,180

Audit Fees - Other 8,720 6,766 - - 8,720 6,766 Total Other Expenses 657,403 919,123 271,725 170,110 929,128 1,089,233

Expenditure using Capital Purpose Income

- - 38,545 2,205 38,545 2,205

Depreciation (Refer Note 4) - - 552,499 592,112 552,499 592,112 Share Adjustment in Hume Rural Health Alliance Joint Venture

- - 886 1,194 886 1,194

Total Expenses 4,712,578 5,089,163 1,700,303 1,566,137 6,412,881 6,655,300



NOTE 3A: ANALYSIS OF EXPENSES BY SOURCE

AdmittedPatients

2014$


2014$

Aged Care2014

$

PrimaryHealth

2014$

Other2014

$

Total2014

$

Services Supported By Health Service AgreementEmployee Expenses 930,583 1,294,166 235,493 186,601 1,101,214 3,748,057 Non Salary Labour Costs 98,263 - - - - 98,263 Supplies & Consumables 58,640 31,039 3,091 2,963 113,122 208,855 Other Expenses from Continuing Operations

367,597 1,193,018 132,994 109,912 (1,146,118) 657,403

Total Expenses from Services Supported by Health Service Agreement

1,455,083 2,518,223 371,578 299,476 68,218 4,712,578

Services Supported By Hospital and Community InitiativesEmployee Expenses - - - - 311,820 311,820 Non Salary Labour Costs - - - - 518,166 518,166 Supplies and Consumables - - - - 6,662 6,662 Other Expenses from Continuing Operations

- - - - 271,725 271,725

Total Expenses from Services Supported by Hospital and Community Initiatives

- - - - 1,108,373 1,108,373

Expenditure Using Capital Purpose IncomeEquipment Purchases/Infrastructure Renewal

- - - - 38,545 38,545

Interest Expense on Accommodation Bond Refunds

- - - - 886 886

Depreciation (Refer Note 4) - - - - 552,499 552,499 Total Expenditure from Services supported by Health Services Agreement and by Hospital and Community Initiatives

- - - - 1,700,303 1,700,303

Total Expenses 1,455,083 2,518,223 371,578 299,476 1,768,521 6,412,881



NOTE 3A: ANALYSIS OF EXPENSES BY SOURCE

AdmittedPatients

2013$


2013$

Aged Care2013

$

PrimaryHealth

2013$

Other2013

$

Total2013

$

Services Supported By Health Service AgreementEmployee Expenses 783,109 1,367,191 220,627 239,041 1,210,730 3,820,698 Non Salary Labour Costs 98,149 - - - - 98,149 Supplies & Consumables 82,843 40,648 1,957 4,100 121,645 251,193 Other Expenses from Continuing Operations

714,451 918,053 136,838 102,585 (952,804) 919,123

Total Expenses from Services Supported by Health Service Agreement

1,678,552 2,325,892 359,422 345,726 379,571 5,089,163

Services Supported By Hospital & Community InitiativesEmployee Expense - - - - 360,644 360,644 Non Salary Labour Costs - - - - 428,662 428,662 Supplies & Consumables - - - - 11,210 11,210 Other Expenses from Continuing Operations

- - - - 170,110 170,110

Total Expenses from Services Supported by Hospital and Community Initiatives

- - - - 970,626 970,626

Expenditure Using Capital Purpose IncomeEquipment Purchases/Infrastructure Renewal

- - - - 2,205 2,205

Interest Expense on Accommodation Bond Refunds

- - - - 1,194 1,194

Depreciation (Refer Note 4) - - - - 592,112 592,112 Total Expenditure from Services supported by Health Services Agreement and by Hospital and Community Initiatives

- - - - 1,566,137 1,566,137

Total Expenses 1,678,552 2,325,892 359,422 345,726 1,945,708 6,655,300



NOTE 3B: ANALYSIS OF EXPENSES BY INTERNALLY MANAGED AND RESTRICTED SPECIFIC PURPOSE FUNDS FOR SERVICES SUPPORTED BY HOSPITAL AND COMMUNITY INITIATIVES

Total2014

$

Total2013

$Commercial Activities

Medical Clinic 1,016,790 896,659

Catering Services 64,794 52,533

Rental Properties 26,789 21,435

Total 1,108,373 970,627

NOTE 4: DEPRECIATION

Total2014

$

Total2013

$

Buildings 387,511 386,304

Computers & Communications 1,704 34,027

Furniture & Fittings 6,309 7,543

Medical Equipment 93,095 94,234

Motor Vehicles 15,221 18,171

Plant & Equipment 12,226 11,582

Non-Medical Equipment 36,319 39,753

Hume Rural Health Alliance - Share of Plant and Equipment at Fair Value 114 498

Total Depreciation 552,499 592,112

NOTE 5: CASH AND CASH EQUIVALENTSFor the purposes of the Cash Flow Statement, cash assets includes cash on hand and in banks, and short-term deposits which are readily convertible to cash on hand, and are subject to an insignificant risk of change in value, net of outstanding bank overdrafts.

Total2014

$

Total2013

$

Cash on Hand 500 500

Cash at Bank 136,163 540,589

Short Term Deposits 2,343,677 1,904,041

Total Cash and Cash Equivalents 2,480,340 2,445,130

Represented by:

Total Cash for Health Service Operations (as per Cash Flow Statement) 2,201,650 2,156,867

Cash for Monies Held in Trust

Term Deposits 278,690 288,263

Total Cash and Cash Equivalents 2,480,340 2,445,130



NOTE 6: RECEIVABLES

Current

Total2014

$

Total2013

$ContractualTrade Debtors 66,280 101,108 Patient Fees 86,084 69,789 Accrued Investment Income 11,628 11,451 Other Accrued Revenue - -

163,992 182,348 StatutoryGST Receivable 29,054 20,921 Total Current Receivables 193,046 203,269

Non CurrentStatutoryLong Service Leave - Department of Health 263,196 173,372 Total Non Current Receivables 263,196 173,372

Total Receivables 456,242 376,641

NOTE 7: OTHER ASSETS

Current

Total2014

$

Total2013

$

Prepayments 47,313 20,803 Total Other Assets 47,313 20,803



NOTE 8: PROPERTY, PLANT AND EQUIPMENT

Total2014

$

Total2013

$(a) Gross carrying amount and accumulated depreciation

LandLand at Fair Value 357,000 641,148 Total Land 357,000 641,148

BuildingsBuildings Under Construction at Cost 139,987 -Buildings at Fair Value 18,679,000 15,338,630 Less Accumulated Depreciation - 1,176,554 Total Buildings 18,818,987 14,162,076

Plant and EquipmentPlant and Equipment at Fair Value 65,945 65,945 Less Accumulated Depreciation 50,194 37,968 Total Plant and Equipment 15,751 27,977

Motor VehiclesMotor Vehicles at Fair Value 161,462 159,238 Less Accumulated Depreciation 89,163 84,162 Total Motor Vehicles 72,299 75,076

Medical EquipmentMedical Equipment at Fair Value 490,004 488,237 Less Accumulated Depreciation 417,867 326,943 Total Medical Equipment 72,137 161,294

Computers and CommunicationComputers and Communication at Fair Value 207,757 199,079 Less Accumulated Depreciation 199,454 197,751 Total Computers and Communication 8,303 1,328

Non-Medical EquipmentNon-Medical Equipment at Fair Value 216,877 211,493 Less Accumulated Depreciation 183,330 147,714 Total Non-Medical Equipment 33,547 63,779

Furniture and FittingsFurniture and Fittings at Fair Value 59,303 59,303 Less Accumulated Depreciation 31,292 24,983 Total Furniture and Fittings 28,011 34,320

Information Technology - Work in Progress at Cost 5,996 - 5,996 -

Rural Health Alliance - Share of Plant and Equipment at Fair Value 7,854 555

TOTAL 19,419,885 15,167,553



NO

TE

8: P

RO

PE

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, PLA

NT

AN

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mo

unts

of

each

cla

ss o

f as

set

at t

he b

egin

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and

end

of

the

pre

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ear

is s

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elo

w.

Land

$B

uild

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s $

Pla

nt &

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men

t $

Med

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Eq

uip

men

t $

Co

mp

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s &C

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mun

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Furn

itur

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Fit

ting

s $

Mo

tor

Vehi

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No

n M

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men

t $

Hum

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Wo

rk in

P

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Tota

l $

Bal

ance

at

1 Ju

ly 2

012

537,

450

14,5

57,4

66

30,

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243,

768

33,7

61

41,

863

82,

906

102,

311

5

08

- 15

,630

,103

Add

ition

s79

8 17

,914

9,4

89

11,

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1,59

4

- 2

2,08

6

1,2

21

5

45

- 65

,407

Dis

posa

ls

- -

-

- -

-

(11,

745)

-

- -

(11,

745)

Net

Tra

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rs b

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een

Cla

sses

27,

000

(27,

000)

-

-

-

-

-

- -

- -

Ass

ets

Rec

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d Fr

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f C

harg

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-

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-

-

-

- -

75,9

00

Dep

reci

atio

n (n

ote

4)

- (3

86,3

04)

(11,

582)

(94,

234)

(3

4,02

7)

(7,5

43)

(18,

171)

(39,

753)

(4

98)

- (5

92,1

12)

Bal

ance

at

1 Ju

ly 2

013

641,

148

14,1

62,0

76

27,

977

161,

294

1,32

8 3

4,32

0 7

5,07

6 6

3,77

9

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-

15,1

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53

Add

ition

s 1

1,43

4

3,9

38

8,67

9 2

2,66

2

6,0

87

7,4

13

171,

232

231,

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Dis

posa

ls(2

49,1

32)

-

-

-

-

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8)

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(2

59,3

50)

Net

Tra

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rs b

etw

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Cla

sses

-

25,2

49

-

-

-

-

-

- -

(25,

249)

-

Rev

alua

tion

Incr

emen

ts/

(Dec

rem

ents

) (4

6,45

0)4,

879,

186

-

-

-

-

-

- -

- 4,

832,

736

Dep

reci

atio

n (n

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(387

,511

) (1

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5)(1

,704

)

(6,3

09)

(15,

221)

(36,

319)

(1

14)

- (5

52,4

99)

Bal

ance

at

30 J

une

2014

357,

000

18,6

79,0

00

15,

751

72,

137

8,30

3 2

8,01

1 7

2,29

9 3

3,54

7 7

,854

14

5,98

3 19

,419

,885

Land

and

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gs

Car

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Valu

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the

Valu

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ine

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the

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atio

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, was

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NOTE 8: PROPERTY, PLANT AND EQUIPMENT (Continued)(c) Fair value measurement hierarchy for assets as at 30 June 2014

CarryingAmount as at30 June 2014

Fair value measurementat end of reporting period using:

Level 1 (1) Level 2 (1) Level 3 (1) Land at Fair ValueNon-Specialised Land 182,000 - 182,000 -

Specialised land - NDH, McDonell St, Nathalia 175,000 - - 175,000

Total of Land at Fair Value 357,000 - 182,000 175,000

Buildings at Fair ValueNon-Specialised Buildings 418,000 - 418,000 -Specialised Buildings 18,261,000 - - 18,261,000Total of Buildings at Fair Value 18,679,000 - 418,000 18,261,000

Plant and Equipment at Fair Value

Plant, Equipment and Motor Vehicles at Fair ValueMotor Vehicles 72,299 - 72,299 Plant and Equipment

Plant and Non-Medical Equipment 57,152 - 57,152 Computers and Communications 8,303 - 8,303 Furniture and Fittings 28,011 - 28,011

Total Plant, Equipment and Motor Vehicles at Fair Value

165,765 - - 165,765

Total Medical Equipment at Fair Value 72,137 - - 72,137

19,273,902 - 600,000 18,673,902

(1) Classified in accordance with the fair value hierarchy, see Note 1

Non-specialised land and non-specialised buildingsNon-specialised land and non-specialised buildings are valued using the market approach. Under this valuation method, the assets are compared to recent comparable sales or sales of comparable assets which are considered to have nominal or no added improvement value.For non-specialised land and non-specialised buildings, an independent valuation was performed by independent valuers, Victorian Valuer General, to determine the fair value using the market approach. Valuation of the assets was determined by analysing comparable sales and allowing for share, size, topography, location and other relevant factors specific to the asset being valued. An appropriate rate per square metre has been applied to the subject asset. The effective date of the valuation is 30 June 2014.To the extent that non-specialised land and non-specialised buildings do not contain significant, unobservable adjustments, these assets are classified as Level 2 under the market approach.


NOTE 8: PROPERTY, PLANT AND EQUIPMENT (Continued)

Specialised land and specialised buildingsThe market approach is also used for specialised land and specialised buildings although is adjusted for the community service obligation (CSO) to reflect the specialised nature of the assets being valued. Specialised assets contain significant, unobservable adjustments; therefore these assets are classified as Level 3 under the market based direct comparison approach.The CSO adjustment is a reflection of the valuer’s assessment of the impact of restrictions associated with an asset to the extent that is also equally applicable to market participants. This approach is in light of the highest and best use consideration required for fair value measurement, and takes into account the use of the asset that is physically possible, legally permissible and financially feasible. As adjustments of CSO are considered as significant unobservable inputs, specialised land would be classified as Level 3 assets. For the Health Services, the depreciated replacement cost method is used for the majority of specialised buildings, adjusting for the associated depreciation. As depreciation adjustments are considered as significant and unobservable inputs in nature, specialised buildings are classified as Level 3 for fair value measurements.An independent valuation of the Health Service’s specialised land and specialised buildings was performed by the Valuer-General Victoria. The valuation was performed using the market approach adjusted for CSO. The effective date of the valuation is 30 June 2014.

VehiclesThe Health Service acquires new vehicles and at times disposes of them before completion of their economic life. The process of acquisition, use and disposal in the market is managed by the Health Service who set relevant depreciation rates during use to reflect the consumption of the vehicles. As a result, the fair value of vehicles does not differ materially from the carrying value (depreciated cost).

Plant and equipment and Medical EquipmentPlant and equipment is held at carrying value (depreciated cost). When plant and equipment is specialised in use, such that it is rarely sold other than as part of a going concern, the depreciated replacement cost is used to estimate the fair value. Unless there is market evidence that current replacement costs are significantly different from the original acquisition cost, it is considered unlikely that depreciated replacement cost will be materially different from the existing carrying value. There were no changes in valuation techniques throughout the period to 30 June 2014. For all assets measured at fair value, the current use is considered the highest and best use.


(d) Reconciliation of Level 3 fair value

2014 Land Buildings Plant and

Equipment Medical

Equipment

Opening Balance 241,450 13,774,740 203,035 161,294 Purchases (sales) - 25,249 34,623 3,938 Transfers in (out) of Level 3 - - - -

Gains or losses recognised in net result - Depreciation - (374,268) (71,893) (93,095) - Impairment - - - -Subtotal - (374,268) (71,893) (93,095)

Items recognised in other comprehensive income - Revaluation (66,450) 4,835,279 - -Subtotal (66,450) 4,835,279 - -Closing Balance 175,000 18,261,000 165,765 72,137

Unrealised gains/(losses) on non-financial assets175,000 18,261,000 165,765 72,137


NOTE 8: PROPERTY, PLANT AND EQUIPMENT (Continued)(e) Description of significant unobservable inputs to Level 3 valuations:

Valuation technique (i)

Significant unobservable

inputs (i)

Range (weighted

average) (i)

Sensitivity of fair value measurement to changes in significant

unobservable inputs

Specialised landMcDonell St, Nathalia Market

approach Community

Service Obligation (CSO)

adjustment

20% (20%) A significant increase or decrease in the CSO adjustment would result

in a significantly lower (higher) fair value

Specialised buildingsMcDonell St, Nathalia Depreciated

replacement cost

Direct cost per square metre

$515 - $1,880/m2

($1,434)

A significant increase or decrease in direct

cost per square meter adjustment would result

in a significantly higher or lower fair value.

Useful life of specialised

buildings

20-45 years (33 years)

A significant increase or decrease in the

estimated useful life of the asset would result in

a significantly higher or lower valuation.

Plant and equipment at fair valuePlant and Non Medical EquipmentComputers and CommunicationFurniture and Fittings

Depreciated replacement

cost

Cost per unit $1,000 - $33,000 ($3,507)

A significant increase or decrease in cost per

unit would result in a significantly higher or

lower fair value. Useful life of

PPE 5-10 years

(7 years) A significant increase

or decrease in the estimated useful life of

the asset would result in a significantly higher or

lower valuation.

Vehicles Motor Vehicles Depreciated

replacement cost

Cost per unit $20,000-$58,000 per unit

($31,630 per unit)

A significant increase or decrease in cost per

unit would result in a significantly higher or

lower fair value. Useful life of

vehicles 7 years (7 years)

A significant increase or decrease in the

estimated useful life of the asset would result in

a significantly higher or lower valuation.




NOTE 9: PAYABLES

Total2014

$

Total2013

$CurrentContractualTrade Creditors 318,857 234,461 Accrued Expenses 57,823 170,200 Income In Advance - Other - 45,315

376,680 449,976 StatutoryGST Payable 2,027 1,443 Income In Advance - Department of Health 47,635 65,159 Income In Advance - Commonwealth 3,448 6,356

53,110 72,958

TOTAL PAYABLES 429,790 522,934

(a) Maturity analysis of payablesPlease refer to Note 15(b) for the ageing analysis of contractual payables

(b) Nature and extent of risk arising from payables

Please refer to note 15(b) for the nature and extent of risks arising from contractual payables

NOTE 8: PROPERTY, PLANT AND EQUIPMENT (Continued)

(e) Description of significant unobservable inputs to Level 3 valuations continued:

Valuation technique (i)

Significant unobservable

inputs (i)

Range (weighted

average) (i)

Sensitivity of fair value measurement to changes in significant

unobservable inputs

Medical equipment at fair valueMedical Equipment Depreciated

replacement cost

Cost per unit $1,000 - $78,900 ($4,800)

Increase (decrease) in gross replacement cost would result in a

significantly higher (lower) fair value.

Useful life of medical equipment

5-7 years (6 years)

Increase (decrease) in useful life would result in a significantly higher

(lower) fair value.

(i) [Illustrations on the valuation techniques, significant unobservable inputs and the related quantitative range of those inputs are indicative and should not be directly used without consultation with entities’ independent valuer.]

(ii) CSO adjustments of 20% were applied to reduce the market approach value for the Department’s specialised land.



NOTE 10: PROVISIONS

Total2014

$

Total2013

$Current ProvisionsEmployee Benefits (i) (Note 10 (a))Annual Leave - unconditional and expected to be settled within 12 months 330,629 359,677 - unconditional and expected to be settled after 12 months (ii) - -

Long Service Leave - unconditional and expected to be settled within 12 months 281,649 264,100 - unconditional and expected to be settled after 12 months (ii) 145,092 136,052

Accrued Days Off - unconditional and expected to be settled within 12 months 5,371 7,593

Accrued Salaries & Wages - unconditional and expected to be settled within 12 months 74,873 69,607

837,614 837,029

Provisions related to employee benefit on-costsUnconditional and expected to be settled within 12 months 60,814 61,885 Unconditional and expected to be settled after 12 months (ii) 15,116 13,922

75,930 75,807 Total Current Provisions 913,544 912,836

Non-Current ProvisionsEmployee Benefits (i) (Note 10 (a)) 256,899 160,476 Provisions related to employee benefit on-costs 27,085 15,593 Total Non Current Provisions (ii) 283,984 176,069

Total Provisions 1,197,528 1,088,905

(a) Employee Benefits and Related On-CostsCurrent Employee Benefits and related on-costsAccrued Salaries and Wages 74,873 69,607 Accrued Days Off 5,984 8,500 Annual Leave entitlements 361,488 393,629 Unconditional long service leave entitlements 471,199 441,100 Non-Current Employee Benefits and related on-costsConditional long service leave entitlements (present value) 283,984 176,069 Total Employee Benefits and Related On-Costs 1,197,528 1,088,905

Movement in Long Service Leave:Balance at start of year 617,169 513,784 Provisions made during the year - Revaluations 789 (9,377) - Expense recognising employee service 183,923 172,276 Settlements made during the year (46,698) (59,514)Balance at end of year 755,183 617,169

(ii) The amounts disclosed are at present values.



NOTE 11: SUPERANNUATION

Employees of the Health Services are entitled to receive superannuation benefits and the Health Services contributes to both defined benefit and defined contribution plans.The defined benefit plan provides benefits based on years of service and final average salary.

The Health Service does not recognise any defined benefit liability in respect of the plan(s) because the entity has no legal or constructive obligation to pay future benefits relating to its employees; its only obligation is to pay superannuation contributions as they fall due.The Department of Treasury and Finance discloses the States' defined benefits liabilities in its disclosure for administered items.

However superannuation contributions paid or payable for the reporting period are included as part of employee benefits in the comprehensive operating statement of the Health Service.The name, details and amounts expense in relation to the major employee superannuation funds and contributions made by the Health Services are as follows:

Total2014

$

Total2013

$Defined Benefit Plans:First State Super 4,711 5,328 Defined Contribution Plans:First State Super 230,516 230,811 HESTA 86,101 86,740 Total 321,328 322,879

NOTE 12: OTHER LIABILITIES

Total2014

$

Total2013

$CurrentMonies Held in TrustEmployee Parental Leave Funds 2,488 1,851 Accommodation Bonds (Refundable Entrance Fees) 251,302 259,570 Government Grants - Hume Region Programs 24,900 26,842 Total Current 278,690 288,263

Total Monies Held in TrustRepresented by the following assets:Cash at Bank 278,690 288,263 Total 278,690 288,263



NOTE 13: EQUITY

Total2014

$

Total2013

$(a) SurplusesProperty, Plant and Equipment Revaluation SurplusBalance at the Beginning of the Reporting Period 239,977 239,977

Decrease in the Value of Land (46,450) -

Increase in the Value of Buildings 4,879,186 -

Balance at the End of the Reporting Period 5,072,713 239,977

Represented by:Land 188,037 234,487

Buildings 4,879,186 -

Plant & Equipment 5,490 5,490

Total 5,072,713 239,977

General Purpose SurplusBalance at the Beginning of the Reporting Period 1,179,136 1,032,130

Transfer to and from Accumulated Surplus 89,561 147,006

Balance at the End of the Reporting Period 1,268,697 1,179,136

Restricted Specific Purpose SurplusBalance at the Beginning of the Reporting Period 162,466 162,466

Transfer to and from Accumulated Surplus - -

Balance at the End of the Reporting Period 162,466 162,466

Total Surpluses 6,503,876 1,581,579

(b) Contributed CapitalBalance at the Beginning of the Reporting Period 11,103,968 11,103,968


(c) Accumulated SurplusesBalance at the Beginning of the Reporting Period 3,424,478 3,999,122

Net Result for the Year (444,989) (427,638)

Transfers to and from General Reserves (89,561) (147,006)


Total Equity At End Of Financial Year 20,497,772 16,110,025



NOTE 14: RECONCILIATION OF NET RESULT FOR THE YEAR TO NET CASH INFLOW/(OUTFLOW) FROM OPERATING ACTIVITIES

Total2014

$

Total2013

$

Net Result for the Period (444,989) (427,638)

Non-cash movements:Depreciation 552,499 592,112 Assets Received Free of Charge - Other - (75,900)

Movements included in investing and financing activitiesNet (Gain)/Loss from Disposal of Non Financial Physical Assets 37,532 (1,360)

Movements in assets and liabilities:Change in Operating Assets and Liabilities(Increase)/Decrease in Receivables (79,601) (116,534)(Increase)/Decrease in Other Assets (26,510) 5,683 Increase/(Decrease) in Payables (93,144) 57,435 Increase/(Decrease) in Provisions 108,623 95,035 Net Cash Inflow/(Outflow) from Operating Activities 54,410 128,833

NOTE 15: FINANCIAL INSTRUMENTS

15(a) Financial Risk Management Objectives and PoliciesNathalia District Hospital's principal financial instruments comprise of:

Cash AssetsTerm DepositsReceivables (excluding statutory receivables)Payables (excluding statutory Payables)Accommodation Bonds

Details of the significant accounting policies and methods adopted, including the criteria for recognition, the basis of measurement and the basis on which income and expenses are recognised, with respect to each class of financial asset, financial liability and equity instrument are disclosed in note 1 to the financial statements.

The Health Service's main financial risks include credit risk, liquidity risk, interest rate risk and foreign currency risk. The Health Service manages these financial risks in accordance with its financial risk management policy.

The Health Service uses different methods to measure and manage the different risks to which it is exposed. Primary responsibility for the identification and management of financial risks rests with the financial risk management committee of the Health Service.

The main purpose in holding financial instruments is to prudentially manage Nathalia District Hospital's financial risks within the government policy parameters.



NOTE 15: FINANCIAL INSTRUMENTS (Continued)Categorisation of Financial Instruments

Contractual Financial Assets Loans and

Receivables Total

Contractual Financial Assets2014

$2013

$2014

$2013

$

Cash and Cash Equivalents 2,480,340 2,445,130 2,480,340 2,445,130 Receivables 163,992 182,348 163,992 182,348 Total Financial Assets 2,644,332 2,627,478 2,644,332 2,627,478

Contractual Financial Liabilities at Amortised

Cost Total

Contractual Financial Liabilities2014

$2013

$2014

$2013

$

Payables 376,680 449,976 376,680 449,976 Other Liabilities 278,690 288,263 278,690 288,263 Total Financial Liabilities 655,370 738,239 655,370 738,239

Net holding gain/(loss) on financial instruments by category

2014Financial Assets

Net holding

gain / (loss)

Total interest

income / (expense)

Fee income /

(expense) Total

Cash & Cash Equivalents - 89,995 - 89,995 Total Financial Assets - 89,995 - 89,995

Financial LiabilitiesAt Amortised Cost - - - -

2013Financial Assets

Net holding

gain / (loss)

Total interest

income / (expense)

Fee income /

(expense) Total

Cash & Cash Equivalents - 96,501 - 96,501 Total Financial Assets - 96,501 - 96,501

Financial LiabilitiesAt Amortised Cost - - - -



NOTE 15: FINANCIAL INSTRUMENTS (Continued)

15(b) Credit RiskCredit risk arises from the contractual financial assets of Nathalia District Hospital which comprise cash and deposits, non-statutory receivables.Nathalia District Hospital's exposure to credit risk arises from the potential default of a counter party on their contractual obligations resulting in financial loss to Nathalia District Hospital.Credit risk is measured at fair value and is monitored on a regular basis.Credit risk associated with the Nathalia District Hospital's contractual financial assets is minimal because the main debtor is the Victorian Government.For debtors other than the Government, it is Nathalia District Hospital's obligation to provide services and private patient fees are receivable from the patient or the health fund. These are unsecured debts.In addition, Nathalia District Hospital does not engage in hedging for its contractual financial assets and mainly obtains contractual financial assets that are on fixed interest, except for cash assets, which are mainly cash at bank. Nathalia District Hospital's policy is to only deal with banks with high credit ratings.Provision of impairment for contractual financial assets is recognised when there is objective evidence that Nathalia District Hospital will not be able to collect a receivable.Objective evidence includes financial difficulties of the debtor, default payments, debts which are more than 60 days overdue, and changes in debtor credit ratings.Except as otherwise detailed in the following table, the carrying amount of contractual financial assets recorded in the financial statements, net of any allowances for losses, represents Nathalia District Hospital's maximum exposure to credit risk without taking account of the value of any collateral obtained.

Credit Quality of contractual financial assets that are neither past due nor impaired

2014

Financial Institutions

(minimum BBB credit

rating)$

Other$

Total$

Financial AssetsCash and Cash Equivalents 136,163 2,344,177 2,480,340 Receivables:Debtors and Patient Fees - 152,364 152,364 Other Receivables - 11,628 11,628 Total Financial Assets 136,163 2,508,169 2,644,332

2013Financial AssetsCash and Cash Equivalents 540,589 1,904,541 2,445,130 Receivables:Debtors and Patient Fees - 170,897 170,897 Other Receivables - 11,451 11,451 Total Financial Assets 540,589 2,086,889 2,627,478




15(b) Credit Risk (continued)

Ageing Analysis of Financial Assets as at 30 JunePast Due but Not

Impaired

2014

CarryingAmount

$

Not PastDue and

Not Impaired

$

Less than 1

month$

1-3 Months

$Financial AssetsCash and Cash Equivalents 2,480,340 2,480,340 - -

Receivables:Debtors and Patient Fees 152,364 122,165 22,973 7,226 Accrued Revenue 11,628 11,628 - -Total Financial Assets 2,644,332 2,614,133 22,973 7,226

2013Financial AssetsCash and Cash Equivalents 2,445,130 2,445,130 - -Receivables:Debtors and Patient Fees 170,897 150,478 9,587 10,832 Accrued Revenue 11,451 11,451 - -Total Financial Assets 2,627,478 2,607,059 9,587 10,832

Contractual financial assets that are either past due or impairedThere are no material financial assets which are individually determined to be impaired.Currently Nathalia District Hospital does not hold any collateral as security nor credit enhancements relating to any of its financial assets.There are no financial assets that have had their terms renegotiated so as to prevent them from being past due or impaired, and they are stated at the carrying amounts as indicated.The ageing analysis table above discloses the ageing only of contractual financial assets that are past due but not impaired.

15(c) Liquidity RiskLiquidity risk is the risk that Nathalia District Hospital would be unable to meet its financial obligations as and when they fall due.Nathalia District Hospital operates under the Government's fair payments policy of settling financial obligations within 30 days and in the event of a dispute, making payments within 30 days from the date of resolution.Nathalia District Hospital's maximum exposure to liquidity risk is the carrying amounts of financial liabilities as disclosed in the face of the balance sheet.



NOTE 15: FINANCIAL INSTRUMENTS (Continued)15(c) Liquidity Risk (Continued)The following table discloses the contractual maturity analysis for Nathalia District Hospital's financial liabilities.For interest rates applicable to each class of liability refer to individual notes to the financial statements.

Maturity Analysis of Financial Liabilities as at 30 JuneMaturity Dates

2014

CarryingAmount

$

NominalAmount

$

Less than 1 month

$

3 Months- 1 Year

$Financial LiabilitiesPayables 376,680 376,680 376,680 -Other Financial Liabilities - Accommodation Bonds 251,302 251,302 - 251,302 - Other Funds in Trust 27,388 27,388 2,488 24,900 Total Financial Liabilities 655,370 655,370 379,168 276,202

2013Financial LiabilitiesPayables 449,976 449,976 449,976 -Other Financial Liabilities - Accommodation Bonds 259,570 259,570 - 259,570 - Other Funds in Trust 28,693 28,693 1,851 26,842 Total Financial Liabilities 738,239 738,239 451,827 286,412

15(d) Market RiskNathalia District Hospital's exposures to market risk are primarily through interest rate risk with only insignificant exposure to foreign currency and other price risks.Objectives, policies and processes used to manage each of these risks are disclosed in the paragraph below.Currency RiskNathalia District Hospital is exposed to insignificant foreign currency risk through its payables relating to purchases of supplies and consumables from overseas.This is because of a limited amount of purchases denominated in foreign currencies and a short time-frame between commitment and settlement.

Interest Rate RiskExposure to interest rate risk might arise primarily through the Nathalia District Hospital's interest bearing liabilities.Minimisation of risk is achieved by mainly undertaking fixed rate or non-interest bearing financial instruments. For financial liabilities, the hospital mainly undertakes financial liabilities with relatively even maturity profiles. Cash flow interest rate risk is the risk that the future cash flows of a financial instrument will fluctuate because of changes in the market interest rates. The Health Service has minimal exposure to cash flow interest rate risks through its cash and deposits, term deposits and bank overdrafts that are at floating rate.The Health Service manages this risk by mainly undertaking fixed rate or non-interest bearing financial instruments with relatively even maturity profiles, with only insignificant amounts of financial instruments at floating rate. Management has concluded for cash at bank and bank overdraft, as financial assets that can be left at floating rate without necessarily exposing the Health Service to significant bad risk, management monitors movement in interest rates on a daily basis.




15(d) Market Risk (Continued)

Interest Rate Exposure of Financial Assets and Liabilities as at 30 JuneInterest Rate Exposure

2014

WeightedAverageEffective Interest

Rate (%)

CarryingAmount

$

FixedInterest

Rate$

VariableInterest

Rate$

NonInterestBearing

$Financial AssetsCash and Cash Equivalents 3.31% 2,480,340 2,343,677 136,163 500 Receivables:

Patient Fees and Trade Debtors - 152,364 - - 152,364 Other Receivables - 11,628 - - 11,628

Total Financial Assets 2,644,332 2,343,677 136,163 164,492 Financial LiabilitiesPayables - 376,680 - - 376,680 Other Financial Liabilities - Accommodation Bonds 251,302 - - 251,302 - Other Funds in Trust - 27,388 - - 27,388 Total Financial Liabilities 655,370 - - 655,370

2013Financial AssetsCash and Cash Equivalents 3.60% 2,445,130 1,904,041 540,589 500 Receivables:

Patient Fees and Trade Debtors - 170,897 - - 170,897 Other Receivables - 11,451 - - 11,451

Total Financial Assets 2,627,478 1,904,041 540,589 182,848 Financial LiabilitiesPayables - 449,976 - - 449,976 Other Financial Liabilities - Accommodation Bonds 259,570 - - 259,570 - Other Funds in Trust 28,693 - - 28,693 Total Financial Liabilities 738,239 - - 738,239



NOTE 15: FINANCIAL INSTRUMENTS (Continued)(d) Market Risk (continued)Sensitivity Disclosure AnalysisTaking into account past performance, future expectations, economic forecasts, and management's knowledge and experience of the financial markets,Nathalia District Hospital believes the following movements are 'reasonably possible' over the next 12 months (Base rates are sourced from the Reserve Bank of Australia) - A Shift of +1% and -1% in markets interest rates (AUD) from year-end rates of 3.6%; - A parallel shift of +1% and -1% in inflation rate from year-end rates of 2%; - A movement of 15% up and down (2013:15%) for the top ASX 200 index.The following table discloses the impact on net operating result and equity for each category of financial instrument held by Nathalia District Hospital at year end as presented to key management personnel, if changes in the relevant risk occur.

Interest Rate Risk-1% +1%

2014

CarryingAmount

$Profit

$Equity

$Profit

$Equity

$Financial AssetsCash & Cash Equivalents 2,480,340 (24,803) (24,803) 24,803 24,803 Receivables - Trade Debtors 152,364 - - - - - Other Receivables 11,628 - - - -

Financial LiabilitiesPayables 376,680 - - - -Other Financial Liabilities - Accommodation Bonds 251,302 - - - - - Other Funds in Trust 27,388 - - - -

(24,803) (24,803) 24,803 24,803

2013Financial AssetsCash & Cash Equivalents 2,445,130 (24,451) (24,451) 24,451 24,451 Receivables - Trade Debtors 170,897 - - - - - Other Receivables 11,451 - - - -

Financial LiabilitiesPayables 449,976 - - - -Other Financial Liablities - Accommodation Bonds 259,570 - - - - - Other Funds in Trust 28,693

(24,451) (24,451) 24,451 24,451




15(e) Fair ValueThe fair values and net fair values of financial instrument assets and liabilities are determined as follows:*Level 1 - the fair value of financial instrument assets and liabilities with standard terms and conditions and traded in active liquid markets are determined with reference to quoted market prices;* Level 2 - the fair value is determined using inputs other than quoted prices that are observable for the financial asset or liability, either directly or indirectly; and* Level 3 - the fair value is determined in accordance with generally accepted pricing models based on discounted cash flow analysis using unobservable market inputs.The Health Services considers that the carrying amount of financial instrument assets and liabilities recorded in the financial statements to be a fair approximation of their fair values, because of the short-term nature of the financial instruments and the expectation that they will be paid in full.The following table shows that the fair values of most of the contractual financial assets and liabilities are the same as the carrying amounts.

Comparison between carrying amount and fair value

2014

Carrying Amount

2014$

Fair Value2014

$

Carrying Amount

2013$

Fair Value2013

$Financial AssetsCash and Cash Equivalents 2,480,340 2,480,340 2,445,130 2,445,130 Receivables:

Patient Fees and Trade Debtors 152,364 152,364 170,897 170,897 Other Receivables 11,628 11,628 11,451 11,451

Total Financial Assets 2,644,332 2,644,332 2,627,478 2,627,478

Financial LiabilitiesPayables 376,680 376,680 449,976 449,976 Other Financial Liabilities - Accommodation Bonds 251,302 251,302 259,570 259,570 - Other Funds in Trust 27,388 27,388 28,693 28,693 Total Financial Liabilities 655,370 655,370 738,239 738,239



NOTE 16: JOINTLY CONTROLLED OPERATIONS AND ASSETS

Nathalia District Hospital controls 2.03% share of the Hume Rural Health Alliance, whose principal activity is to provide information systems to Health Service Providers in the Department of Health's Hume region.Interests in assets employed in the above jointly controlled operations is detailed below. The amounts are included in the financial statements under their respective assets categories.

Ownership Interest 2014 2013 2.03% 1.81%

Total2014

$

Total2013

$Current AssetsCash and Cash Equivalents 19,547 25,397 Receivables 22,243 19,995 Other Assets 1,674 936 Total Current Assets 43,464 46,328

Non Current AssetsPlant and Equipment 5,957 552

Current LiabilitiesPayables 14,285 18,282 Total Liabilities 14,285 18,282

Nathalia District Hospital's interest in revenue and expenses resulting from jointly controlled operations and assets is detailed below:

RevenuesOperating Revenue 49,861 61,441 Non Operating Revenue 4,875 418 Total Revenue 54,736 61,859

ExpensesNon Salary Labour Costs 31,608 34,431 Operating Expenses 64,296 72,094 Depreciation 92 495 Capital Expenditure 5,430 - Total Expenses 101,426 107,020

Net Result (46,690) (45,161)



NOTE 17: OPERATING SEGMENTS

Residential AgedCare Services

Other HSA &H&CI Services

2014$

2013$

2014$

2013$

Total2014

$

Total2013

$

REVENUETotal Revenue (External Segment Revenue)

2,087,181 2,167,199 3,790,716 3,963,962 5,877,897 6,131,161

EXPENSESTotal Expenses (External Segment Revenue)

(2,518,223) (2,325,892) (3,894,658) (4,329,408) (6,412,881) (6,655,300)

Net Result From Ordinary Activities

(431,042) (158,693) (103,942) (365,446) (534,984) (524,139)

Interest Income - - 89,995 96,501 89,995 96,501 Net Result for Year (431,042) (158,693) (13,947) (268,945) (444,989) (427,638)

Other InformationSegment Assets 41,379 37,721 22,362,401 17,972,406 22,403,780 18,010,127 Total Assets 41,379 37,721 22,362,401 17,972,406 22,403,780 18,010,127

Segment Liabilities - - 1,906,008 1,900,102 1,906,008 1,900,102 Total Liabilities - - 1,906,008 1,900,102 1,906,008 1,900,102

The major services from which the above segments derive income are:Residential Aged Care ServicesOther HSA & H&CI Services - Acute and Community Services

Pricing between inter-segments is at cost

Geographical SegmentNathalia District Hospital operates predominantly in Nathalia, Victoria. More than 90% of revenue, net surplus from ordinary activities and segment assets relate to operations in Nathalia, Victoria.



NOTE 18(A): RESPONSIBLE PERSON RELATED DISCLOSURESIn accordance with the Ministerial Directions issued by the Minister for Finance under the Financial Management Act 1994, the following disclosures are made regarding responsible persons for the reporting period.

PeriodResponsible Ministers: From To The Honourable David Davis, MLC, Minister for Health and Ageing 1/07/2013 30/06/2014

The Honourable Mary Wooldridge, MLA, Minister for Mental Health 1/07/2013 30/06/2014

Board of DirectorsMs S Logie 1/07/2013 30/06/2014Mr D McKenzie 1/07/2013 30/06/2014Mr D Vaughan 1/07/2013 30/06/2014Mr L Bourke 1/07/2013 30/06/2014Mrs B Brooks 1/07/2013 30/06/2014Mr K Pell 1/07/2013 30/06/2014Ms K Rappell 1/07/2013 30/06/2014

Accountable OfficerMr B Morfis 1/07/2013 30/06/2014Mr D Fraser 12/08/2013 30/06/2014

Remuneration of Responsible Persons

Total2014

$

Total2013

$

Nil Nil

NOTE 18(B): EXECUTIVE OFFICER DISCLOSUREThe Chief Executive Officer is employed by Goulburn Valley Health (GVH) and information relating to his remuneration is disclosed in the financial statements of GVH. During the year Nathalia District Hospital paid $92,972 (2013: $89,452) to GVH in relation to the service provided by the CEO and other Administration staff.

NOTE 19: REMUNERATION OF AUDITORS

Total2014

$

Total2013

$

Victorian Auditor - General’s OfficeAudit or review of financial statement 12,420 12,180

12,420 12,180

NOTE 20: EX-GRATIA PAYMENTSThere were no ex-gratia payments made by Nathalia District Hospital during the 2013/2014 financial year.



NOTE 21: COMMITMENTS

Total2014

$

Total2013

$

(a) Commitments for Expenditure

Capital Expenditure Commitments

Plant & Equipment 33,000 -

Total Commitments (Inclusive of GST) 33,000 -

(b) Commitments Payable

Capital Expenditure Commitments

Commitments due not later than one year 33,000 -

Total Commitments for Expenditure (Inclusive of GST) 33,000 -

Less GST Recoverable from the Australian Taxation Office (3,000) -

Total Commitments for Expenditure (Exclusive of GST) 30,000 -

NOTE 23: EVENTS OCCURRING AFTER BALANCE SHEET DATE

There are no known significant financial events after balance date.

NOTE 21: CONTINGENT ASSETS AND LIABILITIESThere are no known contingent assets or liabilities at the date of this report


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Nat

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D istr ict Ho

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Providing Quality Care

Quality of Care ReportNathalia District Hospital

68 N a t h a l i a D i s t r i c t h o s p i t a l - Q u a l i t y o f c a r e r e p o r t 2 0 1 3 / 14

Quality of Care Report 2013/14Our Health ServiceWelcome to Nathalia District Hospital’s (NDH) annual Quality of Care Report. This report aims to inform you, our community, about some of our great achievements for the year, focusing on the quality and safety of the care we provide.

The report reviews the year just gone and endeavours to provide you with an understanding of how we have tried to support and improve your health and wellbeing. It identifies the services and programs we have delivered and the challenges we have faced in providing you with a quality service. This report covers Acute Care, our Residential Aged Care Service (Banawah), Community Health and the Nathalia Medical Clinic.

We have featured a number of examples of feedback you, our consumers, have given us, how we have connected with our community and how we have measured the quality of the care provided. As we highlight our commitment to our community, we seek your feedback to identify ways to make this report more meaningful to you.

Our CommunityThe 2011 Bureau of Statistics estimates the population of Nathalia and district as 1902. They indicate that there were 968 males and 934 females, with a median age of 45, which is considerably over the national average of 37 years. 23% of our community is over 65 years of age compared to the Australian average of 13.5%; however we also meet the Australian average of 19% of our population less than 15 years of age. This creates challenges for our small rural health service to be creative and proactive in providing primary health services across the continuum to ensure our community’s wellbeing.

Nathalia AustraliaPopulation Males 50.9% 49.4%Females 49.1% 50.6%Country of BirthAustralia 90.4% 69.8%Aboriginal or Torres Strait Islander 1.4% 2.5%Median Age

45 37ReligionChristian 71.2% 50.2%No religion or not stated 28.4% 22.5Australian Traditional Aboriginal Religions 0.4% Not stated

During 2013 – 2014 there were no consumer admissions to the health service or Banawah Nursing Home that required the use of an interpreter service.

Nathalia District Hospital is one of the larger employers in the town, currently employing 82 staff. It operates under the Victorian Department of Health Small Rural Health Service Funding Program. This program allows us flexibility for our organisation to decide the balance of services to be provided.

N a t h a l i a D i s t r i c t h o s p i t a l - Q u a l i t y o f c a r e r e p o r t 2 0 1 3 / 14 69

What’s New and Where To From Here

New Equipment Highlights

• Isolation Trolley

• Sara Stedy Lifter

• Acupuncture Machine

• TENS Machine

• Ear Syringe

Moving Forward• Community Health Room Upgrade

• Partial Computer System Upgrade

• Continue Environmental and Cost Saving Measures

• Boost Community Participation

• Installation of Break Tanks

• Energy Efficiency Project

• Upgrade to Nurse Call System

What You Think of Our ServiceAcute CareNathalia District Hospital is committed to enhancing our community's physical, mental and social well-being. One of the key indicators of health care quality is patient satisfaction, which is monitored through the Victorian Patient Satisfaction Monitor (VPSM), a survey that asks patients about how they felt about their hospital visit. Results from the VPSM survey are used by hospitals to identify ways which they can improve.

l i t y o f C a r e r e p o r t 2 0 1 3 / 14


What was the best thing about your stay in hospital?

Everybody was there to help me.

The attention and care given by staff – all extremely nice and come in regularly to see how I was.

No restriction on visiting hours so my children and partner weren’t limited.

What were the worst things about your stay in hospital?

I’m a light sleeper so some noise and light.

Nothing.

What could the hospital do to improve the care and services it provides to better meet the needs of the patients?

I don’t know. I loved my stay.

I think our local hospital is wonderful and we are very lucky to have such a facility.

All is good.

Palliative Care Palliative care is specialised care and support provided for someone living with a terminal illness. Importantly, palliative care also involves care and support for family and caregivers. It aims to maintain the best possible quality of life for the patient as a priority. Our palliative care services may be delivered in the home, or in hospital, depending on the wishes of the person and their families.

The care and respect given to my mother during her illness was brilliant and the support given to me and my family was wonderful (District Nursing).

At a time of overwhelming sadness we felt we were in the hands of caring, well trained friends (In hospital care)

Transition Care ProgramThe Transition Care Program (TCP) is delivered by Nathalia District Hospital in partnership with GV Health to provide options for older people who have experienced an event which, without appropriate recovery time, would see them admitted into Residential Aged Care. TCP gives older consumers time for rehabilitation so they can manage once discharged home. The program runs for a maximum period of 12 weeks once the patient is ready for discharge from acute care and is tailored to meet the needs of the person at the time of their discharge. In 2013-2014, fourteen patients were admitted to the TCP program for a total of 505 bed days.

My mother recently was an inpatient for TCP at Nathalia. I visited her regularly and was extremely impressed by your lovely hospital, caring staff and beautiful surroundings. Mum was an inpatient in three other hospitals before ending up in Nathalia, and thank goodness she did end up there. Thanks for the excellent care she received.

Banawah Nursing HomeBanawah has 20 beds to accommodate elderly persons with high care needs who are unable to be cared for in their own homes. In Banawah we undertake an annual internal residential satisfaction survey of all residents and their elected next of kin which provides us with valuable feedback to guide us to areas that may need improving. The return rate of completed surveys in February 2013 was 70% for residents and 50% for next of kin. The survey covered 14 topics, including involvement in care planning, appropriate emotional support being given and satisfaction with the current activities program.


Feedback Resident Satisfaction Family Satisfaction

Overall Satisfaction Level 80% 87%

Least Satisfaction

Staff Availability 69.3% 83%

Complaints and Compliments 73.5% 87.9%

Most Satisfaction

Level of Information Provided 85.6% 85.6%

Visiting Service Options 85.6% 91.8%

Activities Programs 85.1% 85.2%

Dealing with ComplaintsAlthough most feedback received has been very positive, Nathalia District Hospital acknowledges everyone’s right to express their dissatisfaction with our services. Feedback and complaints provide valuable feedback which assists us to evaluate our systems and processes, and are viewed as an opportunity for continuous improvement.

We have a policy of open disclosure when dealing with complaints, which is modelled on the guidelines of the Australian Commission on Quality and Safety in Healthcare. All complaints are taken seriously and managed in an accountable, transparent and timely manner.

In 2013-2014, Nathalia District Hospital received 9 complaints, 10 comments about the service and 16 compliments. 44% of complaints were about direct care delivery to consumers, 33% related to communication concerns. All complaints were resolved.

9 Complaints

16 Compliments

10 Comments

Compliments/Comments/ComplaintsJuly 2013 - June 2014

n a t h a l i a D i s t r i C t h o s p i t a l Q u a


As a result of consumer complaints received in 2013-2014, the organisation reviewed and further improved its systems and processes. Some of the improvements include:

• Clinical staff received education regarding resident rights and choices

• Clinical staff received education regarding managing and dealing with complex and challenging behaviours

• Media releases informing the community of the services offered at Nathalia District Hospital

• Changes to Policy (adding an escalation process to the complaints policy)

• Changes to policy (all equipment brought into the facility must meet Australian Standards for safety)

Clinical GovernanceClinical Governance is how we, as a health service, share the responsibility and accountability for ensuring high standards of health care, continuous improvement of service quality and fostering an environment of excellence in care for consumers. That is, the structure we use to make things better and safer.

Nathalia District Hospital delivers clinical governance using the Clinical Governance Framework of the Department of Health; focussing on four domains of quality and safety. These are:

• Developing consumer participation.

• Clinical effectiveness.

• Risk Management

• Effective workforce

Open Access Meetings are one system we have put in place so members of the community can observe the Nathalia District Hospital Board of Management and gain insight into how the Board functions. We hold open access meetings prior to our Annual General Meeting each year and encourage members of our community to attend. Our organisation exists solely to serve the community and this gives all attendees’ valuable understanding as to how we work.

As we work to provide the best possible care, our governance system mirrors the diagram below.


CredentialingModern health care is one of the most complex activities ever undertaken by human beings. It is changing rapidly with the introduction of new clinical services, procedures and other technologies. To ensure our doctors, nursing and allied health staff are sufficiently qualified, experienced and skilled to provide the care you need; we have a stringent credentialing process here at Nathalia District Hospital.

All staff must have a current police check at commencement of employment, and renewal of this is required every three years. All health professionals must validate their registration with the Australian Health Practitioner Regulatory Agency (AHPRA). In addition, all clinicians must provide evidence on continuing professional development to support their practice and gain the required professional development points for registration with AHPRA.

Partnering with ConsumersOur community represents our whole customer base, and as such, partnering with them allows us to become a more focused, more responsive organisation. Your help and support makes us a better health service, and gives everyone a better understanding of how the organisation works, and how to influence its future direction.

We formed a Consumer Advisory Committee in March this year to assist in getting the views of our community incorporated into our decision making process. This committee, along with client and patient feedback, guides the services we provide and what the community want us to provide in the future. Our consumer participation policy and plan facilitated this creation and we have already received valuable input.

As our organisation is a reflection of our community, we have worked hard to understand and respond to different cultures and groups within the community. This cultural responsiveness has lead to many changes that improve the healthcare outcomes for our clients and patients. Culturally specific groups within our community include Aboriginal and Torres Strait Islanders (ATSI), Brethren, disabled members of our community, and a very small number of people who have English as a second language.

All of this information from our community shows our commitment to consult and adapt. Many of these changes are communicated in our regular Redgum Courier column, via our website and in monthly newsletters available at the Hospital.

Improving Care for Aboriginal and Torres Strait IslandersThe 2011 Census data reveals 1.4% of the population has identified themselves as being of ATSI decent. During 2013 – 2014 there were 2 patients admitted to Nathalia District Hospital who identified themselves as ATSI. Patients are asked on admission to the service if they are from an ATSI background, as this assists staff to develop a care plan for their patients which is culturally specific to their needs.

Our policy and procedures provide information and the details about the local ATSI cultural concerns and guides staff in providing care. This has been developed with input from the Bangarang people. If further advice is needed, Nathalia District Hospital has specific links with GVHealth in Shepparton, whose Aboriginal Liaison Officers can advise on care needs.

Access To CareUrgent CareOur Urgent Care Centre offers timely clinical interventions for patients who present for urgent treatment twenty-four hours a day, seven days a week. All presentations are triaged by the nurse on duty and treated according to need.

If one of our Rural and Isolated Practice Endorsed Registered Nurses (RIPERN) is on duty, they are able to provide basic interventions and medications when the hospital is unable to provide an on call doctor. This enables our community to be treated for less serious presentations at the hospital rather than travelling 40kms to Shepparton. We currently have three nurses with a RIPERN certificate and five more staff working towards this qualification.


Urgent Care Triage StatisticsJune 2013 - July 2014

Urgent Care Admission StatisticsJune 2013 - July 2014

30

25

20

15

10

5

0No Admittance Nathalia DH Transferred

0Triage 1 Triage 2 Triage 3 Triage 4 Triage 5 Triage 6

20

40

60

80

100


Discharge PlanningDischarge planning is the process of linking the treatment received by a patient in hospital to post-discharge care provided in the community. The discharge process begins on admission when staff ask questions about any services that are currently in place before admission or if they feel there is a need for any services when you are discharged home. We focus on patient centered care, meaning care is tailored to what the patient feels is best for them and what they understand is happening in regards to diagnosis and treatment. When a patient is discharged home, nursing staff will do a follow up phone call.

District Nursing ServicesThe District Nursing Service continues to be an essential service in the local community, and remains the link between hospital based services and care delivered in the home environment. The service is offered daily to assist people to live in the community as independently and autonomously as possible whilst they receive their care. Care is tailored to meet the individual goals and aims of clients and nursing care can involve assistance with medications, wound care services, end of life care, and provision of support for those caring for loved ones with life limiting conditions. To enable them to complete their role effectively, the District Nurses work closely with an array of other services, ranging from The Moira Palliative Care Service and Goulbourn Valley Health Hospital in the Home Service, to Post Acute Care Services, and an array of Medical and Allied Health Professionals.

As a part of providing carer support, the District Nurses also coordinate a carer program which offers day outings, in home music therapy sessions, and a diversional therapy program for carers and their loved ones.

The District Nurses provided 5,967 occasions of care, including 11 post natal domiciliary visits and numerous Hospital in the Home clients. The District Nursing Team has offered approximately 4 months of student placement in 2013-2014.

Allied HealthAllied Health services are specialised health services which can enhance a consumers, independence and health outcomes. Access to an array of allied health services has been demonstrated to promote better physical and mental wellbeing for the consumer, their carers and/or families. These services can assist people to maintain their independence and in some cases, reduce the need for more costly health services, including residential care and hospital treatment.

With this in mind, Nathalia District Hospital has continued to make the provision of allied health services a focus in 2013-2014, and has continued to offer a wide array of services which include the following:

• McGrath Foundation Breast Care Nurse

• Audiology

• Optometry

• Physiotherapy

• Dietetics

• Speech Pathology – contracted as required/requested

• Diabetes Education

• Generalist Counselling

• Podiatry

• Occupational Therapy

As funding for these services is limited, the need for these services is reviewed annually and priority given to those most needed in the community.

Questions Asked 2012-13 2013-14

Number of patients who received a follow up phone call

25% 67%

Provided with a discharge summary

50% 100%

Required further information about your condition

0% 0%

Coping with the support systems put in place post discharge

100% 100%


Support ServicesSupport Services at Nathalia District Hospital continued to deliver quality services during 2013/14 which meet all Victorian and Australian standards in healthcare. Support services include such areas as catering, cleaning, preventative and reactive maintenance and gardening. These services enhance patient and resident health experiences.

Community HealthNathalia District Hospital Community Health team continues to provide the community with education, assistance and advice on a wide range of health issues relevant to their needs. Using local demographic, social, and health characteristics of our region to highlighted areas of concern in regard to health and wellbeing and determine a focus for the year.

The 2013/14 focus areas included:

• Smiles 4 Miles

• Act, Belong Commit

• Women’s Health Clinics (pap tests/cervical screening)

• Healthy Eating

• Early Intervention into Chronic Disease

• School Health Programs

Act, Belong, CommitAct-Belong-Commit is a comprehensive health promotion campaign that encourages individuals to take action to protect and promote their own mental wellbeing and encourages organisations that provide mentally healthy activities to promote participation in those activities. Being active, having a sense of belonging and having a purpose in life all contribute to happiness and good mental health.

The A-B-C guidelines for positive mental health provide a simple approach that we can adopt to become more mentally healthy:

Act - Keep mentally, physically, socially, and spiritually active.

Belong – Join a club, take a class, be more involved in groups you are already involved with, go along to a community event.

Commit – Take up a cause, help a neighbour, learn something new, take on a challenge, volunteer.

The team held a staff breakfast and community launch (which occurred in partnership with eight other community groups), with the theme being the promotion of Act-Belong-Commit logo, and mentally healthy communities. A pledge wall was installed with many staff and community members making pledges to commit to different activities or to further involvement with groups they are already involved with. Information was provided, enquiries made and discussion generated relating to mental health and wellbeing, depression and anxiety.

Smiles for MilesSmiles for Miles is a program aimed to improve the oral health of preschool aged children in Victoria. It is an initiative of Dental Health Services Victoria which works in partnership with organisations including community health services and local councils to improve the oral health of the youngest children in the community. The program is based on the World Health Organisation’s Health Promoting Schools Framework and is delivered predominantly in kindergartens.

The Community Health team has been working extensively with the local preschools and early learning centre, completing a number of activities with the children. This proved to be a very positive exercise, as the children received education regarding healthy eating and oral and dental health.

Staff Demographics and Feedback

Nathalia

Males 18%

Females 82%

Over 55 years of age 30%Under 34 years of age 16%

Full Time 23%

Part Time 77%Worked at Nathalia District Hospital more than 10 years

32%

Born in Australia 95%

Each year our staff are invited to participate in the Victorian People Matter Survey, which measures a range of aspects of workforce culture and climate in the Victorian public sector. It is an external survey completed on line. The survey focuses on employees’ perspectives on the application of the public sector values and employment principles as well as aiming to measure job satisfaction and workplace wellbeing.


This information is used to identify our strengths and weaknesses and to measure our progress in embedding the public sector values and employment principles into our organisation’s culture.

Feedback Staff Satisfaction

Overall Satisfaction Level 89%

Least Satisfaction: There were 4 areas that rated less than 80% satisfaction including:

I am provided with opportunity to influence changes in my organisation

72%

In times of change, senior managers provide sufficient information about the purpose of the changes

75%

Communication about change from senior managers are timely and relevant

77%

Most Satisfaction: There were 10 responses that rated 100% including:

Age or gender is not a barrier to my success

100%

I feel I make a contribution towards achieving the organisation’s objectives

100%

In my workgroup, work is undertaken using best practice approaches

100%

Education The National Safety and Quality Health Service (NSQHS) Standards require us to maintain the professional standard of our services. As a part of this requirement, all employees must undertake ongoing education to maintain the currency of their professional and vocational, knowledge and skills.

To ensure Nathalia District Hospital continues to excel in this area, the organisation maintains a strong commitment to the promotion of learning and the professional development of all staff and the health workforce of the future.

Internal TrainingWe have a robust internal education program which ensures all staff maintain fundamental skills essential to safe practice. This education is driven by the Clinical Nurse Educator who manages the professional development and ongoing education of all staff.

At the end of each 12 months an education and training needs analysis is completed, the results of which then guide planning and the development of an education program for the following 12 months. The program includes weekly education opportunities for all staff, ranging from in-service training, to linking with off-site specialists via video-conferencing technology. This variety of training and training delivery allows staff to access the latest, up to date information, without hours of travel to major rural cities or metropolitan locations.

Staff are also required to maintain skills essential to safe practice by completing an array of annual competencies which are individualised, both to work roles and work areas. Examples of competencies completed include Advanced Life Support (Registered Nurses), Basic Life Support (all other staff), manual handling, food safety, fire and emergency training, and bullying & harassment training. Many of these competencies are now completed on line via an e-learning portal, the Victorian Regional Health Service E-learning Network.

98%

94%

%001%001%001%001%001

91%92%93%94%95%96%97%98%99%

100%101%

Basic Life Support

Manual Handling

Work Place Hygiene

Fire and Emergency

Medication Safety

Food Safety

Clinical Staff Non Clinical Staff

98% 98% 98%

Timely Completion of Compulsory Competencies 2013 - 2014


External StudyMany staff have undertaken external training in 2013-2014 as staff continue to be supported to develop their skills and upgrade their qualifications. Examples of external training staff have completed include; Diploma of Nursing traineeships, Certificate IV in Training and Assessment, food safety auditing training, cleaning auditing training and RIPERN training. This support is an important focus of the organisation to develop and maintain a highly skilled workforce whilst helping employees to prosper and develop their own careers.

Student Work Placement/ExperienceWe continue to have a strong commitment in assisting to develop the health workforce of the future, and have provided approximately 50 weeks of student placement across the service during the last 12 months.

Students are catered for at many levels and varying disciplines, including; medical and allied health students, nursing and aged care students, through to work experience students and placement for persons with disabilities.

Working collaboratively with education providers ranging from Higher Education organisations (LaTrobe University) to local schools (Nathalia Secondary College & St Mary of the Angles Secondary College), the organisation continues to offer work placement opportunities which develop and consolidate student knowledge and skills.

Volunteers

If you want to touch the past, touch a rock. If you want to touch the present, touch a flower. If you want to touch the future, touch a life. ~Author Unknown

We are blessed with a small band of volunteers who support the services we provide by generously donating their time and energies for the benefit of our community and our hospital. We have numerous areas where volunteers help out including Banawah Nursing Home, our Planned Activities Group, serving on the Consumer Advisory Committee and our Board of Management. Our volunteers are a group of compassionate people who are respectful and kind to our consumers, and work passionately for the good of our small hospital. Thank you for all that you do.

Accreditation FrameworksNathalia District Hospital is required to achieve and maintain accreditation with a number of accreditation bodies as part of our health service agreement. Our acute services are accredited under the Australian Council on Health Care Standards EQuIP National Program, residential aged care under Australian Aged Care Quality Agency, District Nursing Service and Planned Activities Group through Home and Community Care and the Nathalia Medical Clinic under the Australian General Practice Accreditation Limited.

Each accreditation body has its own separate requirements which must be complied with for the health service to meet full compliance. However they are all driven by the same principles of good care set out in the Australian Safety and Quality Framework for Health Care.

Australian Safety and Quality Framework for Health Care The Australian Safety and Quality Framework for Health Care, describes a vision for safe and high quality care for all Australians, and sets out the actions needed to achieve this vision. It specifies three core principles for safe and high quality care. These principles of care are:

• Consumer centred,

• Driven by information, and

• Organised for safety.

The Framework was endorsed by Health Ministers as the National Safety and Quality Framework for Australia in November 2010. It provides areas of action that all people in the health system can take to improve the safety and quality of care provided in all healthcare settings over the next decade.

This framework can be used as the basis of strategic and operational safety and quality plans, providing a mechanism for refocusing current safety and quality improvement activities and designing goals for health service improvement, and be used as a guide for reviewing investments and research in safety and quality.


Interventions used include:

• Increasing lighting

• De-cluttering the environment

• Motion sensors

• Electric beds that go to the floor

• Medication reviews

• Strength training

• Hip protectors

In addition, we have implemented an hourly rounding program which requires staff to check on the patient or resident each hour and ask them a series of questions designed to limit their risk of falls. Questions include whether the person needs to go to the toilet or needs pain relief.

Summary of Accreditation Surveys

Service NSQHC Residential Aged Care

Nathalia Medical Clinic

District Nursing and Planned Activities

Accreditation Agency

ACHS EQuIP National Australian Aged Care Quality Agency

Australian General Practice Accreditation Limited

Home and Community Care

Last Visit September 2013 June 2012 November 2012 September 2013

Results Full Compliance and 5 Met with Merit

Met all 44 Standards Full Compliance Full Compliance

Next Review September 2015 June 2015 November 2015 September 2016

Self assessment due September 2014

One support visit per year

Continue to provide feedback on implementation of Active Service Model

Preventing Falls and Harm from FallsThe definition used at Nathalia District Hospital for falls is any event which results in a person coming to rest inadvertently on the ground, floor, or a lower level. This is the definition recommended by the World Health Organisation.

Although falls are an inevitable part of ageing, our aim is to not only reduce the incidence of falls amongst our patients, clients, and residents, but minimise the associated injuries that may occur. Each person is assessed for falls risk on admission to the facility regardless of whether they are a home based, hospital based, or residential aged care client. If the person sustains a fall following admission, they are reassessed. We closely monitor the number of falls, the time they occur and where they occur in an attempt to better manage them.

Some areas of accreditation addressed across the service are listed as follows.


Falls Reported 2012 - 2014

0

2

4

6

8

10

12

14

2012-13 2013-14

The Public Sector Residential Aged Care system collects statistics using the Aged Care Quality Indicator Reports. In these reports Banawah falls frequency was 3.66 falls per 1000 occupied bed days. Last year the prevalence was 5.00 per 1000 bed days.

Preventing and Managing Pressure InjuriesPressure sores, now called pressure injuries, can develop in anyone with reduced mobility, such as being confined to a bed or chair. This type of skin damage is difficult to treat and can lead to serious complications. Prevention tips include regular changes of position, good hygiene and skin care, and a healthy diet.

A skin integrity risk assessment is completed on all residents and patients in our care. Those indentified as “at risk” will then have preventative strategies implemented. Ongoing assessment ensures that risk management strategies are working as a part of the day to day care of the resident/patient. Staff undertake education on early recognition of pressure ulcers and are provided with the knowledge to implement early preventative measures.

During 2013 -2014, four patients were admitted to Nathalia District Hospital with existing pressure injuries, and one patient developed a pressure injury after admission.

In the Aged Care Quality Indicator Reports, Banawah was above the state average of Stage 1 pressure injuries with a prevalence of 0.71 incidents per 1000 occupied bed days and 0.55 for Stage 2 pressure injuries. There were no Stage 3 or 4 pressure injuries identified.

Medication SafetyMedication incidents are monitored and analysed each month across both acute and residential aged care because reducing errors and harm through safe and timely administration of medications is vital to ensure the safety of our residents, patients and staff.

Our Patient Care Review Committee reviews drug related incidents and issues and ensure both compliance with state and federal legislative requirements relating to drug administration and oversee that each individual incident has been reviewed appropriately to avoid any recurrence.

All clinical staff who administer medication must undertake an annual medication competency assessment, as safe use and administration of medications is dependent on highly skilled and committed staff. This assessment ensures that staff have the necessary skills and competence to undertake this important task.

In 2013-2014 the hospital recorded 39 medication errors. 78% of the reported errors were low risk, predominantly staff failing to record the Schedule 4 medication count which is being monitored. The other 22% related to wrong frequency, wrong drug or ceased medication being continued. Improvements made as a result of reviewing the medication incidents include the purchase of a reference book to identify which medications can be crushed and the review of what information should be recorded on the allergy alert.


Preventing and Controlling Healthcare Associated Infections

Hand HygieneResearch has proven hand hygiene to be the most important component in the event of preventing spreading germs from one person to another.

Hand Hygiene Audit Scores

Hand Hygiene encompasses both hand washing and use of Alcohol Based Handrub. All staff are required to participate in the Hand Hygiene Program which includes staff education, compliance to the five moments of hand hygiene and an auditing program where results are reported to VICNISS (Hospital Acquired Infection Surveillance System).

n a t h a l i a D i s t r i C t h o s p i t a l Q u a l i t y o f C a r e r e p o r t 2 0 1 3 / 14

Apr-13 Jun-13 Oct-13 Mar-14 Jun-140

20

40

60

80

100


Staff ImmunisationOur staff have continued to support the influenza immunisation program, acknowledging that the residents and patients in our care are vulnerable and would suffer adversely if staff were to infect them. Our excellent record continues with 89% of staff taking up the offer this year.

Antimicrobial StewardshipInappropriate and over use of antibiotics is contributing to the emergence of resistant bacteria and causes patient harm. Patients with antimicrobial-resistant infections are more likely to experience ineffective treatment, recurrent infection, delayed recovery or even death.

Nathalia District Hospital has introduced an antimicrobial stewardship (AMS) program in an attempt to ensure appropriate antibiotic usage, and in doing so, improve patient outcomes.

Our staff monitor antibiotic usage to ensure they are in compliance to the Therapeutic Guidelines for Antibiotic Usage which have been endorsed by the Board of Management. Our audits confirm full compliance to these guidelines.

Food ServicesNathalia District Hospital is required to participate in an external Food Safety Audit each year as a Class A food premises. This audit measures compliance with food safety standards. The last audit was conducted by an approved Food Safety Auditor and was carried out in June 2014. The audit results demonstrated a positive and dedicated approach to food safety with a very high level of compliance. There were a number of minor recommendations which have now been implemented.

In January 2014 Nathalia District Hospital food services were reviewed by the Moira Shire Environmental Health Officer with no recommendations recorded.

Cleaning ServicesInternal cleaning audits have been conducted on a monthly basis by our qualified staff in all functional areas to ensure compliance with the Victorian Department of Health Cleaning Standards, with audit scores meeting the required Acceptable Quality Level (AQL) of above 85%.

Nathalia District Hospital’s annual external cleaning audit was conducted in June 2014, by a similar E sized hospital we have formed a partnership with for cleaning audit purposes. Staff have been congratulated on presenting an overall high standard of cleaning, achieving excellent results with the facility presenting as a clean, safe environment for patients, staff and the general public.


Safe Use of Blood and Blood Products The safe use of blood and blood products continues to be one of our major focuses at Nathalia District Hospital. In 2013 the organisation took part in a state wide audit of ‘elective red blood cell use in medical, surgical, and obstetric patients’. This audit was completed for the Victorian Department of Health by the Blood Matters Program, which is a program aimed at improving the quality and safety of hospital transfusion practice, and care.

The Blood Matters Program Management Steering Group identified the area of effective red blood cell usage to determine current practice across the state. The audit identified that Nathalia District Hospital’s practice in regard to the effective use of red blood cells was exemplary, the results having exceeded the state averages in a number of areas, for example:

Evidence of medical documentation indicating the reason for transfusion, (Nathalia District Hospital) 100% of episodes, (State average) 85% of episodes. • Documentation implies that HB and patient’s

clinical status BOTH considered in decision to transfuse, (Nathalia District Hospital) 100% of episodes, (State average) 86% of episodes.

• Transfusion Times- Number of transfusions occurring within hours (8am – 8pm)

• (Nathalia District Hospital) 100% of episodes, (State Average) 83% of episodes.

• A clinical assessment of the patient occurred after 1st unit of transfusion (Nathalia District Hospital) 50% of episodes, (State average) 32% of episodes.

All Registered Nurses are required to have completed ongoing education regarding the safe use of blood and blood products as a means to maintain the currency of their skills and knowledge. This education is required to be completed every two years using the Blood Safe e-learning education package.

Nathalia Medical ClinicNathalia Medical Clinic is an auspice of Nathalia District Hospital and continues to strive for quality patient care and continued staff improvement. We have had Medical Officers change over the last 12 months. After spending two years with us through the Bogong Regional Training Network as a registrar, Dr Chuck Kong left at the end of January 2014 to take up a General Practitioner position at Belgrave Medical Clinic. Dr Kong was a valued member of the clinic and is sorely missed. In April 2014 we welcomed Dr Kamil Cassim to the clinic, Dr Cassim’s previous position was in the Emergency Department at Goulburn Valley Health. Originally from Saudi Arabia, Dr Cassim spent time working in Sri Lanka before coming to Australia.

The After Hours Clinic, funded through the Department of Health and Ageing, ceased in May 2014 due to the funding being discontinued. The After Hours Clinic was well patronised but was no longer viable without government funding support.

Our current doctors Dr Peter Poon, Dr John Drenen, Dr Mogeke Nyorora and Dr Kamil Cassim remain devoted to our community not only servicing the clinic during office hours but also working on a rostered basis to service the community after hours, so that there is always a doctor available. Our practice nurses and administration staff are an integral part of the team and continue to be of great support to facilitate the successful operation of Nathalia Medical Clinic.

External Cleaning Audit Scores

2011/12 2012/13 2013/14

93

99.598.4


Feedback On This Report This report has been written to inform our community about the quality and safety of our services. We value your feedback, this form has been included to provide the opportunity for you to comment on the Annual Report and Quality of Care Report so we can improve the information included for next year.

If you have the time, please complete the enclosed evaluation form and return it to Nathalia District Hospital by:

1. Returning in the Reply Paid envelope

2. Handing it in at the hospital

3. Placing it in the comments and complaints box in the foyer of the hospital

Thank you

www.nathaliahospital.org.au

Nathalia District Hospital & Banawah Nursing Home36-44 McDonell St, Nathalia, VIC 3638

Phone: (03) 5866 9444

Fax: (03) 5866 2042

E-mail: [email protected]

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