swslhd oral health services health...targeted services such preventative dental care and oral health...

South Western Sydney Local Health District 1

SWSLHD Oral Health Services

A Service of South Western Sydney Local Health District Operational Plan

2018 – 2020

Leading care, healthier communities

SWSLHD Oral Health Services Operational Plan 2018 – 2020


Table of Contents Introduction ................................................................................................................................. 3 Background ................................................................................................................................. 4 Map of South Western Sydney Local Health District ................................................................... 5 Values Framework ...................................................................................................................... 6 Community Profile ....................................................................................................................... 7 Oral Health Services Profile ........................................................................................................ 8 Strategic Directions ................................................................................................................... 17 Operational Plan Reporting and Monitoring Framework ............................................................ 18

SWSLHD Strategic Plan 2018 – 2021 – Applicable Strategies for SWSLHD Oral Health Services ................................................................................................................................. 18 SWSLHD Oral Health Services Specific Initiatives July 2018 – June 2020 ............................ 26

Priority Service Developments .................................................................................................. 28 References and Supporting Documents .................................................................................... 29 Appendix – SWSLHD Role Delineation Levels .......................................................................... 30



Introduction

Oral Health Services provide a high quality, affordable and well-managed dental services to the eligible

population of South Western Sydney Local Health District (SWSLHD). The service focuses on evidence

based dentistry, prevention and oral health promotion in all facets of patient care. Additionally, there are well

established linkages with other Local Health Districts and various research institutions to advance and

progress the science and art of dentistry. SWSLHD Oral Health Services have the following goals:

• Ensure that access to Oral Health Services is effective, timely and based on patient needs.

• Continue to improve patient journeys through the oral health system through a patient flow and

performance management strategy.

• Strengthen collaboration with other facilities, services and hospitals across SWSLHD and other

Local Health Districts (LHD) to improve patient oral health outcomes.

• Create a team of valued oral health professionals with improved workforce skills, to deliver

consumer focused care.

• Advocate and plan for improved infrastructure to meet the challenges of Oral Health Service delivery

in view of rapidly growing and ageing populations.

Oral Health Services Operational Plan for 2018-2020 outlines the actions Oral Health Services will take in

the next five years that will contribute to achieving SWSLHD’s strategic priorities.

The plan outlines the geographic and organizational context, and presents brief population profiles of

SWSLHD. Oral Health Services consider the likely demands on service demand over the next five years

and the challenges that will be faced in meeting those demands and identifies priority areas of action. The

major section of the plan details the activities that Oral Health Services intends to undertake to achieve

SWSLHD’s Strategic Plan, improve oral health status, improve service access, deepen clinical capabilities,

develop new models of care and reduce inequalities in health.



Background SWSLHD covers the local government areas (LGAs) of Bankstown, Camden, Campbelltown, Fairfield,

Liverpool, Wingecarribee and Wollondilly. In 2011 the population of SWSLHD was estimated at 875,763

people, projected to increase by 18,000 people per annum over the next decade. By 2016 there were

504,121 residents eligible for public dental care including 253,679 children and young people who are under

18 years which will be a 7.5% increase in eligible population.

Oral Health Services in SWSLHD are provided by a range of professionals in a wide variety of settings.

These include acute hospitals (Liverpool and Fairfield), Community Health Centres (CHCs), standalone

Community Oral Health Clinics (COHCs) and school based clinics. Most clinics combine adult and child

services and are co-located with other services to provide holistic health care treatment and service for the

eligible population.

It is unlikely that there will be any decrease in the current level of activity over the next 10 years. In fact,

with the increasing size of the population, its ageing, an increase in dental caries in the young and

increased numbers in the dentate population, there is likelihood for increased demand for public dental

services. This is based on the assumption that there will be no change to the current eligibility criteria for

public dental services.

Given the anticipated population growth in South Western Sydney and the high numbers of eligible patients,

it is essential to expand the number of existing dental chairs to provide additional services. The preferred

strategy to develop specialist services in these Oral Health Centres of Excellence (OHCOE). Greater

collaboration with University of Sydney Dental School is essential to increase student training places for

both undergraduate, graduate and postgraduate dental programs.

Priority corporate actions include ensuring quality, productivity and efficiency in care provision through use

of clinical audits (QARS); clinical Indicators including monitoring unplanned returns for restorations,

endodontics, extractions and dentures; internal and external benchmarking; benchmarking treatment

appointments and including broader options of care – maintenance of skills; support for continuing

education courses relevant to public sector dentistry; enhance consumer participation in planning, delivery,

reporting and evaluation of services; strengthen and build on partnerships established with the Tharawal

Aboriginal Medical Service and District Aboriginal Health Service to improve the oral Health of aboriginal

people and their access to oral health services; promote research achievements in conferences and in

media to raise the profile of Oral Health Services in the public domain and embed Transforming Your

Experience strategies in daily business.



Map of South Western Sydney Local Health District



Values Framework



Community Profile



Oral Health Services Profile SWSLHD Oral Health Service work to protect, promote, maintain and improve the Oral Health of the

people of South West Sydney and the Southern Highlands, delivering high quality, affordable and well-

managed dental services. The Oral Health model of care for SWSLHD is predicated on reaching a

balance between:

• Providing timely emergency and acute care to the eligible population based on equity of access

to all sites, aligned with the NSW Priority Oral Health Program (POHP).

• Assessing general treatment need and clinically prioritising and offering care through treatment

waiting list codes A to F.

• Ensuring quality, productivity and efficiency in care provision.

• Practising modern evidence based dentistry with focus on prevention and Oral Health

Promotion.

• Progressively investing in the “Population Oral Health Approach” through capacity building of

other health professionals, partnership with other health providers; and engaging community

participation in planning and consultative processes.

Access to Services Public Oral Health Services in NSW are available to two major groups (PD2009_074 Oral Health

– Eligibility of Persons for Public Oral Health Care in NSW):

• For a child or young person to be eligible for free public Oral Health Services they must

o be normally resident within the boundary of the providing LHD, and;

o be eligible for Medicare, and;

o be less than 18 years of age

• For an adult to be eligible for free public Oral Health Services they must:

o be normally resident within the boundary of the providing LHD, and;

o be eligible for Medicare, and

o be 18 years of age or older, and

o Hold or be listed as a dependent on one of the following valid Australian

Government concession cards:

o Health Care Card

o Pensioner Concession Card

o Commonwealth Seniors Health Card

Eligible patients currently access oral health services through Centralised Oral Health Intake and

Information Services (COHIS) which is shared across Sydney Local Health District (SLHD) and

SWSLHD. In some instances, a patient may be issued with an Oral Health Fee for Service

Scheme (OHFFSS) voucher, which allows them to visit a registered private provider for prescribed

routine dental work



Services and Programs

Oral Health Services in SWSLHD are provided by a range of professionals in a wide variety of

settings. These include acute hospitals (Liverpool and Fairfield), Community Health Centres

(CHC), standalone Oral Health Clinics (OHC) and school based clinics. Most clinics combine adult

and child services and are co-located with other services to provide holistic health care treatment

and service for the eligible population. Table 1 summarises the quantum and location of clinical

services in SWSLHD. It should be noted that a proportion of the chairs at Yagoona OHC are

dedicated University of Sydney student chairs.

Table 1

Dental Services Chairs Adult Child Specialist Theatres

Wingecarribee CHC (Bowral) 3 x x

Wollondilly CHC (Tahmoor) 3 x x

Narellan CHC 3 x x

Rosemeadow CHC 7 x x X 1

Campbelltown Hospital X 2 access

Ingleburn OHC 6 x x

Liverpool Hospital OHC 8 x x

Liverpool Hospital access

Yagoona OHC 9 x x

Bankstown North OHC 4 x x

Fairfield Hospital OHC3 11 (14) x x

X1 Specialist Oral Surgery program in partnership with University of Sydney and Nepean Blue Mountains LHD X2 Planned Paediatric Dentistry specialist services 3 Addition of 3 chairs expected to be completed in August 2018

A full range of general dental services (adult and child) and a limited range of specialist clinical

services are offered to eligible patients, including:

Assessment and Emergencies

General Dentistry

Endodontics

Periodontics

Removable Prosthodontics



Dental Trauma

Preventive Dentistry

Special Needs Dentistry

Oral Surgery

Paediatric Dentistry

Relative Analgesia

Oral/Dentoalveolar surgery under General Anaesthesia.

Care to medically and/or surgically compromised patients (Liverpool Hospital OHC)

Special needs programs are also provided including:

Out-of-Home Care children

Aboriginal Oral Health Clinics

HIV and Related Programs

Midwifery Initiated Oral Health Program

Refugee Oral Health pathways

Dental School Assessment Program

Activity and Performance As indicated in the following graph, over the past 3 years, clinical performance measured in Dental

Weighted Activity Units (DWAU) have increased by 25.2% This has been a result of multiple

strategies including a structured clinical patient flow and performance monitoring program,

optimising chair usage, keeping clinical activity and productivity in focus in clinic meetings and

balanced use of the OHFFSS. Providing increased DWAU in view of limited physical clinical

capacity is an ongoing challenge.

0

10,000

20,000

30,000

40,000

50,000

2015-16 2016-17 2017-18

DWAU



Workforce Oral Health Services comprises of a diverse mix of staff, dental officers, dental therapists, oral

health therapists, dental assistants, dental prosthetists and administration officers. The total full –

time equivalent (FTE) count is 131.86 and headcount is 143.26. The uniqueness of the service is

the vast geographical location of clinics while retaining the essence of collaboration and team

work.

Future Demands Assuming there are no major changes in Commonwealth or NSW government policy, future

demand for Oral Health Services is determined using the following methodology:

• In 2011 the population of SWSLHD was estimated at 875,384 people, projected to

increase by 18,000 people per annum over the next decade. By 2016 there will be

504,121 residents eligible for public dental care including 253,679 who are under

18 years which will be a 7.5% increase in eligible population placing increased

demand on existing services.

• The proportion of people who are 65 years are older, who are likely to retain some

or all of their teeth and thereby requiring preventative and restorative Oral Health

care, will increase from 11% to 14%;

• The number of children aged 0-15 years, to whom Oral Health Services delivers

targeted services such preventative dental care and oral health promotion, will

increase from 195,727 to 236,048.

• There are currently 54 chairs in SWSLHD Oral Health Services. Based on 1 chair

per 5,000 eligible people (NSW Health endorsed methodology based on Victorian

planning guidelines), SWSLHD will require a total of 101 chairs by 2020 (100%

increase in the number of chairs available).

• Sydney Local Health District (SLHD) has 36 community dental chairs based at

Sydney Dental Hospital (SDH) and SLHD Community Health Centres which are

assessable to SWSLHD patients, especially in the LHD border areas. In order to

preserve patient flows to meet demand, the continued availability of these chairs is

vital.



Challenges in Meeting Demands – Current and Future The following table summarises the challenges in meeting demand 2014 – 2018, and therefore

planning, based on current oral health issues and an understanding of the likely changes in

Population structure, Health status, Oral Health policy direction, and potential technological

advancements. In summary, it is unlikely that there will be any decrease in the current level of

activity in the next 10 years. In fact, with the increasing size of the population, its ageing, an

increase in dental caries in the young and increased numbers in the dentate population, there is

likelihood for increased demand for public dental services. This is based on the assumption that

there will be no change to the current eligibility criteria for public dental services. The challenges

detailed below exist for current demand and future projected demand for Oral Health care.

Influence on meeting future service demands

Comments

Demography There will be an increasing number of older people forming a greater

proportion of the population, many of whom are likely to hold a concession

card. The number of older people requiring special care dentistry is likely

to increase with the ageing of the population, including the ageing of people

with a disability.

There will be a larger number of school aged children in the eligible

population It is unlikely that this is significant enough to cause a change in

service delivery needs.

The rapid increase of people from culturally and linguistically diverse

(CALD) communities will add to disease burden needing treatment.

Aboriginal population will increase as a proportion of the total population

with unique service needs due to historic Oral Health inequalities.

Epidemiology Smoking, inappropriate diet, high alcohol consumption, xerostomia

associated with prescription medicine use and poor oral hygiene are risk

factors or risk modifiers for diseases such as dental caries, periodontal

disease and oral, head & neck cancers. There will be greater awareness of

these risk factors due to Health Promotion activities but the effect on Oral

Health at the population level is currently unclear (Spencer 2001 in Healthy

Mouths Healthy Lives). Risks associated with cognitive decline (increasing

dementia) will pose special challenges in care delivery.

There is a noticeable trend towards increased caries rates in adolescents

and adults, possibly due to diet, poor oral hygiene and a lack of fluoride

(AHMAC, 2006). The impact of this trend will be a greater need for services

at least in the medium term.




Comments

In the period 1979–1996 the highest rates of edentulism (complete loss of

teeth) were in the 65+ age group. However, more teeth are now being

retained in an ageing population and the incidence of edentulism is

decreasing. There will be a corresponding increase in maintenance and

treatment requirements for those natural teeth and an ongoing need for

denture service for edentulous individuals

Determinants of Oral Health

Low income, older age, lower social class, lower education levels, mental

illness, drug and alcohol misuse, and cultural identity and ethnicity are all

risk factors for oral disease (Turrell et al 1999 in Healthy Mouths Healthy

Lives). Oral Health Services should seek to target high risk groups with

preventive programs.

Impact of Preventive Activity

The National Oral Health Plan makes recommendations for taking a more

proactive approach to Oral health management. Gains through preventive

activity may bring about an improvement in the overall oral health status.

However, the size of the population and the need to manage episodes of

illness means that there is unlikely to be a significant change in activity to

2018.

New Technology

New technology may provide some increased efficiencies in current

practice. Tests to identify individuals’ risk of disease may assist in the

reduction of caries and other oral health problems in the community and

allow the introduction of a more preventive approach in the long term.

Treatment Standards and protocols

Treatment standards and protocols across publicly provided Dental

Services need to be standardised to ensure equity of access to services for

all eligible residents. Some minor efficiency may be gained. The installation

of intra-oral cameras within Oral Health Clinics will expedite collaborative

diagnosis, treatment and therefore increase efficiencies.

Changes in Legislation affecting dental practice

Recent changes in the Dental Act have expanded the scope of practice for

oral health therapists. This will have an influence in managing future

workforce needs and allow greater reach of oral health services to at-risk

populations on a cost effect basis.

Evolving models of care

Integration of oral health services into general health services such as

Antenatal care; ACAT assessments for example including oral health

examinations may permit early intervention thereby reducing the overall

burden of disease resulting from poor oral health status.




Comments

Changes in the way dental services are funded

Dentistry is largely outside the scope of Medicare and is therefore

vulnerable to changes in funding from the Commonwealth. Typically the

lifespan of Medicare funding injections last a few years and are aimed at

mainly treatment services.

Ageing infrastructure

Some of the oral health clinics are located in community health centres with

ageing building infrastructure. Their clinical workplace designs do not meet

contemporary dental practice standards and consumer expectations.

These would need updating to provide care to changing demographics.

Priority Service Development Directions The following sections outline priority service development direction for SWSLHD Oral Health

Service. They describe the proposed model of care for Oral Health Service in SWSLHD to 2020

and beyond.

1. CLINICAL PRACTICE, RESEARCH AND EDUCATION

• Ensuring quality, productivity and efficiency in care provision through the use of clinical

audits; clinical indicators; internal and external benchmarking; benchmarking treatment

appointments; broader options of care; support for relevant continuing education courses

and specialist mentoring programs. • Proving evidence base through appropriate research- Active research program (COHORT)

and oral health promotion activities supporting prevention based dental interventions. • Strengthen partnerships with University of Sydney and Western Sydney University for

education programs from undergraduate to doctoral levels.

2. DEVELOPMENT OF ORAL HEALTH CENTRES OF EXCELLENCE Given the anticipated population growth in South Western Sydney and the high numbers of

eligible patients, it is essential to expand the number of existing dental chairs to provide

additional services. The preferred strategy is to develop specialist services in these Oral

Health Centres of Excellence (OHCOE) in partnership with University of Sydney and other

LHDs.

The location of OHCOEs on hospital grounds facilitates in the development of strong clinical

linkages between Oral Health and the Medical Specialties which may require the provision of

responsive Dental Care, such as oncology, endocrinology, trauma, paediatrics and

cardiovascular and to pathology services.



OHCOEs should have in the order of 15-20 chairs to allow for integration of child and adult

services, along with specialist services. These hubs should be designed with a view to enable

rotation of specialists, undergraduate and postgraduate students which will improve access to

Specialist Dental Services for the eligible population in SWSLHD; a broader case mix; training

opportunities for local dental staff; and an opportunity for students to work with a broad range

of client groups, with a view to attracting graduating students to practice in SWSLHD in future.

Such a service would also address issues of equity of access to specialist/specialised dental

care. OHCOEs are proposed for:

• Liverpool Oral Health Centre of Excellence: 15 chair clinic incorporating existing 8

chairs currently located in the Health Services building with an Oral Surgery and

Special Needs Dentistry (Complex Dental Needs) focus.

• Bankstown Oral Health Centre of Excellence: 13 chair clinic incorporating existing 9 +

4 chairs (Yagoona and Bankstown North OHCs) with a focus on preventive and

minimal dentistry (MID).

• Macarthur Oral Health Centre of Excellence based at Campbelltown: 20 chair with a

focus on paediatric dentistry and hospital dentistry.

3. DEVELOP NEW COMMUNITY DENTAL CLINICS IN NEW COMMUNITY HEALTH CENTRES Community based dental services to be co-located with other health services within

Community Health Centres (CHC), Integrated Primary Health and Community Care Centres

or on hospital sites to ensure the integration of oral health into mainstream health and enable

integrated care for patients with multiple health problems.

4. DEVELOPMENT OF A PRIVATE PRACTICE MODEL OF SERVICE IN “ORAL HEALTH CENTRES OF EXCELLENCE” A Private Practice Model or similar could be developed in SWSLHD facilities, enabling private

practice use out of hours and on weekends. Such a service provides an opportunity for greater

utilisation of existing resources; creates an income stream for the LHD; and offers a financial

incentive to dental and other staff to remain in public dentistry, together with an enhanced

service to improve the Oral Health of the entire South Western Sydney community. This model

will be developed without an impact on public patient flow and will be based on a revenue

share model with the LHD and clinicians. A feasibility study of these models would be required

and is currently being scoped.



5. IMPROVE THE AVAILABILITY TO DAY SURGERY Access to theatres across the SWSLHD for paediatric dentistry, special care dentistry and oral

surgery patients’ will need to be increased and provided at cost. This improved access is

required throughout the whole of SWSLHD to meet current and projected need. One strategy

could be recruit Visiting Dental Officers (VDO) as well as partnering with University of Sydney

and other LHDs for postgraduate specialist training program placements. Almost all general

anaesthetic (GA) services for dental patients, generated by dentists, would be for day-surgery

only, and require only a minor operating theatre with recovery suite. However, it is preferable to offer a range of alternative options (such as anxiolytic modalities

such as oral sedation or IV sedation) to provide a more efficient service to clients and reduce

the demand on theatres. In particular, paediatric and special care dentistry clients rely on the

use of GA for oral surgery to meet their unique needs, whilst adolescents and the majority of

adults could receive an alternative treatment modality if appropriate infrastructure for IV

sedation were available. Ideally this should be developed in conjunction with the development

of Oral Health Centres of Excellence at Campbelltown and Liverpool Hospital campuses.



Strategic Directions



Operational Plan Reporting and Monitoring Framework SWSLHD Strategic Plan 2018 – 2021 – Applicable Strategies for SWSLHD Oral Health Services

ID STRATEGIC DIRECTION

KEY PRIORITY AREA STRATEGY LOCAL ACTIONS TO SUPPORT

IMPLEMENTATION OF STRATEGY

EXECUTIVE SPONSOR (ELT) LOCAL LEAD TIMEFRAME

1.1 Safe, Quality Care

Consistently safe

Implement the Safety Essentials program across all facilities and services

Oral Health is implementing executive leader rounding, safety and risk huddles, clinical handover and transfer of care strategy. This will be discussed in all forums including Oral Health Clinical and Quality Council.

Director Clinical Governance

Service Manager, Oral Health

Dec-21


Consistently safe

Develop and implement a Surgical and Procedural Care Plan which identifies the future location of services, expertise and equipment to improve patient safety

Oral Health will develop a plan for capital infrastructure strategy along with future service needs and development. The focus will be development of specialist dental services

Director Operations

Director of Oral Health

Jun-19


Consistently safe

Expand the use of electronic data management systems such as eMR2 and eMeds prescribing across the District to improve point of care clinical documentation

Oral Health has implemented the electronic Oral Health record (Titanium) and will work the state to further look at integration with electronic medical record.

Chief Information Officer

Director of Oral Health Titanium Manager, Oral Health

Dec-20


Outstanding Quality

Implement the R.E.A.C.H. program across all relevant units to strengthen responsiveness to patient, carer and family concerns about deteriorating patients

Oral Health carer boards including providing support to patient and carers should there be concerns about their dental care.


Service Manager, Oral Health Quality and Patient Safety Officer, Oral Health

Dec-20


Outstanding Quality

Expand SWSLHD Centres of Excellence to strengthen clinical care through delivering services linked to research, teaching and education

Oral Health is planning for Macarthur Centre for Oral Health at Campbelltown Hospital to develop a centre of excellence for general and specialist dental services. Centre for Oral Health Research (COHORT) is being developed at Ingham Institute in collaboration with Western Sydney University.

Chief Executive Director of Oral Health

Dec-21








Appropriate and timely care

Invest in new technologies and models of care to reduce waiting time for elective surgery and improve the delivery of high quality, safe clinical care

Oral Health Services will aim to ensure that all dental practitioners are operating at the top of their scope of practice in order to provide a full course of care to patients from the treatment waiting lists. Oral Health will also invest in new technologies such as intra-oral cameras and OPG machines in order to provide a high standard of care to eligible patients.

Director Operations

Director Oral Health Business Manager Oral Health

Dec-21


Evidence based and patient-centred care

Expand the use of real time consumer experience monitoring systems to improve the way feedback is captured

Oral Health will implement My Experience Matters patient survey to provide timely patient feedback regarding patient experience, specific to an oral health clinic. It will provide de-identified real time summary information. This will be used to inform and improve service delivery.



Jun-18



Implement the You Say, We Did program to provide evidence of changes implemented as a result of consumer feedback

Oral Health will discuss this at the Consumer Consultative Meeting to discuss implementation strategies of this program.



Jun-20



Invest in the delivery of a broad range of support services which recognise the psycho-social needs of people to achieve and maintain health or recover from injury, with a focus on implementing the Arts and Health Strategic Plan

Oral Health is developing a Complex Needs Dental Service to support patients with psycho-social needs by developing a special needs dental clinic.

Director Allied Health

Director Oral Health Dec-21


Cultural safety Improve cultural safety for people from diverse cultures through offering opportunities for staff to complete Respecting the Difference and other cultural competency training

Oral Health will promote the completion of Respecting the Difference online and face to face training and complete any other available cultural competency training. Oral Health will promote the completion of ‘Patient centred care’ module on My Health learning.

Director Workforce

Service Manager, Oral Health Quality and Patient Safety Officer, Oral Health Director Oral Health

Dec-21








Accountability and governance

Implement the Enterprise Risk Management Policy Framework 2017 to further develop risk maturity and reduce exposure to risk

Oral Health will implement this framework under the guidance District Risk.

Chief Executive Director Oral Health Business Manager Oral Health

Jun-21



Review the capabilities of the Risk Management Information System to determine suitability to meet future risk management, clinical governance and internal audit requirements

Oral Health will undertake a review of its current risk register to ensure that all oral health specific risks are included.

Chief Executive Director Oral Health Jun-19



Implement the Legislative Compliance Policy Framework 2017 to ensure processes are in place to support and enhance staff awareness of statutory and organisational reporting requirements

Oral Health will promote awareness as well as support staff for training programs to assist in District implementation of this compliance framework.

Chief Executive Director Oral Health Dec-20



Embed a District-wide Policy Framework to ensure the development and implementation of consistent policies, procedures and guidelines across all facilities and services

Oral Health will promote framework in development and implementation of the oral health LHD specific policies.

Chief Executive Director Oral Health Quality and Patient Safety Officer

Dec-20

2.30 A Healthy Community

Prevention and early intervention

Implement the Child Protection in Your Hands Strategy to support staff to identify the caring responsibilities of adult patients and incorporate stressors and risk issues in care planning to improve child safety

Oral Health staff are required child protection training as part of mandatory training. Child protection resources are widely circulated to all staff members and discussed in team meetings and risk huddles


Director Oral Health Quality and Patient Safety Officer Oral Health Service Manager Oral Health

Dec-21



Collaboratively implement the SWS Childhood Overweight and Obesity Action Plan 'Growing Healthy Kids'

Oral Health will implement the draft NSW guideline ‘Growth Assessment and Dietary Advice in Public Oral Health Services’. A project in collaboration with Health Promotion Services, Population Health and Department of Premier and Cabinet was piloted at Fairfield Oral Health Clinic to test readiness of dental

Director Population Health

Director Oral Health Research Director, COHORT

Dec-21







therapists to conduct BMI measurements, diet analysis, provide brief interventions and arrange referrals.



Embed into clinical practice the identification of modifiable risk factors and referral to appropriate support services, with an initial focus on smoking and high body mass index

Oral Health will implement strategies to provide smoking cessation advice to patients attending dental services. Oral Health will incorporate provision of dietary advice to each patient visiting the service with a focus on looking at the general health as well as Oral Health. For example: Oral Health will promote soft diet options for edentulous patients.

Director Operations




Develop an integrated network of drug and alcohol treatment intervention services to reduce the harm from substance use and increase access to treatment

Oral Health will look at enhancing referral pathways from drug health services.

Director Operations

Director Oral Health Service Manager Oral Health Promotion and Community Participation Officer

Dec-21

3.44 Collaborative Partnerships

Consumer, patient and carer involvement

Increase the number and diversity of people participating in formal Consumer and Community Participation processes to better represent the views of the local community

Oral Health services will consult consumers on the Oral Health Consumer Consultative Committee to look at strategies to increase number and diversity of people participating. When patients show interest, they would be invited to the committee to participate and support will be provided to stay on.

Chief Executive Director Oral Health Service Manager Oral Health Promotion and Community Participation Officer District Consumer Participation Manager

Jun-18



Increase the involvement of children and young people as partners in care, consistent with the Charter on the Rights of Children and Young People in Healthcare Services in Australia

Oral Health services will consult consumers on the Oral Health Consumer Consultative Committee to look at strategies to increase involvement of young people in care


Director Oral Health Service Manager Oral Health Promotion and Community Participation Officer District Consumer Participation Manager

Dec-21









Build staff capacity to understand and initiate consumer participation approaches to their clinical and non-clinical practice

Oral Health will promote to staff the requirements of the NSQHS Version 2 and the specific requirements around health literacy as well as consumer engagement in governance and service design. Staff would be encouraged to attend training to improve understanding. Consumers will be invited to team meetings and other oral health forums to talk about their experiences in order to improve staff understanding.

Chief Executive Director Oral Health Service Manager Oral Health Promotion and Community Participation Officer District Consumer Participation Manager

Dec-21


Genuine engagement and communication

Implement a core District wide communication program to support effective communication with patients and staff

Oral Health will support staff to complete the district wide communication program

Director Workforce

Service Manager Dec-20


Genuine engagement and communication

Provide outreach programs and forums with established community groups and organisations to increase community awareness and understanding of health services and systems

Oral Health in consultation with the OHCCC investigate opportunities to provide outreach programs. It will engage Oral Health Promotion team to engage with consumers to increase health literacy and understanding access of public dental services

Chief Executive Director Oral Health Service Manager Oral Health Promotion and Community Participation Officer

Dec-21


Strategic partnerships

Establish innovative partnerships models with the private sector to reduce the cost of providing and replacing high end technology

Oral Health with build University partnerships and look at areas of funding to reduce cost of operations. Oral Health will look at increasing Medicare CDBS revenue to fund OHFFSS vouchers to outsource some services to private practitioners. Oral Health will investigate in consultation with MoH opportunities to purchase orthodontic services from private orthodontists to provide care to children with severe malocclusion.

Director Finance Director Oral Health Business Manager

Dec-21








Funding opportunities

Widely promote South West Giving to facilitate fundraising from the local community, consumers and staff

Oral Health will include South West Giving in all new staff orientation program as well as promote this in the newsletter

Chief Executive Service Manager Dec-21

4.62 A Healthcare System for the Future

Building and adapting for the future

Enhance the availability of paediatric services across the District to provide specialist care close to where people live

Oral Health will develop a specialist paediatric dental services with theatre sessions in Campbelltown Hospital

Director Operations




Implement existing plans addressing future healthcare development, including the SWSLHD Cancer Plan and SWSLHD Advance Care Planning, End of Life and Palliative Care Plan

Oral Health will develop the unique referral pathway informed by research methodology (PALLIOH) to improve understanding about palliative care in dentists.

Director Operations

Director, Oral Health

Dec-21



Expand existing Wi-Fi capability and incorporate digital readiness into new health care facilities

Oral Health is heavily reliant on strong data connections and will be purchasing equipment compatible with existing digital networks


Director Oral Health Business Manager

Dec-21


Networked and integrated services

Develop Emergency Department avoidance strategies in collaboration with the residential aged care and primary health sector to improve community based management of chronic disease and end of life care

Oral Health will contribute by developing referral pathways which would prevent avoidable hospital admissions due to dental infections

Director Operations




Extend the hours of operation of designated ambulatory services to improve access and flexibility to meet consumer needs

Oral Health will review business case to extend operations after normal operating hours.

Director Operations

Business Manager Dec-21



Increase access to acute or post-acute services delivered in community or ambulatory settings to provide more accessible services to the community and reduce the need for Emergency Department presentations and inpatient admissions

Oral health will implement plan to ensure timely access for patients requiring acute or emergency care by optimising use of clinical time in chair allocations. This would minimise hospital presentations due to dental infections.

Director Operations

Director Oral Health Business Manager

Dec-21








Agile and innovative care

Implement evidence based models of care in priority clinical areas identified through the Leading Better Value Care initiative to improve health outcomes, improve the experience of care and provide efficient and effective care

Oral Health will review areas of clinical service provision to ensure that these are value based including measuring of outcomes compared to financial commitment.

Director Finance Director Oral Health Business Manager Oral Health

Jun-19


Responsive to community diversity

Grow the use of telehealth models of care to support people living in rural areas of the District and beyond to access specialist expertise

Oral Health will implement intra-oral cameras and digital radiography to support telehealth.




Responsive to community diversity

Develop services to provide improved access, care coordination and self-management of chronic and complex conditions, with a focus on clients from a CALD background

Oral Health will partner with NSW Refugee Health Service to develop pathways for children. Oral Health will collaborate with schools in Bankstown and Fairfield with high CALD populations to offer care pathways including DSAP

Director Operations


5.87 Our People Make a Difference

Workforce for the future

Strengthen the professional development review process and increase uptake of professional development plans to support staff to achieve their career goals and meet the needs of the community

Oral Health will support development of leaders and emergency leaders via the Transforming Your Experience (TYE) leadership programs. Promotion of CEWD programs will be given to clinic managers to develop core manager competencies.

Director Workforce



Workforce for the future

Develop a SWSLHD Volunteer Program to coordinate the engagement and support of volunteers

Oral Health will investigate this area in consultation with Oral Health Consumer Consultative Committee.

Director Workforce

Service Manager Oral Health

Dec-20


Culture of respect and compassion

Review the SWSLHD On-Boarding Program to ensure alignment with Transforming Your Experience

Oral health with review process with District Workforce Manager to ensure alignment with TYE

Director Workforce

Service Manager District Workforce Manager

Jun-19


Culture of respect and compassion

Develop and implement a District wide coaching and mentoring program to support staff development

Oral Health will implement coaching and mentoring program in line with District expectations.

Director Workforce

Director Oral Health Jun-20








Employer of choice

Develop and implement a SWSLHD Workplace Safety and Wellbeing Program to support the physical, mental and emotional health and wellbeing of staff

Oral Health will further enhance existing staff well-being programs such as passport to fitness

Director Workforce

Service Manager Jun-20


Employer of choice

Establish a District wide staff reward and recognition program to acknowledge exceptional behaviours and years of service

Oral Health Services nominates a staff member to receive a recognition letter from the CE for displaying behaviours consistent with Transforming Your Experience.

Director Workforce



Effective leadership and empowered staff

Establish a multidisciplinary review committee to revise the Delegations of Authority Manual to identify opportunities to lower decision making thresholds

Oral Health will ensure that managers operate under the delegations manual and there are formal meetings to discuss expectations of the Delegations of Authority Manual

Director Finance Director Oral Health Service Manager Business Manager

Dec-18



Develop and implement programs to support and develop staff capabilities in leadership, within the context of the SWSLHD Leadership Model

Oral Health will support development of leaders and emergency leaders via the Transforming Your Experience (TYE) leadership programs.

Director Workforce




Strengthen the capacity of managers across the District in relation to recruitment, performance management and financial management

Oral Health will support staff members to complete training in the areas of recruitment and performance management. Completion of performance management is a focus area for oral health services

Director Workforce


6.110 A Leader in Research and Teaching

Acknowledgement and recognition of research

Expand the research profile of SWSLHD through the establishment of new research institutes in priority areas including Robotics and Automation in Health, Innovation in Medical Technology, Cancer and Cardiovascular Disease and strengthen the roles of existing Research Institutes

Oral Health will further develop the Oral health research centre based at Ingham Institute (COHORT) to lead interdisciplinary population oral health research in partnership with clinical streams and universities

Chief Executive Director Oral Health Jun-20



SWSLHD Oral Health Services Specific Initiatives July 2018 – June 2020


STRATEGY ACTIONS TO SUPPORT IMPLEMENTATION OF STRATEGY

FACILITY EXECUTIVE SPONSOR

LOCAL LEAD TIMEFRAME

1.1 Safe, Quality Care Implement clinical efficiencies to move clinician cultural change from block funding to activity based funding leading to value based care

• Clinician scorecard with transparent reporting of DWAU productivity per clinician.

• Used Australasian clinical indicators to encourage reflective clinical practice and improve clinical standards of care

• Undertake audits • Deliver staff education about value based care in

dentistry


Business Manager, Oral Health

June 2019

1.2 Safe, Quality Care Oral Health is able to meet accreditation requirements of NSQHS Version 2

• Gap analysis between Version 1 and 2 • Map out actions which were not covered in Version

1 to ensure that Version 2 actions are met • Plan working groups in advance to work through the

Version 2 NSQHS


A/Quality and Patient Safety Officer

June 2019


Recruiting child patients from the Oral Health Promotion visits

• Oral Health promotion program will actively recruit child patients from each session.

• Names will be collected and booking made directly


Oral Health Promotion champions

June 2019


Refugee and asylum seekers oral health referral pathway

• Provision of timely access via single point of contact for refugee patients

• Consider options for asylum seekers who are not eligible for public dental services



June 2020


Wingecarribee Aboriginal Oral Health Project • Referral pathway for patients living in the Wingecarribee LGA referred from Aboriginal Health Services requiring dental care



June 2019


Commence DMD University of Sydney student placements at clinics with spare chair capacity

• University of Sydney dental school will provide clinical educators

• Discussions with Dean • Look at provision of broader scope of service to

public patients under this education model



June 2020


Collaborate with University of Sydney BOH program to recruit child patients from schools a part of Dental School Assessment Program (DSAP)

• University BOH educators and students would conduct child dental screening and then book children for any required treatment

• School Principals would need to be engaged with • Builds on a successful pilot program at Fairfield

schools (incorporating lessons learnt)



June 2019




STRATEGY ACTIONS TO SUPPORT IMPLEMENTATION OF STRATEGY

FACILITY EXECUTIVE SPONSOR

LOCAL LEAD TIMEFRAME


Prevention intervention to prevent sporting dental injuries

• Installation of mouthguard machines at clinics to provide custom made mouthguards to children based on assessment of sporting history

• Clinical staff will be provided training to provide this service


Business Manager

June 2020


Investing in new dental radiology solutions • Currently oral health refers patients requiring OPGs to private radiology providers.

• Installation of OPG machines for clinics over 11 chairs so that these extra-oral radiographs can be taken locally minimising patient travel for these services externally


Business Manager

June 2020

5.10 Our People make a Difference

Training of clinic managers in having difficult conversions in order to performance manage and management of unplanned leave

• Support staff to complete courses run by CEWD, MyHealth Learning

• HR Manager will be engaged in the process for changing workforce culture



June 2020



Priority Service Developments

2019/2020 Priority Service Developments (include in priority order)

Linkage with Clinical Service Plans

1. Complex Needs Dental Services 2.29 SWSLHD Cancer Service Plan 2. Specialist Paediatric Dentistry 5.1 SWSLHD Strategic Plan: Health

Improvement for Children, Young People and Families 2016-2025

3. Addition of 4 dental chairs to Fairfield Hospital Oral Health Clinic

NSW Oral Health 2020 State Strategic Plan Oral Health Services Operational Plan 2014-2018

2020/2021 Priority Service Developments (include in priority order)

Linkage with Clinical Service Plans

1. Macarthur Centre for Oral Health (Campbelltown Hospital) 20 chair centre

NSW Oral Health 2020 State Strategic Plan Oral Health Services Operational Plan 2014-2018 NSW Oral Health Capital Strategy, 2011-2020

2. IV sedation service at Campbelltown and Liverpool Hospitals

3. Liverpool Hospital Oral Health Centre 15 chairs NSW Oral Health 2020 State Strategic Plan Oral Health Services Operational Plan 2014-2018 NSW Oral Health Capital Strategy, 2011-2020



References and Supporting Documents 1. South Western Sydney Local Health District, Directions to Better Health ‐ South Western Sydney

Local Health District Corporate Plan 2013 – 2017. SWSLHD: Sydney. 2013.

2. Centre for Oral Health Strategy NSW, Eligibility of Persons for Public Oral Health Care in NSW

PD2009_074. NSW Ministry of Health: Sydney.2009.

3. Australian Bureau of Statistics, Socioeconomic Indexes for Areas (SEIFA) 2011 Australian Bureau

of Statistics (Catalogue Number 2033.0.55.001): Canberra. 2013.

4. Centre for Oral Health Strategy NSW, Oral Health 2020: A Strategic Framework for Dental Health

in NSW. NSW Ministry of Health: Sydney. 2013.

5. Australian Institute of Health and Welfare, Young Australians: Their Health and Wellbeing 2011.

AIHW Cat. No. PHE 140: Canberra. 2011.

6. Chrisopoulos S & Harford JE Oral health and dental care in Australia: key facts and figures 2012.

AIHW Cat. No. DEN 224. Canberra. 2013.

7. NSW Oral Health Alliance, Issues in Oral Health for Low Income and Disadvantaged Groups in

NSW: An Advocacy Kit for Community & Welfare Non‐Government Organisations (NGOs).

Available from: http://www.ncoss.org.au/resources/issues‐in‐oral‐health‐kit.pdf Accessed on: 28

June 2012.

8. Centre for Oral Health Strategy NSW, The New South Wales Child Dental Health Survey 2007.

NSW Department of Health: Sydney. 2009.

9. NSW Ministry of Health, NSW Aboriginal Health Plan 2013-2023. NSW Ministry of Health: Sydney.

2012.

10. Australian Health Minister’s Conference, Healthy mouths healthy lives: Australia’s national oral

health plan 2004-2013. South Australian Department of Health. 2004.

11. Sydney South West Area Health Service, Aboriginal Health Plan 2010 ‐ 2014: Summary &

Strategies Overview. South Western Sydney Area Health Service: Liverpool. 2010.

12. Centre for Oral Health Strategy NSW, NSW Oral Health Strategic Directions 2011-2020. NSW

Department of Health: Sydney.2010.

13. Sheiham A & Watt RG The common risk factor approach: a rational basis for promoting oral health

Community Dentistry & Oral Epidemiology Dec; 28(6):399-406 2000.



Appendix – SWSLHD Role Delineation Levels Service B’town

Lidcombe Bowral Braeside Camden Campbell town Fairfield Liverpool

Core Services

Anaesthetics and Recovery 5 3 NPS 1 5 3 6 Operating Suites 5 3 NPS 1 5 3 6 Close Observation Unit NPS 3 NPS NPS NPS NPS NPS Intensive Care 5 NPS NPS NPS 5 4 6 Nuclear Medicine 5 4 4 4 4 4 6 Radiology / Interventional 5 4 4 3 5 3 6 Pathology 5 3 4 2 5 4 6 Pharmacy 5 3 4 4 5 4 6

Clinical Services ED Emergency Medicine 5 3 NPS 2 5 3 6

Medi

cine

Cardiology / Interventional 4 3 NPS NPS 4 3 6 Clinical Genetics NPS NPS NPS NPS NPS NPS 6 Dermatology 3 3 NPS NPS 3 NPS 6 Endocrinology 5 3 NPS NPS 5 3 6 Gastroenterology 6 3 NPS NPS 5 3 6 General and Acute Medicine 6 3 NPS NPS 5 3 6 Geriatric Medicine 6 4 NPS NPS 5 3 5 Haematology 3 NPS NPS NPS 3 NPS 6 Immunology 4 2 NPS NPS 5 NPS 6 Infectious Diseases 5 2 NPS NPS 5 2 6 Neurology 5 3 NPS NPS 5 3 6 Medical Oncology 5 3 NPS NPS 5 1 6 Radiation Oncology 4 NPS NPS NPS 5 NPS 6 Palliative care 3 3 6 6 3 3 6 Rehabilitation 5 2 6 5 2 4 6 Renal Medicine 5 2 NPS NPS 4 3 6 Respiratory and Sleep Medicine 5 3 NPS NPS 5 3 6 Rheumatology 5 2 NPS NPS 5 2 6 Sexual Assault Services 3 1 NPS NPS 3 1 4 Sexual Health and HIV Medicine NPS 1 NPS NPS 2 NPS 4

Surg

ery

Burns 2 2 NPS NPS 2 2 4 Cardiothoracic Surgery NPS NPS NPS NPS NPS NPS 6 Ear, Nose and Throat 5 NPS NPS NPS 4 NPS 6 General Surgery 5 3 NPS NPS 4 3 6 Gynaecology 5 3 NPS NPS 5 3 6 Neurosurgery 4 NPS NPS NPS NPS NPS 6 Ophthalmology 5 3 NPS NPS 3 NPS 6 Oral health 3 3 NPS 3 3 3 4 Orthopaedic Surgery 5 3 NPS NPS 5 3 6 Plastic Surgery 5 NPS NPS NPS NPS NPS 6 Urology 5 NPS NPS NPS 5 NPS 6 Vascular Surgery 4 NPS NPS NPS NPS NPS 6

Service B’stown

Lidcombe Bowral Braeside Camden Campbell town Fairfield Liverpool



Child

and

fam

ily H

ealth

Se

rvice

s

Child and Family Health 4 2 NPS 5 5 5 6 Child Protection Services 3 3 NPS 1 4 4 4 Maternity 4 3 NPS 1 4 3 6 Neonatal 3 2 NPS NPS 3 3 5 Paediatric Medicine 4 3 NPS NPS 5 3 4 Surgery for Children 3 2 NPS 2 3 3 4 Youth Health 4 2 NPS NPS 4 3 4

Ment

al He

alth

and

Drug

and

Alco

hol

Serv

ices

Child/Adolescent Mental Health (I/P) 3 NPS NPS NPS 5 NPS 3

Child/Adolescent Mental Health (Community) 3 3 NPS NPS 3 3 4

Adult Mental Health (Inpatient) 5 1 NPS NPS 5 NPS 5

Adult Mental Health (Community) 4 4 NPS NPS 4 4 4

Older Adult Mental Health (I/P) 2 NPS 2 NPS NPS NPS 1

Older Adult Mental Health (Community) 4 2 2 3 2 2 4

Drug and Alcohol Services 6 4 NPS 3 6 6 6

Com

mun

ity

Base

d

Aboriginal Health 4 2 2 4 4 4 6

Community Health 4 4 NPS 4 4 4 4

Notes:

• NPS - No Planned Service • Role delineation levels are guided by NSW Health Guide to the Role Delineation of Clinical

Services 2018 accessible via https://www.health.nsw.gov.au/services/Publications/role-delineation-of-clinical-services.PDF

• Role delineation levels may be updated in line with 2018 review.

https://www.health.nsw.gov.au/services/Publications/role-delineation-of-clinical-services.PDF

https://www.health.nsw.gov.au/services/Publications/role-delineation-of-clinical-services.PDF