ACT State of the Environment 2007

Indicator: Health services

Summary

The Territory's health and hospital system is trying to cope with large increases in demand for services amid an environment of workforce shortage of health professionals, an ageing population and increased health burden from conditions and diseases including diabetes, cancer, heart disease, mental illness, and alcohol and drug abuse. Despite significant increases in health spending, health services, such as hospital, primary care and other services are finding it increasingly difficult to keep pace with demand. Client access, emergency responses, waiting times and facilities are under increasing pressure; a situation that prevails in most jurisdictions.

What the results tell us about the ACT

Primary health care

Limited access to general practitioners

Access to general practitioners (GPs) in the ACT continues to be below the national average of 86.1 full-time workforce equivalent (FWE) GPs per 100,000 people (Table 1, Figure 1). The ACT GP availability fell from 73.2 FWE GPs per 100,000 in 1998–99 to 61.0 in 2003–04; the addition of eight FWE lifted the rate to 63.3 by 2005–06. Some of the increase can be attributed to doctors accessing incentives to establish their practices in parts of the ACT classified as 'areas of need'.

The National Health Survey 2004–05 found that the ACT had the lowest rate (19.7% compared to 22.8% nationally) of people consulting a GP in the two weeks before being interviewed. This result could be due to proportionally more healthy people, poor access to GPs or greater use of alternative strategies. The ACT had slightly higher than national average rates of consultations with dentists (6.2% compared to 5.9%) and other health practitioners (13.7% compared to 13.5%).

Introduction of a number of larger medical centres in town centres has helped lift bulk-billing rates but has not significantly added to the total number of GPs practicing in the Territory. Instead, these centres appear to have exacerbated GP distribution problems by drawing many GPs who formerly practiced in outer metropolitan areas to work in the town centres. As a result some of the Territory's outlying areas, have poor local access to GPs, particularly for disadvantaged or less mobile residents. The shortage of GPs has also limited access to after-hours GPs, especially in the outlying areas.

Introduction of the Australian National University medical school is expected to help produce GPs for the ACT if the Australian Government approves further training places. However, since accepting students in 2004, the school has been training GPs largely for export to other jurisdictions (Legislative Assembly for the ACT, 2006). Introduction of after-hours GP services at both hospital campuses has provided some relief.

Table 1: Availability of full-time workload equivalent GPs per 100,000, ACT and Australia, 2002–03 to 2006–07

Category 2002–03 2003–04 2004–05 2005–06 2006–07
ACT Aus ACT Aus ACT Aus ACT Aus ACT Aus
FWE GPs 203 16,772 198 16,872 200 17,273 208 17,649 226 18,091
FWEs per 100,000 62.8 84.4 61.0 83.9 61.5 84.9 63.3 85.8 66.8 86.1

Source: Productivity Commission 2008, Report on Government Services 2008

Figure 1: Availability of full-time workload equivalent GPs, ACT and Australia, 2002–03 to 2006–07

Graph of Availability of full-time workload equivalent GPs, ACT and Australia

Source: SCRGSP (Steering Committee for the Review of Government Service Provision) 2008, Report on Government Services 2008, Productivity Commission, Canberra.

Bulk-billing rates still the lowest

Bulk-billing rates in the ACT were consistently the lowest for any jurisdiction during the reporting period; they reached a record low of 36.8% in 2003–04 before climbing steadily to 44.2% in 2005–06 and 51.9% in 2006–07 (Table 2; Figure 2). Coupled with the GP shortage, this poor access to bulk-billing means many ACT residents are continuing to delay or forego primary care and placing pressure on the public hospital system.

The recovery in bulk-billing rates since 2004–05 is a significant improvement on the last reporting period. Bulk billing rates collapsed in the two years to September 2002 in the Fraser electorate (from 64.7% to 38.8%) and in the Canberra electorate (58.3% to 44.1%).

Recent improvements in bulk-billing rates are attributed to changes in the area classifications and incentives applying to the ACT as well as introduction of large bulk-billing medical centres at the Belconnen and Woden town centres.

Table 2: Bulk-billing rates for the ACT, 2002–03 to 2006–07
Year 2002–03 2003–04 2004–05 2005–06 2006–07
Rates 39.2% 36.8% 40.6% 44.2% 51.2%

Source: Productivity Commission 2008, Report on Government Services 2008

Figure 2: Non-referred attendances bulk billed, 2002–03 to 2006–07

Graph of Non-referred attendances bulk billed

Source: SCRGSP (Steering Committee for the Review of Government Service Provision) 2008, Report on Government Services 2008, Productivity Commission, Canberra.

Hospital system

The ACT public hospital system was under increasing pressure from the growing demand for hospitalisation, elective surgery and other services throughout the reporting period. In response, ACT Health increased bed numbers at both the Canberra and Calvary hospitals and opened an intensive care unit at the Canberra Hospital during the reporting period (ACT Health 2005).

The ACT Government spends more than any other jurisdiction on hospitals ($865 recurrent expenditure per person compared to $665 nationally).  ACT public hospitals also report utilisation rates well above national averages.  The latest report by the Australian Institute of Health and Welfare on Australian Hospital Statistics shows that in 2006-07, ACT public hospitals provided 244.8 public hospital inpatient separations per 1,000 population, 12 percent above the national figure of 218.8.  This higher level of public hospital utilisation continues despite high levels of private health insurance coverage in the ACT and the availability of private hospital services in the ACT and close by in NSW.

ACT Health data show the number of inpatients has increased each year from 65,048 at the end of the last reporting period (2002–03) to 73,573 in 2006–07. Over the same period, the number of operations has risen from 14,247 to 18,569.  The number of outpatient services also increased rapidly from 238,777 to 313, 447 2004–05.

These trends are consistent with the needs of a growing and ageing population and a shortage of accessible GPs. Emergency department presentations dropped to 93,693 in 2004–05 and peaked at 99,822 in 2005–06 but have otherwise been relatively steady at around 96,000 since 2001–02 (Table 3).

Table 3: ACT public hospital activity, 2000–01 to 2006–07
Year 2000–01 2001–02 2002–03 2003–04 2004–05 2005–06 2006–07
Inpatient separations 63,035 63,065 65,048 70,367 65,026 69,671 73,573
Operations 15,190 14,966 14,247 16,316 16,737 17,605 18,569
Outpatients occasions of services 231,095 239,363 238,777 273,094 313,477
Emergency department presentations 92,737 95,126 96,049 96,653 93,693 99,822 96,302

Source: ACT Health, Admitted patient care data set, Information Management Service and Calvary Public Hospital, Emergency Department information System, Hospital Activity Bulletin 2000–01 to 2006–07. provided by ACT Health

Table 3.1 ACT Public hospital activity, separations per 1,000 population ACT v Australia
Jurisdiction 2002–03 2003–04 2004–05 2005-06 2006-07
Australia 205.7 207.8 208.1 213.6 218.8
ACT 219.8 235.7 214.4 238.4 244.8

Source: Australian Institute of Health and Welfare Australian Hospital Statistics 2002–03, 2003–04, 2004–05, 2005-06 and 2006-07

Elective surgery waiting lists grow

ACT Health reports that 10,602 people were added to the elective surgery waiting list during 2005-06.  This jumped 8% during 2006-07, with 11,458 people added to the list over the year.  During 2006-07, ACT public hospitals provided 9,327 elective surgery operations, up from 9,120 in 2005-06 and well up on the 7,661 provided in 2002–03.  At the end of 2006-07 there were 4,844 people on the ACT public hospitals elective surgery waiting list.  The ACT Government budgeted an additional $2.5 million in 2007-08 to provide a further 300 elective surgery procedures.  Figures to the end of March 2008 show the Government is on target to fulfil this commitment (pers. com.)

Table 4: Removals from elective surgery waiting list, 2001–02 to 2006–07
Year 2001–02 2002–03 2003–04 2004–05 2005–06 2006–07
No. of people 7946 7661 8548 8617 9120 9326*

Note: *2006–07 data preliminary
Source: ACT Health - Elective surgery data set, provided by ACT Health 

Median Waiting times for people accessing surgery continue to increase

Figures published by the Australian Institute of Health and Welfare1 show that in 2005-06 the waiting time for care at the 50th percentile (or median waiting time) was 61 days for people admitted for surgery (compared with 32 days nationally).  For the first ten months of 2007-08 this has increased to 71 days (using latest ACT Health data).  This increase is directly related to the Government's commitment to increase access to surgery for people waiting beyond standard waiting times for care. 

Over the first ten months of 2007-08, ACT Health reported a 20% increase in the number of category two and three long wait patients accessing surgery over the same period, from 2,082 patients admitted for surgery with long waits to the end of April in 2006-07 to 2,648 so far this year.

At the same time, 96% of people classified as category one patients (those who should receive surgery within 30 days) received their surgery within standard timeframes.

A major foundation of the additional $49 million added to the ACT Health budget since 2002–03 for elective surgery has been the commitment to improve access to surgery for patients with extended waiting times.  This investment, together with the additional $2.5 million provided by the Commonwealth Government in 2008 to provide for a further 250 "long wait" patients to receive elective surgery by 31 December 2008 will ensure that the ACT's median waiting times for elective surgery will remain high until the backlog of long wait patients is addressed (pers.com.).

The additional ACT Government contributions has already resulted in a drop in the number of people waiting longer than one year for surgery, from 1,242 in March 2005 down to 1,082 in March 2006, 950 in March 2007 and 851 in March 2008 (pers.com.).

The increase in the number of long wait patients accessing surgery has also, by definition, resulted in an increase in the number of days waited to have their surgery for people at the 90th percentile.  The latest national figures (2005-06) show that the waiting time for people at the 90th percentile who had their surgery was 372 days, against a national figure of 237 days.  For the first 10 months of 2007-08, using latest ACT Health data, the ACT result was 380 days (pers.com.).

Importantly, the per capita rates for access to elective surgery at ACT public hospitals is 15 percent above the national rate using figures published by the Commonwealth Department of Health and Ageing (The State of Our Public Hospitals 2005-06),which shows that 30 people per 1,000 population access elective surgery at public hospitals in the ACT compared with the national figure of 26 people per 1,000.  This shows that more Canberrans choose to be treated within the public hospital system rather than in private hospitals for elective surgery, despite the ACT population having the highest level of private health insurance coverage in the nation and the waiting times to care.

Days waited at the 50th percentile (50% of patients admitted in the given time) increased to 61 for the ACT (32 nationally) in 2005–06 (Table 5) after stabilising at 46 (28) and 45 (29) in 2003–04 and 2004–05. Days waited at the 90th percentile (90% of patients admitted in the given time) blew out to more than one year for the ACT (368–372 days, compared with 193–237 nationally) after finishing at 300 (197 nationally) days in the last reporting period.

Table 5: Waiting times for admissions for ACT public hospitals, 2000–06
% admitted 2000–01 2001–02 2002–03 2003–04 2004–05 2005–06*
ACT Aus ACT Aus ACT Aus ACT Aus ACT Aus ACT Aus
50% 44 27 40 27 48 28 46 28 45 29 61 32
90% 266 202 268 202 300 197 373 193 368 217 372 237
% waiting 365 days+ 5.3 4.4 6.8 4.5 7.1 4.0 10.8 3.9 4.8 4.8 10.3 4.6

Note: *2006–07 data preliminary
Source: AIHW, Australian Hospital Statistics, 2000–01, 2001–02, 2002–03, 2003–04, 2004–05 and 2005–06

Emergency department waiting times need to improve further

Waiting times for emergency department services, while improving, are still below national averages for most patients.

However, figures provided by the Australian Institute of Health and Welfare (2005-06) show that all people who present at ACT emergency department with the most urgent needs (category one presentations) are seen on arrival.  This level of service has been extended beyond 2005-06, with internal ACT Health figures showing that all category one presentations are seen on arrival.

Figures for the remaining categories of patients are well below national averages.  However, over more recent quarters, waiting times for emergency department care have improved following the introduction of a range of initiatives implemented to speed up access to emergency department services.  These initiatives include:

  • The recruitment of additional emergency department physicians and nurses, with our emergency department approaching full staffing levels in mid-2008.
  • The establishment of new services such as:
    • inpatient observation units adjacent to our emergency departments which provide for the transfer of patients out of the emergency department where active treatment is no longer required by continued observation and monitoring is still warranted
    • "fast track" which provides for the quicker assessment and treatment of patients presenting with less serious illnesses
    • the provision of an emergency department waiting room nurse who can monitor the condition of patients and provide quicker access to care for patients whose condition deteriorates while waiting for care
    • the funding of an additional 172 public hospital beds up to the 2008-09 budget which provide additional bed capacity in our hospitals, thus improving access to ward beds, reducing 'blockages' from the emergency department and freeing up emergency department resources to treat waiting patients.

More needs to be done.  However, these initiatives have assisted in improving waiting times for care, especially for the most serious patients.

In 2005-06, 71% of category two (emergency) patients were seen within the standard timeframe of 10 minutes.  This compares with the national total of 77% and the national target of 80% treated within 10 minutes.  However, for the first 10 months of 2007-08, ACT public hospitals have reported that 80% of these patients were seen within 10 minutes of arrival at an emergency department – an increase of nine percent on the 2005-06 total and right on the national target for this triage category (pers.com.).

In 2005-06, 44% of category three (urgent) patients were seen within the standard timeframe of 30 minutes.  This was 20% below the national average of 64% and well below the national target of 75% seen on time.  In the most recently reported quarter, the March quarter of 2008, on time performance for category three patients had risen to 56% on time, still below the national target – but well up on performance reported in 2005-06.

Category four (semi-urgent) patients have also seen an improvement in on-time performance in recent times, albeit more modest than for category three patients.  In the March quarter of 2008, 54% of these patients were seen within the standard maximum waiting time of 60 minutes.  This is seven percent above the 47% reported in 2005-06, but continues to be well below the national target of 70%.

ACT public hospitals perform well in terms of access to care for the least serious presentations (category five).  The national target for this group of patients is 70% seen within 120 minutes.  The ACT reported a total of 84% seen within standard waiting times in 2005-06.  While this has slipped in the most recent quarter (77%), our on-time performance continues to exceed the national target.

While more needs to be done within the ACT to improve waiting times for emergency department care, external factors also hamper efforts in this area.  As noted at the beginning of this chapter, the ACT has a chronic shortage of general practitioners.  While it is correct that not all lower urgency emergency department cases should be seen by General Practitioners, the lack of adequate (including after hours and bulk billing) GP services in Canberra adds to pressures on our emergency departments.  This comes though in relative usage patterns for our emergency departments.  The Commonwealth Department of Health and Ageing reported in its State of our Public Hospitals Report 2005-06 that our emergency departments managed 322 presentations per 1,000 weighted population against a national average of 223 per 1,000.  This considerable difference demonstrates the added pressures that ACT emergency departments face in managing the demand for care.

Table 6: Proportion (%) of public hospital emergency department patients seen on time, ACT and Australia, 2000–01 to 2005–06
Triage category 2000–01 2001–02 2002–03 2003–04 2004–05 2005–06*
ACT Aus ACT Aus ACT Aus ACT Aus ACT Aus ACT Aus
1 Resuscitation 98 98 99 99 100 99 100 99 100 100 100 99
2 Emergency 85 73 87 76 82 75 69 76 76 76 71 77
3 Urgent 82 61 80 60 74 61 64 62 50 64 44 64
4 Semi-urgent 71 60 72 59 67 61 58 61 52 65 47 65
5 Non-urgent 83 83 78 84 79 85 77 82 83 88 84 87

Sources: ACT Health Performance Reports * AIHW 2006b

Government responses

More public beds

To meet the rising demand, ACT Health commissioned additional beds at the Canberra and Calvary hospitals in 2005–06.

As a result, the number of ACT public hospital beds rose 5% to 714 in 2005–06 after stabilising at around 680 beds for most of the reporting period (Table 7). This increase was not as large as the national increase of 9.5% in the same period and was partly offset by the drop of 19 (4.6%) private hospital beds. This reporting period contrasted with the last, when public hospital bed numbers declined and private hospital bed numbers increased.

In 2006–07, a 14-bed Medical Assessment and Planning Unit was commissioned at the Canberra Hospital, this allowed acutely ill patients with complex assessment and care needs to be rapidly transferred from the hospital's emergency department.

Preliminary figures for 2006-07 show the impact of the Government's continued investment in additional hospital capacity, with the number of beds in our public hospitals rising to 785.

Additional funding for 2007-08 and 2008-09 provided in subsequent budgets should see our hospitals reach a capacity of almost 830 beds by the end of 2007-08 and well over 850 beds by the end of the following year.

Table 7: Public and private hospital beds in the ACT, 2002–03 to 2005–06
Hospital type 2002–03 2003–04 2004–05 2005–06*
ACT Aus ACT Aus ACT Aus ACT Aus
Public 682 49,841 683 50,915 679 55,112 714 54,601
Private 408 27,112 379 26,580 389 26,988 n.p n.p

Sources: ACT Health Performance Reports; * AIHW 2006b

Cardiovascular disease

ACT Health established a10-bed acute stroke unit at the Canberra Hospital in October 2004. The unit provides coordinated care and early rehabilitation with the aim of vastly improved outcomes for stroke patients.

Aged care

An older persons unit, incorporating mental health and sub-acute rehabilitation and geriatric medicine services, was commissioned at Calvary Hospital in 2006–07. This 60-bed service operates as part of the Aged Care and Rehabilitation Service and Mental Health ACT clinical streams. Calvary Health Care ACT has operational responsibility for the unit.  This new service provides a purpose built facility which provides a better environment for longer term aged care and rehabilitation services.

Health expenditure increases

Data released by the Australian Institute of Health and Welfare in June 2007 shows that ACT Health is already on the way to meeting the target set for it by the ACT Government, with a 2005–06 hospital cost structure of 115% of the national average, down from more than 130% two years ago (Table 8).

Table 8: Total recurrent health expenditure, constant prices, for each state and territory, all sources of funds, 1996–97 to 2005–06 ($ million)
Year NSW Vic. Qld WA SA Tas. NT ACT Aus
2002–03 $22,987 $18,063 $12,203 $6,787 $5,470 $1,622 $832 $1,265 $69,229
2003–04 $24,335 $17,881 $12,760 $7,107 $5,732 $1,613 $886 $1,328 $71,641
2004–05 $25,440 $18,825 $13,431 $7,519 $5,977 $1,699 $932 $1,403 $75,196
2005–06 $25,869 $19,216 $14,264 $7,65 $6,105 $1,707 $992 $1,446 $77,254
Growth rate 6.3% 7.5% 11.8% 7.7% 6.5% 5.8% 12.0% 8.9% 7.8%

Source: AIHW 2006b

Quarterly reporting

The quarterly reporting system, ACT Public Health Services Performance Report, introduced in 2005–06 allows continuous monitoring of ACT health service performance against targets. This system appears to be having a positive effect with improvements in a number of strategic priority areas and setting of improved targets.

For example, the proportion of patients not admitted (via emergency department) to an inpatient bed within eight hours has dropped from around 50% in 2004–05 to 27% in 2005–07 (Figure 3; Figure 4). Likewise inpatient bed access within eight hours for those over 75 years, has improved from 60% not admitted to 40% not admitted for the same period.

In their current format, the quarterly reports are useful for tracking changes over the past five quarters but are not as useful for tracking changes over longer periods or for comparing figures with national outcomes.

Figure 3: ACT Public Hospitals Emergency Department Access Block, 2004–05 to 2005–06

Graph of ACT Public Hospitals Emergency Department Access Block

Source: ACT Heath, Performance Report 2004–05

Figure 4: ACT Public Hospitals Emergency Department Access Block 2005–06 to 2006–07

Graph of ACT Public Hospitals Emergency Department Access Block

Source: ACT Health, Performance Report 2006–07

Patient satisfaction surveyed for cancer patients

Creation of the Capital Region Cancer Service during 2004–05 increased delivery of cancer services to residents of the ACT and region. New computer planning technology and new graduate radiation therapists have significantly boosted ACT radiation oncology services.

Radiation oncology treatments grew by 8% from 13,474 in 2003–04 to 14,575 in 2004–05. Also, the number of fields per treatment for radiation oncology has increased by 17%, from 34,893 in 2003–04 to 41,101 in 2004–05. These increases are reducing the need for ACT residents to travel outside the Territory for radiotherapy (ACT Health 2005). A breakdown in one of the cancer machines did cause extended waiting times or patient travel to other hospitals; this machine has now been replaced.

BreastScreen ACT reports that the number of breast cancer screens performed in the ACT has increased each year in the reporting period from 10,487 in 2003–04 to 11,495 in 2005–06 (Table 9).

Table 9: Capital Region Cancer Service, breast screens, 2003–04 to 2005–06
Year 2003–04 2004–05 2005–06
Breast screens 10,487 10,667 11,495

Source: ACT Health, Annual Report 2005–06

During 2006–07, 38,595 women were added to the cervical screen register. This is nearly 17% above the target of 33,000 suggesting that the strong early intervention messages are reaching their target. There has been increased publicity surrounding introduction of the new Pap test guidelines and the new human papilloma virus vaccination. The increased level of reporting of cervical screens provides an indication of the effectiveness of early intervention health messages.

Mental health challenge continues

The Territory is still trying to come to terms with its mental health challenges. To try to tackle this growing issue, the ACT has introduced various plans and early intervention initiatives and boosted funding.

Mental Health ACT launched the ACT Mental Health Strategy and Action Plan 2003–08 in May 2004, the ACT Mental Health Promotion, Prevention and Early Intervention Action Plan 2005–08 in 2005, and the ACT Suicide prevention: managing the risk of suicide in the ACT 2005–08, in 2005.

ACT Health reports that the number of patients accessing mental health services increased from 6102 in 2002–03 to 6387 in 2003–04, dropping to 6,350 in 2004–05. While the number of mental health inpatient separations decreased each year from 1353 in 2002–03 (last report) to 1198 in 2005–06, the number of inpatient bed days increased from 13,945 to 15,963 over the same period (Table 10). These data suggest there were successively fewer mental health patients staying for longer periods.

A key reason for the drop in mental health inpatients is the corresponding increase in mental health services provided in the community. Community-based occasions of mental health services have risen steadily during this reporting period to 210,014 in 2005–06 (Table 10).

Table 10: Mental Health activity data, 2002–03 to 2005–06
Year 2002–03 2003–04 2004–05 2005–06
Community-based occasions of service* 172,349 168,194 184,331 210,014
Inpatient separations 1,353 1,252 1,234 1,198
Inpatient bed days 13,945 14,213 14,378 15,963
Provided services for 6,102 6,387 6,350 N/A

Sources: ACT Health

Bed shortages and access for acute cases only may also contribute to inpatient reductions. ACT Health quarterly reporting shows the proportion of mental health patients not being admitted to an inpatient bed, via emergency department, within eight hours of commencing treatment rose from around 10% in 2005–06 (Figure 5) to almost 20% by the end of 2006–07 (Figure 6).

Figure 5: ACT Hospital Emergency Department Access Block Mental Health clients, 2004–05 to 2005–06

Graph of ACT Hospital Emergency Department Access Block Mental Health clients

Source: ACT Health, Performance Report 2004–05

Figure 6: ACT Hospital Emergency Department Access Block Mental Health clients, 2005–06 to 2006–07

Graph of ACT Hospital Emergency Department Access Block Mental Health clients

Source: ACT Health, Performance Report 2006–07

In response to demand, the ACT Government raised Mental Health ACT funding of services from $3.4 million in 2002–03 to $5.1 million in 2004–05 and introduced initiatives such as:

  • integrating Calvary Mental Health Services with Mental Health ACT in 2003–04
  • establishing Gungahlin Outreach and post bushfire counselling
  • introducing early intervention programs and 'Mindmatters' to 90% of secondary schools by June 2004
  • implementing a 'Suicide Prevention Strategy 2005–08' from 2004–05.

These initiatives have been reflected in an increase in the number of mental health professional staff since 2000–01, although it is still below the Australian average (Figure 7).

Figure 7: Full-time workload equivalent direct care staff employed in specialised mental health services, 2001–02 to 2005–06

Graph of full-time workload equivalent direct care staff employed in specialised mental health services

Source: SCRGSP (Steering Committee for the Review of Government Service Provision) 2008, Report on Government Services 2008, Productivity Commission, Canberra.

Facilities for acute care of children

Despite a recommendation in the 2003 State of the Environment Report for provision of an acute care facility for children, and acceptance of this by the ACT government, no such facility has been provided. The result is that acutely mentally ill children and adolescents are still hospitalised with adults, potentially exposing children to age-inappropriate influences. For the safety and welfare of children, this recommendation should be implemented and, as a result, is restated in this report.

Preventative health initiatives

Substance abuse

The ACT Alcohol, Tobacco and Other Drug Strategy 2004–08 was in its third year of operation in 2006–07. Key aspects are:

  • funding of the Turning Point Alcohol and Drug Centre
  • funding of the Youth Coalition to support the ACT Alcohol and Drug Workers Group in reducing the harm caused by misuse of alcohol and other drugs in the community
  • funding of Red Cross and the Youth Coalition to operate a peer education program
  • recurrent funding until 2010 for a sobering-up facility operated by Centacare.

Nine government-funded alcohol and other drug treatment agencies provided alcohol or drug treatment services in the ACT in 2004–05 namely:

  • 4213 treatment services provided
  • 38% of treatment episodes were for clients aged 20–29 and 27% were for clients aged 30–39 years
  • male clients accounted for 70% and females 30% of treatment episodes
  • alcohol was the principle drug of concern in 43% of these services followed by opioids (29%), heroin (27%), cannabis (19%) and amphetamines (8%)
  • the proportion of treatment episodes involving clients identified as Aboriginal or Torres Strait Islander was slightly lower in the ACT than nationally (7% compared with 10%), but higher than their representation in the Australian population (2.1%; Australian Bureau of Statistics 2005)
  • counselling was the most common primary treatment (28%), followed by detoxification (27%) and assessment (19%)
  • treatment episodes involved clients who were self-referred (60%) or referred by family members or friends (11%) and alcohol and other drug treatment services (8%) and court diversion (8%)
  • treatment most commonly ceased because it was completed (57%).

The ACT Alcohol and Drug program assessed 538 clients in 2003–04 leading to provision of 3494 services. This was in excess of service targets of 420 clients and 1536 services and significantly higher than the 2743 services provided in 2000–01.

A higher proportion of ACT clients sought treatment for heroin addiction and a lower proportion sought treatment for cannabis dependence compared with Australian averages. Ice has been identified as a potential problem drug but had not yet shown up in data or police reports in the ACT.

Diabetes and obesity

The ACT Health Diabetes Service is the major provider of diabetes services to people in the ACT. The service catered for about 11,640 people in 2005 but may need to cater for double that figure by 2020 based on diabetes growth estimates.

A twofold increase in the number of people accessing diabetes services will place an enormous strain on the Territory's already stretched primary care and health workforce and services. The draft ACT Diabetes Service Plan 2006–09 focuses on a general practice centred model of care but ACT already has a significant shortage of GPs and nursing staff. The direct health care costs for each person with diabetes was estimated to be $5360 per annum in 2003 and will be significantly more by 2020.

While increasing funding is going towards chronic diabetes prevention and management, the ACT is investing in national health promotion campaigns and other early intervention strategies against diabetes and related childhood obesity through:

  • $2 million over four years to combating childhood obesity, including promoting consumption of fruit and vegetables through the successful 'Go for 2&5┬«' campaign
  • the framework to promote the health benefits of physical activity – Be Active ACT
  • a schools health promotion funding round
  • school nutrition programs run in collaboration with the Department of Education and Training
  • approximately $1 million over four years starting 2003–04, for ACT schools to help improve students' nutrition and fitness and physical activity through the School Canteen Accreditation program, the 'Feat 4 Feet' physical activity program and the 'Tuckatalk in Schools' program
  • mandated hours for health promotion, physical education and sport for each ACT student in kindergarten to Year 10
  • the obesity prevention initiative 'Early Childhood Active Play and Eating Well Project' spanning 2007–10.
Aboriginal and Torres Strait Islander health

ACT Health developed a new plan outlining how it will deliver health services to Aboriginal and Torres Strait Islander people living in the ACT. A New Way: Aboriginal and Torres Strait Islander Health and Family Wellbeing Plan 2006–11 introduces a mandatory Aboriginal and Torres Strait Islander Health Impact Statement process to ensure all new Territory policy and planning takes account of Aboriginal health and wellbeing. Activities and strategies under the plan include:

  • implementation of ACT Health's Cultural Respect Implementation Plan
  • introduction of an Integrated Aboriginal Service Delivery Project
  • construction of the Dennis Davison Gathering Place at Clare Holland House ACT following a grant of $100,000 from the Australian Government Department of Health and Ageing and a $50,000 bequest.
Immunisations

ACT Health reports that immunisation coverage for ACT children has increased significantly in the period 2002–03 to 2006–07. While immunisation rates for one-year-olds have fluctuated from 90 to 96%, rates for two-year-olds have increased steadily from 87% to 94% and for six-year-olds from 80 to 89% (Table 11).

Table 11: ACT and Australian immunisation coverage rates (%), at 30 June 2003 to 30 June 2007
Age 2002–03 2003–04 2004–05 2005–06 2006–07
ACT Aus ACT Aus ACT Aus ACT Aus ACT Aus
12–<15 months 91.50 91.16 90.76 90.91 95.65 90.99 90.74 90.71 94.34 91.16
24–<27 months 86.94 89.31 90.00 91.70 91.64 91.75 94.21 92.36 91.87 92.53
72–<75 months 80.39 82.29 84.90 83.52 87.89 83.23 83.23 82.65 89.41 87.94

Source: ACT Health Performance Reports

A number of new vaccines have been introduced since 2003 under the National Immunisation Program including chicken pox– (2005), human papilloma virus (2007), rotavirus (2007), meningococcal C (2003) and pneumococcal (2005). New combination vaccines containing inactivated polio replaced oral polio vaccine in 2005.

ACT Health has developed the ACT Health infection control guidelines for office practices and other community based services 2006 for achieving the infection control standards contained in its 2005 Code of Practice.

The human papilloma virus vaccine, Gardasil┬«, was introduced in 2007 in a large-scale catch-up program aimed at high school aged girls, which will continue throughout 2007–08, and will then be incorporated in the standard ACT immunisation schedule.

Other

Private health insurance increases

The proportion of ACT residents holding private health insurance rose 6.3% from the previous reporting period to be 54.0% in 2006. The ACT continues to maintain a higher percent of the population with hospital insurance than other States and Territories. (PHIAC, 2006). The ACT upturn recovered most of the slump (from 57% in 2001 to 52% in 2002) experienced in the last reporting period. In December 2006, 178,455 ACT residents had private health insurance.

Private health insurance in the ACT increased dramatically from 34% in 1998 to 56% in 2000 following the Australian Government's Lifetime Health Cover initiative and the 30% rebate.

Data sources and references

Australian Bureau of Statistics Australian Bureau of Statistics, 2005 National Aboriginal and Torres Strait Islander Health Survey 2004–05 Cat No. 4715.8.55.005 available at <http://www.abs.gov.au/AUSSTATS/abs@.nsf/ProductsbyReleaseDate/EBA8E2AF9E560271CA25714C001C4F5F?OpenDocument>

ACT Health 2005, Annual Report 2004–05, ACT Government, Canberra available at <http://www.health.act.gov.au/c/health?a=da&did=10009129&pid=1128405649>

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Notes

1 Australian Hospital Statistics 2004-05 and 2005-06 Australian Institute of Health and Welfare

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