Developing a Plan

Developing a plan is a structured process that requires consideration of purpose, audience, latest evidence, consumer involvement and future need. The following processes are used in developing plans across Sydney Local Health District.

 

Governance	Establish a steering committee or service development working party. Ensure executive representation and appropriate stakeholder representation. Establish roles and responsibilities of committee/working party. Create a Terms of Reference. Establish a planning time frame, meeting frequency and dates.
Scope	Is a scoping document required (involves timeline or gantt chart). What type of plan is required – for example strategic plan, enabling plan, facility plan, clinical service plan, operational plan or project plan. Determine goals, objectives, broad outcomes and evaluation measures. Align issues with State priorities. Determine if Ministry of Health or other peer organisation should be included.
Literature	Review a wide variety of literature sources for example: Legislative requirements and overarching policy – for example Ministry and District Plans. Previous plans, recommendations and implementation status. International, National, State and Local District plans and reports. Clinical Guidelines from Pillar Organisations – for example Clinical Excellence Commission.
Consultation	Determine appropriate stakeholders and communication plan (Includes timing and approach). Determine consultation methods – for example interviews, meetings focus groups, forums, virtual or site visits, email or surveys. Consider a variety of methods to suit stakeholders needs. Develop questions for consultation.
Data	Quantitative Data: Analyse relevant data sources that meet strategic goals for example geographic, demographic, epidemiological and utilisation data. Consider if historical data is required (contact Performance Unit or access STARS). Determine time periods, inclusions and exclusions. Consider different data visualisation methods. Refer data to service managers to ensure data is robust. Qualitative Data: Gather information for example focus groups, forum feedback or survey data.
Analyse Data	Analyse data against best practice guidelines, standards or models of care. Refer data to source to ensure data is robust and accurate and reflective of the service. Consider if forecasted data is required for example population projections, activity projections (contact Planning Unit for assistance). For Planning Staff: refer to expert opinion to inform forecasted changes; use Ministry tools for example FlowInfo and HealthApp; liaise with Ministry of Health for major service planning to ensure methodology is robust. Consider costing: Capital costs can usually be broadly estimated within a service plan or alternatively the plan may recommend that a capital planning process be undertaken.
Develop Strategies	Strategies are to be developed in collaboration with identified working party members and is based on data, key policies and strategic direction. Present and discuss findings to Steering Committee or Working Group. Set priorities – high, medium and low. Include evaluation criteria, for example, measurable outcomes linked to the Service Agreement. Include timeframes for implementation and review.
Draft and final plans	Develop a draft plan with date and version reference. Send draft plan to the Steering Committee or Working Group for initial comment. Send revised draft plan to stakeholders for final comments. Submit final plan (if applicable) for design, print, digital publication and implementation.

District Information

Sydney Local Health District (the District), one of 15 local health districts in NSW, encompasses the Local Government Areas (LGAs) of the City of Sydney (western part), Inner West Council, Canterbury-Bankstown (Canterbury part), Canada Bay, Burwood, and Strathfield (See District Area Map). The District is responsible for the health and wellbeing of  local residents, a large number of people who travel to the District to use its tertiary and quaternary services and more than a million people who come into our District every day to work, study and visit. As our District includes the main campuses of the University of Sydney, The University of Technology (Sydney) and a number of other tertiary facilities the District is home to a large number of international and local students. It covers 126 square kilometres, with a population density of over 5555 residents per square kilometre.

The District is a leader in healthcare and a top performing District in Australia. 74 per cent of the public hospital care required by our residents is provided locally, reflecting a high level of self-sufficiency. Over a third of Sydney Local Health District services are provided for people living outside of our District, reflecting the strength of the District’s tertiary and quaternary healthcare services.

The Sydney Local Health District annual budget is $2.183 billion. The District employs 15,000 staff of whom 72 per cent are women and 42 per cent are aged under 35 years. We pride ourselves in equipping our staff with skills and capabilities and annually educate another 5280 students.

Research and innovation underpin our clinical service delivery, with over 2000 publications, 730 clinical trials and 445 grants worth $638 million in 2021-22.

Our Principal Referral Hospitals

• Royal Prince Alfred (RPA)
• Concord Repatriation General Hospital (Concord Hospital)

Our Major Metropolitan Hospital

• Canterbury Hospital

Our Specialist Hospitals

• RPA Virtual Hospital (rpavirtual) – a major virtual hospital
• Balmain Hospital – an aged care and rehabilitation specialist hospital
• Concord Centre for Mental Health – a tertiary mental health facility
• Professor Marie Bashir Centre for Mental Health – a tertiary mental health facility
• Sydney Dental Hospital - a tertiary oral health facility

Our Community-Based Health Services

Services are provided face to face and virtually, in the home, in community settings and in community health centres.

Public Health	Youth Health	Interpreter Services
Child Health and Development	Sydney District Nursing	Mental Health
Aged Health	Demand Management	Population Health and Health Promotion
Planned Care for Better Health	Aboriginal Health Services	Diversity Hub including CALD, LGBTIQ+
Sexual Health and Blood Borne Virus services	Drug Health Services	Oral Health
Sexual Assault services	Child Wellbeing and Protection Services	BreastScreen

Our Partners in Care

• Primary and specialist care providers
• Community-based organisations
• NSW Health and specialist health organisations
• Other health agencies
• Other government agencies and services
• Aboriginal Community Controlled Health Organisations
• Affiliated health services
• Universities, colleges, and tertiary institutions
• Medical Research Institutes

Our Specialty Services

The District has many services which are provided on a supra local health district or state-wide basis, such as the Australian Liver Transplant Centre, the State Burns Unit, kidney transplantation, organ retrieval, blood and marrow transplantation, cardiovascular and cardiothoracic services, neurosciences and neuro-intervention, complex epilepsy, genomics and gene therapy, cancer and haematological care, highly complex surgery, intensive care, Extracorporeal Membrane Oxygenation Retrieval (ECMO), mental health intensive care, neonatal care, high risk maternity, and gynaecology.

Our Clinical Streams

Aged Care, Rehabilitation and General Medicine linked with Chronic and Ambulatory Care and General Practice	Cancer Services	Cardiovascular
Gastroenterology and Liver	Critical Care	Medical Imaging
Neurosciences, Bone and Joint, Plastics and Trauma Surgery	NSW Health Pathology	Pain and Anaesthesia
Women’s Health, Neonatology and Paediatrics	Renal/Urology	Drug Health
Mental Health	Oral Health	Public Health
Royal Prince Alfred Virtual Hospital	Community Health	Population Health

Sydney Local Health District has a substantial and widely recognised health and medical research role with world leading and world class research groups in biomedical research, substantial strengths in clinical research, public and population health research, and health services research. Through our strong partnerships with the University of Sydney, Sydney Research, Sydney Health Partners, Tech Central, our Medical Research Institutes and other affiliations, we will further develop our national and international leadership in health and medical research and its translation.

The District provides significant education services through the Centre for Education and Workforce Development, the University of Sydney Clinical Schools and through affiliations with a wide range of university and higher education partners. 

Our Community

The District population is growing and ageing. The current population is expected to increase to 819,540 by 2036, an increase of 17 per cent (DPE, 2022). Tables 1 and 2 provide the projected District population by Local Government Area from 2021 to 2036 and by age groupings (Table 2). 

Table 1: Sydney Local Health District Population Projections by Local Government Area, 2021 to 2036

LGA^	2021	2026	2031	2036	growth 2021-2036
Ashfield	47,135	48,111	49,387	50,509	7.2%
Burwood	41,256	47,306	53,517	59,258	43.6%
Canada Bay	96,823	101,906	105,208	111,941	15.6%
Canterbury	163,552	170,814	181,414	190,297	16.4%
Leichhardt	61,643	62,402	63,946	67,445	9.4%
Marrickville	91,152	92,452	94,741	97,915	7.4%
Strathfield	47,763	53,973	56,356	60,212	26.1%
Sydney  (SLHD*)	148,457	155,769	168,567	181,963	22.6%
Total SLHD	697,781	732,733	773,137	819,540	17.4%
Other NSW	7,473,777	7,887,199	8,377,363	8,832,961	18.2%

^{Source: DPE 2022 High Series Population Projections, LGAs as per pre-amalgamated borders 2016, Sydney LGA includes South and Sydney regions.}

Table 2: Sydney Local Health District by age groupings, 2021 to 2036

Age Group	2021	2026	2031	2036
00-04	37,576	38,021	38,043	39,013
05-09	32,557	32,262	32,895	33,317
10-14	29,739	30,759	30,588	31,567
15-19	28,574	34,326	35,552	35,721
20-24	58,054	55,706	63,125	65,627
25-29	80,290	75,941	78,272	85,864
30-34	76,379	76,319	75,381	78,974
35-39	62,312	66,663	66,922	67,872
40-44	47,108	54,601	57,750	59,117
45-49	42,319	42,771	48,795	52,090
50-54	39,358	40,187	40,646	46,401
55-59	37,151	38,475	39,405	40,216
60-64	32,705	36,100	37,369	38,576
65-69	27,498	31,652	34,622	36,048
70-74	23,507	26,225	30,077	32,895
75-79	17,007	22,082	24,686	28,451
80-84	12,327	15,188	19,863	22,526
85-89	7,971	9,406	11,896	15,874
90-94	3,972	4,364	5,323	6,993
95-99	1,185	1,390	1,570	1,988
100-104	181	260	305	348
105+	11	35	52	62
Total	697,781	732,733	773,137	819,540

^{Source: DPE 2022 High Series Population Projections}

The District population is ageing. 9.5 per cent of our residents are currently aged over 70 but this will increase to 13.3 per cent by 2036; a total of 42,976 extra older persons. There are currently 4000 people living in residential aged care facilities and 10,000 of our residents are living with dementia. 11 per cent of residents are unpaid carers.

Each year around 7790 babies are born in our District and there are over 100,000 children living in our District.

There are more than 7000 Aboriginal and Torres Strait Islander people (1.1 per cent) living in Sydney Local Health District. Redfern remains one of the most recognised and historically significant urban Aboriginal places in Australia.

Our District is rich in cultural and social diversity with significant numbers of refugees, asylum seekers and special humanitarian entrants. 34 per cent of our residents were born in a non-English speaking country, and 47,150 residents speak little or no English. The most common languages spoken at home are Chinese, Arabic, Greek, Korean and Italian.

A feature of the District’s social diversity is our proud lesbian, gay, bisexual, transgender, intersex, queer and asexual (LGBTIQ+) community. A number of our suburbs have the highest proportions of same-sex couples in Australia.

Life expectancy in the District is 84 years for men and 89 years for women, however, the District is characterised by socio-economic diversity, with pockets of both extreme advantage and disadvantage. People who are most disadvantaged experience a lower life expectancy than the general community. Those who are most disadvantaged have lower incomes, less education, live in poor housing or in overcrowded conditions, experience varied levels of social exclusion and typically have access to fewer resources to maintain good health.

Our District has a large homeless population, many residents with insecure housing, and the largest proportion of Boarding Houses in NSW (463 Boarding Houses). Homelessness is related to poor health outcomes and people who have experienced homelessness are more likely to report having mental health and physical health problems.

Overall, people living in the District are in good health compared to the rest of NSW, however, there are considerable disparities in health status: 21 per cent of our residents live with a mental health problem, 8 per cent have diabetes, 15 per cent of pregnant women have gestational diabetes, 7 per cent report having a long-term health condition. 47 per cent are overweight or obese and 32 per cent of adults do not exercise enough. These issues, along with our growing and aging population, and our priority populations with significant risk factors, has significant implications for our services,

Forecasted Health Service Demand

Our District healthcare demand is forecasted to increase substantially due to the growth, ageing and increased chronicity of our population. Table three provides a snapshot of the expected changes in demand between 2021-22 and 2030-31.

Table 3: Forecasted Sydney Local Health District Activity, 2021-22 to 2030-31

On an Average Day in Our District:	2021-22	2030-31:
Patients in our hospitals	2,245	3,129
People attending Emergency Departments	470	637
Ambulances arriving	123	171
People receiving outpatient services	6,456	9,334
People receiving care in the community	1,404	2,181
People receiving care from rpaVirtual	500	777
People receiving care from Sydney District Nursing	244	379
People receiving care from Oral Health Services	487	757
People receiving Interpreter Services	299	465
People having a surgical operation	130	182

Census and Data

Australian Bureau of Statistics (ABS)	Population and census information and projections, including examples of important surveys such as the National Health Survey, The National ATSI Survey, the National Disability Survey.
Australian Institute of Health and Welfare (AIHW)	Important health care publications including Australia's Health, hospital statistics, BEACH (General practice data).
Cancer Council NSW	Data in relation to cancer incidence, morbidity, mortality and future projections.
NSW Health	A range of important data and information is available from NSW Health. For example NSW Midwives Data Collection, NSW Health Population Projections, Chief Health Officers' Report, NSW Health Promotion Surveys, Aboriginal Health Impact Statement guidelines, Process of Facility Planning, inpatient data, emergency department data.
Sydney Local Health District Public Health Observatory	A range of publications and reports relevant to Sydney Local Health District. A partnership with the University of Sydney.
HealthStats NSW	A 'one-stop-shop' public website bringing together data from many sources to produce statistical information about the health of the NSW population. Users can view and download data and select indicators to produce tailored reports that provide insights into a wide range of health determinants and outcomes.  Information can be found on the health status of the NSW population, health inequalities and the determinants of health, the major causes of diseases and injury, and current health challenges, trends in health and comparisons between age groups and geographic locations.
Bureau of Health Information	The Bureau of Health Information provides independent reports about the performance of the NSW healthcare system to inform improvements to care for patients, and enhance transparency and accountability.