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Western NSW LHD Facility Clinical Service Plans
Cowra Health Clinical Services Plan 2020-2030
About Cowra Health Service
Cowra Health Service is an acute inpatient procedural hospital within Western NSW Local Health District (LHD). It provides a range of inpatient, outpatient and community clinical services to Cowra and surrounding communities and works as part of a network of health services and hospitals within the region.
A Clinical Services Plan (the Plan) has been developed for Cowra Hospital and Health Service. It describes the key directions for Cowra Hospital and Health Service over the next 10 years to support healthier lives for people living in Cowra and local surrounding communities, and deliver reliable and contemporary health care both inside and outside of the hospital setting.
Why we need a plan
Cowra Hospital and Health Service is the primary provider of hospital services to the people of Cowra and surrounding communities.
The Cowra population is predicted to grow slowly over the next 10 years, and like other parts of Australia the population is ageing. There are higher rates of chronic disease, inequalities in the health and wellbeing between some groups in the community, and key health issues like mental health and children who are developmentally vulnerable which are important challenges for the future.
The Plan has been developed to respond to these challenges by considering the health needs of the population, services to meet these needs and the infrastructure requirements for Cowra into the future.
A clinical services plan is the first step for any significant facility refurbishment or redevelopment.
NSW Health Infrastructure's - How to Build a Hospital (pictured) outlines the steps in the process.
Cowra Health Service Catchment
The Cowra Health Service provides services to the local community, across the Local Government Areas (LGA’s) of Cowra and Weddin and Canowindra (state suburb) in the Cabonne LGA.
The total estimated population of the Cowra Health Service catchment area is approximately 18,382 persons. According to the NSW Department of Planning, Industry and Environment (2019), it is anticipated that in 2041, the population of the Cowra Health Service catchment area will be 18,018 persons.
Population projections suggest continued growth in the 70 years and older group to 23% of total Cowra population in 2041. This is consistent with the ageing population across NSW.
Cowra catchment: Health needs
Biomedical risk factors for health, such as high blood pressure, blood cholesterol and blood glucose, high psychological distress and high body mass index have been associated with the development of chronic diseases such as cardiovascular disease, type 2 diabetes, mental health disorders, musculoskeletal conditions and some cancers.
People living in Cowra were more likely to experience a chronic condition than the rest of NSW. The most common chronic conditions seen are diabetes, vascular disease, respiratory disease, asthma and mental health.
Life expectancy is lower in Cowra compared to the rest of NSW (82.6 years and 83.6 years respectively), more women are smoking in pregnancy, and the rate of obesity and premature death (<75 years) are higher than the NSW average.
Biomedical risk factors may be influenced by behavioural risk factors. Behavioural and modifiable risk factors incluse smoking, alcohol consumption, inadequate fruit consumption and inadequate physical exercise. These behavioural risk factors have been associated with the development of chronic disease.
Health-related behaviours for the Cowra population (compared with the rest of NSW) include:
- smoking rates (smoking in the general population) are greater than the rest of NSW
- lower exercise, as defined as 30 mins of moderate exercise on most days of the week
- inadequate fruit and vegetable intake
- higher rates of alcohol consumption (>2 alcoholic drinks per day)
- higher proportion of the population who are overweight or obese.
Community consultation
Extensive community consultation was sought throughout the development of the plan and included:
- Cowra CSP Steering Committee.
- community survey resulting in 416 responses
- appointment of a consultant to conduct 24 community meetings with 74 attendees
- workshops with 3 stakeholder groups consisting of 35 participants
- Indigenous engagement with 8 participants
- staff consultation and drop-in sessions.
The key health needs and issues identified by the community included:
- mental health services
- transport systems and services
- issues with the current infrastructure and functionality of the Emergency Department
- supports for an ageing population
- palliative care
- telehealth
- connection to local history, community and Indigenous culture
- hospital infrastructure and services
- partnerships
- workforce
- medical imaging
- access to transport.
Current services
Cowra Health Service is an acute inpatient procedural hospital and district health service.
It provides:
- 24 hour emergency services
- acute medical and surgical inpatient and day only services for adults and children
- maternity services
- diagnostic services
- chemotherapy services
- renal dialysis services
- allied health services
- child oral health services (with a voucher system for adults to access private dentists)
- a range of primary and community health services.
Drivers for change
There are a number of factors driving change in health care for the Cowra community. These include:
- Age and function of the current infrastructure of the health service.
- The changing profile of the population, with an increase in the number of people aged over 65.
- Increasing prevalence of chronic diseases and risky health related behaviours.
- Vulnerable communities and health inequities.
- Workforce succession planning.
- Changing models of service delivery and new and emerging evidence, including:
- virtual health
- alternatives to in-hospital care
- enhanced and integrated primary care
- shorter length of stay and proactive community following.
By reviewing the historical activity for Cowra Health Service, understanding the health needs for the Cowra region, the projected changes in the population, and listening to the community, we develop the Clinical Services Plan.
The way forward
The draft Plan describes a vision for Cowra Health Service over the next 10 years, including its role as the hub for public health service delivery and supporting smaller health services in surrounding communities. The Plan responds to the needs of the community, and outlines the opportunity for an integrated and digitally connected health and wellbeing approach to healthcare, alongside contemporary acute care.
The key directions for Cowra Health Service include:
1
Providing reliable and contemporary health care
Contemporary urgent and emergency care
- New models of care (fast track, paediatric safe assessment area).
- Additional ED treatment bays (4 treatment bays, resuscitation bay), triage assessment room, isolation room and mental health declared safe assessment room.
- Improve the waiting area and functional relationship to other diagnostic care areas.
- Improved access to out of hospital care programs.
- Expansion of virtual health technology to improve access to care.
- Create partnerships to provide in-reach service to residential aged care.
Safe, quality acute care
- Proactive discharge planning and case management.
- Integration with community-based services on discharge.
- Inpatient capacity for around 26 patients (with ability to accommodate paediatric patients, and telemetry monitoring).
- Culturally appropriate setting for Aboriginal people.
Strengthened and streamlined surgery
- Provide contemporary perioperative care to meet demand.
- Increase activity for local residents, and capacity for day only procedures.
- Strengthen links to post-acute care where required ie: HiTH.
- Operating theatre and procedure room, and day only surgery chairs.
Slow stream rehabilitation and reenablement and supportive end of life care and planning
- Restorative services that promote or restore an individual’s functional ability through slow stream rehabilitation or reenablement care.
- Supportive end of life care.
- 4 sub-acute beds within the inpatient setting to accommodate slow stream rehabilitation, restorative care, bariatric care and palliative care supported by well -designed areas for activities of daily living.
Strengthening ambulatory care and alternatives to hospital care
- Dedicated outpatient/ ambulatory care area focussing on a wellness. model.
- Chemotherapy and Ambulatory Care.
- Purpose built dental service.
- Renal dialysis.
Diagnostic support
- To meet clinical needs with good functional relationships to key services.
Culturally appropriate design setting to welcome Aboriginal people for treatment.
- Signage in Wiradjuri, culturally appropriate artwork, physical space, natural light and access to outdoor space.
2
Improve the health and wellbeing of the Cowra community
Supporting families in the first 2,000 days of life, from pre-conception through to school
- Shared-care model, shorter length of stay and early follow up for women and babies in the community.
- Support local women to birth in Cowra (for normal risk pregnancies)
- Infrastructure to support the birthing needs of women in Cowra - birthing suite and rooms.
- Services to address mental health needs of children; and access to networked perinatal mental health.
Integrated health and wellbeing, including outpatient and community health services with strengthened care in the community
- Continue to strengthen outpatient, ambulatory and community or home based services (general health, mental health and integration with primary health care clinicians).
- Enhance outpatient multi-purpose clinic rooms accommodate current staff, visiting specialist clinicians, education opportunities and community partnerships with virtual health technology capability.
- Integrating care around priority needs cohorts (children, aged health, mental health, chronic disease).
Reducing the inequality in priority populations and delivering culturally safe care
- Increase the number of Aboriginal people employed in Cowra
- Expand culturally appropriate programs to support Aboriginal children.
Strengthening mental health care
- Community based care - assessment, early intervention and crisis support.
- Improving care for young people close to home – local clinicians supported by access to specialist services such as:
- Infant, child, youth and family mental health team
- Youth drug and alcohol clinical support network
- Virtual Perinatal and infant mental health service.
- Build alternatives to hospital care - mobile mental health emergency care, mental health hospital in the home and suicide prevention outreach teams.
Supporting people to live well with chronic conditions and as they age.
- Integrated care for chronic or complex health program, and further development of Hospital in The Home (HiTH)
- ‘In-reach’ service to older people in the community or residential aged care
- Access to specialist palliative care services for end of life decision making
- Improve communication between primary care, residential aged care and the hospital to avoid readmission and unnecessary emergency presentation.
3
Building partnerships, better value and sustainability for health services
Building better value, financial sustainability.
Building a digitally connected health service of the future, embracing technology and innovation to deliver care closer to home.
Supporting opportunities for a rural health precinct and partnerships that deliver health care for the community, such as:
- A single focal point for the delivery of health, wellbeing & other social services aligned to health needs such as:
- Child and family health
- Mental Health
- Aged health, aged care and community support
- Opportunities to partner with other health and social care providers to deliver value for the community (e.g. Tresillian, private or not for profit providers).
Strengthening education and training for rural generalists across medicine, nursing and allied health.
The Plan incorporates the infrastructure needs required to future proof Cowra Health Service, but also identifies a number of service enhancements to improve the local health of the community.
These include improvements in access to out of hospital care, to redirect low acuity presentations to appropriate care settings, establishing new services (including public oral health), and improved access to health care utilising the network of services in the region.
This plan also identifies opportunities to partner with other health providers in Cowra in a precinct approach to improve health care and provide value for the community.
Where we are - early 2022
The Ministry of Health approved the Cowra CSP in 2021. The approved CSP is being used to inform capital planning processes, in line with the funding announced in the NSW 2020 Budget. Capital planning processes remain flexible to best deliver the CSP scope and suite of services to meet the needs of the community into the future in the most efficient way. Information on capital planning progress is available on the Cowra Hospital redevelopment website.