About NSW Area 802,000km2

Population 7,232,589 Average Population Density 9/km2

Combined Population : Syd, W’gong, Newc

4,462,892 (62% NSW pop)

Combined Surface Area : Syd, W’gong, Newc

13,090km2

(1.7% NSW surf area) Combined Population Density : Syd, W’gong, Newc

341/km2

Surface Area : Rest NSW 788,910 Population Density : Rest NSW 3.5/km2

Surface Area and Population : Some Comparisons

Country/ Region

Surface Area (Km2)

Population Population Density

Germany 357,127 80,548,000 226 England 130,395 52,234,000 401 France 549,190 65,806,000 120 Spain 505,370 46,704,314 92 Australia 7,741,220 22,906,355 3.0 NSW 802,000 7,232,589 9 HNE 130,000 866,000 6.7

New Cancer Diagnosed in NSW: Actual and Projected

12,490

27,241 29,450

34,958 39,721

45,889 45,245

51,027

0

10,000

20,000

30,000

40,000

50,000

60,000

1990 1995 2000 2005 2010 2015 2016 2021

Incidence & Mortality Variation

LHD Incidence Number

Incidence Rate/100,000

Mortality Number

Mortality Rate/100,000

Metropolitan Local Health Districts Sydney 2299 441.7 879 171.5

SE Syd 4240 501.2 1473 166.5

Rural Local Health Districts Southern 1187 493.4 431 180.7

Western 1511 486.0 581 188.0

Cancer Incidence & Treatment Cost : Increase (%) by Year

Cost of Health Service Increasing cost of Health as a percentage of total NSW expenditure

Year % Total NSW expenditure

2008 28

2017 35

2032 54

Regional Cancer Centres

Centre No of Linacs

North Coast Cancer Institute (Coffs, Lismore, PM) 6

Central Coast 2

North West Regional Cancer Centre 1

Central West 1

Illawarra Shoalhaven 2

Introducing Hunter New England

HNE Local Health District Newcastle to Moree : 504Km or 6.5hrs

Newcastle to Boggabilla: 619Km or 8hrs

Amsterdam to Paris : 428Km

Dieppe to Marseilles : 348Km

HNE Cancer Service

Networked Service since 2007

Represents cancer services across HNE

Supported by Cancer Leadership Committee

Incorporates six clinical streams

Twelve tumour groups

Structure of HNE Cancer Network It is a Hub & Spoke Model Metropolitan Hub Located in Newcastle (John Hunter & Calvary Mater) A Level 6 Service providing :

All major modalities except State-wide and some highly specialised services, Specialist Palliative Care

Structure of HNE Cancer Network

Surgery

Chemotherapy

Radiotherapy

Palliative Care

Other regional services in

Armidale and Taree

Regional Hub: North West Regional Cancer Centre (Tamworth)

Structure of HNE Cancer Network

Outreach Services

Located at Moree, Muswellbrook and Forster

Provide:

Limited surgery

Non-complex chemotherapy

Palliative Care

Projected Cancer Incidence Cancers  

Incidence 2007  

Incidence 2008  

Projected 2016  

Projected 2021  

Prostate   1167   1235   1704   1914  

Colorectal   737   673   877   951  

Melanoma   562   599   709   815  

Breast   567   563   731   771  

Lung   445   469   507   521  

All others   1788 1875 1825 2181

Total   5,266   5,414   6,353   7,153  36% increase from 2007 to 2021

Cancer Network Challenges

Large geographical area (130,000Km2)

Account for 14% NSW cancer incidence

Number of solo practitioners in regional centres

Major gaps in some services, eg palliative care, haematology, allied health

Multiple accountabilities – HNE LHD, LCM, CI

Cancer Network Challenges Access to some specialist services (radiotherapy, haematology)

Low levels of radiotherapy utilisation

Supporting rural workforce to manage people with cancer

High Aboriginal and Torres Strait Islander population (20% of NSW)

Out-of-Area Cancer Services Used by Patients from NW Region

% Patients Destination Distance

37 Sydney 8 hours

12 Newcastle 5+

26 Brisbane 6.5

22 North Coast NSW 3+

2008 data

Cancer Network Challenges

Economic issues Accommodation costs Building patient and carer accommodation Distance to treatment centre Limited transport options Investment in Tele-Health options Outreach services

Cancer Network Challenges

Breaking down silos

Partnering with Medicare Local and NGOs

Care integration across facilities and LHDs

Addressing Demand

New Cancer Diagnosed in NSW: Actual and Projected

12,490

27,241 29,450

34,958 39,721

45,889 45,245

51,027

0

10,000

20,000

30,000

40,000

50,000

60,000

1990 1995 2000 2005 2010 2015 2016 2021

HNE Cancer Plan : Goals Redesign cancer services to provide high quality, integrated care Reduce inappropriate variation in patient outcomes Establish effective partnerships and communication with other service providers and community groups Position cancer services for the future Develop a workforce that meets the needs of the future

Possible Strategies Shared Care model with GP and community sector

Integrating care across primary, community and acute services via Health Pathways

Co-ordinated care

Reduce unwanted variation and Closing the Gap

Have the right workforce

Be sustainable

Possible Strategies

Develop network links, eg via telehealth Tailoring service model to local health needs and service capacity Local MDT supported by main oncology service District-wide policies to achieve consistency (eg adoption of eviQ protocols)

Barriers

Inappropriate treatment

Poor co-ordination

Inefficient processes

Administrative complexity

Need to align with the Triple Aim (population health, patient experience, per capita cost)

Barriers

Funding failing to keep pace with service development Challenges of recruiting and retaining staff in regional areas Limited capacity of the non-cancer services to take on additional responsibilities Culture change required to modify traditional roles

The Future : We’re Coming Ready or Not