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annual report 2008
December 2008
The Hon John Della Bosca MP
The Hon NSW Minister for Health
Parliament House
Macquarie Street
SYDNEY NSW 2000
Dear Minister
We have pleasure submitting The Children’s Hospital at Westmead 2008 Annual Report,
including statements for the financial year ended 30 June 2008 as certified by the Auditor
General of NSW.
This report is consistent with the statutory requirements for annual reporting as provided by
NSW Health under the Accounts and Audit Determination for Public Health Organisations
and the 2007/2008 Directions for Health Service Annual Reporting and is submitted to the
Minister for Health.
Yours sincerely
Dr Antonio Penna
Chief Executive
Contents
Contents
128th Annual Report of The Children’s Hospital at Westmead
for the year ending 30 June 2008.
Highlights ......................................................
2
Chief Executive’s year in review .....................
4
Profile, Purpose and Goals ............................. 9
Organisational Chart ..................................... 11
Performance Summary ..................................
Actions and initiatives ...................................
12
17
Corporate Governance Statement ...................
19
Clinical Governance ......................................
Activity Levels ..............................................
22
26
Service Planning ..........................................
27
Overview of Operations ..................................
Clinical Programs
Ambulatory and Emergency Program .......
Medical Program .....................................
Perioperative and Critical Care Program ....
Clinical Support
Allied Health ............................................
Diagnostic Services ..................................
Mental Health Services .................................
Corporate and Shared Services .....................
Information Management Services ................
Community Relations and Marketing ............
Internal Audit ...............................................
28
Our People ...................................................
Workforce Development ...............................
Executive Management ................................
Executive Profiles .........................................
Staff Profile ..................................................
Disability Action Plan ....................................
Occupational Health and Safety ....................
Equal Employment Opportunity ....................
Teaching and Training Initiatives ...................
Overseas Travel ............................................
Research .....................................................
68
68
71
72
73
74
74
75
79
83
83
Our Community .............................................
Children’s Hospital Advisory Council .............
Consumer Feedback ....................................
Cultural Diversity ..........................................
Our Volunteers .............................................
The Chaplains ..............................................
Benefactors and Donors ...............................
Roll of Honour ..............................................
90
90
92
93
93
94
94
99
Freedom of Information Report .....................
101
Financial Report .........................................
Financial Overview .....................................
Certification of Parent/Consolidated
Financial Statements ..................................
Certification of Special Purpose
Independent Audit Report ..........................
Special Purpose Service Entity Statements ..
108
108
114
154
156
28
32
43
50
52
59
63
64
64
66
1
Highlights
Highlights
• The Emergency Department entered into a
redevelopment phase, with the first stage being
the opening of the Emergency Medical Unit
(EMU). Additionally, 3.5 additional consultant
medical positions were assigned to the Emergency
Department and performance against key
performance indicators (KPIs) was of a
high standard.
• The Children’s Hospital at Westmead has been
widely praised for remarkable success in the areas
of revenue improvement, wastage reduction and
workforce productivity, exceeding annual targets by
33 per cent. The Hospital leads the state in salary
packaging, is exemplary in improvement of private
patient revenue and has made great improvements
in blood products wastage.
• The Children’s Hospital at Westmead was the first
organisation in Australia to receive the globally
recognised International Disability Management
Standards Council Certification for Excellence in
Injury Management, recognising the Hospital’s
strong commitment to occupational health and
safety and injury management for employees.
• An Evening Pharmacy Service commenced, along
with a telephone triage system allowing parents
and carers to query medications and dosages for
their sick child.
• The Animal Assisted Therapies Program was
launched by the Physiotherapy Department
and the Delta Dog Society. This innovative
program involves therapy dogs working alongside
physiotherapists to assist and motivate long term
physiotherapy patients.
• The Diabetes Prevention Research Centre was
launched on World Diabetes Day by Goodwill
Ambassador, Bec Hewitt. This initiative was
made possible by donations from the Diavitiko
Association and the Laki Bank.
• The Kidz Factor Zone was officially opened by
the Minister for Health, Hon Reba Meagher
MP, to provide specialised care to children with
haemophilia who require frequent hospital visits.
2
• The story of Demi-Lee Brennan attracted
international media coverage. Demi-Lee received
a liver transplant at The Children’s Hospital at
Westmead and miraculously took on the blood
group and immune system of her donor, effectively
eliminating the chance of her body rejecting the
precious new organ.
• The Long Term Ventilation Unit assisted to
return five ventilated children back to their home
environment. These children were previously
treated within the Paediatric Intensive Care Unit,
but this initiative allows them to transition to care
within the community.
• A new interventional angiography suite in Radiology
was installed to allow greater diagnosis and
treatment of patients.
Highlights
• One of Paediatric Intensive Care Unit’s (PICU)
major achievements has been a steady reduction
in the mortality rate of critically ill children and
infants over the last three years. Following a 20%
reduction in standardised mortality rate between
2005-06 and 2006-07, there has been a further
14% reduction between 2006-07 and 2007-08.
The standardised mortality rate is now only 54% of
its value ten years ago.
• The opening of the Aboriginal Memorial Garden
was a pinnacle in the Hospital’s commitment to the
Aboriginal Community, allowing a place of reflection
for families and venue to showcase Aboriginal
heritage within the history of the Hospital and the
local area.
• The Annual Memorial Service activities were
expanded to include group sessions for bereaved
parents and siblings. Attended by over 450 people,
the Memorial Service is designed to allow families
the chance to remember children associated with
The Children’s Hospital at Westmead who
have died.
• The inaugural Bandaged Bear Cup was held to
recognise the staff and volunteers of The Children’s
Hospital at Westmead. This is a feature on the
NRL schedule and is an initiative of ANZ Stadium,
with the Cup being contested by the Canterbury
Bulldogs and the Parramatta Eels.
• The Book Bunker celebrated ten years as part
of The Children’s Hospital at Westmead with a
birthday party attended by famous children’s
author, Mem Fox. Established by Scholastic, the
Book Bunker is part of the Hospital’s total healing
environment, allowing children and families access
to books and a library environment staffed by
volunteer librarians.
• The Pain and Palliative Care Service was awarded
the highly prestigious Institution Award by the
International Association for Hospice and
Palliative Care.
• The successful Grace Neonatal Intensive Care
Unit Gala Ball raised over $300,000 for the Grace
Centre for Newborn Care.
• After staff at The Children’s Hospital at Westmead
uncovered that the Toy of the Year, Bindeez,
contained toxic chemical equivalent to an illicit
drug, a major awareness campaign was launched,
resulting in an international recall of this
dangerous product.
• The Occupational Therapy Department celebrated
70 years of service, having been an integral part
of the Hospital’s care for sick children since the
Camperdown days.
• The Speech Pathology Department received a
Service Award from the University of Sydney for
continuous contribution to clinical education.
3
Chief Executive’s year in review
Reflecting upon the last year, my mind fills with
many thoughts of successes, challenges and
highlights. Although one thing stands out in my
mind above all else, my strong sense of pride
to be part of such a inspirational organisation,
which is underpinned by the talent of dedicated
staff and volunteers.
To be at the helm of an organisation such as
The Children’s Hospital at Westmead is a great
honour. I am part of a team of people who feel
passionately about creating healthier futures for
children and families.
Our reputation as one of the world’s great children’s
hospitals is not based on the equipment we have or
the buildings we work in, it has come about because
of our people. Together we all contribute to the
positive experience that many families comment upon
when they trust us with the care of their child.
The Children’s Hospital at Westmead is built firmly
upon three platforms – clinical care, research and
education. These three platforms are intertwined
and ensure that we are providing the best care today
and are accelerating this standard of care into the
future, through research into the causes and cures
of childhood diseases and education across the
paediatric discipline to keep skills at the cutting-edge.
While there have been challenges over the last year,
I am very pleased to say that our performance across
all areas has been very good. With the continued
support and dedication of staff across all disciplines,
I am sure that we can continue to effectively tackle
future challenges and demands.
Clinical Services
Despite some disruption from renovations, the
Emergency Department has managed to meet Key
Performance Indicators (KPIs) set by NSW Health.
This is a fantastic achievement which shows the
excellent effort of staff.
We have also met elective surgical KPIs above
all other Area Health Services, a magnificent
achievement in the face of increasing demand
for services.
4
We welcomed an allocation of an additional 3.5 fulltime equivalent consultant medical positions in our
Emergency Department during the year. This has
allowed for increased clinical care for patients and
smoother transition through the triage system.
Five children were transitioned back into the
community from the Long Term Ventilation Unit during
the financial year. This is a major achievement as
children with conditions requiring long term ventilation
were previously patients of the Paediatric Intensive
Care Unit (PICU). Moving these children to the Long
Term Ventilation Unit and working towards their return
to the community has not only been a wonderful result
for their families, it has also improved bed availability
in PICU, increasing surgery capacity.
PICU has seen a steady reduction in the mortality rate
of critically ill children. This is a major achievement,
especially considering that the rate has decreased by
34 per cent since 2005-2006. I have no doubt that
this amazing feat is not only as a result of improved
treatment options, but is also a reflection of the
dedication and talent of staff.
The Minister for Health launched two exciting
initiatives at The Children’s Hospital at Westmead
during the year. The first was the opening of the
Kidz Factor Zone, an innovative treatment centre for
children with haemophilia. This was officially opened
in July 2007 and has proven to be an effective venue
for care and support of haemophilia patients and
their families.
The Minister for Health also officially launched the
Animal Assisted Therapies Program, an initiative
of the Physiotherapy Department and Delta Dogs
Association. This is a physiotherapy-based program,
using dogs to help facilitate rehabilitation and
treatment for sick children.
One of the highlights of the year has been the fantastic
media coverage of some of the major achievements
of The Children’s Hospital at Westmead. One of
these stories was that of Demi-Lee Brennan, a young
liver transplant patient who miraculously took on the
immune system and blood group of her liver donor.
This was the first time this had happened in the world,
allowing this ‘one-in-six-billion miracle girl’ to live a life
free of immune suppressant drugs. Her treatment and
Another major story developed in the lead up
to Christmas 2007 when staff from the Poisons
Information Centre, based here at The Children’s
Hospital at Westmead, discovered that the ‘Toy
of the Year’, Bindeez Beads, contain a potentially
lethal chemical which, when ingested, became the
equivalent of an illicit drug in a young child’s body.
This discovery was made in the Hospital’s laboratory
and resulted in a world-wide recall of this popular toy,
which was rapidly filling the Christmas stockings of
children of all nationalities.
During the year we installed a new state-of-the-art
paediatric interventional radiology operating suite.
This suite is the most advanced of its kind in the
world and allows Interventional Radiologists to operate
on children by inserting small, sophisticated devices
through one to two millimetre holes in the skin,
seeing inside the body using the angiography
machine and ultrasound. This is a major step
forward for The Children’s Hospital at Westmead,
resulting in minimal scarring, less risk, less pain,
shorter hospitalisation and faster recovery for
children with vascular malformations.
Clinical Governance
During the year, 165 improvement projects were
lodged with our Service Improvement Unit, all of
which underwent comprehensive ethical review. This
is a true reflection of the amazing work being done
by staff in all areas of the Hospital and how they are
not afraid to challenge the ways things are done and
continually improve for the benefit of children
and families.
Development continued on the Hospital’s new
database for improvements, special achievements,
external visits and information sharing. This
database, known as CHARLI, will revolutionise
the way we do business, allowing a greater central
knowledge of the activities of Departments,
something which has previously been a challenge
in this complex organisation.
The Service Improvement Unit continued to
coordinate a number of projects to improve patient
safety and quality of care. One of the key projects is
the Clean Hands Save Lives initiative, promoting hand
hygiene practices of staff. We are currently the top
performing hospital in NSW for hand hygiene, with
85 per cent compliance. Our success in this area has
been commended by NSW Health and the Clinical
Excellence Commission.
the handling of this unique phenomenon was a credit
to staff in various departments around the Hospital,
including the transplant team and haematology staff.
Research
Our Research Division, based at the Kerry Packer
Institute for Child Health Research here at The
Children’s Hospital at Westmead, continues to go from
strength to strength.
The ultimate measure of the success of our research
activity is improved health for children. As a direct
result of our research, there have been significant
advances by the Hospital in treatments, cures
and prevention of diseases, and these advances
have benefited many children. Over the coming
months and years, we will continue adding to these
achievements as we strive to achieve our vision of
being a leading global centre for clinical translational
research in children.
Having started with a team of 40 scientists, the
Research Division has now grown to a staff of more
than 250 working in 30 research groups. Our work
covers basic, clinical and population health studies
and is driven by the needs we see in the children
who come to the Hospital every day. We take pride in
the fact that our research is ‘bench to bedside’ – the
advances we make at the laboratory bench can be
directly applied to the needs of sick patients here at
The Children’s Hospital at Westmead.
One of the highlights of the year was opening the
Diabetes Prevention Research Centre on World
Diabetes Day. This was made possible by generous
donations from Diavitiko and the Laki Bank. The
Centre will concentrate on research into the causes,
treatments and cures for Type 1 and Type 2 Diabetes.
5
Performance Management
and Planning
We have now fully implemented our Corporate
Strategic Plan, which is supported by our Healthcare
Services Plan, Financial Impact Statement and
Clinical Services Plans. Key enabling plans will bring
these strategies to fruition in the areas of Finance,
Asset Management, Workforce Development and
Information Services.
One of the major benefits of having these plans in
place is that we have a strong platform to measure
our priorities against and they give us a much clearer
direction for the future. All proposed new initiatives
are now subject to a formal process of prioritisation
and are tracked in a central database.
The planning process is ably supported by technology,
allowing for consistent measurement and reporting,
including risk profiling.
Building, Equipment and
Information Technology
We have begun to see significant change in our
Emergency Department, thanks to $450,000
of funding from NSW Health. This has allowed
completion of two stages of a three stage
redevelopment, which has made this area more
functional and comfortable for families.
One of the major features of the Emergency
Department redevelopment has been the first stage
of redevelopment, the opening of the Emergency
Medical Unit (EMU). This new overnight-stay
eight bed ward allows children and families to be
accommodated for observation periods or other
extended stays in greater comfort.
The second stage is based around making the
Emergency Department more functional and
comfortable for families. Major features of this
development is making the waiting room more private,
providing a more comfortable setting and making the
whole area more safe and secure.
6
In addition, three fast track cubicles will be built.
These can also be used for assessment in case of
a disaster with multiple casualties. Air flow will be
enhanced in the infectious waiting room facilities to
minimise the spread of air-borne viruses and a waiting
area for children midway through their treatment will
be created to avoid congestion in treatment areas.
During the year we also completed an upgrade of
our Oncology Treatment Centre, an initiative made
possible through the generosity of our donors. This
refurbishment has created a more comfortable
environment for patients and families who visit the
Hospital as outpatients for chemotherapy treatment
for cancer and leukaemia.
Finance
During this financial year, the Hospital was remarkably
successful in improving financial performance in
those areas within our control, such as revenue
improvement, waste reduction and workforce
productivity. The Hospital now proudly leads the state
in salary packaging, is exemplary in our improvement
of private patient revenue and, in only ten months,
achieved the full year revenue improvement target of
$2 million more than last year. Other examples of the
widespread financial improvement this year include
blood wastage and control. Overall, the Hospital
achieved a pleasing financial result in the face of
increased activity and greater pressure on funding.
At a strategic level, the Hospital has developed a Five
Year Plan consolidating both capital and operating
financial projections for all Programs and Divisions
over the next five years and integrating the annual
budgets and operating plans. The Five Year Plan was
presented to the Minister for Health. Major reviews
were commenced into the funding model and also
into Special Purpose and Trust Funds. The results of
these reviews will be reported next year.
At a management level, the Hospital transitioned
to the new statewide Oracle financial systems,
involving a new chart of accounts. Improved cost
centre reporting for financial and staffing information
was introduced through Corvu. New, online billing
systems were rolled out progressively to departments
during the year. A review commenced to identify and
allocate overhead costs across the Hospital on a more
transparent and equitable basis.
Workforce and Education
We were honoured to be the first organisation
in Australia to receive the globally recognised
International Disability Management Standards
Council Certification for Excellence in Injury
Management. This award recognises our ongoing
commitment to occupational health, safety and injury
management for all employees, as we continue to be
one of the best performing hospitals in this area within
the state.
We continued the development of the Kim Oates
Australian Paediatric Simulation Centre, a unique
facility designed to keep staff skilled in the most
cutting-edge treatments for sick children, especially in
emergency scenarios.
This Centre will train those who care for our precious
sick children to intervene in patient care instinctively,
quickly, consistently and appropriately, using
techniques that have been proven to save lives. This
will allow for greater learning, educational innovation,
collaboration and research.
Family-focussed care
Our Hospital is well known for our family-focussed
approach to paediatric health care. This approach is
based around the health and wellbeing of the whole
family and there are many examples of how we strive
to achieve this.
One of the major contributing factors to familyfocussed care is our total healing environment.
This incorporates our gardens, playgrounds, our
entertainment program and all of the extra things we
do to bring fun and laughter to the road to recovery.
This year we celebrated the tenth birthday of the Book
Bunker, an initiative of Scholastic which sees trained
volunteer librarians maintaining a wonderful library for
children of all ages. This has been a valued service
for children and families over the years, providing a
welcome escape from the challenges of illness
and injury.
The Hospital continued to work with HealthSupport
Service Centre, Parramatta, to address the challenges
of transitioning support services to their new operation
and location. The Performance Improvement Unit
worked with PricewaterhouseCoopers to identify new
revenue and cost-saving opportunities. The benefits
to the Hospital from these initiatives will be realised in
future years.
Our annual Service of Remembrance continues to be
an important ongoing aspect of our care for families
of children who have sadly passed away. This Service,
attended by around 450 people annually, has been
expanded to include bereavement groups for parents
and siblings and is just one way that we can extend
our care to families and show our compassion and
ongoing support.
Staff and Volunteers
I am constantly amazed by the talent and tenacity of
staff across all disciplines. Our international reputation
for excellence attracts the best staff from around the
globe and our investment into education and training
ensures that their skills remain world-class.
This year we introduced Celebration Week, a chance
for us to recognise the significant contribution of staff
and to provide recognition and thanks. There were
several planned activities, a highlight being a display
in the Hospital’s galleria of hundreds of thank-you
cards for staff and departments from other staff,
patients and families.
I am keen to continue the tradition of Celebration
Week annually and I am also looking towards
additional ways we can provide recognition to staff.
Roger Corbett, the Chair of our Advisory Council,
was awarded an Officer of the Order of Australia in
2008. This honour is very well-deserved, as Roger has
contributed so much to business and the community
and we are honoured and grateful that he is part of
our Hospital and assists us in so many ways.
Some of the other major awards given to our staff
during the year include A/Prof Elizabeth Elliot
becoming a Member of the Order of Australia for her
work with the Australian Paediatric Surveillance Unit.
7
Prof Peter Van Asperen was awarded the prestigious
John Sands Medal by the Royal Australiasian College
of Physicians and Prof Richard Widmer was awarded
a College Meritorious Service Award from the Council
of Paediatric Dentistry.
We are very fortunate to have a committed band of
400 Volunteers who dedicate many hours each week
towards assisting in various areas of the Hospital
and fundraising towards special projects. These
men and women are one of the cornerstones of our
organisation and their support is a large part of our
ongoing success.
Our Sponsors
We have many committed donors and supporters in
the community. Their interest in our work and their
unwavering support of our aspirations is one of our
greatest strengths.
During the past year we have received close to $25
million in donations. This money is used in a variety of
ways, including supporting clinical initiatives, funding
research and allowing us to provide extra services for
families as part of our total healing environment.
8
While many of our donors like to choose where
their donation is directed, it’s also important that a
significant portion of our donations are untagged,
meaning that we can direct this money towards the
area of the Hospital in most need. These priorities are
continually formally re-assessed.
I am thoroughly enjoying my role as Chief Executive of
The Children’s Hospital at Westmead and feel a strong
sense of achievement as I reflect upon the past year.
With the immediate support of my Executive and the
Children’s Hospital’s Advisory Council, I feel that we
will move ahead and achieve even more in the future.
Our vision is ‘Healthy Children for a Healthy Future’
and I am confident that, as a team, we can put an
enormous amount of energy toward this vision and
change the lives of sick children and their families.
Dr Antonio Penna
Chief Executive
The majority of patients treated by The Children’s
Hospital at Westmead come from Sydney West
(49.84%) and Sydney South West (22.9%) areas.
Western Sydney is home to over half the children in
NSW, with over 90 different cultural groups, including
people from non-English speaking backgrounds and
one of the largest Aboriginal Communities in NSW.
Of the 25,754 admissions to The Children’s
Hospital at Westmead in 2007-2008, 670 (2.6%)
are Aboriginal or Torres Strait Islanders and 3406
(13.23%) patients do not speak English at home.
The largest number of admissions to The Children’s
Hospital at Westmead is in the under one year old
category (16.95%) and 54.93% of patients are aged
five years and under.
Our Vision
Profile, Purposes and Goals
Healthy Children for a Healthy Future
Our Mission
The Children’s Hospital at Westmead will strive for
excellence and build on our strengths as leaders
in clinical care, research and education with an
emphasis on:
• Balancing our role in providing high quality
tertiary and quaternary care with our primary and
secondary commitments to the community
• Chronic and complex care
A teaching hospital of the University of Sydney and
the University of Western Sydney, The Children’s
Hospital at Westmead is a leading institution in
children’s clinical research, focusing on turning
today’s research into tomorrow’s medicine.
• Building partnerships
The Children’s Hospital at Westmead is a Statutory
Health Corporation, established pursuant to the
Health Services Act 1997 (NSW).
• Accountability
Values
• Commitment
• Respect
• Excellence
• Service
9
Principles Guiding Our Work
Purpose and Goals
• Health gain – to ensure that improving
children’s health and quality of life are the focus
of our efforts.
• To keep children and young people healthy
• Concern for people – to care for our patients, their
families, our staff and our supporters as individual
people with their own needs.
• Doing it better – to provide the best possible patient
care by the effective use of resources, recognising
the need to continuously review and improve
procedures and processes.
• A hub of paediatrics – to play a pivotal role in
cooperating to establish a network to share our
knowledge and skills in paediatrics for the health
of children.
• Making the future better – to invest in and facilitate
research that improves our understanding of how
to prevent or treat diseases in children and to
work with government and community agencies to
promote the health and well-being of all children.
- More children adopt healthy lifestyles
- Prevention and early detection of
health problems
- A healthy start to life
• To provide the health care people need
- Emergency care without delay
- Shorter waiting times for booked nonemergency care
- Fair access to health services
• To deliver high quality health services
- Consumers satisfied with all aspects of
services provided
- High quality clinical treatment
- Care in the right setting
• To manage health services well
- Sound resource and financial management
- Skilled, motivated staff working in
innovative environments
- Strong corporate and clinical governance
10
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Aboriginal Health
Audiology
Cochlear Implant
Kids Health
Nutrition & Dietetics
- Formula Room
Occupational Therapy
Orthoptics
Orthotics
Pharmacy
Physiotherapy
Play Therapy
Psychology
Social Work
Speech Pathology
Allied Health
Immunology & Infectious Diseases
Institute of Endocrinology & Diabetes
Medical Imaging/ Nuclear Medicine
Pathology:
- Biochemistry
- Endocrinology
- Haematology: - Blood Bank
- Histopathology
- Laboratory Services
- Microbiology
- Pathology Collection Services
- Virology
- Molecular Pathology
• Western Sydney Genetics Program:
- Biochemical Genetics
- Clinical Genetics
- Cytogenetics
- Genetic Metabolic Diseases Service
- Molecular Genetics
- Newborn Screening
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Accounting
Revenue
Reporting
Performance Improvement
Logistics
Property Management
Security
Child Care Centre
Domestic Services
Engineering & Maintenance
Food Services
Accommodation
Linen & Sewing
Shared Services
Diagnostics
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Ms Wendy Haigh
Dr Ralph Hanson
• CASU
• IT Services
• Management Support &
Analysis Unit
• Medical Records
• Project & Business
Planning
• Switchboard Services
• Planning & Population
Health Unit
Finance &
Corporate Services
Information Services
& Planning
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Clinical
Programs
Bear Cottage
Camperdown Ward
Chaplains
Clancy Ward
Commercial Travellers Ward
David Reed Sleep Unit
Dermatology
Gastroenterology / James Fairfax Institute
General Medicine
Hepatology Liver Transplant
Hunter Baillie Ward
Nephrology Renal Transplant
Neurology/ Neuro-surgery
Oncology Medical
Oncology Treatment Centre
Pain & Palliative Care Services
Poisons Information Centre & Toxicology
Renal Treatment Unit
Respiratory Medicine
Rheumatology
Sydney University Dept. of Paediatrics &
Child Health
• Turner Ward
• Variety Ward
• Weight Management
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Medical
Fundraising
Public Relations
Radio Bed Rock
Starlight Express
Ms Gilly Paxton
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MH-Kids
Redesign Unit
Medical Profession - MADAC
Service Improvement Unit
Corporate Governance &
Risk Management
Dr Stuart Dorney
Clinical Governance
& Medicine
• Adolescent Medicine
• Centre for the Advancement
of Adolescent Health
• Child Development
- PECAT
- DSU
• Child Protection
• CHISM
• CAPAC
• Deafness Centre
• Dentistry
• Emergency Services:
- Kidsnet
• Mental Health Services
- Psychological Medicine
- Hall Ward
- CAPTOS
• Outpatients
- Appliance Centre
• Rehabilitation:
- Brain Injury
- Limb Deficiency
- Physical Disabilities
- Spina Bifida
- Spinal Injuries and Disease
• Wade Ward
Ambulatory and
Emergency
Area Director for
Mental Health
Academic Surgery
Adolph Basser Cardiac Institute
Anaesthesia
Biomedical Engineering Inhalation Therapy
Burns
Burns Plastics Surgical
Treatment Centre
Clubbe Ward
CSSD
Edgar Stephen Ward
ENT
General Surgery - Transplant
Surgery, Trauma
Facio-maxillary Surgery
Grace Centre for Newborn Care
- NICU
Helen McMillan - PICU
Middleton – Day Surgery Ward
Operating Theatres
Ophthalmology
Orthopaedics
Plastic Surgery
Recovery & Anaesthetics
Surgical Unit
Theatre Porters
Urology
Perioperative &
Critical Care
Ms Annette Solman
Ms Cheryl McCullagh
• Patient Flow Unit Patient Administration
• Nursing Profession Practice Development
• Volunteers
Nursing
Clinical Operations
Dr Antonio Penna
Mr Alan Ching
Community Relations
& Marketing
CHIEF EXECUTIVE
Internal Audit
•
•
•
•
•
•
•
•
•
Dr Chris Cowell
Research
Education
HR Medical
HR General & Payroll
HR Clinical Programs
OHS&R/Workers Comp
Research Office
Ethics
Intellectual Property
Infrastructure Support
Clinical Trials
Clinical Research
CHERI
Laboratory Research
Population Health Research
•
•
•
•
•
Mr Frank Horn
Workforce
Development
ORGANISATIONAL STRUCTURE OF THE CHILDREN’S HOSPITAL AT WESTMEAD
11
Performance Summary
Performance Summary
Indicator
Strategic
Direction
Baseline
Target
Result
1
76.4
85
76%
90
96
100
100
80
100
To keep people healthy
A healthy start to life
Infants, admitted as inpatients with ‘not up to date’ status,
receiving documented catch-up immunisation (%)
To provide the health care people need
Emergency care without delay
Off-Stretcher time <30 minutes (%)
2
Emergency Department triage times – Cases treated within
benchmark times (%):
•
Triage 1 (within 2 minutes)
•
•
75
74
•
70
74
•
70
80
2
Emergency Admission Performance - patients transferred to
an inpatient bed within 8 hours of treatment (%):
2
•
Overall
74
80
79.1
•
Mental Health
70
80
92
Shorter waiting times for non-emergency care
Booked medical and surgical patients waiting (number):
2
•
Overdues > 30 days
0
0
0
•
Long waits >12 months
0
0
0
<2
5
Planned surgery - cancellations on the day of surgery (%)
2
To deliver high quality health services
High quality clinical treatment
Wrong patient, site, procedures (numbers)
2
0
▼
0
Falls in Hospitals (rate per 1,000 bed days)
2
0
▼
0
Net cost of service – General Fund (General) variance against
budget (%)
5
5.79
0
0.71
Creditors > Benchmark as at the end of the year ($’000)
5
1,335
0
0
Major and minor works - Variance against Budget Paper 4
(BP4) total capital allocation (%)
5
95.8
0
100.0
To manage health services well
Sound resource and financial management
Overall finance assessment
12
Health Service
Management
Accountability
Strategic
Direction
Reduce childhood
obesity
1
Process
Measure
Achievements in 2007/08 /
Further work to be done
Identify and manage
children and young
people attending
CHW who are at risk
of obesity
•
Establish the
prevalence of
overweight and
obesity among
CHW patients
•
Increase the
percentage of
inpatients for whom
height and weight
measurements are
recorded and charted
on Powerchart
•
Increased number
of children recruited
to Stretch and
Grow Program
Partially Achieved
Measures are documented
electronically in Powerchart.
Trend showing a steady increase
but room for improvement.
Further work
Collaboration continues with
SWAHS & DET on “Crunch and
Sip” program. (Supersedes
previous ‘Stretch and Grow’
program). Increased number of
schools involved in the “Crunch
and Sip” program.
Improvement of the Weight
Management Services – funding
provided by WCHN for
Obesity project.
Prevention of
Sports Injuries in
children
1
Collaborate with
other AHS to
enhance health
promotion and
prevention efforts for
children and young
people statewide
•
Safe physical activity
and sport for children
and youth program in
place (CHISM) (CHW)
Achievements
‘Physical as Anything’
Program used in schools.
CHISM conducts Train the
Trainer courses in physical
activity. Uses exercise testing
as a predictor in level of risk
of injury.
Further work
CHISM – examining role
of exercise interventions in
children with chronic illness
and disability
Refugee Children
1
Collaborate with
other AHS to
enhance health
prevention efforts
for children and
young people
•
Increased access to
services for Refugee
children (CHW)
Refugee children
06/07 = 190 clinic visits.
07/08 = 190 clinic visits.
Safe physical activity
Currently being trialled with
800 children in Western Sydney
Performance Summary
To keep people healthy
13
Performance Summary
To provide the health care people need
• Complete
‘Pulling our Wait’
Clinical Redesign
Program
• Steps of clinical
redesign followed
improving the
emergency
patient journey
• Progress
recommendations
from previous
project ‘Joining
the Dots’
• Continue
to progress
remaining
recommendations
from surgical
patient journey
redesign
2
• Emphasis on
sustainability of
skills in this area
14
Outcome measures –
sustainable access :
• KPIs
• long wait list
• DOSA rate
• triage waiting times
• access block
• consumer
satisfaction
Achievements
Progressing well in the face
of increased demand:
RSI continuously declining
DOSA rate on target,
Long waits maintained at or
near zero for 12 months
Triage waiting times all
improved on previous year.
Access block improved on
previous year.
Further work
The unplanned readmission
rate is: 06/07: 11.8%
05/06: 12.2% A decrease of
0.4% in readmissions.
Further refine patient flow
business rules, isolation
practices and transport.
Medical ward re-alignment
evaluation.
Health Services
Management
accountabilities
Strategic
Direction
Progress the
implementation of
shared services with
a focus on:
• the introduction
of new models
of care and
partnerships that
facilitate care in
the right setting
targeting
• orthopaedics
• diabetes
• transitional care
Process
Measure
Achievements in
2007/08 / Further
work required
Operationalise
the model of
partnership
between SWAHS
and CHW to
manage minor
trauma in
peripheral centres
Demonstrate
improvement from
baseline;
• reduce minor
orthopaedic trauma
presenting to CHW
by 10%
• reduce non-tertiary
proportion of
orthopaedic work
done by CHW by
10%
Partially Achieved
Approached GP
representatives who did not
wish to follow up children
with minor trauma that had
been treated at CHW
Further work
Plan to reapproach with new
group at next GP forum.
Approaching through
the Divisions of General
Practice State Contact, Matt
Hanrahan
Operationalise
the MOU between
Endocrine service
CHW and SWAHS
•
Appointment of
Endocrinologist by
Feb 07
Establishment of
regular clinics at
Nepean by Mar 07
Handover of >50%
of endocrinology
patients local to
Nepean, to Nepean
clinic by Jun 07
Achieved
MOU has been signed by
SWAHS; we have recruited
to the position in July 2007.
Education has commenced
and first clinics booked.
Reduce the number
of patients under the
care of CHW, aged
19 years and over,
by 50% by Jun 07
All remaining
patients 19 years
and over will have
transition plan
in place to be
completed within
2007
50% of patients
between 16-18 will
have documented
transition plan, to be
completed within 6
months of their 18th
birthday
Partially Achieved
Reduced both numbers of
admitted patients over 19
years from 135 to 87.
The numbers of outpatients
over 19 has increased, from
607 in 2006 to 670 in
2007. Some of the increase
is due to bringing patients in
to finalise transition plans,
as part of our strategy.
Further work
All specialties will have
a process for transition
articulated by the end of
this year.
The numbers of outpatients
over 19 will be targeted in
the year ahead. We expect to
see a steady reduction once
the backlog of patients has
been addressed.
•
•
5
Transition plans will
be established for
all subspecialties
•
•
•
Performance Summary
15
Performance Summary
Health Services
Management
accountabilities
Introduce a
responsible
spending culture at
CHW targeting
• high cost goods
and services
• waste reduction
• staff management
Progress the Shared
Corporate Services
agenda
• Achieve savings
• Ensure
appropriate SLAs
• Maintain
business
continuity
• Ensure high
quality service
is provided by
external provider
16
Strategic
Direction
5
Process
Measure
Achievements in
2007/08 / Further work
required
Ongoing
procurement
and tender
policy complied
and purchases
comply with state
contracts.
Expenditure of Goods
and Services including
drugs and high
value categories of
expenditure
Achieved
Goods & services variance
$1.5M or < 3% considered
small, reflecting significant
number of new cost
saving initiatives, eg blood
and drugs noted huge
improvement.
Waste reduction – VHIA and
Clinical Redesign Program
identified big reductions
in waste.
Staff management – ERE
variance $1.7M or < 1%,
very small due to restraint
over recruitment, clinical
redesign and salary
packaging savings $2.9M.
Savings achieved with
reduction of staff
– estimated to be 10
FTE total
Achieved
Transitioned: IT –
October 2006.
Purchasing, payables,
general ledger, sundry
debtors – February 2007.
Payroll – May 2007.
Transferred ten staff to
Health Technology. Four
other staff transferred to new
positions in the Performance
Improvement Unit.
Numerical waste
audit
Implementation of
Shared Services
and transition of
Health Technology,
IMET & Health
Support
5
Departments
planned during
06/07 include
Purchasing, AP,
Sundry Debtors
and Payroll
Major actions
achieved/initiated
Major actions for
2007/08
• Improve access to quality healthcare
• Sustained improvement in
all measures of Access for
patients presenting to ED
despite increased activity
– now meeting targets.
- Enhanmced staffing
- MAU
- EMU
• Reduced waiting times for
outpatients
• Improved all waitlist
indicators for planned
procedures
• Appropriate access to
outpatient services
• Improved access for
mental health patients
• Reduce waiting time for
Interventional Radiology
• Improved time
of throughput of
patients attending the
emergency department
• Continue to maintain
and improve on
performance
• Improve survival rates and quality of life for people with
potentially fatal or chronic illness through improvements
in health care
• Safe discharge of long
term ventilated patients
home
• Management plan for
asthmatics
• Increase of immunisation
uptake
• Strengthening of split liver
transplantation practices
• Introduction of the
Children’s Home
Ventilation Program
• Enhance Cardiac
services
• Enhance Cerebral Palsy
services
• Lymphoedema Clinic
• Improve Liver
Transplant services
• Employment of
additional Transplant
Surgeon
• Continue to improve
timeliness of discharge
for Children’s Home
Ventilations Program, aim for stay < 6 months
• Improved health through reduced obesity, smoking, illicit
drug use and risk drinking
• Safe physical activity
program
• Delivery of weight
management clinic for
children and adolescents
• Member of SWAHS & DET
Strategy Group – mental
health and drug related
issues working group
reports to this group
• Expansion of CNC hours to
improve access to family
obesity clinic
• Hospital became
smoke free
• Smoke cessation
education program
• Expansion of weight
management services
• Development of clinical
pathways for obese
children
• Further involvement in
the SWAHS and DET
Strategy Group
• Investment in medical
staff to sustain obesity
service
• See customer complaint
as opportunity to
improve through Public
Accountability
• Complaints resolved
within 35 days (975)
• Survey children, young
people and families
• Involve parents/carers in
planning services
• Increase committees
with consumer and GP
representation
Healthy Communities
Performance Summary
Actions and initiatives supporting
NSW State Plan
Customer friendly services
• Increased customer satisfaction with Government services.
17
Performance Summary
Strengthening Aboriginal communities
• Improved health for Aboriginal people
• Updated Aboriginal
Health Plan
• “Yarning Circle” cultural
training
• Launch of Aboriginal
Garden – July 2007
• Continue to implement
Aboriginal Health and
Workforce plans
• Telemedicine outreach – 41
community health services
across four rural and
remote areas
• Mental Health Ward
functioning at full capacity
• Statewide Eating Disorders
Service
• Joint assessment with
DADHC for Autism and
Developmental Disability
• Joint collaboration with
SWAHS and CHW eg
Redbank House Clinic
• Introduction of Emergency
Department Mental
Health CNC
• Research into Eating
Disorder Management Model
• Plan for expansion of
emergency mental health
services
• Further collaboration with
SWAHS and other AHS
• Increase academic and
research profile
• Expand Mental Health
Services such as telemedicine,
networks with community,
transcultural services
• Increase hours and scope of
Mental Health CNC
• Potential to increase beds
available to eating
disorder patients
• Introduction of Eating
Disorder CNC
• Embedding the principle of prevention and early
intervention into Government service delivery
in NSW
• Promotion of immunisation
• Neonatal Screening
• Genetic counselling
for parents
• Regular interviews and
media articles on relevant
paediatric health topics
• Collaborate with other
children’s hospitals as a
single voice for child and
adolescent health
• Child protection promotional
program in place
• Burns injury prevention
program in place
• Ongoing road safety
promotional program
in place
• Development of a brokerage
model for funding of CP
patient allied care
• Increase identification of
potential obesity in children
presenting to CHW
• Health promotion and health
prevention activities external
to CHW
• Implement an agreed
coordinated advocacy plan
• Implement brokerage model
with support of NSW Health
• Engage in partnership with
DET re transition of children
to adulthood
• Reduced avoidable hospitalisations
• Continue to implement
redesign programs
• Improved quality and safety
of treatment with reduced
unplanned events
• Identification of changes in
paediatric workforce trends
and develop appropriate
strategies
• Community outreach
modified service, - addition
of Nurse Practitioner
• Evaluate models of care to
ensure improved outcomes
• New model design underway
for pilot targeting skin
conditions and Cystic
Fibrosis
Opportunities and support for the most vulnerable
• Improved outcomes in mental health
Early intervention to tackle disadvantage
18
The Chief Executive is responsible for the
corporate governance practices of The
Children’s Hospital at Westmead. This
statement sets out the main corporate
governance practices in operation
throughout the financial year.
Strategic Direction
The Chief Executive has in place processes for the
effective planning and delivery of health services
to the communities and patients serviced by The
Children’s Hospital at Westmead. This process
includes setting of a strategic direction for both The
Children’s Hospital at Westmead and for the health
services it provides.
Corporate Governance Statement
The Chief Executive
The Chief Executive carries out all functions,
responsibilities and obligations in accordance with the
Health Services Act of 1997.
The Chief Executive is committed to better
practices contained in the Corporate Governance
and Accountability Compendium for NSW Health
published by the NSW Department of Health.
The Chief Executive has in place practices that ensure
that the primary governing responsibilities in relation
to the public health organisation are fulfilled with
respect to:
•
•
•
•
setting strategic direction
•
•
•
monitoring the quality of health services
•
ensuring ethical practice.
ensuring compliance with statutory requirements
monitoring performance of the organisation
monitoring financial performance of
the organisation
industrial relations / workforce development
monitoring clinical, consumer and
community participation
Code of Conduct
The Hospital has adopted the NSW Health Code
of Conduct (the Code) to guide all employees
and contractors in carrying out their duties and
responsibilities. The Code covers such matters as
professionalism and competence, conflicts of interest
and fairness in decision making.
Appropriate communication strategies have been in
place during the year to ensure that all employees
are aware of the Code. The Code and Statement of
Business Ethics are available on the Hospital web site.
Risk Management
The Chief Executive is responsible for supervising
and monitoring risk management by the public
health organisation, including the organisation’s
system of internal controls. The Chief Executive
has mechanisms for monitoring the operations and
financial performance of the organisation.
The Chief Executive receives and considers all reports
of the organisation’s external and internal auditors
and, through the Audit and Risk Management
Committee, ensures that internal audit and external
audit recommendations are implemented.
19
There is in place a risk management plan for the
public health organisation. This plan enables the
management of key risk areas including:
Audit and Risk Management
Committee
• clinical
The Chief Executive has established an Audit and Risk
Management Committee.
• workforce
• infrastructure / environmental
• governance
This committee is chaired by Mr Kevin Doyle
(independent member) and consists of the following
members:
• reputation
• Mr John Dunlop (independent member)
• finance
• Chief Executive
Committee Structure
The Children’s Hospital at Westmead has a
committee structure in place to enhance its corporate
governance role and which complies with NSW
Department of Health policy regarding mandatory
committees – Health Care Quality Committee, Audit
and Risk Management Committee, Finance and
Performance Committee, and Medical and Dental
Appointment Advisory Committee. These committees
meet regularly and have defined terms of reference
and responsibilities.
20
The Audit and Risk Management Committee
meets quarterly.
The objectives of the Audit and Risk Management
Committee are to:
• maintain an effective internal control framework
• review and ensure the reliability and integrity of
management and financial information systems
• review and ensure the effectiveness of the internal
and external audit functions
Health Care Quality Committee
• monitor the management of the key risk areas
The Chief Executive has in place systems and
activities for measuring and routinely reporting on the
safety and quality of care provided to the community.
These systems and activities reflect the principles,
performance and reporting guidelines as detailed
in NSW Department of Health core documentation
relating to Managing the Quality of Health Services
in NSW.
Engagement of External Auditors
The Hospital did not engage external auditors to
conduct any non-audit assignments.
The Chief Executive has established a Finance and
Performance Committee.
This Committee is chaired by the Chief Executive and
consists of the following members:
• Mr John Dunlop (independent member)
• Mr Kevin Doyle (independent member)
• Director of Information Services and Planning
• Director of Clinical Governance and Medicine
• Director of Clinical Operations
• Director of Finance and Corporate Services
• Director of Community Relations and Marketing
Performance Appraisal
The Chief Executive has ensured that there are
processes in place to:
Finance and Performance
Committee
• monitor progress of the matters and achievement
of targets contained within the performance
agreement between the Chief Executive and the
Director-General of the NSW Department of Health
• regularly review the performance of the Hospital
through the Annual Governance Review process
• annually review the performance of employees in
line with corporate objectives and targets
• annually review the performance of all
Executives who are employed under the
Senior Executive Service Award, through
current performance agreements
• Director of Workforce Development
• Director of Nursing
The Finance and Performance Committee
meets monthly.
The objectives of the Finance and Performance
Committee are to:
• examine budget allocations
• monitor overall financial performance in
accordance with budget targets
• develop and maintain an efficient, cost effective
finance function and information systems
• ensure appropriate financial controls are in place
• manage funds effectively
The Chief Executive complies with the provisions
of the Accounts and Audit Determination for public
health organisations, issued by the NSW Department
of Health.
21
Clinical Governance
Clinical Governance
Clinical Governance is the term used to describe the
systems and processes that ensure that the health
care provided at The Children’s Hospital at Westmead
is safe and of the highest quality possible. The
Clinical Governance Unit is known as the Service
Improvement Unit (SIU) and its major role is to
coordinate improvement, patient safety and consumer
participation activities for the Hospital as a whole.
The Health Care Quality Committee (HCQC) meets
once a month to oversight the clinical governance,
quality improvement, patient safety and accreditation
processes at the Hospital which are coordinated
and managed by SIU. As well as supporting
HCQC, SIU also supports several other high level
Hospital committees, such as the Clinical Review
Committee, Policy and Procedure Committee, Public
Accountability Committee, Clinical Review Committee
and the Family Advisory Council.
Patient safety initiatives have continued to be a focus
for the SIU this past year. We have further developed
and embedded incident reporting and management
as a cornerstone of improving safety and quality. A
key part of our Safety at Kids Program is the Incident
Information Management System (IIMS), where we
continue to collect incidents with a strong emphasis
on recording ‘near misses’. This information is
analysed and looks for trends and opportunities for
improvement. SIU is continuing to help staff view
every incident and near miss as an opportunity for
improvement to the system.
The SIU continued to coordinate a number of hospital,
state-wide and national projects to improve patient
safety and quality of care. As a result, significant
improvements have been made in reducing surgical
site infections, central venous related blood stream
infections in the Intensive Care Unit and hospital
acquired infections throughout the Hospital.
One key project which underpins many of the other
projects is improving the hand hygiene practices
of staff throughout the Hospital. Our compliance
rate for June 2008 was 85% and was the highest
22
rate recorded by any Area Health Service in NSW.
This figure was the eighth month in a row where we
recorded over 80% compliance with hand hygiene
practice. NSW Health and the Clinical Excellence
Commission have commended the success of our
approach and achievements, which were featured in a
recent state-wide HAI newsletter.
Development continued on CHARLI Children’s
Hospital Achievements Research Links &
Improvements) the Hospital’s database for
recording improvement activities, special
achievements, external visits and information
sharing. Screen designs were documented with
programming and testing well underway. CHARLI
is due to be launched in late 2008.
Major policy and procedure (P&P) processing
improvements were implemented during 2007-2008,
as proven through an evaluation undertaken in
July 2007 which confirmed that all of the new P&P
processes are significant improvements from preexisting processes and that staff are more confident in
using hospital documents.
The Hospital now produces high quality policies,
procedures and guidelines and the improvements
made in the last 18 months have been so successful
that our P&P framework is being recognised
throughout the State. Several meetings have occurred
with NSW Health, other Area Health Services and
organisations, such as the Western Child Health
Network, for them to look at and assess the feasibility
of implementing our processes, in particular
ePolicy (our document control database), into their
organisations.
During 2007-2008, 165 improvement projects
were logged with the SIU, all of which underwent
comprehensive ethical review and received support
by the SIU. A large number of these improvement
projects involved consumers, through activities such
as surveys, focus groups, forums and consumer
involvement on project teams.
Clinical Governance
SIU continued to coordinate the benchmarking
activities through the Australian Council on Healthcare
Standards (ACHS) and submitted over 50 indicators
each six month period for comparison with other
hospitals. SIU uses the comparative information
provided by the ACHS to create user-friendly reports
for the information and action of the relevant
stakeholders, which includes the HCQC. SIU is also
taking a lead in coordinating benchmarking with
the member hospitals of the Children’s Hospital
Australasia (CHA). The Mental Health specific interest
group has progressed significantly in the last year to
compare various clinical and operational indicators
with peer hospitals.
Improvement and Safety Week was held from 15-19
October 2007 and was a huge success with much
positive feedback received from staff. Around 600
staff attended events during the week and the profile
of improvement and safety was greatly enhanced. Not
only did a large percentage of staff attend the events
held during the week, the SIU Intranet site had triple
the number of hits as normal, with almost 900 hits
being recorded in October 2007.
2007 Quality at Kids Awards
We had another successful Quality at Kids Awards
(QuAKs) in 2007, with the results being announced
during the August Staff Forum. There were a total of
23 entries submitted, comprising involvement from 99
staff members. The Judges Choice was awarded for
the eight entry categories and a Highly Commended
was also awarded in four of these categories. One
Special Award, the Caring for Parents and Carers
Award, was also awarded. The judging for the QuAKs
Awards occurs completely independently of the SIU
and the panels of judges are drawn from the Executive
and representatives from directorates, programs and
divisions. It was great to see so many staff packed
into Lorimer Dods to support their colleagues and to
celebrate improvement at the Hospital.
CHW also had 13 entries in the 2007 NSW Health
Awards, with two becoming finalists, which were:
• The ‘Prioritising Paediatric Care in Disasters’
project submitted by the Emergency Department
in the ‘New Risks and Opportunities’ category
• The ‘Water Watcher Armband - Keeping Kids Safe’
project submitted by Kids Health in the ‘Make
Prevention Everybody’s Business’ category
These two projects plus three of our non-finalist
entries were asked to present their project at the
NSW Health Expo in October. The three additional
projects were:
• The ‘Parent and Carer Resource Centre A Practical Approach to Caring for Carers’ project,
submitted by SIU in the ‘Better Experiences for
People using Health Services’ category
• The ‘Communicating Hands Free in the Kids
ED’ project, submitted by IT Services and the
Emergency Department in the ‘Smart Choices
about the Costs and Benefits of Health
Services’ category
• The ‘Prioritised Clinical Assets Replacement Plan’
project, submitted by the Equipment Committee in
the ‘Smart Choices about the Costs and Benefits of
Health Services’ category
We also won an award in the Performance Awards
Division, which was Most Improved Performance in
the ‘To Manage Health Services Well’ category.
23
Clinical Governance
Category
Results
Safety Of Service
Judges Choice: Implementing Oral Syringes in ED
(submitted by the Emergency Department)
Highly Commended: Reducing CVC Related Bloodstream Infections in
PICU (submitted by SIU and PICU)
Appropriateness of Service
Judges Choice: Push Hard Push Fast
(submitted by the Resuscitation Committee)
Effectiveness of Service
Judges Choice: Policy and Procedure Processing Improvements (submitted
by SIU and IT Services)
Highly Commended: Improve Hospital Inpatient Revenue (submitted by
Patient Administration)
Prevention and Health Promotion
Judges Choice: Healthy Food and Drink Provision at CHW
(submitted by Nutrition & Dietetics and Food Services)
Partnerships with Consumers
Judges Choice: Parent and Carer Resource Centre (submitted by SIU)
Highly Commended: Refurbishment of the Clancy Ward Interview Room
(submitted by Clancy Ward)
24
Partnerships with External Groups
Judges Choice: The George Gregan Foundation Playground
(submitted by Fundraising and Allied Health)
Education and Training
Judges Choice: Physio’s Think Kids (submitted by Physiotherapy)
Special Award Results:
Caring For Parents and Carers Award
Parent and Carer Resource Centre (submitted by SIU)
Clinical Governance
Complaints Management,
Carer Support and
Consumer Participation
Complaints management is the responsibility of
the SIU and there are two designated complaints
managers at the Hospital, the Director of Clinical
Governance and Medicine, Dr Stuart Dorney, and the
Patients’ Friend, Betty Radcliffe.
All complaints are taken seriously and documented
very carefully. As much time as is required is spent
with families in order to ensure that their concerns
are addressed fully. Some matters are easily and
quickly resolved. Others of a more serious or complex
nature may take a number of weeks and numerous
discussions and meetings to reach a satisfactory
outcome.
Frequently raised issues include difficulties with
physical access, access to services, communication
and hotel services.
All complaints and the processes involved in achieving
resolution are reviewed by a high level committee,
the Public Accountability Committee (PAC), which
meets quarterly. The Chief Executive chairs PAC and
membership includes most of the senior executive,
a representative of the Medical Staff Council and
two community representatives. The complaints
mechanism is a rich source of improvement activities
and each complaint is regarded as an opportunity to
review and revise policy and practice.
During 2007-2008, 272 patient complaints were
received, with 16 of these being Ministerials and
seven being referred from the HCCC. NSW Health
KPIs for complaints management are 100%
acknowledgement within five working days and 85%
resolution within 35 working days. Our KPIs for the
year under review are 92% and 96.5% respectively
and we are consistently the best performer in
complaints management across NSW Health.
We participated in the 2007-2008 NSW Health
Patient Survey and we were very pleased with our
results. Across three categories, paediatric inpatients,
emergency patients and outpatients, 89% of families
rated our overall care as very good, which was higher
than the State average of 88%.
In July 2007, the evaluation report of the Parent and
Carer Resource Centre (PCRC)was finalised, with
initial data confirming a dramatic increase in average
daily visits to the PCRC from May 2006 to May 2007.
We also increased the proportion of male service
users and people from ATSI and CALD backgrounds.
In July, the new policy, ‘Supporting Staff who are
Carers’, was finalised and the Carer Support Program
(CSP) formed a partnership with the Working Carers
Liaison Project, run by Hills Community Care, to offer
services and support to our staff who are carers.
The CSP took a lead role in the refurbishment of the
parent lounges on each of the wards in August 2007.
Carers Week was celebrated and was a very
successful week. In May 2008, the CSP began the
first ever hospital-based MyTime group in Australia
and is working in partnership with Playgroups
Australia. The Carers Action Plan was developed,
consulted on and finalised over the 2007-2008 period
and submitted to NSW Health in July 2008. The
Carer Support Program continued to offer a range
of events and activities for parents and carers in the
Parent and Carer Resource Centre throughout 20072008, with almost 4000 occasions of service.
The Family Advisory Council is the peak consumer
group at The Children’s Hospital at Westmead and is
a dynamic and motivated group of parents who have
made significant contributions to improvements at the
Hospital. Some of the things they have been involved
in this year and have provided feedback from a family
perspective are:
•
•
•
•
The redesign of the Emergency Department
The CHW Smoking Cessation Committee
Various Clinical Redesign projects
The Improvement Action Plan from the 2007 NSW
Patient Health Survey, and
• Staff Guidelines on Consumer Participation
The FAC have also been Involved in the recruitment
of several key consumer staff positions, as well as
looking nationally and internationally at how best
practise peak consumer groups operate elsewhere.
25
Clinical Governance
Activity Levels
Notes
2007/08
2006/07
2005/06
339
Bed Capacity
Total Beds at 30 June
339
339
Average number of beds available during year
1
266
264
268
June bed Equivalents
2
267
272
271
Patient Details - Inpatients
Number in hospital at 1 July
211
194
207
25,731
27,625
26,775
Planned as % of total admissions
53%
45%
48%
Same day as % of total admissions
43%
47%
48%
25,965
27,836
26,969
Separations during year
Total patients treated
Number in hospital at 30 June
Bed days of inpatients treated
234
211
194
88,080
87,526
86,165
Acute Bed Days
3
88,080
87,526
86,165
Overnight acute bed days
3
77,009
74,627
73,391
14,274
13,537
13,294
732,947
575,147
665,537
Number of operations
Outpatients
Total occasions of service
4
Emergency Department attendances
Expenses – All Programs ($1000)
49,630
48,895
45,818
313,777
301,908
275,907
Averages
Daily average of inpatients
5
Adjustment for outpatients
241
240
236
200
188.0
182.3
Adjusted daily average (ADA)
6
441
428
418
Average stay of inpatients (days)
7
3.42
3.17
3.22
8
86%
83%
90%
Bed occupancy rate (%)
(after adjustment for weekday beds)
Notes:
1. The 2005/06 figure is not comparable with other years as it covers only June data instead of full year (due to the introduction
of SAP Bed count system). It is calculated as Total Available Beds / No. of days in financial year.
2. 2007/08 and 2006/07 figures are not comparable with previous years as they exclude bed types mentioned in Note 1. They
are calculated as Total June Beds/30.
3. Acute bed days and acute separations are defined by service category of acute or new born.
4. Total occasions of service includes groups, individual and telephone consults excludes some activity performance programs.
5. Daily average of inpatients = Total Bed Days / No. of days in financial year.
6. Adjusted daily average = Daily average of inpatients + Adjustment for outpatients.
7. Acute average length of stay = Acute bed days / Acute separations.
8. 2007/08 and 2006/07 information are not comparable with previous years as bed occupancy calculations now exclude
the following bed types: Emergency Departments, Delivery Suites, Operating theatres and Recovery Wards, and include
surge beds.
26
The Information Services Portfolio has been expanded
to include Planning and Population Health.
Highlights through the year include:
• The finalisation of key strategies to guide the
Hospital into the future including a Corporate
Strategic Plan, supported by a draft Healthcare
Services Plan, Financial Impact Statement and
Clinical Service Plans. Underpinning these are a
range of key enabling plans, including financial,
asset, workforce and IT, which ensure our planning
becomes reality by providing the necessary
building blocks. The emphasis has now shifted to
marketing the Hospital’s vision of ‘Healthy Children
for a Healthy Future’ and building on our strengths
as leaders in clinical care, research and education.
Service Planning
Service Planning
• The Governance process for setting priorities and
the approval of business cases has been refined
and adopted Hospital-wide. All initiatives are now
tracked in a central data base.
• Our planning and performance framework is
supported by excellent technology and has
been expanded to include a corporate
scorecard, operational dashboards,
management reporting and risk-profiling.
This will provide the Hospital with the ability
to track performance against strategy
27
Overview of Operations
Ambulatory and Emergency
Program
The Ambulatory and Emergency Program represents
a group of clinical departments and wards that
provide services to children with a wide range of
medical, developmental and behavioural conditions.
The Program includes the Emergency Department
and inpatient services within the adolescent and
mental health wards. The other Departments primarily
provide outpatient services through the Outpatient
Clinics, Child Protection Unit, Child Development
Unit and the Departments of Adolescent Medicine,
Deafness Centre, Dentistry, Psychological Medicine,
Rehabilitation and the Children’s Hospital Institute of
Sports Medicine (CHISM). Where required, outpatient
services are provided through home and school visits.
During the past year, initiatives have occurred in all
areas in response to changing needs, demands and
new opportunities.
Adolescent Medicine
Comprehensive multi-disciplinary health care and
health promotion is provided for young people with
complex medico-psychosocial presentations, nutrition
and eating disorders, chronic illness, disability
transition and gynaecological issues.
The key highlight over the past year was the highly
successful International Youth Health Conference, that
attracted over 500 participants from across Australia,
New Zealand and the South Pacific. An inaugural
Fellowship in Adolescent Addiction Medicine
provided an excellent training opportunity, increased
awareness of addiction issues among young people
and improved systems of assessment and early
intervention.
The Transition Care Project enabled better planning
and preparation for young people with a wide range of
chronic conditions moving into adult health care. New
triage procedures were introduced to ensure timely
assessment of young people presenting with complex
conditions. Planning towards the establishment of
a Chair in Adolescent Medicine was undertaken, in
conjunction with Sydney University.
28
Child Development Services
Child Development Services are located within the
Child Development Unit (CDU), the Parramatta
Early Childhood Assessment Team (PECAT) and the
Disability Specialist Unit (DSU), Burwood. These
services provide a comprehensive range of tertiary
level assessments of children with developmental
delay and complex developmental disorders from
across NSW.
A major working meeting was convened to enhance
communication and networking among developmental
disability services within NSW. The meeting initiated a
major service mapping exercise that will enable better
service planning and coordination. Within the CDU,
assessments of preschoolers were further refined
with updated testing tools. There was an increase
in joint consultations with genetics services and a
comprehensive survey was undertaken to obtain
feedback from parents and other services on the
assessment process and services provided.
The survey confirmed the high regard for this
specialised developmental service and identified
opportunities to enhance communication and
information provided. The Developmental Outreach
Service to Broken Hill was further consolidated.
The School Starters Group, led by Social Worker,
Janis Mendoza, and Occupational Therapist, Neralie
Cocks, was further enhanced with the integration
of successful parenting techniques and received
recognition at the International Conference on Social
Work in Health Care.
At DSU, new medical specialist appointments
were made with Dr Anna Ward, Staff Specialist
in Developmental Disabilities and Dr Jim Xu,
Rehabilitation Staff Specialist (adults with
developmental disability), commencing. A Clinical
Psychology Student Placement Unit was also
established at DSU, led by clinical psychologist Louisa
Carroll, in conjunction with the University of Western
Sydney and University of NSW.
The Unit provides experience in diagnosis and
assessment of children and adults with developmental
disability. A project was undertaken to establish
and refine a key referrer pathway. This initiative has
enabled more timely and effective referrals and better
support for families through the assessment process
when parents often learn about the extent of their
child’s disability.
At PECAT, new Visiting Medical Officer appointments
were made, with Dr Meg Phelps and Dr Robert
Hardwick. A range of initiatives were also introduced
to provide more information and support families
through the assessment process. An interagency
forum was conducted to inform a wide range of early
childhood organisations about services provided
through PECAT and to enhance networking and
collaboration among services.
Dr Paul Hutchins, Dr Natalie Silove, Dr Jacqueline
Small and Dr Bee Hong Lo made significant
contributions to the field of developmental paediatrics
with major contributions to the development of policy
and practice in areas such as autism intervention,
early childhood services, developmental screening,
needs of people with intellectual disability and
management of ADHD.
Child Protection Unit (CPU)
The Child Protection Coordination Committee, chaired
by the Chief Executive, brought greater recognition
of child protection as an important concern for all
clinicians.
Clinical services were surveyed in relation to their
support needs when dealing with complex and
challenging child protection situations and inservice training programs were further enhanced.
Involvement in World Child Abuse Prevention Day and
promotion of The Children’s Hospital at Westmead’s
Child Protection Awards has increased awareness of
vulnerable children and the value of early intervention
and timely support to families experiencing parenting
stress.
Dr Anna Stakurska established a new developmental
assessment and screening service for children in outof-home care, a new clinic was established for review
of complex sexual assault cases and the Shaken
Baby Prevention Project gained wider international
recognition through a range of conference
presentations. The CPU also received recognition
at the QUAKS Awards for the Healthy Children’s
Program, which provides an outreach service to the
Sydney West Addiction Services for young children
who have parents enrolled in a methadone program.
Children’s Hospital Institute for
Sports Medicine (CHISM)
CHISM provides a leading service in clinical paediatric
sports medicine, paediatric sports physiotherapy,
clinical research, education and training. This year
saw a significant increase in the number of patients
referred from clinical departments within the Hospital,
particularly from the Weight Management Service and
Endocrinology, as well as an increase in the number of
referrals from external sources.
Research was initiated into ‘best practice’ models for
exercise testing and exercise prescription for children
with a wide range of illness and disability, such as
haemophilia, cerebral palsy, insulin resistance and
morbid obesity. A major initiative was taken toward the
establishment of a national Adopt-a-School Program,
to promote fitness in schools in partnership with the
peak body, Fitness Australia.
CHISM received international recognition through
links established with KK Women’s and Children’s
Hospital in Singapore and Beijing Children’s Hospital,
and contributed to the establishment of paediatric
sports medicine in these hospitals through hosting
visiting fellows. A new Human Movement Laboratory
was opened in the Research Building, which provides
state-of-the-art exercise equipment and much needed
additional space for testing.
The Deafness Centre
Hearing loss is a common and pervasive problem.
It may invade every aspect of a child’s or adult’s life.
At some time in their lives, one in six Australians
will have a problem with hearing loss. To help draw
attention to this problem, the Deafness Centre,
Audiology, Psychological Medicine and the Children’s
Cochlear Implant Centre organised an information
stall in the Hospital for Hearing Awareness Week to
highlight services available to assist deaf and hearingimpaired children and their families.
In addition, the Deafness Centre and Educators of
Deaf Students Association held a conference in July
which was helpful in updating many people regarding
recent developments in deafness. It also allowed our
staff to network with many teachers of the deaf from
rural and metropolitan areas. A combined Deafness
Centre/ Psychological Medicine Clinic was established
to address the emotional and behavioural problems of
deaf and hearing impaired children.
29
Dental
A comprehensive dental care service is provided for
inpatients and outpatients requiring complex dental
care, often associated with other medical conditions.
A research project was commenced to evaluate new
restorative dental materials and better understand
saliva flow in patients with chronic and disabling
conditions. Oral health education programs were
introduced into support groups for parents of children
with haemophilia, renal problems and liver disease.
Head of Department, Dr Richard Widmer, also made
significant contributions to oral health education
through training programs for rural doctors, speech
pathologists and nurses.
Eating Disorders Service
The Eating Disorders Team, led by Dr Michael Kohn
from the Department of Adolescent Medicine and Dr
Sloane Madden from Department of Psychological
Medicine, has received recognition of their world
standard service in obtaining a NHMRC grant for
$530,000.
The study is examining the effectiveness of the
Maudsley Model Family Therapy Service with a
shorter versus longer admission, and is conducted
in collaboration with the Adolescent Medical Service
at Westmead Hospital. The study has the potential to
further advance care by reducing the amount of time
young people with eating disorders need to stay in
hospital.
Emergency Department
During the year 48,974 patients were seen and
treated in the Emergency Department. There was an
increase in the numbers of children presenting with
gastroenteritis in spring, asthma at the start of the
school year and bronchiolitis in autumn. The increase
in the numbers of acutely ill children presenting to
Emergency has continued to put pressure on waiting
times. Changes planned for the next financial year
will improve the overall patient experience for children
and families.
There was a focus on the journey of emergency
patients through the Hospital in a major Clinical
Redesign Project. The Project reviewed the full
patient journey through the Emergency Department,
diagnostic tests, admission to wards and discharge
from Hospital. Focus groups were held with both
30
families and staff to obtain their feedback and gather
ideas for improvement. These discussions produced a
range of ideas which were able to be implemented to
streamline the patient journey.
The Emergency Department received a QUAKS
awards in 2006 for service improvement projects on
safely administering medications via infusions pumps
and submitted four projects for the QUAKS awards for
2007.
Kidsnet received a total of 17,627 calls over the year
from parents regarding the acute care of their child.
Our experienced nursing staff give advice on common
illnesses and direct families to the most appropriate
care for their child.
Our outreach services are undergoing a major review
to work towards service delivery which allows for
children to be cared for in the home.
Mental Health Services
Mental Health Services have made significant
progress through expanding partnerships, new
appointments, improving services, establishing
internationally recognised research and contributing
to statewide planning to address an increase in the
demand for Mental Health Services in the Emergency
Department of 300% over the past three years.
The role of the Mental Health CNC in the Emergency
Department has become an integral part of
emergency services, providing more timely and
effective assessment of young people with acute
mental illness. There has also been a corresponding
reduction in clinical incidents, including presentations
of incidents involving self-harm or aggressive
behaviours, through more systemised harm
minimisation training for our Emergency Department
staff.
The leadership of Hall Ward Mental Health Inpatient
Unit has been consolidated with the appointment
of Dr Lucy Chapman, who works collaboratively
with the Nursing Unit Manager, Mr Earle Durheim,
in a nursing/medical co-management model. Hall
Ward is leading the development of standardised
clinical indicators throughout the Australasian Child
and Adolescent Mental Health Services to facilitate
benchmarking environments that specialise in this
area.
As part of the closer collaboration with Sydney West
AHS, an Outreach Mental Health Service has been
established through two staff attending community
clinics at Castle Hill and Parramatta North. The
initiative will provide better access to specialist
assessment for children and young people and clinical
support for community health professionals providing
ongoing care.
The clinical partnership with the Statewide
Behavioural Intervention Service of the Department
of Aging, Disability and Homecare has produced
important new research initiatives to assist children
with developmental disabilities in two areas. The first
involves the development of educational curricula to
train community professionals treating children with
mental health problems and intellectual disability. The
second aims to establish and research an EmotionBased Social Skills Training Program for young
people with Autism or Asperger’s Syndrome and mild
intellectual disability.
The Child and Adolescent Psychiatric Telemedicine
Outreach Service was consolidated through research
that found a high level of satisfaction with the range
and quality of the teaching and supervision provided.
A statewide reference group is being developed
to enable further service planning in collaboration
with the Child and Adolescent Mental Health
Subcommittee of the NSW Mental Health Program
Council.
Ruth Urwin, molecular biologist was the coinvestigator for two significant NHMRC grants for
$422,000 for ‘Relating genetic, biological, and
behavioural markers of early vulnerability in conduct
problem children’ and $472,000 for ‘Healthy Start to
Life’.
In the last year, the Program developed a number
of initiatives to assist children and young people
with complex needs who are in out-of-home-care.
A partnership between The Children’s Hospital at
Westmead, Sydney West AHS and the Department of
Community Services was further developed, with the
appointment of an additional part-time staff psychiatry
position. A specialised mental health service for
children in care of DOCS was also enhanced, with
the appointment of a Clinical Psychologist. This has
enabled a significant number of children who require
intensive support to be able to live in the community.
NSW Centre for the Advancement of Adolescent Health
The Centre aims to build the confidence and
capacity of partner agencies in responding to youth
health issues through research, dissemination of
information and resources, delivering professional
education and training and contributing to advocacy
and policy development. Key highlights have been
the organisation of a major youth health forum,
‘Youth Services in Western Sydney’, the launch of an
important report on young people’s access to health
care, publication of a youth health better practice
framework and completion of the Spinning the Web
Project, which will improve the coordination and
linkages among services.
Outpatient Department
Over the past three years, the number of outpatient
attendances has doubled. The increase in outpatient
activity has produced new challenges and this
year has seen a number of exciting changes. The
management structure of the Department was
enhanced with the establishment of a new Clerical
Manager position and increased administrative
support to the Eye Clinic. Telecommunications have
been upgraded, resulting in significant reductions
in waiting times for parents making appointments
and more efficient processes for staff. A monthly
newsletter has been created to inform staff of new
developments and involve all clinical teams in service
improvements.
The customer focus has been further enhanced, with
the streamlining of check-in procedures. There is
now a smoother flow of patients, even on the busiest
clinic days, with very few complaints regarding delays.
There have been corresponding improvements in the
accuracy of data collection and billing procedures.
An innovative Clinical Nurse Specialist position was
established to support the ENT clinics and assist in
identifying children with more urgent problems.
Rehabilitation Department
The Rehabilitation Department is a leader in five
specialist clinical areas, cerebral palsy, spinal cord
injury and disease, acquired brain injury, spina
bifida and limb deficiency. A tertiary and quaternary
multidisciplinary clinical management service is
offered for children and adolescents with physical and
acquired cognitive disability.
31
The Department faces a growing demand for services,
after a 20% increase in occasions of service in the last
12 months. Inpatients and outpatients from across
NSW are treated and a model of transition is in place,
whereby children are seen regularly over several years
and then referred to an adult service for ongoing
management.
The Rehabilitation Department is a training centre for
consultant Rehabilitation Paediatricians and utilises
a multidisciplinary, family-focused model of care.
Significant input into the Connective Tissue Dysplasia
Service is provided, which is coordinated through the
Clinical Genetics Department.
Inpatient and outpatient provision of care is being
reviewed by the Rehabilitation Department. This is
focussing on inpatient and outpatient rehabilitation
activity. The pivotal role of the Clinical Nurse
Consultants in the relevant areas is also being
reviewed.
Growth of clinics, increase demand on clinic and
assessment space and increases in staff numbers
will continue to require consideration for capital
works and/or acquisition of suitable space for clinical
practice to take place.
to link with their model of care and offer a more
coordinated medical specialist review.
Active pursuit and assessment of suitability of
improved treatment options will continue to be
undertaken. Functional electrical stimulation cycling
and strengthening for children with spinal cord
lesions, or as part of a spasticity treatment program,
has been implemented.
Brain Injury Service
We have been reviewing resources, service delivery
and staffing, to improve service provision to children
with brain tumours and children following epilepsy
surgery.
Spina Bifida
The Spina Bifida Team has been succession planning
for the Clinical Nurse Consultant and Consultant
positions.
Limb Deficiency Clinic
Fundraising has taken place to fund newer expensive
technologies. There is now clearer documentation
of positive outcomes and cost and this practice will
influence policies in the future through evidencebased best practice.
Physical Disability Service
A business proposal has been considered by
Senior Management for a funding package for a
multidisciplinary team. The urgent area still to be
addressed is an immediate increase in therapist and
staff specialist positions.
A priority system for new referrals and follow-up
reviews has been implemented. Active pursuit and
assessment of suitability of improved treatment
options will continue to be undertaken. The main
focus is on Deep Brain Stimulation (DBS) for children
with severe Dystonia and Robot-Assisted-Walking
(RAW) for children after intervention.
We are exploring greater opportunities to discharge
and transition adolescent patients by working with
adult specialists
Spinal Cord Injury and Disease
We have implemented changes to the clinic system,
where children with a spinal cord injury are now seen
at the same time as the children with Spina Bifida,
32
Medical Program
The Medical Program has continued to work with all
medical and nursing teams to improve efficiency of
service delivery. Many services have seen increasing
workloads during the year, with both increased
numbers of inpatients and outpatients. With a number
of senior physicians reaching retirement age, work
is taking place on succession planning in many
Departments.
Highlights during the year include:
• Successful completion of the Ward Realignment
Project through which it was demonstrated that
the patients’ journeys through the Hospital was
shortened by cohorting general medical patients
on Hunter Baillie Ward
• The successful establishment of the Medical
Assessment Unit in Hunter Baillie Ward, to enable
children with illnesses requiring short stays to be
discharged more rapidly
• Funding for junior medical staff and a Clinical
Nurse Consultant for the Medical Assessment Unit
• The appointment of the first Staff Specialist in
Australia dedicated to the management of children
with obesity
• The appointment of an additional Staff Specialist in
Neurology
• The appointment of Fellows in Liver Transplant
and Neurology
• Additional funding for the Poisons Information Centre
Dermatology
Dermatology is one of the first services to take part in
the new Community Acute/Post Acute Care Service.
Throughout the year, plans have been developed
to allow a home-based service for wet dressings for
illnesses such as eczema. This service, which should
be fully functional by the end of 2008, will allow many
children to have their care at home, rather than travel
frequently to The Children’s Hospital at Westmead.
Gastroenterology, Hepatology and Liver Transplant Unit
The Liver Transplant Team has now performed over
200 transplants and, during the last eight years, the
vast majority of the patients have received split liver
grafts in which the child receives the smaller left
lobe of a donor liver, allowing the larger right lobe to
be transplanted into an adult recipient. Despite this
being a more difficult procedure, the current two year
survival is 100%.
The Liver Transplant team also reported a world first,
where a young girl transplanted for acute liver failure
became completely tolerant of her new liver, enabling
her to stop taking all of her immunosuppressant
medication. Laboratory studies, done in conjunction
with Dr Stephen Alexander’s Renal Laboratory,
demonstrated that her immune system had changed
and become that of the donor. This unique event was
reported in the New England Journal of Medicine in
January 2008, along with an editorial, and received
widespread international media coverage.
Dr Michael Stormon and a group of friends undertook
the arduous Kokoda Track walk over the Anzac Day
period this year, using it as a means of rasing money
for the Liver Transplant Unit. Thus far, nearly $40,000
has been raised, which will be used to help undertake
clinical research. The Liver Transplant Unit also
received a $100,000 donation from the Inner Wheel
Club.
Gastroenterology continues to have a large influx of
inflammatory bowel disease (mainly Crohn’s disease)
with referrals exceeding 40 per annum over the last
five years. In both situations we have been helped
considerably by the establishment of a medical Fellow
position for Liver/Liver Transplant and a Database
Manager’s position.
Academically, the highlights include the publication
of the James Fairfax Institute of Paediatric Nutrition’s
longitudinal study of energy metabolism in cystic
fibrosis, with accompanying editorial comment in the
premier international paediatric journal, the Journal of
Paediatrics.
Vicki Jermyn, CNC Liver Transplant Unit, received the
Rotary International Paul Harris Fellow Award Medal
from the Hills Rotary Club for her devoted work to sick
children in the community.
General Medicine
General Medicine has seen many changes in the last
twelve months. An ambitious Clinical Redesign Project
resulted in significant improvements in the patient
journey, with more co-ordinated discharge processes,
shorter length of stay and improved team-work
amongst the medical and nursing staff.
After many years of contribution to the Department
as Heads of Medical Teams, Dr Maurie Gett, Dr Chris
Poon and Prof Henry Kilham have stepped down from
these positions.
General Medicine continues to play a prominent
role in junior medical staff training. There have been
major improvements to the junior staff roster including
consistent attachment to one of the medical teams
for both the registrar and resident, improved cover
of the wards and the Emergency Department after
hours and a new roster, resulting in improved clinical
experience and better supervision. A new initiative,
in collaboration with the Anaesthetic Department, is
for one of the General Medical registrars to attend an
anaesthetic list each week for airway management
experience. This has significantly increased the skills
and confidence of the registrars in resuscitation
situations.
33
The annual FRACP clinical examination was organised
by the General Medical Fellow, Dr Jeanette Marchant,
with the support of Dr Ken Peacock, regional
examiner for the RACP and acting Network Director
of Paediatric Physician training. This year, due to the
large number of candidates, the exam was held over
two days at The Children’s Hospital at Westmead. This
was a large and complex task which, to Jeanette and
Ken’s credit, ran without mishap with complimentary
feedback from the examiners and families involved.
Dr Emma McCahon, who is acting as Head of General
Medicine during Professor Kilham’s long service leave,
continues in her role as State Director of Paediatric
Training for NSW Institute of Medical Education and
Training (IMET) and has recently been appointed to
the IMET Management Committee.
General Medicine continues to play a key clinical
support role in a number of services across the
Hospital, including Adolescent Medicine, Eating
Disorders, Immunology and Allergy, Haematology,
Vascular Malformations and Rheumatology. This is at
both a junior staff and senior staff level. In addition,
General Medicine continues to play a key role in
organising Grand Rounds, the Annual Paediatric
Update and the Clinical Ethics Discussion Group and
is co-ordinating the writing of a new edition of the
Children’s Hospital Handbook.
Hunter Baillie Ward
Hunter Baillie Ward cares for many children admitted
under General Medicine. Following on from the
success of the Ward Realignment Project 2007,
which aimed for all general medical patients to be
cohorted in Hunter Baillie Ward and increased bed
numbers to 27, a Medical Assessment Unit (MAU)
was set up. The aim of the MAU is to improve patient
transfer from the Emergency Department to the
ward and discharge children within 72 hours, where
appropriate.
A Senior Registrar has been appointed to the MAU
to ensure regular patient review and to facilitate early
discharge.
The Clinical Coordinators or the Team Leader attends
the morning medical handover meeting. This enables
nursing staff to have a more efficient plan of action
for patients on the ward, particularly in relation
to discharge plans, and also allows them more
opportunity to provide input into a child’s care.
34
These improved avenues of communication between
physicians, nurses and allied health professionals
is particularly important in the case management of
long-term chronically ill patients and has resulted in
improved patient and family experiences, improved
communication amongst the multidisciplinary team,
expedited discharges and a smoother transition to
home care.
Hunter Baillie is involved in the reviewing and
rewriting of the intravenous cannulation policy, with
plans for some nursing staff to become accredited.
Hunter Baillie, in conjunction with Clancy Ward, has
coordinated and presented a study day, entitled ‘Pee
and Puff Study Day’ to teach nurses about kidney and
respiratory disorder. This was open to internal and
external participants and was a huge success with
great attendance.
Variety Ward
Variety Ward has had another busy year, with a
substantial increase in the number of oncology
patients, including bone marrow transplant patients,
who require isolation. Variety Ward received a
donation of $22,000 from the Oncology Department
to purchase two fixed monitors, which has given the
ward four high observation rooms.
The Variety Ward Staff Recognition Award was
introduced at the beginning of the year, with staff
nominated by their peers. This has certainly increased
moral amongst the staff. Variety Ward has supported
four new graduate nurses. They were provided with
a comprehensive orientation program. They have all
had positive experiences and some have requested
positions in the ward at the end of their training.
Variety Ward is currently in the second year of the
TLC Project (Teamwork, Learning and Change), which
is facilitated by the Variety Ward Educator and the
Nursing Research and Practice Development Unit.
The workplace culture analysis has taken place and
there are currently six projects being worked on with
four to six staff in each group. Projects include ‘How
do we value the contribution of each member of the
team?’ ‘How do we provide opportunities and support
for staff’s learning and development?’ ‘How do we give
and receive feedback?’ and ‘How do we support staff
in developing leadership skills?’
Variety Ward had two staff members present at the
ACPCHN conference in Darwin, which was very well
accepted. The staff are now working on a handbook
and updating the policy for the administration of
Ribavirin.
Variety Ward is one of the wards utilised by UTS as a
Clinical Development Unit for third year students. We
participated in this program in 2007 and it was very
successful. These students are studying paediatrics as
their sub-major. We are also preparing Team Leader
Workshops, aimed at staff who are working towards
the Team Leader role. Several topics will be covered
in one hour workshops in the clinical area, facilitated
by the Clinical Nurse Educator and Nursing Clinical
Co-ordinators. We are aiming to provide support and
education, as well as sharing experiences from other
senior members of staff.
Nephrology and Renal Treatment Centre
The Nephrology Service continues to have between
1500 and 2000 inpatient occasions of service
annually. Outpatient visits have increased to almost
1900 per year. The Renal Treatment Centre continues
to have a large workload, with over 1000 episodes
of peritoneal dialysis, haemodialysis and plasma
exchange treatments each year. We continue to have
a strong transplantation program with a recent series
of young recipients who have all done well.
Dr Deborah Lewis is the Paediatric Stream Coordinator
for Advanced Training (specialities) at the Institute of
Medical Education and Training. She continues to play
a major role in the education of the junior medical
staff. She has continued her interest in transplantation
and lupus nephritis, with a recent period of study time
at Guy’s Hospital in London.
Prof Jonathan Craig has received his Professorship,
in recognition of his many academic activities. He
has completed the PRIVENT trial, which aimed to
determine whether antibiotics prevented recurrence of
urinary tract infection, and the results are awaited. He
continues to oversee the FEVER study, which aims to
develop a decision support system to assist clinicians
in determining whether a child has a serious bacterial
infection. He has recently been appointed chair of
the NHMRC Clinical Trials Committee. His clinical
research effort has continued to expand and attract
many students and researchers.
Dr Elisabeth Hodson, in addition to her clinical
nephrology role, has continued as Co-chair of the
Medical Program. She continues her strong clinical
research interest in nephrotic syndrome and in the
study of antecedents of renal disease in Aboriginal
children and young adults. The latter study was
funded for a further five years by the NHMRC. Dr
Stephen Alexander has received research funding
from the NHMRC to study regulation of immune cells
in kidney disease and is involved in an international
study of processes of rejection in kidney transplants.
He continues work on the genetics of renal disease
with Dr Fletcher, who is completing his PhD research.
He has also been involved in organising the recent
World Transplantation Congress in Sydney.
Prof Jonathan Craig has completed his work as
co-editor for a new book, entitled Evidence-Based
Nephrology, to be published in 2008. Dr Elisabeth
Hodson was one of editors for the paediatric section
of this book while she, Prof Jonathan Craig, Dr Patrina
Caldwell and other members of the Centre for Kidney
Research contributed chapters. Dr Elisabeth Hodson
and Dr Stephen Alexander, as well as Prof Jonathan
Craig and Dr Gabrielle Williams, contributed chapters
on the steroid responsive nephrotic syndrome and
urinary tract infection respectively in ‘Comprehensive
Pediatric Nephrology’, a recently published paediatric
nephrology textbook.
The development by Dr Patrina Caldwell of separate
clinics for children with incontinence problems
has freed up Nephrology Outpatient Clinic time,
allowing staff to see more patients without delays.
During 2007-2008, outreach clinics were provided
to Canberra Hospital and to Bathurst and Orange,
in addition to clinics at John Hunter Hospital in
Newcastle. The expansion of the Bladder and
Nocturnal Enuresis Clinics allows an average of 27
children to be seen each week, with a reduction in
waiting times. This service is the only multidisciplinary
service of its kind in NSW and patients from all over
NSW have found help for their incontinence problems.
We are increasingly referred complex patients who
have failed previous treatments, with an excellent
success rate.
The team has expanded to include a general
paediatrician, two continence nurses, three
physiotherapists, a nurse aid and a clinical
psychologist. We also play an important role in
educating clinicians in the management of urinary
incontinence and members of the team are frequently
invited to speak to doctors, continence advisors and
the general public on incontinence issues. We have
35
produced an education resource for clinicians, the
Nocturnal Enuresis Resource Kit, which has proved
very popular.
The ongoing challenge for the Renal Service has
been the shortage of renal nurses and, in particular,
paediatric renal nurses. Despite continuing
recruitment campaigns, the Renal Treatment Centre
is now critically short-staffed. Management are
working hard to improve the situation. Despite these
difficulties, the service continues to provide a high
standard of care to its patients, due to the dedication
of staff, in particular the Nurse Practitioner, Jill
Farquhar. We hope to attract more nurses to train in
this specialty.
Clancy Ward
Clancy Ward commenced team nursing during the
year. This has provided better continuity of care for
patients and learning/teaching opportunities for staff.
Team nursing is working well to provide support to staff
to assist them to rapidly become competent in all basic
aspects of care provided on Clancy Ward. In support
of the Trainee Enrolled Nurse Program, we have
increased the number of Endorsed Enrolled Nurses
on the ward to four. Two of these nurses undertook
their training at The Children’s Hospital at Westmead.
These new nurses have adapted well to the Team
Nursing Model of Care and are effectively delivering
high quality care to patients and their families.
We currently have a number of quality improvement
projects underway. These include labelling and
frequency of changing of intravenous fluids/lines,
arrest trolley checking compliance project, admission
paperwork audit project and knowledge/administration
of oral opioids project. Clancy Ward has undertaken
a follow-up parent satisfaction survey. Feedback on
the physical environment was much more positive,
demonstrating that the redecorating and other
changes we undertook last year have had a positive
benefit for families. Feedback on care delivery
remained very positive. The orientation manual for
the ward has had an initial review and more detailed
review and restyling will occur this year. Policies
and care plans relating to care of the liver transplant
patient have been developed.
A Diabetes Study Day was organised jointly with the
Diabetes Education Service to train staff regarding
educating parents about the care of a child with newly
diagnosed type one diabetes mellitus.
36
Neurology
This has seen a busy year with many landmarks
and new initiatives. We have seen the departure of
Dr Elizabeth Fagan as Head of Department, with
Dr Deepak Gill taking on this role. Dr Fagan and Dr
Jayne Antony have steered the Department through a
period of transition, which will be a major theme over
the next three years as the Department establishes
subspecialty interests as a major way of increasing its
focus on specialised neurology services.
On a world scale, neurology at The Children’s Hospital
at Westmead is represented by Professor Robert
Ouvrier who is in the second year of his tenure
as President of the International Child Neurology
Association. He has been the driving force of the
Association, giving it a wider profile helping child
neurology advocacy throughout the world and helping
to secure the Asian Congress on Child Neurology,
which will be held in Australia in 2011.
Dr Russell Dale has been invited to be the co-editor of
an international textbook on Inflammatory Disorders
of the Brain. This continues to highlight Russell’s
authority, in this field in which he has already
published widely. Russell, along with Dr Elizabeth
Fagan, have continued to build up the complex
movement disorders clinics and the tic disorders
clinics; both services are unique to The Children’s
Hospital at Westmead.
The Institute for Neuromuscular Research (INMR)
has had a very productive and successful 2007/8
– the group has published over 60 peer reviewed
journal articles and has been awarded nearly $1M in
peer reviewed funding for 2008. A number of clinical
trials are actively underway including studies in the
evaluation of genetic therapy for Duchenne muscular
dystrophy (DMD), a multi-centre trial looking at the
drug PTC-124 to treat DMD and the world’s first
paediatric vitamin C trial in Charcot-Marie-Tooth
(CMT) disease. In addition to this exciting work, the
INMR continues to conduct groundbreaking research
in a number of areas: including the identification and
role in health and disease of a gene associated with
athletic performance and the study of the processes
of muscle membrane repair with an aim to develop
therapies for muscular dystrophy.
Dr Richard Webster, with colleagues, has won a grant
to study cognition and cerebellar disorders, which will
be undertaken with the Children’s Hospital Education
Research Institute (CHERI), and he will be a coinvestigator looking into the relationship of memory
and epilepsy.
annual scientific meeting in Adelaide and the visiting
specialist to the International Workshop on Epilepsy in
New Delhi in 2008.
The Comprehensive Epilepsy Program (CEP) has
continued to flourish, and is now firmly established
as part of a combined adult and paediatric
Westmead Comprehensive Epilepsy Program. This
combines specialised children, adolescent and
adult services and expertise at one site. The CEP is
a multidisciplinary program that offers the highest
level of care for children with complex epilepsy,
bringing together teams from nursing, neurosurgery,
neuropsychology, imaging and rehabilitation.
2007/08 has seen the introduction of a phone triage
system for children with epilepsy, which allows their
difficulties to be dealt with promptly and expertly by
doctors and nurse clinicians. Fiona Wade and Tony
Galea have been driving this new initiative, that is
providing quality care for children with epilepsy and
reducing visits to emergency and outpatients.
The last year has seen the 100th surgery performed
for epilepsy at The Children’s Hospital at Westmead
and, in most of these children, the operation has been
curative, allowing them to live a life free of seizures.
This expertise has allowed us to win the prestigious
Asian Oceanian ESA scholarship for Dr Vinayan
Puthenveetil, a talented Paediatric Neurologist from
Cochin, India who will be appointed as an Honorary
Fellow for 2008/09 to allow him to gain expertise in
epilepsy surgery to establish a centre in India.
Ms Samantha Soe underwent a clinical attachment
in Uppsala, Sweden and has established a high
standard of neurophysiology technology running the
Video-EEG Service. The Video-EEG Service, as part
of CEP, has been running efficiently with very few
cancellations and excellent patient flow, monitoring
over 150 children per year, in addition to the 2300
EEGs performed per year. The Service has been
helped significantly by very generous donations from
the Humpty Dumpty Foundation and the Economus
Sisters, who donated new EEG monitoring equipment.
The collaboration with the Epilepsy Research Centre
in Melbourne continues into its second year with
observations from patients at The Children’s Hospital
at Westmead, allowing us to make significant
breakthroughs into the genetic causes of epilepsy
and mental retardation. The collaboration between
the CEP at The Children’s Hospital at Westmead
and Sydney Children’s Hospital, as well as the adult
programs, has allowed epilepsy services to come to
the fore and this has resulted in a significant grant
from NSW Health to build epilepsy services and
increase evaluations for complex epilepsy throughout
NSW in 2008-2009. Dr Deepak Gill was invited as
a guest speaker to the Epilepsy Society of Australia
The next 12 months will see changes as the
Neurology Department enters a transitional phase.
One of the major goals will be the establishment of a
Neurology Training Program, allowing comprehensive
training in all aspects of neurology at a single campus.
Research initiatives are underway in many areas of
neurology, with targeted areas being critical care,
status epilepticus, neuroinflammatory disorders and
language and memory.
Neurosurgery
The Neurosurgical Unit has been accredited
for paediatric neurosurgical training by the
Royal Australasian College of Surgeons and the
Neurosurgical Society of Australasia, until 2011. We
offer an accredited training registrar position and one
non-accredited registrar position. The accredited
registrar is appointed by the College of Surgeons.
The Surgical Epilepsy Service continues to expand.
A NSW Paediatric Epilepsy Group has been formed,
with regular meetings at The Children’s Hospital at
Westmead, to look at services available in the state
and advise NSW Health about resource allocation.
This group continues with gaps in service being
identified and presented to government. Surgery for
spasticity continues as before, with botox clinics,
baclofan pumps and selective dorsal rhizotomy now
offering the children of NSW a complete service in the
management of cerebral palsy. Referrals for selective
dorsal rhizotomy from interstate have been treated.
Craniofacial work progresses, with the introduction
and approval by the Therapeutic Goods Administration
of springs for the surgical correction of craniostenosis.
There is an increasing workload surgically and
through the Outpatients Department. The Unit has
helped Operation Smile in Hanoi Vietnam over the
past two years, with visits to the Military Hospital 108
to do complex craniofacial surgery. A further visit is
37
planned for October 2008.
The Shunt Infection Study, with the Clinical
Excellence Commission, which commenced in April
2007 and is funded through the Safer SystemsSaving Lives Initiative from NSW Health, continues
with outstanding results. The shunt infection rate
has dropped from 7.5% to 1.4% as a result of the
introduction of a strict shunt insertion protocol and
excellent compliance. This protocol is now standard
practice. Two of the consultant staff has been involved
with the Clinical Excellence Commission by doing
the Clinical Leadership Program in 2007 and 2008.
Clinical auditing continues, with surgical data and
surgical indicators being directly reported to the
GMCT Neurosurgical Database electronically for statewide analysis, thus ensuring good clinical governance.
Laboratory research continues into Aquaporins
and CSF circulation disorders. There is continuing
development of the Westmead campus, with medical
staff all having appointments at Westmead and
registrars rotating through the campus for training.
There is a sharing of resources with complex vascular
and base-of-skull cases being treated at Westmead.
Commercial Travellers Ward
Commercial Travellers Ward has maintained a high
level of occupancy over the past 12 months, but has
seen a significant decrease in the number of booked
admissions that have been cancelled. The multidisciplinary approach to providing holistic care for
patients on Commercial Travellers Ward has been
upheld during 2008, through strong communication
between medical, nursing and allied health staff.
The Ward has continued to provide a supported
learning environment for new graduate nurses in the
area of paediatric neuroscience nursing, in addition
to extended clinical placements for nursing students
from UTS. Seven staff are currently engaged in post
graduate studies, three at master’s level and four
through the College of Nursing. One staff member will
shortly complete the CEC Leadership Course for 2008.
The TLC Process (Teamwork, Leadership, Change) has
continued, with support from the Nursing Research
and Practice Development Unit. Nursing staff have
identified five key areas for improvement, which
include the handover process, medication safety,
leadership development, facilitation and retention of
new graduates and the development of clinical care
guidelines for the paediatric neuroscience patient.
38
The ward has continued to receive much appreciated
financial support from three of its sponsors.
Brainwaves are developing a survival kit for parents of
children who are admitted to Commercial Travellers
Ward, the Rouse Hill Renegades Rugby Club
have provided funds for the purchase of a Phillips
Monitor for the telemetry room and the upgrade of
the playroom and ward interview room has recently
commenced, with funding support from the George
Gregan Foundation.
Oncology, Camperdown Ward and the
Oncology Treatment Centre
In 2007, 121 new patients with malignancy were
referred to the Oncology Unit. The Oncology
Treatment Centre provided 6500 occasions of service
and Camperdown Ward cared for 2000 admissions.
Service provision and advocating for additional
resources was undertaken to continue to provide
excellent care for our patients.
Throughout 2007 we placed particular emphasis
on the growth of services and provision of
adequate support structures in our departmental
plan. Consequently, the following positions were
established:
• Quality Manager for Oncology Services
• Office Manager, Personal Assistant to Head of
Department
• Permanent Clinical Nurse Specialist position to
Oncology Long Term Follow-up
• Clinical Nurse Consultant, Oncology Community
Outreach
• Lead Clinical Research Associate
• Clinical Research Associate – Stem Cell Transplantation
The Oncology Department has seen leadership
changes also, with the appointment of Amy Walker
to Nurse Manager Oncology Services in mid 2007.
During the year, the Department has worked with staff
to focus on succession planning, on promoting role
development and on professional development. With
these plans in place, we envisage creating ongoing
stability in the workplace, focusing on improving
morale, culture and team effectiveness.
We have also been working on the creation of a
Team-Based Model of Care. Large amounts of work
have been dedicated to this theme over the years,
including the work from Connect 4 Redesign, but we
expect to bring it to fruition and transition to this in the
near future. We believe that this will create a stronger
patient-orientated, coordinated care approach, with
thorough case management occurring through a
team-based model.
We continue to collaborate with the Cancer Institute
and have commenced a number of collaborative
approaches with Sydney Children’s Hospital and John
Hunter Hospital. This is being undertaken through
monthly case review presentations and the Nursing
Cancer Collaborative projects.
The Oncology Unit has been well represented at
numerous national and international conferences
throughout 2007-2008, through oral and written
presentations in areas of Long Term Follow-up, Bone
Marrow Transplantation, Adolescents and Young
Adults and General Oncology.
The Bone Marrow Transplant Service continues to
work toward obtaining accreditation by the Foundation
for the Accreditation of Cellular Therapy (FACT) in
2008. The Team, alongside the Quality Manager and
Project Leader for FACT continue to press forward
with implementation of a number of initiatives for this
to become successful. Accreditation will ensure the
Unit’s capacity to participate in frontline clinical trials
and to enable independent review of the quality of the
Unit’s activities.
Our Late Effects Clinic underwent a name change
in late 2007 to the Long Term Follow-up Clinic.
We felt this better represented the work which is
undertaken in this specialised area and contributed
to a more optimistic approach. A number of initiatives
are occurring in this area and we look to seeing
advancements in our team approach, through
creation of key positions to meet International Best
Practice Standards within the multidisciplinary team.
Importantly, we will focus on Adolescent and Young
Adult Care (AYA) through 2008, with the creation
of a Clinical Nurse Consultant position dedicated
to this age group and building relations with other
area health services to undertake a multidisciplinary
approach to care. We will also be facilitating transition
of young people to adult services and will strive for
an approach which is consistent with our values of
providing high quality care for all.
Pain and Palliative Care Service and Bear Cottage
The Department of Pain Medicine and Palliative Care
is responsible for the management of paediatric acute
(post-operative and procedural) pain management
and chronic pain (complex and intractable). The
Department operates an integrated system of
paediatric palliative care through the home, hospital
and hospice (Bear Cottage, Manly).
The Department has continued to be extraordinarily
busy over the last financial year. The acute pain
service has had approximately 12,000 occasions of
service in the 2007-2008 financial year. The Chronic
Pain Clinic continues to see record numbers of
patients, with 265 occasions of service in the 2007
calendar year and 217 occasions of service in the first
six months of 2008. 48 new palliative patients were
referred to the Department in the 2007 calendar year
and 21 patients were referred in the first six months of
2008. In the 2007-2008 financial year, Bear Cottage
admitted 268 patients and their families and had 74
new referrals of children with life-limiting illnesses.
The Department has been successful in obtaining
funding for a number of new palliative care initiatives,
including appointment of part-time Play Therapist, a
project evaluating provision of volunteers in the home,
a project evaluating provision of in-home nursing
support and a project to recruit a Nurse Educator to
provide paediatric palliative care education within the
Western Child Health Network.
The Department has appointed a senior social worker
from the United States and, as a result, we have
been able to offer increased social work support
through both the Hospital service and Bear Cottage.
Innovations at Bear Cottage this financial year have
included a weekend residential camp for siblings, a
residential camp for mothers of current patients and
the successful trial appointment of a Senior Nurse to
co-ordinate the bookings and admissions process.
The Department has continued to work toward
establishment of an integrated medicine service,
with staff developing skills in hypnosis/hypnotherapy,
remedial massage and acupuncture.
The Program Development and Quality Care Manager
has put in place quality programs and policies that
have enhanced the functioning and efficiency of
the Department. The Department now has clinical
indicators developed for the pain clinic and outcome
measures and a review program for palliative care.
This has contributed to the major goal of providing
and maintaining a world-class pain management and
palliative care service.
39
Poisons Information Centre
Respiratory Medicine, Sleep Unit
The NSW Poisons Information Centre currently
employs 20 Poison Information Specialists, who
provide 24-hour advice to the general public and
health care providers throughout Australia. There
are approximately 115,000 phone calls for poisoning
advice taken by the information specialists yearly, with
1100-1200 cases referred to the medical consultants.
They provide a service to all states of Australia after
hours, with about 30% of calls originating outside
NSW. Call numbers are increasing at about 7% per
year. Sixteen medical toxicologists provide back-up
medical advice to doctors and other health care
professionals for serious or complex poisonings. Each
toxicologist is affiliated with one of several toxicology
units in Australia, thus providing a diverse range of
toxicological knowledge to the Centre.
The Department is responsible for the care of children
admitted with acute respiratory and airway conditions,
as well as the long-term care of patients with chronic
conditions, such as asthma, cystic fibrosis, chronic
neonatal lung disease and sleep-related breathing
disorders. The Department co-ordinates the
management of asthma within the Hospital and also
provides a comprehensive Asthma Education Service,
aimed at health professionals, parents and children.
The Centre also provides training in medical poisons
information for a number of fellows with toxicology
training who are considering a career path in clinical
toxicology. The Centre is staffed with a part-time
Medical Director and Assistant Medical Director
who provide medical leadership, perform toxicology
consultations for The Children’s Hospital at Westmead
and NETS and co-ordinate teaching, clinical meetings
and research projects in the Poisons Information
Centre.
Advice regarding exposure to paracetamol remains
the most common reason for calling the Poisons
Information Centre. The most common referrals to
medical toxicologists are for management of snake
envenomation or for paracetamol, antidepressant
and anticonvulsant poisoning. The Centre provides
risk assessment to prevent unnecessary hospital
referrals for trivial poisonings and to identify potentially
serious poisonings that may require time critical
medical intervention. The Poisons Information Centre
can identify trends in poisoning in the community
associated with new pharmaceutical agents,
recreational substances and other chemical agents.
The Centre provides teaching on the management
of poisonings and risk assessment to health care
professionals and is a focal point for coordination of
clinical toxicology research in Australia. The medical
consultants have been closely involved in the revision
of national paracetamol overdose management
guidelines recently published in the Medical Journal
of Australia.
40
There are also two multi-disciplinary clinical services,
the Cystic Fibrosis (CF) Service which is involved
in the care of children with CF and the Respiratory
Support Service (RSS) which is involved in the care
of patients with sleep related breathing problems or
requiring respiratory support, including home oxygen,
CPAP or ventilation. These multi-disciplinary services
are supported by other Departments in the Hospital,
including Allied Health, Gastroenterology and
Endocrinology (CF Service) and Paediatric Intensive
Care and the Long Term Ventilation Unit.
The Department also provides lung function and
allergy testing and, in co-operation with the Children’s
Hospital Institute of Sports Medicine (CHISM), an
exercise testing facility. Research on lung disease
within the Department of Respiratory Medicine is
carried out under the auspices of the Children’s Chest
Research Centre, which was established in 1998,
while research relating to sleep-related breathing
disorders is under the auspices of the SIDS and Sleep
Apnoea Research group.
Key highlights for 2007/2008 have included:
• Establishment of regional Cystic Fibrosis Clinics to
facilitate optimal co-management of patients with
regional paediatricians
• Revision of Cystic Fibrosis Policy and Procedures
Manual, with availability on the Intranet
• Establishment and implementation of protocol
for blood sugar level monitoring in Cystic Fibrosis
patients
• Establishment and implementation of protocol for
once daily tobramycin therapy for pseudomonas in
Cystic Fibrosis patients
• Pharmacy support for Cystic Fibrosis clinic and
service provided through donated funds
• Development of Asthma Care Path and
accreditation of Registered Nurses in Short Stay
Ward and selected General Medical Wards to
increase time between inhaled salbutamol doses
• Revision of Acute Asthma - Management,
Education and Discharge Practice Guidelines
• Completion of an audit of asthma education
• Parental satisfaction survey of children presenting
to Emergency Department or admitted with asthma
• Provision of electronic Reducing Medication Plans
and Asthma Action Plans, through Powerchart
• Development of E-Learning Package and Tutorials
for Smoking Cessation Brief Intervention
• Continuing Paediatric Asthma Nurse Resource
Workshops
• Publication of ‘When your child has asthma’, a
book for parents of children and young people
with asthma
• Contribution to the revision of the NAC Information
Paper on ‘Leukotriene receptor antagonists: their
therapeutic role in children with asthma’
• Development and submission to Thoracic
Society of Australia and New Zealand (TSANZ) of
accreditation documentation for the accreditation
of the Respiratory Function Unit for the provision
of lung function testing and allergen skin tests
• Completion of an audit of exercise testing results in
children presenting with exercise limitation
• Establishment of an effective pathway for
transitioning and transferring patients requiring
chronic respiratory support to community care
• Updating of equipment for Sleep Laboratory
• Lucia Smith awarded PhD for her thesis, entitled
‘The cardiorespiratory consequences of very preterm birth’
• Kirstie Moore awarded MScMed for thesis, entitled
‘Factors affecting airway morphometry’
• Paul Robinson awarded NHMRC PhD scholarship
and TSANZ Allen and Hanbury’s Paediatric
Fellowship to undertake his PhD studies on
‘Complex lung function in paediatric respiratory
disease’
• NHMRC project grant for ‘Multicentre evaluation
of a management protocol for chronic cough in
children’.
Rheumatology
The Rheumatology Department provides a tertiary
and quaternary level multidisciplinary referral service.
It provides a significant contribution to the Hospital,
with around 500 outpatient episodes of service in
the 2007/8 year and a large number of related allied
health outpatient visits. The service also provides
around 100 inpatient consultations for a wide range of
other departments within the Hospital.
The Department continues to provide a number of
subspecialty/inter-disciplinary clinics, with combined
orthopaedic surgery and dermatology clinics and
regular scleroderma and periodic fever clinics,
that are the only such clinics which exist anywhere
in Australia. We are currently working with the
Department of Haematology to establish a specific
Paediatric Haemophilia Joint Disease Clinic, which will
be the first of its type in NSW.
Department members continue to be actively involved
in education and training. We have had the benefit
of two enthusiastic advanced trainees, supervised
under the RACP in the 2007-2008 year, which
has allowed us to improve the service provided.
We have also lectured and taught at various levels,
including at patient and parent forums, primary care,
Diploma in Child Health, FRACP and post-fellowship
levels. Through these activities, we have developed
relationships with many professional and patient
organisations and maintained already established
links, such as those with Arthritis Australia and the
NSW Arthritis Foundation. The Department is a regular
contributor to Hospital Grand Rounds and Team
meetings. Both consultants involved in the service are
part of the Rheumatology SAC of the RACP.
Innovations for 2007-2008 include the establishment
of regular intra-articular steroid injections for children
with acute arthritis under conscious sedation in Turner
Ward (in excess of 100 injections were performed
during the year). This procedure is considered best
practice for this painful condition and we expect
that the demand for this procedure will increase
progressively. We currently have three children with
severe recalcitrant systemic arthritis treated with
Tocilizumab, an experimental biological therapy with
good results thus far and are currently part of an
international trial of this drug.
The Department has made a strong commitment to
research with six papers published in peer reviewed
journals in the 2007-2008 year. Furthermore, we are
currently involved in three multinational drug trials,
are the national co-ordinating centre for an Australian
multi-centre study and have two additional single
centre studies underway with ethics approval granted.
The Department is an active member of international
and national research consortia.
The Department of Rheumatology aims to continue
improving the service we offer to our patients and their
41
families in the face of steadily increasing demand for
service, along with increasing complexity of disease
and treatment.
Turner Ward
As the move towards ambulatory care gains more
focus within the Organisation, we are anticipating
further increases in patient numbers. This trend is
evident with a 9% increase in patient numbers from
2007 to 2008. The main specialities seen within the
Department are haematology, immunology, neurology,
gastroenterology, cardiology and rheumatology.
MRI/CT lists under general anaesthetic have also
increased. Care by Parent is at capacity most days.
The admissions that come through this area are
becoming more complex, thus requiring a nurse to coordinate the daily activities/admissions in the unit.
The Endocrine Testing Unit has also had an increase
in patient numbers, including outpatient admissions.
The exciting development for the Endocrine Testing
Unit is the involvement in two new research studies,
the Intranasal Insulin Trial and the Vibration Study.
These studies have increased the clinical workload,
allowing the Unit to be staffed four days per week.
With efficient training and education, the aim
eventually is to have the Unit opened five days per
week to optimise the resources within the Unit and
also cope with the increasing clinical demands.
The new initiative for Turner Ward is taking an
overflow of patients from the Emergency Department.
The aim of this is to relieve the pressure and assist
with access block by moving appropriate children
out of the Emergency Department to a single room in
Turner Ward, where they are then cared for until a bed
becomes available. Turner Ward will continue to work
to improve this initiative.
Turner Ward now has a new consultation room and
treatment room which provide fantastic resources to
cope with the increase in clinical demands and also
ensures patient confidentiality.
Weight Management Services
Weight Management Services provide clinical care for
severely obese children and adolescents at a tertiary
and quaternary level of care, health professional training
programs on the assessment and management of
paediatric obesity, selected work on advocacy, general
community education and health promotion and
research into aspects of child and adolescent obesity.
42
Highlights for 2007-2008 include:
• Development of parent group programs adolescent and child programs each conduct three
sets of three education sessions per year
• A shared advanced trainee position was
established in 2007
• Successful application for funding for an
Administration Officer and appointment to position
• Successful application for funding and
appointment of a part-time Staff Specialist in
Weight Management
• Further provision of a child-friendly environment
for Child Weight Management Clinic (eg. use
of eye-toy, other games; sensitive approach to
potentially embarrassing aspects such as
weigh-ins)
• Improving the links for transition of Child Weight
Management Program families to Adolescent
Weight Management Services at 12 years of age
• Develop clinical research training opportunities in
paediatric weight management for clinicians in
the state
• Part funding has been achieved, through the Child
Health Network, as a project for the development
and evaluation of a state-wide health professional
training program (in conjunction with SWAHS and
NSW Centre for Overweight and Obesity)
• Regular staff planning days, in both adolescent
and child programs, scheduled for at least three
times per year to assess and evaluate program
• Executive approval to increase the Clinical Nurse
Consultant Child Weight Management hours
• Establishment of parent groups
• Prof Louise Baur was an invited participant at the
Australia 2020 summit
In the future there will be provision of a dedicated
clinical area for Weight Management Services
and adequate clinical rooms for the Child Weight
Management Program. More formal and integrated
links will be established with services and the Weight
Management Service planning will become core
business of all programs and divisions, with
Executive sponsorship.
A Weight Management Training Program for health
professionals will be established, with the successful
integration of a permanent staff specialist to the
service. This will streamline care and improve service
provision in the multidisciplinary teams.
Perioperative and Critical Care Program
The Perioperative and Critical Care Program has had a
very successful year. The challenges of providing high
quality patient care, while meeting State and Federal
Government performance targets, have been met by
all multidisciplinary teams through their dedication
and commitment within the Program.
Perioperative Services continue to be a leader in
waiting list management, achieving all or most targets
on a monthly basis. The Neonatal and Paediatric
Intensive Care Units have continued to improve
patient outcomes and to reduce access block and
cancellations for elective surgical procedures.
The marked increase in emergency surgery
presentations has also been a significant resource
concern, with a 15% increase over the last year. This
has created significant access block issues for patient
flow, Surgical Unit and operating suite management.
The Perioperative Critical Care Program will continue
to strive to provide best practice surgical and acute
care services into the future. A priority for the future
is to define the tertiary services provided by the
Program, that will enable us to make smart choices
for our future health service delivery. We will also
continue to work with the Surgical Taskforce to
develop strategies to reduce inflows of non-tertiary
surgical patients over the age of 12.
The Operating Theatres performed 14,274 procedures
in the 2007-2008 financial year and continues to
perform well in meeting NSW Health key performance
indicators. This is highlighted in the following graphs.
Total Cases
14500
14000
13500
13000
12500
12000
11500
Total Cases
03-04
04-05
05-06
06-07
07-08
12,508
13,561
13,294
13,537
14,274
Over the past four years there has been a significant
increase in the number of emergency surgical
procedures being performed. To meet the increasing
demands, a second emergency room has been
opened on a Friday. This initiative has improved the
access of the Operating Suite for patients requiring
emergency surgery.
3 Year Comparison - Non-Elective Procedures - TYD Total
2008 brings new NSW Health emergency surgery
performance targets that will require creative solutions
and management challenges to achieve and sustain
benchmark performance.
5600
5400
We will continue to foster and pursue research and
teaching programs and activities within our clinical
departments to promote excellence and awareness of
our services.
5200
Operating Theatres
4600
This year has seen the Operating Suite undertake
elective, emergency and additional waiting list
sessions. The Operating Suite’s performance
continues to be monitored against NSW key
performance indicators. In 2007-2008, we performed
very well against the indicators.
5000
4800
4400
YTD Total
2005 – 2006
2006 – 2007
2007 – 2008
4810
5122
5461
43
Burns Unit - Clubbe Ward and Burns and Plastic
Treatment Centre
The Burns Unit is the paediatric arm of the NSW
Severe Burns Injury Service and is responsible for
the care of all major burns in children in NSW.
The Burns unit staff provide a 24-hour consultative
service for health providers treating children with
less severe burns.
The majority of paediatric burns are less than 5%
body surface area and these children are managed
as outpatients in the Burns and Plastic Treatment
Centre, which is part of the Burns Unit. The numbers
continue to increase and 964 children with minor
burns were referred in 2007. There is a noticeable
increase in contact burns, overtaking flame burns as
the second most common cause of injury. Significant
work has been done in preventing exercise treadmill
injuries which present on a steady basis.
The results of our efforts to accept direct referrals
from medical practitioners in general and Hospital
practice were also evident during 2006-2007.
Direct referrals now comprise 50% of our
outpatients, the remainder being referred from
the Emergency Department.
Clubbe Ward burn patient numbers and /or acuity
continue to fluctuate. There has been a noticeable
increase in complex combined medical and plastic
surgical patients requiring intricate coordination,
management and care.
The Burns Unit and the Western Child Health Network
project, ‘Capacity building in the management of
children with a burn injury’, funded by NSW Health,
has progressed well. Evidence-based Guidelines
for the management of minor burns have been
established, A digital photographic consultation
service has been successfully implemented, which is
allowing children to be treated at their local hospital
with direct consultation and support from the Burns
Unit. Education resources have been developed and
a Burns workshop undertaken for medical, nursing
and allied health staff. An ambulatory care Paediatric
Burn Care Service has been established at Fairfield
Hospital, with the direct support of our Burns Unit.
It is proposed to pilot further clinics at Wyong and
Campbelltown in late 2008.
Several initiatives have been implemented in the
Unit in 2008. The Unit’s staff have collaborated
44
with Information Technology Services to develop the
electronic annotation of clinical notes in Powerchart.
This has allowed instantaneous access to the patient
record at all times in the various multi-disciplinary
clinics. Data collection has improved through the
appointment of a data collector who collects data for
research and audit purposes.
On the technological front, the increasing use of the
‘Versajet’ debriding instrument has resulted in less
blood loss and the ability to debride burnt tissue more
accurately with better preservation of skin structure
and less subsequent scarring. The use of Tisseel glue
has improved graft take and prevented the ruckling of
skin grafts, resulting in a better cosmetic outcome.
The Children’s Hospital Burns Research Institute
(CHBRI) was established in 2004 to foster clinical
and laboratory research into burns at The Children’s
Hospital at Westmead. In 2006 the Institute was
able to appoint Rachel Murray, an NHMRC Fellow,
to establish the CHBRI Wound Healing Laboratory.
Rachel is undertaking basic scientific research to the
biochemical modulation of scar development at a
cellular level.
Our Research Fellow has established the scientific
basis for first aid management; work that has been
published and presented internationally. Currently,
we are undertaking clinical and experimental studies
to establish the relationship of the depth and healing
time of a burn to the development of a hypertrophic
scar. Three of the burn residents completed research
projects whilst at the Unit, of which all will be
presented at scientific meetings. In addition, medical,
nursing and allied health staff contributed seven
papers to the RACS ASM in Hong Kong and are
presenting at the ISBI meeting in Montreal and to the
ANZBA ASM in Melbourne in September .
The Unit has, in collaboration with Kids Health,
developed a Burns Prevention Package for primary
schools. The Program is currently being trialled at
selected primary schools across Sydney, prior to
evaluation and dissemination across all Primary
Schools in NSW.
The staff of the Unit are dedicated to contributing to
the scientific advancement of burns management
by undertaking clinical and scientific research, the
dissemination of knowledge through education
and communication and to the process of burns
prevention through intervention in schools and in the
community. The Burns Service Transitional Nurse
Practitioner will shortly receive Nurse Practitioner
– Burns [Paediatric] status, which will be a unique
position to Australia and New Zealand. It is expected
that this position will provide additional support to
outreach clinics, as well as to patients and families.
Surgical Unit
This year saw the relocation of the four medical short
stay beds from the Surgical Unit to Hunter Baillie
Ward. Wait list funding has been utilised to provide
an additional four temporary surgical beds that have
been supporting the Hospital in the surgical wait
list strategy.
In addition, the ward was able to increase capacity
to 44 beds on occasions to allow elective surgery to
continue when the organisation has had an increased
number of emergency surgical cases.
These responses were dependent on a dedicated
team of nurses who willingly supporting this initiative
through flexible work practices. Nursing staff are
currently participating in the REACH performance
appraisal research project and have continued to
demonstrate a strong commitment to continuing
professional development.
General surgery
The Department of Surgery is proud to have achieved
success with three major projects in 2008.
1. On-call roster and theatre list redesign.
The goal was to achieve a more fair and equitable
allocation of operating sessions and to make
operating time available for two new Consultants.
Overall, this has resulted in the Consultants being
provided with their allocation of theatre lists. The
current members of the Department who were in
deficit on theatre lists now have an appropriate
allocation. It is hoped that this rearrangement of
operating lists will also have a secondary benefit by
encouraging people to more efficiently utilise the
operating lists that they now have allocated.
2. The expansion of Transplant Team.
An additional Transplant/General Surgeon,
Transplant Fellow and a full-time Secretary
were appointed, thus expanding the service
considerably. As the new Transplant Surgeon
also performs general surgery, this also impacts
upon waiting times for appointments to see a
general surgeon and assists with the shortening of
operating waiting lists.
3. Minimally Invasive Surgical Laboratory.
The first Minimally Invasive Surgical Laboratory
for Paediatric Surgeons in Australia has opened,
which has the support of the Animal Ethics
Committees and the Royal Australasian College
of Surgeons.
Plastic surgery
The Plastic Surgery Department has increased, with
two registrars this year to reduce the after-hours
demand on services.
Prof Michael Poole retired this year after many
dedicated years of service in Craniofacial surgery.
Dr Damien Marucci has commenced as Craniofacial
Surgeon to ensure that high quality care and services
are provided into the future.
The Plastics Team continue to be involved in the
development of vascular anomalies treatment services
with Dr David Lord.
Ophthalmics
Dr Stephen Hing has taken over as Department
Head and Gillian Green has been appointed as the
Opthalmic Liaison Nurse, replacing Lisa Sugar.
An additional Registrar position has increased service
provision and also increased the competence of NSW
Opthalmology trainees in Paediatric Opthalmology.
Clinical activity continues with greater demand being
placed on the Department’s resources. Satellite clinics
continue at Campbelltown and Mt Druitt hospitals.
New software and electrodiagnostic equipment has
enhanced the reliability of electroretinograms and
other tests.
Ear, Nose and Throat (ENT)
The ENT Department continues to be very busy, with
referrals to the outpatient clinics and for surgery.
Dr John Curotta has been appointed as full-time
Staff Specialist and will commence in that role in
September 2008. The Federal Waiting List Strategy
has also meant that the ENT Department has been
actively involved in the waiting list initiative this year.
45
Orthopaedics
Education and training
The Orthopaedic Department is one of the busiest
in the Hospital, offering care for a broad range of
musculoskeletal conditions. Issues of patient access
and care were addressed, with the establishment of
an additional weekly triage clinic, second monthly
multidisciplinary Osteogenesis Imperfecta Clinics,
fortnightly Scoliosis Review Clinic conducted by a
Clinical Nurse Practitioner and the doubling of the
number of Fellow lists. To gauge efficiency and
maintain a high level of service, the Department has
taken steps to formalise a policy regarding the clinic
referral system for elective patients by assigning
clinical priority categories.
The Department successfully hosted the second
Australasian Ponseti Conference for health care
professionals. The Ponseti Method is an effective and
inexpensive method for the treatment of congenital
talipes equinovarus (clubfoot) which avoids the need
for major surgery.
The latest advancements in clubfoot treatment
are also disseminated by an ongoing program of
workshops and lectures by senior orthopaedic
physiotherapists at regional NSW hospitals.
Cerebral Palsy and Neuromuscular Disorders
During the past year, patients have benefited
from the continuation of a waiting list reduction
scheme, providing additional theatre lists and the
implementation of clinic scheduling changes which
have reduced rescheduling of patients.
The Department is working toward transition of care
for older patients with Cerebral Palsy, which will
eventually see the transfer of their management
to SWAHS.
In conjunction with Sydney Children’s Hospital, the
Department is planning to establish a Paediatric
Orthopaedic Fellowship in Neuromuscular Disorders,
which will provide advanced training in the
orthopaedic management of this complex
group of disorders.
Spine
The increasing demand for complex spinal surgery
and insufficient numbers of spinal surgeons will be
addressed with the appointment to the Department of
another Spinal Surgeon in 2008. A tendering process
is also being considered to contain the escalating
costs for spinal prosthetics.
A six month Research Fellowship in Spinal
Surgery was established to investigate basic and
clinical aspects related to the pathophysiology and
biomechanics of spinal disorders and diseases.
The Fellow carried out a study on TL Flexiondistraction injuries.
46
The Nurses and Midwives Board recognises
Paediatric Nursing as one of its broad areas of
practice. During the year, Corinne Bridge completed
her training and is authorised to practice as a Nurse
Practitioner, the first paediatric Orthopaedic Nurse
Practitioner in Australia.
As part of the Department’s commitment to furthering
medical education in Asia and developing countries,
the Department hosted an honorary fellow from India
and observers from Afghanistan, India, Nepal, Israel
and Saudi Arabia.
Orthopaedic Research and Biotechnology Unit
The Orthopaedic Research Unit continues to expand
and is a world recognised leader in the development
of clinically relevant model systems of bone diseases
affecting children. This work is carried out by a
dedicated team of orthopaedic surgeons, research
scientists, veterinary surgeons, biomechanical and
biomedical engineers, experienced technical support
staff and students.
Paediatric Intensive Care [PICU]
The PICU has had a very successful year, with strong
clinical service provision, ongoing improvements to
patient safety and a positive budgetary performance.
Just some of the highlights include:
• We have increased our bed numbers to 18
beds, as a result of a funding enhancement from
NSW Health. This makes the Unit one of the
largest intensive care units (adult or paediatric)
in Australia. As a result of much hard work, the
surgical cancellation rate has been very low.
• PICU has experienced a steadily increasing
workload, with admissions increasing by 10%.
The past financial year saw 1205 admissions
to the Unit. Patients stayed a median of 1.71
days. There were 24 deaths over the period
(absolute mortality rate 2.0%) with a standardised
mortality rate of 0.53 (by PIM2), our lowest ever.
One of PICU’s major achievements has been a
steady reduction in the mortality rate of critically
ill children and infants over the last three years.
Following a 20% reduction in standardised
mortality rate between 2005-06 and 2006-07,
there has been a further 14% reduction between
2006-07 and 2007-08. The standardised mortality
rate is now only 54% of its value ten years ago.
The PICU was also involved a number of
initiatives intended to improve quality of service.
These included:
• A daily PICU/Microbiology round between the
consultant on-call Intensivist and the Hospital’s
Microbiologist to discuss all positive cultures as
well as antibiotic usage within the Unit. Analysis of
our usage of third-generation cephalosporin has
revealed that this initiative has had a very positive
impact already.
• We have Increased Fellow cover, ensuring a further
layer of more senior clinical medical cover during
the day, especially in view of our increased activity.
• The PICU Nurse Practitioner Outreach Service has
allowed Nurse Practitioners to provide education
and training to nursing staff on the wards.
• In addition to assessing patients referred to the
PICU, Nurse Practitioners have also been following
up all patients on the wards following discharge
from PICU. We are monitoring readmission rates
to assess the impact of this initiative.
• We are currently in the process of designing a
replacement for our ageing (DOS-based) CRS
patient database. Funding for the project has
been secured.
• The Unit is actively participating in the in
CLAB-ICU Study, sponsored by the Clinical
Excellence Commission.
• Extracorporeal membrane oxygenation (ECMO)
has recently been introduced as our preferred
means of cardiac support following cardiac
surgery. Currently, this is still a perfusionist-led
service, however, a course was organised to further
staff knowledge and experience using this mode
of support. A business case is being prepared
examining the extra resources that might be
required in the future in order to transition the
service to one that is nurse-led.
• The Intensive Care Specialists established an
Education Fund (using funds from their private
practice trust) to provide funding to members
of the nursing staff so that they could attend
important conferences and courses, such as the
Advanced Paediatric Life Support (APLS) course.
Feedback suggests that this initiative has been
appreciated by all members of the nursing staff.
• The Intensive Care Specialists also sponsored a
visiting Professor from overseas to spend a week in
the PICU. Last year our inaugural visiting Professor
was Professor Vinay Nadkarni of the PICU at
the Children’s Hospital of Philadelphia (CHoP).
His visit was most stimulating and, in addition to
invigorating our clinical practice, this initiative also
built bridges between our unit and CHoP for
future collaboration.
• A working group was established which undertook
a rigorous selection process to choose the best
available CVVH machine, as our current machines
are no longer supported by the manufacturer and
will require replacement very soon.
• The PICU has almost 100 policies and procedure
guidelines in its internal manual and these are
constantly being revised and updated through a
formalized process.
• The PICU hosted a number of students and
observers throughout the year. This included
supervising four medical students on three
month electives from Holland, as well as
supervising observers from Adelaide, Vietnam,
Kenya, and India.
• Once again, the Intensivists sponsored a University
of Sydney summer scholarship student from
the Department of Informatics to work on data
presentation and utilisation in the Unit.
• Members of the staff continue to perform
significant clinical and laboratory-based research,
both locally and nationally, and make valuable
contributions to the critical care literature.
• Several PICU staff members are currently
involved in organising the upcoming Annual
Scientific Meeting, to be held in Sydney in
October, as well as the World Paediatric Critical
Care Congress in 2011.
47
Cardiac Services
This year has seen a redesign of the Cardiac Services
management structure, with the creation of a Head of
Department for Cardiology and a Head of Department
for Cardiothoracic Surgery. Dr Gary Sholler remains
the Head of Adolph Basser Cardiac Institute and
Cardiology Services. Prof David Winlaw is the Head of
Cardiothoracic Surgery.
There has been considerable work to action
the priorities outlined in the Cardiac Services
Enhancement plan, including:
• The appointment of a Interventional Cardiologist
• Development of additional Clinical Nurse
Consultant – Cardiac Services role
• Refinement of programmes for surgical care
of neonates
Cardiac surgery has continued to provide a high level
service. A recent restructure of both senior and junior
positions has consolidated the training and service
commitments, with greater out-of-hours support
provided in the Hospital. This has been necessary
because of the increasing complexity of cases and
utilisation of extra-corporeal life support systems in
difficult cases. A wider range of cases are now being
referred for surgery, including neonates with complex
left ventricular outflow tract obstruction.
A grant was sought to commence a research project,
titled ‘Heart Beads’. This creative initiative allows the
journey of children who have had heart surgery to be
created through a collection of beads. This research
project will be evaluated and presented at a paediatric
conference in September 2008. A further ward-based
study on warfarin administration will be presented at
the Children’s Health Conference in November 2008.
The Cardiac Team has also been successful in gaining
a second Clinical Nurse Consultant position to case
manage children through the acute inpatient phase
of their treatment plan This position will be advertised
in the coming months and will certainly enhance the
current service provided to our patients and their
families and carers.
Long-Term Ventilation Unit
The Long Term Ventilation Unit has had a very
successful year. The Nurse Practitioner led
multidisciplinary team has successfully transitioned
five children to the community, with only two children
remaining in the Unit. A strategic management team
was created to look at the future management of
long-term ventilated children into the community. An
appropriate management plan has now been created
for both the management of new and existing long
term ventilated patients.
Grace Centre for Newborn Care
The Cardiac Surgery Group has also had a successful
year in basic and clinical research, with completion
of a series of experiments studying the role of novel
agents in a model of poor cardiac function after heart
surgery. This work has been presented at international
meetings and is in-press in highly ranked cardiac
surgery journals. The expanded work of Kids Heart
Reseach has also resulted in major international
publications. Adolph Basser Cardiac Institute
continues to voluntarily participate in international
projects where multidisciplinary surgical teams bring
care to developing countries.
The Grace Centre for Newborn Care continued to
have a higher number of admissions. This reached
650 babies last year, with a sustained increase in
the survival rate of over 97%, despite earlier and
more complex medical and surgical treatment being
provided to smaller and sicker babies. The Unit has
also embarked on a developmental follow-up program
for infants who undergo major surgery early in life.
This decision was based on the early findings of a
study conducted in the Unit, funded by the March of
Dimes in the USA, that approximately 40% of these
children have some developmental delay.
Edgar Stephen Ward
The staff in Grace have been raising money to build
a follow-up clinic, research offices and an education
room. The highlight of their fundraising effort was
the highly successful inaugural Grace Gala Ball,
which was held on 29 February at the Art Gallery of
NSW. The MC for the night was Tracey Spicer and
over $400,000 was raised towards the cost of the
construction.
In April 2008, Edgar Stephen Ward updated the
cardiac monitoring system to the new Phillips
monitors. This initiative has allowed the Ward to have
14 monitored bed spaces and a much improved
monitoring system. Six staff members will be trained
as super-users of the monitors to allow expert and
effective patient care to be delivered.
48
Two Staff Specialists have recenlty been appointed as
permanent members of staff, Dr Alison Loughran, fulltime, and Dr Kathryn Carmo, half-time, in a shared
position with NETS. They are both PhD candidates
and this brings the number of PhD candidates in
the unit to five. Grace continues to attract newly
graduated nurses to the workforce as there is an
extensive orientation, preceptor and support program.
The Unit prides itself on working successfully as a
multidisciplinary team and this also extends to the
research program. A/Prof Kaye Spence and A/Prof
Nadia Badawi are collaborating with Melbourne
University on a grant to study the emotional and
social burden of caring for a young child with complex
health needs. Dr Peter Barr is continuing his research
on personality predictors of acute and chronic stress
in NICU parents.
There have been ten international peer reviewed
publications and many international presentations
by the staff of Grace during this year. Dr Barr gave
presentations to the Association for Death Education
and Counselling in Montreal and also facilitated a
Parent Bereavement Retreat as part of his annual
visit to the USA as a guest of Arizona State University.
Dr Carmo gave two presentations at the Paediatric
Academic Society in the USA and the European
Academy of Paediatrics on targeting the duration
of Indomethacin treatment to the PDA constrictive
response using echocardiography, a randomised
controlled trial.
A/Prof Spence was on the scientific committee of
the 6th International Neonatal Nursing Conference
in India and facilitated a workshop. Ms Jenny Elliott
and A/Prof Spence also gave several presentations at
the conference, as did A/Prof Badawi at the British
International Congress on Obstetrics and Gynaecology
in London. The Annual Susan Ryan Conference,
which the Unit organises, is becoming increasingly
successful, with nearly 200 local and interstate
attendees.
Biomedical Engineering
efficiency. Technically, it is highly advanced and allows
clinicians web-based access to real time patient
monitoring, thus reducing the need for urgent callins. As the network is relatively new, clinicians are
just beginning to take advantage of some the more
advanced features.
Another major achievement during the year was to
develop and produce the most advanced neonatal
system known, as well as highly advanced paediatric
and paediatric/adult retrieval systems. These systems
have given NSW the most advanced neonatal and
paediatric aeromedical and road retrieval
service known.
The Department also provides both internal and
external respiratory support services and is currently
managing over 60 home patients. We currently
manage eight of these patients under service level
agreements to other Area Health Services and
produce specialised equipment to enable these
patients to return home. This number of these
patients we support is steadily increasing.
Our Department provides inpatient technical support
and manages the point-of-care biochemistry labs
throughout the Hospital. We source, order and
supply much of the specialised non-sterile stock
throughout the Hospital and actively participate in
clinical research, equipment development and publish
research papers.
During the year we supervised two international and
two Australian University students for their Industrial
Placement Program during the year, as well as a Fijian
post-grad research student.
The Department is always very busy, completing
repairs, testing equipment and providing clinical
support. We engage volunteers to help us in
these duties.
We are an ISO 9001 certified Department and
produce or help to produce quality systems for other
Departments, as required.
Biomedical Engineering supports and advances
patient care by applying engineering and
management skills to healthcare technology. In 2008,
we completed installation of an integrated patient
monitoring network throughout the Hospital. This has
increased patient safety and also enabled streamlined
internal patient transfers, improving overall operational
49
Allied Health
The Departments within the Clinical Support Program,
Allied Health, are:
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Clinical Aboriginal Health Services
Audiology
Sydney Children’s Cochlear Implant Centre
Kids Health
Nutrition and Dietetics, including the
Formula Room
Occupational Therapy, including Music Therapy
Orthoptics
Orthotics
Pharmacy
Physiotherapy
Play Therapy
Psychology
Social Work
Speech Pathology
Clinic is being developed, so these patients and their
parents will have a contact point and a continuity of
care. An education day has been held for parents
and families.
Procedural support is an ever-growing need in the
Hospital. It presents itself in many ways, such as
in the Emergency Department, long term patient
procedures, PICU, MRI preparation, radiation,
palliative care and Turner Ward, to mention a few. Play
Therapy are actively trying to reduce the numbers
of children missing out on the vital service through
business case submissions, the use of donated funds,
and regular reviews of our service delivery.
After over two years of collaboration with colleagues
at Sydney Children’s Hospital, consumer groups
and interested health professionals, a large, brightlycoloured parent resource, ‘Hearing Loss and Your
Baby’, was printed and distributed throughout NSW to
families of infants diagnosed with hearing loss through
the SWISH program.
Major Goals and Outcomes
To add to the Allied Health New Graduate Programs,
regular sessions have been organised and coordinated by Head, Social Work and Deputy Head,
Occupational Therapy, to support new Allied Health
graduates to not only be competent practitioners,
but also have the ability to work independently
and collaboratively within multi-disciplinary teams.
Hospital retention rates of new graduates remaining
in Paediatrics are testimony that the programs are
successful. This addition is proving to add value.
Ten professional groups within the Division of Allied
Health have moved to a new amalgamated award.
The process was made as smooth as possible through
the support of all concerned, especially those in Staff
Services who worked on the transition.
There has been strong collaboration with NSW Health
and Orthoptics to develop and implement the statewide Eyesight Preschool Screening Program (StEPS).
Tender for design, implementation and evaluation of a
Train the Trainer Course for StEPS was won for $5000.
Congenital lymphoedema is a growing clinical area.
The Physiotherapy Department has had a number of
staff trained in the correct physiotherapy treatment
of lymphoedema patients, which includes massage,
bandaging and pressure garments. A Lymphoedema
50
Orthotics and Physiotherapy presented at the
second international Ponseti Talipes Conference in
Darling Harbour in February 2008. The presentation
highlighted a newly developed orthoses for the
treatment of talipes.
Speech Pathology instigated a simple reporting system
to increase the consensus on reporting of modified
barium swallow results between Speech Pathology
and Medical Imaging, and is currently in the process
of reviewing the system.
The Annual Memorial Service aims to support the
families of patients who have died and to promote
healthy grief. Parents and staff from many areas of
the Hospital are involved in the planning and running
of the Service. A survey in 2006 indicated an interest
by parents in meeting and sharing experiences with
other bereaved parents in small groups. A group work
program for parents and siblings was piloted by the
Social Work Department, with assistance from the
Chaplains, in 2007. Subsequent evaluations indicated
that this new aspect to the Service allowed families
to make closer supportive connections with other
bereaved families and help them express grief in an
understanding and supportive environment.
Key Issues and Events
Kids Health, working with the Respiratory Unit,
Adolescent Medicine Unit and Pharmacy, have
produced an eLearning package and tutorial to
educate staff on how to conduct evidence-based
smoking cessation brief interventions. This has been
piloted with two Hospital wards (91 staff accessed
eLearning, with 45 having completed the eLearning
package). Pre and post tests will be compared to
assess knowledge of smoking cessation and also
confidence to conduct brief interventions.
Kids Health, working with Fundraising and Allied
Health Departments, has begun a project on creating
child-friendly waiting rooms.
Physiotherapy, in conjunction with Technical Aid for
the Disabled (TAD) is running a bike clinic in the
Department twice annually. The TAD group bring
bikes and a large variety of modifications that can be
fitted so that children with a variety of disabilities are
able to ride a bike safely, a skill that many of us take
for granted. The smiles in the faces of both children
and parents are priceless.
Play Therapy has been establishing themselves as a
new stand alone Department and has been worked
with Palliative Care and Emergency to trial two new,
limited-hours positions. One is for home-based care
and the other for procedural support.
To encourage increased collaboration, there have
now been two interdepartmental meetings between
The Children’s Hospital at Westmead and the Sydney
Children’s Hospital Orthotics Departments.
The Nutrition and Dietetics and Speech Pathology
Departments have worked closely with Food Services
to establish and implement a standardised hospitalwide modified diet for patients who present with
dysphagia and feeding problems. This diet will comply
with the Australian Standards set by the Dietetics and
Speech Pathology professional associations.
Prevention of childhood eye injury has been identified
by Orthoptics as a key health promotion issue. A
project has begun, supported by a retrospective
study of the last ten years of eye injury referrals to the
Eye Clinic. The aim is to impact on the prevalence
of childhood eye injuries occurring in NSW through
improved parental and child education into risk
factors for eye injury.
Occupational Therapy celebrated its 70th Birthday
by organising a one day Seminar ‘Networking for
Kids: Building Partnerships in Occupational Therapy
Practice’, in October 2007. 178 Occupational
Therapists from around NSW and a few from further
afield heard of the varied and challenging work of
Occupational Therapy at the Hospital.
Future Directions
Kids Health plans to pilot an online education portal
for parents and carers to access health and safety fact
sheets, audio clips and lectures.
Audiology will see it’s 1000th infant under the SWISH
program sometime late 2008/early 2009.A celebration
of this achievement, as well as the arrival of new
cutting-edge technology, is planned for that time.
Audiology is steering the set-up of a new regional
Visual Reward Audiometry Clinic at Mount Druitt
Hospital, as services for the 12-36 month age group
are very poor in Western Sydney. Rooms have been
allocated and equipment has been purchased.
Training/commissioning should be completed in the
next 12 months.
Speech Pathology will continue to engage in
discussion with local community health services
to review the provision of services to children with
feeding difficulties and dysphagia.
The current practice and clinical protocols used for
electrophysiology have been recently reviewed. A
staff member will be travelling to electrophysiology
locations in Canada and England in August and
September 2008, to increase their electrophysiology
knowledge and clinical expertise and form links
between these locations and our Hospital. This trip is
partly sponsored by Designs for Vision, an ophthalmic
supply company and LKC, the supplier of the
electrophysiology system.
The Social Work Department is working to develop
and implement uniform minimum standards of
care and follow-up for bereaved families across the
Hospital and a more comprehensive bereavement
care service.
Pharmacy is planning to enhance services to the
Emergency Department and to provide universal
medication reconciliation and pharmaceutical review
to all patients.
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Diagnostic Services
The Division of Diagnostic Services is a diverse group
of Departments, both diagnostic and clinical. All
Departments are run by dedicated staff, whose main
priority is to promote a quality and timely service,
both diagnostic and clinical, for the patients of this
Hospital and NSW. Both the clinical and diagnostic
Departments service not only the children of this
region, but also the wider community in NSW, and, in
the case of many of the Departments, Australia.
As a testimony to the quality of service offered by
these departments, the Diagnostic Services Division
was involved in three of the entries that won the
QuAKs award or were highly commended (Clean
Hands Save Lives, Platelet Wastage Improvement
Projection and Reduction in Turnaround Times for
Potassium (K)).
Prof Bridget Wilcken has this year substantively
retired from her position in Newborn Screening and
Biochemical Genetics. Bridget has an international
reputation in her field and is admired by all who
have worked with her or sought her opinion. We are
grateful that she continues to give some of her time
to the Hospital. Professor Martin Silink has played
a major advocate role for diabetes in young people
and for those living with diabetes in disadvantaged
circumstances, in his position as President of the
World Diabetes Association. He has had extensive
involvement with the United Nations and the World
health Organisation. He has recently received
the Kellion Award, which is the highest award in
Australian Diabetes.
In the past twelve months, A/Prof Christopher
Cowell, as well as maintaining his clinical load in
endocrinology and as Head of Endocrinology, has
been Acting Director of Research, doing an amazing
job in both areas.
We have been fortunate with the help of our Chief
Executive, Dr Antonio Penna, and Chair of the
Children’s Hospital Advisory Committee, Roger
Corbett, to have retained pathology here at The
Children’s Hospital at Westmead, rather than joining
a Western Cluster. Our major challenge for the
laboratory section of the Division is to now form an
independent business unit. This is going to create
some difficulties, but it will enable us to retain the
close contact and relationships with the clinicians of
52
the Hospital and continue to serve the children
of NSW.
Department of Allergy and Immunology
The Immunology Laboratory has again had a very
busy year, with record numbers of investigations
performed. There has been major investment in a
new FLOW cytometer, which is at the forefront of
diagnostic equipment. Mr Mark Hanlon left The
Children’s Hospital at Westmead after almost 30 years
of service in order to take up a new position as a
Senior Scientist and Dr Andrew Williams, a Principal
Hospital Scientist, has been appointed as the
Immunology Laboratory Manager, bringing a wealth of
experience to the position.
The clinical service remains in very high demand. In
order to cope with this we have developed a series of
allergy fact sheets, which are available to clinicians
and patients. The peanut allergy fact sheet has had
6,864 hits from the Hospital alone over the past
ten months. The Department is lobbying the RACP
to set up a more formal process for accrediting
paediatricians for post-graduate training in allergy,
which we envisage will partly meet the escalating
demand for clinical services.
Department members continue to play an active role
in development of the specialty by participating in
both state and national committee work. Dr Alyson
Kakakios has completed eight years as a member of
the Australian Drug Evaluation Committee (ADEC),
the key advisory committee to the Therapeutic Goods
Administration (TGA).
Dr Melanie Wong is a member of the RACP
Written Exam Committee and the National Examining
Panel, as well as the JSAC in Clinical Immunology/
Allergy and Paediatrics. She is a member of the
NSW Health IVIG Users Advisory Group and is on the
Asia Pacific Immunoglobulins in Immunology Advisory
Board. Prof Andrew Kemp is a member of the ASCIA
Anaphylaxis Working Party and the Asia Pacific
Immunoglobulins in Immunology Advisory Board.
Both Dr Kakakios and Prof Kemp continue
as members of the NSW Health Anaphylaxis
Working Party.
Education remains a priority, with the Department
actively involved at all levels of education, both within
the Hospital and in a wider context. We organised a
very successful Paediatric Allergy Update for the past
two years and will be holding a third one in 2008.
Dr Preeti Joshi participated in an educational video
developed by Anaphylaxis Australia.
We remain an accredited training site for the
combined subspecialties of Clinical Immunology and
Allergy (RACP) and Immunopathology (RCPA) and
have undergone two successful site visits, with the
next one due in 2011. Dr Sam Mehr was successful in
the RACP examinations in Immunopathology.
The Department has submitted an expression of
interest in administering the NSW Health Anaphylaxis
Education Program, which is responsible for a
statewide education program targeting all NSW
Schools in the prevention and management of
anaphylaxis. Ms Geraldine Dunne, the Coordinator of
the current program, is based within our Department.
We continue to be active in both clinical and
laboratory-based research and have been successful
in publishing the results in a number of highly
regarded peer-reviewed journals.
Department of Clinical Biochemistry
One of the highlights of this year for the Department
of Biochemistry was the awarding of an NHMRC grant
to Dr John Earl, Deputy Head of the Department,
for research into the role of tryptophan metabolism
in liver transplant tolerance and rejection. This
work will be carried out in collaboration with Dr Ian
Alexander of the Gene Therapy Unit and workers at
the Collaborative Transplant Group, the University
of Sydney and Liverpool Hospital. Dr Earl was also
the principal organiser of a successful Australasian
Association of Clinical Biochemists Conference, with
overseas speakers on chromatography and mass
spectrometry. This meeting was held over three days
in Sydney, in July, 2007.
The work of the Biochemistry Department continues
to increase, especially in the area of blood gases,
where there has been a 30% increase in the
numbers. There has also been a very gratifying
improvement in the turnaround times for results. At
the beginning of 2006, 41% of our electrolyte results
had a turnaround time of less than 60 minutes during
normal working hours. In the first six months of 2007,
this figure rose to 85%, well above the average for
other hospital laboratories.
Institute of Endocrinology and Diabetes
The Institute of Endocrinology and Diabetes is a
centre for excellence in clinical care, education,
advocacy and research for children with endocrine
disorders, diabetes and disorders of bone health. Our
major achievements over the past 12 months include
changes in service delivery for children with diabetes
in Western Sydney via a partnership with Sydney
West Area Health, increasing use of insulin pumps
to improve diabetes control, leadership nationally in
the assessment and management of children with
secondary osteoporosis and opening of the Diabetes
Prevention Research Centre.
Our major challenge is continue to maintain and
enhance our clinical excellence, despite the growth
in demand and limited resources. As examples,
there has been a 19.5% growth in outpatient
occasions of service over four years and a 61%
growth in separations due to the Bisphosphonate
program for osteoporosis and focal bone lesions, and
investigations for children with complex endocrine
disorders associated with multisystem disease and
children with insulin resistance associated with
obesity. Our high and increasing workload is reflected
by the disparity in staff to patient ratio, compared to
other paediatric tertiary centres in NSW.
The Institute has a proud history of providing
leadership in management of children with diabetes
in NSW. This year, a Memorandum of Understanding
was signed between Sydney West Area Health
Service and The Children’s Hospital at Westmead
to enhance paediatric diabetes services at Nepean
Hospital. Dr Ann Maguire has been appointed to
a joint paediatric endocrinology position with the
Nepean Hospital. We have coordinated the up-skilling
of four paediatricians who provide the 24 hour on-site
services and participate in the weekly clinic with the
Paediatric Allied Health Diabetes Team. The transition
of patients attending our Diabetes Clinic from the
Nepean and Windsor areas to the joint Nepean Clinic
is progressing well.
Our priority for children with diabetes is to improve
their metabolic outcomes. This should lead to
improved quality of life and reduced long-term
diabetes complications in children. There has been
improved metabolic control, as measured by median
HBA1c, decreasing from 8.5% in 2003-2004 to
8.0% in 2007-2008. This has been achieved by staff
commitment and increased use of insulin pumps and
53
multiple daily injections. However, we will require a
large investment of resources and increased use of
insulin pumps to achieve the global target of median
HbA1c < 7.5%.
The Bone and Mineral Service is a referral centre
for the State and ACT and we are the only paediatric
Hospital nationally to provide the paediatric
community with a transiliac bone biopsy service for
early detection and management of osteopenia and
other bone health related issues. Other achievements
include the management program for prevention
of secondary osteoporosis and fractures in children
with genetic bone fragility disorders and prevention
of secondary rickets caused by Vitamin D deficiency.
The bone and endocrine services are supported
by the excellent diagnostic services of the NATA
accredited regional NSW referral paediatric
endocrine laboratory.
Our continuing education has been strengthened in
the past year with meetings each week organised by
the junior medical staff. We have been enriched by
overseas trainees from Denmark, China and Taiwan.
Our Diabetes Team has provided ongoing clinical
support to health professionals in the Western Child
Health Network and educators in Wagga, Dubbo and
Bathurst were given education and training in insulin
pump therapy. The Endocrine Nurse Consultants have
led the revision of our patient information pamphlets
over the past year.
A highlight for 2007 was the opening of the Diabetes
Prevention Research Centre on World Diabetes Day.
This was made possible by generous donations from
Diavitiko and the Laki Bank. The Centre will facilitate
our research activities which have three main themes
in diabetes:
• Diabetes epidemiology and aetiology, leading to
intervention studies to prevent type 1 diabetes
• Diabetes complications, especially pathogenesis
and role of genetics, with intervention studies
commencing in 2008
• Pathogenesis of insulin resistance in obesity, with
two intervention studies to prevent type 2 diabetes
commencing in 2008.
Additionally, research activity in the understanding
of bone development, including randomised trials
and clinical endocrine audits, underpin our clinical
excellence in these areas. A Diagnostic and Treatment
54
Centre for children with bone and mineral disorders
has been developed, in collaboration with the
Department of Endocrinology and the Departments of
Clinical Genetics, Nuclear Medicine, Rehabilitation,
Allied Health and Orthopaedic Surgery .
As the awareness of paediatric osteopenia,
osteogenesis imperfecta and the medical
management of focal orthopaedic increases, so too do
the demands placed upon the Bone Service for expert
investigation and management services.
Our productivity is high, with 30 publications and $2
million in competitive grant income in the past year.
Our senior staff are recognised nationally and
internationally, not only for their excellence in clinical
medicine and research, but for their contributions to
advocating for the rights for children with diabetes
and endocrine disorders to achieve the best
health outcomes.
Prof Martin Silink, President of the International
Diabetes Federation (IDF), continues to be at the
forefront of the international fight against diabetes,
with the aim to increase its global awareness and
allow for affordable public health strategies for the
prevention of diabetes and its complications. Prof
Kim Donaghue, a council member of the International
Society for Paediatric and Adolescent Diabetes, has
coordinated the international paediatric diabetes
evidence-based guidelines.
Dr Neville Howard, in his role as President of
Diabetes Australia in NSW, has advocated for
increased resources for paediatric diabetes and for
the up-skilling of school staff in their management of
children with diabetes. Nuala Harkin, Diabetes Nurse
Practitioner, is a council member for the Australian
Diabetes Educator Association. Dr Maria Craig has
become the President of the Australasian Paediatric
Endocrine Society and A/Prof Geoff Ambler was
appointed as Chair of the National Growth Hormone
Advisory Committee.
Haematology Department
The Haematology Department continues to be very
busy, with both clinical and laboratory work. The
laboratory successfully underwent NATA accreditation
in August 2007. During the year we have purchased
a second STAGO coagulation analyser and have
expanded the number of coagulation tests we perform
in-house to include protein C and S and anti-Xa
assays. This results in improved turn-around times
for these assays, which no longer need to be sent out
for analysis. Our total laboratory workload continues
to increase at about 3% per year, with certain tests
(such as sickle preps and malaria testing), increasing
significantly more than this in the past three to four
years as a reflection of the increased numbers of
migrants from the African continent.
Since December 2006, we have taken part in
the statewide Bloodwatch Transfusion Medicine
Improvement Project, initiated by the Clinical
Excellence Commission. With this project, we received
temporary funding for a transfusion nurse, which ran
through until March 2008. Following a series of audits
of our current practices, we identified a number of
areas that required changes in practice.
Quality improvement projects were then established to
address these problems. These projects included the
improved and standardised blood giving sets in the
Hospital and removal of unnecessary leucodepletion
filters, resulting in a saving of $120,000,
implementation of a new all-in-one REM neonatal
blood set that can be used with syringe drives in
Grace Centre for Newborn Care, development and
implementation of improved blood transport around
the Hospital, development and implementation of
parent blood transfusion fact sheet, development and
implementation of Transfusion of Blood and Blood
Components Policy to reflect current national and
international best practice guidelines, development
and implementation of Nursing Blood Competency
Assessment, improvement of JRMO blood safety
education, implementation of zero tolerance of blood
sampling labelling errors, development of haematology
web page and blood transfusion resources online for
the intranet and implementation of the Bloodsafe elearning program to Pathlore and e-learning portal.
An important project established as part of our
Bloodwatch initiative is the Platelet Wastage
Improvement Project, which was aimed at reducing
our wastage of platelets by 50% from an average of 42
units per month. This project has been a combined
effort, with team members from Haematology,
Oncology and Blood Bank working together to develop
strategies to reduce platelet wastage. The strategies
developed have been highly successful and over the
first six months of 2008 our platelet wastage has been
reduced by 65% to an average of 14 units per month,
with a projected cost saving of $200,000 per year. The
significance of this result has recently been evidenced
by the success of this project in the Quality at Kids
awards for 2008
On the clinical front, the Haematology Department
continues to care for a wide range of children with
non-malignant haematological conditions. We have
established a weekly clinical review meeting at
which all inpatients, day-stay patients, outpatient
attendances and telephone consults are discussed.
Children with bleeding disorders continue to make
up a large component of our workload, with over 180
patients registered on our books.
The Kids’ Factor Zone was officially opened in July
2007 by the Health Minister, Reba Meagher. This
treatment room represents a fantastic collaboration
between parents and carers to improve the care of
children with bleeding disorders. Over the first year in
operation, we have seen over 500 attendances at the
Kids’ Factor Zone for assessment and treatment.
The feedback from the patients and families is
extremely positive.
Histopathology Department
The vacant Staff Specialist position, created after the
retirement of Dr Alex Kan in early 2007, was filled with
Dr Meena Shingde commencing in February 2008.
She had settled extremely well into the Department,
gaining experience in all aspects of paediatric
pathology, however unfortunately has recently
resigned to take up a full time position in another
hospital. Dr Alex Kan continues to offer an opinion as
an Emeritus Consultant, allowing us to benefit from his
vast knowledge and experience.
The Histopathology Unit has continued to be very
busy and stretched with surgical pathology and
the Perinatal Autopsy Service. The increase in
autopsies has been over 350% in a six year period.
We completed close to 300 autopsies in 2007, with
numbers remaining at a similar level for 2008 to date.
The Perinatal Autopsy Service continues to provide
services to many major teaching hospitals throughout
the state, as well as many country hospitals and the
majority of private obstetric hospitals in Sydney. We
also continue to process and report surgical placental
specimens for the Sydney West Area Health Service,
which has resulted in an increase surgical caseload of
approximately 20% over the past two years. Numbers
of complex surgical specimens, including muscle
biopsies, also continues to increase as a proportion of
55
the workload. Specialist electron microscopy is
now performed at Concord Hospital Electron
Microscopy Unit.
The pathologists and scientists within the Department
continue to serve on numerous hospital, college, state
and national committees. These include the Perinatal
and Maternal State Committee and the Health
Priority Taskforce, as well as the Maternal Deaths in
Australia Committee and the NPAAC committee on
mortuaries. Within the hospital, Histopathology staff
provide representations on the Human Research
Ethics Committee and the Tumour Bank Committee.
Our senior scientist, Tony Henwood, is the Editor of
the journal Histograph, and is actively involved with
helping clinical sciences research and in writing
papers and teaching. Some research work is being
performed within the Department also, with a number
of papers accepted for publication over the past year.
The Department has introduced extra US lists to
decrease the waiting time for Outpatients. We also
provide extra lists for non general anaesthetic (GA)
MRI patients on a Saturday, when the waiting time
increases to over four weeks. We have been able to
provide these services due to the tireless efforts of our
hard-working radiographers, sonographers, nursing
and clerical staff. Unfortunately our waiting times for
GA MRIs are more difficult to decrease, due to lack of
extra anaesthetic lists, however we are trying, together
with the cooperation of the Anaesthetics Department,
to achieve this.
The Medical Imaging Department maintains its close
relationship with the clinical units of this Hospital,
with regular interdepartmental conferences. These
form the basis of mutual understanding and are wellattended by medical staff, from the Junior Residents
to Senior Consultants. It is often here that important
decisions on clinical management are made.
Medical Imaging
The Medical Imaging Department continues to
provide a dedicated diagnostic and interventional
service and remains a tertiary referral base for parts
of NSW. It also provides this service to surrounding
GPs. The referral base continues to grow and, despite
being short of senior medical staff during the last 12
months, our turnaround time for putting out reports
has decreased. This is due to the very hard work put
in by the available staff.
The Department is in a state of transition – Dr
Christopher Wong has resigned and Albert Lam has
been made a Professor and continues his teaching
role throughout Asia during his attendances at
multiple centres. Dr Vivienne Stockton has retired, her
position being filled by Dr Susi Bottger.
We have very recently installed a new biplane
angiography suite. This was made possible by a
substantial donation, for which we are most grateful.
This equipment enables our interventionalists to
provide the most advanced and intricate angiography
at the lowest radiation doses and the greatest speed
for our paediatric population. This, combined with
the 64 slice CT scanner which was acquired in 2006,
offers state-of-the-art technology. Replacement of
other radiographic equipment is on the agenda for the
next 12 months as this equipment is now nearly 13
years old.
56
We remain an international centre for the training
of Paediatric Radiologists, with Fellowship positions
being filled by overseas and local candidates. These
positions are highly sought, due to the fact that our
case mix is so extensive and covers all aspects of
paediatric radiology. We also provide the paediatric
component of the Radiology Registrar Training
Program for most of the NSW candidates.
The overtime budget remains a difficulty for the
Department, due to the demand of a 24 hour service.
Together with the Emergency Department, we are
always seeking new avenues in terms of rostering
and reassessing to improve this. In the next twelve
months we are hoping that further improvements will
be made.
Department of Infectious Diseases and Microbiology
This is a newly-formed Department, which integrates
the areas consisting of the Clinical Infectious Diseases
Consultation Service, the diagnostic laboratories of
microbiology, virology and molecular pathology, the
Infection Control Service and, more recently, the
Antimicrobial Stewardship Program. We also provide
advice to, and medical oversight of staff health issues,
including the mandatory Vaccination Program.
The workload in the Department continues to
increase, with requests for over 500 clinical
consultations per year and an increase in laboratory
testing of 8% per annum over ten years. The
introduction of the Antimicrobial Stewardship Service
has considerably increased the workload of the
clinicians involved.
The clinicians, pathologists, nurses and scientists
within the Department continue to serve on numerous
hospital, college, state and national committees.
These include the Drug Committee, Infection Control
Committee, Institutional Biohazards Committee,
Clinical Facilities Planning Committee, Demand and
Access Management Committee, Clinical Review
Committee, Library Committee, RACP Examinations
Committee, RCPA Microbiology Committee, NATA,
Australian Adverse Drug Reactions Committee and the
Pharmaceutical Benefits Committee
The Department is an accredited training site for
the combined sub-specialties of Clinical Infectious
Diseases (RACP) and Microbiology (RCPA). The
registrar, Dr Brendan McMullan, is commencing
his infectious diseases training, supervised by A/
Prof Alison Kesson and Prof David Isaacs. There
have been several visitors to the Department over
the last year for education, Dr Renuka Fernando
(microbiology) from Sri Lanka, Dr Bilal Kamel and
Dr Ammira AlShummari (molecular biology research)
from Iraq, Dr Tuan Ho (infectious diseases) and Ms
Sinh Tran (molecular biology), both sponsored by the
Hoc Mai Foundation, University of Sydney, as well
as several University of Sydney and overseas
medical students.
Ms Hanady Elbab has commenced her Masters
of Philosophy studies with A/Prof Kesson into
the role of transcription factors and toll-like
receptors in flavivirus-induced expression of major
histocompatibility complex-I and intracellular adhesion
molecule-1 genes.
A major clinical development in 2008 was the
introduction of the Antimicrobial Stewardship
Program, which is a process to assist and support
clinicians with decisions regarding the optimal
selection, dose and duration of an antimicrobial agent.
The objectives are to ensure the best clinical outcome
in terms of the treatment or prevention of infection,
with minimal toxicity to the patient and minimal
impact on subsequent resistance development in
micro-organisms. Cost-savings are often observed with
successful stewardship programs, but are not their
primary purpose.
The Program has been staffed by a Senior
Pharmacist, Ms Lucy Holt and three staff specialists,
Dr David Andresen, Prof David Isaacs and A/ Prof
Alison Kesson.
Major goals ahead for the Department are to develop
and expand the diagnostic test repertoire to serve the
both the clinical and infection control needs of the
Hospital.
Nuclear Medicine
The Nuclear Medicine Department performed
studies on 3988 patients and several therapies on
cancer patients in 2007. Over this period, there
has been consolidation of services with the PET/CT
at Westmead now being a routine service for The
Children’s Hospital at Westmead on Thursdays and
any emergency studies on the other days.
PET
For the last financial year, 465 PET/CT studies were
performed by staff on paediatric patients, with the
majority from The Children’s Hospital at Westmead.
Our PET service is the only dedicated paediatric
service nationally and it also receives requests
for PET studies from Sydney Children’s Hospital.
The application of PET in paediatric oncology and
neurology has continued to rise and be shown to have
a significant impact on clinical patient management.
Dr Kevin London has commenced a six month
research project, in conjunction with the Oncology
Department, to correlate the role of PET/CT with
conventional medical imaging and to determine the
change and impact on patient management. The
funding for PET has been renegotiated by NSW Health
and the Federal Government.
The Western Sydney Genetics Program
Academic Department of Medical Genetics
The Department contributed to the new Foundation
Block for the Sydney Medical Program in February.
This followed a year of detailed planning with other
members of the Discipline of Genetic Medicine,
demonstrating that our knowledge and skills goals
should address the needs for genetics in clinical
practice of our future graduates. Although we are
a small University Discipline, our faculty spanning
clinical, counselling and laboratory areas are making a
real contribution to academic genetics in medicine.
2008 witnessed 20 years of teaching and research of
genetics here at The Children’s Hospital at Westmead.
57
In this period we have made an outstanding
contribution to teaching and training, having trained
50 clinical geneticists since 1988. Our fiftieth trainee,
Dr Sunita Bijarnia has just returned to New Delhi with
the experience and knowledge to establish a model
service for children with Genetic Metabolic Disorders.
Clinical Genetics
The Clinical Genetics Department continues to
provide clinical services to our patients, Westmead
Hospital and outreach clinics. The services provided
to Westmead Hospital are formally recognised under
the Department of Genetic Medicine (SWAHS). In
collaboration with stakeholders at The Children’s
Hospital at Westmead and Westmead Hospital, we
have continued promoting the need for enhanced
provision of adult genetics services.
We remain a fully accredited training site for
clinical genetics, with two permanently funded
advanced training positions. We contribute actively
to undergraduate and postgraduate teaching and
participate in a number of statewide and national
committees related to genetics. Several clinicians
undertake ongoing formal research, as detailed
under the Human Genome Research Program, but
other staff are also active contributors. Publication
highlights for 2007-2008 include an invited book
chapter on Mowat-Wilson Syndrome by Dr Meredith
Wilson for Inborn Errors of Development, second
edition, Oxford University Press and Fiona Richards’
ongoing contribution to the literature regarding the
case against predictive testing for Huntington Disease
in minors.
Cytogenetics
The Diagnostic Cytogenetic and Molecular Cytogenetic
Service had 6000 referrals in the year. This includes
500 referrals for CGH microarray testing. During this
period, we were the only laboratory in Australia or New
Zealand providing routine testing in CGH arrays and
also introduced a second generation, higher-resolution
CGH array test service, using oligomeric probes.
The array data is used in generating research reports
on patients and principles of interest, in collaboration
with our referring clinicians.
Our prenatal diagnosis service continues, under the
guidance of Dr Art Daniel. Dr Ellie Smith conducted a
Cytogenetics Workshop in Vietnam and was an invited
58
speaker at the International Prader-Willi
Syndrome Conference.
Genetic Metabolic Disorders Service
We farewelled Prof Bridget Wilcken, who has retired
after over 30 years of service. A Festschrift in her
honour was held in early 2008 and was a fitting sendoff. Dr Kaustuv Bhattacharya, a previous fellow from
the UK who trained with us, has now joined us as
Bridget’s replacement. Troy Dalkeith joined the service
as Clinical Nurse Consultant for the Service in
February 2008.
We continue to work with the staff and executive of
the Sydney West Area Health Service to develop an
adult metabolic disorders service. Such a service is
critical for the management of these patients who
often have very complex medical needs.
Molecular Genetics Department
The introduction of MLPA testing for Subtelomeres
and Microdeletion Syndrome by Dr Rachel Smith has
been a major development. This testing complements
the CGH microarray and FISH testing provided by the
Cytogenetics Department. A number of interesting
cases have been diagnosed. It is also allowing the
detection of aneuploidy in fetal demises, many of
which previously went undetected as they failed in the
tissue culture step.
With the help of staff within the Department of
Cytogenetics, the range of tests has been expanded
to include PAX6 and SHOX testing. Mutations in the
PAX6 gene are a major cause for the eye anomaly,
aniridia. Mutations or deletions of the short stature
homeobox-containing gene (SHOX) are a cause of
short stature in children.
In conjunction with the GOLD Service at Hunter
Genetics, the Department has undertaken a pilot
screening study for Fragile X Syndrome, looking at
200 newborn screen cards. The study was able to
develop a semi-automated method for extracting DNA
from a portion of the newborn screening cards. The
FMR1 gene was able to be amplified by PCR in all the
specimens though a subset of females who require
further development of the assay.
NSW Biochemical Genetics Service
NSW Biochemical Genetics Service has continued
its involvement in gene therapy research for OTC
deficiency through biochemical measurements of
effectiveness of therapy. We have developed a new
assay studying urea synthesis, using stable isotope
techniques which have been applied to the mouse
model for this condition. One highlight of the year was
the identification of the toxic component in toy beads,
which had led to the hospitalisation of several children
around the world. Our discovery resulted in the recall
of over eight billion beads worldwide and brought the
Hospital great publicity. Sample numbers continue to
grow, up 29% over the last five years.
NSW Newborn Screening Program
Newborn Screening has had a productive year, with
seven papers in peer-reviewed journals arising from
the state-wide program. We have begun research
on the adequacy of diagnosis of hypothyroidism in
very low birth weight babies and are finalising the
Australia-wide research programme we are leading
on the clinical outcome of early diagnosis by tandem
mass spectrometry newborn screening. Professor
Bridget Wilcken and Associate Professor Veronica
Wiley were invited speakers at the International
Society for Newborn Screening in Singapore in 2007.
Human Genome Research Program
A very generous donation from a private individual
allowed us to continue our research into mitochondrial
respiratory chain disorders. This will allow us to build
a body of data to make us more competitive when it
comes to submission of research proposals to funding
agencies in the coming year.
Research performed by Genetic Metabolic
Disorders Research Unit, in conjunction with
Dutch collaborators, led to the discovery of the
gene responsible for the rare X-linked disorder,
Arts Syndrome. Unexpectedly, it was found that
Arts Syndrome was due to an abnormality in purine
metabolism and this led to the identification of a new
treatment, which at this early stage appears to have
resulted in significant benefits for affected individuals.
Two postgraduate students working in the NSW
Centre for Rett Syndrome Research have successfully
completed their studies in 2007, Sarah Williamson
was awarded a PhD and Rose White was awarded a
Masters of Science in Research.
Research work in the Eye and Developmental
Genetics Research Unit has led to the identification
of novel genes and candidate regions in eye diseases
which cause childhood blindness. A novel gene,
important in contributing to cataracts and visual
disability in children, has been identified. This novel
gene, TMEM114, is expressed in the lens and is
disrupted in several members of a family with cataract
formation. Causes of glaucoma in the eye are also
being investigated. Glaucoma is a condition where
build-up of pressure in the eye is associated with
damage to the nerve of the eye, leading to
progressive blindness.
In collaboration with the Department of Cytogenetics,
a detailed genomics approach (CGH microarray) is
used to identify novel genes in this condition. Luke St
Heaps, Masters student, has investigated three new
families with glaucoma and identified novel candidate
disease genes for further investigation. Luke received
a student prize at the recent Discipline of Paediatrics
postgraduate research meeting for this work. Dr
Robyn Jamieson was successful in obtaining grant
funding from the Ophthalmic Research Institute
of Australia for the project, Ocular developmental
disorders: molecular genetics and gene function.
Mental Health Services
This year has been one of some growth in strategic
areas and consolidation of earlier established
services. We also have been looking to scope our
future developments, given service needs in child and
adolescent mental health and the rate of development
since The Children’s Hospital moved to Westmead
in 1995.
Hall Ward
The acute mental health ward, Hall Ward is now fully
staffed, with a growing resource of standby staff. Hall
Ward is now the only consistently fully staffed ward in
the Hospital. Another big achievement is the dramatic
decline by 80% of reportable incidences in the ward.
This not only reflects the consolidation of nurse
staffing and teams, but is a credit to Earl Durheim,
Hall Ward NUM, and other senior management.
We welcomed Dr Lucy Chapman as the new Staff
Specialist for the Unit. Hall Ward is an active
contributor to the NSW Forum for Acute Adolescent
Psychiatric Inpatient Units, contributing to the
establishment of standards and guidelines across
the state. We have also been closely involved in The
Children’s Hospital Australasia benchmarking of
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psychiatric inpatient units in paediatric hospitals.
Emergency Department
The increase in acute mental health presentations
in the Emergency Department reflects the presence
of the Acute Mental Health Unit, the collaborative
management of complex cases with the intensive
support services of DoCS and the continuing growth
of the mental health epidemic in young people. We
received $200,000 enhancement funding to expand
our presence of Clinical Nurse Consultants in mental
health in the Emergency Department, so that there will
be presence until eleven o’clock at night on weekdays
and a presence for a day shift on weekends. These
positions are currently being recruited. There has
been an improvement in mental health access block
over the year.
Addiction Medicine
The new project for this year has been the
establishment of an Addiction Medicine Service,
funded by the Consultation Liaison Project of the
Drug Program, through the Mental Health and Drug
and Alcohol Office. This will be run through the
Department of Adolescent Medicine. We received
$100,000 in the initial year and have appointed Dr
Bronwyn Milne as a Staff Specialist in Addiction
Medicine and expanded Popi Zappia’s hours as a
Clinical Psychologist. The enhancement of the Mental
Health Clinical Nurse Consultant’s service in the
Emergency Department will also benefit this project,
which is currently under development.
Eating Disorders
Our Department has been coordinating an information
sharing working group between the three children’s
hospitals of NSW. The primary focus has been
on eating disorders, where there are discussions
over establishing a common data set. The Eating
Disorder Service continues to be of high profile,
with their findings from the national study on prepubertal presentations of eating disorder, through
the Australian Paediatric Surveillance Unit, gaining
significant media coverage. Similar studies have now
been completed in Canada and the UK following the
lead of our Eating Disorder Service.
The Eating Disorder Service continues to pursue an
active research program, with an ongoing NHMRC
funded randomised controlled trial of inpatient
treatment and the submission of a program grant,
60
in conjunction with academics from The University
of Sydney, The University of Western Sydney
and Flinders University in South Australia. The
restructuring of the wards around the medical teams
has lead to increased problems in providing the
inpatient eating disorder services, particularly for preadolescent patients. This has been partially addressed
through the provision of annual funding of $100,000
for four years from the Mental Health Drug and
Alcohol Office to fund a Clinical Nurse Consultant to
provide, amongst other services, improved liaison for
eating disorders patients across the Hospital.
The Western Paediatric Network also provided funding
for a Clinical Nurse Specialist in eating disorders
to improve the liaison networking and education
of Sydney West. The Eating Disorders Service has
also been a beneficiary of funding from the Butterfly
Foundation, which will fund two family admission
units and an expansion of office space for the Eating
Disorders Program, housed in Adolescent Medicine.
The Eating Disorders Foundation has also appointed
a Clinical Psychologist to work across The Children’s
Hospital at Westmead, Westmead Hospital, Northside
Private Hospital and Prince Alfred Hospital, to assist
with the transition of rural patients from hospital
to home. The Eating Disorders Service has been
designated as a separate service and funding
structure, although it still remains accountable to both
mental health and adolescent medicine.
CAPTOS
The Child and Adolescent Psychiatric Telemedicine
Outreach Service (CAPTOS) progresses well. Under
Sue Foley’s leadership as Coordinator for CAPTOS,
there are continuing quality evaluation studies
being done and close linkage with the Area Clinical
Directors of Child and Adolescent Mental Health
that have significant regional populations, through
teleconferencing.
This, and the evaluation of the education outreach
and regular supervision of one hundred regional
clinicians a month, was recognised for service
improvement through winning the Quality at Kids
Award (QUaKS) for Improvement of Service with
External Partners.
CAPTOS remains a highly valued service and its
strategic directions will be considered in the context
of a planned review of regional child and adolescent
mental health services being organised by the Mental
Health and Drug and Alcohol Office. In response to
regional concern, a proposal for a CAPTOS second
opinion service, for next day psychiatric consultations,
was developed and is still due to be considered.
CAPTOS remains a service that has considerable
potential for enhancing the provision of tertiary mental
health services for children and adolescents in rural
and remote areas. We have also had quarterly
teleconference links with the telemedicine service
at Toronto Children’s Hospital, which is a similarly
large telemedicine service. This also led to the Eating
Disorders Team participating in a teleconference
grand round linked with Toronto Children’s Hospital
and the Hospital for Sick Children at Great Ormond
Street in London, simultaneously presenting on their
comparative studies of pre-pubertal eating disorders.
Mental health priority in paediatrics and partnerships
with DCSs and DADHC
In December, a representative of the Department
attended the Children’s Hospital of Australasia Mental
Health Day in Adelaide, where attention was drawn
to the mental health needs of children in paediatric
health settings and there was a consensus view that
this was a concern of highest priority.
In June, we made a submission to the Garling
Enquiry, outlining both the development of the last
ten years and our future concerns. In view of the
perceived success of our collaborative project with
Intensive Support Services of the Department of
Community Services for complex cases of abuse and
trauma and chronic psychiatric morbidity for children
in the care of the Minister, we hope that the outcome
of the Wood Enquiry will lead to further investment in
this area of health provision.
Our partnership with DADHC has flourished this year.
Building on top of the popularity of the Developmental
Psychiatry Conjoint Clinic, co-hosted with the
statewide Behavioural Intervention Service, we have a
number of additional projects.
Firstly, we are developing, in partnership with the
statewide Behavioural Intervention Service, an
Education and Training Curriculum for Community
Clinicians in child and adolescent mental health
and intellectual disability and are planning three
workshops next year. They also kindly host the pilot
study for intervention in Autism with mild intellectual
disability, through the emotion-based social
skills training.
With the statewide Behavioural Intervention Service,
we have embarked on training twenty clinicians in
Stepping Stones Triple P, to enable access for parents
with a child or adolescent with an intellectual disability
to receive this specialist form of parent training
intervention.
Lastly Dr David Dossetor is involved in the working
group to establish fellowships in intellectual disability
for graduating psychiatrists, through the Institute of
Psychiatry, and in the working group between mental
health and DADHC to renew the Memorandum of
Understanding.
Future Concerns
With the continuing concerns about the problems of
rising acuity, more complex co-morbidity and earlier
presentations of children and adolescents with mental
health problems, the Department of Psychological
Medicine at The Children’s Hospital at Westmead can
potentially play an important role in working to meet
these needs of young people in NSW.
In particular, we have shown a capacity to develop
tertiary services, particularly for special need
populations that are not adequately catered for in
current services and to provide innovative clinical
research, collaborative specialty tertiary services and
education to enable wider workforce development in
these areas.
We are evidently involved in some of these areas, with
the capacity to expand in some others with support
and funding where we have clinical champions
with special interest. We already have elements of
programs to provide workforce development and
education more broadly through NSW, for example in
Autism and Mental Health and Intellectual Disability,
some specialist parent training, and potentially
classroom intervention for Autism. We feel that
collaborative clinical pathways with key agencies that
share responsibility for child and adolescent wellbeing
are a critical part of building service capacity for these
complex high-need populations.
One key element that has to be considered for future
development is our space needs. This involves a
need to plan for the re-building of Hall Ward, so that
it is purpose-built and could expand its bed numbers
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2 Collection of Outcome Measures.
This indicator measures the number of outcome
measures recorded by each area, as a percentage
of the expected number of measures for that
area. The formula applied to derive the expected
number of measures is based on total area
population. As our Hospital has no defined
catchment population, this cannot be estimated.
However, the table below shows the total outcome
measure collections of outpatient and inpatients
at the required standard collection occasions of
their episode of care, as per the MHOAT protocol.
A significant shift is notable in outcome measure
collection in the number of collections at standard
review occasions and at discharge, due to feedback
mechanism to the clinical teams started in beginning
of year 2007. There is a minor increase (11%)
reported in the number of admission collection of
outpatients this year, 210, compared to 185 last year.
Reported number of admission outcome measure
collections in the Acute Inpatient Unit (Hall Ward) this
year showing an upward trend from 83 in 07/07.
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Total
Collections
1 Community Mental Health Care Hours.
Statewide expected target for ambulatory client
related provider time is 67% of clinician time spent
on client related activities. Suggested target for
The Children’s Hospital at Westmead is 50%. We
have achieved 44.6% of the expected target in
this financial year, (Year 06/07 was 47%) a minor
decrease of 3.5%. The main problem is resourcing
and supporting clinicians to an adequate level of
compliance with reporting, given their workloads.
Clinicians’ workload includes supervision and
training and clinical research.
Discharges
Performance Statistics
Service Unit Name
Reviews
Lastly, MH-Kids, which is the Strategic, Policy and
Advisory Body on Child and Adolescent Mental Health
to the Director of the Mental Health Drug and Alcohol
Office, has moved to Gladesville Hospital, but under
the auspices of The Children’s Hospital at Westmead.
Table of number of outcome measures collected
Admissions
for the same staffing. We also need to significantly
increase our outpatient capacity, co-locating our
service, and plan for an expansion of both tertiary
clinical and clinical research and education capacity.
Psychological
Medicine Service
(Outpatients)
210
100
173
483
Hall Ward Mental
Health Inpatient
Service (Inpatients)
93
8
92
193
3 In-patient self sufficiency.
This indicator measures how self-sufficient each
area is in providing inpatient mental health care to
its own residents.
This measure is not a pure indicator of inpatient
activity, as our mental health service has no
defined catchment population to provide this
data. Instead, service utilisation by the population
can be reported. The table below shows the total
separation and length of stay for SWAHS and other
area health services (n=116), 61 from SWAHS and
55 from other Area Health Services (including one
from overseas) reported for 07/08. Separation from
both NSCCAHS and SWAHS is 68%.
The actual average length of stay was 20.3 days down
from 22 in 06/7.
Corporate and Shared Services
The Division of Corporate and Shared Services
includes the following services:
Area Health
Group
Area Code
Separations
Total LOS
Other Area
GSAHS
3
76
GWAHS
5
132
HNEAHS
2
26
NCAHS
5
111
NSCCAHS
19
674
SESIAHS
5
25
SSWAHS
15
167
Own Area
SWAHS
61
1,131
OS
OS
1
10
116
2,352
Grand Total
4 Emergency Department Access Block.
This indicator measures the percentage of
people with mental health problems seen in the
emergency department who are admitted to a
mental health unit within eight hours of active
treatment, as captured by the NSW Emergency
Department Information System. This is down from
28.7% in the previous year.
Total Admissions
Total in Access Block
% in Access
Block
108
16
14.8%
•
•
•
•
•
•
•
•
•
•
•
•
Procurement
Engineering and Maintenance
Facilities Planning and Management
Food Services
Linen Services
Domestic (Cleaning) Services
Security and Fire Control
Transport and Stores
Mail and Photocopying
Accommodation
Child Care Centre
Shared Services co-ordination (provided by
HealthSupport)
Engineering and Maintenance Departments
coordinated several major building projects during the
year, including construction of an Emergency Medical
Unit and triage redevelopment.
Child Care Centre fees increased in January 2008,
ensuring the cost of these services to the Hospital
is minimised. The Parent Hostel was restructured
as the Accommodation Department, to oversee the
management of all parent and staff accommodation,
while maximising revenue opportunities.
The Facilities Planning Committee inaugural meeting
occurred in November 2007, bringing together the
overall planning and management of the facilities,
including design and operational management. The
Corporate Services Assets Management Plan was
further reviewed to ensure repairs and maintenance of
existing facilities minimises any risks.
Food Services major assets were reviewed, with
planning for replacement of the assets that had
reached their effective life, such as the pot washer
and dishwasher.
Engineering and Maintenance is conducting a detailed
consultants review of central energy infrastructure and
emergency generators.
In future, in-house retail food outlets are moving
further towards being privately operated on a
phased-in approach. There is ongoing involvement
63
in operations of HealthSupport to ensure the daily
performance meets the operational needs of this
Hospital.
Restructure of Child Care Services, including vacation
and occasional care, will be centralised under the
Child Care Centre.
Waste management strategies to maximise recycling
and minimise clinical waste costs will be introduced,
where appropriate. Further review of all facilities
contracts, including engineering, maintenance, fire
and security, will be undertaken to ensure the services
supplied to maintain buildings and grounds are at
necessary standards.
A detailed review of campus parking is underway,
including the replacement of the visitor parking pay
stations with a Parking Management System and a
review of staff parking.
Information Management Services
Information Services played a pivotal role over the year
in supporting Directorates and Programs and has led
the implementation of key systems.
The move to Health Support (Health Technology) has
proven to be challenging, with a significant impact
on internal reporting. From a technology perspective,
there have been no major issues, although the
budgetary pressures continue.
The Hospital continues to advance the functionality
of our Electronic Medical Record (EMR), however the
implementation of the statewide program has been
slow to gain momentum, largely due to functionality
issues in the State Baseline Build.
The expertise of our team will continue to ensure a
good outcome for the Hospital. A major focus through
the implementation continues to be on the alignment
of the strategy for the EMR with the needs of staff and
the Clinical Redesign Program.
Regrettably the Cerner Electronic Medication
Management system has been put on hold, due to the
lack of funds. Improving medication safety remains a
strategic priority and will progress as soon as funding
becomes available.
64
The ongoing deployment of a wireless infrastructure
and applied technologies is seen as fundamental to
future initiatives and will continue to progress and
expand the benefits already being felt in the busy
Emergency Department. This work has been widely
presented and acknowledged as a leading example of
demonstrated benefits.
We continue to be recognised as an e-learning Centre
of Excellence with the development of learning
modules for many Hospital systems.
Management reporting continued to be hampered
by a number of factors through the year, including
the loss of key personnel and the transition to Health
Support. These issues have been resolved and we
are now making significant progress with the ongoing
development of accessible management information,
using Business Objects and Balanced Scorecard
technology. Despite this progress, there is still much
work to be done.
In preparation for episode funding, we have ensured
that our costing system is stable and the coding of
inpatient discharges is well within the NSW Health
benchmark, ensuring timely reporting. Clinical
documentation continues to improve with the
development of documentation guidelines on cards
which are carried by clinicians on their lanyards.
These were developed in consultation with clinicians,
other paediatric hospitals and experienced coders for
each specialty.
Community Relations
and Marketing
The Community Relations and Marketing Division
comprises of the Public Relations Department, the
Fundraising Department and Radio Bedrock.
The Public Relations Department proactively works
towards positioning The Children’s Hospital at
Westmead as a world-class children’s hospital and
an advocate for children. Whilst maintaining the
Hospital’s high profile within the community our
fundraising potential is maximised.
The Fundraising Department utilises an array of
fundraising programs to raise the significant funds
required to enhance The Children’s Hospital at
Westmead each year. Specialist staff work within
areas such as direct marketing, regular giving, trusts
and foundations, major gifts and bequest fundraising
to ensure sustainable fundraising income and they
also provide support and advice to individuals and
groups who wish to support The Children’s Hospital
at Westmead.
Income derived from fundraising contributes towards
around ten per cent of the Hospital’s running costs,
including research, equipment replacement, special
programs and staff positions.
Radio Bedrock is The Children’s Hospital at
Westmead’s in-house radio station, presenting a
live radio program to patients each weeknight. Sick
children and their families can either listen from the
Hospital wards or come to the studio to join in the
fun and activities that Radio Bedrock provides. This
service is run by volunteers and it contributes to the
Hospital’s philosophy of providing a total healing
environment for families.
A number of significant achievements from the
Community Relations and Marketing Division have
contributed to the success of the Hospital overall.
These include:
• A total of $24.3 million was raised through
donations, ranging from corporate partnerships,
community events, bequests, regular individual
giving and merchandise. This includes a record
donation from Woolworths of $1.2 million, bringing
their total donated to The Children’s Hospital at
Westmead to almost $14 million over the past
14 years.
• The Minister for Health, Hon Reba Meagher
MP, officially opened the Kids Factor Zone,
an innovative treatment facility for patients
with haemophilia, and attended the launch
of the Animal Assisted Therapies Program, a
physiotherapy-based program using dogs to help
facilitate rehabilitation and treatment for sick
children. Both of these projects are funded by
donations.
• Internal communications were improved, with the
introduction of the weekly Bandaged Bear Bulletin
and the weekly In the Media newsletter to keep
staff more informed and involved.
• The Volunteer Management Plan was developed
to recruit, train and retain an improved bank of
volunteers for special events, tours and
fundraising events.
• The story of Demi-Lee Brennan, a patient who
received a liver transplant at The Children’s
Hospital at Westmead and her body spontaneously
took on the immune system and blood group of
her donor, received extensive media coverage
on an international scale. This was the lead story
of range of proactive media stories focussing on
organ donation facilitated by the Public Relations
Department.
• There was an overhaul of the Fundraising
Department’s direct mail strategy, in line with the
overall strategy to increase untagged donations
through regular giving from individuals.
• A range of special events were held at the Hospital
during the year, including the launch of the
Diabetes Prevention Unit, attended by one of the
Hospital’s Goodwill Ambassadors, Bec Hewitt,
and the Book Bunker tenth birthday celebrations,
attended by famous author, Mem Fox.
• The Chairman of the Children’s Hospital Advisory
Council (CHAC) hosted a dinner for major donors
at the Hospital to build closer ties with these
individuals and to further communicate the
Hospital’s challenges ahead and need for
further support.
• After staff at The Children’s Hospital at Westmead
uncovered that the Toy of the Year, Bindeez,
contained toxic chemical equivalent to an illicit
drug, a major awareness campaign was launched
by the Public Relations Department, resulting in an
international recall of this dangerous product.
• The inaugural Bandaged Bear Cup was held. This
was a NRL game between the Bulldogs and the
Parramatta Eels and recognised the contribution of
Hospital staff to the community. This annual event
is a result of the Hospital’s ongoing partnership
with ANZ Stadium.
• Two of the major fundraising events to benefit The
Children’s Hospital at Westmead were the Grace
Gala Ball, which raised over $300,000 for the
Grace Centre for Newborn Care, and the Singapore
Airlines maiden voyage of the A380, which had a
significant fundraising aspect and as one of the
beneficiaries we received $236,000.
• A record number of volunteers were recruited to
sell merchandise on Bandaged Bear Day, part of
the Hospital’s major fundraising appeal.
• A nursing recruitment campaign was launched,
targeting nurses to become part of The Children’s
Hospital at Westmead’s team. This consisted of
promotional banners and cards to be used for
displays and a series of advertisements.
65
• The Think Kids Challenge, part of the annual City
to Surf, raised a record amount of $113,000, up
from $55,000 the previous year.
• The Community Relations and Marketing Division
managed the presence of the Special Commission
of Inquiry into Acute Care Services in NSW at
The Children’s Hospital at Westmead. Two public
hearings were held at the Hospital and a number
of closed sessions also enabled staff to give
evidence confidentially.
• Over 15,000 people visited the Radio Bedrock
studio during the broadcast hours and over 18,000
song requests were taken from patients.
Looking towards the future, each department within
the Community Relations and Marketing Division
has a strategic plan and specific strategies in place
to contribute towards the overall success of The
Children’s Hospital at Westmead.
Internal Audit
The role of the Internal Audit is an independent,
objective assurance and consulting activity to add
value and improve the Hospital’s operations. It helps
the Hospital accomplish its objectives by bringing
a systematic, disciplined approach to evaluate and
improve the effectiveness of risk management,
control, and governance process.
Internal Audit is committed to comply with the
Standards for the Professional Practice of Internal
Auditing, issued by the Institute of Internal Auditors.
66
Internal Audit provides reasonable assurance to
executive management and the Chief Executive,
through the Audit and Risk Management Committee,
that at the time of review, all reviewed functions
are working in a manner that is consistent with
established policies and procedures.
One of the main functions of the Internal Audit
is to conduct a broad comprehensive program
of evaluating the effectiveness of the Hospital
management control system.
Internal Audit oversights the Hospital corruption
prevention function, which includes the development
and implementation of the Hospital Fraud Control
Strategy, and investigation of potential and suspected
fraud or other irregularities.
The Hospital Code of Conduct is issued to all staff
members. The Code of Conduct and a Statement of
Business Ethics are available on the Hospital website
for staff and public awareness. All staff members are
expected to read, understand, observe and comply
with these documents by demonstrating honest,
ethical and professional behaviour.
Staff and those who deal with the Hospital are
expected to promptly bring any instance of
suspected internal or external fraud to the attention
of management. This will result in the process
of investigation, as set out in the Hospital Fraud
Reporting Policy and Procedures.
Internal Audit usually conducts investigation on
suspected fraud. This may involve investigation in
cooperation with the Police and/or the Independent
Commission Against Corruption.
comprises the Chief Executive and two independent
persons who are not employees of or contracted to
provide services to the Hospital. At least one member
of the Audit and Risk Management Committee has
significant experience with financial matters. The
chairperson is one of the independent members
appointed by the Director-General NSW Department of
Health. The Audit and Risk Management Committee
receives and considers all reports of the external
and internal auditors and ensures that all audit
recommendations are implemented.
meets four times per year, or more frequently as
circumstances require. A copy of the agenda papers
and minutes is provided to the Director Corporate
Governance and Risk Management of NSW
Department of Health.
The key role of the Audit and Risk Management
Committee is to assist the Chief Executive in carrying
out the corporate governance responsibilities in
relation to the financial reporting, internal control, risk
management, compliance with laws, regulations and
ethics and the internal and external audit functions.
The Audit and Risk Management Committee is
separate from the executive management and has no
decision-making powers or supervisory functions.
The Audit and Risk Management Committee had five
meetings in 2007 / 2008.
Possible Meetings #
Meetings
Attended
Mr Kevin Doyle
(Chair)
4
4
Mr John Dunlop
3
3
Dr Antonio Penna
5
5
Member
# If a member has been granted leave, meetings
held during that leave are not considered as possible
meetings.
The Audit and Risk Management Committee attended
by the following staff members and external auditor:
•
•
•
•
•
•
•
•
•
Director, Information Services and Planning
Director, Clinical Governance and Medicine
Director, Clinical Operations
Director, Finance and Corporate Services
Director, Community Relations and Marketing
Director, Workforce Development
Deputy Director, Finance
Manager, Internal Audit
Representatives, the Audit Office of NSW
(External Audit)
The External Auditor, the Audit Office of NSW, did not
undertake any non-audit assignments in 2007- 2008.
67
Our People
Our People
Workforce Development
The Hospital has a vision of ‘Healthy Children for a Healthy Future’.
The Hospital’s vision is enabled by focussing on achieving strategic goals and operational excellence consistent
with NSW Health and State Government strategies.
The following strategy map expresses the Hospital’s vision and strategic goals from a workforce perspective.
Healthy Children for a Healthy Future
Sustainable
Paediatric
Workforce
Culture of
Wellness
Resources
Education & Learning Culture
Employee
Jorney
Skilled motivated staff, work in safe
innovative environments
Employment
& Equity
CHW is the
Paediatric employer
of choice
Performance
& Recognition
Education, learning and
research develops
staff capacity
Workforce Support
Workforce Leadership
& Innovation
Workforce
Relations
Staff are
accountable and
recognised for
meeting service
standards
Staff respect each
other and work
effectively in
teams
OHS&IM
Staff, teams and the Hospital
demonstrate CHW values
in action
Services, teams
and staff lead
and innovate
68
Education, Learning
& Research
CHW ensures a safe
working environment
Workforce Planning
Service plans reflect
future service and
staff needs
Workforce Infrastructure
& Systems
Workforce systems facilitate
service and staff needs
Our People
Achievements
1. Employment and Equity
The Hospital entered into a partnership with the
Federal Department of Education, Employment and
Workplace Relations (DEWR) to facilitate development
and implementation of an Aboriginal Employment
Strategy (Closing the Gap).
There has been a focus on recruitment of nursing staff
and junior medical staff in 2007-2008. A significant
change to employment of overseas junior medical
staff has been implemented by the NSW Medical
Board. These changes will support implementation of
a National Registration system for specified
clinical groups.
Employment staff participated in a documentary for
German television which focussed on employment
processes for overseas nurses.
The New Graduate Nursing Support Program was
evaluated and changes implemented to support
employment of a large cohort of nursing graduates.
Employment data demonstrates that the Hospital has
increased the number of nursing, medical and allied
health staff to support the Hospital’s clinical services.
2. Education Learning and Research
The Hospital entered into partnership with the
University of Sydney to deliver:
a. A clinical simulation centre, the Kim Oates
Australian Paediatric Simulation Centre, which is
the first simulation centre focussed primarily on
paediatrics in the Southern hemisphere.
b. The Diploma of Child Health (DCH) - the DCH is
an internationally recognised course for medical
officers who wish to become more confident in
treating children and young people.
Mandatory training for employees has developed
over the preceding 12 months. The system has been
enhanced and data integrity improved. At present,
mandatory training is focussed on Fire Training, Child
Protection and Resuscitation.
Approximately 100 employees completed traineeships
that were supported by State and Federal grants. The
success rate for completion of traineeships is very
high and demonstrates the support staff obtain from
their managers and education staff.
3. Performance and Recognition
The Hospital has developed the Performance
Development Review System and will enhance its
reporting capabilities in the subsequent year.
There has been a focus on active management of
clinician registration. A system was put in place by
NSW Health for the capture of registration information
and the Hospital has built on this foundation to
introduce a credentialing and defining scope of
practice policy supported by monthly reporting
and follow-up. An external audit of the Hospitals
registration system for medical staff was very positive.
4. Workforce Relations
There have been a number of significant changes to
awards, requiring education and consultation with
large groups of staff to implement these changes.
These changes have occurred efficiently and
effectively with no significant disputation.
The governance structures for industrial relations were
reviewed and minor changes implemented to improve
communication. There has been no lost time due to
industrial disputes and relationships with industrial
organisations are healthy.
The majority of employees who were displaced by
outsourcing specified services to HealthSupport have
been placed in other positions.
5. Workforce Support
The Hospital offers a range of programs to support
wellness. These include:
a. An external counselling service available to all
staff at any time night or day. The annual report
demonstrates an increase in service usage with a
mixture of personal and work related issues.
69
Our People
6. Occupational Health, Safety and
Injury Management
The Hospital is an extremely good performer in
the Treasury Managed Fund. Performance results
demonstrate that the Hospital is a very safe place
for our staff and visitors. The Hospital’s incident/
accident rate is approximately half that of other
government agencies.
The Children’s Hospital at Westmead is the first
Australian company, across all industries, to be
awarded the International Disability Management
Standards Council Certification for its injury
management program. The Consensus Based
Disability Management Audit, based on international
best practice, was conducted in November 2007 and
certification was awarded in December 2007 for
three years.
The Hospital implemented the NSW Health
Vaccination Policy. Vaccination compliance has
improved from 15% in July 2007 to 62% in June
2008. The Hospital is aiming for 100% compliance
by December 2008.
7. Workforce Leadership and Innovation
A new workforce governance structure was approved
in 2007-2008 with a Workforce Leadership Group
established to provide leadership of workforce issues
across the Hospital.
The Hospital is participating in the Clinical Excellence
Commission’s Clinical Leadership Program. This
program provides opportunities for clinical leaders
to develop their leadership skills and experience.
Anecdotal feedback from participants demonstrates
the program is a success. A formal evaluation will be
completed in late 2008.
The Nursing Clinical Accreditation Program (CAP)
is a joint project between The Children’s Hospital at
Westmead, the Sydney Children’s Hospital and the
University of Technology, Sydney. Eleven new nursing
graduates commenced the pilot program in 2007,
with a further fourteen commencing in May 2008.
8. Workforce Planning
The five year Workforce Plan is in place. Individual
clinical services are ensuring that workforce
requirements are included within their service plans.
Outcomes of planning activities are reviewed and
reported annually.
9. Workforce infrastructure and Systems
The Hospital is a beneficiary of the NSW Health
Human Resource Information Systems (HRIS)
strategy. An updated version of the payroll and roster
systems was implemented. Whilst there were some
initial implementation issues, these are mostly
now resolved.
A new hazardous substance database was introduced
statewide. The Hospital trained a number of key staff
to use the database and all information on hazardous
substances is being loaded into the system. Material
data safety sheets are able to be produced from the
system to aid in safe management, storage and use of
hazardous substances.
New HRIS projects will be implemented in the
coming years, which will enhance the HRIS and
ultimately provide tangible improvements for
employees and management.
10. Nursing
Critical social science theory has been used to
develop a Nursing Strategic Plan to enhance nursing
practice, meet the future workforce needs and to
streamline practices and processes and to develop
innovation in practice. The approach was shared at an
International Conference on Practice Development in
Holland, with the Director of Nursing being a key
note invited speaker.
70
Our People
The Nursing Research and Practice Development
Unit continues to support evidence-based clinical
practice and a culture for patients, their families and
staff that is person-centred. The Professor of Nursing
was co-editor of an international book on Practice
Development for Health Care Professionals, with both
the Professor and Director of Nursing contributing
to writing of chapters within this book. This Unit is
involved and leads local, state-wide and international
research.
Executive Management
The Children’s Hospital at Westmead is the lead site
for the NSW Health Essentials of Care Program for
Paediatrics across the State. The Professor of Nursing
is the lead researcher on the Essentials of Care Project
overall within NSW.
Director of Clinical Operations:
A coaching program was offered to the Nurse
Managers and Nursing Unit Managers to enhance
their leadership capabilities and to support them
in the implementation of a new performance
development system.
There have been many innovative programs offered,
including a speciality New Graduate Program
for newly graduated nurses with the Emergency
Department and transitional educational support
programs to enhance our workforce.
Nurses have presented at local, interstate and
international conferences and shared their experience
and expertise with others. There have been numerous
publications by nurses and this is an area where
we are seeing further growth as the nurses of The
Children’s Hospital at Westmead continue their
research and commitment to share this work with
others to inform their practice.
Chief Executive:
Dr Antonio Penna, MD, FRACP, MBA
Director of Clinical Governance
and Medicine:
Dr Stuart Dorney MBBS, FRACP
Cheryl McCullagh RN, Dips App Sci Nursing,
BN MHSN FACHSE
Director of Finance:
Wendy Haigh BA (Hons), FCA, MAICD
Director of Community Relations
and Marketing:
Gillian Paxton, BA
(Economics and Industrial Relations)
Director of Information Services
and Planning:
Dr Ralph Hanson, BSc(Med), MBBCH, MPH,
MRACMA, FRACP, FACEM
Director of Workforce Development:
Frank Horn, Grad Dip ER, NZTTC, Dip Teach
71
Our People
Executive Profiles
Dr Antonio (Tony) Penna
Dr Antonio Penna was appointed to the position
of Chief Executive of The Children’s Hospital at
Westmead following Prof Kim Oates’ retirement in
February 2006. For one year prior to this he was
Director of Clinical Services - Medical. Before joining
The Children’s Hospital at Westmead, Dr Penna
had been the Director of Medical Services at Royal
North Shore Hospital, a position he had held since
1997. He is an Adelaide graduate, who did his
paediatric training at the Adelaide Children’s Hospital,
followed by time at the University of Melbourne as an
NHMRC Postgraduate Fellow, where he completed
his doctorate in pharmacokinetics. In 1992, he
became Clinical Superintendent in the Department
of Paediatrics at Westmead Hospital, where he
was subsequently promoted through a range of
administration positions, while still maintaining a
clinical role.
Dr Stuart Dorney
Dr Stuart Dorney was appointed to the position of
Director of Clinical Governance and Medicine in May
2007. He had been acting in the position for three
months prior to this and for the previous five years
he had been the Hospital’s Clinical Risk Manager.
Originally from Townsville, Stuart studied Medicine
at the University of Queensland and came to The
Children’s Hospital in 1978 as a Paediatric resident.
He did all his Paediatric training at the Hospital,
followed by fellowships in Gastroenterology both here
and at the University of California Los Angeles (198385). He was appointed to The Children’s Hospital at
Westmead as a Staff Specialist in Gastroenterology
and Liver Transplantation in July 1985, to help
establish the Pilot National Liver Transplantation
Program which was a joint venture with Royal Prince
Alfred Hospital. He continued in that role full time
until November 2001. Stuart continued to see
outpatients in the weekly Liver Clinic until
January 2006.
Annette Solman
Annette joined The Children’s Hospital at Westmead
in July 2007 in the position of Director of Nursing. She
previously worked with the NSW Clinical Excellence
72
Commission Statewide Clinical Leadership Programme
as the Statewide Coordinator. In addition, Annette
worked with Northern Sydney Central Coast Area
Health Service, as the Manager responsible for Area
Organisational Culture and Practice Development
Annette is patient, family and staff orientated. She
has extensive experience in practice development,
management, change management, leadership
development, strategic planning, research and
workforce development towards meeting the needs of
a contemporary healthcare system.
Cheryl McCullagh
Cheryl McCullagh moved from the Women’s and
Children’s Hospital in Adelaide in 2001 to take up the
position as Nurse Manager for Oncology Services. She
worked in several roles before accepting the position
of Medical Program Chair in April 2004, a new
position in the Hospital structure. She began relieving
in the role of Director of Clinical Operations and
Nursing in October 2006 and formally took over the
new role Director of Clinical Operations in May 2007.
Cheryl has worked in adult and paediatric tertiary
referral hospitals in Adelaide and Sydney, she has a
Diploma in Applied Science, a Bachelor of Nursing,
a certificate in paediatric palliative care and has just
completed a Masters in Health Service Management.
She is also a Fellow of the Australian College of Health
Service Executives. Cheryl is focussed on developing
people and is committed to creating models which
address fair resource allocation and inequities of
access to health services.
Wendy Haigh
Wendy joined the Hospital in August 2006 as Director
of Finance and was appointed Director of Finance
and Corporate Services in May 2007. She has a
successful track record in finance, having held a
number of senior management positions across both
the private and public sectors. After completing an
honours degree in accounting, Wendy qualified as a
Chartered Accountant with PricewaterhouseCoopers
in the UK before transferring to Sydney in 1984. She
is a Fellow of the Institute of Chartered Accountants
of England and Wales, an Associate of the Institute of
Chartered Accountants of Australia and a Member of
the Australian Institute of Company Directors.
Our People
Gilly Paxton
Gilly Paxton joined The Children’s Hospital at
Westmead as Public Relations Manager in March
1998. After five years in the position she moved into
the Fundraising Department and was appointed
Deputy Director Community Relations in 2004. Gilly is
now the Director Community Relations and Marketing.
Dr Ralph Hanson
in Employment Relations/Industrial Law and was
awarded the NSW Industrial Relations Society Prize
and graduated top of his year. He has worked in
the NSW Public Health sector for almost 20 years
and been employed at The Children’s Hospital at
Westmead for approximately seven years. Frank is
dedicated to furthering the professionalism of human
resources, improving systems and developing the
Hospital’s workforce.
Staff Profile
Dr Ralph Hanson joined the Hospital in 1982. After
successfully completing his training in paediatrics, he
was appointed as Staff Specialist and subsequently
Head of the Emergency Department and Outpatients.
In 1997 he was seconded to the position of Manager,
Clinical Services Network Taskforce and subsequently
appointed Chair of Information Services in 1998 and
Director of Information Services in February 2000.
He has extensive experience in health informatics
and information management. He is both a Fellow
of the Australasian College of Physicians and the
Australasian College of Emergency Medicine and has
a Masters in Public Health.
Jun-07
Jun-08
Medical
334
369
Nursing
819
849
Allied Health
213
221
30
24
5
5
Corporate Services
136
131
Scientific & technical clinical support staff
296
246
Hotel Services
152
149
12
12
364
432
15
15
2,376
2,453
Other Prof. & Para professionals
Oral Health Practitioners & Therapists
Maintenance & Trades
Hospital Support Workers
Other
Frank Horn
Grand Total
Frank originally trained as a teacher, eventually
tutoring part time and casual at TAFE, the University
of Sydney and Western Sydney University. He
entered the NSW Health system as a Training Officer,
before commencing a career in Human Resources.
Frank completed post graduate university studies
Notes:
1. There has been a welcome increases in the number of
nurses, medical officers and allied health staff to support
increased demand.
2. Scientific and technical clinical support staff have decreased
due to a re-classification of research staff resulting in an
increase in hospital support workers
Staff Excellence
Month
Employee of the Month
Department
Category
Jul-07
Cale O’Bryan
Information Services
Service Delivery
Aug-07
John Coakley
Biochemistry
Across all categories
Sep-07
Kanchan Das
Brain Injury and Rehabilitation
Oct-07
Therese Baker
Service Delivery and Innovation
Nov-07
Janette Clarkson
Oncology
Jan-08
Kevin Carpenter
Biochemical Genetics
Service Delivery, Leadership and Innovation
Feb-08
Scott Rowan
Camperdown Ward
Mar-08
Grant Maddaford
IT Services
Service Delivery and Leadership
Apr-08
Sally Markoska
Food Services
Service Delivery and Leadership
May-08
Robyn Lamb
Child Protection Unit
Leadership and Innovation
Jun-08
Marguerite Ogg
Haemotology
Service Delivery and Innovation
73
People with a
Disability Requiring
Work-related
Adjustment
People with a
Disability
People Whose
Language First
Spoken as a Child
was not English
People from Racial,
Ethnic, EthnoReligious Minority
Groups
Aboriginal People
& Torres Strait
Islanders
Women
Weighted Estimate
Men
LEVEL
Respondents
Actual Number
TOTAL
STAFF
(Number)
Our People
Actual and Estimated Staff Numbers by Level
< $35,266
45
40
8
37
2
9
12
2
$35,266 - $46,319
721
644
134
587
10
199
256
53
11
$46,320 - $51,783
247
214
23
224
2
44
59
18
3
$51,784 - $65,526
688
594
74
614
5
180
180
43
1
$65,527 - $84,737
632
574
92
540
9
133
126
58
7
$84,738 - $105,923
412
383
148
264
134
125
28
1
> $105,923 (non SES)
224
188
122
102
61
46
25
2
2,969
2,637
601
2,368
760
804
228
26
> $105,923 (SES)
TOTAL
Disability Action Plan
The Children’s Hospital at Westmead has an updated
Disability Action Plan, with a changed format to
assist in assigning tasks and priorities. New terms of
reference have also been developed.
There is now a reviewed membership to ensure
improved representation from relevant departments
and personnel working with children with disabilities
and/or staff members with disabilities.
The Hospital reviewed and adapted the relevant NSW
Health Policy to ensure appropriateness and relevance
to children and young people hospitalised and treated
as outpatients. This led to the development of the
policy, Disability - Children and Young People with
Disabilities: Responding to their Needs.
We conducted a retrospective review of the activities
and presentations for 2002–2007 for the annual
celebration of the International Day of People with a
DisAbility.
In response to RTA provision of additional disabled
parking spaces in Hawkesbury Road, we created
posters detailing additional parking spaces with
illustrative photographs. Families with children with
disabilities were informed about these additional
parking spaces.
We facilitated consultation and liaison with relevant
departments regarding access issues, such as lift
renovations and complex clinic appointments.
74
28
Occupational Health, Safety
and Rehabilitation (OHS&IM)
For the 2007-2008 finance year:
• 330 incident/accidents were reported
• 75 Workers’ Compensation claims were lodged
- total hours paid: 7,377 hours
• Mean time lost per claim: 98 hours or 2.5 weeks
• 36 staff participated in rehabilitation and six of
these were for non-work related conditions. Of
the 23 finalised rehabilitation programs, there has
been a 100% success rate in returning staff to
pre-injury duties. For non-work related programs,
there was an 83% return to pre-injury duties and
the remaining 17% were terminated as they were
unable to fulfil their substantive role. 85% of other
programs are ongoing and progressing well. 15%
remain totally incapacitated with one of the two
claims being declined
• There were no WorkCover prosecutions during
this period
Staff Vaccinations
For the 2007-2008 financial year, a total of 3316
staff vaccinations were given – representing a 235%
increase on the previous year. Vaccinations included:
•
•
•
•
•
•
•
Hepatitis B (1157)
Influenza (812)
Boostrix (872)
MMR (354)
Varicella zoster (114)
Hepatitis A (3)
Typhoid (4)
Men
Women
Aboriginal People
& Torres Strait
Islanders
People from Racial,
Ethnic, EthnoReligious Minority
Groups
People Whose
Language First
Spoken as a Child
was not English
1,260
93%
25%
75%
0.9%
27%
29%
8%
0.7%
Permanent Part-time
737
88%
9%
91%
0.8%
23%
25%
10%
1.7%
Temporary Full-time
653
86%
27%
73%
1.1%
30%
29%
4%
0.4%
Temporary Part-time
309
79%
11%
89%
1.2%
19%
21%
7%
0.8%
25%
75%
36%
64%
25%
13%
Our People
Respondents
Permanent Full-time
EMPLOYMENT
BASIS
People with a
Disability
TOTAL
STAFF
(Number)
People with a
Disability Requiring
Work-related
Adjustment
Equal Employment Opportunity
Contract - SES
Contract - Non SES
4
Training Positions
11
73%
Retained Staff
Casual
336
39%
16%
84%
0.8%
14%
20%
4%
0.8%
TOTAL
3,310*
84%
20%
80%
0.9%
24%
26%
7%
0.9%
* Total staff difference with Actual and Estimated Staff Numbers by Level due to contractor and casual staff variances.
Distribution of Workplace Incidents/Accidents
Type
Blood exposure
Manual handling
Slip/Fall
Scabies
No lost time injuries
Time lost injuries
Journey injuries
Visitors
Incidents
Total
03/04
04/05
05/06
06/07
07/08
64
61
57
96
23
44
30
15
390
52
55
48
38
100
22
39
26
14
394
57
50
57
139
24
35
21
10
393
41
59
70
108
16
42
27
18
381
40
46
67
94
15
41
23
4
330
Workplace Claims – Main Occupation Groups
Total Claims
03/04
Total Claims
04/05
Total Claims
05/06
Total Claims
06/07
Total Claims
07/08
Nursing
42
38
35
33
29
General Admin
19
14
13
12
12
Medical/Med Support
21
15
19
12
10
Hotel Services
20
27
24
19
21
Linen
0
0
0
1
0
Main Occupation Groups
General Maintenance
Total
6
4
6
3
3
108
98
97
80
75
Worker’s Compensation for 2007/2008 - Treasury Managed Fund (TMF)
premium detail. Claims data as at 30 June 2008
Benchmark premium
(budget allocation)
$3,706,875
Deposit premium
(amount paid into fund)
$1,684,755
Surplus
$2,022,120
Claims total: 75
Incurred cost: $402,128
75
Our People
Risk Minimisation
Strategies employed during the year to eliminate or reduce workplace incidents and staff injuries include:
•
•
•
•
•
Extensive review of existing OHS system with major policy and procedure reviews
Consolidated OHS forms to assist with the implementation of the OHS system
Developed and implemented a comprehensive OHS training package for managers
Increased staff vaccination uptake to comply with Health Department Policy
Ongoing extensive ergonomic surveys, workplace and equipment modifications and/or designs to promote a
safe working environment
• We are the first organisation in Australia to achieve the globally recognised International Disability Management
Standards Council (IDMSC) Certification for Excellence in Injury Management
Working Together Targets
The Working Together Strategy Report was received from NSW Treasury Managed Fund. The report measures
claim activity using data extracted from the SICorp Data Warehouse as at 31 March 2008, for claims made as at 31
December 2007. Note that target 2 statistics are as at June 2007.
• TARGET 1 – INJURY PREVENTION
Workplace injury incidence rate
Workplace injuries as % of employees
9.0%
8.0%
All Health - Actual incidence
rate per annum
7.0%
All Government Agencies Actual incidence rate per
annum
6.0%
5.0%
CHW - Target incidence rate
per annum
4.0%
All Health - Target incidence
rate per annum
3.0%
2.0%
CHW - Actual incidence rate
per annum
1.0%
0.0%
Jun
02
Jun
03
Jun
04
Jun
05
Dec
05
Jun
06
Dec
06
Jun
07
Dec
07
Jun
12
Period entered onto system
Data source: NSW Treasury Managed Fund Workers’ Compensation
The baseline year (2001/2002) was an exceptionally good year and the Hospital has maintained a good
performance. The most recent figures demonstrate that the target has almost been achieved.
76
Percentage of claimants on weekly benefits on or after
8 weeks since injury
Our People
• TARGET 2 – INJURY MANAGEMENT
18.0%
All Health - Actual proportion
of weekly benefits per annum
Percentage of claimants (%)
16.0%
All Government Agencies Actual proportion of weekly
benefits per annum
14.0%
12.0%
CHW - Target Actual proportion
10.0%
8.0%
All Health - Target Actual
proportion of weekly benefits
per annum
6.0%
2.0%
All Government Agencies Target Actual proportion of
weekly benefits per annum
0.0%
CHW - Actual proportion of
4.0%
Jun
05
Dec
05
Jun
06
Dec
06
Jun
07
Dec
07
Jun
08
Measurement Period
14.0%
12.0%
10.0%
benefits per annum
8.0%
6.0%
per annum
4.0%
2.0%
0.0%
Jun
05
Dec
05
Jun
06
Dec
06
Jun
07
Dec
07
Jun
08
Measurement Period
77
Our People
4.5%
4.0%
benefits per annum
3.5%
3.0%
2.5%
2.0%
per annum
1.5%
0.5%
0.0%
1.0%
Jun
05
Dec
05
Jun
06
Dec
06
Jun
07
Dec
07
Jun
08
Measurement Period
• TARGET 3 – COST OF CLAIMS
Average cost of claims
30,000
All Health - Actual average
cost of claims
Average cost of claims ($)
25,000
All Government Agencies Actual average cost of claims
20,000
CHW - Target average cost
of claims
15,000
All Health - Target average
cost of claims
10,000
All Government Agencies Target average cost of claims
5,000
CHW - Actual average cost
of claims
0
2004/05
2005/06
2006/07
July 2007
- Dec 2007
2007/08
Injury Period
78
Percentage of weekly claimants on S38 benefits
for 2 or more weeks
Our People
• TARGET 4 – INJURY MANAGEMENT
Percentage of S38 Claimants
7.0%
6.0%
All Health - Actual % S38
benefits
5.0%
All Government Agencies Actual % S38 benefits
4.0%
CHW - Target % S38 benefits
3.0%
All Health - Actual % S38
benefits
2.0%
All Government Agencies Target % S38 benefits
1.0%
CHW - Actual % S38 benefits
0.0%
Jun
05
Dec
05
Jun
06
Dec
06
Jun
07
Dec
07
Jun
08
Measurement Period
Teaching and Training Initiatives
Nursing Educational Activities
The Clinical Accreditation Program (CAP) was
developed and is derived from a model of workplace
learning. It draws on theories of experiential learning
and reflective practice. Content focuses on working
with children, young people and families, growth and
development and utilises relevant specialist nursing
competencies or standards.
CAP is given advanced standing for an equivalent
subject (Specialty Clinical Practice) in UTS Graduate
certificate in Children’s Nursing. 15 new graduate
nurses will be undertaking the inaugural program.
Four CAP participants have enrolled in the UTS
Graduate Certificate for 2008 following the completion
of CAP.
14 New Graduates are undertaking CAP in 2008.
It is planned that CAP will be available to all Nursing
staff across the Hospital in 2009.
Nursing education programs were attended by
454 nurses, including orientation for nurses, high
dependency paediatric nursing, nursing management
of children with cancer, new graduate orientation
and study days, preceptor workshops, assessment
and recognition of the sick child and professional
development seminars on portfolios.
The Hospital’s New Graduate Program supported
60 new graduate nurses over the last financial year.
Intakes of new graduates occurred in August 2006
(ten participants), January 2007 (30 participants) and
March 2007 (20 participants). 83% were employed
following completion of the Program.
Four new graduates commenced the August 2007
Program and 50 commenced the January 2008
Program. We have also developed and implemented
an Emergency Department New Graduate Program,
with four NGs participating in 2008.
The Trainee Enrolled Nurse (TEN) program had 12
participants who started in September 2006, all of
these TENs were successful in gaining employment
at The Children’s Hospital at Westmead following
completion of the Program. The TEN Program had
four participants commence in September 2007.
The Hospital has provided approximately 30,000
clinical hours of undergraduate nursing student
clinical placements.
Postgraduate Medical Education
A range of postgraduate medical education for Junior
Medical Staff is offered fortnightly. This includes lunch
time teaching sessions, FRACP lectures, Diploma
in Child Health (DCH), journal club and internal
department tutorials. A total of ten from 28 people
79
Our People
passed the written FRACP exam and nine from 15
people passed the clinical exam.
The current format of the FRACP lectures and written
and clinical exam preparation is being evaluated,
with the aim of providing more suitable, informative
and useful training for our Junior Medical Staff. The
FRACP lectures are now being recorded and made
available to trainees, both internally and externally at
various hospital libraries. We hope for the lectures to
go online in the near future.
The Diploma in Child Health continues to provide
excellent post-graduate paediatric education and
has proved to be a successful program nationally
and internationally. With valuable assistance from a
group of expert volunteers, there has been significant
added impetus in 2008 with course development and
distribution. There were 352 participants in total
in 2008.
The Diploma in Child Health offers a comprehensive,
evidence-based overview of paediatrics, teaching
current best practice. It aims to measurably improve
the health of children globally by enhancing the
knowledge, confidence and skills of doctors who
work at the frontline of child health care. Teaching is
case-based, with immediate relevance in day-to-day
practice.
Since its commencement, this Program has had a
primary focus for staff at The Children’s Hospital at
Westmead. It has grown since its establishment in
1998 as a distance education course around Australia
and is now conducted internationally in Hong Kong,
Cambodia, China, the Solomon Islands and Vanuatu.
Plans for deployment in Maharashtra and possibly
Vietnem are under development for 2009. The model
of distance education incorporates 111 hours of
lectures via DVDs or internet with local tutoring to
enhance geographical and cultural relevance.
Kim Oates Australian Paediatric Clinical Skills Centre
Planning for the Kim Oates Australian Paediatric
Clinical Skills Centre has continued, in cooperation
with the University of Sydney Clinical School. A
Manager for the Centre will commence in August
2008. The Centre has increasingly been used for a
range of initiatives, including resuscitation training.
80
Education Centre: Key Statistics
• Mandatory Training compliance has remained
steady at between 90 - 95% compliance for Child
Protection Training
• Fire Awareness compliance dropped to 70% but has
increased steadily to 80% for both components
• 197 staff completed or attended non-clinical training
within the Hospital
• 46 traineeships were completed
• 119 ongoing traineeships were completed
• 2895 staff completed an online course
(including Fire Theory)
The Education Centre has provided organisational
assistance to a number of conferences run by the
Hospital. These include Paediatric Update, Paediatric
Postgraduate Weekend for General Practitioners,
Palliative Care Symposium, Pee and Puff Seminar,
Putting Siblings on the Agenda Symposium and Asia
Pacific Guest Fellowship.
E-Learning and Videoconferencing
Applications developed in e-learning were the
Electronic Health Record (EHR), which is accessible
across the state, Electronic Medical Record (EMR),
PowerChart and Patient Management for Health
Technology. A Risk Management Module was created
for staff and production of the Paediatric Resuscitation
and Smoking Cessation: Brief Interventions E-learning
Programs are nearing completion. The E-Learning
Team is assisting in the investigation and testing of
solutions to a statewide platform for e-learning delivery
for NSW Health.
Videoconferencing has been used for participation
in a number of education programs. These include
the NSW Clinical Genetics Fellows’ Training Program,
Paediatric Further Education and Training Program
(VicFEAT), Respiratory Medicine, Bug Breakfasts and
Community Child Health Training
Grand Rounds presentations are offered to other
interested Hospitals via videoconferencing.
Selected presentations are also available to
paediatricians via a CD-ROM distributed through
Merck Sharp and Dohme.
Our People
Allied Health
To add to the Allied Health New Graduate Programs,
regular sessions have been organised and coordinated by Head, Social Work and Deputy Head,
Occupational Therapy, to support new Allied Health
graduates to not only be competent practitioners,
but also have the ability to work independently
and collaboratively within multi-disciplinary teams.
Hospital retention rates of new graduates remaining
in paediatrics are testimony that the programs are
successful. This addition is proving to add value.
Allied Health Departments continue to take students
for their undergraduate and postgraduate clinical
education placements from a variety of NSW and
interstate universities.
Physiotherapy
The Physiotherapy Department continues to be invited
to present in many centres in regional and rural NSW,
including Armidale, Brewarrina, Coffs Harbour, Wagga
Wagga and Newcastle. They present for Health, as
well as DADHC and other NGOs.
We are also providing paediatric education to smaller
metropolitan hospitals so they can take referrals
that are better seen close to home. The most recent
education program was for Auburn Hospital. The
Department also continues to provide workshops and
conference days at the Hospital on topics that are
requested by outside paediatric physiotherapists.
The physiotherapists from the Burns Unit are
currently involved in developing the paediatric portion
of the Burns Education Package.
Our educators recently took part in the process
to develop a national assessment tool to allow
for consistent grading of the clinical education
physiotherapy students Australia wide.
Occupational Therapy celebrated its 70th Birthday
by organising a one day seminar, Networking for
Kids: Building Partnerships in Occupational Therapy
Practice, in October 2007. 178 Occupational
Therapists from across the country heard of the varied
and work of Occupational Therapy at the Hospital.
Diana Barnett, as part of the Hospital’s Feeding
Clinic Tea went to Orange to present at the two-day
workshop organised by Carmel Blayden, Project
Officer for the WCH Network’s project, Supporting
Allied Health Professionals Working with Children.
Kids Health
Kids Health, working with Respiratory Unit,
Adolescent Medicine Unit and Pharmacy, have
produced an eLearning package and tutorial to
educate staff on how to conduct evidence-based
smoking cessation brief interventions. This has been
piloted with two wards (91 staff accessed eLearning,
with 45 having completed the eLearning package).
Pre and Post tests will be used to assess knowledge of
smoking cessation and confidence to conduct
brief interventions.
Kids Health, working with the Burns Unit, Kidsafe
and NSW Severe Burn Injury Service, have engaged
an education consultant to develop the “Learn to
Stop Burns!” program and teaching resource. The
“Learn to Stop Burns!” program is a computerbased, animated hazard house, which allows users to
journey through a house to see and learn how burns
can happen and also how they can be prevented.
A teaching resource was developed, containing
suggested teaching and learning activities, which
assist students in exploring the house. The activities
allow students to work towards achieving the stage two
and stage three outcomes in the Safe Living Strand of
the K-6 Syllabus Personal Development, Health and
Physical Education (PDHPE). Kids Health piloted
the program with 89 students in NSW (aged between
8-12 years), and found an 18% increase in burns
prevention knowledge.
Kids Health organised and coordinated five seminars
for parents, carers and professionals in 2007. The
seminars, addressing topics such as protective
behaviours, parenting adolescents, bullying and
starting (pre) school, were presented by experts at
the Hospital. Kids Health now plans to make this
information available via their website, along with
many other child health and safety topics.
Kids Health and Nutrition and Dietetics Departments
provided lectures as a part of the DCH program.
Social Work
The Integrating Social Work Practice and Research
Seminar was held, organised by a committee of
Social Workers from across the Hospital. The invited
speaker was Ted McNeill, Director of Social Work
81
Our People
and Child Life, Toronto Hospital for Sick Children. Six
Social Workers from within the Hospital presented on
research projects.
Psychology
The Developmental Cognitive Neuropsychology
Research Unit (DeCog) hosted its biennial conference
in March 2008. This year’s conference theme centred
on the evolution of cognitive processes in normal
development. Two international keynote speakers,
Dr Brad Duchaine and Professor Gerry Taylor, were
in attendance, along with 70 delegates from around
Australia and the world.
Neuropsychologists in the Hospital co-ordinate a
statewide Paediatric Neuropsychological Interest
Group. This group is held at various locations around
Sydney and its aim is to foster links with other
psychology professionals working in paediatric settings
and promote paediatric research and clinical practice.
This year, the group focussed on topics such as
childhood dementia and literacy remediation.
The Psychology Department has run six child
psychology seminars at over the last financial year.
This is a successful ongoing program with a focus on
up-to-date evidence-based practice that attracts a
wide range of health and education professionals.
The Student Intern Program supported a total
of 21 Neuropsychology and Clinical Psychology
postgraduate students over the last financial year,
seven across the Rehabilitation Department and Child
Development Unit, seven in Psychological Medicine,
four in the Disability Specialist Unit, two in the
Adolescent Medicine Unit and one in the
NF1LD clinic.
Psychologists in the Hospital make a significant
contribution to teaching, both within our Hospital and
into a range of outside programs, including the NSW
Institute of Psychiatry, the Diploma of Child Health
and the postgraduate medical student program at the
University of Sydney. Psychologists in Psychological
Medicine support a range of rural and remote allied
health professionals across NSW through the CAPTOS
program. This provides supervision and education
via videoconferencing, as well as regular site visits to
deliver teaching and training workshops tailored to the
specific needs of clinicians at the rural sites.
82
The Department of Psychological Medicine runs
a secondary supervision program for all Clinical
Psychologists within the Department with less than
two years postgraduate experience. This program
is aimed at supporting competencies and ongoing
professional development.
Pharmacy
The Pharmacy Department runs a structured
education program for two pharmacy graduates
undergoing their supervised practice year, required
prior to registration as a pharmacist. Several
pharmacists are also working nationally to conduct
a specialised training course in paediatric medicines
and this group is also developing specialised
paediatric pharmacist competencies.
Audiology
In 2007, two of our postgraduate Masters in Audiology
clinicians were being supervised for their 12 month
Clinical Practicum, prior to acceptance for clinical
certification by the Audiological Society of Australia.
This number increased to three in 2008.
Orthoptics
Orthoptics have participated in the SCORPIO
sessions run by the Clinical School. The focus of
the orthoptic session has been practical advice
and tips on assessing babies and children’s eyes
with limited resources. Monitoring for normal visual
development and detection of eye disease has also
been addressed.
Orthoptics have also been involved in external
teaching, offering a seminar to the College of Nursing
on vision screening and Train the Trainer sessions for
nurses in Sydney and Tamworth, to orientate them to
StEPS - the new preschool Vision Screening Program
being implemented in NSW in 2008.
Orthoptics have presented an update on
electrophysiology to orthoptic colleagues at an annual
general meeting.
Our People
Overseas travel
Title
Overseas travel (all employees) for period
Domestic/other travel (all employees)
Funding
$1,956,214.48
$753,479.08
No of Applications
385
1,083
$2,709,693.56
1,468
Other
$18,924.75
$1,104,829.68
$85,400.26
$672,222.76
$25,199.51
$1,906,576.96
$803,116.60
11
250
400
529
13
1,203
265
Totals
$2,709,693.56
1,468
Bulkeley fund (cost centre 9259)
Staff Specialists (Level 1 general funds & PPT)
General funds
SPT funds
General funds - Clinical Trials
Research
Research is one of the key mechanisms by which
the Hospital provides the highest possible standards
in care and treatment. The primary objective of our
research activity is improved health for all children
- healthy children for a healthy future. Our research
groups are associated with clinical departments/
groups within the Hospital and have members who
directly participate in health delivery. We take pride
in the fact that our research is ‘bench to bedside’
– the advances we make at the laboratory bench are
ultimately aimed at helping children in hospital beds.
The past year has witnessed significant investment in
planning for our future. We have grown substantially
over the past ten years from a group of 60 researchers
when the Research Division was formalised in 1997
to over 250 research staff in 25 research units. Our
current research covers basic, clinical and population
health fields, with our activities to a large extent
driven by our research staff exposure to clinical and
population health issues.
A large proportion of the growth in the past ten
years has been in basic and population health
research, indeed the doubling of research space
with the opening of the new building in 2005
significantly enhanced our capacity in these areas.
In broad consultation with the research and Hospital
community, staff in the past year have worked
creatively and collaboratively on our future direction
and our governance structure.
Our vision
Our vision is to become a leading global translational
research centre for children. In order for us to become
a global leader in translational research, we will be
making significant investments in;
• Clinical Trials Research Centre to enhance our
capacity to conduct clinical trials
• Strategic health priorities building on the core
expertise that is currently present. This will include
maximising opportunities with our Westmead
Research Hub partners, the Children’s Medical
Research Institute and the Millennium Institute
and the University of Sydney and other partners to
create critical mass in research themes relevant to
child health.
• Enhancing the Westmead Research Hub Core
Technology, with partners Children’s Medical
Research Institute, Millennium Institute, University
of Sydney and the Office for Science and
Medical Research
83
Our People
Already, the first step in enhancing our clinical trial
capacity is underway with a generous donation from
a bequest from the University of Sydney. The bequest
will support a Clinical Trials Project Coordinator whose
role will involve an assessment of future infrastructure
requirements (resources and facilities) and
developing models for growth. Broad consultation with
researchers, clinicians, other key staff and external
stakeholders to achieve these goals and to coordinate
the establishment of a paediatric network will be a
part of the role.
Research Governance
The governance structure for the Research Division
has been reviewed with a clear objective of providing
accountability for research activities and their finances
through the Research Committee. New terms of
reference for the Research Committee have been
endorsed by the Hospital and are being progressively
implemented throughout 2008.
Our Partners
Research at The Children’s Hospital at Westmead
is part of a vibrant research community of over
800 researchers, the Westmead Research Hub.
Our major partners in the Hub are the Westmead
Millennium Institute, Children’s Medical Research
Institute (CMRI), University of Sydney and the Office
for Science and Medical Research. Planning has
started for a new Hub building on the Westmead
campus, which will house an expanded Millennium
Institute and core high technology facilities that will
be jointly funded and used by the partners. This is an
exciting collaborative initiative that will enhance our
strong biomedical research base, provide increasing
opportunity to attract leading clinician researchers
and postgraduate students and ensure quality and
excellence in clinical care.
84
One of the unique strengths of the Research Hub
is that we are the only campus of the University of
Sydney that can offer research and clinical trials
across all age groups. One of the main focuses of
this campus will be to increase the capacity of our
clinical trials initiatives across all age groups where
there are common issues and expertise, for example
cancer, diabetes, infectious disease, novel therapies to
promote fracture healing and minimise osteoporosis,
inherited neuromuscular disorders and asthma.
Our Research Division and the CMRI share a
common history, several strong collaborations,
shared facilities and close geographical proximity,
but are independent in their governance and in
most of their research activities. During the year, we
have provided background information for a review
of the two organisations by an external committee,
chaired by Professor Brandon Wainwright from
University of Queensland. The purpose of the review
is to determine whether there is a case for some
form of amalgamation of the research efforts of both
institutions, in particular:
o What benefits and synergies might flow from a
closer organisational alignment?
o If these are substantial, what is the optimal form
of organisational restructuring to capture
these benefits?
The information prepared by our research units
highlighted the high quality of our research and our
productivity – this is now available on our website,
www.chw.edu.au/research
Senior staff changes
I wish to acknowledge the contributions of two key
staff who have taken positions in other institutions.
Professor Peter Gunning was the first director of the
Research Division being appointed in 1997.
Our People
Peter made enormous contributions in his leadership
of the Research Division, his enthusiasm and
expertise in translational research, linking the bench
to bedside, saw a four fold growth in the research
community and more than doubling of our laboratory
and office space. The inclusion of the Human
Applications Laboratory and the Transgenic Facility
in the new building position us at the forefront of
facilities for translational research and reflected
Peter’s clear vision for research at The Children’s
Hospital at Westmead.
Peter has a broad perspective on biomedical research
and has been a key individual in developing strong
relationships with our Westmead Hub partners. Peter
was instrumental in promoting the commercialisation
of biomedical research. He successfully lobbied
government to establish a technology transfer office
(Bio-Link) in NSW and was the founding Chairman
of the board, Bio-Link Partners Ltd. We wish him well
for the future leading his research program at the
University of NSW.
Professor Raina McIntyre has been a senior member
of the National Centre for Immunisation Research
and Surveillance since 2003. Raina has been active
in immunisation clinical trials and has provided
unique expertise in economic modelling of infectious
disease. Raina will be taking up a position as Head of
Population Health at the University of NSW.
Our Achievements
The ultimate measure of the success of our
research activity is improved health for children.
As a direct result of past research, there have
been significant advances by the Hospital in the
development of treatments, cures and prevention of
diseases, which have benefited numerous children
with cancer, obesity, kidney, heart and respiratory
problems. Our researchers share their knowledge in
a multidisciplinary approach to improve child health
and this has led to over 450 publications in the past
year. Our research activity has resulted in some
extraordinary outcomes for our patients and their
families and a few of these are described below.
• Discovery of a new form of muscle disease and
development of mouse models to help develop
therapies that may help children with this
muscle disease
• Identification of a common genetic variant that
influences muscle performance in elite athletes
and the general population
• Discovery of new treatments to promote
bone healing
• First report of spontaneous bone marrow
chimerism following liver transplant in a
12 year old girl
• Commissioning of the first Australian facility for
gene therapy applications. This facility will allow
us to harvest and manipulate patient cells prior
to their delivery back into the patient and we will
also be able to produce our own gene vectors at
therapeutic levels. The first trial to assist children
with cancer will commence during the next year.
• National centre for paediatric clinical trials
- First large randomised trials of asthma and
diabetes prevention from birth
- First randomised trial of inpatient weight
restoration versus brief hospitalisation for
management of anorexia nervosa
- Large randomised trials for immunisation of
children and adults, neurogenetic and respiratory
disorders, diabetes and obesity
The past year has also witnessed increasing success
with competitive grant funding of more than $12
million, from a broad array of funding organisations
including NHMRC/ARC and competitive USA based
organisations.
85
Our People
86
Grant Type
Chief Investigators
Title
NHMRC Project Grant
A/Prof David Little
Dr Paul Baldock;
Dr Ian Alexander;
Dr Aaron Schindeler
Modelling the loss of NF1 heterozygosity in congenital
pseudarthrosis of the tibia (CPT)
NHMRC Project Grant
Dr Stephen Alexander
Dr G. Alex Bishop;
Dr Alexandra Sharland
Kidney Transplantation; Improving Outcomes
NHMRC Project Grant
A/Prof Jonathon Craig
Dr Elisabeth Hodson;
Prof David Lyle;
Ms Della Yarnold;
Prof Paul Roy;
Dr Leigh Haysom
Antecedents of Renal Disease in Aboriginal Children and Young
Adults - 12 year follow-up
NHMRC Project Grant
Dr Geraldine O’Neill
Prof Peter Gunning
Understanding Focal Adhesion Dynamics in Cells Migration
NHMRC Project Grant
Prof Kathryn North
Dr Edna Hardeman;
Prof Peter Gunning;
Dr Stewart Head;
Dr Nan Yang
The influence of alpha actinins on human performance in health
and disease
NHMRC Project Grant
Dr Rachael Murray
Integrin intracellular transport, expression and function in
macrophages regulates inflammation during wound healing
NHMRC Project Grant
Prof Sandra Eades
Prof Peter McIntyre;
Prof Kim Oates;
Dr John Daniels;
Dr Susan Woolfenden
Ear health, hearing, speech and language development in urban
Aboriginal children
NHMRC Project Grant
Prof Tien Wong
A/Pr Kim Donaghue;
A/Pr Alicia Jenkins;
Dr Gabriella Tikellis
Prediction of Microvascular Complications in Type 1 Diabetes
Using Novel Retinal Vascular Imaging Techniques
NHMRC Project Grant
Dr Genevieve McAuthur
Prof Max Coltheart;
Prof Anne Castles
A randomised control trial of treatments for children with different
types of reading difficulty
NHMRC Project Grant
A/Prof Maria Kavallaris
Prof Peter Gunning
Targeting the cytoskeleton in cancer
NHMRC Project Grant
Dr Maria Craig
Viral triggers of autoimmunity and type 1 diabetes: a prospective
study of at risk children
NHMRC Project Grant
Prof Anne Simpson
Dr Bronwyn O’Brien;
Dr Ian Alexander
Reversal of diabetes in pigs using liver-directed gene therapy
NHMRC Project Grant
Prof Anne Chang
Dr Peter Morris;
Prof Collin Robertson;
Prof Peter Van Asperen;
Prof Nicholas Glasgow;
Dr Ian Masters
Multi-centre evaluation of a clinical pathway for chronic cough in
children – can it’s use improve clinical outcomes
ARC Discovery Project
A/Prof Cheryl Jones
Prof A Cunningham;
Dr S Alexander
The effect of age on regulatory T cell control of the innate and
adaptive antiviral immune responses
Dr James Wood
Dr P Caley
Modelling and estimation techniques for the transmission and
control of Tuberculosis with new and existing vaccines
Prof Kathryn North
Dr G Huttley
Molecular dissection of the effects of alpha-actinin-3 deficiency on
normal variation in skeletal muscle function
Chief Investigators
Title
Dr Ms Gold
A/Prof AJ Braunack-Mayer;
A/Prof P Ryan;
Prof CA Gericke;
Prof JJ McNeil;
Dr CJ Freemantle;
Prof CJ Thomson;
Dr EE Roughead;
Dr LK Taylor;
Prof E Elliott;
Dr DR Filby;
Dr JP Buttery
Can and should we link data at a national level? Vaccine safety
surveillance: A case study
NHMRC Australian
Based Public Health
Fellowship
Dr Mohamud Sheikh
Infection, Immunity and immigration – prevention and control of
infectious diseases in refugee children
NHMRC Overseas
Biomedical Fellowship
Dr Kate Quinlan
The role of growth factors in pluripotency and differentstion of
human embryonic stem cells - towards human therapy
NHMRC Dora Lush
Scholarship
Ms Leigh Waddell
To apply evidence based practice to the diagnosis of muscular
dystrophies’
NHMRC Public Health
Scholarship
Ms Anita Heywood
Travel patterns, traveller behaviour and their relationship to the
importation of infectious disease into Australia
NHMRC Biomedical
Scholarship
Ms Vanessa Shrewsbury
Treatment of overweight and obesity in adolescence
NHMRC Clinical
Scholarship
Dr Paul Robinson
The Clinical Utility of Small Airway Function Tests in Paediatric
Respiratory Disease
NHMRC Public Health
Scholarship
Ms Michelle Irving
Implementation of evidence into clinical practice in chronic kidney
disease (CKD)
NHMRC Biomedical
Scholarship
Ms Nicole Yu
Manipulating the anabolic and catabolic responses for Bone Tissue
engineering
AOA Research
Foundation Grant
A/Prof David Little
Manipulating the anabolic and catabolic Responses for bone tissue
engineering
Apex Foundation
for Research into
Intellectual Disability Ltd
Dr Belinda Barton
Does the cognitive psychsocial profile of children with
velocardiofacial syndrome (VCFS) differ from an IQ matched
control group?
Cancer Inst. Clinical
Research Fellowship
Dr Loretta Lau
Selective targeting of the actin cytoskeleton in cancer therapy
Coles Community Grant
Prof Louise Baur
Patterns and predictors of physical activity in young children
Diabetes Australia
Research Trust Grant
Dr Sarah Garnett
Dietary protein: the effects of insulin resistance in adolescents
Muscular Dystrophy
Association
Dr Sandra Cooper
Prof Kathryn North
Dysferlin and defective muscle membrane repair in limb girdle
muscular dystrophy
Perpetual Foundation
Grant
Prof Peter Gunning
Application of a state of the art intermediate voltage transmission
electron microscope to further elucidate the underlying
mechanisms of cancer
Pfizer Endocrine Care
Dr Kim Ramjan
Dr Sarah Garnett
Dr Craig Munns
A/Prof Chris Cowell
The effect of whole body vibration training on insulin sensitivity in
overweight adolescents
Clive and Vera
Ramaciotti Foundation
Medical Research Grant
A/Prof Chris Cowell
Real-time Amplification System (QPCR) and high resolution Melt
(HRM) - Gene Expression and analysis Facility
Australian Rotary Health
Research Fund
Prof John Christodoulou
Dr Ian Alexander
Development of Novel Treatment Strategies for Phenylketonuria
Our People
Grant Type
87
Our People
Grant Type
Chief Investigators
Title
March of Dimes
Prof Kathryn North
The Role of Contactin-1 in serve Childhood Myopathy
MBF Foundation
Dr Sarah Garnett
The role of dietary protein and exercise in pre-diabetic adolescents
The Financial Markets
Foundation for Children
Prof Lousie Baur
Loozit: a community-based healthy, active living program for
overweight and obese young people aged 13-16 year
March of Dimes
Prof John Christodoulou
The Utility of forced Myogenesis of cells in culture: Unmasking
mitochondrial Respiratory Chain (RC) Disorders
Children’s Tumour
Foundation
Dr Aaron Schindeler
Modelling the loss of NF1 heterozygosity in congenital
pseudarthrosis of the tibia (CTP)
US Army Grant
Prof Kathryn North
A randomised placebo controlled study of lovastatin in children
with neurofibromatosis Type 1
ARC Linkage Grant
Ms Kaye Spence
Dr Nadia Badawi
The emotional and social burden of caring for a young child with
complex health needs
ARC Linkage Grant
Prof Robert Booy
Dr Julie Leask
Prof Theodorous Sloots
Prof Stephen Lambert
Social, Economic, and Health Benefits of Vaccinating Children in
Day Care Centres against Influenza
Infrastructure Support for Research
The Research Office is an administrative unit of 20
staff that supports laboratory management, facilities
including microscopy, transgenic, human movement
laboratory, clinical research rooms and the human
application laboratory, ethics and governance
including Intellectual Property and manages an
infrastructure budget of approximately $2.6M. The
unit also administers grants and scholarships in
partnership with The University of Sydney and our
Clinical School (Faculty of Medicine, Discipline of
Paediatrics and Child Health).
Fundraising
Trish van Leeuwen has joined the Research Division
as a dedicated Fundraiser with the objective of
building an endowment and recurrent revenue for
research. Trish’s experience will be instrumental in
helping overcome the challenges of developing a
dedicated research fundraising program and strategy
in fundraising in a highly competitive environment.
Salary Structure
The NSW Health salary structure for research is
not linked to enterprise bargaining and, as such,
salaries have not increased in three years. We have
successfully implemented a new salary structure
for research which will provide a new framework for
performance management and career development of
research staff.
88
Ethical Assessment of Research Projects
All research projects involving human subjects carried
out within the Hospital are required to conform with
the principles set out in the Declaration of Helsinki,
the National Health and Medical Research Council’s
‘Statement on Human Experimentation’ and the
Australian College of Paediatrics Code of Ethics in
Regard to Research in Children.
For research involving animals, projects are required
to conform to the National Health and Medical
Research Council’s Australian Code of Practice for
the care and use of animals for scientific purposes
(7th Edition, 2004) and the Animal Research
Regulation 2005.
The Human Research Ethics Committee (HREC)
is one of the principal committees of the Hospital,
and is constituted according to the guidelines for
Human Research Ethics Committees determined by
the National Health and Medical Research Council
in its Statement on Human Experimentation. The
committee consists of chairperson and secretary,
three laypeople, two members with legal expertise,
one minister of religion, one representative of the
Hospital Executive, one professional care member and
representatives from research including allied health
and nursing research, basic/laboratory research and
anaesthetic/surgical research.
The HREC meets eight times per year and has two
sub-committees, the Form Review Committee (FRC)
and the Scientific Advisory Committee (SAC).
Project Type
Clinical Drug/Device Trials
COG new Clinical Trial/Project
Clinical Studies
Laboratory Studies
Qualitative
Questionnaire
Other
Total Projects
Submitted
17
4
36
8
14
6
10
95
Our People
In the financial year there were 95 HREC submissions
comprising of:
The Animal Care and Ethics Committee (ACEC)
meets six times a year and is a joint committee with
the Children’s Medical Research Institute (CMRI).
The committee is constituted as per item 2.2.2 of
the Code of Practice. The committee is comprised of
two category A people (Veterinarian), four category
B people (Researchers with current animal handling
experience, two each from the Hospital and the
CMRI), two category C people (demonstrable activity
and experience in animal welfare) and two category D
people (Layperson viewed by the wider community as
bringing an independent view to the AEC).
89
Our Community
Our Community
Children’s Hospital
Advisory Council
Children’s Hospital Advisory
Council Report
Chairman’s Year in Review
The Children’s Hospital Advisory Council (CHAC)
met ten times during the 2007/2008 financial year.
Council members have contributed enormously to the
policies, plans and initiatives of the Hospital since the
Council’s inception in 2005.
The Children’s Hospital at Westmead is one of this
State’s most precious assets. The tradition of the
Hospital at the highest level goes back to the Royal
Alexandra Hospital for Children at Camperown
and this institution has now been an icon for many
decades – why so?
The Hospital literally has the biggest facility
and, above all, the greatest faculty of clinicians,
researchers and the highest levels of professional
support in NSW. Each year, through the dedication,
skill, research, innovation and selfless application of
these wonderful people, countless children are given
another chance in life, despite illnesses or handicaps.
The Children’s Hospital at Westmead brings together
a world-class group of talented and experienced
individuals who have chosen to make their experience
and knowledge available to develop and shape the
Hospital for the future.
My own association with the Hospital goes back to
the Camperdown days, along with many of my fellow
Council members, who I thank for their ongoing
support. I am delighted to serve on the Advisory
Council as a small way to support this outstanding
institution.
I also wish to express our appreciation for the
countless thousands of individuals and groups
who support The Children’s Hospital at Westmead
and for the other major opportunities provided to
financially support this great work. Thank you for your
commitment and ongoing support to the Hospital.
I look forward to working with you all in the
coming year.
Roger Corbett AO
Chair, Children’s Hospital Advisory Council
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CHAC continues to provide excellent financial advice
and support to the Hospital. The Council has been
particularly involved in the Hospital’s long term
financial planning and asset replacement strategy.
An important consideration of CHAC is to ensure that
clinicians, patients and the community are effectively
engaged and consulted on an ongoing basis.
Members have been selected for their understanding
of health challenges facing NSW communities and
bring a unique perspective on the issues facing the
provision of paediatric health care.
CHAC has been consulted on a range of issues
throughout the 2007/2008 financial year and have
made a significant contribution to the Hospital in the
following areas:
• Supporting and advising on the Hospital’s financial
position and strategic direction
• Consumer and patient satisfaction initiatives
• Donor nurturing and support
The Chairman’s major donor dinner was also held to
nurture some of the Hospital’s major supporters. This
event was a success, building closer ties with these
individuals and further communicating the Hospital’s
challenges ahead and need for further support. It is
anticipated that this will be a regular event.
The role of CHAC will continue to strengthen over
time. Important issues which will be addressed in the
future by CHAC include:
• Financial management
• Future strategic direction
• Positioning and branding
Our Community
Member profiles
Mr Roger Corbett, AO (Chair)
Roger Corbett’s esteemed career in the retail sector
spans over 40 years, the pinnacle being his position
as Chief Executive and Group Managing Director
of Woolworths Limited. He currently holds various
Chairman and Board of Director positions in a variety
of organisations, including Fairfax Holdings and the
Reserve Bank of Australia. Roger is renowned within
the business sector for his intuitive understanding of
the changing needs of consumers and his ability to set
and maintain high standards.
Dr Bronwyn Gould, AM
Dr Gould has experience working in a primary care
practice specialising in child and family health for
more than a quarter of a century. She has served on
the Australian Council for Children and Parenting
(ACCAP) since 2001 and as Chair since 2005. She
is a member of the NSW Ombudsman’s Reviewable
Child Deaths Advisory Committee. She is an active
leader with young people in Guides NSW.
Professor Ralph Nanan
Professor Nanan is the Chair of Paediatrics, Nepean
Clinical School, The University of Sydney. As a clinical
academic at Nepean Hospital, he is responsible for
clinical supervision and teaching in paediatrics and is
also involved in research.
Dr Michael Fasher
Dr Fasher has worked as a health care provider in
western Sydney for nearly 30 years. He is a member
of the management committee of the Blacktown
Medical Practitioners Association and is involved in
the education of parent groups in the community,
medical students and registrars in Vocational General
Practice Training.
Mr John Conde, AO
Mr Conde is Chairman of EnergyAustralia, MBF
Australia Limited and PowerTel Limited. He is a
Director of Excel Coal Limited, the Sydney Symphony
Orchestra, The Australian Elizabethan Theatre Trust.
He is President of the Commonwealth Remuneration
Tribunal. He is also Chairman of the Australian
Olympic Committee (NSW) Fundraising Committee,
President of the Dermatology Research Foundation
(University of Sydney), and Member of the President’s
Council of the Art Gallery of NSW.
Mrs Renata Kaldor, AO
Mrs Kaldor is the Deputy Chancellor of the University
of Western Sydney and is involved in business,
education and community affairs. She was a director
of the Sydney Symphony Orchestra for eight years
from 1996 to 2004 and was made an Officer in the
Order of Australia in 2002.
Ms Kerry West
Ms West is the Deputy Head Physiotherapist at The
Children’s Hospital at Westmead. She is Chair of the
Allied Health Quality Improvement Committee and
is also a member of the Nursing and Allied Health
Research Committee.
Mr Bradley Ceely
Mr Ceely is a Nurse Practitioner in Paediatric Intensive
Care at The Children’s Hospital at Westmead. He has
developed a model of care for long-term ventilated
children at the hospital and has presented at state
and national conferences on critical care and quality
improvement.
Mr Harry Michaels, OAM (to October 2007)
Mr Michaels is the owner and Managing Director of a
major innovator of studio and digital outside broadcast
facilities. He has created and directed more than
4,000 episodes of the fitness show, Aerobics Oz Style.
Mrs Joanna Capon, OAM
Mrs Capon is a member of the Health Care Quality
Committee of The Children’s Hospital at Westmead,
the Operations Art Management Committee and the
Australian Centre for Photography. She was awarded a
Medal of the Order of Australia (OAM) in 2002 for her
services to The Children’s Hospital at Westmead.
Professor Kim Oates, AM
Professor Oates’ positions at The Children’s Hospital
have included Community Paediatrician; Head of the
Child Protection Unit; Head of the Child Development
Unit and Children’s Assessment Centre; Chairman
and Director of Medical Services and Chief Executive
(retired February, 2006) and he was the Foundation
Douglas Burrows Professor of Paediatrics and Child
Health in the University of Sydney.
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Our Community
He has been President of the International Society
for the Prevention of Child Abuse and Neglect (and
is currently an Executive Councillor), Inaugural Chair
of the NSW Child Death Review Team and chaired
the Federal Government’s National Council on the
Prevention of Child Abuse. Professor Oates was
appointed to the Advisory Council in June 2006.
Consumer Feedback
Complaints management is the responsibility of the
Service Improvement Unit (SIU) and there are two
designated complaints managers at the Hospital; the
Director of Clinical Governance and Medicine (Dr
Stuart Dorney) and the Patients’ Friend
(Betty Radcliffe).
All complaints are taken seriously and documented
very carefully. As much time as is required is spent
with families in order to ensure that their concerns
are addressed fully. Some matters are easily and
quickly resolved. Others of a more serious or complex
nature may take a number of weeks and numerous
discussions and meetings to reach a satisfactory
outcome.
Frequently raised issues include difficulties with
physical access, access to services, communication
and hotel services.
All complaints and the processes involved in achieving
resolution are reviewed by a high level committee,
the Public Accountability Committee (PAC), which
meets quarterly. The Chief Executive chairs PAC and
membership includes most of the senior executive,
a representative of the Medical Staff Council and
two community representatives. The complaints
mechanism is a rich source of improvement activities,
and each complaint is regarded as an opportunity to
review and revise policy and practice.
During 2007-2008, 272 patient complaints were
received, with 16 of these being Ministerials and
seven being referred from the Health Care Complaints
Commission (HCCC). NSW Health KPIs for
complaints management are 100% acknowledgement
within five working days and 85% resolution within 35
working days. Our KPIs for the year under review are
92% and 96.5% respectively and we are consistently
the best performer in complaints management across
NSW Health.
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We participated in the 2007-2008 NSW Health
Patient Survey and we were very pleased with our
results. Across three categories (paediatric inpatients,
emergency patients and outpatients) 89% of families
rated our overall care as very good, which was higher
than the State average of 88%.
In July 2007, the evaluation report of the Parent and
Carer Resource Centre (PCRC) was finalised, with
initial data confirming a dramatic increase in average
daily visits to the PCRC from May 2006 to May 2007.
We also increased the proportion of male service
users and people from ATSI and CALD backgrounds.
In July the new policy, Supporting Staff who are
Carers, was finalised and the Carer Support Program
(CSP) formed a partnership with the Working Carers
Liaison Project, run by Hills Community Care, to offer
services and support to our staff who are carers.
The CSP took a lead role in the refurbishment of
the parent lounges on each of the wards in August
2007. Carers Week was celebrated and was a very
successful week. In May 2008, the CSP began the
first ever hospital-based MyTime group in Australia
and is working in partnership with Playgroups
Australia.
The Carers Action Plan was developed, consulted
on and finalised over the 2007-2008 period and
submitted to NSW Health in July 2008. The Carer
Support Program continued to offer a range of events
and activities for parents and carers in the Parent and
Carer Resource Centre throughout 2007-2008, with
almost 4000 occasions of service.
The Family Advisory Council is the peak consumer
group at The Children’s Hospital at Westmead and is
a dynamic and motivated group of parents who have
made significant contributions to improvements at the
Hospital. Some of the things they have been involved
in this year and have provided feedback from a family
perspective are:
•
•
•
•
The redesign of the Emergency Department
The Smoking Cessation Committee
Various Clinical Redesign projects
Improvement Action Plan from the 2007 NSW
Patient Health Survey, and
• Staff Guidelines on Consumer Participation
The FAC have also been Involved in the recruitment
of several key consumer staff positions, as well as
Our Community
looking nationally and internationally at how best
practise peak consumer groups operate elsewhere.
Cultural Diversity
The Children’s Hospital at Westmead continues
to serve a very culturally and linguistically diverse
community and is committed to ensuring equity
of access to all services. The Hospital has been
recognised generally as a leader in family centred
and child friendly care. This means addressing not
only the child’s specific illness, but the broader
developmental, emotional and social needs of the
child within the context of their family.
As parents and carers are partners in care, it is
essential to share information and engage with
them in collaborative decision making. In applying
this approach, it is also important to recognise that
hospital staff as well as patients and families come
from a wide range of cultural backgrounds. Particular
challenges arise with variable English language skills,
cross generational conflicts and differing practices
around parenting and the health care of children.
Moreover, cultures are constantly changing in
response to new circumstances and opportunities.
This requires staff to be not only skilled, respectful
and comfortable in working across cultures but to be
open to new learning from the experiences of families
who use our services.
The past year saw the completion of valuable research
in relation to how cultural diversity among the Hospital
patients and staff influences care. With support
of an ARC Grant, a research team at the Centre
for Cultural Research at the University of Western
Sydney worked in a constructive and rewarding
partnership with The Children’s Hospital at Westmead
and Sydney Children’s Hospital at Randwick. Other
partners included the NSW Department of Health,
the Multicultural Health Service of South East Sydney
Illawarra Health and Community Paediatrics in Sydney
South West.
A multi-method research approach delivered
significant findings and recommendations that are
highly useful in developing future policy, practice,
educational programs. The findings highlighted
opportunities for improvement, as well as an overall
sense of commitment and compassion among staff
caring for children and their families. Communication
difficulties remain a significant challenge and more
recently arrived migrants, especially refugee families,
are particularly vulnerable in accessing healthcare
because of linguistic barriers and misunderstandings.
There is a continuing need for translations of fact
sheets and other health promotion material for
patients and their families. Major translations this year
included the Asthma Education Plan and the DVD for
the Shaken Baby Prevention Project. Our bilingual
staff also provided valuable assistance in reviewing
translations to help ensure the quality of translations.
The Hospital’s Cultural Diversity intranet website also
has fact sheets and profiles a range of cultural issues
with links to other multicultural health websites. The
information is available to support staff in working
across cultures.
Other cultural diversity initiatives included special
educational events within the Pain and Palliative Care
Service to enhance the cultural competence of staff
and new teaching modules within the Diploma of
Child Health related to cultural and social influences
on child health. The Volunteers Department also
developed a project to enable mature aged TAFE
students from diverse cultural backgrounds to gain
volunteer experience here at the Hospital.
Our Volunteers
The Hospital relies on its volunteers for the strong
support they offer in so many different ways.
Volunteers support staff by helping out in ward areas,
feeding and caring for babies and children who need
assistance, taking kids for walks, reading them stories
or playing with them, both to assist staff and to allow
parents some time for themselves.
Our ‘Vollies’, as they are affectionately known, also
provide a Hospital escort service for those who are
new to the Hospital or need to find a department
which is some distance from the front entrance.
The volunteers continue to operate the Volunteers’
Shop and the Trash and Treasure Stall, which sells
mostly donated goods. These funds are used to
provide equipment and services which supplement
those purchased from the general budget. They not
only sell raffle tickets in-house for the Hospital, but
also help raise money in external raffles. They also
spend many hours giving their service to external
activities, such as at the Teddy Bears’ Picnic.
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Our Community
Another service provided by the volunteers is vacation
care for children of staff who cannot take the time
off in the school holidays. They also support parents
in the evenings and on weekends in the Emergency
Department. They offer assistance in caring for the
other children, providing a listening ear, the occasional
cup of tea and generally helping the Department to
maintain a friendly environment.
Volunteers also work in offices, various clinics, the
Hydrotherapy Pool and the Medical Library.
The weekend opening of the Sibling Care Centre has
proved very successful and is appreciated by parents
who are able to relax while visiting their sick child,
knowing their other children are being well looked
after. In 2006, the Sibling Care Centre accommodated
2050 children.
The 400 Volunteers who offered their time to the
Hospital this year gave a total of over 1800 hours of
their time each week. Volunteer donations to The
Children’s Hospital at Westmead for 2008 amounted
to $180,000.
Chaplains
Providing pastoral care for the patients, families and
staff of the Hospital remains the core business of the
Chaplains. Every baby, child and teenage patient has
access to spiritual support while at the Hospital. Some
families are followed up further by phone, mail, email
or home visits. Unique to our Hospital is our program
of ward-based chaplaincy. This means that support is
available to all, beyond the limits of religious affiliation.
Individually packaged pastoral care is designed to
meet the expressed need of the patient and family.
Visiting in the ward, initial spiritual assessment,
empathic listening and, if requested, spiritual or
religious services are provided in flexible response to
the dynamic nature of the hospital experience.
A network of accredited visitors from many faiths
and cultural communities is maintained to provide a
prompt and appropriate response to specific religious
requests, beyond the expertise of the current team. A
key development of this network is that an accredited
part time Muslim pastoral visitor has now been
providing twice weekly visits to all Muslim patients
since August 2007.
Meetings initiated by Hospital staff members
themselves are overseen by the Department.
These take the form of public lectures and
discussions and regular prayer and study groups.
There has been a constant interest in these groups
by the Hospital community.
The Department has eight part time Chaplains (4.15
FTE) appointed and funded by their churches with
some State government assistance in the form
of grants.
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Our team of Volunteer Chaplains supplement the
services provided by the chaplaincy team. Their initial
training has been followed up by ongoing mentoring.
We are currently organising a Volunteers’ Training
Course to recruit and accredit new volunteers.
A 24 hour on-call service is always provided for the
Hospital. It has been noted that chaplaincy services
are still not routinely accessed at times of trauma
or death. We are seeking to address the reasons
behind this trend. Chaplains are involved in Hospital
committees. We keenly support the provision of
pastoral care at Bear Cottage and would participate in
any improvement deemed necessary in the future.
Resources, memorial services, baptisms, funerals
and celebrations of special religious days are
frequently requested.
The Chaplaincy team appreciates the way the Hospital
openly values and supports the holistic care of its
patients, staff and families.
Benefactors and Donors
Each year we turn to the community for additional
financial support to allow us to transform The
Children’s Hospital at Westmead from a very good
hospital to one which provides excellence in care for
sick children, equal to the world’s best.
Again we extend a very special thank you to all our
donors and supporters who have given so generously
this year.
Founders
Australasian Order of Old Bastards
Bridgestar Pty Ltd
Clubs NSW Eastern Zone Bear Cottage & Other
Charities Committee
Emerald Ball Committee
Inghams Enterprises Pty Ltd
John R Turk Fund
Rett Syndrome Australian Research Fund
Estate Late Edward O Drysdale
Estate Late Noni Dora Audette
Estate Late Phyllis Lillian Rose
Benefactors
Canterbury Bulldogs Leagues Club
Diavitiko Committee
Integral Energy Australia
Jardine Lloyd Thompson
Kel Geddes Management
Shipping Industry Golf Challenge
Sir Robert & Lady Askin Charities Trust
Estate Late Arthur Brown
Estate Late Joan Margaret Economus
Estate Late John Arthur Fairless Dent
Estate Late John Thomas Ryan
Estate Late Marius Joseph Bourke
11:11 Productions
400 in 4 Charity Ride
A Bear Affair Committee
Access Security Pty Ltd
ACCO Australia
Allergan
Amyson Pty Ltd
Andrews & Rech Pty Limited
ANZ Stadium
Associazione S. Sebastiano Martire
Auburn RSL Bowling Club Ltd
Austbrokers RWD Pty Ltd
Australasian Order of Old Bastards
Australia Post
Australian Poker League (APL)
Australian Reptile Park
Balgowlah RSL Memorial Club
Bandaged Bear Benefit Night
Bankstown District Sports Club
Bears to Broome
Blue Mountains Home Hardware
BP
BREATHE
Bridgestar Pty Ltd
BT Financial Group
Bulldogs Rugby League Football Club
Cabramatta Rugby League Club
Camp Quality Ltd
Canterbury Bulldogs Leagues Club
Canterbury-Hurlstone Park RSL Club
Caring for Kids - Bankstown Group
Case Fabrication Pty Ltd
Central Coast Kids In Need Inc
Children’s Oncology Group
Citi Australia
City Tattersalls Club
CLM Excavations Pty Ltd
Clubs NSW Eastern Zone Bear Cottage & Other
Charities Committee
Coastal Watch Pty Ltd
Combined Ford Clubs of NSW
Commercial Travellers Cot Fund
ConnecTeD Committee
Convoy for Kids Sydney Inc
Cornucopia Committee Inc
Cranium Hair
Cupcake Creations
Cure Our Kids Inc
Delahunty Constructions
Dell Computers Pty Ltd
Delta Society Australia
Diavitiko Committee
Dooleys Lidcombe Catholic Club Ltd
Dounia’s Dancing World
Drummoyne Rowing Club
Dulux Australia
Edwin Street Residents
Emerald Ball Committee
Era Polymers Pty Ltd
Ethcorp & Associates Pty Ltd
Eventide Homes (NSW)
Fairfield RSL Memorial Club Ltd
Finity Consulting Pty Limited
Fire Fighters Calendar
Footwear Leather And Allied Trades Cot Fund
Fred’s Fruit Markets
Freight Train Music
Friends of Bear Cottage
Front Row Events
GA & SW Commerford Pty Ltd
GE Capital Finance Australia
Geberit
Gilbert & Roach
Goodman Fielder
Goodman International
Granville RSL Sub-Branch Ltd
Gresham Partners Limited
Greyhound Publications Pty Ltd
Gypsy Jokers
Heartkids NSW Inc
Hornsby RSL Club Limited
Howards Storage World
IGA Distributions
Inghams Enterprises Pty Ltd
Inner Wheel Club of Liverpool Combined Inc
Insurance Australia Group
Integrated Group
International Order of the Rainbow for Girls
Intrepid Travelling Troupe
IUS Holdings Pty Ltd
J J Lawson Customs & Freight Brokers
J.A.C.E.K. Pty Ltd
Jardine Lloyd Thompson
Jenolan Caves Reserve Trust
John Swire & Sons Pty Ltd
Kandalee Grazing Co
Kandiut Holdings Pty Ltd
Kayaking for Kemo Kids
Keith Soames Real Estate
Kel Geddes Management
Kindifarm
Lill Bayley & Friends
Lions Club of Carlingford-Dundas
Lions Club of West Pennant Hills - Cherrybrook Inc
Lions Clubs International District 201N5
Liquid Learning Group Pty Ltd
Little Wishes Inc
Liverpool West Rotary
Loud & Clear
Luxe Medispa
Marsupial Landscapes Pty Ltd
Massel Pty Ltd
MBF Australia Limited
McHugh Holdings
Medtronic Australasia Pty Ltd
Meteora Benevolent Society
Metromix Pty Ltd
Mount Lewis Bowling Club
Mounties Swimming Club
Munich Holdings of Australasia Pty Ltd
Mustang Owners Club of Australia (NSW) Inc
National Foods
Nationwide News Pty Ltd
Near East Distributors
Our Community
Groups and Corporate Donors over $5000
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NeuroFriends Committee
Novartis
NSW Fire Brigades - Katoomba
NSW Fire Brigades - Payroll Contribution Scheme
NSW Fire Brigades - Training College
NSW Fire Brigades Band
NSW Food & Allied Trades Golf Assoc
NSW Police Hurstville Local Area Command
NSW Rural Fire Service (Coffee4Kids)
Olex Australia Pty Ltd - Golf Day
Osteogenesis Imperfecta Society of Australia
Pacific Hoists
Panthers Club North Richmond
Parramatta City Council
Parramatta Social Club - DCS
Perkin Elmer Wallac Oy
Poseidon Tarama Pty Ltd
Princeton Publishing Pty Ltd
Print Management Australia
Pubfaast Holdings Pty Ltd
Pymble Pub Pensioners
Qantas Airways Ltd
Rachel Parkinson Hospital Equipment Fund
Radiomarathon
Rat Pack Golf Tours
RBC Dexia Investor Services
RED Abrasive Blasting & Protective Coatings
Reed Elsevier Australia Pty Ltd
Rellim Holdings No 2 Pty Ltd
Rett Syndrome Australian Research Fund
Roche Products Pty Limited
Rotary Club of Balgowlah
Rotary Club of Belrose
Rotary Club of Burwood
Rotary Club of Frenchs Forest
Rotary Club of Glenhaven
Rotary Club of Ku-ring-gai
Rotary Club of Manly Sunrise
Rotary Club of Terrey Hills
Rouse Hill “Renegades Rugby”
Russell Investment Group
Sargents Pty Limited
Save Our Sons
Scholastic Australia
Shin-A Pty Ltd
Shipping Industry Golf Challenge
Singapore Airlines
Smartline
Sovereign Order of St John of Jerusalem
Specialized Engineering Services
Sports Outdoor Media Pty Ltd
Springvale Colliery CFMEU Lodge
St George Bank
Starbucks Coffee Company
Sydney Ferries
Sydney Invitational Pty Ltd
Sydney Water Corporation
SydneySiders Express Inc
Synovate Aztec Pty Ltd
T Greenway & J Banks Pty Ltd
Tarkett Australia
Tasome
Techsmart International Pty Ltd
The Buchan Group
The Cameron’s Bandaged Bear Blues
The Ettamogah Pub Social Club
The Independent Liquor Group (Suppliers) CoOperative Ltd
The Laugh Garage Comedy Club
The Sound of Music
Thomas Hare Investments Ltd
Toongabbie Sports & Bowling Club Limited
Total Advertising & Communications
UCB Pharma
Unilever Australasia
Variety the Children’s Charity
Vietnamese Australian Welfare Association
Western Earthmoving Pty Ltd
Westpac
Whites Wires Australia Pty Ltd
Woolworths Supermarkets
Private donor gifts over $1000
Adams W F & K H Mr & Mrs
Adams Elizabeth
Adams Rob & Sarah Mr & Mrs
Adamsas D Mr & Mrs
Ahrens M Mr
Albert AO Robert Mr
Alfaro Mario Mr
Ali Avsar Serdar Mr
Allen Gary
Allen R & M Mr & Mrs
Amata Phillip Mr
Anderson Garry Mr
Anderssen Susan Mrs
Ball Steve Mr
Barber & Vella Rosemary & Tess Mrs & Mrs
Barker C&R
Barnes David Mr
Barrett Marcia Mrs
Barter R G Mr & Mrs
Basha Ken Mr
Basil-Jones Richard Mr
Baur Louise A Professor
Beattie & Maher Scott & Taryn Mr & Ms
Bedwell Esq J B Mr
Bennett Margaret Mrs
Bickford E Mr
Blackley Grant Mr
Blomfield C I Mrs
Bloom QC David Mr
Bolster Sarah Ms
Bonifacio Michael Mr
Bovis Darren Mr
Brasher Richard Mr
Brown Stewart H M Mr
Brown Adam Mr
Brown Jenny Mrs
Bunting Richard Mr
Burgess John Mr
Burgic Vera Ms
Butler E G Mrs
Butt K & J Mr & Mrs
Butterfield Peter Mr
Freeman Stuart Mr
Fuchs Matthias Mr
Fung & Lee Denis & Doris Mr & Miss
Furness Des Mr
Gardner Wayne Mr
Gaskin AO Kevin Prof
Gaudry Alan J Mr
Gedeon Gilbert Mr
Gibbs Susan
Golby Craig Mr
Gollan K Mrs
Goodyear Tricia
Goodyear Rob
Goodyear & Sattout Neville & Sonie Mr & Ms
Gowen Alison
Gowing BG Mrs
Goymer Ray & Margaret Mr & Mrs
Grace Michael E Mr
Grace Megan Ms
Grady Maggie
Graham James & Helen Mr & Mrs
Graham Mavis Mrs
Greer Pamela Mrs
Griffith Danae Ms
Griffith Andrew Mr
Grigg John Dr
Grimish Geoff Mr
Grove Scott Mr
Grzonkowski P Mr
Gwynne M & C Mr & Mrs
Hallam Reggie Mr
Harris Pepper Mrs
Harris Stephen Mr
Hatton Ken & Paddy Mr & Mrs
Hawker RE Dr
Hawkins Stephen Mr
Hay Jean & David Mr & Mrs
Hill M Mr
Hoggard Peter Mr
Holland Andrew J Assoc Prof
Hornery David & Bronwyn Mr & Mrs
Houghton Barbara Mrs
Hutchinson H & D Mr & Mrs
Ibbotson Terry Mr
Ireland Mr & Mrs
Isaacs David Professor
Jacobs Ken Mr
Jones Michael Mr
Keogh John Dr
Kerameas C & A
Kinghorn Geoffrey Mr
Klimenko Betty
Langley Andrew Mr
Larkin Deborah Ms
Lavermicocca Rosalinda Ms
Lawler Gary Mr
Laws John Mr
Lee Judy Ms
Liljemark Grace Ms
Linton Neil Mr
Littlejohn A Mrs
Littlejohn Kirsten Ms
Loewenthal Lady
Our Community
Caldwell Charity
Callaghan MJ Mr
Cameron David Mr
Capon OAM Joanna Mrs
Carpenter Brian Mr
Carrier Phil Mr
Carroll Helen Ms
Carroll Noel Mr
Cary Barbara Ms
Chalmers Josephine Ms
Chan Michael Mr
Cheng FY Ms
Clark Jim & Angela Mr & Mrs
Clark Patrick Mr
Clarke AO David Mr
Clarkson Una Ms
Clijsters Mathias Mr
Coates Peter Mr
Colmer D & K Mr & Mrs
Condor Robert Mr
Connell Barry & Helen Mr & Mrs
Connor Jeff Mr
Conry Melinda Ms
Cooley Damien Mr
Corney Kent Mr
Cosenza Narelle Mrs
Cottee Beverley Mrs
Cottrell Joan Mrs
Courtenay Bryce Mr
Cramond David Mr
Crane Carmel Mrs
Craven Catherine
Cutrupi Michael Mr
Da Prato Janelle Ms
Daft Linda Mrs
Darragh Debbie
Dascal Evelyn Mrs
Davidson JA Dr
Dawson Jennie Ms
Day Kerrie Mrs
Day Jodie Lee
De Mestre John Mr
De Ravin John Mr
Dean Simon Mr
Desai BK Dr
Di Bello Gabriel
Dickson JE Ms
Didio Antonio Dr
Dixon Connie Ms
Dolman Bette Mrs
Doran Susan Ms
Dovico Marc Mr
Drayton D & S Mr & Mrs
Eabry Michelle
Economus HM Miss
Edmonds Bill & Joyce Mr & Mrs
Edwards Tim Mr
Eid Elie Mr
Farrell Lionel Mr
Federman Diane and Edward Mr & Mrs
Flahvin Tim Mr
Franchimon Charles Mr
Freeman Lindsay Mr
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Lowe Kim Miss
Mackisack JM Mrs
Maclean Connor & Cheryl
Madden Tam
Madden Greg
Mailman Greg
Maini Marco & Mary Mr & Mrs
Mapp AM Grahame Mr
Maroney John Mr
Matthews John Mr
Maxwell Roy A Mr
Maxwell Marion Ms
McClelland Alan Mr
McDougall Peter Mr
McEwan Matthew
McGregor James Mr
McIntyre Sarah Ms
McIvor Gus Mr
McLaren Sean Mr
McNee M & K Mr & Mrs
Mellak Albert Mr
Merchant OAM Dennis & Gay Mr & Mrs
Metzmacher Susan Mrs
Millar James Mr
Mills Brian & Elaine Mr & Mrs
Miltenyi GP Mr & Mrs
Mitchell David Mr
Monaghan Michael Mr
Mong Daniel
Moore Peter Mr & Mrs
Moscato John & Teresa Mr & Mrs
Moulos Konstantina
Mullett Gavin Mr
Murdocca Nancy Mrs
Murray Jason & Danni Mr & Mrs
Mustica Carmelo A Mr
Myers Lawrence Mr
Nevell David Mr
Nicholls Brian & Cassandra Mr & Mrs
North Kathryn N Professor
O Neill Edel
O’Brien Barry
O’Brien Michael Mr
O’Connor John R Mr
O’Connor Mary Ms
O’Connor John Mr
Overton Peter & Lauraine Mr & Mrs
Ovington Derek Mr
Pacey Nathan
Pang Peter Mr
Papadimitriou Peter Mr
Parker Benjamin Mr
Peden AJ & ML Mr & Mrs
Perceval EC Mrs
Perinetto Giulio Mr
Peter Shanks Mr
Philpotts Graeme & Gayle Mr & Mrs
Pires Francis Anthony Mr
Pluss Jeanette Mrs
Podda Efisio Mr
Pollock AM Reg Mr
Pontifex Gary Mr
Portlock Gary & Michelle Mr & Mrs
Potter Robin Ms
Pragastis Katrina Ms
Priestley Rob & Alexandra Mr & Mrs
Quatroville Mario
Quinlan Kate Dr
Quinn Matthew Mr
Reoch Andrew Mr
Riach Lesley Miss
Rice Mark Mr
Richardson Richard
Ronayne Barbara
Ross Ben Mr
Rowe Paul Mr
Sampson Ruth Mrs
Scobie Carolyn Ms
Scopelitis George Mr
Scott Gordon & Meredith Mr & Mrs
Scott Gregory Mr
Screnci Paula Mrs
Shields Stephen Mr
Sholler Gary Dr
Simons Hedley P Mr
Simpson Wayne Mr
Smedley N & D Mr & Mrs
Smith Grahame Dr
Smith Bob & Liddy Mr & Mrs
Smith Damian Mr
Smith David Mr
Solomon Ezekiel
Standfield Shaun Mr
Stanley Ian Mr
Steel Jodi Dr
Stephan Armenouhi Mrs
Stephan Said Mr
Stephens Malcolm Mr
Stevens Margaret Mrs
Stevenson OAM Shirley Mrs
Steward Val Miss
Stewart Shanna Ms
Stewart Greg Mr
Stewart Rhys Mr
Stinson Anne Ms
Stinson John Mr
Stone Katherine Ms
Strange Brian Mr
Styles Robert Mr
Talbot Antony
Taylor Mark & Bronwyn Mr & Mrs
Thomas Jack Mr
Thomson Kirsten Mrs
Threkeld P
Threlfo Paul Mr
Tighe Hugh & Colleen Mr & Mrs
Toomeh Elias Mr
Topalov Michael
Triguboff Michael Mr
Tuckerman Gregor Mr
Turner Peter Mr
Turner M Mr
Turton MP Mrs
Underwood Dean Mr
Veitch Margaret Mrs
Visevic Vera Ms
Roll of Honour
We were again honoured this year by a number of
very special people who remembered The Children’s
Hospital at Westmead in their Will. Each bequest is a
special gift, promising a better future for children now
and in future generations. We extend our condolences
to their families and, with gratitude and respect,
honour their memories.
Legacies and Bequests
James Raymond Ashley
Elsie Marie Baddeley
Robert William Battye
Annie Beatrice Bourke
Marius Joseph Bourke
Arthur Brown
Zohry Adele Cameron
Thelma Sophia Louise Campbell
Norma Campbell Hamilton
Gwenyth Carpenter
Zelie Maude H Cole
Kathleen Maud Connelly
Eric Francis Cook
Harold Ernest Court
Frederick Arthur Crimson
Brenda Eunice Davey
Smoky Dawson
Trevor W Dewsbury
Svetomir Djunovic
Edward O Drysdale
Joan Margaret Economus
Patricia Ann Edwards
John Arthur Fairless Dent
Vivianne Eleanor Falconer
Violet Falls
Bruce and Corrie Fletcher
Mary Fraser
Loyal Leslie Gabb
Paul Gauci
Eileen May Gittoes
Gustave A Gluck
Kenneth Walter Gray
Anastasia Gronski
Leila Mary Hamer
Alice Holliday
Margaret Ellen Hume
Neville Vernon Huntington
Kenneth Lee Jones
Martin Leslie Keating
Barbara Kathleen Kendall
Allan St Ruth Knights
Irene Muriel Lawton Haynes
Laurence Charles Lye
Doris May Lewsam
Vera Ellaine Marshall
Hovsep Mazloumian
James Patrick McCann
Sydney Thomas Metcher
Sybil May Millington
Esme Vera Muir
Myrtle Amber Mulvaney
Dorothy Murphy
Sami Nicolas
Ellen Frances Olsen
Josephine Elizabeth Pearson
Eileen Margaret Pering
Alma Margaret Puxley
Marian Florence Rawlinson
Margaret Leicester Rhodes
Herbert Dean Rose
John Thomas Ryan
Gary Sellers
Gwen Smith
Victor Spence
Emil Surnicky
John Uhlir
Norma May Versperman
Everene Jean Vidler
Eileen Stella Weidmann
Ruth Marjorie White
Evan Frederick J Williams
John Cyril Williams
Beryl Edna Williamson
Claudia Mary Willis
Georgette Yared
Our Community
Wales Tony & Gai Mr & Mrs
Wallace Ben Mr
Ward Karen & Mal Mr & Mrs
Warren Kent & Fiona Mr& Mrs
Wechsler Adam Mr
Welsh RM Miss
West EHL Mr
White Tony Mr
Whittle David & Catherine Mr & Mrs
Wikramanayake Shemara Ms
Williams Sarah Mrs
Wills David Mr
Wilson GR Mr
Wood Craig & Alicia Mr & Mrs
Woods Tony Mr
Yates Peter Mr
Zavone John Mr
Ziade Anthony Mr
Trusts and Foundations over $5000
Adolph Basser Trust
AOA Research Foundation Ltd
Australian Allergy Foundation
Baxter Perpetual Trust
Bluey Day Foundation NSW
Bluffpoint Corporation Pty Ltd AL Rigoll Family Trust
CAF Community Fund
Charitable Trusts
Day of Difference Foundation
Dunn Family Trust Fund
Fairbridge Foundation
First Hand Foundation
Fred P Archer Charitable Trust
H & R Israel Fund
Humpty Dumpty Foundation
99
Our Community
100
J & G Bedwell Foundation
John R Turk Fund
Ken West Family Trust
Kids with Cancer Foundation
Liangrove Foundation Pty Ltd
Macintosh Foundation
Macquarie Group Foundation Limited
Madeline Foundation
Maple-Brown Family Charitable Foundation
Margaret Pemberton Foundation
Oncology Children’s Foundation
Owen Miller Foundation
Paint a Rainbow Foundation
Perpetual Trustees Australia Ltd
Rett Syndrome Research Foundation
Sherman Foundation
Sir Robert & Lady Askin Charities Trust
Skipper-Jacobs Family Trust
Smile Foundation Limited
Starlight Children’s Foundation Australia
The Balnaves Foundation
The Bernard David Rothbury Trust
The Charlotte Dopson Memorial Fund
The Corio Foundation
The Freedman Foundation
The George Gregan Foundation
The Humour Foundation
The John Bedwell Foundation
The McLean Perpetual Children’s Foundation
The Petre Foundation
The Pratt Family Foundation
The Profield Foundation
Unilever Australasia Foundation
Woodend Foundation
Freedom of Information Report
NEW FOI APPLICATIONS
NUMBER OF FOI APPLICATIONS
How many FOI applications were
received, discontinued or completed?
Personal
Other
TOTAL
2006/2007
2007/2008
2006/2007
2007/2008
2006/2007
2007/2008
A1
New
0
0
6
3
6
3
A2
Brought forward
0
0
2
0
2
0
A3
Total to be processed
0
0
8
3
8
3
A4
Completed
0
0
6
3
6
3
A5
Discontinued
n/a
n/a
n/a
n/a
n/a
n/a
A6
Total processed
0
0
6
3
6
3
A7
Unfinished (carried forward)
0
0
2
0
2
0
DISCONTINUED APPLICATIONS
NUMBER OF DISCONTINUED FOI APPLICATIONS
Why were FOI applications
discontinued?
Personal
Other
TOTAL
2006/2007
2007/2008
2006/2007
2007/2008
2006/2007
2007/2008
B1
Request transferred out to another
agency (s.20)
0
0
0
0
0
0
B2
Applicant withdrew request
0
0
0
0
0
0
B3
Applicant failed to pay advance
deposit (s.22)
Applicant failed to amend a
request that would have been
an unreasonable diversion
of resources to complete
(s.25(1)(a1))
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
B4
B5
Total discontinued
101
COMPLETED APPLICATIONS
NUMBER OF COMPLETED FOI APPLICATIONS
What happened to completed FOI
applications?
C1
C2
Granted or otherwise available
in full
Granted or otherwise available
in part
Personal
Other
TOTAL
2006/2007
2007/2008
2006/2007
2007/2008
2006/2007
2007/2008
0
0
1
1
1
1
0
0
0
0
0
0
C3
Refused
0
0
2
1
2
1
C4
No documents held
0
0
0
1
0
1
C5
Total completed
0
0
1
1
1
1
APPLICATIONS GRANTED OR OTHERWISE AVAILABLE IN FULL
(GRANTED OR OTHERWISE AVAILABLE IN FULL)
How were the documents made
available to the applicant?
Personal
Other
TOTAL
2006/2007
2007/2008
2006/2007
2007/2008
2006/2007
2007/2008
0
0
1
1
1
1
Applications
Under
Patient
Access
Applications
Under
Patient
Access
Applications
Under
Patient
Access
Applications
Under
Patient
Access
Applications
Under
Patient
Access
Applications
Under
Patient
Access
Applications
Under
Patient
Access
Applications
Under
Patient
Access
Applications
Under
Patient
Access
Applications
Under
Patient
Access
Applications
Under
Patient
Access
Applications
Under
Patient
Access
All documents requested were:
D1
Provided to the applicant
D2
Provided to the applicant’s
medical Practitioner
D3
Available for inspection
D4
Available for purchase
n/a
n/a
n/a
n/a
n/a
n/a
D5
Library material
n/a
n/a
n/a
n/a
n/a
n/a
D6
Subject to deferred access
n/a
n/a
n/a
n/a
n/a
n/a
D7
Available by a combination of any
of the reasons listed in D1-D6
above
Total granted or otherwise
available in full
n/a
n/a
n/a
n/a
n/a
n/a
0
0
1
1
1
1
D8
Note: The figures in D8 should correspond to those in C1.
102
(GRANTED OR OTHERWISE AVAILABLE IN PART)
How were the documents made
available to the applicant?
Personal
Other
TOTAL
2006/2007
2007/2008
2006/2007
2007/2008
2006/2007
2007/2008
n/a
n/a
n/a
n/a
n/a
n/a
Applications
Under
Patient
Access
Applications
Under
Patient
Access
Applications
Under
Patient
Access
Applications
Under
Patient
Access
Applications
Under
Patient
Access
Applications
Under
Patient
Access
Applications
Under
Patient
Access
Applications
Under
Patient
Access
Applications
Under
Patient
Access
Applications
Under
Patient
Access
Applications
Under
Patient
Access
Applications
Under
Patient
Access
Documents made available were:
E1
Provided to the applicant
E2
Provided to the applicant’s
medical Practitioner
E3
Available for inspection
E4
Available for purchase
n/a
n/a
n/a
n/a
n/a
n/a
E5
Library material
n/a
n/a
n/a
n/a
n/a
n/a
E6
Subject to deferred access
n/a
n/a
n/a
n/a
n/a
n/a
E7
Available by a combination of any
of the reasons listed in E1-E6
above
Total granted or otherwise
available in part
n/a
n/a
n/a
n/a
n/a
n/a
E8
APPLICATIONS GRANTED OR OTHERWISE AVAILABLE IN PART
Note: The figures in E8 should correspond to those in C2.
REFUSED FOI APPLICATIONS
NUMBER OF REFUSED FOI APPLICATIONS
Why was access to the documents
refused?
Personal
Other
TOTAL
2006/2007
2007/2008
2006/2007
2007/2008
2006/2007
2007/2008
F1
Exempt
0
0
2
1
2
1
F2
Deemed refused
0
0
0
0
0
0
F3
Total refused
0
0
2
1
2
1
Note: The figures in F3 should correspond with those in C3.
103
EXEMPT DOCUMENTS
Why were the documents classified
as exempt?
(identify one reason only)
(REFUSED OR ACCESS GRANTED OR OTHERWISE AVAILABLE IN PART ONLY)
Personal
2006/2007
2007/2008
Other
2006/2007
2007/2008
TOTAL
2006/2007
2007/2008
Restricted documents:
G1
G2
Cabinet documents (Clause 1)
Executive Council documents
(Clause 2)
G3
Documents affecting law
enforcement and public safety
(Clause 4)
G4
Documents affecting counter
terrorism measures (Clause 4A)
Documents requiring consultation:
G5
Documents affecting
intergovernmental relations
(Clause 5)
G6
Documents affecting personal
affairs (Clause 6)
G7
Documents affecting business
affairs (Clause 7)
G8
Documents affecting the conduct
of research (Clause 8)
Documents otherwise exempt:
G9
G10
G11
G12
G13
G14
G15
G16
G17
G18
G19
G20
G21
G22
104
Schedule 2 exempt agency
Documents containing information
confidential to Olympic
Committees (Clause 22)
Documents relating to threatened
species, Aboriginal objects or
Aboriginal places (Clause 23)
Documents relating to threatened
species conservation (Clause 24)
Plans of management containing
information of Aboriginal
significance (Clause 25)
Private documents in public library
collections (Clause 19)
Documents relating to judicial
functions (Clause 11)
Documents subject to contempt
(Clause 17)
Documents arising out of
companies and securities
legislation (Clause 18)
Exempt documents under
interstate FOI Legislation
(Clause 21)
Documents subject to legal
professional privilege (Clause 10)
Documents containing confidential
material (Clause 13)
Documents subject to secrecy
provisions (Clause 12)
Documents affecting the economy
of the State (Clause 14)
1
2
1
2
G24
G25
G26
G27
Documents affecting financial or
property Interests of the State or an
agency (Clause 15)
Documents concerning operations
of agencies (Clause 16)
Internal working documents
(Clause 9)
Other exemptions (eg., Clauses 20,
22A and 26)
Total applications including exempt
documents
2
1
2
1
Note: Where more than one exemption applies to a request select the exemption category first occurring in the
above table. The figures in G27 should correspond to the sum of the figures in C2 and F1.
G23
MINISTERIAL CERTIFICATES (S.59)
How many Ministerial Certificates were issued?
NUMBER OF MINISTERIAL CERTIFICATES
2006/2007
H1
Ministerial Certificates issued
0
2007/2008
0
FORMAL CONSULTATIONS
How many formal consultations were conducted?
NUMBER
2006/2007
2007/2008
I1
Number of applications requiring formal consultation
2
5
I2
Number of persons formally consulted
2
5
AMENDMENT OF PERSONAL RECORDS
How many applications for amendment of personal records were
agreed or refused?
NUMBER OF APPLICATIONS FOR AMENDMENT OF
PERSONAL RECORDS
2006/2007
0
2007/2008
J1
Agreed in full
0
J2
Agreed in part
0
0
J3
Refused
0
0
J4
Total
0
0
NOTATION OF PERSONAL RECORDS
How many applications for notation of personal records were
made (s.46)?
NUMBER OF APPLICATIONS FOR NOTATION
2006/2007
K1
Applications for notation
0
2007/2008
0
105
FEES AND COSTS
What fees were assessed and received for FOI applications
processed (excluding applications transferred out)?
L1
All completed applications
ASSESSED COSTS
FEES RECEIVED
2006/2007
2007/2008
2006/2007
2007/2008
$532.50
$850.00
$532.50
$850.00
FEE DISCOUNTS
(WHERE FEES WERE WAIVED OR DISCOUNTED)
How many fee waivers or discounts
were allowed and why?
M1
Processing fees waived in full
M2
Public interest discount
M3
Financial hardship discount
– pensioner or child
M4
Financial hardship discount – non
profit organisation
M5
Total
Personal
Other
TOTAL
2006/2007
2007/2008
2006/2007
2007/2008
2006/2007
2007/2008
Under
Patient
Access
Under
Patient
Access
Under
Patient
Access
Under
Patient
Access
Under
Patient
Access
Under
Patient
Access
FEE REFUNDS
How many fee refunds were granted as a result of significant
correction of personal records?
NUMBER OF REFUNDS
2006/2007
N1
Number of fee refunds granted as a result of significant
correction of personal records
0
2007/2008
0
DAYS TAKEN TO COMPLETE REQUEST
How long did it take to process
completed applications?
(Note: calendar days)
Personal
2006/2007
O1
O2
O3
O4
O5
0-21 days – statutory
n/a
determination period
22-35 days – extendedstatutory
determination period for
consultation or retrieval of archived
records (S.59B)
Over 21 days – deemed refusal
where no extended determination
period applies
Over 35 days – deemed refusal
where extended determination
period applies
TOTAL
2007/2008
2006/2007
2007/2008
2006/2007
2007/2008
n/a
6
1
6
1
6
1
6
1
Total
Note: Figures in O5 should correspond to figures in A4.
106
Other
How long did it take to process
completed applications?
Personal
Other
TOTAL
2006/2007
2007/2008
2006/2007
2007/2008
2006/2007
2007/2008
n/a
n/a
n/a
1
n/a
1
P1
0-10 hours
P2
11-20 hours
n/a
n/a
n/a
n/a
P3
21-40 hours
n/a
n/a
n/a
n/a
P4
Over 40 hours
n/a
n/a
n/a
P5
Total
n/a
n/a
n/a
n/a
1
n/a
1
PROCESSING TIME: HOURS
Note: Figures in P5 should correspond to figures in A4.
NUMBER OF REVIEWS
How many reviews were finalised?
NUMBER OF COMPLETED REVIEWS
2006/2007
2007/2008
Q1
Internal reviews
1
0
Q2
Ombudsman reviews
1
0
Q3
ADT reviews
0
0
RESULTS OF INTERNAL REVIEWS
What were the results of internal reviews finalised?
NUMBER OF INTERNAL REVIEWS
Grounds on which the internal review
was requested.
Personal
Original
Agency
Decision
Upheld
Original
Agency
Decision
Varied
Other
Original
Agency
Decision
Upheld
TOTAL
Original
Agency
Decision
Varied
Original
Agency
Decision
Upheld
Original
Agency
Decision
Varied
R1
Access refused
n/a
n/a
n/a
n/a
n/a
n/a
R2
Access deferred
n/a
n/a
n/a
n/a
n/a
n/a
R3
Exempt matter deleted from
documents
n/a
n/a
n/a
n/a
n/a
n/a
R4
Unreasonable charges
n/a
n/a
n/a
n/a
n/a
n/a
R5
Failure to consult with third parties n/a
n/a
n/a
n/a
n/a
n/a
R6
Third parties views disregarded
n/a
n/a
n/a
n/a
n/a
n/a
R7
Amendment of personal records
refused
n/a
n/a
n/a
n/a
n/a
n/a
R8
Total
n/a
n/a
n/a
n/a
n/a
n/a
Note: Figures in R8 should correspond to figures in A4.
107
Financial Overview
Financial Overview
Executive Summary
The audited financial statements presented for the Royal Alexandra Hospital for Children for the year ended 30 June
2008 provide for a Net Cost of Services budget of $96.3 million, against which the audited actual of $98.7 million
represents an unfavourable variation of $2.4 million or 2.5%.
This was primarily due to higher activity than expected, particularly from Inter Area Patient Flows which increased by
11% from last year. The increase in activity resulted in higher employee costs. In addition, the cost of blood, drugs,
medical and surgical supplies have all increased compared to budget as a result of the increase in activity.
In achieving the above result the Royal Alexandra Hospital for Children is satisfied that it has operated within the level
of government cash payments. It has also ensured that no general creditors exist at the end of the month in excess
of levels agreed with the NSW Department of Health and, further, has effected all loan repayments within the time
frames agreed.
Financial information is summarised below:
108
2007/08
Actuals
$000
2007/08
Budget
$000
2006/07
Actuals
$000
Employee Related Expenses
Visiting Medical Officers
Goods and Services
Maintenance
Depreciation and Amortisation
Grants and Subsidies
Borrowing Costs
218,053
4,913
70,073
4,618
15,525
564
31
213,511
5,068
63,973
4,618
15,156
325
-
204,621
4,652
68,650
5,648
14,346
320
51
Total Expenses
313,777
302,651
298,288
Sale of Goods and Services
Investment Income
Grants and Contributions
Other Revenue
178,547
(340)
31,281
7,504
172,777
1,280
27,302
5,489
158,411
8,069
34,508
7,150
Total Revenues
216,992
206,848
208,138
Gain/(Loss) on Disposal of Non Current Assets
Other Gains / (Losses)
(402)
(1504)
(484)
(57)
(277)
Net Cost of Services (NCOS)
98,691
96,287
90,484
Financial Overview
Program Reporting
The Royal Alexandra Hospital for Children reporting of programs is consistent with the ten programs of health
care delivery utilised across NSW Health and satisfies the methodology for apportionment advised by the NSW
Department of Health.
Program
Exp
$000
2007/08
Rev
$000
NCOS
$000
Exp
$000
2006/07
Rev
$000
NCOS
$000
Primary and Community
Aboriginal Health
Outpatients
Emergency Care
Overnight Acute
Same Day Acute
Mental Health
Rehab & Extended Care
Population Health
Teaching and Research
6,530
141
65,207
15,735
141,643
10,749
9,777
6,309
9,204
48,482
2,747
3,783
94
47
12,979
52,228
12,882
2,853
128,301
13,342
25,667 (14,918)
170
9,607
3,164
3,145
3,772
5,432
25,310
23,172
7,582
159
62,332
15,187
137,965
12,657
9,088
7,382
10,013
35,923
3,845
3,737
143
16
12,583 49,749
11,810
3,377
114,990 22,975
24,279 (11,622)
216
8,872
4,754
2,628
5,628
4,385
29,556
6,367
Total
313,777
215,086
298,288
207,804
98,691
90,484
The Challenges 2007/2008
The Royal Alexandra Hospital for Children had Net Cost of Service, which was 9% higher than the NCoS of
2006/07. The following were significant contributors to this achievement in 2007/08:
• overall growth in revenue of 4% over that of 2006/07, despite significant decline in the investment revenue
compared to that of the last year;
• the performance improvement initiatives helped achieve $2.7M in revenue improvement over last year;
• the Inter Area Patients Flows revenue continued to increase during 2007/08. This increase is 11% over that of
the last year;
• increase in the loss on disposal and other losses on account of impairment of receivables has jumped to 0.88%
of the 2007/08 overall revenue compared to 0.16% for 2006/07;
• overall increase in costs was contained to just 5% over that of 2006/07.
109
Financial Overview
The 2008/2009 Budget
The Royal Alexandra Hospital for Children received its 2008/09 allocation on 27 June 2008. The allocation
provides additional funding to address:
• replacement of Plant and Equipment up to $2.5M;
• the provision of more elective surgery to tackle existing waiting lists;
• the provision of four new beds including Medical Assessment Units;
• mental health service improvements- Child & Adolescent Health - $100k;
• new nurse educator positions.
Future Direction
The Royal Alexandra Hospital for Children will continue to work with the NSW Department of Health in a major
reform program that will focus on ensuring that each child has the best possible journey through the health
system. This will ensure that patient care is better coordinated, leading to improved patient outcomes and more
efficient use of resources. Ultimately it will provide better care for more children.
110
Text goes here
111
112
113
Financial Statements
Financial Statements
For the 128th Annual Report of
The Royal Alexandra Hospital for Children
(The Children’s Hospital at Westmead)
for the year ending 30 June 2008
114
Royal Alexandra Hospital for Children
Operating Statement for the year ended 30 June 2008
PARENT
Actual
2008
$000
218,053
4,913
74,691
15,525
564
31
Budget
2008
$000
213,511
5,068
68,591
15,156
325
-
CONSOLIDATION
Actual
2007
$000
204,621
4,652
74,298
14,346
320
51
______ ______ ______
313,777
302,651
298,288
______
______
______
______
______
______
178,547
(340)
35,225
7,504
______
220,936
______
(402)
(1,504)
______
94,747
______
172,777
1,280
31,307
5,489
______
210,853
______
-
(484)
______
92,282
______
158,411
8,069
37,180
7,150
______
210,810
______
(57)
(277)
______
87,812
______
Notes
Expenses excluding losses
Operating Expenses
Employee Related
Personnel Services
Other Operating Expenses
Finance Costs
3
4
5
2(i), 6
7
8
Total Expenses excluding losses
Revenue
Investment Revenue
Other Revenue
9
10
11
12
Total Revenue
Gain/(Loss) on Disposal
Other Gains/(Losses)
13
14
Net Cost of Services
32
73,759
73,759
82,263
1,152
1,000
309
______-
______-
______-
Government Contributions
NSW Department of Health
Recurrent Allocations
Capital Allocations
Acceptance by the Crown Entity of
Employee Benefits
74,911
______
74,759
______
82,572
______
Total Government Contributions
(19,836)
______
(17,523)
______
(5,240)
______
RESULT FOR THE YEAR
Actual
2008
$000
Budget
2008
$000
Actual
2007
$000
218,053
4,913
74,691
15,525
564
31
213,511
5,068
68,591
15,156
325
-
204,621
4,652
74,298
14,346
320
51
172,777
1,280
27,302
5,489
158,411
8,069
34,508
7,150
-
(57)
______
313,777
______
______
178,547
(340)
31,281
7,504
______
216,992
______
(402)
(1,504)
______
98,691
______
______ ______
302,651
298,288
______
______
______
______
______ ______
206,848
208,138
______
______
(484)
(277)
______
______
96,287
90,484
______
______
2(d)
73,759
73,759
82,263
2(d)
1,152
1,000
309
2(a)(ii)
28
3,944
______
4,005
2,672
______
______
78,855
______
78,764
85,244
______
______
(19,836)
______
(17,523)
(5,240)
______
______
Statement of Recognised Income and Expense for the Year Ended 30 June 2008
PARENT
Actual
2008
$000
Budget
2008
$000
CONSOLIDATION
Actual
2007
$000
28,867
______
______-
______-
28,867
______
(19,836)
______
______(17,523)
______
______(5,240)
______
9,031
______
(17,523)
______
(5,240)
______
Notes
Net Increase/(Decrease) in Property, Plant
and Equipment Asset Revaluation
Reserve
28
TOTAL INCOME AND EXPENSE RECOGNISED
DIRECTLY IN EQUITY
Result for the Year
TOTAL INCOME AND EXPENSE
RECOGNISED FOR THE YEAR
The accompanying notes form part of these Financial Statements
Actual
2008
$000
Budget
2008
$000
Actual
2007
$000
28,867
______
______- ______-
28,867
______
(19,836)
______
______- ______(17,523)
(5,240)
______
______
9,031
______
(17,523)
(5,240)
______
______
115
Balance Sheet as at 30 June 2008
PARENT
Actual
2008
$000
Budget
2008
$000
CONSOLIDATION
Actual
2007
$000
Notes
Actual
2008
$000
Budget
2008
$000
Actual
2007
$000
41,727
10,663
4,424
39,018
8,362
4,135
44,435
8,090
4,081
ASSETS
41,727
10,663
4,424
39,018
8,362
4,135
44,435
8,090
4,081
______
56,814
______
______
51,515
______
______
56,606
______
59
33,238
303
36,625
303
37,147
303,719
28,808
27,760
______
279,565
24,766
26,040
______
284,385
28,565
25,768
______
360,287
4,783
330,371
6,163
338,718
5,433
______
398,367
______
455,181
______
______
373,462
______
424,977
______
______
381,601
______
438,207
______
Current Assets
Cash and Cash Equivalents
Receivables
Inventories
17
18
19
______
56,814
______
______
51,515
______
______
56,606
______
18
20
59
33,238
303
36,625
303
37,147
21
21
21
303,719
28,808
27,760
______
279,565
24,766
26,040
______
284,385
28,565
25,768
22
360,287
4,783
330,371
6,163
Total Current Assets
Non-Current Assets
Receivables
Financial Assets at Fair Value
Property, Plant and Equipment
- Land and Buildings
- Plant and Equipment
- Infrastructure Systems
Total Property, Plant and Equipment
Intangible Assets
Total Non-Current Assets
Total Assets
______
338,718
______
398,367
______
455,181
______
______
373,462
______
424,977
______
5,433
______
381,601
______
438,207
______
22,655
123
67,526
108
20,733
65,091
50
19,280
116
63,451
50
LIABILITIES
22,655
123
67,526
108
20,733
65,091
50
19,280
116
63,451
50
______
90,412
______
______
85,874
______
______
82,897
______
305
4,326
544
4,978
428
3,775
______
4,631
______
95,043
______
360,138
______
______
5,522
______
91,396
______
333,581
______
______
4,203
______
87,100
______
351,107
______
Current Liabilities
Payables
Borrowings
Provisions
Other
24
25
26
27
Total Current Liabilities
Non-Current Liabilities
Borrowings
Provisions
25
26
Total Non-Current Liabilities
Total Liabilities
Net Assets
______
90,412
______
305
4,326
______
4,631
______
95,043
______
360,138
______
______
85,874
______
544
______
82,897
______
428
4,978
______
5,522
______
91,396
______
333,581
______
3,775
______
4,203
______
87,100
______
351,107
______
137,895
137,895
EQUITY
166,762
193,376
______
360,138
______
116
137,895
195,686
______
333,581
______
137,895
213,212
______
351,107
______
Reserves
Accumulated Funds
28
28
Total Equity
166,762
193,376
______
360,138
______
195,686
213,212
______
______
333,581
351,107
______
______
Cash Flow Statement for the year ended 30 June 2008
PARENT
Actual
2008
$000
Budget
2008
$000
CONSOLIDATION
Actual
2007
$000
Notes
Actual
2008
$000
Budget
2008
$000
Actual
2007
$000
(209,147)
(564)
(31)
(84,909)
(205,649)
(325)
(70,026)
(191,156)
(320)
(51)
(89,115)
CASH FLOWS FROM OPERATING ACTIVITIES
(209,147)
(564)
(31)
(84,909)
(205,649)
(325)
(70,026)
(191,156)
(320)
(51)
(89,115)
______
(294,651)
______
______
(276,000)
______
______
(280,642)
______
175,672
3,569
44,597
168,774
1,802
32,790
162,501
2,647
48,159
______
223,838
______
______
203,366
______
______
213,307
______
73,759
659
73,759
1,000
82,263
309
______
74,418
______
______
74,759
______
______
82,572
______
3,605
______
2,125
______
15,237
______
Payments
Employee Related
Finance Costs
Other
Total Payments
Receipts
Investment Income
Other
______
(276,000)
______
______
(280,642)
______
175,672
3,569
44,597
168,774
1,802
32,790
162,501
2,647
48,159
______
223,838
______
Total Receipts
Cash Flows From Government
NSW Department of Health Recurrent Allocations
NSW Department of Health Capital Allocations
73,759
Net Cash Flows from Government
NET CASH FLOWS FROM OPERATING
ACTIVITIES
______
(294,651)
______
32
______
203,366
______
73,759
______
213,307
______
82,263
659
______
74,418
______
1,000
______
74,759
______
309
______
82,572
______
3,605
______
2,125
______
15,237
______
8
-
-
(6,205)
______
(6,197)
______
(7,542)
______
(7,542)
______
(10,163)
______
(10,163)
______
(116)
______
(116)
______
____________-
(462)
______
(462)
______
(2,708)
(5,417)
4,612
44,435
______
41,727
______
44,435
______
39,018
______
39,823
______
44,435
______
CASH FLOWS FROM INVESTING ACTIVITIES
8
-
-
(6,205)
______
(6,197)
______
(7,542)
______
(7,542)
______
(10,163)
______
(10,163)
______
Proceeds from Sale of Land and Buildings, Plant and Equipment
and Infrastructure Systems
Purchases of Land and Buildings, Plant and Equipment
and Infrastructure Systems
NET CASH FLOWS FROM INVESTING ACTIVITIES
CASH FLOWS FROM FINANCING ACTIVITIES
(116)
______
(116)
______
____________-
(462)
______
(462)
______
(2,708)
(5,417)
4,612
44,435
______
41,727
______
44,435
______
39,018
______
39,823
______
44,435
______
Repayment of Borrowings and Advances
NET CASH FLOWS FROM FINANCING ACTIVITIES
NET INCREASE / (DECREASE) IN CASH
Opening Cash and Cash Equivalents
CLOSING CASH AND CASH EQUIVALENTS
17
117
3,783
RESULT FOR THE YEAR
-
3,737
(5)
(6)
3,856
137
2,993
651
-
75
7,582
1
7
440
1,591
13
-
47
(1)
-
95
(24)
113
(3)
-
9
141
-
-
7
32
2
100
$000
2008
-
16
-
-
143
5
111
24
-
3
159
-
-
12
37
-
110
$000
2007
Program
1.2*
Aboriginal Health
Services
-
52,228
(324)
(97)
13,400
1,265
1,356
334
-
10,445
65,207
7
107
3,277
15,135
1,063
45,618
$000
2008
-
49,749
(61)
(11)
12,655
1,621
1,283
765
-
8,986
62,332
13
83
3,174
19,300
2,199
37,563
$000
2007
Program
1.3*
Outpatients Services
-
2,853
(83)
(13)
12,978
140
89
35
190
12,524
15,735
2
26
824
3,577
269
11,037
$000
2008
-
3,377
(17)
(2)
11,829
163
83
68
277
11,238
15,187
1
9
624
2,044
26
12,483
$000
2007
Program
2.1*
Emergency
Services
-
13,342
(752)
(113)
129,166
1,080
447
266
1,806
125,567
141,643
16
230
7,424
32,180
2,429
99,364
$000
2008
-
22,975
(135)
(18)
115,143
1,198
406
455
2,636
110,448
137,965
22
138
5,736
32,124
2,085
97,860
$000
2007
Program
2.2*
Overnight Acute
Inpatient Services
-
(14,918)
(57)
(9)
25,733
259
48
62
380
24,984
10,749
1
17
562
2,445
184
7,540
$000
2008
-
(11,622)
(17)
(1)
24,297
273
40
93
555
23,336
12,657
2
14
611
3,195
186
8,649
$000
2007
Program
2.3*
Same Day Acute
Inpatient Services
-
9,607
(52)
(8)
230
6
46
3
-
175
9,777
1
16
513
2,220
168
6,859
$000
2008
-
8,872
(9)
(1)
226
18
44
15
-
149
9,088
-
3
286
719
89
7,991
$000
2007
Program
3.1*
Mental Health
Services
-
3,145
(20)
(33)
3,217
(801)
3,764
(89)
-
343
6,309
-
11
242
1,634
74
4,348
$000
2008
-
2,628
(4)
(5)
4,763
168
3,672
799
-
124
7,382
2
10
406
2,251
12
4,701
$000
2007
Program
4.1*
Rehabilitation and
Extended Care
Services
-
5,432
(48)
(10)
3,830
(938)
4,411
(104)
-
461
9,204
1
15
475
2,108
155
6,450
$000
2008
-
4,385
(9)
(3)
5,640
197
4,303
936
-
204
10,013
1
9
544
2,146
5
7,308
$000
2007
Program
5.1*
Population Health
Services
Program Statement - Expenses and Revenues for the year ended 30 June 2008
-
23,172
(141)
(96)
25,547
7,170
17,739
(772)
-
1,410
48,482
2
131
1,914
13,751
479
32,205
$000
2008
-
6,367
(20)
(10)
29,586
3,370
21,573
4,263
-
380
35,923
9
47
2,513
10,891
37
22,426
$000
2007
Program
6.1*
Teaching and
Research
78,855
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
$000
2008
85,244
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
$000
2007
Non Attributable
(19,836)
78,855
98,691
(1,504)
(402)
216,992
7,504
31,281
(340)
2,376
176,171
313,777
31
564
15,525
74,691
4,913
218,053
$000
2008
$000
2007
(5,240)
85,244
90,484
(277)
(57)
208,138
7,150
34,508
8,069
3,468
154,943
298,288
51
320
14,346
74,298
4,652
204,621
TOTAL
*The name and purpose of each program is summarised in Note 16.
The program statement uses statistical data to 31 December 2007 to allocate the current period’s financial information to each program.
No changes have occurred during the period between 1 January 2008 and 30 June 2008 which would materially impact this allocation.
** Allocations are made on an agency basis and not to individual programs. Consequently, government contributions must be included in the ‘Not Attributable’ column.
-
(26)
Government Contributions **
(23)
2,796
Total Revenue
Other Gains / (Losses)
(653)
Gain / (Loss) on Disposal
3,268
Other Revenue
(72)
-
253
6,530
1
Investment Income
InterState Patient Flows
Revenue
Total Expenses excluding losses
Finance Costs
11
287
1,609
90
5,530
$000
$000
4,532
2007
2008
Program
1.1*
Primary and Community Based Services
Employee Related
Operating Expenses
Expenses excluding losses
HOSPITAL’S EXPENSES AND
REVENUE
118
Notes to and forming part of the Financial Statements for the year ended 30 June 2008
1. The Hospital Reporting Entity
The Royal Alexandra Hospital for Children was established under the provisions of Health Services Act 1997 as a statutory
corporation with effect from 1 July 1998.
The Royal Alexandra Hospital for Children, “the Hospital”, trading as The Children’s Hospital at Westmead, comprises all
the operating activities of the Hospital facilities under its control. It also encompasses the Special Purposes and Trust Funds
which, while containing assets which are restricted for specified uses by the grantor or the donor, are nevertheless controlled
by the Hospital. The Hospital is a not for profit entity.
With effect from 17 March 2006 fundamental changes to the employment arrangements of Health Services were made
through amendment to the Public Sector Employment and Management Act 2002 and other Acts including the Health
Services Act 1997.
The status of the previous employees of Health Services changed from that date. They are now employees of the Government
of New South Wales in the service of the Crown rather than employees of the Hospital. Employees of the Government are
employed in Divisions of the Government Service.
In accordance with Accounting Standards these Divisions are regarded as special purpose entities that are consolidated with
the financial report of the Hospital. This is because the Divisions were established to provide personnel services to enable the
Hospital to exercise its functions.
As a consequence the values in the annual financial statements presented herein consist of the Hospital (as the parent entity),
the financial report of the special purpose entity Division and the consolidated financial report of the economic entity.
Notes have been extended to capture both the parent and consolidated values with Notes 3, 4, 11, 24, 26 and 32 being
especially relevant.
In the process of preparing the consolidated financial statements for the economic entity consisting of the controlling and
controlled entities, all inter-entity transactions and balances have been eliminated.
The reporting entity is consolidated as part of the NSW Total State Sector Accounts.
These financial statements have been authorised for issue by the Chief Executive on 8 December 2008
2. Summary of Significant Accounting Policies
The Hospital’s financial report is a general purpose financial report which has been prepared in accordance with applicable
Australian Accounting Standards (which include Australian Accounting Interpretations), the requirements of the Health
Services Act 1997 and its regulations including observation of the Accounts and Audit Determination for Area Health Services
and Public Hospitals.
Property, plant and equipment and financial assets at ‘fair value through profit and loss’ are measured at fair value. Other
financial report items are prepared in accordance with the historical cost convention.
The consolidated entity has a deficiency of working capital of $33,598,000 (2007 $ 26,291,000). Notwithstanding this
deficiency the financial report has been prepared on a going concern basis because the entity has the support of the New
South Wales Department of Health.
All amounts are rounded to the nearest one thousand dollars and are expressed in Australian currency.
Judgements, key assumptions and estimations made by management are disclosed in the relevant notes to the
financial report.
Comparative figures are, where appropriate, reclassified to give a meaningful comparison with the current year.
No new or revised accounting standards or interpretations are adopted earlier than their prescribed date of application. Set
out below are changes to be effected, their date of application and the possible impact on the financial report of the Royal
Alexandra Hospital for Children.
119
Standards/Interpretations
Operative Date
Comment
AASB3, AASB127 & AASB2008-3, Business
Combinations
1 July 2009
The changes address business combinations and the Australian Accounting
Standards Board has indicated that it is yet to consider its suitability for
combinations among not-for-profit entities.
AASB8 & AASB2007-3,
Operating Segments
1 July 2009
The changes do not apply to not-for-profit entities and have no application within
NSW Health.
AASB101 & AASB2007-8,
Presentation of Financial Statements
1 July 2009
Health agencies are currently required to present a statement of recognised
income and expense and no variation is expected.
AASB123 & AASB2007-6,
Borrowing Costs
1 July 2009
Borrowing costs that are directly attributable to the acquisition, construction or
production of a qualifying asset form part of the cost of that asset.
As Health Service borrowings are restricted to the Sustainable Energy Development
Authority negligible impact is expected.
AASB1004, Contributions
1 July 2008
The requirements on contributions from AASB27, 29 and 31 have been relocated,
substantially unamended in AASB4.
AASB1049, Whole of Government and General
Government Sector Financial Reporting
1 July 2008
The standard aims to provide the harmonisation of Government Finance Statistics
and Generally Accepted Accounting Principles (GAAP) reporting.
The impact of changes will be considered in conjunction with the reporting
requirements of the Financial Reporting Code for Budget Dependent General
Government Sector Agencies.
AASB1050 regarding administered items
1 July 2008
The requirements of AAS29 have been relocated, substantially unamended and are
not expected to have material effect on Health entities.
AASB1051 regarding land under roads
1 July 2008
The standard will require the disclosure of “accounting policy for land under
roads”. It is expected that all such assets will need to be recognised “at fair value”.
The standard will have negligible impact on Health entities.
AASB1052 regarding disaggregated disclosures
1 July 2008
The standard requires disclosure of financial information about Service costs and
achievements. Like other standards not yet effective the requirements have been
relocated from AAS29 largely unamended.
AASB2007-9 regarding amendments arising from
the review of AAS27, AAS29 and AAS31
1 July 2008
The changes made are aimed at removing the uncertainties that previously existed
over cross references to other Australian Accounting Standards and the override
provisions in AAS29.
AAS2008-1, Share Based Payments
1 July 2009
The standard will not have application to health entities under the control of the
NSW Department of Health.
AASB2008-2 regarding puttable financial
instruments
1 July 2009
The standard introduces an exception to the definition of financial liability to
classify as equity instruments certain puttable financial instruments and certain
instruments that impose on an entity an obligation to deliver to another party a
pro-rata share of the net assets of the entity only on liquidation. Nil impact is
anticipated.
Other significant accounting policies used in the preparation of these financial statements are as follows:
a) Employee Benefits and Other Provisions
i)
Salaries & Wages, Annual Leave, Sick Leave and On Costs
At the consolidated level of reporting liabilities for salaries and wages (including non monetary benefits), annual leave
and paid sick leave that fall wholly within 12 months of the reporting date are recognised and measured in respect of
employees’ services up to the reporting date at undiscounted amounts based on the amounts expected to be paid when
the liabilities are settled.
All Annual Leave employee benefits are reported as “Current” as there is an unconditional right to payment. Current
liabilities are then further classified as “Short Term” or “Long Term” based on past trends and known resignations
and retirements. Anticipated payments to be made in the next twelve months are reported as “Short Term”. On
costs of 17% are applied to the value of leave payable at 30 June 2008, such on costs being consistent with actuarial
assessment (Comparable on costs for 30 June 2007 were 21.7% which in addition to the 17% increase also included
the impact of awards immediately payable from 1 July 2007).
.
Unused non-vesting sick leave does not give rise to a liability as it is not considered probable that sick leave taken in the
future will be greater than the benefits accrued in the future.
The outstanding amounts of workers’ compensation insurance premiums and fringe benefits which are consequential
to employment, are recognised as liabilities and expenses where the employee benefits to which they relate have been
recognised.
120
ii)
Long Service Leave and Superannuation
At the consolidated level of reporting, Long Service Leave employee leave entitlements are dissected as ”Current” if
there is an unconditional right to payment and ”Non Current” if the entitlements are conditional. Current entitlements
are further dissected between ”Short Term” and ”Long Term” on the basis of anticipated payments for the next twelve
months. This in turn is based on past trends and known resignations and retirements.
Long Service Leave provisions are measured on a short hand basis at an escalated rate of 8.1% (also 8.1% at 30 June
2007) for all employees with five or more years of service. Actuarial assessment has found that this measurement
technique produces results not materially different from the estimate determined by using the present value basis of
measurement.
The Hospital’s liability for the closed superannuation pool schemes (State Authorities Superannuation Scheme and
State Superannuation Scheme) is assumed by the Crown Entity. The Hospital accounts for the liability as having been
extinguished resulting in the amount assumed being shown as part of the non-monetary revenue item described as
“Acceptance by the Crown Entity of Employee Benefits”. Any liability attached to Superannuation Guarantee Charge
cover is reported in Note 24, “Payables”.
The superannuation expense for the financial year is determined by using the formulae specified by the NSW
Department of Health. The expense for certain superannuation schemes (ie Basic Benefit and First State Super) is
calculated as a percentage of the employees’ salary. For other superannuation schemes (ie State Superannuation
Scheme and State Authorities Superannuation Scheme), the expense is calculated as a multiple of the employees’
superannuation contributions.
iii)
Other Provisions
Other provisions exist when: the Hospital has a present legal or constructive obligation as a result of a past event; it is
probable that an outflow of resources will be required to settle the obligation; and a reliable estimate can be made of the
amount of the obligation.
These provisions are recognised when it is probable that a future sacrifice of economic benefits will be required and the
amount can be measured reliably.
b) Insurance
The Hospital’s insurance activities are conducted through the NSW Treasury Managed Fund Scheme of self insurance for
Government Agencies. The expense (premium) is determined by the Fund Manager based on past experience.
c) Finance Costs
Finance costs are recognised as expenses in the period in which they are incurred.
121
d) Income Recognition
Income is measured at the fair value of the consideration or contribution received or receivable. Additional comments
regarding the accounting policies for the recognition of revenue are discussed below.
Revenue from the sale of goods and services comprises revenue from the provision of products or services, i.e. user charges.
User charges are recognised as revenue when the service is provided or by reference to the stage of completion.
Patient Fees
Patient Fees are derived from chargeable inpatients and non-inpatients on the basis of rates specified by the NSW Department
of Health from time to time.
Investment Revenue
Interest revenue is recognised using the effective interest method as set out in AASB139, “Financial Instruments: Recognition
and Measurement”. Rental revenue is recognised in accordance with AASB117 “Leases” on a straight line basis over the
lease term. Dividend revenue is recognised in accordance with AASB118 “Revenue” when the Hospital’s right to receive
payment is established.
Debt Forgiveness
Debts are accounted for as extinguished when and only when settlement occurs through repayment or replacement by
another liability.
Use of Hospital Facilities
Specialist doctors with rights of private practice are subject to an infrastructure charge for the use of hospital facilities at rates
determined by the NSW Department of Health. Charges consist of two components:
* a monthly charge raised by the Hospital based on a percentage of receipts generated
* the residue of the Private Practice Trust Fund at the end of each financial year, such sum being credited for the Hospital’s
use in the advancement of the Hospital or individuals within it.
Use of Outside Facilities
The Hospital uses a number of facilities owned and maintained by the local authorities in the area to deliver community health
services for which no charges are raised by the authorities. The Hospital is unable to estimate the value of services provided
and as such no amounts have been recognised in the financial report.
Grants and Contributions are generally recognised as revenues when the Hospital obtains control over the assets comprising
the contributions. Control over contributions is normally obtained upon the receipt of cash.
NSW Department of Health Allocations
Payments are made by the NSW Department of Health on the basis of the allocation for the Hospital as adjusted for approved
supplementations mostly for salary agreements, patient flows between Health Services and approved enhancement projects.
This allocation is included in the Operating Statement before arriving at the “Result for the Year” on the basis that the
allocation is earned in return for the Hospital’s services provided on behalf of the Department. Allocations are normally
recognised upon the receipt of cash.
122
e) Accounting for Goods & Services Tax (GST)
Revenues, expenses and assets are recognised net of the amount of GST, except that:
* the amount of GST incurred by the Hospital as a purchaser that is not recoverable from the Australian Taxation Office is
recognised as part of the cost of acquisition of an asset or as part of an item of expense;
* receivables and payables are stated with the amount of GST included.
f)
Inter Area and Interstate Patient Flows
Inter Area Patient Flows
The Hospital recognises patient flows for patients it has treated that live outside the Hospital’s regional area. The flows
recognised are for acute inpatients (other than Mental Health Services), emergency and rehabilitation and extended care.
Patient flows have been calculated using benchmarks for the cost of services for each of the categories identified and
deducting estimated revenue, based on the payment category of the patient. The flow information is based on activity for the
last completed calendar year. The NSW Department of Health accepts that category identification for various surgical and
medical procedures is impacted by the complexities of the coding process and the interpretation of the coding staff when
coding a patient’s medical records. The Department reviews the flow information extracted from the Hospital records and once
it has accepted it, requires the Hospital to bring to account the value of patient flows in accordance with the Department’s
assessment.
The adjustments have no effect on equity values as the movement in Net Cost of Services is matched by a corresponding
adjustment to the value of the NSW Department of Health Recurrent Allocation.
Inter State Patient Flows
The Hospital recognises the value of inflows for acute inpatient treatment provided to residents from other States and
Territories within Australia. The revenue values reported within the financial statements have been based on 2006/07
activity data using standard cost weighted separation values to reflect estimated costs in 2007/08 for acute weighted
inpatient separations.
The reporting adopted for both inter area and interstate patient flows aims to provide a greater accuracy of the cost of service
provision to the Area’s resident population and disclose the extent to which service is provided to non residents.
The composition of patient flow revenue is disclosed in Note 9.
123
g) Acquisition of Assets
The cost method of accounting is used for the initial recording of all acquisitions of assets controlled by the Hospital. Cost is
the amount of cash or cash equivalents paid or the fair value of the other consideration given to acquire the asset at the time of
its acquisition or construction or, where applicable, the amount attributed to that asset when initially recognised in accordance
with the specific requirements of other Australian Accounting Standards.
Assets acquired at no cost, or for nominal consideration, are initially recognised as assets and revenues at their fair value at the
date of acquisition except for assets transferred as a result of an administrative restructure.
Fair value means the amount for which an asset could be exchanged between knowledgeable, willing parties in an arm’s
length transaction.
Where settlement of any part of cash consideration is deferred beyond normal credit terms, its cost is the cash price
equivalent, i.e. the deferred payment amount is effectively discounted at an asset-specific rate.
Land and Buildings which are owned by the Health Administration Corporation or the State and administered by the Hospital
are deemed to be controlled by the Hospital and are reflected as such in the financial statements.
h) Plant and Equipment and Infrastructure Systems
Individual items of property, plant & equipment are capitalised where their cost is $10,000 or above.
“Infrastructure Systems” means assets that comprise public facilities and which provide essential services and enhance the
productive capacity of the economy including roads, bridges, water infrastructure and distribution works, sewage treatment
plants, seawalls and water reticulation systems.
i)
Depreciation
Depreciation is provided for on a straight line basis for all depreciable assets so as to write off the depreciable amount of each
asset as it is consumed over its useful life to the Hospital. Land is not a depreciable asset.
Details of depreciation rates initially applied for major asset categories are as follows:
Buildings
Electro Medical Equipment
- Costing less than $200,000
- Costing more than or equal to $200,000
Computer Equipment
Infrastructure Systems
Motor Vehicle Sedans
Motor Vehicles, Trucks & Vans
Office Equipment
Plant and Machinery
Furniture, Fittings and Furnishings
2.5%
10.0%
12.5%
20.0%
2.5%
12.5%
20.0%
10.0%
10.0%
5.0%
Depreciation rates are subsequently varied where changes occur in the assessment of the remaining
useful life of the assets reported.
124
j)
Revaluation of Non Current Assets
Physical non-current assets are valued in accordance with the NSW Department of Health’s “Valuation of Physical NonCurrent Assets at Fair Value” policy. This policy adopts fair value in accordance with AASB116, “Property, Plant & Equipment”
and AASB140, “Investment Property”.
Property, plant and equipment is measured on an existing use basis, where there are no feasible alternative uses in the
existing natural, legal, financial and socio-political environment. However, in the limited circumstances where there are
feasible alternative uses, assets are valued at their highest and best use.
Fair value of property, plant and equipment is determined based on the best available market evidence, including current
market selling prices for the same or similar assets. Where there is no available market evidence the asset’s fair value is
measured at its market buying price, the best indicator of which is depreciated replacement cost.
The Hospital revalues Land and Buildings and Infrastructure at minimum every three years by independent valuation. To
ensure that the carrying amount of each asset does not differ materially from its fair value at reporting date, indices provided
in expert advice from the Department of Lands are applied. The indices reflect an assessment of movements in the period
between revaluations.
Non-specialised assets with short useful lives are measured at depreciated historical cost, as a surrogate for fair value.
When revaluing non-current assets by reference to current prices for assets newer than those being revalued
(adjusted to reflect the present condition of the assets), the gross amount and the related accumulated depreciation
are separately restated.
For other assets, any balances of accumulated depreciation existing at the revaluation date in respect of those assets are
credited to the asset accounts to which they relate. The net asset accounts are then increased or decreased by the revaluation
increments or decrements.
Revaluation increments are credited directly to the asset revaluation reserve, except that, to the extent that an increment
reverses a revaluation decrement in respect of that class of asset previously recognised as an expense in the Result for the
Year, the increment is recognised immediately as revenue in the Result for the Year.
Revaluation decrements are recognised immediately as expenses in the Result for the Year, except that, to the extent that a
credit balance exists in the asset revaluation reserve in respect of the same class of assets, they are debited directly to the
asset revaluation reserve.
As a not-for-profit entity, revaluation increments and decrements are offset against one another within a class of non-current
assets, but not otherwise.
Where an asset that has previously been revalued is disposed of, any balance remaining in the asset revaluation reserve in
respect of that asset is transferred to accumulated funds.
125
k) Impairment of Property, Plant and Equipment
As a not-for-profit entity with no cash generating units, the Hospital is effectively exempt from AASB 136” Impairment of
Assets” and impairment testing. This is because AASB136 modifies the recoverable amount test to the higher of fair value less
costs to sell and depreciated replacement cost. This means that, for an asset already measured at fair value, impairment can
only arise if selling costs are regarded as material. Selling costs are regarded as immaterial.
l)
Restoration Costs
The estimated cost of dismantling and removing an asset and restoring the site is included in the cost of an asset, to the extent
it is recognised as a liability.
m) Intangible Assets
The Hospital recognises intangible assets only if it is probable that future economic benefits will flow to the Hospital and the
cost of the asset can be measured reliably. Intangible assets are measured initially at cost. Where an asset is acquired at no or
nominal cost, the cost is its fair value as at the date of acquisition. All research costs are expensed. Development costs are
only capitalised when certain criteria are met.
The useful lives of intangible assets are assessed to be finite. Intangible assets are subsequently measured at fair value only
if there is an active market. As there is no active market for the Hospital’s intangible assets, the assets are carried at cost less
any accumulated amortisation. The Hospital’s intangible assets are amortised using the straight line method based on the
useful life of the asset for both internally developed assets and direct acquisitions. In general, intangible assets are tested for
impairment where an indicator of impairment exists. However, as a not-for-profit entity the Hospital is effectively exempt from
impairment testing (see Note 2[k]).
n) Maintenance
The costs of maintenance are charged as expenses as incurred, except where they relate to the replacement of a component
of an asset in which case the costs are capitalised and depreciated.
o) Leased Assets
A distinction is made between finance leases which effectively transfer from the lessor to the lessee substantially all the risks
and benefits incidental to ownership of the leased assets, and operating leases under which the lessor effectively retains all
such risks and benefits.
Where a non-current asset is acquired by means of a finance lease, the asset is recognised at its fair value at the
commencement of the lease term. The corresponding liability is established at the same amount. Lease payments are
allocated between the principal component and the interest expense.
Operating lease payments are charged to the Operating Statement in the periods in which they are incurred.
p) Inventories
Inventories are stated at cost. Costs are assigned to individual items of stock mainly on the basis of weighted average costs.
Obsolete items are disposed off in accordance with instructions issued by the NSW Department of Health.
126
q) Loans and Receivables
Loans and receivables are non-derivative financial assets with fixed or determinable payments that are not quoted in an
active market. These financial assets are recognised initially at fair value, usually based on the transaction cost or face value.
Subsequent measurement is at amortised cost using the effective interest method, less an allowance for any impairment
of receivables. Any changes are accounted for in the Operating Statement when impaired, derecognised or through the
amortisation process.
Short-term receivables with no stated interest rate are measured at the original invoice amount where the effect of discounting
is immaterial.
r)
Investments
Investments are initially recognised at fair value through profit or loss. The Hospital determines the classification of its financial
assets after initial recognition and, when allowed and appropriate, re-evaluates this at each financial year end.
• Fair value through profit or loss - The Hospital subsequently measures investments classified as “held for trading” or
designated upon initial recognition “at fair value through profit or loss” at fair value. Financial assets are classified as “held
for trading” if they are acquired for the purpose of selling in the near term. Derivatives are also classified as held for trading.
Gains or losses on these assets are recognised in the Operating Statement.
The Hour-Glass Investment facilities are designated at fair value through profit or loss using the second leg of the fair value
option i.e. these financial assets are managed and their performance is evaluated on a fair value basis, in accordance with
a documented risk management strategy, and information about these assets is provided internally on that basis to the
Hospital’s key management personnel.
The risk management strategy of the Hospital has been developed consistent with the investment powers granted under the
provision of the Public Authorities (Financial Arrangements) Act. T Corp investments are made in an effort to improve total
return on investments through access to equities and fixed interest products managed professionally by NSW Treasury.
The movement in the fair value of the Hour-Glass Investment facilities incorporates distributions received as well as
unrealised movements in fair value and is reported in the line item ‘investment revenue’.
• Held to maturity investments – Non-derivative financial assets with fixed or determinable payments and fixed maturity that
the Hospital has the positive intention and ability to hold to maturity are classified as “held to maturity”. These investments
are measured at amortised cost using the effective interest method. Changes are recognised in the Operating Statement
when impaired, derecognised or through the amortisation process.
• Available for sale investments - Any residual investments that do not fall into any other category are accounted for as
available for sale investments and measured at fair value directly in equity until disposed or impaired, at which time
the cumulative gain or loss previously recognised in equity is recognised in the Operating Statement. However, interest
calculated using the effective interest method and dividends are recognised in the Operating Statement.
Purchases or sales of investments under contract that require delivery of the asset within the timeframe established by
convention or regulation are recognised on the trade date; i.e. the date the Hospital commits to purchase or sell the asset.
The fair value of investments that are traded at fair value in an active market is determined by reference to quoted current bid
prices at the close of business on the balance sheet date.
127
s) Impairment of financial assets
All financial assets, except those measured at fair value through profit and loss, are subject to an annual review for
impairment. An allowance for impairment is established when there is objective evidence that the Hospital will not be able to
collect all amounts due.
For financial assets carried at amortised cost, the amount of the allowance is the difference between the asset’s carrying
amount and the present value of estimated future cash flows, discounted at the effective interest rate. The amount of the
impairment loss is recognised in the Operating Statement.
When an available for sale financial asset is impaired, the amount of the cumulative loss is removed from equity and
recognised in the Operating Statement, based on the difference between the acquisition cost (net of any principal repayment
and amortisation) and current fair value, less any impairment loss previously recognised in the Operating Statement.
Any reversals of impairment losses are reversed through the Operating Statement, where there is objective evidence, except
reversals of impairment losses on an investment in an equity instrument classified as “available for sale” must be made
through the reserve. Reversals of impairment losses of financial assets carried at amortised cost cannot result in a carrying
amount that exceeds what the carrying amount would have been had there not been an impairment loss.
t)
De-recognition of financial assets and financial liabilities
A financial asset is derecognised when the contractual rights to the cash flows from the financial assets expire; or if the
Hospital transfers the financial asset:
* where substantially all the risks and rewards have been transferred; or
* where the Hospital has not transferred substantially all the risks and rewards, if the Hospital has not retained control.
Where the Hospital has neither transferred nor retained substantially all the risks and rewards or transferred control, the asset
is recognised to the extent of the Hospital’s continuing involvement in the asset.
A financial liability is derecognised when the obligation specified in the contract is discharged or cancelled or expires.
u) Payables
These amounts represent liabilities for goods and services provided to the Hospital and other amounts. Payables are
recognised initially at fair value, usually based on the transaction cost or face value. Subsequent measurement is at amortised
cost using the effective interest method. Short-term payables with no stated interest rate are measured at the original invoice
amount where the effect of discounting is immaterial.
Payables are recognised for amounts to be paid in the future for goods and services received, whether or not billed to the
Hospital.
v) Borrowings
Loans are not held for trading or designated at fair value through profit or loss and are recognised at amortised cost using the
effective interest rate method. Gains or losses are recognised in the Operating Statement on derecognition.
The finance lease liability is determined in accordance with AASB 117 “Leases”.
128
w) Trust Funds
The Hospital receives monies in a trustee capacity for various trusts as set out in Note 30. As the Hospital performs only a
custodial role in respect of these monies, and because the monies cannot be used for the achievement of the Hospital’s own
objectives, they are not brought to account in the financial statements.
x) Budgeted Amounts
The budgeted amounts are drawn from the budgets agreed with the NSW Department of Health at the beginning of the
financial reporting period and with any adjustments for the effects of additional supplementation provided.
y) Summary of Capital Management
With effect from 1 July 2008 project management for all capital projects over $10M will be provided by Health Infrastructure,
a division of the Health Administration Corporation created with the purpose of managing and coordinating approved capital
works projects within time, budget and quality standards specified by the NSW Department of Health.
129
PARENT
2008
$000
CONSOLIDATION
2007
$000
2008
$000
3.
2007
$000
Employee Related
Employee related expenses comprise the following:
- _________
__________
Salaries and Wages
Superannuation - defined benefit plans
Superannuation - defined contributions
Long Service Leave
Annual Leave
Workers Compensation Insurance
Fringe Benefits Tax
- _________
__________
175,836
162,555
3,944
2,672
14,005
13,025
5,599
6,126
16,896
18,386
1,704
1,812
69 __________
45
__________
218,053 __________
204,621
__________
4.
Personnel Services
Personnel Services comprise the purchase of the following:
175,836
162,555
3,944
2,672
14,005
13,025
5,599
6,126
16,896
18,386
1,704
1,812
69 _________
45
__________
Salaries and Wages
Superannuation - defined benefit plans
Superannuation - defined contributions
Long Service Leave
Annual Leave
Fringe Benefits Tax
218,053 _________
204,621
__________
__________- __________
5.
9,895
3,038
12,847
2,698
1,533
6,536
869
1,770
45
11,785
2,718
11,263
2,243
1,729
5,527
723
262
88
4,618
5,648
1,321
4,240
1,882
2,797
11,215
9,750
1,161
1,055
1,368
1,261
501
510
139
188
8,989
8,266
1,526
1,865
2,740 _________
2,380
__________
74,691 _________
74,298
__________
130
__________- __________
Blood and Blood Products
Domestic Supplies and Services
Drug Supplies
Food Supplies
Fuel, Light and Power
General Expenses (See (a) below)
Hospital Ambulance Transport Costs
Information Management Expenses
Insurance
Maintenance (See (b) below)
Maintenance Contracts
New/Replacement Equipment under $10,000
Repairs
Medical and Surgical Supplies
Postal and Telephone Costs
Printing and Stationery
Rates and Charges
Rental
Special Service Departments
Staff Related Costs
Travel Related Costs
9,895
3,038
12,847
2,698
1,533
6,536
869
1,770
45
11,785
2,718
11,263
2,243
1,729
5,527
723
262
88
4,618
5,648
1,321
4,240
1,882
2,797
11,215
9,750
1,161
1,055
1,368
1,261
501
510
139
188
8,989
8,266
1,526
1,865
2,740 __________
2,380
__________
74,691 __________
74,298
__________
PARENT
2008
$000
CONSOLIDATION
2007
$000
2008
$000
(a) General Expenses comprise:
Advertising
Books, Magazines and Journals
Consultancies
- Operating Activities
Courier and Freight
Auditor’s Remuneration - Audit of financial reports
Auditor’s Remuneration - Other Services
Data Recording and Storage
Legal Services
Membership/Professional Fees
Motor Vehicle Operating Lease Expense - minimum lease payments
Other Operating Lease Expense - minimum lease payments
Payroll Services
Quality Assurance/Accreditation
Translator Services
Other general operating expenses
443
399
427
381
1,065
1,812
350
308
153
81
2
160
29
362
235
129
138
152
165
358
397
6
2
47
414
231
2,468 _________
1,349
__________
6,536 _________
5,527
__________
2007
$000
443
399
427
381
1,065
1,791
350
308
153
102
2
160
29
362
235
129
138
152
165
358
397
6
2
47
414
231
2,468 __________
1,349
__________
6,536 __________
5,527
__________
(b) Reconciliation Total Maintenance
Maintenance expense - contracted labour and other (non employee
related), included in Note 5
4,618 _________
5,648
__________
4,618 _________
5,648
__________
Total maintenance expenses included in Notes 5
6.
8,259
8,248
5,214
3,954
812
813
1,221
1,312
19 _________
19
__________
Depreciation - Buildings
Depreciation - Plant and Equipment
Depreciation - Infrastructure Systems
Amortisation - Intangible Assets
Amortisation - Leased Buildings
15,525 _________
14,346
__________
4,618 __________
5,648
__________
4,618 __________
5,648
__________
8,259
8,248
5,214
3,954
812
813
1,221
1,312
19 __________
19
__________
15,525 __________
14,346
__________
7.
322
312
242 _________
8
__________
Non Government Voluntary Organisations
Other
564 _________
320
__________
322
312
242 __________
8
__________
564 __________
320
__________
8.
Finance Costs
31 _________
51
__________
Interest on Loans
31 __________
51
__________
31 _________
51
__________
Total Finance Costs
31 __________
51
__________
131
PARENT
2008
$000
CONSOLIDATION
2007
$000
9.
2008
$000
2007
$000
1,753
730
1,404
452
(a) Sale of Goods comprises the following:
1,753
730
1,404
452
Sale of Prostheses
Pharmacy Sales
(b) Rendering of Services comprises the following:
9,964
7,616
90
469
9,601
8,712
506
533
1,757
2,248
1,867
1,808
551
427
1,451
1
1,460
351
38
23
143,029
128,804
104
111
13
12
2,376
3,469
3,257 _________
1,971
__________
Patient Fees [see note 2(d)]
Staff-Meals and Accommodation
Infrastructure Fees - Monthly Facility Charge [see note 2(d)]
- Annual Charge
Cafeteria/Kiosk
Car Parking
Child Care Fees
Clinical Services (excluding Clinical Drug Trials)
Commercial Activities
Fees for Medical Records
Allocation from Inter Area Patient Inflows, NSW [see Note 9(c)]
Salary Packaging Fee
PADP Patient Copayments
Patient inflows from Interstate [see Note 9(d)]
Other
178,547 _________
158,411
__________
9,964
7,616
90
469
9,601
8,712
506
533
1,757
2,248
1,867
1,808
551
427
1,451
1
1,460
351
38
23
143,029
128,804
104
111
13
12
2,376
3,469
3,257 __________
1,971
__________
178,547 __________
158,411
__________
(c) Details of the Allocations received for Inter Area Patient Flows,
NSW on an Area basis as accepted by the NSW Department of
Health are as follows:
33,249
30,582
21,173
18,190
62,526
54,728
5,383
6,047
6,397
5,973
3,433
3,338
7,388
5,880
3,480 _________
4,066
__________
Sydney South West
North Sydney/Central Coast
Sydney West
Hunter/New England
South East/Illawarra
North Coast
Greater Western
Greater Southern
143,029 _________
128,804
__________
33,249
30,582
21,173
18,190
62,526
54,728
5,383
6,047
6,397
5,973
3,433
3,338
7,388
5,880
3,480 __________
4,066
__________
143,029 __________
128,804
__________
(d) Revenues from Patient Inflows from Interstate are as follows:
1,448
2,429
111
159
150
478
(29)
82
103
255
394
2
199 _________
64
__________
2,376 _________
3,469
__________
132
Australian Capital Territory
Northern Territory
Queensland
South Australia
Tasmania
Victoria
Western Australia
1,448
2,429
111
159
150
478
(29)
82
103
255
394
2
199 __________
64
__________
2,376 __________
3,469
__________
PARENT
2008
$000
CONSOLIDATION
2007
$000
2008
$000
2007
$000
10. Investment Revenue
(1,193)
7,010
319
570
534 _________
489
__________
Investment Income
- T Corp Hour Glass Investment Facilities designated at Fair Value
through profit or loss
Interest - Other
Lease and Rental Income
(340) _________
8,069
__________
(1,193)
7,010
319
570
534 __________
489
__________
(340) __________
8,069
__________
11. Grants and Contributions
900
612
2,066
2,723
24,027
25,366
53
3,944
2,672
4,204
5,807
31 _________
__________
Clinical Drug Trials
Commonwealth Government Grants
Industry Contributions/Donations
NSW Government Grants
Personnel Services - Superannuation Defined Benefits
Research Grants
Other Grants
35,225 _________
37,180
__________
900
612
2,066
2,723
24,027
25,366
53
4,204
5,807
31 __________
__________
31,281 __________
34,508
__________
12. Other Revenue
Other Revenue comprises the following:
2
3
122
70
1,274
1,069
8
198
136
69
313
1,189
5,526 _________
4,675
__________
Bad Debts recovered
Commissions
Conference and Training Fees
Discounts
Sale of Merchandise, Old Wares and Books
Sponsorship Income
Treasury Managed Fund Hindsight Adjustment
Other
7,504 _________
7,150
__________
2
3
122
70
1,274
1,069
8
198
136
69
313
1,189
5,526 __________
4,675
__________
7,504 __________
7,150
__________
13. Gain/(Loss) on Disposal
21,220
9,101
20,813 _________
9,044
__________
Property, Plant and Equipment
Less Accumulated Depreciation
21,220
9,101
20,813 __________
9,044
__________
407
57
5 _________
__________
Written Down Value
Less Proceeds from Disposal
407
57
__________5 __________
(402) _________
(57)
__________
Gain/(Loss) on Disposal of Property Plant and Equipment
(402) __________
(57)
__________
3
3 _________
__________
__________- _________
Intangible Assets
Less Proceeds from Disposal
Gain/(Loss) on Disposal of Intangible Assets
3
__________3 __________
__________- __________
(402) _________
(57)
__________
Total Gain/(Loss) on Disposal
(402) __________
(57)
__________
14. Other Gains/(Losses)
(1,504) _________
(277)
__________
(1,504) _________
(277)
__________
Impairment of Receivables
(1,504) __________
(277)
__________
(1,504) __________
(277)
__________
133
PARENT AND CONSOLIDATION
15.
Conditions on Contributions
Contributions recognised as revenues during the
current reporting period for which expenditure in the
manner specified had not occurred as at balance date
Purchase of
Assets
Health Promotion,
Education and
Research
Other
Total
$000
$000
$000
$000
539
4,572
507
5,618
Contributions recognised in amalgamated balance
as at 30 June 2007 which were not expended in the
current reporting period
0
________
61,147
_______
2,103
_______
63,250
________
Total amount of unexpended contributions
as at balance date
539
________
65,719
_______
2,610
_______
68,868
________
There is a change in the methodology used to split the unspent contribution between the above categories. The 2006/07
unspent contribution for purchase of assets was based on a percentage of some major cost centres that regularly receive
donations and purchase assets. However, as conditional contributions for the purchase of assets are generally spent in the year
of receipt, in 2007/08 any unexpended contributions are based on known amounts.
Comment on restricted assets appears in Note 23
134
16.
Programs/Activities of the Hospital
Program 1.1 - Primary and Community Based Services
Objective:
To improve, maintain or restore health through health promotion, early intervention,
assessment, therapy and treatment services for children in a home or community setting.
Program 1.2 - Aboriginal Health Services
Objective:
To raise the health status of Aborigines and to promote a healthy life style.
Program 1.3 - Outpatient Services
Objective:
To improve, maintain or restore health through diagnosis, therapy, education and treatment
services for ambulant patients in a hospital setting.
Program 2.1 - Emergency Services
Objective:
To reduce the risk of premature death and disability for children suffering injury or acute
illness by providing timely emergency diagnostic, treatment and transport services.
Program 2.2 - Overnight Acute Inpatient Services
Objective:
To restore or improve health and manage risks of illness, injury and childbirth through
diagnosis and treatment for children intended to be admitted to hospital on an overnight basis.
Program 2.3 - Same Day Acute Inpatient Services
Objective:
To restore or improve health and manage risks of illness, injury and childbirth through
diagnosis and treatment for children intended to be admitted to hospital and discharged on the same day.
Program 3.1 - Mental Health Services
Objective:
To improve the health, well being and social functioning of children with disabling mental
disorders and to reduce the incidence of suicide, mental health problems and mental disorders
in the community.
Program 4.1 - Rehabilitation and Extended Care Services
Objective:
To improve or maintain the well being and independent functioning of children with
disabilities or chronic conditions, the frail and the terminally ill.
Program 5.1 - Population Health Services
Objective:
To promote health and reduce the incidence of preventable disease and disability by
improving access to opportunities and prerequisites for good health.
Program 6.1 - Teaching and Research
Objective:
To develop the skills and knowledge of the health workforce to support patient care and
population health. To extend knowledge through scientific enquiry and applied research aimed
at improving the health and well being of the children of New South Wales.
135
PARENT
2008
$000
CONSOLIDATION
2007
$000
2008
$000
2007
$000
17. Cash and Cash Equivalents
6,032
7,646
35,695 _________
36,789
__________
Cash at bank and on hand
Short Term Deposits
41,727 _________
44,435
__________
6,032
7,646
35,695 __________
36,789
__________
41,727 __________
44,435
__________
Cash & cash equivalent assets recognised in the Balance Sheet are reconciled
at the end of the financial year to the Cash Flow Statement as follows:
41,727 _________
44,435
__________
Cash and cash equivalents (per Balance Sheet)
41,727 __________
44,435
__________
41,727 _________
44,435
__________
Closing Cash and Cash Equivalents (per Cash Flow Statement)
41,727 __________
44,435
__________
Refer to Note 36 for details regarding credit risk, liquidity risk and market risk arising from financial instruments.
18. Receivables
2,724
5,301
847
141
827
290
650
671
7,001 _________
1,971
__________
12,049
8,374
(1,830) _________
(737)
__________
10,219
7,637
444 _________
453
__________
Current
(a) Sale of Goods and Services
Leave Mobility
Goods and Services Tax
Other Debtors
Sub Total
Less Allowance for impairment
Sub Total
Prepayments
10,663 _________
8,090
__________
712
(266)
255
701
36
30
(176)
(11)
1,452
17
1,312 _________
36
__________
(c) Movement in the allowance for impairment
Other Debtors
Balance at 1 July
Amounts written off during the year
Amounts recovered during the year
Increase/(decrease) in allowance recognised in profit or loss
Balance at 30 June
1,830 _________
737
__________
136
(1,830) __________
(737)
__________
10,219
7,637
444 __________
453
__________
10,663 __________
8,090
__________
(b) Movement in the allowance for impairment
Sale of Goods & Services
Balance at 1 July
Balance at 30 June
701
(233)
(2)
52
518
2,724
5,301
847
141
827
290
650
671
7,001 __________
1,971
__________
12,049
8,374
701
(233)
(2)
52
518
712
(266)
255
701
36
30
(176)
(11)
1,452
17
1,312 __________
36
__________
1,830 __________
737
__________
PARENT
2008
$000
CONSOLIDATION
2007
$000
2008
$000
2007
$000
59
437
__________- _________
59
437
Non Current
(a) Sale of Goods and Services
Other Debtors
Sub Total
59
437
- __________
__________
59
437
(134)
__________- _________
59
303
Less Allowance for impairment
Sub Total
- __________
(134)
__________
59
303
__________- _________
Prepayments
59 _________
303
__________
134
135
(134)
(1)
134
__________- _________
59 __________
303
__________
(b) Movement in the allowance for impairment
Balance at 1 July
Balance at 30 June
134
__________- _________
105
283
662
1,286 _________
2,236
__________
- __________
__________
134
135
(134)
(1)
- __________
134
__________
- __________
134
__________
(c) Sale of Goods and Services Receivables
(Current and Non Current) include:
Patient Fees - Compensable
Patient Fees - Ineligible
Patient Fees - Other
2,053 _________
2,519
__________
105
283
662
1,286 __________
2,236
__________
2,053 __________
2,519
__________
Details regarding credit risk, liquidity risk and market risk, including financial assets that are either past due or impaired are disclosed in Note
36.
19. Inventories
1,324
1,235
2,066
1,873
31
26
142
105
231
286
630 _________
556
__________
4,424 _________
4,081
__________
Current - at cost
Drugs
Medical and Surgical Supplies
Food and Hotel Supplies
Engineering Supplies
Fundraising Merchandise
Other
1,324
1,235
2,066
1,873
31
26
142
105
231
286
630 __________
556
__________
4,424 __________
4,081
__________
137
PARENT
2008
$000
CONSOLIDATION
2007
$000
2008
$000
2007
$000
20. Financial Assets at Fair Value
33,238 _________
37,147
__________
Non Current
Treasury Corporation - Hour Glass Investment Facilities
33,238 _________
37,147
__________
33,238 __________
37,147
__________
33,238 __________
37,147
__________
Refer to Note 36 for details regarding credit risk, liquidity risk and market risk arising from financial investments.
21. Property, Plant and Equipment
387,439
352,324
(83,720) _________
(67,939)
__________
Land and Buildings
At Fair Value
Less Accumulated depreciation
387,439
352,324
(83,720) __________
(67,939)
__________
303,719 _________
284,385
__________
Net Carrying Amount
303,719 __________
284,385
__________
118,624
133,981
(89,816) _________
(105,416)
__________
Plant and Equipment
At Fair Value
118,624
133,981
(89,816) __________
(105,416)
__________
28,808 _________
28,565
__________
Net Carrying Amount
28,808 __________
28,565
__________
36,050
32,510
(8,290) _________
(6,742)
__________
At Fair Value
36,050
32,510
(8,290) __________
(6,742)
__________
25,760 _________
25,768
__________
Net Carrying Amount
27,760 __________
25,768
__________
360,287 _________
338,718
__________
Total Property, Plant and Equipment
At Net Carrying Amount
360,287 __________
338,718
__________
138
PARENT AND C0NSOLIDATION
21.
Property, Plant and Equipment - Reconciliations
Land
Buildings
Leased
Buildings
Plant and
Equipment
Infrastructure
Systems
Total
$000
$000
$000
$000
$000
$000
2008
20,720
263,038
627
28,565
25,768
338,718
Additions
-
1,341
-
5,920
208
7,469
Reclassification of Intangibles
-
-
-
(56)
-
(56)
Disposals
-
-
-
(407)
-
(407)
Net revaluation increment less revaluation
decrements recognised in reserves
-
26,271
-
-
2,596
28,867
Depreciation expense
-
(8,259)
(19)
(5,214)
(812)
(14,304)
20,720
282,391
608
28,808
27,760
360,287
Carrying amount at start of year
Carrying amount at end of year
Land
Buildings
Leased
Buildings
Plant and
Equipment
Infrastructure
Systems
Total
$000
$000
$000
$000
$000
$000
2007
20,720
270,067
646
29,005
26,581
347,019
Additions
-
1,219
-
3,571
-
4,790
Disposals
-
-
-
(57)
-
(57)
Depreciation expense
-
(8,248)
(19)
(3,954)
(813)
(13,034)
20,720
263,038
627
28,565
25,768
338,718
Carrying amount at start of year
Carrying amount at end of year
(i) Land and Buildings include land owned by the Health Administration Corporation and administered by the Hospital [see note 2(g)].
(ii)Land and Buildings at Westmead were revalued at fair value by an independent valuer, Mr P. Goldsmith APPI (Certified Practising Valuer)
Registered Valuer No 3099 from the Property Valuation Services on 31 March 2006. Indices provided by the Department of Lands have been
applied at 30 June 2008 [see note 2(j)].
Buildings were valued at fair value of $329,500,000 (cost $221,275,000) on 31 March 2006. Indices applied at 30 June 2008 have resulted in
an increase in the fair value of $26,271,000.
Land was revalued at fair value of $20,720,000 (cost $14,600,000) based on valuation dated 31 March 2006. It did not include the leasehold
land at Manly, on which Bear Cottage is located. Indices advised by the Department of Lands at 30 June 2008 showed no movement in the fair
value of land.
The term of the lease is 20 years with an option to renew for a further 20 years. The rent payable is $1 per annum.
139
PARENT
2008
$000
CONSOLIDATION
2007
$000
2008
$000
2007
$000
22. Intangible Assets
10,879
10,308
(6,462) _________
(5,398)
__________
Software
Cost (Gross Carrying Amount)
Less Accumulated Amortisation
10,879
10,308
(6,462) __________
(5,398)
__________
4,417 _________
4,910
__________
Net Carrying Amount
4,417 __________
4,910
__________
991
991
(625) _________
(468)
__________
Other
Cost (Gross Carrying Amount)
Less Accumulated Amortisation
991
991
(625) __________
(468)
__________
366 _________
523
__________
Net Carrying Amount
366 __________
523
__________
4,783 _________
5,433
__________
Total Intangible Assets at Net Carrying Amount
4,783 __________
5,433
__________
22.
Intangibles - Reconciliation
Software
Other
Total
$000
$000
$000
2008
Net Carrying amount at start of year
Additions (from internal development or acquired separately)
4,910
523
5,433
518
-
518
56
-
56
(1,064)
(157)
(1,221)
(3)
-
(3)
4,417
366
4,783
Reclassification from Plant & Equipment
Amortisation (recognised in depreciation and amortisation)
Other Movements - Disposals
Net Carrying amount at end of year
Software
Other
Total
$000
$000
$000
2007
Net Carrying amount at start of year
Additions (from internal development or acquired separately)
Amortisation (recognised in depreciation and amortisation)
Net Carrying amount at end of year
140
6,051
554
6,605
-
139
139
(1,141)
(170)
(1,311)
4,910
523
5,433
PARENT
2008
$000
CONSOLIDATION
2007
$000
2008
$000
2007
$000
613
2,669
32,313
32,243
6,861
6,765
22,568
24,655
2,609
2,242
148
212
3,756
4,381
23. Restricted Assets
The Hospital’s financial statements include the following assets which are
restricted by externally imposed conditions. e.g. donor requirements. The
assets are only available for application in accordance with the terms of the
donor restrictions.
613
2,669
32,313
32,243
6,861
6,765
22,568
24,655
2,609
2,242
148
212
3,756
4,381
__________ _________
68,868 _________
73,167
__________
Category
Brief Details of Externally Imposed conditions
including Asset Category affected
Children’s Hospital Funds
Donations and Fundraisings held for specific
purchases of equipment and / or services.
Specific Purposes
Donations, Contributions and Fundraisings held in
trust for the benefit of specific patient, departments
and / or staff group.
Perpetually Invested Funds Funds invested in perpetuity. The income there from is
used in accordance with donors’ or trustees’
instructions for the benefit of patients and / or in support
of Hospital Services.
Research Grants
Funds to be held for research on child health and
other related research carried out by the Hospital.
Private Practice Funds
Funds to be held for the use of training, education and
professional development of staff.
Bear Cottage
Donations, contributions and fund raisings held towards
the cost of operating Bear Cottage, a home for chronically
ill children and their families, to provide them with
palliative care in a home environment
Research Capital Campaign Donations, contributions and fund raisings held towards
the building of the Clinical Research Building, to provide
infrastructure and facilities to meet the growing needs of
the research on disease and children’s health.
__________ __________
68,868 __________
73,167
__________
141
PARENT
2008
$000
CONSOLIDATION
2007
$000
2008
$000
2007
$000
7,504
389
10,288
6,871
686
7,383
24. Payables
389
7,504
10,288
686
6,871
7,383
2,621
839
300
263
1,553 _________
3,238
__________
Current
Accrued Salaries and Wages
Payroll Deductions
Accrued Liability - Purchase of Personnel Services
Creditors
Other Creditors
- Capital Works
- Intra Health Liability
- Other
22,655 _________
19,280
__________
2,621
839
300
263
1,553 __________
3,238
__________
22,655 __________
19,280
__________
Details regarding credit risk, liquidity risk and market risk, including a maturity analysis of the above payables are disclosed in Note 36.
123 _________
116
__________
123 _________
116
__________
305 _________
428
__________
305 _________
428
__________
25. Borrowings
Current
Other Loans and Deposits
Non Current
Other Loans and Deposits
123 __________
116
__________
123 __________
116
__________
305 __________
428
__________
305 __________
428
__________
Other loans still to be extinguished represent monies to be repaid to the
Sustainable Energy Development Authority
Final Repayment is scheduled for 31 December 2011
Repayment of Borrowings
(excluding Finance Leases)
123
116
305 _________
428
__________
Not later than one year
Between one and five years
123
116
305 __________
428
__________
428 _________
544
__________
Total Borrowings at face value
(excluding Finance Leases)
428 __________
544
__________
Details regarding credit risk, liquidity risk and market risk, including a maturity analysis of the above payables are disclosed in Note 36.
142
PARENT
2008
$000
CONSOLIDATION
2007
$000
2008
$000
2007
$000
26. Provisions
67,526 _________
63,451
__________
Current Employee benefits and related on-costs
Annual Leave - Short Term Benefit
Annual Leave - Long Term Benefit
Long Service Leave -Short term Benefit
Long Service Leave - Long Term Benefit
Provision for Personnel Services Liability
20,127
20,918
10,623
8,352
3,677
3,387
33,099
30,794
__________- __________
67,526 _________
63,451
__________
Total Current Provisions
67,526 __________
63,451
__________
4,326 _________
3,775
__________
Non Current Employee benefits and related on-costs
Long Service Leave - Conditional
Provision for Personnel Services Liability
4,326
3,775
__________- __________
4,326 _________
3,775
__________
Total Non Current Provisions
4,326 __________
3,775
__________
67,526
63,451
4,326
3,775
7,893 _________
7,557
__________
Aggregate Employee Benefits and Related On-costs
Provisions - current
Provisions - non-current
Accrued Salaries and Wages and on-costs (Note 24)
Accrued Liability - Purchase of Personnel Services (Note 24)
67,526
63,451
4,326
3,775
7,893
7,557
__________- __________
79,745 _________
74,783
__________
79,745 __________
74,783
__________
27. Other Liabilities
108 _________
50
__________
108
50
__________ _________
Current
Income in Advance
- Patients Fees received in advance
108 __________
50
__________
108
50
__________ __________
28.
Equity
Accumulated Funds
Asset Revaluation Reserve
Total Equity
2008
$000
2007
$000
2008
$000
2007
$000
2008
$000
2007
$000
213,212
218,452
137,895
137,895
351,107
356,347
(19,836)
(5,240)
-
-
(19,836)
(5,240)
-
-
26,271
2,596
-
26,271
2,596
-
Total
(19,836)
(5,240)
28,867
-
9,031
(5,240)
Balance at the end of the
financial year
193,376
213,212
166,762
137,895
360,138
351,107
Balance at the beginning of the
financial year
Changes in Equity
other than transaction with owners as owners
Result for the year
Increment/(Decrement) on Revaluation of:
Buildings
The asset revaluation reserve is used to record increments and decrements on the revaluation of non current assets. This accords with
the Hospital’s policy on the “Revaluation of Physical Non Current Assets” and “Investments”, as discussed in Note 2(j).
143
PARENT
2008
$000
CONSOLIDATION
2007
$000
2008
$000
2007
$000
29. Commitments for Expenditure
(a) Capital Commitments
Aggregate capital expenditure for the acquisition of land and buildings,
plant and equipment, infrastructure and intangible assets, contracted for
at balance date and not provided for:
668 _________
103
__________
668 _________
103
__________
Total Capital Expenditure Commitments (including GST)
668 __________
103
__________
668 __________
103
__________
Of the commitments reported at 30 June 2008 it is expected that
$668,000 will be met from locally generated monies.
(b) Other Expenditure Commitments
Aggregate other expenditure for operating expenses contracted for at
balance date and not provided for:
2,552
629
532 _________
__________
3,084 _________
629
__________
Later than one year and not later than five years
Total Other Expenditure Commitments (including GST)
2,552
629
532 __________
__________
3,084 __________
629
__________
(c) Operating Lease Commitments
Commitments in relation to non-cancellable operating leases are
payable as follows:
178
380
80 _________
198
__________
258 _________
578
__________
Later than one year and not later than five years
Total Operating Lease Commitments (including GST)
178
380
80 __________
198
__________
258 __________
578
__________
These Operating Leases are not recognised in the Financial Statements as
liabilities until due. The Operating Leases represent rental of medical plant
and equipment, computer equipment and vehicles.
(d) Contingent Asset related to Commitments for Expenditure
The total of “Commitments for Expenditure” above, i.e. $4.01 million as
at 30 June 2008 includes input tax credits of $364,000 (this compares
with $119,000 for the previous year) that are expected to be recoverable
from the Australian Taxation Office.
144
30.
Trust Funds
The Hospital holds trust fund moneys of $1.045 million which are used for the safe keeping of patients’ monies, employee
related monies, deposits on hired items of equipment and Private Practice Trusts. These monies are excluded from the
financial statements as the Hospital cannot use them for the achievement of its objectives. The following is a summary of the
transactions in the trust account.
Employee Trust/Refundable Deposits
Private Practice Trust Funds
2008
$000
2007
$000
2008
$000
2007
$000
Cash Balance at the beginning
of the financial reporting period
29
13
632
270
Receipts
43
41
16,204
15,378
(26)
(25)
(16,461)
(15,060)
-
-
624
44
46
29
999
632
Expenditure
Movement in Net Assets
Cash Balance at the end
of the financial reporting period
31.
Contingent Liabilities
a) Claims on Managed Fund
Since 1 July 1989, the Hospital has been a member of the NSW Treasury Managed Fund. The Fund will pay to or on
behalf of the Hospital all sums which it shall become legally liable to pay by way of compensation or legal liability if
sued except for employment related, discrimination and harassment claims that do not have statewide implications.
The costs relating to such exceptions are to be absorbed by the Hospital. As such, since 1 July 1989, apart from the
exceptions noted above no contingent liabilities exist in respect of liability claims against the Hospital. A Solvency Fund
(now called Pre-Managed Fund Reserve) was established to deal with the insurance matters incurred before 1 July
1989 that were above the limit of insurance held or for matters that were incurred prior to 1 July 1989 that would have
become verdicts against the State. That Solvency Fund will likewise respond to all claims against the Hospital.
b) Workers Compensation Hindsight Adjustment
Treasury Managed Fund normally calculates hindsight premiums each year. However, in regards to workers
compensation the final hindsight adjustment for the 2001/02 fund year and an interim adjustment for the 2003/04
fund year were not calculated until 2007/08. As a result, the 2002/03 final and 2004/05 interim hindsight calculations
will be paid in 2008/09.
145
PARENT
2008
$000
CONSOLIDATION
2007
$000
2008
$000
2007
$000
32. Reconciliation Of Net Cash Flows from Operating
Activities To Net Cost Of Services
3,605
15,237
(15,525)
(14,346)
(959)
6
(4,626)
(8,155)
(770)
3,153
(1,651)
(1,078)
(403)
(57)
(73,759)
(82,263)
(659) _________
(309)
__________
Net Cash Flows from Operating Activities
Provision for Doubtful Debts
Acceptance by the Crown Entity of Employee Superannuation Benefits
(Increase)/ Decrease in Provisions
Increase / (Decrease) in Prepayments and Other Assets
(Increase)/ Decrease in Creditors
Net Gain/ (Loss) on Sale of Property, Plant and Equipment
NSW Department of Health Recurrent Allocations
NSW Department of Health Capital Allocations
3,605
15,237
(15,525)
(14,346)
(959)
6
(3,944)
(2,672)
(4,626)
(8,155)
(770)
3,153
(1,651)
(1,078)
(403)
(57)
(73,759)
(82,263)
(659) __________
(309)
__________
(94,747) _________
(87,812)
__________
(98,691) __________
(90,484)
__________
33. 2007/08 Voluntary Services
It is considered impracticable to quantify the monetary value of voluntary
services provided to the Hospital. Services provided include:
• Chaplaincies and Pastoral Care • Patient Support Groups • Community Organisations -
• Pink Ladies/Hospital Auxiliaries
and Volunteers -
Patient & Family Support
Practical Support to Patients and Relatives
Counselling, Health Education, Transport,
Book Bunker, Starlight Rooms
and Radio Bed Rock, Home Help
and Patient Activities
Patient Services, Fund Raising, Assistance in
Sibling Child Care Centre, relief staff to
administration areas.
PARENT AND CONSOLIDATED
34.
Unclaimed Moneys
Unclaimed salaries and wages are paid to the credit of the Department of Industrial Relations and Employment in accordance with
the provisions of the Industrial Arbitration Act, 1940, as amended.
All money and personal effects of patients which are left in the custody of Hospital by any patient who is discharged or dies in the
Hospital and which are not claimed by the person lawfully entitled thereto within a period of twelve months are recognised as the
property of Hospital.
All such money and the proceeds of the realisation of any personal effects are lodged to the credit of the Samaritan Fund which is
used specifically for the benefit of necessitous patients or necessitous outgoing patients.
146
35.
Budget Review - Parent and Consolidated
The actual net cost of services is $2.4 million higher than budget.
This was primarily due to higher activity than expected, particularly from Inter Area Patient Flows.
The increase in activity resulted in higher employee costs. In addition, the cost of blood, drugs, medical and surgical supplies have
all increased compared to budget as a result of the increase in activity.
Results for the Year
The actual result for the year is $2.3 million higher than budget primarily due to the reasons mentioned under Net Cost of
Services above.
Assets and Liabilities
Net assets are $27 million more than budget, due mainly to the revaluation of buildings and infrastructure systems of $28 million,
which was not budgeted.
Cash Flows
Net cash flows from operating activities are $1.5 million higher than budget due mainly to increased operating receipts partially offset
by increased operating payments. In addition, net cash flows from investing activities are $1.3 million better than budget, resulting in
total net cash flows of $2.7 million better than budget.
Movements in the level of the NSW Department of Health Recurrent Allocation that have occurred since the time of the initial
allocation on 29 June 2007 are as follows:
$000
Initial Allocations
Revenue
Blood & Blood Products
Paediatric Liver Transplants
Award Increase
Inter-Area Patient Flow Adjustment
Other Miscellanious Funding Allocations
Allocation as per Operating Statement
207,180
4,085
3,832
1,510
920
(143,029)
(739)
____________
73,759
____________
147
36.
Financial Instruments
The Hospital’s principal financial instruments are outlined below. These financial instruments arise directly from the
Hospital’s operations or are required to finance its operations. The Hospital does not enter into or trade financial instruments,
including derivative financial instruments, for speculative purposes.
The Hospital’s main risks arising from financial instruments are outlined below, together with the Hospital’s objectives,
policies and processes for measuring and managing risk. Further quantitative and qualitative disclosures are included
throughout this financial report.
The Chief Executive has overall responsibility for the establishment and oversight of risk management and reviews and agrees
policies for managing each of these risks. Risk management policies are established to identify and analyse the risk faced by
the Hospital, to set risk limits and controls and monitor risks. Compliance with policies is reviewed by the Audit Committee
and Internal Auditors on a continuous basis.
(a) Financial Instrument Categories
Note Category
Financial Assets Class:
Cash and Cash Equivalents
Receivables 1
Financial Assets at Fair Value
17
18
20
N/A
Receivables at amortised cost
At fair value through profit or
loss - designated as such upon
initial recognition
Total Financial Assets
Financial Liabilities Class:
Borrowings
25
Payables 2
24
Other
27
Financial liabilities measured
at amortised cost
Finanical liabilities measured
at amortised cost
Total Financial Liabilities
Total carrying amounts as per
the Balance Sheet
2008
$000
2007
$000
41,727
9,628
33,238
44,435
7,269
37,147
84,593
88,851
428
544
22,655
19,280
108
50
23,191
19,874
Notes
1. Excludes statutory receivables and prepayments (ie not within scope of AASB 7)
2. Excludes unearned revenue (ie not within scope of AASB 7)
(b) Credit Risk
Credit risk arises when there is the possibility of the Hospital’s debtors defaulting on their contractual obligations, resulting in
a financial loss to the Hospital. The maximum exposure to credit risk is generally represented by the carrying amount of the
financial assets (net of any allowance for impairment).
Credit risk arises from financial assets of the Hospital i.e receivables. No collateral is held by the Hospital nor has it granted
any financial guarantees.
Credit risk associated with the Hospital’s financial assets, other than receivables, is managed through the selection of
counterparties and establishment of minimum credit rating standards. Authority deposits held with NSW TCorp are
guaranteed by the State.
148
Cash
Cash comprises cash on hand and bank balance deposited in accordance with Public Authorities (Financial Arrangements) Act
approvals. Interest is earned on daily bank balances at rates of approximately 6.90% in 2007/08 compared to 6.42% in the previous
year. The TCorp Hour Glass Cash Facility is discussed in paragraph (d) below.
Receivables - trade debtors
All trade debtors are recognised at amounts receivable at balance date. Collectibility of trade debtors is reviewed on an ongoing
basis. Procedures as established in the NSW Department of Health Accounting Manual and Fee Procedures Manual are followed to
recover outstanding amounts, including letters of demand. Debts which are known to be uncollectable are written off. An allowance
for impairment is raised when there is objective evidence that the entity will not be able to collect the amounts due. The evidence
includes past experience and current and expected changes in economic conditions and debtor credit ratings. No interest is earned
on trade debtors.
The Hospital is not materially exposed to concentrations of credit risk to a single trade debtor or group of debtors. Based on past
experience, debtors that are not past due (2008:$5,773,000; 2007: $3,178,000) are not considered impaired and these represent
60.6% of the total trade debtors. In addition Patient Fees Compensables are frequently not settled within 6 months of the date of
the service provision due to the length of time it takes to settle legal claims. Most of the Hospital’s debtors are health insurance
companies or compensation insurers settling claims in respect of inpatient treatments. There are no debtors which are currently not
past due or impaired whose terms have not been renegotiated.
The only financial assets that are past due or impaired are ‘sales of goods and services’ in the ‘receivables’ category of the balance
sheet. Patient Fees Ineligibles represent a significant portion of financial assets that are past due or impaired.
$000
2008
<3 months overdue
3 months - 6 months overdue
>6 months overdue
Total
Past due but not impaired
Considered impaired
1,445
659
786
794
794
1,518
1,518
2007
<3 months overdue
1,666
1,174
492
3 months - 6 months overdue
1,015
731
284
795
414
381
>6 months overdue
The ageing analysis excludes statutory receivables, as these are not within the scope of AASB 7.
(c) Liquidity risk
Liquidity risk is the risk that the Hospital will be unable to meet its payment obligations when they fall due. The Hospital continuously
manages risk through monitoring future cash flows and maturities planning to ensure adequate holding of high quality liquid
assets. The objective is to maintain a balance between continuity of funding and flexibility through effective management of cash,
investments and liquid assets and liabilities.
The Hospital has negotiated no loan outside of arrangements with the NSW Department of Health or the Sustainable Energy
Development Authority.
During the current and prior year, there were no defaults or breaches on any loans or payable. No assets have been pledged as
collateral. The Hospital’s exposure to liquidity risk is considered significant. However, the risk is mitigated as the NSW Department of
Health has indicated its ongoing financial support for the Hospital (Refer Note 2).
The liabilities are recognised for amounts due to be paid in the future for goods or services received, whether or not invoiced.
Amounts owing to suppliers (which are unsecured) are settled in accordance with the policy set by the NSW Department of Health. If
trade terms are not specified, payment is generally made no later than the end of the month following the month in which an invoice
or a statement is received.
In those instances where settlement cannot be effected in accordance with the above, eg due to short term liquidity constraints,
contact is made with creditors and terms of payment are negotiated.
The table below summarises the maturity profile of the Hospital’s financial liabilities together with the interest rate exposure.
149
Maturity Analysis and interest rate exposure of financial liabilities.
Interest Rate Exposure
Fixed Interest Rate Nominal Amount 1
Maturity Dates
Non - Interest
Bearing
1 Year or less
Over 1 to 5 Years
Weighted Average
Effective Interest
Rate
$000
$000
$000
%
123
305
6.07%
123
305
116
428
116
428
2008
%
Payables:
Accrued salaries
Wages and payroll
deductions
Creditors
Borrowings:
Other Loans and
Deposits
$000
7,504
389
14,762
6.07%
428
428
2007
Payables:
Accrued salaries
Wages and payroll
deductions
Creditors
Borrowings:
Other Loans and
Deposits
22,655
6,871
686
11,723
6.07%
544
544
19,280
6.07%
Notes:
1. The amounts disclosed are the contractual undiscounted cash flows of each class of financial liabilities, therefore the amounts disclosed
above may not reconcile to the balance sheet in respect of non interest bearing loans negotiated with the NSW Department of Health.
(d) Market risk
Market risk is the risk that the fair value of future cash flows of a financial instrument will fluctuate because of changes in
market prices. The Hospital’s exposures to market risk are primarily through interest rate risk on the Hospital’s borrowings
and other price risks associated with the movement in the unit price of the Hour Glass Investment facilities. The Hospital has
no exposure to foreign currency risk and does not enter into commodity contracts.
The effect on profit and equity due to a reasonably possible change in risk variable is outlined in the information below, for
interest rate risk and other price risk. A reasonably possible change in risk variable has been determined after taking into
account the economic environment in which the Hospital operates and the time frame for the assessment (i.e. until the end
of the next annual reporting period). The sensitivity analysis is based on risk exposures in existence at the balance sheet
date. The analysis is performed on the same basis for 2007. The analysis assumes that all other variables remain constant.
150
Interest rate risk
Exposure to interest rate risk arises primarily through the Hospital’s interest bearing liabilities.
However, Health Services are not permitted to borrow external to the NSW Department of Health (Sustainable Energy
Development Authority loans which are negotiated through Treasury excepted). Both SEDA and NSW Department of Health
loans are set at fixed rates and therefore are generally not affected by fluctuations in market rates. For financial instruments
a reasonably possible change of +/-1% is consistent with trends in interest. The Hospital’s exposure to interest rate risk is set
out below.
$000
-1%
+1%
Profit
Profit
Carrying Amount
2008
Financial assets
Cash and cash equivalents
Receivables
41,727
10,722
(382)
-
382
-
Financial assets at fair value
Other financial assets
33,238
3,322
(3,322)
Payables
Borrowings
2007
Financial assets
22,655
428
-
-
Cash and cash equivalents
Receivables
44,435
8,393
(408)
-
408
-
Financial assets at fair value
Other financial assets
37,147
3,974
(3,974)
19,280
544
-
-
Financial liabilities
Payables
Borrowings
Other price risk - TCorp Hour Glass facilities
Exposure to ‘other price risk’ primarily arises through the investment in the TCorp Hour Glass Investment facilities, which are
held for strategic rather than trading purposes. The Hospital has no direct equity investments. The Hospital holds units in the
following Hour-Glass investment trusts:
Facility
Investment Sectors
Investment horizon
2008
$’000
2007
$’000
Cash facility
Cash,money market instruments
Up to 2 years
35,695
36,674
Long term growth
facility
Cash, money market instruments,
Australian and International bonds listed property,
Australian and International shares
7 years and over
33,238
37,147
151
The unit price of each facility is equal to the total fair value of net assets held by the facility divided by the total number of
units on issue for that facility. Unit prices are calculated and published daily.
NSW TCorp as trustee for each of the above facilities is required to act in the best interest of the unitholders and to
administer the trusts in accordance with the trust deeds. As trustee, TCorp has appointed external managers to manage the
performance and risk of each facility in accordance with a mandate agreed by the parties. However, TCorp, acts as manager
for part of the Cash facility. A significant portion of the administration of the facilities is outsourced to an external custodian.
Investment in the Hour Glass facilities limits the Hospital’s exposure to risk, as it allows diversification across a pool of funds,
with different investment horizons and a mix of investments.
NSW TCorp provides sensitivity analysis information for each of the facilities, using historically based volatility information.
The TCorp Hour Glass Investment facilities are designated at fair value through profit or loss and therefore any change in unit
price impacts directly on profit (rather than equity).
Impact on profit/loss
Hour Glass Investment - Cash facility
Hour glass Investment - Long Term
Growth Facility
Change in unit price
2008
$’000
2007
$’000
+/- 1%
357
367
+/- 15%
4,986
5,572
A reasonable possible change is based on the percentage change in unit price multiplied by the redemption price as at 30
June each year for each facility ( as advised by TCorp).
(e) Fair Value
Financial instruments are generally recognised at cost, with the exception of the TCorp Hour Glass facilities, which are
measured at fair value. As discussed, the value of the Hour Glass Investments is based on the Hospital’s share of the value of
the underlying assets of the facility, based on the market value. All of the Hour Glass facilities are valued using ‘redemption’
pricing.
The amortised cost of financial instruments recognised in the balance sheet approximates the fair value because of the short
term nature of many of the financial instruments.
37.
Post Balance Date Events
The Hospital is not aware of any after balance date events.
END OF AUDITED FINANCIAL STATEMENTS
152
153
154
155
Special Purpose Service Entity Income Statement for the year ended 30 June 2008
2008
$000
2007
$000
218,053
204,621
Income
Personnel Services
Acceptance by the Crown Entity of Employee Benefits
3,944 _________
2,672
_________
Total Income
221,997 _________
207,293
_________
Expenses
Salaries and Wages
Defined Benefit Superannuation
Defined Contributions Superannuation
Long Service Leave
Annual Leave
175,836
162,555
3,944
2,672
14,005
13,025
5,599
6,126
16,896
18,386
1,704
1,812
69
45
Fringe Benefits Tax
156
3,944 _________
2,672
_________
Total Expenses
221,997 _________
207,293
_________
Result For The Year
- _________
_________
Special Purpose Service Entity
Balance Sheet as at 30 June 2008
Notes
2008
$000
2007
$000
ASSETS
Current Assets
Receivables
2
Total Current Assets
75,419 _________
71,008
_________
75,419 _________
71,008
_________
Non-Current Assets
Receivables
2
4,326 _________
3,775
_________
Total Non-Current Assets
4,326 _________
3,775
_________
Total Assets
79,745 _________
74,783
_________
LIABILITIES
Current Liabilities
Payables
3
Provisions
4
Total Current Liabilities
7,893
7,557
67,526 _________
63,451
_________
75,419 _________
71,008
_________
Non-Current Liabilities
Provisions
4
4,326 _________
3,775
_________
Total Non-Current Liabilities
4,326 _________
3,775
_________
Total Liabilities
79,745 _________
74,783
_________
Net Assets
- _________
_________
EQUITY
Accumulated Funds
- _________
_________
Total Equity
- _________
_________
157
Statement of Recognised Income and Expenses for the year ended 30 June 2008
2008
$000
2007
$000
Total Income and Expense Recognised Directly in Equity
_________- _________
Result for the Year
_________- _________
Total Income and Expense Recognised for the year
_________- _________
Cash Flow Statement for the Year Ended 30 June 2008
2008
$000
2007
$000
Net Cash Flows from Operating Activities
_________- _________
Net Cash Flows from Investing Activities
_________- _________
Net Cash Flows from Financing Activities
_________- _________
Net Increase/(Decrease) in Cash
_________- _________
Closing Cash and Cash Equivalents
_________- _________
The Royal Alexandra Hospital for Children Special Purpose Service Entity does not hold any cash or cash equivalent assets
and therefore there are nil cash flows.
158
1. Summary of Significant Accounting Policies
a)
The Royal Alexandra Hospital for Children Special Purpose Service Entity
The Royal Alexandra Hospital for Children Special Purpose Service Entity “the Entity”, is a Division of the Government
Service, established pursuant to Part 2 of Schedule 1 to the Public Sector Employment and Management Act 2002
and amendment of the Health Services Act 1997. It is a not-for-profit entity as profit is not its principal objective. It is
consolidated as part of the NSW Total State Sector Accounts. It is domiciled in Australia and its principal office is at
Westmead, New South Wales.
The Entity’s objective is to provide personnel services to the Royal Alexandra Hospital for Children, “the Hospital”.
The Entity commenced operations on 17 March 2006 when it assumed responsibility for the employees and employeerelated liabilities of the Hospital. The assumed liabilities were recognised on 17 March 2006 with an offsetting receivable
representing the related funding due from the former employer.
The financial report was authorised for issue by the Chief Executive Officer on 8 December 2008.
b)
Basis of preparation
This is a general purpose financial report prepared in accordance with the requirements of Australian Accounting
Standards (including Australian Accounting Interpretations), the requirements of the Health Services Act 1997 and
its regulations including observation of the Accounts and Audit Determination for Area Health Services and
Public Hospitals.
Generally, the historical cost basis of accounting has been adopted and the financial report does not take into account
changing money values or current valuations. However, certain provisions are measured at fair value. See note (j).
The accrual basis of accounting has been adopted in the preparation of the financial report, except for cash flow
information.
Management’s judgements, key assumptions and estimates are disclosed in the relevant notes to the financial report.
All amounts are rounded to the nearest one thousand dollars and are expressed in Australian currency.
c)
Comparative Information
Comparative figures are, where appropriate, reclassified to give meaningful comparison with the current year.
159
d)
New Australian Accounting Standards Issued But Not Effective
No new or revised accounting standards or interpretations are adopted earlier than their prescribed date of application.
Set out below are changes to be effected, their date of application and the possible impact on the financial report of the
Royal Alexandra Hospital for Children Special Purpose Service Entity.
Standards/Interpretations
Operative Date
Comment
AASB3, AASB127 &
AASB2008-3, Business
Combinations
1 July 2009
The changes address business combinations and the Australian Accounting
Standards Board has indicated that it is yet to consider its suitability for
combinations among not-for-profit entities.
AASB8 & AASB2007-3,
Operating Segments
1 July 2009
The changes do not apply to not-for-profit entities and have no application
within NSW Health.
AASB101 & AASB2007-8,
Presentation of Financial
Statements
1 July 2009
Health agencies are currently required to present a statement of recognised
income and expense and no variation is expected.
AASB123 & AASB2007-6,
Borrowing Costs
1 July 2009
Borrowing costs that are directly attributable to the acquisition, construction
or production of a qualifying asset form part of the cost of that asset.
As Health Service borrowings are restricted to the Sustainable Energy
Development Authority negligible impact is expected.
AASB1004, Contributions
1 July 2008
The requirements on contributions from AASB27, 29 and 31 have been
relocated, substantially unamended in AASB4.
AASB1049, Whole of
Government and General
Government Sector Financial
Reporting
1 July 2008
The standard aims to provide the harmonisation of Government Finance
Statistics and Generally Accepted Accounting Principles (GAAP) reporting.
The impact of changes will be considered in conjunction with the reporting
requirements of the Financial Reporting Code for Budget Dependent
General Government Sector Agencies.
AASB1050 regarding
administered items
1 July 2008
The requirements of AAS29 have been relocated, substantially unamended
and are not expected to have material effect on Health entities.
AASB1051 regarding land
under roads
1 July 2008
The standard will require the disclosure of “accounting policy for land under
roads”. It is expected that all such assets will need to be recognised “at fair
value”. The standard will have negligible impact on Health entities.
AASB1052 regarding
disaggregated disclosures
1 July 2008
The standard requires disclosure of financial information about Service costs
and achievements. Like other standards not yet effective the requirements
have been relocated from AAS29 largely unamended.
AASB2007-9 regarding
amendments arising from
the review of AAS27, AAS29
and AAS31
1 July 2008
The changes made are aimed at removing the uncertainties that previously
existed over cross references to other Australian Accounting Standards and
the override provisions in AAS29.
AAS2008-1, Share Based
Payments
1 July 2009
The standard will not have application to health entities under the control of
the NSW Department of Health.
AASB2008-2 regarding
puttable financial
instruments
1 July 2009
The standard introduces an exception to the definition of financial liability
to classify as equity instruments certain puttable financial instruments
and certain instruments that impose on an entity an obligation to deliver
to another party a pro-rata share of the net assets of the entity only on
liquidation. Nil impact is anticipated.
Other significant accounting policies used in the preparation of these financial statements are as follows:
e)
Income
Income is measured at the fair value of the consideration received or receivable. Revenue from the rendering of
personnel services is recognised when the service is provided and only to the extent that the associated recoverable
expenses are recognised.
160
f)
Receivables
A receivable is recognised when it is probable that the future cash inflows associated with it will be realised and it has a
value that can be measured reliably. It is derecognised when the contractual or other rights to future cash flows from it
expire or are transferred.
Receivables are non-derivative financial assets with fixed or deteminable payments that are not quoted in an active
market. These financial assets are recognised initially at fair value, usually based on the transaction cost or face value.
Subsequent measurement is at amortised cost using the effective interest method, less an allowance for any impairment
of receivables. Any changes are accounted for in the operating statement when impaired, derecognised or through the
amortisation process.
Short term receivables with no stated interest rate are measured at the original invoice amount where the effect of
discounting is immaterial.
If there is objective evidence at year end that a receivable may not be collectable, its carrying amount is reduced by
means of an allowance for impairment and the resulting loss is recognised in the income statement. Receivables
are monitored during the year and bad debts are written off against the allowance when they are determined to be
irrecoverable. Any other loss or gain arising when a receivable is derecognised is also recognised in the income
statement.
g)
Impairment of Financial Assets
As both receivables and payables are measured at fair value through profit and loss there is no need for annual reviews
for impairment.
h)
De-recognition of Financial Assets and Financial Liabilities
A financial asset is derecognised when the contractual rights to the cash flows from the financial assets expire; or if the
Entity transfers the financial asset:
• where substantially all the risks and rewards have been transferred; or
• where the Entity has not transferred substantially all the risks and rewards, if the Entity has not retained control.
Where the Entity has neither transferred nor retained substantially all the risks and rewards or transferred control, the
asset is recognised to the extent of the Entity’s continuing involvement in the asset.
A financial liability is derecognised when the obligation specified in the contract is discharged or cancelled or expires.
i)
Payables
Payables include accrued wages, salaries and related on-costs (such as payroll deduction liability, payroll tax, fringe
benefits tax and workers’ compensation insurance) where there is certainty as to the amount and timing of settlement.
A payable is recognised when a present obligation arises under a contract or otherwise. It is derecognised when the
obligation expires or is discharged, cancelled or substituted.
Payables are recognised initially at fair value, usually based on the transaction cost or face value. Subsequent
measurement is at amortised cost using the effective interest method. Short term payables with no stated interest rate
are measured at the original invoice amount where the effect of discounting is immaterial. Payables are recognised for
amounts to be paid in the future for goods and services received, whether or not billed to the Entity.
161
j)
Employee Benefit Provisions and Expenses
i)
Salaries and Wages, Annual Leave, Sick Leave and On-Costs
Liabilities for salaries and wages (including non-monetary benefits), annual leave and paid sick leave that fall wholly
within 12 months of the reporting date are recognised and measured in respect of employees’ services up to the
reporting date at undiscounted amounts based on the amounts expected to be paid when the liabilities are settled.
All Annual Leave employee benefits are reported as “Current” as there is an unconditional right to payment. Current
liabilities are then classified as “Short Term” and “Long Term” based on past trends and known resignations and
retirements. Anticipated payments to be made in the next 12 months are reported as “Short Term”. On-costs of
17% are applied to the value of leave payable at 30 June 2008, such on-costs being consistent with actuarial
assessment. (Comparable on-costs for 30 June 2007 were 21.7% which, in addition to the 17% increase, also
included the impact of awards immediately payable from 1 July 2007).
Unused non-vesting sick leave does not give rise to a liability, as it is not considered probable that sick leave taken
in the future will be greater than the benefits accrued in the future.
The outstanding amounts of payroll tax, workers’ compensation insurance premiums and fringe benefits tax, which
are consequential to employment, are recognised as liabilities and expenses where the employee benefits to which
they relate have been recognised.
ii)
Long Service Leave and Superannuation
Long Service Leave employee leave entitlements are dissected as “Current” if there is an unconditional right to
payment and “Non-Current” if the entitlements are conditional. Current entitlements are further dissected between
“Short Term” and “Long Term” on the basis of anticipated payments for the next 12 months. This in turn is based
on past trends and known resignations and retirements.
Long Service Leave provisions are measured on a short hand basis at an escalated rate of 8.1% above the salary
rates immediately payable at 30 June 2008 (comparable on-costs for 30 June 2007 were 8.1%, which included
the impact of awards immediately payable from 1 July 2007) for all employees with five or more years of service.
Actuarial assessment has found that this measurement technique produces results not materially different from the
estimate determined by using the present value basis of measurement.
The Entity’s liability for the closed superannuation pool schemes (State Authorities Superannuation Scheme and
State Superannuation Scheme) is assumed by the Crown Entity. The Entity accounts for the liability as having been
extinguished resulting in the amount assumed being shown as part of the non-monetary revenue item described
as “Acceptance by the Crown Entity of Employee benefits”. Any liability attached to Superannuation Guarantee
Charge cover is reported in Note 3, “Payables”.
The superannuation expense for the financial year is determined by using the formulae specified in the NSW Health
Department Directions. The expense for certain superannuation schemes (i.e. Basic Benefit and Superannuation
Guarantee Charge) is calculated as a percentage of the employees’ salary. For other superannuation schemes
(i.e. State Superannuation Scheme and State Authorities Superannuation Scheme), the expense is calculated as a
multiple of the employees’ superannuation contributions.
162
2.
2008
$000
2007
$000
75,419
71,008
4,326
3,775
79,745
74,783
7,893
7,557
7,893
7,557
PROVISIONS
Current Benefits and Related On-Costs
Annual Leave - Short Term Benefit
Annual Leave - Long Term Benefit
Long Service Leave - Short Term Benefit
Long Service Leave - Long Term Benefit
20,127
10,623
3,677
33,099
20,918
8,352
3,387
30,794
Total Current Provisions
67,526
63,451
4,326
3,775
RECEIVABLES
Current
Accrued Income - Personnel Services Provided
Non-Current
Accrued Income - Personnel Services Provided
Total Receivables
Details regarding credit risk, liquidity risk and market risk are disclosed in Note 5
3.
PAYABLES
Current
Accrued Salaries and Wages and On-Costs
Total Payables
Details regarding credit risk, liquidity risk and market risk are disclosed in Note 5
4.
Non-Current Employee Benefits and Related On-Costs
Long Service Leave - Conditional
Total Non-Current Provisions
Aggregate Benefits and Related On-Costs
Provision - Current
Provision - Non-Current
Accrued Salaries and Wages and On-Costs
4,326
3,775
67,526
4,326
7,893
63,451
3,775
7,557
Total
79,745
74,783
5. Financial Instruments
The Entity’s financial instruments are outlined below. These financial instruments arise directly from the Entity’s operations
or are required to finance its operations. The Entity does not enter into or trade in financial instruments, including derivative
financial instruments for speculative purposes.
The Chief Executive has overall responsibility for the establishment and oversight of risk management and reviews and agrees
policies for managing each of these risks. The Entity carries minimal risks within its operation as it carries only the value
of employee provisions and accrued salaries and wages offset in full by accounts receivable from the Parent Entity. Risk
management policies are established by the Parent Entity to identify and analyse the risk faced by the Entity, to set risk limits
and controls and monitor risks. Compliance with policies is reviewed by the Audit Committee and Internal Auditors of the
Parent Entity on a continous basis.
163
a)
Financial Instruments Categories
Financial Assets
Class:
Receivables *
Note
Category
2
Receivables at
amortised cost
Total carrying amounts as per
the Balance Sheet
2008
2007
$000
$000
Total Financial Assets
Financial Liabilities
Class:
Payables **
3
measured at
amortised cost
Total Financial Liabilities
79,745
74,783
79,745
74,783
7,893
7,557
7,893
7,557
* Excludes statutory receivables and prepayments (ie not within scope of AASB 7)
** Excludes unearned revenue (ie not within scope of AASB 7)
b)
Credit Risk
Credit risk arises when there is the possibility of the Entity’s debtors defaulting on their contractual obligations, resulting
in a financial loss to the Entity. The maximum exposure to credit risk is generally represented by the carrying amount of
the financial assets (net of any allowance for impairment).
Credit risk arises from financial assets of the Entity i.e receivables. No collateral is held by the Entity nor has it granted
any financial guarantees.
Receivables - trade debtors
Receivables are restricted to accrued income for personnel services provided and employee leave provisions and are
recognised as amounts receivable at balance date. The parent entity of the Royal Alexandra Hospital for Children Special
Purpose Service Entity is the sole debtor of the Entity and it is assessed that there is no risk of default. No accounts
receivables are classified as “Past Due but not Impaired” or “Considered Impaired”.
c)
Liquidity Risk
Liquidity risk is the risk that the Entity will be unable to meet its payment obligations when they fall due. No such risk
exists with the Entity not having any cash flows. All movements that occur in Payables are fully offest by an increase in
Receivables from the Royal Alexandra Hospital for Children, the parent entity.
d)
Market Risk
Market risk is the risk that the fair value or future cash flows of a financial instrument will fluctuate because of changes
in market prices. The Entity’s exposures to market risk are considered to be minimal and the Entity has no exposure to
foreign currency risk and does not enter into commodity contracts.
Interest rate risk
Exposure to interest rate risk arises primarily through interest bearing liabilities.
However the Entity has no such liabilities and the interest rate risk is assessed as Nil. Similarly it is considered that the
Entity is not exposed to other price risks.
164
e)
Fair Value
Financial instruments are generally recognised at cost.
The amortised cost of financial instruments recognised in the balance sheet approximates fair value because of the short
term nature of the financial instruments.
6. Related Parties
The Royal Alexandra Hospital for Children is deemed to control the Royal Alexandra Hospital for Children Special Purpose
Service Entity in accordance with Australian Accounting Standards. The controlling entity is incorporated under the Health
Services Act 1997.
Transactions and balances in this financial report relate only to the Entity’s function as provider of personnel services to the
controlling entity. The Entity’s total income is sourced from the Royal Alexandra Hospital for Children. Cash receipts and
payments are effected by the Royal Alexandra Hospital for Children on the Entity’s behalf.
7. Post Balance Date Events
No post balance date events have occurred which warrant inclusion in this report.
END OF AUDITED FINANCIAL STATEMENTS
165
Hours of operation
•
•
The Emergency Department of The Children’s Hospital at Westmead is open 24 hours a day.
Outpatients Clinics are open from 8am to 5pm, Monday to Friday.
Cnr Hawkesbury Road and
Hainsworth Street, Westmead
Locked Bag 4001
Westmead NSW 2145
Telephone: (02) 9845 0000
Fax: (02) 9845 3489
Website: www.chw.edu.au
Annual report available: http://www.chw.edu.au/about/corporate/#annual_report
Copyright 2009 The Children’s Hospital at Westmead
150 copies of this report were printed at a total cost of $2776.00
166
Our cover boy is seven-year-old Charlie Munns. Charlie is
an intelligent, caring and courageous boy who, when this
photo was taken, was suffering from liver failure and was
severely jaundiced, desperately needing a liver transplant.
In November 2008, Charlie’s Mum, Julie-Anne, donated
part of her own liver to Charlie in a risky operation for them
both. Today Charlie is a thriving young boy who is feeling
much better and has the sparkle back in his blue eyes.
The Children’s Hospital at Westmead
Corner Hawkesbury Road and Hainsworth Street
Locked Bag 4001 Westmead NSW 2145
Tel: (02) 9845 0000 Visit: www.chw.edu.au
Charlie is now enjoying being home and playing with
his dog and his cat, as well as reading and inventing
electronic gadgets.
Reﬂecting on his time at The Children’s Hospital at
Westmead, Charlie says, “Thank you for caring for me when
I’m sick. I have many friends here who are special to me.”

Download: PDF - OpenGov NSW

Transcription

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