New South Wales report, May 2017

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In this report

This report includes the following tables:

This report is issued by the Administrator of the National Health Funding Pool under section 240 of the National Health Reform Act 2011.

This report is prepared on a cash basis. It shows monthly and year-to-date (YTD) National Health Reform (NHR) funding and payments for New South Wales for May 2017 as part of the National Health Reform Agreement.

Local hospital networks and National Health Reform

A local hospital network (LHN) is an organisation that provides public hospital services in accordance with the Agreement. An LHN can contain one or more hospitals, and is usually defined as a business group, geographical area or community. Every Australian public hospital is part of an LHN.

Note: The term ‘local hospital network’ is a national term. Some states and territories use their own terminology to describe these networks, such as local health districts, health organisations, and hospital and health services.

Under the Agreement, LHNs receive funding for the following public hospital services:

  • All admitted and non-admitted services
  • All emergency department services provided by a recognised emergency department
  • Other outpatient, mental health, sub-acute services and other services that could reasonably be considered a public hospital service.

Note: LHNs also receive funding from other sources, including the Commonwealth, states and territories, and third parties for the provision of other specific functions and services outside the scope of the Agreement, for example dental services, primary care, home and community care, residential aged care and pharmaceuticals. For further information on total funding to a particular LHN, contact the NSW Ministry of Health to view the service agreement for that LHN.

Basis for National Health Reform payments – New South Wales, May 2017

For the basis of the Commonwealth contribution to NHR funding, see Basis of Commonwealth NHR funding, 2016-17.

The basis for NHR payments to local hospital networks (LHNs) in New South Wales was advised by the NSW Ministry of Health to be as follows:

Basis used to determine NHR payments to Local Health Networks (LHNs) – New South Wales

The process for determining 2016/17 NHR payments to LHNs encompassed three distinct elements of preparation for the individual LHN Service Agreements, including development of annual activity estimates, discussion/negotiation of activity levels with individual LHNs, and total state-wide activity across each activity type.

Consistent with last year’s methodology and pursuant with the National Health Reform Agreement (NHRA), the Ministry of Health has adopted the National Weighted Activity Unit (NWAU) as the currency for Activity Based Funding with the applicable version being NWAU16, which is different from the previous year.

The Independent Hospital Pricing Authority (IHPA) has issued the National Efficient Cost (NEC16) funding model that applies to small regional and remote hospitals. NSW has adopted the mechanics of this funding model expressed in the NEC16 matrix to determine the aggregate funding allocation to LHNs for these small hospitals within the NSW funding model parameters.

Ensuring access to health services for local populations is a key objective of NSW health policy. The Health Services Act 1997 stipulates that in determining LHN budgets, the Minister have regard to the size and health needs of the local population and provision of services to residents outside the local area. Accordingly, targets are adjusted considering factors appropriate to each LHN and service type, rather than simple extrapolation from historical activity data. The factors considered are reviewed on an annual basis.

In 2016/17, a series of elements will be applied to each in-scope service stream to ensure that activity targets are tailored to the requirements and patterns of each LHD/SHN. Activity targets are developed by the Ministry and LHDs/SHNs based on analysis of activity level drivers. This analysis was informed for 2016/17 by the following factors:

  • Weighted population change: providing an indication of expected 'natural' growth
  • Recent trends in activity growth for each LHD/SH
  • Rate of unplanned re-admissions within 28 days
  • Potentially preventable hospitalisations (PPH)
  • Relative Utilisation Rate adjusted for relevant demographic factors
  • Service quality and appropriateness performance in selected key area
  • Inter-district and cross-border flows (where relevant)
  • Current year activity relative to targets (for adjustment of baseline volumes, where relevant)
  • Known service changes and developments, including planned capacity increases.

Price weight adjustments which are being applied in 2016/17 include:

  • Paediatric Adjustment;
  • Specialist Psychiatric Age Adjustment;
  • Patient Remoteness Area Adjustment;
  • Indigenous Adjustment;
  • Radiotherapy Adjustment;
  • Dialysis Adjustment;
  • Intensive Care Unit (ICU) Adjustment for eligible facilities;
  • Private Patient Service Adjustment;
  • Private Patient Accommodation Adjustment;
  • Multidisciplinary Clinic Adjustment;
  • Emergency Care Age Adjustment.

Provisional activity estimates are created at a LHD level to provide the basis for discussion and negotiation with individual health services to determine agreed LHD level activity targets, with the activity volumes measured using the NWAU for each Service Category. Additionally, where applicable, activity estimation is split by financial class to allow differential funding mechanisms to be applied to the respective service groups to reflect the variation in funding source.

Provisional estimates and historical activity measures provide the basis for discussions with individual LHDs and subsequent negotiations for approval or adjustment.

The negotiation process allows for relevant local LHN service issues and activity impacts to be communicated with the NSW Ministry of Health (Ministry) to assess the potential impact on future year activity volumes and the relevance of related service strategies to address these. It is important that negotiation processes recognise that funding and purchasing are undertaken in the environment of a capped State / Commonwealth funding pool for 2016/17 and recognition that NSW contributes the larger portion of these funds as well as being responsible for management of the system as a whole. When negotiations have concluded, the Ministry incorporates the final activity targets in each LHN’s annual Service Agreement. Where an LHN achieves delivery of selected services through Affiliated Health Organisations or contracted services with a private provider these arrangements are to be specified in agreements between the LHN and the respective provider. Both the funding (and subsidy) and associated activity pertaining to such providers are included in the budget and the activity estimates appearing in the LHN’s annual Service Agreement.

Cash payments processed within the National Health Funding Pool (NHFP) Payments System and included within the Administrator’s monthly reports are based on the accrued budget for both ABF and in-scope block funding derived from the LHN Service Agreements after deducting an allowance to recognise own sourced revenue earned, and retained by the LHNs and liabilities for superannuation and long service leave which are accepted by the Crown.

The resultant cash value is processed through the state pool account (ABF) or the state managed fund (in-scope block). Although a consistent methodology has been applied, variations in cash prices between LHNs reflect the differing mix of the above components (own sourced revenue and Crown accepted liabilities) of each local hospital network’s accrued cost.

In addition to receiving weekly cash payments from the state pool account and the state managed fund, LHNs also receive direct State Government funding for 2016/17 for all “out of scope” services not subject to the National Health Reform Agreement arrangements as required under their 2016/17 Service Agreements.

Monthly reports– Basis on which payments were made

For NSW, all dollar values included in the tables issued by the Administrator are cash payments from either the NSW state pool account to LHNs and or cash payments from the state managed fund to LHNs. This includes cash payment to the Victorian Department of Health for Albury-Wodonga inter-jurisdictional agreement.

The weekly cash payment to an LHN reflects the estimated cost of patient related services anticipated to be delivered during the monthly cash payment period. The estimated monthly activity and the weekly cash payments are determined based on the annual LHN Service Agreements.

Cash payments from the NSW state pool account and from the state managed fund to LHNs are processed each Tuesday. Reporting by the Administrator is based on cash payments made during a given month and is therefore dependent on the number of Tuesdays in a particular month. During 2016/17, August 2016, November 2016, January 2017 and May 2017 each have five Tuesdays. If accrual accounting principles were being applied within the NHFA Payments System, the value of the reported cash payments would recognise only the number of calendar days in a particular month, not the 35 days (five weeks paid) or 28 days (four weeks paid), as reported by the Administrator.

In 2016/17 cash payments to LHNs from the NSW state pool account are generally calculated based on equal weekly instalments to health services unless otherwise negotiated.

State Managed Fund cash payments occur as cash is required and dependent on the LHD bank balance in accordance with NSW Treasury Circular TC15-01 Cash Management – expanding the Scope of the Treasury Banking System. As a result not all of the Commonwealth funding was paid to LHNs. The residual of $6.2M Commonwealth will be paid in August 2016.

Other payments will occur in 2016/17 that are outside the regular weekly (Tuesday) payment cycle for payments to other States/Territories for NSW residents treated in their public hospitals. Payments to LHNs may also vary where their cash entitlement alters during the financial year.

Monthly comparison of cash payments from the NSW state pool and state managed fund can vary month to month predominately due to these planned payments and cash requirements of an LHN.

The cash payments from the NSW state pool account or state managed fund do not reflect the full budgeted funding available to health services in NSW. Other sources of funds available to LHNs include separate payments from the Crown (for example, defined superannuation scheme and long service leave cash recovery) as well as own sourced revenues earned and retained by each LHN.

In the months of August 2016 to October 2016 NSW continued to pay its estimated cashflowed amount into the NHFP despite the increase in the Commonwealth contribution for those months. This resulted in an accumulated amount of $69M for the State contribution that was remaining in the account as at 31 October 2016. $30M of the accumulated State deposit was subsequently paid out to LHN’s in the first week of November 2016. The remaining $39M was initially required to be paid out by June 2017. Based on latest advice from the NHFB, this will need to remain in the account until advised. This will be a source of funds in 2017/18 to cover the liability to the NHFB for final reconciled 2015/16 activity.

The April and May interest amounts of $136,863 and $201,872 also remain in the account for distribution in June 2017.

In respect to LHN payments Far West LHN inadvertently received $2.1M more through the NHFP than was anticipated due to a technical issue with the subsidy calculation sheet. To negate the cash impact to the LHN the payments made from the Ministry’s operating account to the LHN have been reduced by that amount. Therefore resulting in the LHN only receiving for the 2016/17 year their approved cash allocation.

For more information on budget allocations, see the 2016/17 LHN Service Agreements which are available on each NSW LHN website as the Chief Executive and Board of the LHN’s provide sign off.

Reference information

The financial information outlined in the following report is categorised as:

  • NHR funding – when the Commonwealth or state or territory government pays NHR funding into a state pool account or state managed fund.
  • NHR payments – when NHR funding that has been deposited into a state pool account or state managed fund is paid out of the state pool account by the Administrator, or is paid out of the state managed fund by the state or territory.

State pool account transactions

Table 1a – State pool account transactions – New South Wales, May 2017

This table shows funding paid into the New South Wales state pool account by the Commonwealth, New South Wales or other states/territories, and payments out of the state pool account to LHNs, the state managed fund, the NSW Ministry of Health or the state pool accounts of other states/territories for May 2017.

NHR funding by source Paid into state pool account Paid out of state pool account
To Local hospital networks To State
Managed Fund
To state
health department
To state pool (other State) Total paid out
($) ($) ($) ($) ($) ($)
Commonwealth
ABF funding
408,779,967 408,779,967 408,779,967
Commonwealth
Block funding
58,943,761 58,943,761 58,943,761
Commonwealth
Other funding
9,839,473 9,839,473 9,839,473
Total C'wealth
funding
477,563,200 408,779,967 58,943,761 9,839,473 477,563,200
NSW
funding
573,260,504 557,058,632 0 16,000,000 573,058,632
Other state/territory funding 5,200,000 0 5,200,000 5,200,000
Total 1,056,023,705 965,838,599 58,943,761 15,039,473 16,000,000 1,055,821,833

See definitions and explanatory notes following table 1b.

Table 1b – State pool account transactions YTD – New South Wales, May 2017

Following on from table 1a, this table shows year-to-date (YTD) funding paid into the New South Wales state pool account by the Commonwealth, New South Wales or other states/territories, and payments out of the state pool account to LHNs, the state managed fund, the NSW Ministry of Health or the state pool accounts of other states/territories as at May 2017.

NHR funding by source Paid into state
pool account
Paid out of state pool account
To Local hospital
networks
YTD
To State
Managed Fund
YTD
To state health
department
YTD
To state pool (other State)
YTD
Total paid out
YTD
($) ($) ($) ($) ($) ($)
Commonwealth
ABF funding
4,532,077,774 4,532,077,774 4,532,077,774
Commonwealth
Block funding
612,831,536 612,831,536 612,831,536
Commonwealth
Other funding
108,881,475 108,881,475 108,881,475
Total C'wealth
funding
5,253,790,785 4,532,077,774 612,831,536 108,881,475 5,253,790,785
NSW
funding
5,569,038,700 5,340,485,532 1,388,432 187,826,000 5,529,699,964
Other state/territory funding 64,864,000 0 64,864,000 64,864,000
Total 10,887,693,485 9,872,563,307 612,831,536 175,133,907 187,826,000 10,848,354,749

Commonwealth ABF funding represents Acute admitted, Non-admitted, Emergency department, Sub-acute, and Admitted mental health service categories, which are funded by the Commonwealth through the state pool account and subsequently paid to LHNs.

Commonwealth Block funding represents Non-admitted mental health, Small rural hospitals, Teaching, training & research, and Other non-admitted categories, which are funded by the Commonwealth and paid to the state managed fund.

Commonwealth Other funding represents other amounts funded by the Commonwealth, transacted through the state pool account and subsequently paid to state or territory health departments. This currently represents the Commonwealth contribution to public health.

NSW funding represents funding contributions paid by New South Wales into its own state pool account, and subsequently paid to LHNs within the state, to the New South Wales health department and/or to other state pool accounts.

Other state/territory funding represents contributions paid to New South Wales by other states and territories for cross-border activity.

Note: The grey shaded areas in these tables reflect cells that are not applicable for a particular 'paid out' column. For example, Commonwealth block funding is only paid to state managed funds and not to local hospital networks or state or territory health departments.

NHR funding and payments shown in these tables include GST where applicable.

For more information, see National Health Reform funding and payments.

State managed fund transactions

Table 2a – State managed fund transactions – New South Wales, May 2017

This table shows funding paid into the New South Wales state managed fund by the Commonwealth and New South Wales, and payments out of the state managed fund to LHNs and other provider organisations for May 2017.

NHR funding by source Paid into state managed fund Paid out of state managed fund
To local hospital networks To Other Total paid out
($) ($) ($) ($)
Commonwealth Block funding 58,943,761 58,943,761
State/territory Block funding 93,395,153 93,395,153
Total 152,338,914 152,338,914 0 152,338,914

See explanatory notes following table 2b.

Table 2b – State managed fund transactions YTD – New South Wales, May 2017

Following on from table 2a, this table shows year-to-date (YTD) funding paid into the New South Wales state managed fund by the Commonwealth and New South Wales, and YTD payments out of the state managed fund to LHNs and other provider organisations as at May 2017.

NHR funding by source Paid into state
managed fund
YTD
Paid out of state managed fund YTD
To local hospital
networks
YTD
To Other
YTD
Total paid out
YTD
($) ($) ($) ($)
Commonwealth Block funding 612,831,536 612,831,536
State/territory Block funding 815,861,923 815,861,923
Total 1,428,693,459 1,428,693,459 0 1,428,693,459

Block funding represents Non-admitted mental health, Small rural hospitals, Teaching, training & research, and Other non-admitted categories.

Commonwealth Block funding represents Commonwealth block funding contributions paid into the state managed fund from the state pool account, and block payments out of the state managed fund to LHNs and other provider organisations.

State/territory Block funding represents New South Wales block funding contributions into the state managed fund, and block payments out of the state managed fund to LHNs and other provider organisations.

Note: The grey shaded areas in these tables reflect that these block payments cannot at this stage be identified by source of funding (state, territory or Commonwealth contribution).

NHR funding and payments shown in these tables include GST where applicable.

For more, see National Health Reform funding and payments.

NHR funding and payments by service category

Table 3 – NHR funding and payments by service category – New South Wales, May 2017

This table shows NHR funding and payments by service category on both a monthly and year-to-date (YTD) basis for New South Wales for May 2017. NHR funding and payments are separated into the following service categories – activity-based funding (ABF), block funding, and other funding.

Service category NHR
funding
NHR
payments
NHR
funding YTD
NHR
payments YTD
($) ($) ($) ($)
ABF
Acute admitted 562,743,295 562,743,295 5,753,656,467 5,753,656,467
Admitted mental health 52,323,846 52,323,846 533,268,727 533,268,727
Sub-acute 64,668,771 64,668,771 663,427,323 663,427,323
Emergency department 116,180,453 116,180,453 1,191,383,783 1,191,383,783
Non-admitted 169,922,234 169,922,234 1,730,827,007 1,730,827,007
Total ABF (Pool) 965,838,599 965,838,599 9,872,563,307 9,872,563,307
Block
Small rural hospitals 71,709,174 71,709,174 728,677,120 728,677,120
Teaching, training & research 35,125,852 35,125,852 330,823,655 330,823,655
Non-admitted mental health 45,503,888 45,503,888 369,192,683 369,192,683
Other non-admitted services 0 0 0 0
Total Block (SMF) 152,338,914 152,338,914 1,428,693,459 1,428,693,459
Other
Public health funding 9,839,473 9,839,473 108,881,475 108,881,475
Overdeposit 0 0 0 0
Cross-border 21,200,000 21,200,000 252,690,000 252,690,000
Interest 201,872 0 1,727,167 1,388,432
Total Other (Pool) 31,241,345 31,039,473 363,298,642 362,959,907
Grand Total 1,149,418,858 1,149,216,986 11,664,555,407 11,664,216,672

Total ABF (Pool) is an aggregate of both Commonwealth and state or territory NHR funding and payments for activity-based funding (ABF) which is transacted through the state pool account.

Total Block (SMF) is an aggregate of both Commonwealth and state or territory NHR funding and payments for block funding which is transacted through the state managed fund (SMF).

Total Other (Pool) represents other funding and payments transacted through the state pool account, including public health funding, overdeposits, cross-border funding and payments, and interest.

State and territory cross-border payments can either be:

  • Paid to the relevant state or territory's LHNs - included within ABF and/or block payments in the above table, or
  • Reimbursed to the relevant state or territory where the state or territory's LHNs are already being funded for the cost of treating cross-border patients - shown in the Cross-border row under Other in the above table.

NHR funding and payments shown in these tables include GST where applicable.

For more information, see National Health Reform funding and payments.

NHR contributions by local hospital network

Table 4a – NHR contributions by local hospital network – New South Wales, May 2017

This table shows NHR contributions (from state, territory and Commonwealth sources) made to each LHN in New South Wales during May 2017.

NHR contributions to LHNs are separated into an activity-based funding (ABF) component and a block component.

Local hospital network (LHN) ABF component
(ex GST)
Block component
(ex GST)
Total NHR payment
(ex GST)
($) ($) ($)
Albury NSW Local Health District 3,053,493 989,341 4,042,834
Central Coast Local Health District 49,759,210 4,577,524 54,336,734
Contracted Services 784,141 784,141
Far West Local Health District 5,020,888 852,562 5,873,450
Hunter New England Local Health District 118,266,238 33,547,744 151,813,982
Illawarra Shoalhaven Local Health District 47,487,995 1,500,000 48,987,995
Justice Health & Forensic Mental Health Network 0 3,502,464 3,502,464
Mid North Coast Local Health District 33,211,967 7,913,120 41,125,087
Murrumbidgee Local Health District 19,340,263 2,310,812 21,651,075
Nepean Blue Mountains Local Health District 48,632,416 35,710 48,668,126
Northern NSW Local Health District 43,032,421 7,618,816 50,651,237
Northern Sydney Local Health District 79,397,872 15,887,569 95,285,441
South Eastern Sydney Local Health District 96,976,636 4,700,000 101,676,636
South Western Sydney Local Health District 114,396,460 13,460,632 127,857,092
Southern NSW Local Health District 21,034,672 4,520,511 25,555,183
St Vincent's Health Network 24,876,056 1,892,000 26,768,056
Sydney Children's Hospitals Network 34,987,238 1,033,419 36,020,657
Sydney Local Health District 90,215,457 19,453,425 109,668,882
Western NSW Local Health District 36,787,320 28,243,265 65,030,585
Western Sydney Local Health District 98,577,859 300,000 98,877,859
Total 965,838,599 152,338,914 1,118,177,513

See explanatory notes below table 4b.

Table 4b – NHR contributions by local hospital network YTD – New South Wales, May 2017

This table shows YTD NHR contributions (from state, territory and Commonwealth sources) made to each LHN in New South Wales as at May 2017.

NHR contributions to LHNs are separated into an activity-based funding (ABF) component and a block component.

Local hospital network ABF component YTD
(ex GST)
Block component YTD
(ex GST)
Total NHR payment YTD
(ex GST)
($) ($) ($)
Albury NSW Local Health District 38,184,530 10,882,751 49,067,281
Central Coast Local Health District 491,643,772 35,104,726 526,748,498
Contracted Services 4,148,494 4,148,494
Far West Local Health District 53,507,906 22,202,550 75,710,456
Hunter New England Local Health District 1,142,133,154 235,144,545 1,377,277,699
Illawarra Shoalhaven Local Health District 541,390,539 71,446,197 612,836,736
Justice Health & Forensic Mental Health Network 0 57,990,575 57,990,575
Mid North Coast Local Health District 362,080,791 39,191,253 401,272,044
Murrumbidgee Local Health District 226,084,228 148,084,105 374,168,333
Nepean Blue Mountains Local Health District 502,720,948 40,430,515 543,151,463
Northern NSW Local Health District 458,547,869 40,453,877 499,001,746
Northern Sydney Local Health District 801,769,758 110,442,179 912,211,937
South Eastern Sydney Local Health District 957,166,231 78,521,376 1,035,687,607
South Western Sydney Local Health District 1,107,158,688 66,023,591 1,173,182,279
Southern NSW Local Health District 224,222,103 50,434,694 274,656,797
St Vincent's Health Network 232,884,088 17,431,000 250,315,088
Sydney Children's Hospitals Network 396,191,766 31,896,278 428,088,044
Sydney Local Health District 894,531,783 125,869,660 1,020,401,443
Western NSW Local Health District 403,293,339 153,873,590 557,166,929
Western Sydney Local Health District 1,034,903,317 93,269,997 1,128,173,314
Total 9,872,563,307 1,428,693,459 11,301,256,765

NHR contributions in this table are GST exclusive to enable comparability of NHR payments in each LHN report.

Note: This table excludes GST.
The majority of government funding to LHNs is not subject to GST. However in some cases hospital funding to non-government entities does attract GST, for example, denominational hospitals, privately and commercially owned health facilities, or any other non-government third party provider of health services or related supplies.

For more information, see National Health Reform funding and payments.

Estimated monthly, YTD and annual activity

States and territories provide service volume estimates at the start of each financial year, and if required, can continue to refine these estimates during the course of the year. These estimates form the basis of monthly reporting of service volumes until actual service numbers become available. These estimates are expressed as National Weighted Activity Units (NWAU).

States and territories provide estimated annual NWAU to the Administrator as a basis for determining the Commonwealth activity-based funding. Current month NWAU estimates accumulate through the year-to-date (YTD) NWAU, to be equal to the annual NWAU at the end of the financial year.

States and territories may also provide activity information relating to the delivery of other public hospital functions funded.

Table 5 – Estimated monthly, YTD and annual NWAU by local hospital network – New South Wales, May 2017

This table shows estimated state or territory hospital activity for activity-based funding services expressed as NWAU for May 2017, the associated cumulative year-to-date (YTD), and total estimated annual NWAU for each LHN in New South Wales.

Local hospital network (LHN) Estimated NWAU delivered in current month Estimated NWAU delivered YTD Estimated annual NWAU 2016-17
Albury NSW Local Health District 1,608 17,684 19,911
Central Coast Local Health District 9,777 107,551 117,328
Contracted Services 338 3,713 4,050
Far West Local Health District 864 9,505 10,369
Hunter New England Local Health District 25,369 279,061 304,430
Illawarra Shoalhaven Local Health District 11,427 125,695 137,121
Mid North Coast Local Health District 7,963 87,591 95,554
Murrumbidgee Local Health District 4,700 51,702 56,402
Nepean Blue Mountains Local Health District 10,406 114,467 124,874
Northern NSW Local Health District 9,861 108,471 118,332
Northern Sydney Local Health District 16,929 186,221 203,150
South Eastern Sydney Local Health District 22,023 242,254 264,277
South Western Sydney Local Health District 23,528 258,813 282,342
Southern NSW Local Health District 4,546 50,002 54,547
St Vincent's Health Network 6,142 67,560 73,702
Sydney Children's Hospitals Network 8,251 90,757 99,008
Sydney Local Health District 20,288 223,173 243,462
Western NSW Local Health District 8,298 91,282 99,580
Western Sydney Local Health District 23,031 253,343 276,374
Total 215,350 2,368,845 2,584,814

An NWAU is a measure of health service activity expressed as a common unit. It provides a way of comparing and valuing each public hospital service, whether they are admissions, emergency department presentations or outpatient episodes, by weighting them for their clinical complexity. The average hospital service is worth one NWAU - the most intensive and expensive activities are worth multiple NWAU, the simplest and least expensive are worth fractions of an NWAU.

Monthly NHR payments relate to the cash needs of public hospitals and do not necessarily reflect the volume of services to be delivered in the month.

For more information on the NWAU calculation, see Calculation of NWAU.