Department of Health Financial Statements ... 71

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www.health.nt.gov.au

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TEHS Financial StatementsDoH Financial StatementsCentral Australia Health ServiceTop End Health ServiceCAHS Financial StatementsDepartment of Health

www.health.nt.gov.au Chief Executive Officer (Acting) Postal Address:

PO Box 40596 CASUARINA NT 0811

The Honourable Natasha Fyles MLA Minister for Health

Parliament House DARWIN NT 0800 Dear Minister

RE: 2015-16 Department of Health Annual Report

I am pleased to present you with the 2015-16 Annual Report for the Department of Health. The report has been prepared in accordance with the provisions of section 28 of the Public Sector Employment and Management Act and section 12 of the Financial Management Act, for presentation to the Northern Territory Legislative Assembly.

The report provides information about the Northern Territory public health system and includes financial and non-financial reports for the:

 Department of Health

 Top End Health Service

 Central Australia Health Service

Pursuant to my responsibilities as an Accountable Officer under the Public Sector Employment and Management Act, the Financial Management Act and the Information Act, I advise that to the best of my knowledge and belief:

a) proper records of all transactions affecting the agency and its employees were kept and all employees under my control observe the provisions of the Public Sector Employment and Management Act, the Financial Management Act, the Financial Management Regulations and the Treasurer’s Directions b) procedures within the agency afford proper internal control, and a current description of such

procedures is recorded in the Department’s Accounting and Property Manual, which has been prepared and updated in accordance with the Financial Management Act

c) there is no indication of fraud, malpractice, major breaches of legislation or delegation, major error in, or omission from, the accounts and records

d) in accordance with the requirements of section 15 of the Financial Management Act, the internal audit capacity available to the agency was adequate and the results of all internal audits were reported to the Audit Committee and the Chief Executive

e) the financial statements included in this annual report have been prepared from proper accounts and records and are in accordance with the Treasurer’s Directions

f) all Employment Instructions issued by the Commissioner for Public Employment have been satisfied g) all public sector principles have been upheld and no significant failures to uphold them have occurred.

Yours sincerely

Janet Anderson PSM 27 September 2016

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epartment of HealthTEHS Financial StatementsDoH Financial StatementsCentral Australia Health ServiceTop End Health ServiceCAHS Financial Statements

The Department of Health Annual Report 2015-16 provides detailed information about the Northern Territory (NT) Health System and its financial and non-financial performance for the 2015-16 year.

It includes reports for the:

• Department of Health

• Top End Health Service

• Central Australia Health Service

All three entities report against their strategic plans and agreed budget program outputs with their associated key performance indicators.

Pursuant to section 28 of the Public Sector Employment and Management Act and section 12 of the Financial Management Act, the report has been prepared for the Minister of Health to submit to the NT Legislative Assembly. It has also been prepared to provide information to other stakeholders about the primary functions of the Department, the performance of the NT Health System and to report significant activities undertaken during the year. Other stakeholders include the healthcare industry, the community, other government agencies and employees.

Throughout this report the terms NT Health and NT Health System are used to describe the public health system in the Northern Territory and are inclusive of the Department of Health, Top End and Central Australia Health Services.

Under the current Administrative Arrangements the Department of Health has responsibility for administering 32 pieces of legislation, 23 Acts and nine Regulations. This legislation is listed in Appendix A.

Acknowledgement to traditional owners

The Department of Health respectfully acknowledges the traditional owners and custodians of the

lands and seas on which we work. We show our recognition and respect for Aboriginal people, their culture, traditions and heritage by working towards improving Aboriginal health and wellbeing.

Throughout this report the term Aboriginal should be taken to include Torres Strait Islander people.

Publishing/Copyright and Contact

Published by the Northern Territory Department of Health

CASUARINA NT 0811

Telephone + 61 8 8999 2400 Fax +61 8 8999 2700

For more information or electronic versions of this document, visit the Department of Health website: www.health.nt.gov.au This work is copyright. Apart from any use permitted under the Copyright Act, no part of this document may be reproduced without prior written permission from the Northern Territory Government through the Department of Health.

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Department of HealthTEHS Financial StatementsDoH Financial StatementsCentral Australia Health ServiceTop End Health ServiceCAHS Financial Statements

Letter to the Minister ... iii

Purpose of report ... iv

Introduction ... 1

Chief Executive Officer’s Report ... 2

Chief Health Officer’s Report ... 5

Chief Nursing and Midwifery Officer’s Report ... 6

Chief Psychiatrist's Report ... 9

Delivering health in the NT context ... 10

NT Health Snapshot ... 16

Northern Territory Health System ... 18

Our leaders ... 20

Department of Health ... 23

Overview of the Department ... 24

NT Health Strategic Plan ... 26

NT Health 2015-16 Highlights ... 27

Priorities for 2016-17 ... 32

Corporate governance ... 34

Clinical governance ... 39

Our people ... 41

Outputs and performance ... 48

Performance achievements and outcomes ... 56

Department of Health Financial Statements ... 71

Top End Health Service ... 123

Foreword - Board Chair ... 124

The year in review – Chief Operating Officer ... 125

Role and function ... 126

Highlights 2015-16 ... 127

Strategic priorities 2016-17 ... 129

Our leaders ... 130

Health Service structure ... 133

Our people ... 141

Performance, achievements and outcomes ... 148

Top End Health Service Financial Statements ... 151

Central Australia Health Service ... 201

The year in review - Board Chair and Chief Operating Officer ... 202

Role and function ... 204

Highlights 2015-16 ... 205

Strategic priorities 2016-17 ... 208

Our leaders ... 209

Health Service structure ... 215

Our people ... 221

Performance, achievements and outcomes ... 227

Central Australia Health Service Financial Statements ... 233

Appendices ... 283

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Introduction

Chief Executive Officer’s Report ... 2

Chief Health Officer’s Report ... 5

Chief Nursing and Midwifery Officer’s Report ... 6

Chief Psychiatrist's Report ... 9

Delivering health in the NT context ... 10

NT Health Snapshot ... 16

Northern Territory Health System ... 18

Our leaders ... 20

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Professor Len Notaras AM

Having spent over two years in the role of Chief Executive of the Department of Health I have been fortunate enough to have been party to what could reasonably be described as some of the most significant and exciting changes ever to occur in Territory health.

We have, of course, seen the establishment of two new health services, the Top End Health Service (TEHS) and the Central Australia Health Service (CAHS), which sit alongside the Department of Health. It is now two years since the Health Service Act 2014 brought both the Services into existence.

It is highly encouraging to note the pace with which the two services have continued to evolve.

Recently, I had the privilege of signing the 2016-17 Service Delivery Agreements (SDA) between the Department, as the System Manager, and the Chairs of both the TEHS and CAHS Boards. The SDAs detail the services that the Health Services will deliver, the funding for those services and the agreed performance measures.

There is no doubt the seamless transition of almost all services from the Department to the new entities has played a significant part in the establishment of what are already two extremely robust health services.

I would like to thank Michael Kalimnios (Chief Operating Officer, TEHS), Sue Korner (Chief Operating Officer, CAHS) and their respective leadership teams, for their strong collaborative efforts over the last 12 months.

It isn’t, however, just the development of the new Health Services that has made the last 12 months so exciting. One of the truly forward looking initiatives currently occurring is the construction of the 116- bed Palmerston Regional Hospital. Work is now well advanced on the $150 million project. Once fully operational in 2018, the Palmerston Regional Hospital will significantly reduce pressure on waiting times at Royal Darwin Hospital. It will also mean the people of Palmerston and Darwin’s rural area will enjoy more timely access to hospital treatment.

From our perspective we are concentrating on the commissioning phase of the new hospital to ensure that everything – including the staffing and equipment – is in place and ready for the first patients in 2018.

While work continues on this major initiative, the

$64 million upgrade of Royal Darwin Hospital (RDH) has now passed the half-way mark.

Once completed the upgrade will see enhanced paediatrics facilities, new out-patients and pre- admission services and a relocated allied health unit along with a new front entrance and lobby.

RDH is not the only Territory hospital being upgraded. Both Alice Springs Hospital (ASH) and Gove District Hospital (GDH) will benefit from major enhancement works funded in part by the Australian Government. GDH will receive a

$10.7 million Emergency Department upgrade and ASH a $5.3m clinical services building.

Over and above the work occurring in our urban centres there is also plenty of activity in health facilities in the more remote corners of the Territory. The NT is currently managing $50 million in Federal funding for the construction of seven new remote health centres and the upgrading of three existing clinics.

We are currently moving towards a sweeping change on the information technology (IT) front with the development and implementation of a five year,

$186 million program to replace our core clinical systems across the Northern Territory. This will be the largest ICT reform ever undertaken within the Northern Territory public sector. The Core Clinical Systems Renewal Program (CCSRP) will transform our service provision across the Territory allowing access to critical clinical information

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at the point of service. The CCSRP will replace four existing and ageing clinical information systems with a single end-to-end information system. It will make the Territory the first jurisdiction in Australia where public health clinicians will be able to electronically access client records regardless of their geographic location.

In my role as Community Champion for the

communities of Ramingining and Millingimbi I visited these two communities and witnessed first-hand not only the great work that our health staff undertake daily, but also the enthusiasm of community members for local initiatives that will provide economic and social benefits. Planning is underway on a range of exciting initiatives that will take shape in coming months. Participating in the community champion program has proven to be a rewarding experience for me and one that I shall remember for years to come.

Everything I have seen over the past 12 months has again affirmed that over 6500 staff across the NT public health system are our greatest asset and the reason Territorians continue to enjoy access to such a high level of health care. This is confirmed for me every day; every time I visit a Territory health facility, no matter where it might be. In the context of the unique challenges of delivering health services in the Territory, the commitment and professionalism of staff shines through, and deserves acknowledgement.

With respect to the achievements of our staff I would like to list some of the highlights over the year in review:

Local and national awards won by staff in 2015-16 include:

Clinical/Professional Recognition

• 2015 Fullbright postgraduate scholarship Dr Robert Marshall

• 2016 Fullbright Professional Scholarship in Non-Profit Leadership Hichem Demortier, NCCTRC

• 2015 Sidney Sax medal Professor Len Notaras AM

• 2015 AIM NT Manager of the Year Nicholas Coatsworth

• Member of the Order of Australia, Australia Day Honours

Dr Brian Spain, RDH

• 2015 Menzies medallion

Dr Vicki Krause, Centre for Disease Control

• 2016 Guild Intern of the Year, Pharmacy Guild of Australia Jessica Cahill, ASH

• 2016 Medal for Clinical Services in Rural and Remote Areas,

Royal Australasian College of Physicians Dr Stephen Brady, ASH

• 2015 Remote Health Professional of the Year, CRANAplus conference

Sandra McElligott, CAHS

• Excellence in Mentoring, 2015 CRANAplus Conference Pauline Rubin, CAHS

• 2015 Telstra Health RDAA-ACRRM Rural Registrar of the Year Award Dr Sarah Koffmann

• Aboriginal and Torres Strait Islander Health Medal of the Royal College of Surgeons Dr Jacob Jacob, ASH

• Advanced Accredited Practicing Dietician by Dietitians Association Louise Moodie, RDH Dietetics Manager

• 2016 Australia’s Midwife of the Year Jenny Kenna, ASH

2015 Medical Education and

Training Centre NT Junior Doctor and Clinical Educator of the Year Awards:

• NT Junior Doctor of the Year Dr Cameron Spenceley, ASH

• NT Clinical Educator of the Year Dr Mary Wicks, ASH

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2015 NT ATSIHP Excellence awards:

• New Practitioner Category Kylie (Helen) Parry winner, Adelaide River Health Centre, TEHS

• Remote Practitioner Category Helen Lalara highly commended, Angurugu Health Centre, TEHS

• Urban Practitioner Category Natasha Tatipata, winner, Clinic 34

Training Awards

2016 GTNT Awards:

• GTNT School Based Apprentice of the Year, GTNT Indigenous Apprentice of the Year Allana Neave

• GTNT Supervisor of the Year

Anthony Sievers, Manager Alcohol and Other Drugs

Leadership Achievements

• 2015 OCPE Future Leaders Graduates Anita Maertens Helen Judd Brendon Sherratt Trish Pini

I would like to thank each and every one of you for your dedication and enthusiasm. I would also like to thank the Chair and members of the Top End and Central Australia Health Service Boards respectively for their willingness to work in a collaborative and productive manner with the Department during the last 12 months. Thank you also to our Non- Government Organisation partners who play such a vital role alongside public and private health services in meeting the community’s health care needs.

The year in review was a time of tight fiscal challenges that required strategic expenditure decisions and disciplined management and performance monitoring across the public health system. 2016-17 will see a continuation of the need for all of us to be diligent in ensuring that we maximise the resources allocated to us and use them in an accountable, effective and efficient manner for the benefit of Territorians.

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Professor Dinesh Arya

The Office of the Chief Health Officer (CHO) continues to experience a high level of activity in line with the statutory legislated and representational functions of the CHO. Collaboration within the NT and across other jurisdictions, along with representation on significant national committees is an essential function of the CHO and ensures that responses to public health and protection issues as well as disaster responses are seamlessly coordinated amongst day-to-day business.

In the role of Chief Health Officer I have worked closely with the Centre for Disease Control and Environmental Health branch across the domains of health protection and public health. Dr Vicki Krause and Mr Xavier Schobben have provided effective leadership in assisting with projects of public health significance. These have included specific projects in relation to immunisation, infectious disease control, environmental health and monitoring, water safety and possible contamination of food sources. These projects have required development of health solutions with cross-sector agency engagement and working with government and non-government health services, land councils, communities and other stakeholders.

Acting on identified elevated levels of minerals and chemicals in waterways has been another major project involving the CHO and cross-sector engagement.

The Centre for Disease Control, Environmental Health, Department of Lands, Mines and Energy and Department of Primary Industry and Fisheries have worked together to investigate the human health impact of heavy metals that were identified in some waterways and aquatic life in the Borroloola region. This investigation resulted in a public health campaign about safe levels of consumption for fish and other aquatic life.

Concern in relation to reports of elevated lead levels in children in some specific communities was investigated using a science-based methodology to explore potential causes and provide guidance for a population health approach to managing this problem. Dr Steven Skov provided effective leadership for both projects.

Per- and poly-fluoroalkyl substances (PFAs) are an emerging problem nationally and these chemicals have been found in waterways and aquatic species including Rapid and Ludmilla creeks. Environmental Health, in collaboration with a number of universities, and the Larrakia Nation is currently contributing to a national scientific based investigation. The Australian Defence Force, NT Airports and NT

Emergencies Services are key partners along with other jurisdictions, agencies, stakeholders and community.

Infectious diseases issues are an ongoing concern for the CHO. Zika virus has gained a foothold internationally and I have worked closely with the Centre for Disease Control and the Entomology Branch to monitor for mosquito borne infectious diseases, working with other jurisdictions and the Australian government and engaging in prevention activities and responses.

I am proud to acknowledge that the NT has also taken a lead role in the control of a Syphilis outbreak, with NT experts contributing to the response across Northern Australia as well as making contributions towards the Communicable Disease National Framework and Implementation Plan.

With the Australian Government approving changes to regulation of cannabis cultivation, it is also timely to acknowledge the work of the Medicines and Poisons Control Unit and the Alcohol and Other Drugs Directorate, along with the Department of the Chief Minister. Together, we are working to predict and plan legislative changes to safeguard against potential dangers and anticipate requirements for medical use of cannabis.

The Chief Health Officer is also responsible for managing epidemics and pandemics, and planning is well underway to ensure that we are able to respond effectively to a potential influenza pandemic, should this occur.

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Heather Keighley

A/Chief Nursing and Midwifery Officer

The Chief Nursing and Midwifery Officer (CNMO) provides NT wide professional leadership, advice and support to all nurses and midwives working in the NT, drawing on best practice and evidence based standards to continually build and improve the sustainability of the Territory’s nursing and midwifery workforce. As the incoming incumbent into this position, I would like to acknowledge the work of Dr Robyn Aitken, who held this position from January 2014 until midway through this financial year. Dr Aitken is now the Executive Director, Clinical Support, Education and Public Health Services, and she continues to play a significant role in professional leadership for nurses and midwives.

The Office of the Chief Nursing and Midwifery Officer (OCNMO) works with the operational units of the Department of Health, Top End Health Service and Central Australia Health Service to improve service delivery within NT Health. Representing the nursing and midwifery profession locally, nationally and internationally, the OCNMO has jurisdictional links with other health service providers and is an important link between NT Health as the largest employer of nurses and midwives in the Territory and the tertiary education sector, locally and nationally.

Recognising Excellence in NT Nursing and Midwifery

Each year, the OCNMO works in partnership with key stakeholders to deliver the NT Nursing and Midwifery Excellence Awards. Now in its 13th year, these prestigious awards are a wonderful opportunity to recognise and reward excellence in nursing and midwifery.

Hosted during May 2016, these awards were celebrated with three main events: an official launch hosted in Alice Springs, a Professional Education Day (Symposium) and Gala Dinner, both hosted in Darwin.

Coinciding with the International Day of the Midwife on 5 May 2016, the official launch saw more than 100 people attend the event. Each category was strongly contested this year, making the task of determining the award finalists a difficult job for selection panels.

Celebrations continued on 7 May, where more than 400 nurses, midwives, their colleagues, friends and family travelled from across the Territory to witness the moment award recipients were announced.

Thirteen awards were presented, all received by passionate and dedicated individuals who have gone beyond usual expectations to deliver excellent care to people living across the Territory.

Held at the Darwin Convention Centre on 9 May 2016, the Professional Education Day (Symposium):

Colliding Cultures in Health Care, saw participants learn new strategies to operate safely and provide culturally-appropriate health care in the NT. Jointly sponsored by the NT Department of Health and the Australian Nursing and Midwifery Federation NT, this full-day professional development event focused on the challenges nurses and midwives face working in the multicultural, multilingual, and multidisciplinary NT environment. Participants were from a range of nursing and midwifery health disciplines and represented the Top End and Central Australia.

Diana Baseley – Nurse/Midwife of the Year

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The Nursing and Midwifery Excellence Awards are the annual opportunity to reward outstanding achievements of nurses and midwives working across the NT. The award recipients this year were:

Award Category Recipient

Nurse/Midwife of the Year Diana Baseley: Maternity Unit,

Alice Springs Hospital (CAHS) NT Administrator's Medal for Lifetime

Achievement in Nursing/Midwifery

Sandra McElligott: Remote Women's Health Educator (CAHS)

1st Year Graduate Nurse/Midwife of the Year Ingrid Potgieter: Alice Springs Hospital (CAHS) Excellence in Aged, Disability and Residential Nursing Rosemary Jeffery: Alzheimer's Australia (NGO) Excellence in Nursing/Midwifery

Education, Research and Innovation

Gina Majid: Paediatrics Ward, Royal Darwin Hospital (TEHS) Excellence in Enrolled Nursing Kay Stevens: Rehabilitation Ward,

Royal Darwin Hospital (TEHS)

Excellence in Nursing/Midwifery Hospital Care Lea Davidson: Preventable Chronic Disease Unit, Alice Springs Hospital (CAHS)

Excellence in Nursing/Midwifery Leadership Diana Baseley: Maternity Unit, Alice Springs Hospital (CAHS) Excellence in Alcohol and Other Drugs Nursing Kim Meighan: Alcohol and Other

Drugs, Nhulunbuy (TEHS)

Excellence in Mental Health Nursing Kym Richardson: Adult Community Mental Health (MHAT), Top End Mental Health Service (TEHS)

Excellence in Midwifery Katie Michell: Midwifery and Women's

Health Outreach Team, Yulara, (CAHS) Excellence in Nursing/Midwifery Community Health Emma Louise Corcoran: Flynn Drive

Primary Health Care (CAHS) Excellence in Remote Health Nursing/Midwifery E. Ann Sanotti: Nyrippi Primary

Health Care Clinic (CAHS)

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Developing a Sustainable Workforce

Substantial progress has been made this year towards meeting the target of 25 nurse practitioners in the Territory by the end of the 2016 calendar year.

At April 2016, 21 nurse practitioners were endorsed in the NT and an additional 12 Nurse Practitioner candidates are undertaking study. Of the currently endorsed Nurse Practitioner and Nurse Practitioner candidates, 16 are working remote, outreach remote or in Aboriginal Community Controlled Health Services. There are currently four designated Nurse Practitioners in NT Health and five positions currently being assessed for implementation. The OCNMO is supporting work implementation groups and developing the governance framework to comply with Nursing and Midwifery Board of Australia requirements for all Nurse Practitioners in the NT.

The OCNMO also maintained focus on streamlining processes to recruit new graduates with support provided in their first year of practice as a nurse or midwife. This year, 94 grants were awarded for the Nursing and Midwifery Studies Assistance and Grants Scheme, three of which were provided for the Ministerial Nurse Practitioner Scholarships. Overall, the grants totalled $95,170 and were used to support accredited postgraduate tertiary study in priority health areas, including primary health care, child health, chronic disease, renal, remote and Aboriginal health, mental health and midwifery. Aboriginal and non-Aboriginal Territorians were also supported to commence studies in undergraduate Bachelor of Nursing, Bachelor of Midwifery and Diploma of Enrolled Nursing courses.

With remote area nurses’ safety and wellbeing front of mind, the OCNMO conducted a peer and stakeholder review to determine current issues and areas for improvement for nurses working in remote locations. The Department has now collated all feedback and is working with partners/service providers to identify and recommend changes.

Midwifery in the Northern Territory

Since September 2015, the OCNMO has been working on a national research project, commissioned by the Australian Health Ministers’ Advisory Council (AHMAC) to evaluate cultural competence in maternity care for Aboriginal women. The project is raising awareness and organisational knowledge of cultural competence and provides guidance in cultural security of maternity services in Australia.

At the start of 2016, the OCNMO implemented a policy to improve access for Territory women to long acting reversible contraception. The OCNMO hosted an accredited workshop to support local nurses and midwives to develop advanced practice skills in this area.

Led by the OCNMO and in partnership with the University of South Australia and the Society for Ultrasound in Medicine, the NT is proactively involved in providing ultrasound training for midwives operating in remote services. A training workshop for new and currently accredited midwives is planned for November 2016 to improve access to this service for remote women and accurately estimate their date of birth.

In partnership with the National Perinatal Epidemiology and Statistics Unit the OCNMO hosted a workshop for maternity stakeholders in the NT to classify different maternity models of care. Two NT Hospitals, Alice Springs and Royal Darwin participated in the national pilot program for this system. For the first time in Australia, this will enable recording of maternity models of care, data that have not been captured before.

Jenny Kenna recipient of the Australia’s Midwife of the Year award with her Award nominators Jarl and Chris Le Page and baby Thomas

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Dr Peggy Brown

I was pleased to take up the part-time role of the NT Chief Psychiatrist in November 2015.

The focus of the role is to provide expert specialist advice to the Chief Executive Officer, NT Health Leaders, Health Services, Government and the private and non-government sector on the clinical care and treatment of persons with a mental illness, ensuring compliance with the NT Mental Health and Related Services Act and providing advice on mental health legislation. Working collaboratively with health services, my role is also to contribute to quality and safety programs relevant to mental health care and to monitor the standards of mental health care provided in the NT, in line with the System Manager function.

Areas of focus in the initial eight months have included contributions to the NT Law Reform Commission’s review of the interaction between people with mental health issues and the criminal justice system, the Senate Inquiry into Indefinite Detention of People with Cognitive or Psychiatric Impairment, and consideration of the policy provisions underpinning mental health legislation changes around Australia over the past decade.

The approved procedures underpinning the

implementation and administration of the Mental Health and Related Services Act have been recently updated and set the basis for the continued monitoring of compliance with the Act. I anticipate that monitoring of clinical standards and the effectiveness of quality and safety provisions within the mental health program will be an ongoing area of focus, along with performance monitoring arrangements in line with the System Manager role. Enhancing the input from those with lived experience of mental illness to policy and planning initiatives and emphasising cultural safety and security in service delivery will also be a priority.

I have been pleased to represent the NT in a range of national mental health forums and committees at a time of significant mental health reform nationally, and in particular to ensure that the issues of service delivery to rural and remote areas and to Aboriginal Territorians is given appropriate consideration at this level.

I would like to thank my colleagues for the very warm welcome they have extended to me in joining the mental health team in the Territory, and for their support as I have advanced my knowledge of the service system.

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Our Population

The NT has distinctive population characteristics compared with other Australian states. Geographically, the NT is the third largest of the states and territories, covering approximately 18% of the Australian land mass, yet it has only 1% of the national population. The population density of 0.2 people per square kilometre is the lowest of any state or territory. As of June 2015, the estimated resident population was 244,600, meaning that there was an annual growth rate of 0.4% since June 2014 which, in that year, was the lowest among states and territories. Over the previous five years the NT population increased by 13,020 (5.6%) with an average annual growth rate of 1.1%. The NT also has a relatively young population, with a median age of 32 years, compared with the national median age of 37 years. Males outnumber females, with 112 males for every 100 females.

Two further characteristics of the NT population are the high proportion of Aboriginal people and the geographic distribution of the population. There was estimated to be 71,870 Aboriginal residents, as of June 2015, which was 29.4% of the total NT population and 10.3% of the total Australian Aboriginal population. The geographic distribution of the Aboriginal population is different from the non-Aboriginal population. The highest proportion of Aboriginal residents (58.3%) lives in ‘very remote’ areas, including in discrete Aboriginal communities and regional towns. By contrast the majority of the non-Aboriginal population (71%) live in an area covering the greater Darwin area including Darwin city, Palmerston city and Litchfield Shire. The NT Aboriginal population is generally younger than the non-Aboriginal population (Figure 1).

Figure 1: Population distribution by age group and Aboriginal status, Northern Territory, 2015

14500 13500 12500 11500 10500 9500 8500 7500 6500 5500 4500 3500 2500 1500 500 500 1500 2500 3500 4500 5500 6500 7500 8500 9500 10500 11500 12500 13500 14500

0-4 yrs.

5-9 yrs.

10-14 yrs.

15-19 yrs.

20-24 yrs 25-29 yrs 30-34 yrs.

35-39 yrs.

40-44 yrs.

45-49 yrs.

50-54 yrs.

55-59 yrs.

60-64 yrs.

65-69 yrs.

70-74 yrs.

75-79 yrs.

80-84 yrs.

85+ yrs.

Persons

Non-Aboriginal Aboriginal

Source: Department of Health, 2015, ‘Northern Territory Resident Population Estimates by Age, Sex, Indigenous Status and Health Districts (1971-2015)', prepared by Health Gains Planning. File updated on 20 June 2016, using ABS Estimated Resident Population.

While the NT has historically had the youngest population among all states and territories, falling fertility rates, improved life expectancy and reduced interstate migration has meant that the proportions of different age groups are changing. The proportion of NT persons aged 65 years and over increased from 3.0% in 1995 to 6.9%

in 2015, an increase which is the greatest among all jurisdictions. By contrast, during the same period, the proportion of children aged less than 15 years fell in both the Aboriginal and non-Aboriginal populations (Figure 2).

Figure 2: Population change (%) by broad age group, NT Aboriginal and non-Aboriginal populations, 1995-2015

Figure 2: Population change (%), NT Aboriginal and non-Aboriginal population, 1995-2015

-8.0%

-6.0%

-4.0%

-2.0%

0.0%

2.0%

4.0%

6.0%

8.0%

Age group 0-14 Age group 15-64 Age group 65+

Aboriginal Non-Aboriginal

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NT health regions

Top End Health Service

The TEHS region covers 35.3% (475,338 km²) of the total area of the Northern Territory. The TEHS region includes the Darwin, East Arnhem and Katherine districts. As of June 2015 the resident population of the TEHS region was 195,330, representing 80% of the total NT population. Almost three quarters (141,850, 72.6%) of TEHS residents reside within the Darwin Urban area, of which the majority are non-Aboriginal (89.2%). The distribution of the TEHS Aboriginal population varies within regions, with Darwin Rural (12,650, 79.1%) having the largest proportion, followed by East Arnhem (11,360, 66.0%), Katherine (11,010, 54.4%), and Darwin Urban (15,270, 10.8%).

Map 1: Top End Health Service (TEHS) region

Source: Department of Health, 2015. Map created using ABS 2011 Census Geography.

Milikapiti Nguiu Pirlangimpi

Minjilang

Belyuen

Lajamanu

Urapunga

Galiwinku

Gunyangara Millingimbi

Jabiru

Pine Creek

Gapuwiyak Kapalaga

Alyangula Angurugu Adelaide River

Daly River Milyakburra

Numbulwar

Mataranka Barunga Katherine

Binjari

Yarralin Wadeye

Maningrida

Palumpa

Warruwi

Yirrkala Nhulunbuy

Robinson River

Daguragu

Batchelor

Oenpelli

Woodycupildiya

Ramingining

Umbakumba

Amanbidji

Borroloola Bulman

Kalkarindji

Minyerri Ngukurr

Timber Creek Peppimenarti

Beswick Jilkminggan Manyallaluk

Pidgeon Hole Bulla

Remoteness Area Outer Regional Remote Very Remote

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Figure 3: Top End Health Service - population distribution by age groups and Aboriginal status

Central Australia Health Service

The CAHS region covers two-thirds (64.7%) of the total area of the Northern Territory, and includes 20.1% of the total NT population. As of June 2015, the CAHS region had an estimated resident population of 49,270 people, of whom 43.8% (21,570) were Aboriginal. The majority of the non-Aboriginal CAHS population reside in Alice Springs (83.2%). Of Aboriginal residents, 48.1% live in discrete communities within the Alice Springs Rural area, 30.3% reside in the Alice Springs Urban area and the remaining 21.7% live in the Barkly area.

Figure 4: Central Australia Health Service - population distribution by age group and Aboriginal status

Persons

Figure 4: CAHS population distribution

2500 1500 500 500 1500 2500

0-4 yrs.

5-9 yrs.

10-14 yrs.

15-19 yrs.

20-24 yrs 25-29 yrs 30-34 yrs.

35-39 yrs.

40-44 yrs.

45-49 yrs.

50-54 yrs.

55-59 yrs.

60-64 yrs.

65-69 yrs.

70-74 yrs.

75-79 yrs.

80-84 yrs.

85+ yrs.

Figure 3: TEHS population distribution

14500 13500 12500 11500 10500 9500 8500 7500 6500 5500 4500 3500 2500 1500 500 500 1500 2500 3500 4500 5500 6500 7500 8500 9500 10500 11500 12500 13500 14500 0-4 yrs.

5-9 yrs.

10-14 yrs.

15-19 yrs.

20-24 yrs 25-29 yrs 30-34 yrs.

35-39 yrs.

40-44 yrs.

45-49 yrs.

50-54 yrs.

55-59 yrs.

60-64 yrs.

65-69 yrs.

70-74 yrs.

75-79 yrs.

80-84 yrs.

85+ yrs.

Persons

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Ti-Tree Pmara Jutunta

Amoonguna Santa Teresa Hermannsburg

Areyonga

Alice Springs Marlinja

Nturiya Urapuntja

Kintore Mt Liebig

Yuelamu Laramba

Wilora Willowra

Mutitjulu

Wallace Rockhole Engawala

Imanpa Ukaka Kings Canyon

Yulara Yuendumu

Alpurrurulam McLaren Creek

Tennant Creek

Ali Curung Elliott

Epenarra

Ampilatwatja

Aputula Harts Range

Bonya

Haasts Bluﬀ

Kaltukatjara

Nyrripi

Papunya

Tara

Titjikala Remoteness Area

Remote Australia Very Remote Australia

South Australia

Western Australia Queensland

Map 2: Central Australia Health Service (CAHS) region

Source: Department of Health, 2015. Map created using ABS 2011 Census Geography.

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Our Health

The health needs within a population are a result of a mixture of the age and sex profile of the population and are influenced by a number of potentially modifiable risk factors which impact on the development of various conditions. The health needs are then modified by access and quality of health care services. For the NT Aboriginal population in particular, a range of historical, social, economic and environmental factors contribute to increased health risks and poorer health outcomes. The following section provides recently available information on three important issues for the health of Territorians – key pregnancy measures (tobacco and alcohol use and low birth weight), early childhood development and the future demand for renal replacement therapy.

Tobacco and alcohol use in pregnancy and trends in low birth weight

Tobacco and alcohol use during pregnancy can have adverse health effects on women and infants. In the NT, smoking status during pregnancy is collected in the NT Midwives Collection. Smoking status is self-reported, and is recorded as having smoked during the first 20 weeks gestation and after 20 weeks gestation. Between 2000 and 2014, the proportion of NT Aboriginal mothers who reported smoking at any time during pregnancy increased by 5.8% to 2013 before a small decline in 2014 (Figure 5). While encouraging, it is too early to assess whether the 2014 result is a turning point ahead of a sustained reduction. For NT non Aboriginal mothers there has been a sustained decrease in smoking, with a total 11.6% reduction (Figure 5).

Self-reported alcohol consumption during pregnancy is collected at the first antenatal visit and again at 36 weeks gestation. The proportion of Aboriginal and non Aboriginal mothers who reported drinking alcohol at their first antenatal visit decreased between 2000 and 2014, with a reduction of 3%

and 7.6% in the proportions respectively (Figure 6).

Low birth weight is defined as weight at birth of less than 2500 grams, and is associated with a range of short and long term adverse outcomes. During the period from 2000 to 2014, the proportion of low birth weight Aboriginal and non-Aboriginal babies has seen little changed at approximately 14% and 6% respectively (Figure 7).

Figure 5: Self-reported maternal smoking during pregnancy as a proportion of NT mothers, 2000 to 2014

Figure 6: Self-reported maternal drinking during pregnancy, as a proportion of NT mothers, 2000 to 2014

Figure 7: Proportion of low birth weight NT live born babies by Aboriginal status, 2000 to 2014

Figure 5: Self-reported maternal smoking, NT mothers

0.0 10.0 20.0 30.0 40.0 50.0 60.0

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

0 5 10 15 20 25

Proportion of mothers

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Aboriginal Non-Aboriginal Figure 7: Low birth weight NT live born babies

0.00 2.00 4.00 6.00 8.00 10.00 12.00 14.00 16.00 18.00

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

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Childhood Developmental Outcomes

A range of social, individual, health and family factors influence early development of children. A new teacher rated measure of children’s readiness for school, the Australian Early Development Census (AEDC), was introduced in 2009 for assessment of all Australian children in their first few months of school. The census is conducted every three years. The AEDC assesses five domains of a child’s development including social, physical and cognitive development. A research project was undertaken as a collaboration between the Department of Health and Menzies School of Health Research, which examined the influence of fourteen separate explanatory factors on the AEDC results.

The results confirmed the substantial gap between NT Aboriginal and non-Aboriginal children, but more importantly highlighted that much of this difference is explained by the combination of health and social factors, such as gestational age, education level of the mother or whether a child had attended day care or pre-school. The results are important in informing initiatives to overcome disadvantage among all NT children through addressing modifiable risks such as optimising birth outcomes, access to early childhood programs and targeted support for young or poorly educated mothers. A study such as this also highlights the emerging capacity in the NT to examine a range of factors affecting childhood development through the linkage of administrative data sets. The investigators in the project have been given further approval to extend the study by also including hospital, primary care, youth justice, education and child protection data.

Renal Demand

Across Australia, demand for renal replacement therapy services has been growing at a substantial rate over the last decade. Health service funders are faced with increasing service delivery costs and investment requirements. In the five-year period from 2007 to 2011, the number of dialysis patients increased by 27%

in the NT. Same day haemodialysis (HD) now comprises close to 50% of total NT public hospital admissions and in recent years the number of NT patients with end-stage kidney disease (ESKD) using palliative care

has doubled. From 2001 to 2012, the number of HD treatments in the NT increased, on average, by around 3,200 per year. In a NT Department of Health report, three separate methods were used to determine renal demand projections - linear regression, an autoregressive integrated moving average time series model and a static Markov chain model. The projections for the number of facility based HD treatments estimate a further increase of between 41% and 70% from 2013 to 2022. The projected average annual increase of HD treatments through this period ranged from 2,700 using the Markov chain model, through 3,300 using the time-series model, to 4,600 using the linear regression model (Figure 8). This type of projection analysis is not only important in planning future dialysis services but is also important in monitoring the effectiveness of a range of strategies to slow the development of end stage kidney disease through improved management of diabetes and high blood pressure in primary care services. The results also provide impetus for the long term goal of preventing end stage kidney disease.

Figure 8: Demand projections for facility-based haemodialysis treatments, using three statistical models, NT 2013 - 2022

Source: You JQ et al. Renal Replacement Therapy Demand Study, Northern Territory, 2001 to 2022, Department of Health, Darwin, 2015

Figure 8: Demand projections for facility-based haemodialysis treatments, using three statistical models, NT 2013 - 2022

2001 2003 2005 2007 2009 2011 2013 2015 2017 2019 2021

0 20,000 40,000 60,000 80,000 100,000 120,000

Number of treatments Actual

Number of treatments Projected by regression

Number of treatments Projected by time-series Number of treatments

Projected by static Markov Chain

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Number of public hospital admissions (excluding dialysis)

74,168

Number of episodes of haemodialysis

74,191

Number of emergency department presentations

144,517

Number of admissions for injuries and poisonings

10,976

Number of pathology tests

1,427,094

Number of NT residents enrolled in national My Health Record

37,535

Number of episodes

of Telehealth *provider only

2,207

Number of babies born

3,331

Number of heart attacks

540

Number of admissions with diagnosis of Chronic Obstructive Pulmonary Disease (COPD)

1,125

Number of admissions with mental health diagnosis

3,282

Number of admissions involving a surgical procedure

12,931

Number of gall bladders removed (cholecystectomies)

1,333

Number of

aeromedical retrievals

5,496

Number of patients attended

by St John Ambulance

46,614

Number of specialist

outreach services provided

to remote communities

6,852

(23)

Number of public hospital admissions (excluding dialysis)

74,168

Number of episodes of haemodialysis

74,191

Number of emergency department presentations

144,517

Number of admissions for injuries and poisonings

10,976

Number of pathology tests

1,427,094

Number of NT residents enrolled in national My Health Record

37,535

Number of episodes

of Telehealth *provider only

2,207

Number of babies born

3,331

Number of heart attacks

540

Number of admissions with diagnosis of Chronic Obstructive Pulmonary Disease (COPD)

1,125

Number of admissions with mental health diagnosis

3,282

Number of admissions involving a surgical procedure

12,931

Number of gall bladders removed (cholecystectomies)

1,333

Number of

aeromedical retrievals

5,496

Number of patients attended

by St John Ambulance

46,614

Number of specialist

outreach services provided

to remote communities

6,852

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Since 1 July 2014, the public health system in the Northern Territory has comprised three entities: the Department of Health as System Manager, the Top End Health Service (TEHS) and the Central Australia Health Service (CAHS). The purchaser/provider model of health service delivery is still evolving in the Northern Territory, as responsibilities for a range of public health programs and activities transition to the health services where local decisions and knowledge will guide and lead improved service delivery and better client outcomes.

The NT Health System is challenged by demographic and geographic factors which include:

• Large, sparsely populated areas

• High levels of chronic disease and co-morbidity

• An ageing population and the accompanying burden of disease

• Social and economic disadvantage with particular links to remoteness

The NT Health System covers 1.35 million square kilometres and employs approximately 6648 staff (Full Time Equivalent as at 30 June 2016).

Over 43% of the NT population reside in remote or very remote areas. There are over 600 communities and remote outstations in the NT, all with small populations, and the system experiences high fixed and unit costs associated with the challenges of the above factors.

There are 85 remote primary health care centres, 52 of which are operated by the NT Government and 33 by Aboriginal Community Controlled Health Organisations.

The overall development, management and performance of the public health system in the NT is the responsibility of the Department of Health. As System Manager, the Department is responsible for Territory wide system planning, capital works and monitoring/managing the performance of the Health Services and the public health system as a whole. The Department is also responsible for policy advice and intergovernmental relations.

Each Health Service is an autonomous entity responsible for the provision of health services as set out in its Service Delivery Agreement with the Department.

The two Health Services are each governed by a Health Service Board and are accountable to the Chief Executive Officer NT Department of Health through SDAs and regular performance reporting.

The Health Services and the Department are working collaboratively to build a cohesive and integrated health system that meets the needs of Territorians and to achieve better health outcomes.

Further devolution, structural and governance changes will occur in 2016-17, with the following services transitioning from the Department to the Health Services:

• Oral Health Services

• Hearing Health Services

• Cancer Screening Services