Regional Review Issue 2 | Summer 2023
Loddon Mallee Shared Services
Loddon Mallee Public Health Unit
Virtual Emergency Response
In this issue
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Message from the Chair of Loddon Mallee Health Network, Peter Faulkner Reflections from the CEO, Rochester & Elmore District Health Service, Karen Laing
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Care at Home
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Loddon Mallee Public Health Unit Virtual Emergency Health Response
Cybersecurity
Cover and inside cover photos: Kate Monotti
Acknowledgement of Country Loddon Mallee Health Network acknowledges the traditional custodians of the land upon which we work, including Dja Dja Wurrung, Yorta Yorta, Barapa Barapa, Wemba Wemba, Latje Latje and Taungurung and pays respects to Elders both past and present. Loddon Mallee Health Network also pays respects to All Aboriginal Nations of Victoria and their Stories, Traditions, waterways, plants, animals and Country.
Family violence is a health issue
Message from the Chair, Loddon Mallee Health Network
Since our last issue, Central and Northern Victoria have experienced devastating impacts of floods. Late Spring and early Summer saw our health services working tirelessly in unprecedented and challenging conditions which impacted their health service operations and staff availability (as many were isolated by flood waters, responding to households that were inundated or damaged). It was a truly challenging time and I watched in in awe of those impacted as they provided leadership to their staff and to their communities. I am proud of the hard work and tireless efforts of LMHN health service CEOs and their teams as they responded and worked collectively to support each other during this time of need. None of the other daily challenges of operating a health service had diminished (i.e. responding to COVID, workforce availability and high levels of patient demand) and teams were already tired from these existing demands. The LMHN team mobilised quickly to support and coordinate forums which allowed our members to collaborate and coordinate matters that responded to ways of working in the emergency response and relief stages of the flood event. The rapid implementation of the LM Emergency Response Module to assist with
the identification and triage of community members who presented at flood evacuation centres was another example of the strength and agility of LMHN to identify, develop and apply solutions as a collective group of health services for the benefit of many. I want to personally thank my colleagues in those health services that were impacted by the floods and I hope you enjoy this edition of the Regional Review as we hear from Karen Laing, CEO, Rochester & Elmore District Health Service and her experience responding to the devastating floods in Rochester which resulted in the full evacuation and subsequent prolonged closure of their health service. It is clear that our region is already being impacted by the impacts of climate change and this will need to be a focus for us to respond collectively, not just to disasters as they occur but also to supporting our communities to reduce the impact of climate related disasters. We have shown time and time again that we are better together and I thank you for your ongoing commitment to collaboration. As you know I recently announced my intention to retire this year. The recruitment for my replacement has commenced and the timing of my departure will be dependent upon that process. Until that time I am committed to working with you on further
improvements to the provision of health services throughout the Loddon Mallee and look forward to seeing what we can achieve.
Our region is already being impacted by climate change and this will need to be a focus for us to respond collectively.
Peter Faulkner Chair Loddon Mallee Health Network CEO Bendigo Health
LMHN Regional Review | Issue 2 | Summer 2023
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Reflections from the CEO of Rochester & Elmore District Health Service As the flood water was coming down the Campapse River from Lake Eppalock we knew it was looking like being worse than the 2011 floods. We reviewed our Emergency Plans, but quickly learnt there is no time to look at them in any detail or use the raft of checklists contained in them. It was too quick a scenario and you just have to act in the moment and focus on what’s in front of you. We made our decisions really quickly and with the benefit of hindsight, I think they were sensible ones. Reflecting on that time is difficult because in many ways we are still experiencing it. Four months on, our staff are still living and working in the most extraordinary circumstances. 35% of staff have been directly impacted; their homes have been flooded and most are yet to be rebuilt. We are still not back in our own Health Service facility and continue to care for residents in dislocated workplace environments. But I hope that keeping staff informed about what their colleagues are up to across multiple sites and small extras like gift bag of goodies for Christmas and regular opportunities to re- connect with your colleagues have helped staff during the toughest times. Despite feeling pretty vulnerable, it was reassuring to know we could rely on our health network partners, emergency services and community members. We
electively transferred 17 residents the day before the flood to Kyabram, Echuca, Rushworth and Bendigo. The next day Bendigo Health and Goulburn Valley Health each offered us an empty acute ward to accommodate the 42 remaining residents we needed to evacuate. Some of our staff voluntarily went with them, despite knowing their own homes were likely to go underwater. We did one day coordinating the Emergency Recovery from the Elmore Pub and the next day Robyn Lindsay, CEO of Echuca Regional Health (ERH), rang and offered us their Boardroom and IT services, as our servers were all down and we had nowhere to operate from. By the next week we had our first demountable building delivered to the car park, so we could base ourselves back in Rochester. To keep services as close as possible to Rochester we opted to reinstate Home Care and Allied Health services in Elmore. Within days, staff were back at work; some while living in caravans or a shed or with neighbours or family. Four months in and almost every one of our staff is engaged back with us in some capacity. Looking back and thinking what we could or should have done differently, I think you just have to trust your instincts and trust your staff and be reassured that people want to help without hesitation. You’re
not alone. This is what the health network is about. Everybody was really supportive, even when facing their own impending crisis as the flood water made its way along the river toward them. Keeping everyone informed and optimistic was important. Initially I did this with daily email updates to all staff, and now with a weekly video update and a staff Facebook page. This has proven really helpful. The feedback I’ve received is that the regular updates were reassuring and people felt things were under control and going to be OK, which was the nicest thing for me. You can’t leave people in a vacuum where they don’t know what’s going on. Otherwise, they feel no one is there to look after them.
You have to trust your instincts and trust your staff and be reassured that people want to help without hesitation This is what the health network is about.
Karen Laing CEO Rochester and District Health Service
LMHN Regional Review | Issue 2 | Summer 2023
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Care at Home
Programs providing hospital-standard care at home now offer patients convenient, more restful and tailored 1-1 treatment by health professionals. Marjorie Lowery, retired Bendigo Health Nurse, survived breast cancer in 1999. Her lymphatic system, however, is since compromised and Marjorie needs intravenous antibiotics periodically. “It’s wonderful being able to stay at home rather than staying in the hospital when no one can visit. It’s very convenient, the staff come to you [at home] and keep you company. They’re extremely good, and we would be lost without them.” Virtual and home-care programs are vital extensions of the patient care offering from health services across the Loddon Mallee region, yet many people haven’t heard about them, or that so many services are appropriate for in-home care. Complex treatments need not be confined to within hospital walls, allowing more availability of hospital beds available for urgent cases, and easing the burden on the hospital system. Home-care fosters a faster recovery through the nurturing of patients’ well-being, and they can avoid the stress and costs of travel and of sharing facilities. Patients can eat meals prepared in their own kitchen, with greater comfort, surrounded by their loved ones at home. Katherine Formica, Nurse Unit Manager at Echuca Regional Health (ERH) is passionate about the advances she has seen in home-care over the last ten years, which she says are “phenomenal.” “Our ERH@home team is a dedicated group of highly-skilled Specialist Nurses and Allied Health Professionals working tirelessly to ensure we are providing safe, best-practice, excellent health care in people’s homes,” said Katherine. “We now are able to safely care for people at home
who can be quite unwell with an acute or chronic condition, who previously would have been sent to hospital for an admission or would have stayed in hospital for a much longer period of time,” said Katherine. Treatment can suit people across all demographics. And for those autoimmune compromised patients who have a very real fear of contracting COVID or other highly contagious viruses, they are relieved to avoid busy public spaces and queuing. Rodney Grist is very familiar with this feeling of fear and anxiety and appreciates the peace of mind of being able to avoid the hospital setting. He travelled back and forth to Peter Mac Hospital in Melbourne every fortnight for 18 months to receive a trial chemotherapy treatment which includes a pump for stomach-related cancer. The treatment requires a strict follow-up procedure after 48-hours, but in Rodney’s case, a specially trained BH home-care nurse now comes to him at home at the required time to reconnect his new infusion. “My wife (72) and I are very cautious – it’s scary for someone who is immune compromised like me having to sit in a hospital. This way, they come to you. Nurses and clinicians always wear a mask adhering to the guidelines.” “They’ve been very good; they’ve gone above and beyond the call of duty, even when understaffed due to COVID. We appreciate what they do for us because if they couldn’t come, there is no way we could go to Melbourne, it’s too tiring.” This sentiment is echoed by participants in a recent 2022 market research focus group for the Victorian government’s Better at Home initiative. They cited benefits including a high level of quality in 1-1 treatments, having company throughout the home visits, greater convenience, less anxiety, finding the
It is such a pleasure and a privilege to care
for people in their own environment whether that be at home, in residential aged care or at their workplace.
appointments more restful, and the cost effectiveness of at-home care. Katherine agrees, having seen the benefits first-hand. “It is such a pleasure and a privilege to care for people in their own environment at home, in residential aged care or at their workplace. We see every day the benefits of people staying at home to receive their care, whether that is because they are in their own environments with their families, in their own beds, eating their own meals, wearing their own clothes or simply having their pets close to them.”
LMHN Regional Review | Issue 2 | Summer 2023
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Loddon Mallee Public Health Unit
114 COVID-19 outbreaks managed
3823 vaccinations
54 Risk assessments in residential aged care
While large scale and targeted outreach, State-funded testing and vaccination services have now been scaled down across the state, LMPHU staff continue to provide specialist advice and support for the management of significant outbreaks in residential aged care and other high-risk settings. This last quarter has seen scores of outbreaks as a consequence of new viral variants and waning immunity for many people living in our region. It is imperative that we continue to promote COVIDsafe behaviours and, most importantly, vaccination as our best line of defence to stop the spread, protect the health system and save lives. Almost of third of the highest risk over 65 year old age group in the Loddon-Mallee are not up to date with their jabs, and promoting uptake through GPs and pharmacies, particularly for the most vulnerable, is critical to continuing our world-class successes in managing the pandemic to date. A particular challenge for our region is, of course, mosquito-borne disease. The existing impact of endemic diseases such as Ross River and Barmah Forest viruses is only likely to grow with climate change, as already witnesses in a case of JEV and
finding of Murray Valley virus in mosquitos in our region this season. Local governments continue to lead the charge on surveillance and control of mosquito populations, and the LMPHU has been working closely with our councils and the Department of Health to promote the prevention message and to coordinate and deliver several thousands of JEV vaccine to individuals at high risk of infection. Engaging with priority community during the floods has been critical, and the LMPHU have been working together with the Department of Health and community-based organisations such as Aboriginal Community Controlled Health Organisations and Sunraysia Mallee Ethnic Communities Council to help create and translate public health messages and resources into language that is accessible for all those living and working in our region. It was wonderful to have some of the partnership work the LMPHU has helped supported be recognised at the Victorian Healthcare Awards, with Sunraysia District Health and partners recognised for incredible work targeting vaccination services to vulnerable communities in Mildura during the 2022 community lock down.
Public health is the science and art of preventing disease, prolonging life and promoting health through organized efforts of society. Recent flooding also serves as a timely reminder of the implications of climate change. There is a rapidly growing demand for place-based work to address climate change’s health and social impacts. The Loddon Mallee Public Health Unit (LMPHU), together with local, regional and state cross-sector organisations, are developing the building climate change resilient service systems and communities framework to assist health and community
organisations in the Loddon Mallee to identify and reduce the impact of climate change on the health and wellbeing of our community. The LMPHU prevention and population health team, who are working through the final steps in the formation of a sub-regional approach to prevention and population health. We’re excited to finalise the governance arrangements for the Loddon, Murray, and Mallee subregions in the coming months. The LMPHU continues to support services and communities in the region to promote protective behaviours and respond to significant outbreaks.
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Virtual Emergency Health Response
Cybersecurity
Loddon Mallee Health Services are participating in a specialised Cyber Security Program which includes assessment of: • Regional Cyber Security Protection • Anti-Virus Protection • Medical Device security review • Participation in an new Cybersecurity Awareness Program The cyber security annual works plan has been updated and represents the targeted initiatives and activities to improve the cyber security levels across the Loddon Mallee health region, in line with industry and Department of Health (DoH) standards. A number of these initiatives are in flight, whilst others are yet to be fully defined as they await the outputs of current audit or assessment activities (e.g. penetration testing and cyber security maturity assessments.) Case study Recently, a staff member fell victim to a cyber incident in which an attacker gained access to their personal Gmail account through a phishing incident. Unfortunately, the attacker was able to use this information to also gain access to the staff member’s corporate email account, as the same password was being used for both accounts.This incident serves as a reminder of the importance of using unique passwords for all of our online accounts, including our corporate accounts. While it may be convenient to use the same password across multiple accounts, it also makes it easier for attackers to gain access to multiple areas of our personal and professional lives.
I n October 2022, in response to the emerging flood emergency across the Loddon Mallee, the LMHN board endorsed immediate development, trialling and implementation of a Loddon Mallee Virtual Response to help connect patients from flood-affected areas to targeted care and support Now implemented, the Emergency Response Module enables the region to rapidly respond to, and coordinate, disaster events into the future. This ability is unique to the Loddon Mallee region, making the Loddon Mallee the benchmark for the State. System benefits of the implementation include: • Single, standardised method of monitoring clients, including use of standardised assessment tools • Dashboard views for local clinical teams Standardised systems across the region to support rapid on-boarding of additional staff to work in these services • PDF Summary created upon discharge of service, enabling sharing with GPs and Specialists • Cloud based, secure and accessible anywhere • Immediate integration for all agencies’ patient information systems • Cheap, sustainable and well-known platform, capable of immediate deployment due to existing infrastructure From project initiation on Friday the 21st of October, the teams were able to deliver the system, establish the service, and on-board the first health services within five days. The majority of the remaining impacted Health Services were on-boarded within the subsequent five days, with the final Health Service on- boarded within two weeks. The following Health Services were on-boarded to the Virtual Emergency Health Response service:
Thankfully, the LMSS Cybersecurity team were able to detect and stop the malicious activity before any greater harm could be done. But we want to ensure that all health service staff members are aware of the dangers of password reuse and take steps to protect themselves and our organisation. Simple safe steps As set out in our password policy, it is mandatory for all staff members to use unique passwords for their corporate email account and all other online accounts. Additionally, be vigilant of suspicious emails or messages and never click on links or enter personal information unless you are certain of the sender’s identity. By taking these simple steps, we can work together to elevate our cybersecurity awareness and protect ourselves and our organization from future cyber threats.
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Echuca Regional Health Service
Swan Hill District Health
• Mallee Track Health and Community Service • Robinvale District Health Service • Mildura Base Public Health • Rochester & Elmore District Health Service Future opportunities Significant opportunities exist to further develop this functionality and expand the utilisation of this service in future disaster events. Utilising existing functionality, the ability to support any future disaster event exists. There is also the potential to include functions such as large scale SMS capability that would support public health responses to disasters.
LMHN Regional Review | Issue 2 | Summer 2023
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