The territory of a Local Health District (LHD) comprises multiple local government areas (LGAs). The recent amalgamation of several LGAs in metropolitan Sydney has resulted in two new LGAs being expanded across multiple LHDs, resulting in nonconcordance of boundaries. Here, we discuss the implications for planning health activities and service delivery, and ways to address them.
In Australia, local health governing bodies operate public hospitals and institutions and provide public health services to communities in specific geographical areas.1 In New South Wales (NSW), this regionalisation of the health system occurred in the mid-1980s2 and the local health governing bodies are now called Local Health Districts (LHDs). Local government areas (LGAs) constitute the third tier of government in Australia and have roles in regulation, planning, service delivery and community development, including as major partners in the protection of public health in communities.3 LHDs closely interact with LGAs to align resources and actions in service delivery.
In NSW, LHDs and LGAs benefit from sharing population and care indicators, which are routinely measured and publicly reported by the NSW Ministry of Health at the LHD level and, increasingly, the LGA level.4 LHDs also have access to census and other de-identified nonaggregated data, which are mostly geocoded at the LGA level.5 In metropolitan Sydney, five LHDs served residents with unchanged LGA boundaries until 2016.6 Each of these LHDs accommodated entire LGAs (ranging from five to 11), with the exception of Sydney LGA, which is shared between two LHDs.
In late 2016, the NSW Government began amalgamating LGAs in metropolitan Sydney, decreasing their number from 41 to 24.7 Of the eight new LGAs formed:
The resulting LHD population distribution across shared LGAs is summarised in Table 1.
|Name||Population||Name||Population||Population (%) of shared LGA||% of total LHD population|
|Pre-existing||Sydney LGA||212 563||Sydney LHD||639 745||122 649 (57.7%)||19.2%|
|South Eastern Sydney LHD||910 367||89 914 (42.3%)||9.9%|
|New||Canterbury–Bankstown LGA||360 337||Sydney LHD||639 745||204 671 (56.8%)||32.0%|
|South Western Sydney LHD||967 448||155 666 (43.2%)||16.1%|
|New||Parramatta LGA||238 864||Northern Sydney LHD||808 872||24 125 (10.1%)||3.0%|
|Western Sydney LHD||946 832||214 739 (89.9%)||22.7%|
Alignment of healthcare providers’ boundaries (for Primary Health Networks and LHDs) has been accepted as desirable.11 Nonconcordance between LHD and LGA boundaries will require shared responsibilities, planning and service delivery. Here we discuss these issues, and implications to consider.
LHDs with changed LGAs, and LGAs that need to work with two LHDs, may encounter differences in emphasis, resource allocation and governance. This will require negotiation and careful management among the partners. For example, a multicultural LGA that was recently targeted to address its low child immunisation rate in the Western Sydney LHD no longer exists because of changed boundaries and renaming. This has complicated implementation of planned collaborative interventions in the community and ongoing assessment of outcomes.12
Data at the LGA level, or smaller localities, enable us to recognise variation in needs within LHDs. Immediate adoption of new LGA configurations in population health reports is challenging, but essential for planning and forecasting. For example, a year after LGA amalgamations, data on immunisation coverage (personal communication) and cancer incidence13 are being reported based on old LGAs, including an LGA that no longer exists. At the same time, available indicators for newly merged or changed LGAs that have maintained their original names have questionable utility, particularly for populous and cosmopolitan LGAs where disparities in the characteristics of residents can be substantial. For example, the new Parramatta LGA (Figure 1) has a higher socio-economic status than the previous LGA.5,14 Existing trend data are no longer reflective of newly delineated populations in areas such as Parramatta LGA with its new geography and related demographics. Consequently, existing plans are unable to align with the changed demographics.
Figure 1. Distribution of socio-economic status for Statistical Area Level 1 within Parramatta LGA before and after NSW LGA amalgamation (click to enlarge)
Accurate estimates from up-to-date geocoded data are unobtainable without delineating the new boundaries in public reports and accessible data. The information gap requires specialised analytical skills. A consistent approach by LHDs for reporting on community health indicators for the shared LGA would enable appropriate use and interpretation.
Specific issues arising from changed boundaries could benefit from a collaborative approach.15 This approach requires us to: recognise risks in delivery of services; align internal (inter-LHD) and external (LHD–LGA) priorities, resources and models for interaction; inform communities about new configurations of service delivery; and improve measurement and reporting systems and related infrastructure.
LGAs are partners of LHDs in health service delivery, and their boundaries are used for planning purposes by LHDs. Sydney’s LGAs and their boundaries have changed. The discussed implications, regardless of motives and consequences16-18, are generalisable to any geography and population. Adapting to boundary changes will benefit from a collaborative approach by all parties. The approach should address risks, priorities, partnership models, consumer engagement and alignment of data.
The authors wish to thank Stephen Leeder, Western Sydney LHD Research and Education network; Maureen Fitzpatrick, Nereus Marana, Julie Jones and Julie Meyer, Western Sydney LHD Health Services Planning and Development Department; Stephen Corbett and Sophie Norton, Western Sydney LHD Centre for Population Health; and Graham Burgess, Sydney LHD Public Health Unit, for their valuable comments and feedback.
Externally peer reviewed, not commissioned
© 2018 Assareh et al. This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International Licence, which allows others to redistribute, adapt and share this work non-commercially provided they attribute the work and any adapted version of it is distributed under the same Creative Commons licence terms.