Sydney North Health Network — one-page brief
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100,782-person mental-health service gap · modelled MH cases minus BetterAccess uptake. 61% concentrated in Hub LGAs (NB, Hornsby, Ryde).Tool 07 ↗
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3,174 unmet AOD treatment episodes / yr · +2,142 short of NSW provision rate. NA-cited "non-residential rehab access" priority.Tool 11 ↗
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12,108 after-hours GP attendances / yr below NSW rate · 7 of 9 LGAs have zero local Urgent Care Clinic. NA-cited "after-hours including RACFs".Tool 14 ↗
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04
4,161 missed 75+ health checks / yr · 25% modelled uptake vs national 30%. NA-cited "low proportion of 75+ receiving annual health check".Tool 10 ↗
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349 Aboriginal & TSI 715 health checks short / yr · Modelled 15% uptake vs NSW 22%. NA-cited "significant under-reporting of Aboriginal status" qualifies this as a floor.Tool 08 ↗
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~9,200 missed CALD cancer screenings / round · Breast 4,093 + bowel 5,117 per screening cycle. Ryde 50% CALD share drives the geographic concentration.Tool 09 ↗
§ 01 Population & Demographics
931,439 residents across nine LGAs (ABS ERP 2024). Catchment skews older than NSW — 17.6% aged 65+ vs 17.1% NSW. Population growth 0.89% p.a., slower than the NSW 1.2% average.
§ 02 CALD & First Nations
32.1% CALD (336,628 people) — well above NSW 23%. Concentrated in Ryde (50.5%), Willoughby and Hornsby. Top languages: Mandarin 96k, Cantonese 28k, Korean 21k. Aboriginal & TSI population 4,982 (0.475% of catchment).
§ 03 Mental Health & Suicide
Modelled 176,415 people with mental illness (18.94%) — within 0.7pp of the SNHN NA's 18.3%. A 100,782-person service-need gap between modelled prevalence and BetterAccess uptake, 61% concentrated in the three Hub LGAs (Northern Beaches, Hornsby, Ryde).
§ 04 Maternal & Child Health
161,011 children aged 0–14 (17.3% of catchment). Modelled 10,499 births/yr at SNHN fertility rate 48.0/1,000 women 15–49 (vs national 56.0). AEDC vulnerability 16.8% (NSW 22.4%, national 22.0%) — among the lowest of any PHN. Perinatal depression cohort ~1,575 mothers/yr.
§ 05 AOD & Hospitalisation
164,914 modelled risky-AOD users (21.4% of adults). Catchment-wide treatment gap of 3,174 episodes between modelled seeking and AODTS-received, with a separate 2,142-episode deficit to even the NSW provision rate.
§ 06 After-Hours Care + Telehealth
Modelled 60,544 after-hours GP attendances/yr at 65.0/1,000 (vs NSW 78.0, national 85.0). Catchment runs 12,108 attendances/yr below NSW provision. Telehealth uptake above NSW + national: 144,373/yr (+18,629 vs NSW). Only 2 Urgent Care Clinics in catchment, both in Northern Beaches — 7 of 9 LGAs zero UCC coverage.
§ 07 Aged Care · Demand & Supply
49,784 CALD-elderly people 65+ (30.4% of 65+ cohort) — the single biggest service-design lever for CHSP and HCP commissioning. Commonwealth provision-ratio targets at current 70+ pop: 9,392 RACF beds + 5,419 Home Care Packages. 75+ MBS health-check uptake modelled at 25% (NA-cited low) vs NSW 28% / national 30% — gap of 4,161 assessments/yr.
§ 08 Chronic Disease & PIP-QI
212 of 240 GP practices reporting PIP-QI (88.3% vs NSW 91.0%, national 88.3%). 617,544 regular clients across the 10 PIP-QI Quality Improvement Measures. Largest register-coverage gap is CKD at 36,311 unregistered, then mental-health register at 75,013.
§ 09 Digital Health Adoption
446,848 modelled My Health Record active users in catchment (58.0% of adults · NSW 51.0% · national 49.0%). SNHN runs ahead of state and national across all 6 adoption tracks — GP Shared Health Summary uploads, secure messaging, telehealth, e-prescribing, HealthPathways. Only 26,965 modelled opt-outs (3.5% non-registered).
§ 10 Immunisation Coverage
Childhood 1yr coverage at 94.3% — 1.7pp below NSW (92.6%) and 0.7pp under the 95% herd-immunity target. An estimated 70 children/yr left short of full protection — Northern Beaches + Mosman hesitancy patches drive the gap. Adult cohorts run above state + national: flu 65+ 69.0%, COVID booster 33.0%, pneumococcal 53.0%.
§ 11 Cancer Screening
All three national programs run above NSW + national: BreastScreen 62.3%, NCSP cervical 68.7%, NBCSP bowel 48.1%. Bowel screening still carries the largest absolute gap — 35,991 adults 50-74 under the 60% target. Cervical self-collect at 11.5% (vs 8% national) is the highest near-term uplift lever.
§ 12 Preventable Hospitalisations · ABF ROI
17,568 PPH admissions/yr modelled. SNHN at 1886.1/100k — below NSW (—) and national (2650.0). At best-practice rate, 3,514 admissions are avoidable — A$19.0M in Activity-Based Funding cost on the table. Chronic-PPH dominates (6,698/yr) — tying directly back to Tool 15 register-coverage gaps.
§ 13 Burden of Disease · ABDS 2024
156,668 DALYs lost per year — 168.2/1k vs NSW 182.4 vs national 188.7. 32.0% attributable to modifiable risk factors — 50,134 DALYs/yr preventable through commissioning levers. Overweight, tobacco, diet, BP, alcohol top the risk-factor stack.
§ 14 Disadvantage · NDIS · Income Support
All nine LGAs at IRSD decile 10 — but the catchment carries 87,490 income-support recipients and 14,880 NDIS participants. NDIS growth +41.7% over four years. Within decile 10, IRSD raw-score spread is 55 points — real sub-LGA variance.