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Clinical Services Plan 2018 - 2022 page 1.

CLINICAL SERVICES

PLAN2018-2022

Cairns and Hinterland Hospital and Health Service

Cairns and Hinterland Hospital and Health Service (Cairns and Hinterland HHS) Health Service Plan 2018 - 2022.

Published by the State of Queensland (Cairns and Hinterland Hospital and Health Service), February 2018

This document is licensed under a Creative Commons Attribution 4.0 Australia license.

To view a copy of this license, visit creativecommons.org/licenses/by/4.0/au

© State of Queensland (Cairns and Hinterland Hospital and Health Service) [2018]

You are free to copy, communicate and adapt the work, as long as you attribute the State of Queensland (Cairns and Hinterland Hospital and Health Service).

For more information contact:

Governance and Strategy UnitOffice of the Chief ExecutiveCairns and Hinterland Hospital and Health ServicePO Box 902, Cairns, 4870

Health planning data presented within this document has been

obtained and verified by the Queensland Department of Health,

while population data was sourced from the Australian Bureau

of Statistics. All data presented was accurate at the time of

publication.


ACKNOWLEDGMENT TO TRADITIONAL OWNERSThe Cairns and Hinterland Hospital and Health Service, respectfully acknowledges the Traditional Owners and

Custodians both past and present of the land and sea which we service and declare the Cairns and Hinterland

Hospital and Health Service’s commitment to reducing inequalities between Indigenous and non-Indigenous health

outcomes in line with the Australian Government’s Closing the Gap Initiative.

Cairns and Hinterland Hospital and Health Servicepage 4.

As Board Chair and Chief Executive of the Cairns and Hinterland Hospital

and Health Service, we are immensely proud of the level and quality of

health services provided to Far North Queenslanders every day.

The Cairns and Hinterland Hospital and Health Clinical Service Plan

2018-2022 details how to improve and grow our services over the next

five to 10 years to meet the needs of our community.

The Plan sets out a collective vision for the growth and future direction

of the Health Service, articulated following extensive consultation

and engagement with clinicians, stakeholders and community

representatives who provided valuable insight.

People in the Far North expect and deserve world-class health services.

However, there are a number of challenges in delivering services in

Far North Queensland including geographical distance, high burden

of disease due to risk factors such as obesity, smoking and alcohol

consumption. The Plan provides achievable strategies that can be

implemented to meet these challenges of the future.

To respond to these challenges and our growing demand, the Plan

supports a future where our health service works more collaboratively in

partnership with other providers across the Northern Queensland health

system to reduce duplication, address service delivery gaps and provide

more seamless access to services.

Operational planning to implement the strategies contained within the

Plan will require consideration of various factors including workforce,

infrastructure and funding.

We would like to thank and acknowledge the many staff – clinical and

non-clinical – and community members who provided the valuable

feedback and ideas that have formed the backbone of this Plan.

Every day, every member of our team strives for outstanding performance

and outcomes in the delivery of health care in the Far North. The resolve

of our staff and all involved with our Health Service to work together

with our stakeholders will see us deliver our region a health system that

is not only strong and sustainable but prides itself on being inclusive,

innovative and compassionate.

The Clinical Council has made strong representations during the

development of the Clinical Services plan 2018-2022. As clinicians we

are excited by the challenges and opportunities that are expressed in

the plan, and we look forward to translating the words into meaningful

health outcomes for our communities.

This plan has clearly identified for the first time the challenges posed

by geographic, cultural and social factors in our region .

The Clinical Council support the the principles of streamlining and

integrating care for complex chronic disease, delivering expert

healthcare through improved partnerships with all providers,

maintaining and extending our self sufficiency and moving to close the

gap for all our disadvantaged groups.

Dr Roxanne WuChair Clinical Council

from our cl inical council

foreword

Clare Douglas

Chief ExecutiveCairns and Hinterland Hospital and Health Service

Clive Skarott AM

Chair Cairns and Hinterland Hospital and Health Board


The Cairns and Hinterland Hospital and Health Service (HHS) covers

a large, geographic area with a diverse and growing population. The

Cairns and Hinterland HHS community has a high burden of disease

relative to the Queensland and national average – reflective of its

ageing demographics, low socio-economic status, large Aboriginal

and Torres Strait Islander community, and geographic dispersion.

This Plan sets the direction for clinical services over the next five

to ten years, with further work still to be done to develop detailed,

‘stepped’ implementation plans that outline how these strategies will

be achieved. The Cairns and Hinterland HHS Strategic Plan will also

set the broader direction for the Cairns and Hinterland HHS, including

greater links with education and research.

Specific challenges considered in the development of this Plan include

the extent of the burden of disease in the Cairns and Hinterland

community.

Our population:

• Will age over the next ten years; with the population aged over

60 years increasing from 20% to 24% of the total Cairns and

Hinterland HHS population; and 30% outside of the Cairns city

area.

• Almost three-quarters of the population classed as the most

socioeconomically disadvantaged.

• Has higher rates of risky alcohol use and smoking, compared to

Queensland and nationally.

• Has lower life expectancy (76 years) than the rest of Queensland

(80 years).

The extent of the burden of disease in the Cairns and Hinterland HHS

community is outlined further on the following page, and in the first

section of the Clinical Services Plan.

The Cairns and Hinterland HHS is expected to experience significant

growth in demand for acute services – 2.8% each year to 2027 for

inpatient services, with a commensurate increase in emergency

department and outpatient services. This is well above population

growth, expected to be 1.4% each year to 2027.

This Plan provides a strategic overview of how the airns and Hinterland

HHS will continue to meet the needs of the Cairns and Hinterland

region over the next five years (with a ten-year outlook). Specifically,

the service directions and strategies identified focus on improving the

sustainability of existing services; growing the clinical capability of

some services – with an ambition to become a “university hospital”

with improved research and education links; delivering services

differently to better meet future demands; and partnering more

effectively across the health and human services sector.

The following pages provide an overview of the population and burden

of disease, the service delivery challenges identified within Cairns

and Hinterland HHS, and the service directions and strategies that will

guide the development of clinical services within Cairns and Hinterland

HHS for the next five years.

For clinicians and Cairns and Hinterland HHS, this document provides

a considered direction in which we need to grow to ensure more

patients are seen in our HHS and do not need to travel. We also aim

to increase our capability with an emphasis on research to attract the

best clinicians. This plan will support discussions with government

regarding future funding and infrastructure priorities to meet our

community’s health needs.

executive summar y


.p 5EXECUTIVE SUMMARY

. p 1 0g e o g ra p h i c p r o f i l e

. p 1 1 - 1 5h ea l t h s e r v i ce p r o f i l e

. p 1 8s e r v i ce d e l i ve r y

. p 3 0t h e f u tur e o f o ur h ea l t h s e r v i ce

. p 3 8 - 3 9o ur p la n f o r i m p l e m e n ta t i o n

. p 4 2A . G l o ssa r y o f Te r m s - D a ta S o ur ce s

. p 4 3B . G e o g ra p h i ca l G r o up i n g s

. p 4 4 - 4 5C . CS C F Le ve l by Fa c i l i t y

. p 2 0 - 2 3d e m o g ra p h i c p r o f i l e

. p 3 1 - 3 5s e r v i ce d e l ive r y s t ra t e g i e s

. p 2 4 - 2 7p o p u la t i o n h ea l t h s ta tu s

.p 9OUR ORGANISATION

.p 17OUR CHALLENGES

.p 29GOING FORWARD

.p 37MAKING IT WORK

.p 41APPENDICES

contents.

our organisation


9

2

7

8

34

5

1

11

10

The Cairns and Hinterland HHS is the primary provider

of health services to residents of the Cairns and

Hinterland region, and specialist services to the

Torres and Cape region. Services are provided over

a large geographical area and a range of facilities,

from a large tertiary hospital in Cairns to facilities in

rural and remote areas. Cairns Hospital is the primary

provider of specialised and referral services for the

region, with broader general surgical, medical and

primary care services provided at other facilities

across the Tablelands, Innisfail and Mossman/Port

Douglas areas. The Cairns and Hinterland HHS covers

an area of 142,900 square kilometres from Tully in the

south, Cow Bay in the north and Croydon in the west.

In addition to the provision of acute services

throughout the region, the Cairns and Hinterland HHS

provides a number of clinics and general practice

services through Primary Health Centres that enable

the provision of services in rural and remote areas

of the Cairns and Hinterland HHS. These facilities

include:

Cow Bay Primary Health Centre

Croydon Primary Health Centre

Dimbulah Primary Health Centre

Forsayth Primary Health Centre

Georgetown Primary Health Centre

Malanda Primary Health Centre

Milla Milla Primary Health Centre

Ravenshoe Primary Health Centre

Chillagoe Primary Health Centre

Mount Garnet Primary Health Centre

7

8

9

10

11

5

4

3

2

1 Atherton Hospital (Level 3)

Gordonvale Hospital (Level 2)

Cairns Hospital (Level 5)

Babinda Multi-Purpose Health Centre (Level 2)

Yarrabah Emergency Health Centre (Level 2)

Mossman Multi-Purpose Health Centre (Level 3)

Innisfail Hospital (Level 3)

Tully Hospital (Level 2)

Herberton Hospital (Level 2)

Mareeba Hospital (Level 3)

geographic profi le


The majority of inpatient activity is undertaken at Cairns Hospital, and

is projected to increase over the next ten years, with Cairns Hospital

activity growing at a faster rate than rural hospitals. Cairns Hospital

is projected to reach capacity within five years under current service

configurations and models of care. This includes consideration of

current built capacity and shell space. Rural hospitals across the

Cairns and Hinterland HHS currently undertake a small portion of total

Cairns and Hinterland HHS activity – however, high growth in activity is

projected for the Atherton and Mareeba Hospitals as well as Mossman.

There has been significant growth in inpatient activity at Cairns

Hospital over the past three years driven largely by the increase in

capacity from the hospital’s redevelopment in 2015. Over the next

10 years, activity at Cairns Hospital is projected to grow at a slower

rate compared to historically (because of this spike in supply driven

activity). It is important to note that these projections do not take into

account current levels of unmet need.

• Historical growth at Mossman Hospital is expected to continue

over the next ten years;

• Innisfail and Babinda Hospitals are expected to see a decrease in

the level of growth over the ten year horizon; and

• Atherton and Mareeba are projected to experience an increase

in the level of growth – driven largely by the ageing of their

catchment populations.

FACILIT Y PROFILE

health ser vice profi le

Facility FY15 FY27Average Growth Rate

Cairns Hospital 44,074 63,948 3.20%

Atherton Hospital 5,891 8,088 2.70%

Mareeba Hospital 5,294 7,100 2.50%

Innisfail Hospital 4,394 4,998 1.10%

Mossman Hospital 2,208 3,121 2.90%

Tully Hospital 2,011 2,445 1.60%

Babinda Hospital 552 698 2.00%

Other 4,818 6,591 2.60%

Total 69,242 96,989 2.80%

Aboriginal and Torres Strait Islander Peoples 13,800 17,143 1.80%

10,000

20,000

30,000

40,000

50,000

60,000

CairnsHospital

3.2%

AthertonHospital

2.9%

InnisfailHospital

1.2%

MossmanHospital

3.0%

TullyHospital

1.7%

BabindaHospital

2.0%

Average Annual Growth (%)

2.9%

MareebaHospital

70,000

Sepe

rati

ons

HISTORICAL VS PROJECTED INPATIENT ACTIVITY BY MAIN HOSPITAL SITE FOR CAIRNS AND HINTERLAND HHS

PROJECTED ACUTE AND SUBACUTE INPATIENT ACTIVITY GROWTH BY HOSPITAL SITE

Source: Acute Inpatient Modelling (AIM)

Source: Acute Inpatient Modelling (AIM)

our organisat ion.


Demand for hospital inpatient activity across

the Cairns and Hinterland HHS is projected to

grow by 40% (2.8% per annum) by 2027 under a

status quo baseline projection – which accounts

for demographic changes and recent trends in

service delivery, and also assumes no change to

service capability and patient flow patterns to

and from other health services.

Those services with expected high growth

(including projected % growth rates in inpatient

separations to 2027) include:

• Medicine: Neurology (68%), Renal Medicine

(56%), Cardiology (55%), Gastroenterology

(54%), Immunology & Infectious Disease

(50%), and Respiratory Medicine (40%)

• Surgery: Ophthalmology (64%), Urology

(58%), Orthopaedics (45%), Plastic and

Reconstructive Surgery (41%), and Upper

GIT Surgery (37%)

• Procedures and Interventions:

Interventional Cardiology (270%),

Endoscopy (75%), Renal Dialysis (48%), and

Chemotherapy (43%)

• Sub-acute services: Rehabilitation (176%),

Palliative Care (106%), and Geriatric

Management (53%)

• Emergency Department: Low acuity ED

presentations (56%) and High acuity ED

(23%).

ACTIVIT Y PROFILE PROJECTED ACUTE AND SUBACUTE INPATIENT ACTIVITY GROWTH BY HOSPITAL SITE

Separations

FY13 FY16 Average Annual Growth (%)

Inpatient 53,030 77,917 13.70%

Medical 29,893 49,313 18.20%

Surgical 12,007 16,493 11.20%

Mental Health 2,012 2,021 0.10%

Maternity 7,602 6,864 -3.30%

Other 1,516 3,226 28.60%

Outpatient

Occasions of Service 410,133 468,125 4.50%

Emergency Presentations 141,255 158,732 4.00%

Triage 1 1,052 995 -1.80%

Triage 2 12,100 15,092 7.60%

Triage 3 41,456 47,292 4.50%

Triage 4 56,484 53,941 -1.50%

Triage 5 27,302 23,329 -5.10%

Transfer Presentation - 2,669 n/a

Other 2,861 15,414 75.30%

Procedures and Interventions 40,208 44,214 3.20%

Renal Dialysis 15,603 19,119 7.00%

Chemotherapy & Radiotherapy 20,826 20,357 -0.80%

Endoscopy 3,779 4,738 7.80%

PROJECTED ACUTE AND SUBACUTE INPATIENT ACTIVITY GROWTH BY HOSPITAL SITE

Baseline Projections

FY15 FY22 FY27 Average Annual Growth (%)

Inpatients

Acute 66,527 79,704 92,577 2.80%

Medical 46,953 57,628 68,062 3.10%

Surgical 11,909 14,174 16,215 2.60%

Other 576 709 831 3.10%

Maternity 7,089 7,192 7,468 0.40%

Subacute 2,002 3,019 3,918 5.80%

Procedures and Interventions 55,581 73,713 88,420 3.90%

Interventions

Interventional

Cardiology2,077 5,334 7,664 11.50%

Endoscopy 6,123 8,596w 10,714 4.80%

Chemotherapy 4,927 6,164 7,059 3.00%

Dialysis 42,454 53,619 62,982 3.30%

Emergency Department

Presentations 152,441 182,330 209,369 2.70%

Triage 1 1,152 1,465 1,653 3.10%

Triage 2 15,871 21,504 26,796 4.50%

Triage 3 48,913 62,238 74,540 3.60%

Triage 4 56,585 63,061 68,800 1.60%

Outpatients

Occasions of Service 405,198 478,490 546,282 2.50%

Source: CHAI

Source: Acute Inpatient Modelling (AIM

) and Deloitte projections


The Cairns and Hinterland HHS currently has a

self-sufficiency rate of 95% – indicating that

the Cairns and Hinterland HHS facilities treat

95% of Cairns and Hinterland resident public

inpatient activity. Those

services accessed

outside of the

Cairns and

Hinterland HHS

are primarily

highly specialised

services that are only

provided in Brisbane and Townsville, as well

as Ophthalmology and Gynaecology activity

undertaken in private facilities.

Although the Cairns and Hinterland HHS as a

whole has a high level of self-sufficiency, there

are large differences in regional self-sufficiency

within the Cairns and Hinterland HHS; with

large numbers of patients from rural and remote

areas travelling to the Cairns Hospital to access

specialised medical and surgical services.

Approximately 30% of Cairns Hospital activity

in FY15 was for patients outside of the Cairns

area.

Over the next ten years, the Cairns and

Hinterland HHS will look at the sustainability

of increasing the level of capability in some

services as part of the next service planning

process. Section 5 identifies a number of

specialties to build sustainability at; or grow to

CSCF Level 5 capability; while also noting the

need for CSCF Level 6 services in Cairns in the

longer-term.

PATIENT FLOWS INPATIENT SELF-SUFFICIENCY RATES – SPECIALTY GROUPS (FY15)

CHHHS facility

Townsville Hospital

Brisbane Facilities

Private Facilities

Total Self sufficiency

Cardiology 4,156 62 13 - 97%

Chemotherapy 3,609 1 183 - 95%

Dermatology 374 - 22 - 94%

Diagnostic GI Endoscopy 1,121 6 67 8 92%

Drug & Alcohol 1,768 9 8 - 97%

Endocrinology 1,072 10 23 - 95%

Gastroenterology 1,760 17 20 - 96%

Haematology 1,310 21 31 - 95%

Immunology & Infections 2,894 17 34 - 97%

Interventional Cardiology 519 81 18 - 80%

Medical Oncology 521 22 138 - 75%

Neurology 3,312 42 26 - 97%

Non Subspecialty Medicine 4,484 104 69 - 94%

Renal Dialysis 22,977 100 6 - 99%

Renal Medicine 609 5 35 - 93%

Respiratory Medicine 3,688 31 24 - 96%

Rheumatology 285 2 2 - 96%

Breast Surgery 247 2 7 - 96%

Cardiac Surgery 1 98 11 - 1%

Colorectal Surgery 383 18 16 - 91%

Maxillo Surgery 71 3 8 - 87%

Dentistry 477 9 8 - 96%

Ear, Nose & Throat 1,223 45 43 - 91%

Extensive Burns 64 19 24 - 59%

Gynaecology 1,640 38 12 237 82%

Haematological Surgery 33 24 14 - 46%

Head & Neck Surgery 105 4 16 - 84%

Neurosurgery 617 134 36 1 77%

Non Subspecialty Surgery 5,890 161 83 - 94%

Ophthalmology 982 84 105 466 60%

Orthopaedics 4,635 60 57 - 96%

Plastic & Reconstructive Surgery 983 20 57 - 93%

Thoracic Surgery 80 48 4 - 61%

Prolonged Ventilation 60 33 22 - 52%

Transplantation - - 4 - 0%

Upper GIT Surgery 990 17 43 - 93%

Urology 1,483 61 290 2 80%

Vascular Surgery 577 4 12 - 97%

Obstetrics 6,289 110 8 - 98%

Qualified Neonate 740 74 10 - 88%

Unqualified Neonate 2,342 15 - - 99%

Mental Health 2,434 42 14 - 97%

Geriatric Management (non-acute) 500 1 - - 100%

Other Non-Acute 435 4 3 - 98%

Rehabilitation (non-acute) 404 28 30 - 86%

Palliative (non-acute) 488 7 4 - 98%

Total 88,632 1,693 1,660 714 95%

our organisat ion.


The Cairns and Hinterland HHS’ SOPD

wait lists have declined since the start for

FY17 – driven largely by declines in Ear,

Nose & Throat (ENT), General Surgery and

Ophthalmology wait lists.

PATIENT FLOWS - TORRES AND CAPE

The majority of inflows into the Cairns and

Hinterland HHS are from patients residing in the

Torres and Cape HHS. The services accessed in

highest volume by Torres and Cape HHS residents

include Renal Dialysis, Obstetrics, Orthopaedic

Surgery, and General Surgery, accounting for 62%

of all inflows. In 2014/15, 10% of Cairns Hospital

separations were for patients residing in the

Torres and Cape.

The specialties with the largest intra-HHS flows

include:

• Renal dialysis;

• Orthopaedics;

• Chemotherapy;

• Non-subspecialty surgery; and

• Obstetrics.

Separations

Specialty Group FY15 FY27 Growth (%)

Renal Dialysis 2,793 3,267 17%

Obstetrics 536 468 -13%

Orthopaedics 279 412 48%

Non Subspecialty Surgery 238 310 30%

Unqualified Neonate 216 231 7%

Gynaecology 158 179 13%

Respiratory Medicine 156 179 14%

Chemotherapy 138 262 90%

Cardiology 122 163 34%

Immunology & Infections 114 143 25%

Other 1,254 1,839 47%

Total 6,004 7,452 24%

Specialty Group FY15 FY27

Innisfail - Cassowary Coast 6,332 7,005

Port Douglas - Daintree 2,932 3,886

Tablelands (East) - Kuranda and Far North 8,486 11,368

Total Cairns Hospital inpatient activity 59,556 85,155

Proportion of activity from rural and remote areas 30% 26%

INPATIENT ACTIVITY FLOWS WITHIN THE CAIRNS AND HINTERLAND HHS (SEPARATIONS) – CURRENT AND PROJECTED

Obstetrics - Antenatal

Cardiology General

Neurosurgery

Urology

Nephrology

Orthopaedics General

Plastic and Reconstructive Surgery

General Surgery

Ophthalmology

ENT

0 2000

4000

6000

8000

February 2017

July 2016

SOPD WAITLIST FY17 YTD - TOP 10 SPECIALTIES BY VOLUME

SPECIALIST OUTPATIENT DEPARTMENT (SOPD) WAITING LISTS

Source: CHH

HS w

aitlist performance report

Source: Acute Inpatient Modelling (AIM

)Source: Acute Inpatient M

odelling (AIM)


CLINICAL SERVICES CAPABILIT Y FRAMEWORK COMPARISONAt a broad level, the Cairns and Hinterland HHS’ adult medical and surgical services are classified at a level 5 under the Clinical Services Capability

Framework (CSCF), while the Townsville HHS’ adult medical and surgical services are classified at a level 6. This difference in classification levels is

largely caused by the Townsville HHS having a broader range of surgical sub-specialties – some of which (particularly Cardiac Surgery, Neurosurgery

and Neonatal services) are necessary to achieve an overall CSCF level 6 classification for medical and surgical services. A review of services not at a

level 5 on the CSCF classification, such as plastic and reconstructive surgery, ear, nose and throat, ophthalmology, urology and vascular surgery should

be undertaken to support the Cairns and Hinterland HHS transition towards becoming a sustainable university hospital in the future.

Similarly, the Townsville HHS broadly has a CSCF Level 5 classification for children’s medical services compared to the Cairns and Hinterland HHS CSCF

Level 4 services; once again this is driven by the Townsville HHS having a broader range of paediatric sub specialty services and paediatric support

services (such as a dedicated neonatal and paediatric intensive care unit).

In FY15, 1,693 separations were transferred to Townsville out of a total of 92,699 for Cairns and Hinterland HHS residents – reducing the number of

transfers would require significant investment to increase services to a similar level compared to a 1.8% increase in activity.

Specialty Cairns Townsville

Anaesthetic 5 6

Anaesthetic - Children's 4 5

Cancer

*Children's 5 5

*Haematological Malignancy 5 6

*Medical Oncology 5 6

*Radiation Oncology 5 6

Cardiac

*Cardiac (Coronary) Care Unit 5 6

*Cardiac Diagnostic & Interventional 5 6

*Cardiac Medicine 5 6

*Cardiac Surgery 6

*Cardiac Rehabilitation - Inpatient 6 6

*Cardiac Rehabilitation - Outpatient 6 5

Emergency 5 6

Intensive Care 6 6

Intensive Care - Children's 5 5

Maternity 5 6

Medical 4 6

Medical - Children's 4 5

Medication 5 6

Medical Imaging 5 5

Specialty Cairns Townsville

Mental Health - Adult 5 5

Mental Health - Child & Youth 5 5

Mental Health - Older Persons

*Ambulatory 4 5

*Acute Inpatient 4 4

Neonatal 5 6

Nuclear Medicine 5 5

Palliative Care 5 6

Pathology 5 6

Perioperative

*Acute Pain 5 5

*Day Surgery 4 4

*Endoscopy 5 6

*Operating Suite 5 6

*Post Anaesthetic Care 5 6

*Children's Post-Anaesthetic Care 5 5

Rehabilitation 4 6

Renal 5 6

Surgical 5 6

Surgical oncology 5 6

Surgical-Children's 4 5

CAIRNS HOSPITAL VS TOWNSVILLE HOSPITAL CSCF COMPARISON

Source: Self-reported CSCF summary

our organisat ion.

our challenges


ser vice deliver y

Population demographics and health need

Coordination and provision of ser vices across the HHS

Access to and integration with other health and

human ser vices

Seamless care for TCHHS residents accessing

ser vices in Cairns

The Cairns and Hinterland HHS has a growing and ageing population, that is also socioeconomically disadvantaged compared to Queensland. This indicates that the population has higher rates of chronic disease, risky behaviours and lower life expectancy. In addition, the Cairns and Hinterland HHS has the largest absolute Aboriginal and Torres Strait Islander population of any health service in Queensland. The large geographic area of Cairns and Hinterland HHS provides a challenge for the provision of services, in particular, high need areas such as rural and remote and the Cairns Southern Corridor

The Cairns and Hinterland HHS’ population is dispersed across a large geographic area – resulting in the need to achieve an appropriate balance. between providing local access to services and centralising services to ensure their quality and sustainability. A significant share of activity at Cairns Hospital is for residents outside of the Cairns area (approximately 40%). There is an opportunity to provide some of this activity in the larger rural facilities – which will also require greater coordination and integration integration of specialist and support services across the across the Cairns and Hinterland HHS.

Some parts of Cairns and Hinterland HHS have difficulty accessing primary care, community health, and aged care – in terms of access to providers, bulk billing availability in primary care and/or access to after - hours services. This often results in the Cairns and Hinterland HHS taking on a greater role as primary care and community health service provider in these areas.

Given Cairns and Hinterland HHS’s role as the major referral centre for Torres and Cape HHS residents, there is an opportunity to develop formalised relationships, joint service models and patient pathways to ensure seamless access to care when needed and support to Torres and Cape HHS services locally.

There are a number of service delivery challenges being faced by the Health Service that were raised as part of the extensive consultation undertaken.

In addition, the Health Service is currently operating under financial constraints, providing a challenge for the delivery of health services in the region

in the short term, and requiring the prioritisation of projects based on need.


our chal lenges.

Seamless care for patients accessing highly

special ised ser vices

Mental health ser vices

Workforce sustainabil ity and capacity

Capacity pressure at Cairns Hospital

Some highly specialised services are accessed outside of the Cairns and Hinterland HHS facilities, providing an opportunity to develop formalised patient pathways with other HHS’s such as Townsville and Children’s Health, including the development of shared service models to increase sustainability and reduce patient travel where possible.

Mental health services are currently under significant pressure – with infrastructure that is not fit for purpose, the need for improved community mental health services, and models of care. This will involve integration with other hospital services, primary care, and community care services.

Consultation identified the need to improve retention in some specialties across medical, nursing, allied health and operational staff. Training and retaining is critically important to providing sustainable specialised services in the future.

Cairns Hospital is currently experiencing capacity pressure, with increasing demand – including the fact that almost 40% of activity is for patients who reside outside of the Cairns city area. There is some capacity to grow within existing built infrastructure, however longer-term solutions will be required.


The population of the Cairns and Hinterland HHS has

grown by 6% over the past five years, with further

growth of 15% (1.4% average annual growth) projected

over the next ten years. The majority of population

growth is expected to occur in the Cairns Southern

Corridor, which will account for 59% of the Cairns and

Hinterland HHS’ population growth over the next 10

years.

POPULATION GROWTH

POPULATION AGEING

2016249,427.70

forecasted2021

269,704.29

forecasted2026

287,021.03

RESIDENT POPULATIONCairns Southern Corridor

Cairns North

Tablelands (east) - Kuranda

Innisfail - Cassowary Coast

Port Douglas - Daintree

Far North

Source: Queensland Government Statistician Office (QGSO) *Note that Innisfail has only a portion of the Tully SA2 included within the Cairns and Hinterland HHS region

demographic profi le

Approximately 20% of the Cairns and Hinterland HHS’ population were over the age of 60 in 2015, which is projected to grow to 24% by 2026 – an

increase of almost 20,000 people from 2015 population numbers. In comparison, the share of the Queensland population over the age of 60 is

projected to increase from 20% to 23% between 2015 and 2026. Population ageing is projected to occur largely in the HHS’ rural areas – with the age

structure of the Cairns city area expected to remain largely unchanged.

Male 2015

Male 2026Female 2026

Female 2015

0 - 4

5 - 9

15 - 19

10 - 14

20 - 24

28 - 29

30 - 34

35 - 39

40 - 44

45 - 49

55 - 59

50 - 54

60 - 64

65 - 69

70 - 74

75 - 79

80 - 84

85 +

4.0%0.0% 3.0%1.0% 2.0%2.0% 1.0%3.0% 0.0%4.0%

POPULATION DISTRIBUTION 2015 VS 2026


SOCIOECONOMIC DISADVANTAGEThe Cairns and Hinterland HHS population has higher

rates of socioeconomic disadvantage compared to the rest

of Queensland – with almost 60% of the population in

the bottom two quintiles of disadvantage. Disadvantage

in Cairns and Hinterland HHS and Torres and Cape HHS

is most prominent in rural areas such as the Far North,

Innisfail Cassowary Coast and Tablelands regions.

9%

33%

26%

19%12%

Disadvantaged Advantaged

Source: PHIDU

our chal lenges.

Interstate and overseas visitors

can comprise a large proportion

of the Cairns and Hinterland HHS’

resident population at any one

time. The volume of overseas

visitors is expected to expand

significantly over the next 5-10

years – particularly from China.

In 2016, around 11% (14,519) of

all Cairns and Hinterland HHS ED

presentations were for tourists, of

which 24% were admitted.

TOURIST POPULATION

Source of Visitors FY 2016 FY 2022 % Growth

Domestic 2,043,000 2,470,353 21 %

International 845,163 1,387,819 64 %

China 241,063 632,000 162 %

United States of America 108,954 150,909 39 %

Japan 103,884 134,191 29 %

United Kingdom 96,927 109,156 13 %

New Zealand 42,677 51,455 21 %

Other 251,659 310,108 23 %

Source: Tropical Tourism N

orth Queensland


ABORIGINAL AND TORRES STRAIT ISLANDER PROFILEThe Cairns and Hinterland HHS has the largest

absolute population of Aboriginal and Torres Strait

Islander Peoples of any HHS in Queensland – with

14% (1 in 7) of the resident population identifying

as Aboriginal and Torres Strait Islander compared

to 4% (1 in 25) for Queensland as a whole. This is

projected to increase for the Cairns and Hinterland

HHS (16%) and Queensland (5%) respectively by

2026

One in seven residents in Cairns and Hinterland HHS identify as Aboriginal and Torres Strait Islander Peoples compared to one in 25 for Queensland

CAIRNS AND HINTERLAND HHS

QUEENSLAND AVERAGE

SRG FY 2015 FY 2027 % Growth

Renal Dialysis 2,793 3,267 1.10 %

Obstetrics 536 485 -0.10 %

Orthopaedics 279 396 2.90 %

Non Subspecialty Surgery 238 302 2.20 %

Unqualified Neonate 216 231 0.20 %

Gynaecology 158 165 0.40 %

Respiratory Medicine 156 176 1.40 %

Chemotherapy 138 262 6.40 %

Cardiology 122 159 2.10 %

Immunology & Infections 114 135 1.50 %

Urology 108 166 3.30 %

Other 1,146 1,610 2.50 %

Total 6,004 7,353 1.70 %

TORRES AND CAPE PATIENT INFLOWS

TORRES AND CAPE HOSPITAL AND HEALTH SERVICE

The population of the Torres and

Cape HHS region – a large source

of patient inflows for the Cairns

and Hinterland HHS – is projected

to grow at an average annual rate

of 0.8% to 2026, which is below

the statewide average annual

growth rate of 1.3%.

Approximately

6,000 Torres

and Cape

residents were

treated at Cairns and Hinterland

HHS facilities in FY15, which

represents 8% of total Cairns and

Hinterland HHS activity.

The Aboriginal and Torres Strait

Islander population represents

69% of the Cape and Torres

HHS population –the

largest share of any

HHS in Queensland.

Source: CHH

HS Casem

ix and costing team


ABORIGINAL AND TORRES STRAIT ISLANDER POPULATION

The areas with the largest absolute number of Aboriginal and Torres Strait

Islander Peoples are the Cairns Southern Corridor, Innisfail-Cassowary

Coast and Far North. There is also a large Aboriginal and Torres Strait

Islander population in the Tablelands region of the Cairns and Hinterland

HHS.

Compared to the rest of the population, the median age at death for the

Aboriginal and Torres Strait Islander population is significantly lower

– this is indicative of the poorer health outcomes experienced by the

Aboriginal and Torres Strait Islander population. In addition, it shows that

the utilisation of health services is higher compared to the rest of the

population.

In particular, admission rates for selected illnesses such as mental health

conditions and respiratory system diseases are much higher than rates

for the total Queensland population. Areas of large variances for the

Cairns and Hinterland HHS includes:

• Mental Health at Mareeba

• Circulatory system diseases at Atherton

• Respiratory system diseases at Mareeba.

ABORIGINAL AND TORRES STRAIT ISLANDER POPULATION BY PLANNING REGION (2015)

Planning Regions

Aboriginal and Torres Strait Islander

Total Population Proportion

Port Douglas – Daintree 1,192 11,608 10%

Cairns - North 2,243 52,791 4%

Far North 5,078 7,347 69%

Innisfail - Cassowary Coast 6,248 32,849 19%

Tablelands (East) - Kuranda 4,972 40,784 12%

Cairns Southern Corridor 16,368 104,049 16%

Cairns and Hinterland HHS 33,812 249,428 14%Source: QGSO

MEDIAN AGE AT DEATH FOR ABORIGINAL AND TORRES STRAIT ISLANDER COMMUNITIES IN THE CAIRNS AND HINTERLAND HHS (AS AT 2013/14)

Median age at death

Male Female All

Cairns 56 61 58

Cairns - Far North Coast 54 65 57

Cairns - Southern Hinterlands 61 56 57

Atherton 62 53 60

Mareeba 53 64 56

Innisfail – Johnstone 62 74 70

Tully - Cardwell – Jumbun 55 65 57

Aboriginal and Torres Strait Islander - Queensland

56 61 58

Total Queensland - All population 77 83 80

Aboriginal and Torres Strait Islander - Australia

54 60 57

Source: PHIDU

ADMISSIONS BY SELECTED PRINCIPAL DIAGNOSIS (2012/13)

Selected Illnesses – Admissions ASR per 100,000

Mental Health Related Conditions Circulatory System Diseases

Respiratory System Diseases

Cairns 1,868 1,473 2,035

Cairns - Far North Coast 2,924 2,867 3,916

Cairns - Southern Hinterlands 2,066 1,561 4,092

Atherton 2,392 4,023 2,413

Mareeba 9,074 2,899 9,486

Innisfail – Johnstone 1,229 1,932 3,219

Tully - Cardwell – Jumbun 1,845 2,330 4,040

Aboriginal and Torres Strait Islander - Queensland 2,004 1,783 2,750

Total Queensland - All population 1,889 2,445 1,919

Aboriginal and Torres Strait Islander - Australia 2,371 1,676 3,030

Source: PHIDUNote: the high number of mental health admissions at Mareeba are likely to be due to the inclusion of the mental health presentations from the Lotus Glen prison

our chal lenges.


population health status

The Cairns and Hinterland HHS has higher

prevalence of a range of health risk factors such

as high alcohol consumption, smoking and

obesity – which is expected to translate to a

higher burden of disease for the population and

demand for health services in the future.

HIGH RISK FACTORS

HIGH RISK ALCOHOL CONSUMPTION 5.7 5.3 4.7

19.2 18

31.6 27.5

PREVALENCE OF SMOKING 23.1

PREVALENCE OF OBESITY 31.9

CHHHS QLD National

PREVALENCE RATE (PER 100 POPULATION) OF SELECTED HEALTH RISK FACTORS

Median age at death for the Cairns and Hinterland HHS

population is 76 years, which is 4 years lower than the

Queensland median age at death of 80 years.

Median age at death for the Aboriginal and Torres Strait

Islander population in the Cairns and Hinterland HHS is

below that of the Aboriginal and Torres Strait Islander

population of Queensland and 22 years lower than for

the non-Aboriginal and Torres Strait Islander population

in Queensland, highlighting the gap in health outcomes

for this population. This is different to the Making Tracks

report which presents the life expectancy of an individual

born today.

LIFE EXPECTANCY

BURDEN OF DISEASEOverall, the Cairns and Hinterland HHS is in line with

Queensland and Australia more broadly in the prevalence

rate of a number of chronic diseases - with the exception of

mental and behavioural problems where prevalence rates

are above Queensland and Australian averages.

Diabetes mellitus

5

10

Australia

Total

Total Cairns SA4

15

20

25

30

Hypertensive disease

Respiratory system

diseases

Mental and behavioural

problems

PREVALENCE RATE OF SELECTED DISEASES (2015)

Queensland Aboriginal and Torres Strait Islander Female

All Australian population Female

MEDIAN AGE AT DEATH (2015)

84

61All Australian population Male

Queensland Aboriginal and Torres Strait Islander Male

78

56

Source: PHIDU

Note: data does not allow to show for CHHHS

Source: PHIDU

Source: PHID

U


our chal lenges.

Access to GP services for the Far North region is

estimated to be in line with the rest of the state

– this is however variable at the regional level,

where rural and remote areas have lower access

to GP services and in particular bulk-billing

services.

Access to aged care places in the Far North

region was historically higher than the state

average, however it has been decreasing

over the last 10 years and is now below state

average. This has flow on impacts to demand

for hospital-based services – particularly

emergency department services and sub-acute

beds. A number of additional beds are planned

for the Cairns and Hinterland HHS region to

address this.

PRIMARY HEALTH CARE AND AGED CARE ACCESS

PROPORTION OF ADULTS WHO NEEDED TO SEE A GP BUT DID NOT (2013/14)

Source: Australian Institute of Health and Welfare (AIHW)

0%

Western Queensland

Darling Downs and West Morton

Central Qld, Wide Bay and

Sunshine Coast

Brisbane North

Northern Queensland

(includes CHHHS)

Brisbane South

Gold Coast

5%

10%

15%

20%

25%

30%

Queensland Average Australia Average

POTENTIALLY PREVENTABLE HOSPITALISATIONS

The Northern Queensland Primary Health Network

region has the second highest rate of potentially

preventable hospitalisations in Queensland -

equivalent to 217 overnight beds across Cairns,

Townsville and Torres and Cape HHS (assuming 90%

occupancy rate). Conditions with a large volume

of preventable hospitalisations include diabetes

complications, COPD, and cellulitis.

Source: Australian Institute of Health and Welfare (AIHW)

Western QueenslandDarling Downs & West MoretonBrisbane North

Brisbane South

Central Qld, Wide bay & Sunshine Coast

Gold Coast

Northern Queensland

Northern Queensland (inc. CHHHS)

Total Chronic Acute and Vaccine preventable

1,000

2,000

3,000

4,000

5,000

RATES OF POTENTIALLY PREVENTABLE HOSPITALISATION BY PHN (2013/14)


Population growth 2015-2026 (%)

Share of population expected to be aged over 60 by 2026 (%)

Share of population in two most disadvantaged socioeconomic status quintiles (%)

Aboriginal and Torres Strait Islander population share (%)

Smoking rate per 100 population

Excessive drinking rate per 100 population

Port Douglas - Daintree 13 29 67 10 23.7 5.7

Cairns - North 17 21 17 4 18.1 5.5

Far North 6 30 95 69 Not recorded Not recorded

Innisfail - Cassowary Coast 1 30 84 19 Not recorded Not recorded

Tablelands (East) - Kuranda 11 33 67 12 24.6 5.6

Cairns Southern Corridor 21 17 63 16 24.3 5.7

Cairns and Hinterland HHS Total 15 24 59 11 23.1 5.7

Queensland 14 24 40 5 19.2 5.3

Higher than Queensland Average In line with Queensland Average Lower than Queensland average

There are variances in demographic, socioeconomic, and health status

indicators across the Cairns and Hinterland HHS’ regions. The HHS’

rural and remote areas have a relatively elderly, slow growing, and

socioeconomically disadvantaged population than the Cairns city area

as a whole.

These regional variations in demographics and health status have

important implications for the appropriate delivery of equitable health

services across the region, with a specific focus required to ensure that

high need areas are able to access adequate services through:

• Improved accessibility and coordination of services for the

Aboriginal and Torres Strait Islander population

• Appropriate pathways for the management of the older population

• Greater integration with community and primary care for the

delivery of out of hospital care and management of chronic

diseases

• The development/refurbishment of fit for purpose infrastructure in

high need areas.

REGIONAL VARIANCES


The majority of the regions within Cairns and Hinterland HHS had higher

rates of potentially preventable hospitalisations compared to Queensland

– with Innisfail and Tablelands, having some of the highest rates per

100,000 people. The Cairns and Hinterland HHS had higher rates of

hospitalisations for a number of conditions, including acute myocardial,

atrial fibrillation, cervical loop excision, caesarean and appendicectomy.

There are a number of conditions however, where the Cairns and

Hinterland HHS had a lower hospitalisation rate than Queensland.

CATCHMENT VARIANCES

The Cairns and Hinterland HHS had a higher rate of potentially preventable hospitalisations than the rest of Queensland across a variety of

conditions, including kidney and UTI and Heart Failure – PPHs due to cellulitis compared to Queensland would result in approximately 7 additional

beds being occupied.

The Cairns and Hinterland HHS had higher rates of hospitalisations compared to Queensland for conditions such as acute myocardial infarction,

atrial fibrillation, and appendicectomy.

Where the Cairns and Hinterland HHS has lower rates of hospitalisation than the Queensland average, this could be investigated further to

determine if it is related to access issues.

AGE STANDARDISATION HOSPITALISATION RATES PER 100,000 PEOPLE FOR A NUMBER OF SELECTED CONDITIONS – 2014/15

Atlas Variation Category

Cairns - North

Cairns - South

Innisfail - Cassowary Coast

Port Douglas - Daintree

Tablelands (East) - Kuranda Far North Queensland

Potentially Preventable Hospitalisations

COPD 270 319 358 571 395 631 286

Heart failure 190 226 242 424 228 287 210

Cellulitis 446 484 922 619 717 1131 325

Kidney and UTI 427 459 508 412 523 380 380

Diabetes 196 218 235 237 407 542 205

Hospitalisations

Acute myocardial infarction 241 278 474 602 545 905 293

Atrial fibrillation 675 484 620 488 740 464 520

Hysterectomy 190 245 222 na 205 na 327

Endometrial ablation 91 67 76 na 69 45 116

Cervical loop excision or laser ablation

283 274 195 244 209 282 184

Caesarean section* 307 286 311 170 247 277 280

Third- and fourth-degree perineal tears*

55 32 20 22 20 17 26

Knee replacement 217 196 235 264 255 154 266

Lumbar spinal decompression 67 47 60 86 52 30 75

Lumbar spinal fusion 19 13 14 na 26 na 30

Laparoscopic cholecystectomy 108 153 184 202 158 139 222

Appendectomy 210 215 186 na 259 173 196

Cataract surgery2,386 2,091 2,063 1,834 2,247 2,160 2,474

* Rates are expressed as number per 1,000 live births rather than per 100,000 population

Higher than the Queensland Average

Source: The Second Australian Atlas of Healthcare Variation 2017

our chal lenges.

going for ward


As noted in the previous sections, the Cairns and Hinterland HHS will

continue to experience a number of challenges in providing quality,

safe and sustainable health services to the Cairns and Hinterland HHS

community - and those who travel to Cairns to access services.

Broadly, these include population growth and ageing, increasing burden

of disease - particularly in the Aboriginal and Torres Strait Islander

community, and those parts of the population that are socioeconomically

disadvantaged. Providing services to such a large geographic area also

means the Cairns and Hinterland HHS needs to provide a high level of

specialist services in Cairns, balanced with local access in rural and

remote areas to reduce the need for travel to Cairns.

The Cairns and Hinterland HHS also has an important role to play in the

health system in FNQ - but can not (and should not) be the main solution

to meeting all of the health service needs for the region. This means

improving partnerships with other Hospital and Health Services, the

primary and community services sector, and private and non-government

agencies.

For the full range of services provided locally in Cairns, the Cairns and

Hinterland HHS has relatively high self-sufficiency rates compared

to other major regional centres - meaning residents can access most

specialist services locally, and only need to travel to Townsville or

Brisbane for highly specialised services that can be provided safely and

sustainably in major metropolitan areas.

However, to maintain this self-sufficiency and local access for the

community, the Cairns and Hinterland HHS needs to plan for the growth in

key specialties linked to population demographics and need, and ensure

the tertiary services provided locally are sustainable into the future. This

includes focussing on increasing as many services to the status of a CSCF

level 5 as feasible and ensuring their sustainability. There are services

that Cairns and Hinterland HHS should expand such as interventional

cardiology and some paediatric services, with sustainability achieved

through new and contemporary models of care, improved utilisation

of out-of-hospital strategies to free up capacity for acute patients, and

specialist workforce retention (through ensuring access to continued

professional development, education and research opportunities). In

progressing operational planning for the implementation of these

strategies, consideration must be given to how existing resources can be

reallocated to those priority strategies of the Cairns and Hinterland HHS.

The Cairns and Hinterland HHS provides a high quality service for the Far

North Queensland region, with access to a range of tertiary, specialist

services locally for the community. To ensure this continues, and that the

Cairns and Hinterland HHS provides safe, sustainable services that meet

the community’s needs, the following section of the Plan outlines five

service directions and a number of strategies that if achieved, will have a

meaningful impact on improving the health of the Cairns and Hinterland

HHS population.

the future of our health ser vice


going forward .

Ser vice directions and strategies

The Cairns and Hinterland HHS’ core role is as the provider of high quality, safe secondary

and tertiary level care in the Far North region of Queensland; providing care for its local

population, as well as the main referral service for Torres and Cape HHS. In some locations

where a community service obligation exists, the Cairns and Hinterland HHS also is the sole

or major provider of primary health care services. However, the Cairns and Hinterland HHS

should not shoulder the responsibility for the entire continuum of care, and should partner

effectively to support and develop capacity and capability in the primary, community and

non-government sector. This will ensure all parts of the health system work collaboratively to

improve outcomes for our population.

• Integrate services and partner more

effectively with the PHN and local NGOs,

to reduce duplication and address

service delivery gaps.

• Develop and implement an Engagement

Framework – which articulates how the

Cairns and Hinterland HHS will support

capability and capacity development

and alternative models of care in

adjacent health care sectors, and the

principles for working together with

primary and community partners in

Northern Queensland.

• Actively work with primary care

providers and Aboriginal Community

Controlled Health Organisations to

improve information sharing, to provide

more seamless access to services and

information across the continuum

of care (e.g the Regional e-Health

Program), and ensure the effective and

efficient use of resources.

• Actively participate in the Northern

Queensland planning processes

with Department of Health (including

advocating for level 6 services for Cairns

Hospital over the longer term).

• Develop and agree plans to address

population health issues across Cairns

and Hinterland HHS, including obesity,

chronic diseases and oral health –

including models to jointly intervene

early with high risk population groups.

• Develop and strengthen partnerships

with the primary and community

care sector (such as through the

implementation of Health Pathways)

to better manage chronic disease,

implement promotion and prevention

strategies, and reduce the need for

patients to be treated in an acute

hospital.

• Develop formalised joint service

models & patient pathways (including

appropriate referral and step down)

with specialised service partners in

Townsville and Brisbane to support

consistent and quality care for Cairns

and Hinterland HHS residents who need

to access more specialised services

outside of the Cairns and Hinterland

HHS, while maintaining sustainable

services for Far North Queensland.

Targeted specialties include Plastic

and Reconstructive Surgery, Paediatric

Services, secure Mental Health services,

and Interventional Radiology.

The Cairns and Hinterland HHS will actively partner with other providers across the Northern Queensland health and social care system to support capacity and capability development at a system level.

STRATEGIES


We will address the demand pressures facing the Cairns and Hinterland HHS, while delivering high quality, safe and sustainable care.

The Cairns and Hinterland HHS will respond to growing demand for health services by

optimising the use of its current and planned future infrastructure, as well as developing

community health services and partnerships with primary care services to manage low

acuity activity outside of the hospital setting where appropriate to do so.

• Grow a number of key specialised

services where Cairns and Hinterland

HHS currently has slightly lower

self-sufficiency or not at CSCF Level

5 to meet increasing demand locally,

while ensuring services are safe and

sustainable. Targeted specialties

include ophthalmology, interventional

cardiology, medical paediatrics,

plastic and reconstructive surgery and

rehabilitation services.

• Improve the sustainability of key

existing specialised services, to

maintain Cairns and Hinterland

HHS’ current self-sufficiency to

ensure growing demand is managed

appropriately. Targeted specialties

include plastic and reconstructive

surgery, ear, nose and throat surgery,

ophthalmology, urology and vascular

services.

• Improve the delivery of sub acute

services by developing a Cairns and

Hinterland HHS sub acute services

plan.

• Develop a Cairns and Hinterland

HHS Infrastructure Master Plan for

new, expanded and refurbished

infrastructure across the Cairns and

Hinterland HHS.

• Improve the delivery of community

health services by developing a Cairns

and Hinterland HHS community health

services plan.

• Develop a public health strategy for

the Northern Queensland region, with

particular emphasis on infectious

diseases and containment of

outbreaks.

• Develop a stepped approach to become

a ‘university hospital’ with greater

education and research links

STRATEGIES


going forward .

Our services will be patient focused, delivering better outcomes by integrating services and implementing contemporary, evidence based models of care within the Cairns and Hinterland HHS.

Improvements in integrating care – within the Cairns and Hinterland HHS breaking down

the internal barriers between specialties and facilities – is a key opportunity for improving

access to services and health outcomes for the community. Closely aligned with this is the

development, enhancement and implementation of new models of care – and embedding them

so they become an everyday part of how we deliver care.

• Embed telehealth and digital healthcare

as part of standard service delivery

models to improve integration of the

Cairns and Hinterland HHS’ services as

well as linkages with other providers in

the health and human services sector.

• Improve patient flow across the Cairns

and Hinterland HHS and all services

through the implementation of

multidisciplinary teams and evidence

based contemporary models of care.

• Develop roadmap and coordination of

care across services and facilities to

support seamless continuity of care

for patients across the Cairns and

Hinterland HHS.

• Develop and implement patient centred

evidence-based models of care and

standardised care pathways across all

Cairns and Hinterland HHS services

to reduce clinical variation, improve

clinical outcomes and ensure efficient

and effective allocation of resources. In

particular:

▸ Focus on out of hospital (Hospital

in the Home) and ambulatory care

models (especially in surgery).

▸ Improved navigation, care

coordination and patient flow

through implementation of multi-

disciplinary teams.

▸ Target immediate health priorities

of renal, maternity, mental health,

older persons and emergency

department services.

STRATEGIES


We will provide care closer to home, where it is safe and sustainable to do so.

Our population is dispersed across a large, geographic region – many with growing

and ageing populations of their own. Where possible, people should not need to travel

to access services that are required on a regular basis, and/or where they can be safely

and sustainably provided locally. This will also help us to make the best use of the

facilities and skilled workforce we have.

• Increase the self-sufficiency

of our major rural sites, to

provide care closer to home for

these communities where it is

safe and sustainable to do so.

Service developments will be

explored, which may include

medical, sub-acute, and some

minor procedural activity

(dialysis, chemotherapy and

endoscopy) at Atherton,

Mareeba and Innisfail

Hospitals.

• Undertake a detailed planning

study to identify the feasibility

of greater medical and surgical

capability at Atherton, Mareeba

and Innisfail Hospitals.

• Improve communication,

coordination, and integration

between rural sites and Cairns

Hospital – including greater

use of telehealth and virtual

care.

• Improve our specialist support

to rural and remote areas

by (1) reviewing outreach

services to those services

most aligned with population

and service delivery need

and, (2) expanding the use of

telehealth to provide outreach

specialist support (using

the cancer care model as

exemplar to use across other

specialties).

STRATEGIES


The Cairns and Hinterland HHS will continue partnering to improve the health outcomes of Aboriginal and Torres Strait Islander Peoples.

Recognising the size of, and significant gap in health outcomes for our Aboriginal and

Torres Strait Islander community, the Cairns and Hinterland HHS aims to become leaders in

improving the health outcomes of Aboriginal and Torres Strait Islander Peoples. We will do

this by delivering culturally-appropriate care, alongside our community partners, ensuring

timely access to care.

• Jointly develop an Aboriginal

and Torres Strait Islander health

service plan for Far North

Queensland with neighbouring

HHSs’, the North Queensland

Primary Health Network,

Aboriginal Community Controlled

Health Organisations, and

other health and human service

providers.

• Develop targeted responses to

address high burden of disease

in the Aboriginal and Torres

Strait Islander community – from

prevention to community health

service provision through to acute

hospital care. This should focus

on priority health issues including

chronic disease, maternal and

children health and infectious

diseases (e.g rheumatic heart

disease and sexual health).

• Deliver culturally safe,

appropriate and accessible

services for the Aboriginal and

Torres Strait Islander population

through all clinical service

models.

• Develop formalised joint service

models & patient pathways

(including appropriate referral

and step down) with the Torres

and Cape HHS to support

consistent and quality care for

Torres and Cape residents; and

how Cairns and Hinterland HHS

can continue to support Torres

and Cape HHS to provide more

services locally.

STRATEGIES

going forward .

making it work


Our plan for implementationThe Clinical Services Plan forms part of a broader planning framework

to support the delivery of strategic priorities at the various levels of the

organisation. The planning framework provides an indication of how each layer

of planning fits together in implementing the strategic vision of the Cairns and

Hinterland HHS. The Cairns and Hinterland HHS Clinical Services Plan aligns

with the broader Queensland Health Clinical Services Planning framework

as well as taking into account the Queensland Government priorities and

strategies.

The Clinical Services Plan, along with the Cairns and Hinterland HHS Strategic

Plan will inform the development of the Cairns and Hinterland HHS Operational

Plan, as well as enabling plans (such as for workforce and infrastructure) and

service / unit / facility-level operational plans – that will identify how Cairns

and Hinterland HHS will achieve the directions articulated in this Plan.

Enabling and operational plans, including workforce, ICT, funding, infrastructure

and asset & maintenance plans will provide the operational details required to

deliver on the strategic direction of Cairns and Hinterland HHS.


Service Operational Plans (annual)

Based on the Cairns and Hinterland HHS Operational Plan, these plans identify the priorities and actions for each individual service and/or facility on how they will contribute to achieving the directions and vision set by the Board.

For clinical services and facilities, this includes an annual review of their Clinical Service Capability Framework (CSCF).

Enabling Plans

Cairns & Hinterland HHS – Operational Plan (annual)

The Operational Plan sets detailed priorities and actions for Cairns and Hinterland HHS each year to achieve the directions and vision set by the Board in the Strategic Plan and Clinical Services Plan, and the Service Agreement and Annual Delivery Plan with

the Department of Health. This is agreed annually by the Board and Cairns and Hinterland HHS Executive.

Service Agreement and Annual Delivery Plan

The Service Agreement and Annual Delivery Plan outlines the funding and performance KPIs agreed between the Board and the Department of Health. The Service Agreement provides a three-year funding outlook, and aligns with the Department of Health

Performance Framework.

Cairns and Hinterland HHS Clinical Services Plan (2018-2022, with outlook to 2027)

The Clinical Services Plan considers the demographic and health needs of the population, to understand the future demand for health services – and how our services should evolve over the short-medium term (including changes to models of care, where

and how we deliver certain services, our clinical capability, and growth in services). The CSP also considers changes required over time to the Clinical Services Capability Framework by service and facility.

Workforce Plan – identifies workforce requirements, linked to the Strategic Plan, CSP and Operational Plan

ICT Plan – identifies the information and technology requirements, linked to the Strategic Plan, CSP and Operational Plan

Executive Portfolio Operational Plans

Service / Facility Operational Plans

CSCF Review (clinical service)

Infrastructure Master Plan – provides a strategic view of how infrastructure should be developed in line with the priorities and requirements identified in the Strategic Plan and CSP. This includes refurbished, redeveloped and new infrastructure (such as new hospital beds)

Total Asset & Maintenance Plan – the TAMP prioritises individual capital projects for funding consideration through DoH and HHS processes.

Cairns & Hinterland HHS – Strategic Plan

The Strategic Plan outlines the vision, values, strategic directions and priorities for Cairns and Hinterland HHS, as set by the Board following stakeholder consultation.

Queensland Government priorities and strategies

going forward .

appendices


Appendix 1. Glossar y of Terms - Data Sources

The analysis presented in this report contains a range of data sources; below is a list of sources and description of the data used.

Data Description Source

Population projections Population projections for Cairns and Hinterland HHS are derived from the QGSO SA2 level projections and modified for the small proportion of the Tully SA2 that is part of the Townsville HHS

Queensland Government Statistician’s Office (QGSO)

Population demographic Population demographic statistics are derived from the QGSO with a similar modification as the population projections to account for the portion of the Tully SA2 in Townsville HHS

Queensland Government Statistician’s Office (QGSO)

Population health status The population health status and socioeconomic profiles were derived from data obtained through the Social Health Atlas provided by the Torrens University Australia

Social Health Atlas – PHIDU

Historical activity data The historical activity data was provided by the Cairns and Hinterland HHS Activity, Casemix and Costing team over a four year period (2012/13 to 2015/16)

Cairns Hinterland Analytical Intelligence (CHAI) system

Projected activity data The Queensland Department of Health uses a proprietary model to establish patient demand forecasts based on population ageing, growth, incidence of disease. These projections have been used as a baseline to estimate future activity projections for CHHHS

Acute Inpatient Modelling (AIM)

Cairns and Hinterland HHS Maps

Shapefiles from the ABS were used to map out the planning regions within the Cairns and Hinterland HHS and identify where hospitals were located based on the street address

Australian Bureau of Statistics (ABS)


appendices.

Appendix 2. Geographical Groupings

The analysis presented shows a number

of different geographical groupings based

on the granularity of the information

recorded. Below is a description of the

various levels of geographical regions

and the region fits within the Cairns and

Hinterland HHS boundaries. In addition

to the below geographical concordance

mapping, some data was only available

at the Public Health Network level. The

North Queensland Public Health Network

includes the following four HHSs and

hence covers a wide geographical area:

• Cairns and Hinterland;

• Mackay;

• Torres and Cape; and

• Townsville.

Planning Region 2016 FINAL

SA3 Name SA2 NAME (2011) Total

Cairns - North Cairns - North Brinsmead 100%

Clifton Beach - Kewarra Beach

100%

Freshwater - Stratford 100%

Redlynch 100%

Trinity Beach - Smithfield 100%

Yorkeys Knob - Machans Beach

100%

Cairns - South Cairns - South Cairns City 100%

Earlville - Bayview Heights 100%

Kanimbla - Mooroobool 100%

Manoora 100%

Manunda 100%

Westcourt - Bungalow 100%

Whitfield - Edge Hill 100%

Woree 100%

Cairns - South Cairns - South Bentley Park 100%

Edmonton 100%

Gordonvale - Trinity 100%

Lamb Range 100%

Mount Sheridan 100%

White Rock 100%

Innisfail - Cassowary Coast Innisfail - Cassowary Coast Babinda 100%

Innisfail 100%

Johnstone 100%

Tully 100%

Wooroonooran 100%

Yarrabah 100%

Port Douglas - Daintree Port Douglas - Daintree Daintree 100%

Port Douglas 100%

Tablelands (East) - Kuranda Tablelands (East) - Kuranda Atherton 100%

Herberton 100%

Kuranda 100%

Malanda - Yungaburra 100%

Mareeba 100%

Cook Far North Cape York 100%

Torres Strait Northern Peninsula 100%

Torres 100%

Torres Strait Islands 100%

Aurukun 100%

Weipa Kowanyama - Pormpuraaw 100%

Weipa 100%


Appendix 3. CSCF Level by Facil i ty

CSCF SERVICE Athe

rton

Hos

pita

l

Babi

nda

MPH

S

Cair

ns H

ospi

tal

Chill

agoe

PH

C

Cow

Bay

PH

C

Croy

don

PHC

Dim

bula

h H

ospi

tal

Fors

ayth

Hos

pita

l

Geo

rget

own

Hos

pita

l

Gor

donv

ale

Hos

pita

l

Her

bert

on H

ospi

tal

Inni

sfai

l Hos

pita

l

Lotu

s G

len

Corr

ecti

onal

Cen

tre

Mal

anda

PH

C

Mar

eeba

Hos

pita

l

Mill

aa M

illaa

PH

C

Mos

sman

Hos

pita

l

Mt G

arne

t PH

C

Rave

nsho

e PH

C

Tully

Hos

pita

l

Yarr

abah

Hos

pita

l

Alcohol & Other Drugs

Ambulatory 3 3 5 3 4 3 4 3 4 3 3

Emergency 2 1 5 1 3 1 3 1 1 2 1

Inpatient - adult 3 6 4 4 4

Inpatient - child and youth

Anaesthetic 3 5 3 3

Anaesthetic - Children’s 3 4 3 3

Cancer

Children’s 5

Haematological Malignancy 4 5 3

Medical Oncology 4 5 3

Radiation Oncology 5

Radiation Oncology - Children’s

Cardiac

Cardiac (Coronary) Care Unit 5

Cardiac Diagnostic & Interventional 3 5 3 3

Cardiac Medicine 3 5 3 3 3

Cardiac Outreach

Cardiac Surgery

Cardiac Rehabilitation - Inpatient 6 4

Cardiac Rehabilitation - Outpatient 4 6 4 4

Cardiac Rehabilitation - Ongoing prevention & maintenance Y

Emergency 3 2 5 1 1 1 1 1 1 3 1 1 3 1 2 1 1 2 2

Emergency - Children’s 5

Geriatric

Emergency geriatric care 3 5 1 3 3

Geriatric acute inpatient 3 6 3 4 3

Ambulatory 1 1 4 4 4 1 1

Cognitive impairment 5 4

Consultation liaison 3 6 4 4

Geriatric evaluation and management 6 3 4

Interim care 2 3 2 2

Geriatric rehabilitation 5 3 4

Ortho-geriatric 4

Intensive Care 6

Intensive Care - Children’s 5

Maternity 3 5 3 3 1 1 1

Medical 4 2 5 1 1 1 1 1 1 2 2 4 2 1 3 1 3 1 1 2 1


appendices.

Appendix 3. CSCF Level by Facil i ty cont

CSCF SERVICE Athe

rton

Hos

pita

l

Babi

nda

MPH

S

Cair

ns H

ospi

tal

Chill

agoe

PH

C

Cow

Bay

PH

C

Croy

don

PHC

Dim

bula

h H

ospi

tal

Fors

ayth

Hos

pita

l

Geo

rget

own

Hos

pita

l

Gor

donv

ale

Hos

pita

l

Her

bert

on H

ospi

tal

Inni

sfai

l Hos

pita

l

Lotu

s G

len

Corr

ecti

onal

Cen

tre

Mal

anda

PH

C

Mar

eeba

Hos

pita

l

Mill

aa M

illaa

PH

C

Mos

sman

Hos

pita

l

Mt G

arne

t PH

C

Rave

nsho

e PH

C

Tully

Hos

pita

l

Yarr

abah

Hos

pita

l

Medical - Children’s 2 1 4 1 1 1 1 1 1 2 1 2 1 2 1 1 2 1

Medication 4 2 5 1 1 1 1 1 1 2 2 3 2 1 4 1 3 1 1 2 1

Medical Imaging 4 2 5 1 1 1 4 3 3 2 1

Mental Health - Adult

Ambulatory 4 2 5 1 2 1 1 4 2 4 3 3 3

Acute inpatient 2 2 5 2 2 2 2

Non-acute inpatient

Mental Health - Child & Youth

Ambulatory 4 3 2 2

Acute inpatient 3

Non-acute inpatient

Mental Health - Older Persons

Ambulatory 4

Acute inpatient 4

Mental Health State-wide & Other Targeted services

Adult Forensic

Child & Youth Forensic

Deafness & Mental Health

Eating Disorder

Emergency 4

Evolve Therapeutic 5

Homeless Health Outreach

Perinatal & Infant 3

Transcultural

Neonatal 3 5 3 3 1 1

Nuclear Medicine 5

Palliative Care 4 2 5 1 1 1 1 1 1 3 2 3 1 1 3 1 2 1 1 2

Pathology 4 2 5 2 1 2 1 1 2 1 4 2 1 2 1 2 1 1 2 2

Perioperative

Acute Pain 5

Day Surgery 3 4 3

Endoscopy 4 5 4

"Operating Suite incorporating Sterilising services"

3 5 3 3 2 2

Post-Anaesthetic Care 3 5 3

Children’s Post- Anaesthetic Care 3 5 3 3

Rehabilitation 3 2 4 3 4 2 2

Renal 5 3

Surgical 3 5 3 3 2 2

Surgical oncology 5

Surgical - Children’s 3 4 3 2

Cairns and Hinterland Hospital and Health Service

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