Clinical Services Plan 2018 - 2022 page 1.
CLINICAL SERVICES
PLAN2018-2022
Cairns and Hinterland Hospital and Health Service
page 2.
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.
Clinical Services Plan 2018 - 2022 page 3.
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
Clinical Services Plan 2018 - 2022 page 5.
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
Cairns and Hinterland Hospital and Health Servicepage 6.
Clinical Services Plan 2018 - 2022 page 7.
.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
Cairns and Hinterland Hospital and Health Servicepage 10.
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
Clinical Services Plan 2018 - 2022 page 11.
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.
Cairns and Hinterland Hospital and Health Servicepage 12.
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
Clinical Services Plan 2018 - 2022 page 13.
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.
Cairns and Hinterland Hospital and Health Servicepage 14.
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 Plan 2018 - 2022 page 15.
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
Cairns and Hinterland Hospital and Health Servicepage 18.
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.
Clinical Services Plan 2018 - 2022 page 19.
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.
Cairns and Hinterland Hospital and Health Servicepage 20.
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
Clinical Services Plan 2018 - 2022 page 21.
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
Cairns and Hinterland Hospital and Health Servicepage 22.
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
Clinical Services Plan 2018 - 2022 page 23.
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.
Cairns and Hinterland Hospital and Health Servicepage 24.
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
Clinical Services Plan 2018 - 2022 page 25.
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)
Cairns and Hinterland Hospital and Health Servicepage 26.
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
Clinical Services Plan 2018 - 2022 page 27.
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
Cairns and Hinterland Hospital and Health Servicepage 30.
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
Clinical Services Plan 2018 - 2022 page 31.
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
Cairns and Hinterland Hospital and Health Servicepage 32.
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
Clinical Services Plan 2018 - 2022 page 33.
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
Cairns and Hinterland Hospital and Health Servicepage 34.
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
Clinical Services Plan 2018 - 2022 page 35.
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
Cairns and Hinterland Hospital and Health Servicepage 38.
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.
Clinical Services Plan 2018 - 2022 page 39.
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
Cairns and Hinterland Hospital and Health Servicepage 42.
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)
Clinical Services Plan 2018 - 2022 page 43.
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%
Cairns and Hinterland Hospital and Health Servicepage 44.
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
Clinical Services Plan 2018 - 2022 page 45.
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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