QUEENSLAND HEALTH Gladstone Hospital Health Services Review February 2012 Delivering more services sooner and closer to home Photograph: Bruce Peebles Photograph: Dean Whitling Photograph: Murray Waite and Associates Photograph: Thinkstock
Gladstone Hospital Health Services Review February 2012 Gladstone Hospital Health Services Review Published by the State of Queensland (Queensland Health), February 2012 This document is licensed under a Creative Commons Attribution 3.0 Australia licence. To view a copy of this licence, visit creativecommons.org/licenses/by/3.0/au State of Queensland (Queensland Health) 2012 You are free to copy, communicate and adapt the work, as long as you attribute the State of Queensland (Queensland Health). For more information contact: Senior Planning Officer Health Planning and Infrastructure Division Queensland Health GPO Box 48 BRISBANE QLD 4001 Email CQHealthserviceplan@health.qld.gov.au, phone (07) 49206763 An electronic version of this document is available at www.health.qld.gov.au/buildinghealth
1. Introduction A review of services at Gladstone Hospital (the Review) has been conducted within the broader context of health service planning for the resource rich Bowen, Galilee and Surat Basins (the Basins Plan). Further planning will continue as part of the Central Queensland Health Service District planning activities and will include further detailed planning in relation to workforce, infrastructure, information and communication technology and support services, in line with Queensland Health s rigorous planning processes. Health service planning will account for the provision of services for the projected population growth of both the resident and non-resident population. The Review examines the impact of projected population growth and demographic changes in the Gladstone area on hospital service needs. It describes the capacity and capability of Gladstone Hospital to accommodate those needs over time. The Review has been prepared primarily on the basis of: a review of available data, information provided from the Central Queensland Health Service District and consultation with key stakeholders (including key stakeholders in Gladstone) as part of the development of the Basins Plan. page 3
2. Planning context 2.1 Geographic profile Gladstone, Queensland s largest port, is located approximately 550 kilometres north of Brisbane, 100 kilometres south-east of Rockhampton and 180 kilometres north of Bundaberg. The town is situated on a deep water harbour, the base for much of Gladstone s industrial development. The Gladstone region has a number of significant industrial projects planned to be developed over the short, medium and long term, including the export of coal seam gas and liquefied natural gas produced in the Surat and Bowen Basins. The manufacturing, retail, trade and construction industries are the largest employers in this region, followed by healthcare and social assistance and education and training. Other major employers include: accommodation and food services; agriculture; forestry and fishing; mining; postal and warehousing, and transport. 2.2 Demographic profile For the purpose of this report, demographic information relates to the Statistical Local Areas (SLAs) of Gladstone, Calliope Part A and Calliope Part B and will collectively be referred to as the Gladstone area, as illustrated in Figure 1. This geographic region is within the boundaries of the Central Queensland Health Service District. The regional specialist hospital in this district is Rockhampton Base Hospital. The 2010 estimated residential population of the Gladstone area was 54 249. The fastest growing SLA was Calliope Part A, with a 2.0 per cent population growth, Calliope Part B and Gladstone City had a 0.7 per cent and 0.9 per cent population growth respectively between 2009 and 2010 1. At the time of the 2006 Census there were 1481 persons or 3.2 per cent of the population identifying as Aboriginal or of Torres Strait Islander origin. The majority (1078) of these persons resided in Gladstone City SLA 1. In 2006, 10.3 per cent of the population were born overseas, with 19.8 per cent of those speaking a language other than English at home 1. Calliope Part B had the highest proportion of socioeconomic disadvantage with 49 per cent of the population in the most disadvantaged quintile, in comparison to the total Queensland population which has 20 per cent in the most disadvantaged quintile 1. Overall the Gladstone area had 17 per cent of the population in the most disadvantaged quintile with only 12.7 in the least disadvantaged quintile 1. Projected population growth Government population projections for the Gladstone area indicate that the resident population is expected to increase from approximately 54 249 people in 2010 to approximately 67 001 by 2016 and 77 016 by 2021, based on the 2011 edition of population projections 2. This represents a 42 per cent increase from 2010 2021. Population projections also account for many of the non resident population as they are generally residents of the region and move around for work. Based on these projections, the population would reach 90 000 by 2027 28, however projections this far into the future are likely to be somewhat inaccurate particularly for a region that is so dependant on the boom (but unpredictable) economy of mining. page 4
Figure 1: Map of Gladstone (showing Calliope Part A, Calliope Part B and Gladstone SLAs) Rockhampton (R) - Rockhampton Rockhampton (R) - Fitzroy Pt A Rockhampton (R) - Mount Morgan Rockhampton (R) - Fitzroy Pt B Gladstone Population: 54 249 (2010 ERP) 67 001 (2016 projected 1 ) 77 016 (2021 projected) Hospital: 69 physical beds Gladstone Hospital Gladstone (R) - Gladstone Gladstone (R) - Calliope Pt A Gladstone (R) - Calliope Pt B Gladstone (R) - Miriam Vale Banana (S) North Burnett (R) - Monto Bundaberg (R) - Kolan Bundaberg (R) - Burnett Pt B Population projections by age groups based on the 2011 edition are not as yet available, however projections from the 2008 edition show that by 2026 growth will occur in all age North Burnett (R) - Perry groups. The largest percentage increase will be among those aged 70 years and over. The number of people in these older age groups will increase by over 100 per cent by 2026. The implications for health services of the ageing population are increased demand for a wide range of acute medical and surgical services, chronic disease services, rehabilitation, aged care assessment, and sub-acute care. 2.3 Resource sector development There are currently 17 major resource related projects planned for the Gladstone area. These include expansions to existing projects as well as new projects 3. The cumulative workforce required for these projects is significant, and, based on surveys conducted by the Office of Economic and Statistical Research (OESR), Queensland Treasury, is estimated to be over 8000* during the construction phase. The size of the workforce typically falls during the operational phase of projects of this type. However, based on historical gas and coal project completion data from the Australian Bureau of Agriculture and Resource Economics for 2002 2010, less than half of proposed projects were actually completed and the average delay between the initially listed start * This is an estimate from OESR based on information available on projects at a point in time and is subject to variation. page 5
date and actual start date was 17.5 months 4. Furthermore, advice from the OESR indicates that projected workforce numbers are often much larger than actual workforce numbers for individual projects once they begin operations. Nevertheless, population in the next decade due to expansion in the mining and energy sectors in the Gladstone area is expected to grow significantly due to Gladstone s role as a major export port for these natural resources. It is likely though that there will be fluctuations in population growth according to stages of construction and ongoing running of projects. Decreases in the non-resident population will occur on completion of the construction phase and commencement of operation of projects. 2.4 Changes at Gladstone Hospital Infrastructure The Review has determined that over the last decade there has been growth in the number and type of buildings on site at the Gladstone Hospital. The main Hospital buildings were built in the 1980s with completion of various additional infrastructure redevelopments since 1998 including: a redevelopment of the emergency department in 1998 the addition of two, five bedroom staff housing accommodation buildings in 2003 the addition of two duplexes for staff housing accommodation in 2007. Further redevelopment was enabled with Australian and Queensland Government funding of $17.045 million for relocation of community health, oral health and mental health services on the Gladstone Hospital campus and was provided to enable the provision of more focused services to the community. The relocation of Community Health Services was completed in March 2007, Mental Health Services in June 2008 and construction of a five chair Oral Health facility in 2010. Workforce Growth in the workforce at Gladstone Hospital over the last decade shows an increase in nursing, operational and professional, and technical staff by between 17 and 19 per cent. The largest proportion of the workforce for the last decade has been the nursing workforce, followed by the operational, then managerial and clerical workforce. The proportions of medical, and professional and technical staff are similar, and have remained relatively constant over the last decade, although there has been marginally more growth in the professional and technical workforce. Growth in population means there is a projected need for additional beds at Gladstone Hospital to 2021, and accompanying need for an increased workforce. Workforce numbers have been calculated using the projected increase in beds required out to 2021, which indicate a requirement for almost 200 additional staff across medical, nursing, operational, health practitioners and managerial or clerical streams. Queensland Health is undertaking workforce planning in conjunction with the collocated private hospital that provides medical specialists to the public hospital. In addition, planning is also occurring at a District level, considering integrated District-wide service delivery models. Workforce planning will take into consideration future models of care and sustainability options for attracting and retaining a skilled workforce, including the use of new and emerging roles. Gladstone Hospital will use the Rural Generalist Training model to support provision of a sustainable medical workforce. page 6
Clinical Services As a result of the increase in workforce and new infrastructure, Gladstone Hospital has been able to provide a range of clinical services, including general medicine, surgery, maternity, paediatrics, emergency services, outpatients, medical imaging, pathology and pharmacy. Gladstone Hospital provides health services supported by the provision of services at the private hospital co-located on site. The Rockhampton Base Hospital provides the majority of specialist services in the Central Queensland Health Service District. These services include rehabilitation, renal, coronary care, intensive care, specialist medicine and surgery, oncology and neonatal services. To manage difficulties in recruitment and retention of midwifery staff, a Model of Care project reviewed the current model of care and the way in which maternity services are delivered in both private and public sectors. The Australian Government has announced a GP Super Clinic will be located in Gladstone and is expected to commence in the near future. 3. Service needs Health services in the catchment are facing a range of challenges in the next decade. Added to the general growth in the population, the increased number of older people in this area will bring with it an even greater demand for health services. The forecast increases in population will translate to increases in service demand. Consultation has occurred with key stakeholders as part of the development of the Basins Plan. Initial feedback from the consultation process (July and October 2010) on key service needs specific to Gladstone Hospital included: difficulties in recruitment of skilled health professionals including medical specialists nursing, midwifery and allied health professionals concerns about patients traveling to and from Rockhampton for medical services a desire for local access to renal dialysis the need for expansion of the emergency department at Gladstone Hospital a desire for Gladstone Hospital to have an Intensive Care Unit (ICU). 4. Health status The fertility rates in 2005 2007 for the Gladstone area were between 2.05 and 2.42, this is significantly higher than the Queensland rate of 1.91 and the national rate of 1.83 6. In 2004 05, Gladstone area residents exhibited higher levels of smoking, risky alcohol consumption and obesity than the Queensland rate 6. Gladstone area residents also had higher rates than the Queensland average for avoidable deaths due to cancer, cardiovascular diseases and respiratory system diseases during the period 2003 to 2007 6. page 7
5. Current services The Gladstone Hospital has 69 beds and bed alternatives used predominantly by residents of the Gladstone area. Inpatient and outpatient services are provided at the hospital. Queensland Health also provides a range of community health services. l In 2009 10 Gladstone Hospital provided services to 6443 admitted patients 7, 24 389 presentations to the emergency department, 25 471 outpatient attendances, and 45 025 diagnostic services (including pathology, pharmacy and diagnostic imaging) 8. Most separations in 2009 10 from Gladstone Hospital related to people residing in the SLAs of Gladstone (61.4 per cent) and Calliope (28.9 per cent). The top five service related groups for separations were for: obstetrics; non-subspecialty surgery; diagnostic gastrointestinal endoscopy; cardiology and non-subspecialty medicine. Analysis of hospital separations indicates that of the residents in the Gladstone area who had hospital separations in 2009 10, 37.0 per cent attended Gladstone Hospital, 46.4 per cent attended private hospitals, 8.6 per cent attended Rockhampton Base Hospital, 3.0 per cent attended Royal Brisbane and Women s Hospital, and 5.0 per cent attended other Queensland hospitals. Gladstone Hospital provides a range of clinical services, including general medicine, surgery, maternity, paediatrics, emergency services, outpatients, medical imaging, pathology and pharmacy. The Rockhampton Base Hospital provides the majority of specialist services in the Central Queensland Health Service District. These services include rehabilitation, renal, coronary care, intensive care, specialist medicine and surgery, oncology and neonatal services. Gladstone Hospital provides health services supported by the provision of services at the private hospital co-located on site. The Mater Private Hospital offers a range of low complexity specialist services to the community of Gladstone including maternity, surgical and medical including day only oncology. Gladstone Hospital purchases the services of specialist medical staff and the Computerised Tomography Scanner (CT) at the private hospital when necessary to provide services to the Gladstone community. 6. Future service direction In line with Queensland Health s current planning in the region including the Basin s Plan, Gladstone and Rockhampton hospitals will work towards enhanced coordination of services between the two sites. This will ensure the delivery of safe and sustainable patient care and maximise the use of available workforce skill. Gladstone Hospital will continue to provide a comprehensive range of clinical services and grow capacity over time. Rockhampton Base Hospital will continue to be the regional service providing higher capability health services, and support across the District. Health service planning has accounted for services for both the projected resident and nonresident populations and the expected fluctuations in population growth. As population demands on services at Gladstone Hospital increase, the clinical capability of services will be reviewed and, as required, existing services will grow and new services will be added. While initially the range of clinical services will remain largely unchanged, increased capacity may be required in: emergency medicine, general medical and oncology services by 2021. Provision and sustainability of these services and any increased clinical capability will be impacted by the ability to attract and retain a skilled workforce and the provision of the support services page 8
required. Increasing coordination and integration with Rockhampton Base Hospital and the potential for the further development of partnerships with the co-located private hospital may assist in enhancing the provision of safe and sustainable services to the communities in the Gladstone area. Based on projections, Gladstone Hospital will require approximately 111 overnight and same day beds and 27 emergency treatment spaces by 2021 22. The distribution of these beds will be across surgical and medical services, cancer care, maternity, rehabilitation, endoscopy, paediatrics and palliative care services. Surgical and medical services The Review determined that Gladstone Hospital s two operating theatres and one procedure room would be sufficient for the projected surgery and procedural activity for the growing population. However, expansion and refurbishment of the medical and surgical areas will be required to accommodate additional beds to support future demand and contemporary service delivery models. The number of medical and surgical beds would need to be increased to accommodate the increase in activity from 52 to 67 (including endoscopy) by 2021. Emergency services The Review determined that the Emergency Department at Gladstone Hospital should continue to operate 24 hours a day, seven days a week, with Rockhampton Base Hospital acting as a regional specialist emergency department supporting staff at Gladstone Hospital s Emergency Department. All acute patients would be treated at Gladstone Hospital and if required transferred to either Rockhampton or a Brisbane hospital for higher level care. Telehealth linkages would provide shared staff access to health assessment, diagnosis, intervention, consultation, supervision and information between the two hospitals. This will strengthen communication and improve patient care. The Review also determined that Gladstone Hospital would require expansion of the emergency department from 11 to 27 treatment spaces, including increased trauma and resuscitation services by 2021. Intensive care services To care for acutely ill patients, Gladstone Hospital will continue to have close observations areas integrated within existing clinical areas, such as the surgical wards. Along with the current services of the High Dependency Unit (HDU), these are designated areas where patients with an increased dependence on nursing support and additional monitoring can be cared for. This will provide greater ability for the hospital to service acute patients. Queensland Health will continue to monitor the demand for these services and any further expansion requirements to ensure that the region s population continues to have access to safe, sustainable and quality intensive care services. Renal services The Review determined that the existing self-managed renal dialysis service at Gladstone Hospital is sufficient for the current population. However, to support those in the Gladstone community requiring renal dialysis to access services with minimal travel, and to meet the projected demand from population growth, a satellite renal dialysis service is being established. Cancer services The Review determined that an increase in capacity of cancer services, and in particular chemotherapy services, from three to six chairs, will be required by 2021. page 9
Maternity services The Review supports the midwifery caseload model which is being implemented with the aim of improving recruitment of midwives and will also provide increased choice in maternity services to the women of Gladstone. One additional maternity bed will be required to meet demand to 2021, taking the total to 10 maternity beds. Rehabilitation and sub-acute services The Review determined that the establishment of a dedicated 19 bed sub-acute unit will be required by 2021 to support the projected increase in the ageing population and palliative care service need. Support services The Review determined that clinical support services such as pharmacy should be increased in physical size to meet expected demand by 2021. Based on the projected population to 2021 CT scanning services will continue to be purchased from the private hospital on site and the portable Magnetic Resonance Imager (MRI) will continue to be provided from Rockhampton on a weekly basis. Infrastructure expansion By 2021, Gladstone Hospital will need to increase its current size based on the future service directions. Gladstone Hospital is situated on 8.532 hectares and preliminary infrastructure planning suggests that expansion of services will be accommodated on this site. However detailed master planning of the site will be required to assess and confirm infrastructure requirements to deliver on the future service requirements. Community and private hospital services To meet future demand for health services there may be opportunities in the future for services to be delivered through partnerships and flexible purchasing arrangements with the community and private hospital sectors. Currently there are 30 beds at the co-located private hospital where low complexity maternity, medical (including day oncology) and surgical services are delivered. The Australian Government has announced a GP Super Clinic will be located in Gladstone and is expected to commence in the near future. 7. Summary The Review determined that as the population in the Gladstone area grows to approximately 77 000 by 2021, increased capacity and associated infrastructure will be required in relation to general medical and surgical beds, the emergency department, rehabilitation and subacute services and pharmacy services. There will also be a corresponding impact for the workforce, both in terms of numbers and the composition of the clinical workforce at the Gladstone Hospital and the broader Central Queensland region. Population growth in the area will largely be linked to the resource related projects that are planned for Gladstone. As with any high growth industry, the rate of growth will be integrally linked to the success of the industry and the stages of project development. page 10
8. References 1 ABS. Population by Age and Sex, Australia. Catalogue Number 3235.0. Australian Bureau of Statistics, 2010. 2 ABARE. Mineral and Energy Major development projects. Australian Bureau of Agricultural and Resource Economics (ABARE). Australian Government, 2010. 3 ABARE. Mineral and Energy Major development projects. Australian Bureau of Agricultural and Resource Economics (ABARE). Australian Government, 2002 to 2010. 4 Australian Institute of Health and Welfare. GP Super Clinics: 2007-08 GP Super Clinic Commitments. AIHW, 2011. 5 Public Health Information Development Unit. Social Health Atlas of Australia: Queensland, 2010 internal data 6 Queensland Government. Queensland Health Admitted Patient Data collection, 2011 internal data 7 Queensland Government. Non-Admitted Patient Occasions of Service by Clinic Type, Queensland 2009/10 internal data. page 11
QUEENSLAND HEALTH Gladstone Hospital Health Services Review February 2012