Tasmania’s · A review of regional access to public acute hospital resources suggests that access...

Clinical Services Plan: Update Incorporating changes to ownership of the

Mersey Community Hospital May 2008

Tasmania’s HealTH Plan

Depar tment of Health and Human Ser vices

For more information on Tasmania’s Health Plan visit www.health.tas.gov.au

1Clinical Services Plan: Update

Table of ContentsForeword 3

Executive summary 4

Introduction 8

Implementation commitments 9

Tasmania’s community and its health status 15

Tasmania’s population 15

The socio-economic and health status of Tasmanians 19

Implications for Tasmania’s health care system 21

Tasmania’s public acute hospital system 22

Introduction 22

The Royal Hobart Hospital 22

The Launceston General Hospital 23

The North West Regional Hospital (Burnie) and the Mersey Community Hospital 23

Principles for Tasmania’s health services 27

Progress since publication of the Clinical Services Plan 28

Inpatient activity 28

Emergency activity 28

Community-based services 29

Clinical Services Plan initiatives 29

Aligning the Department’s structure with service delivery objectives 30

The service capability framework 32

Principles 32

Cooperative service development and support 33

Statewide services – governance, funding and accountability 33

Applying the service capability framework to existing services 36

Specific service issues 41

Autologous bone marrow transplantation 41

Adult medical retrieval 41

Bariatric surgery 41

Cardiac electrophysiology 42

Hyperbaric medicine 42

Medical imaging 42

Pathology 42

Rehabilitation 43

Vascular surgery 44

2 Clinical Services Plan: Update

Integrated care centres 46

Commitment to develop purpose-built facilities for integrated care 46

Integrated care – a definition 46

The need for integrated care 46

Types of integration of health care 47

Efficiency and accessibility of hospital services 50

Introduction 50

Benchmarking Tasmania’s resources 50

Using resources efficiently – benchmarking length of stay 51

Using resources efficiently – potentially avoidable hospital admissions 52

Regional utilisation rates 53

Regional self-sufficiency 54

Equity of regional investment 55

Access to emergency department services 59

Predicting future demand 60

Meeting the needs of the community – the future service system 64

Introduction 64

Planning sub-catchments for the North West region 65

A single hospital for the North West region 65

Planning for an integrated service system in the North West region 66

Planning assumptions for the North and North West regions 69

Planned acute hospital activity, 2016–17 72

Planning outcomes for the North West Regional Hospital (Burnie) 75

Planning outcomes for the Mersey Community Hospital 76

Planning outcomes for the Launceston General Hospital 77

Planning outcomes for the Royal Hobart Hospital 78

Enablers of a sustainable service system 81

Clinical networks 81

Workforce 83

Stakeholder engagement and distributed governance 83

Glossary of abbreviations 85

Glossary of terms 86


ForewordLast year, when I released Tasmania’s Health Plan and the documents that underpin it – the Clinical Services Plan and the Primary Health Services Plan – I said that it was time to ‘take the politics out’ of health care. I argued that it was time to make patients, along with the quality, safety and sustainability of the care they receive, our focus.

Four short months later another chapter in the shared history of politics and health was written with former Prime Minister John Howard’s intervention at the Mersey campus of the North West Regional Hospital.

Ownership of the Mersey Community Hospital was transferred from the Tasmanian Government to the Australian Government on 23 November 2007. Given its intended role in the coordination of hospital services in Tasmania, the Mersey’s change of ownership made it necessary to update the Clinical Services Plan.

The update that follows is not only the result of that work, but it also provides an opportunity to do much more than dwell on the change of ownership.

Indeed, it provides a chance to show that work is progressing on the implementation of Tasmania’s Health Plan with the majority of projects associated with it well underway.

It also allows new and updated information to be included to ensure the development of Tasmania’s public acute hospitals and related services is based on the most accurate data projections available.

This update incorporates specific goals and timeframes for implementation, and includes a number of recent initiatives being pursued by the new Australian Government.

These initiatives will significantly improve the availability of acute health services to our community and need to be taken into account as we plan the growth and development of Tasmania’s public acute hospitals.

While the Tasmanian Government believes the 2007 Clinical Services Plan represents the best approach to meeting the health needs of all Tasmanians, this update re-endorses the principles of access, quality, safety and sustainability that underpinned the Plan.

It also sets out an approach to working constructively with the Mersey Community Hospital to ensure the services it provides in the future are integrated as much as possible with other public health care services on the North West Coast.

I am confident that this Clinical Services Plan update, as part of Tasmania’s Health Plan, provides a sound basis for the future of health care in this State. I look forward to its continued implementation and improvements in our health services in coming years.

Lara Giddings Minister for Health and Human Services


Executive summaryTasmania’s Health Plan, published in May 2007, incorporated a Primary Health Services Plan and a Clinical Services Plan which defined the future configuration of Tasmania’s public acute hospital services. Since that time, a number of changes have occurred, including but not limited to the purchase of the Mersey Community Hospital by the Australian Government.

The Tasmanian Government believes that the changes proposed in the 2007 Clinical Services Plan represent the most appropriate approach to meeting the health needs of the community, particularly in the North West region of Tasmania. Nevertheless, the changes that have occurred since the 2007 Clinical Services Plan was published require it to be updated.

This Clinical Services Plan update reviews progress since the Clinical Services Plan was published, addresses the impact of a number of Commonwealth and State initiatives and incorporates data modelling based on the most recent service utilisation and demographic data available.

Planning has continued on the redevelopment of the Royal Hobart Hospital (RHH) and on the development of an Integrated Care Centre (including a renal dialysis unit) in Launceston. Funding commitments have been made for a number of new services including a fifth linear accelerator for the State, two magnetic resonance imaging units (one at the Launceston General Hospital, the purchase of which has been approved, and one in the North West region) and a positron emission tomography (PET) scanner at the RHH. A review of bone marrow transplantation services has been concluded and the results are being implemented, and a number of other service reviews are progressing in accordance with commitments made in the 2007 Clinical Services Plan. The Department of Health and Human Services (the Department) has been restructured to enable it to meet the needs of the community more effectively and efficiently.

The higher prevalence of chronic disease and poorer health of Tasmanians compared to other Australians are confirmed in recent data.

The public acute hospital system continued to provide a high level of service to the community in 2006–07 with growth in both inpatient and emergency department presentations.

In this Clinical Services Plan update, the Tasmanian Government endorses the key principles established for Tasmania’s health services in the 2007 Clinical Services Plan. Service accessibility is a key goal, providing services can be delivered safely, effectively and at acceptable cost locally. Where services are not sustainable locally, they will be coordinated to optimise access for all Tasmanians, regardless of where they live.

With a population of less than 500,000 people, some services (e.g. cardiac surgery) can only be provided on a statewide basis from one site in Tasmania. Other services are provided as regional referral services by the Launceston General Hospital (LGH) to communities in the North West region. The 2007 Clinical Services Plan principles for regional referral and statewide services are endorsed and clarified. The LGH is recognised as the major referral hospital for the North West region. The requirement for the RHH and the LGH to be funded for the provision of necessary outreach services and to demonstrate accountability to the stakeholders in the outreach region for the quality and accessibility of those services is affirmed.

A number of specific service commitments are made in this Clinical Service Plan update. A decision about the introduction of cardiac electrophysiology services will be made by June 2010. The need to invest in rehabilitation services is recognised widely and the Department will publish an implementation plan for rehabilitation services by February 2009. Specific arrangements will be made to ensure that vascular surgery services are accessible to residents across the State while maintaining a sustainable statewide service.


The commitment in the 2007 Clinical Services Plan to develop integrated care centres (ICCs) provides a unique opportunity for the Tasmanian health care system to develop new models of care which span the interface between hospital and community services. The Department will finalise its policy and planning framework for ICCs by July 2008, enabling progression to a detailed model of care and facility planning. Work has commenced with the Australian Government to determine the best way to progress the planned GP Superclinics in Clarence/Sorell, Burnie and Devonport in the context of the Tasmanian Government’s planned investment in ICCs.

Review of resource and activity data suggests that there are continuing opportunities to improve the utilisation of resources in Tasmania’s public acute hospitals. There is a relatively high number of public hospital beds across the State (including a relatively high number of beds in small rural hospitals), but a low number of public hospital separations, a relatively low number of patient bed days per annum, a high average length of stay and a higher-than-average cost weight per casemix-adjusted separation. There was a modest reduction in 2006–07 in the number of admissions of patients with conditions which are classified as potentially able to be managed on a non-admitted basis.

If benchmark lengths of stay were achieved, more than 30 hospital beds would be freed up across the State. The Department and the public acute hospitals will continue to develop strategies to achieve best practice in length of stay across all diagnostic categories.

A review of regional access to public acute hospital resources suggests that access is higher in the North West and North regions compared with the South region, but when public and private access is considered residents of the South region have significantly better access to hospital services than residents of the North and North West regions. It is likely that differential investment will be required to improve access by residents of the North West, in particular, to public acute hospital services, although options to invest in non-admitted services and to encourage greater levels of private service provision also should be explored.

Most Tasmanians access public acute hospital services in the region in which they live. In the North West, 76 per cent of public hospital separations were provided by the North West Regional Hospital (Burnie or Mersey campuses or via public contracts or to dialysis patients treated in Burnie by the LGH) in 2006–07. Fewer than 6 in 100 patients from the North West region who received public hospital inpatient care in the State in that year received care from the RHH. The LGH provided almost 88 per cent of public hospital separations within Tasmania utilised by residents of the North. There was a high level of self-sufficiency for public hospital services in the South of the State.

There are no proposals in this Clinical Services Plan update that will reduce self-sufficiency for Tasmania’s residents. Over time, opportunities to improve self-sufficiency in the North West by increasing the range of services delivered locally or on an outreach basis should be captured.

Some clinicians and managers in Tasmania’s acute public hospitals are concerned that the distribution of resources between the hospitals is inequitable. This is a complex issue that requires consideration of a range of factors including region-specific costs, the costs of teaching and training and the complexity of patient care. The Department recognises that it is an important issue which requires resolution. The Department will complete a detailed study of cost modelling and resource allocation benchmarks to establish a mechanism to ensure equity in future resource allocations.

There are high levels of demand for emergency department services in Tasmania, particularly in the North West and North of the State. The increased demand in these regions correlates with the reduced access to GP services experienced by these communities. The Department will work with the Australian Government, Divisions of General Practice and other relevant organisations to develop a ‘whole-of-state’ strategy for general practice with the objective of improving access to general practitioners, particularly in the North West region.


Demand for public acute hospital services, particularly for older people, is predicted to grow across the State by 30 per cent between 2006–07 and 2016–17. A requirement for an additional 67 same day beds and an additional 345 multi-day beds across the State by 2016–17 is predicted.

There will be a need for more operating theatres, but there is sufficient capacity within current and planned facilities to accommodate this demand.

Emergency department activity is projected to increase by more than 25,000 presentations per year by 2016–17. There will be a need for increased physical capacity, particularly at the LGH, to accommodate this demand unless it can be ameliorated through other strategies. This is being addressed by strategic assessment planning and announcements to upgrade the Department of Emergency Medicine at the LGH.

The 2007 Clinical Services Plan proposed a fundamental redesign of the public acute hospital services in the North West region with consolidation of high acuity services on the Burnie campus of the North West Regional Hospital (NWRH) and consolidation on the Mersey campus of high throughput day surgery and specialist aged care and rehabilitation services. The acquisition of the Mersey Campus of the NWRH by the Australian Government has led to this review.

Both the Australian and Tasmanian Governments have expressed a firm commitment to work together to develop an integrated and sustainable service system for residents of the North West.

This Clinical Services Plan update includes two potential models for services in the North West, which will need to be refined when the Australian Government has confirmed the range and volume of services that will be provided by the Mersey Community Hospital. In the context of current circumstances, the Tasmanian Government prefers Model 1, which is very similar to the service model proposed in the 2007 Clinical Services Plan and which designates the Mersey Community Hospital as a provider of day surgery and specialist aged and rehabilitation services, together with low risk obstetric and emergency services. In addition, the revised model provides for the Mersey Community Hospital to admit medical and paediatric patients with low complexity conditions, supported by a high dependency unit.

Model 2, although not preferred by the Tasmanian Government, reflects its understanding of the intention of the Australian Government to develop the Mersey Community Hospital as a full service community hospital.

Under both models the NWRH (Burnie) will continue to provide the range of services outlined in the 2007 Clinical Services Plan, including a regional intensive care unit.

Both models predict significant growth in overnight admissions to the NWRH (Burnie) with bed growth to either 163 or 183 beds, depending on which model is implemented. Both models also predict modest growth at the Mersey Community Hospital – to either 95 or 118 beds. The number of patients treated at the Mersey Community Hospital is approximately equal under both models, but Model 1 provides a greater focus on same day patients.

The Australian Government is seeking a religious and charitable or private sector organisation to operate the hospital as a full service community hospital. The Tasmanian Government believes that a full service profile as provided for in Model 2 is unlikely to be sustainable. If the new operators are unable to deliver health care services of an acceptable range and quality, the Tasmanian Government would only consider resuming responsibility for the hospital on the basis that Model 1 was implemented.


It will be important for both levels of government to commit to delivering an appropriate range and volume of services and to demonstrate appropriate accountability to the community for the provision of these services. A range of measures including services by type and volume, trends in service complexity and trends in regional and sub-regional self-sufficiency can be used as a basis for monitoring performance and demonstrating accountability to the community. The Tasmanian Government will seek the Australian Government’s agreement to a robust performance monitoring and reporting framework based on these and other appropriate measures for the Mersey Community Hospital.

While some stakeholders consider that a single site regional acute hospital in a ‘neutral’ geographic position would resolve the sustainability problems experienced by public acute hospital services in the North West, a range of factors would need to be considered in relation to that proposal. Should the Tasmanian Government decide to progress the development of a single site regional hospital in the future, a full planning assessment of the best location for that hospital and the potential operational benefits that would be achieved should be conducted. In the absence of identified capital for such a development, this Clinical Services Plan update assumes that both the NWRH (Burnie) and the Mersey Community Hospital will continue to deliver inpatient services from their current sites.

Significant growth is predicted for the LGH, with bed requirements increasing by approximately 20 same day and almost 100 multi-day beds in both models.

Planning for the RHH is continuing, with a growth in separations of 31 per cent expected. Increases of 33 same day beds and 130 multi-day beds will be required to meet this demand. The redevelopment of the RHH also provides a unique opportunity to develop innovative new models of care supported by purpose-built physical facilities.

This Clinical Services Plan update reiterates the importance of Tasmania’s clinicians and health care managers working together to ensure that service development initiatives in specific regions do not compromise the sustainability of existing services or the development of new ones of benefit to the State as a whole.

A large number of specific commitments are made in this Clinical Services Plan update to provide a basis for monitoring progress and ensuring transparency and accountability of implementation.


IntroductionSince the Clinical Services Plan was published in May 2007, a number of changes have occurred that will impact on the future of Tasmania’s acute hospital system, including:

• ownershipofandoperationalresponsibilityfortheMerseycampusoftheNWRHhavemovedfrom the Tasmanian Government to the Australian Government, which has announced that it intends to seek a religious and charitable or private sector organisation experienced in managing public hospitals to operate the Mersey Community Hospital as a public hospital from 1 July 2008;

• thefollowingcommitmentshavebeenconfirmedasAustralianGovernmentpolicy:

– $15 million for GP Superclinics in Clarence/Sorell, Burnie and Devonport. Work has begun with the Australian Government to determine the best way to progress these in association with the ICCs recommended in the Clinical Services Plan;

– $7.7 million for an additional radiation oncology service in the North or North West of the State;

– $3.5 million in support of a PET scanner at the RHH;

– $15 million for an ICC in Launceston;

– $10 million for patient transport services including the purchase of community buses; and

– two Magnetic Resonance Imaging (MRI) services approved for Medicare-eligibility purposes in Launceston and the North West;

• theDepartmenthasannouncedthepurchaseofanMRIfortheLGH;

• considerableprogresshasbeenmadeinplanningtheredevelopmentoftheRHH;and

• variousspecificreviewshavebeencompleted,includingreviewsofstatewideretrievalservicesand autologous bone marrow transplantation services, and recommendations for service redesign and development have been made.

In addition, the Australian Government has made a number of commitments to address health issues nationally, creating significant opportunities for Tasmania:

• anElectiveSurgeryWaitingListReductionPlanincorporatingimmediateandlonger-termactionsto improve access to elective surgery. Significant additional funding will be available to enable an elective surgical blitz in Tasmania. The Elective Surgery Waiting List Reduction Plan provides for patients to elect to be referred to hospitals where waiting times are shorter. Public hospitals will be able to purchase additional capacity from private hospitals if necessary;

• nationalinvestmentsinagedcare,including:

– 2,000 additional transition care places for frail aged people waiting for an aged care place, which will help free up public hospital beds, complementing a transition care program jointly funded by the Australian and Tasmanian Governments;

– $300 million in low-interest loans to build or expand residential and respite facilities in areas of need;

– 600 Community Aged Care Places;

– 400 Extended Aged Care at Home packages (including 200 dementia-specific); and

– 800,000 practice nurse home visits.

It is timely to update the Clinical Services Plan to take account of the initiatives that have been announced since the Plan was first published.

This update has been informed by a full review of the most recent activity and demographic data available as well as consultation with representative clinicians, managers and other stakeholders across the State.


Implementation commitmentsThis Clinical Services Plan update defines a large number of commitments by the Tasmanian Government and in particular the Department to effect changes to the range of health care services and to the way some services are delivered in Tasmania’s public acute hospitals.

It defines projections for activity through to 2016. These projections will facilitate annual and three-yearly planning of activity and models of care. In addition, it defines a number of actions that need to be taken in relation to service development and service governance and the timeframes within which these commitments will be effected. These will form the basis for a detailed implementation plan to ensure that the Clinical Services Plan serves its intended function as a blueprint for the development of Tasmania’s acute hospital system.

The following commitments are made in this Clinical Services Plan update:

Implementation commitment Timeframe

1 The Department will revise and publish the population and demand projections in this Clinical Services Plan update when population projections based on 2006 census data are published by the Australian Bureau of Statistics (ABS), recognising that while those population and demand projections will be more accurate than those available at present, the underlying trends in demand which form the basis for the Plan will not change.

When ABS data are available

2 The Tasmanian Government re-endorses its commitment to the principles defined in the 2007 Clinical Services Plan and in particular to:

•serviceaccessibilitywhereservicescanbedeliveredsafely,effectivelyandefficiently; and

•designingTasmania’spublichealthservicestoensuretheirsustainability.

Ongoing

3 The Department will:

•completethebusinesscasefortheredevelopmentoftheRHH(includinganICC);

•workwiththeAustralianGovernmentto:

– progress planning for an ICC (including a renal dialysis service) in Launceston and a radiation oncology unit in Burnie or Launceston; and

– progress the installation of MRIs at the LGH and in Burnie, and a PET scanner at the RHH as a priority;

•completetheredevelopmentoftheLGHemergencydepartment;

•publishanimplementationplanforasustainablemedicalretrievalservice;

•completeatransportstrategytoenablethedevelopmentofacomprehensive,coordinated service that is client-focused and timely and provides clinically appropriate transport options;

•completeapatientaccommodationstrategy;and

•finaliseimplementationofstatewideservicesforbonemarrowtransplantationand vascular surgery, including identifying a specific statewide services budget and facilitating agreement about the extent of outreach services and the role of LGH clinicians.

By December 2008

Commence immediately

By June 2010

By June 2008

By June 2008

By June 2008

By December 2008

4 The Department endorses and clarifies the following principles for regional referral and statewide services:

•apatient-focused,system-wideapproachwillbetaken,basedontheneedsofall Tasmanians. Services will not be designed or developed around the needs of individual clinicians, individual regions or individual hospitals;

•criticalclinicalinter-dependencieswillbetakenintoaccountwhenplanningthelocation of regional and statewide services;

•fundingtoenableregionalandstatewideservicestofulfiltheiradditionalresponsibilities (e.g. to enable the provision of outreach services) will be provided as appropriate, through funding streams independent of normal hospital budgets;

Ongoing



•regionalandstatewideserviceswillberequiredtoparticipateintheusual clinical and management quality and accountability processes that apply at their host hospital;

•regionalandstatewideservicesthatareprovidedwithadditionalinfrastructurefunding to support an outreach role also will be required to account for their performance to their broader communities of interest, addressing issues such as accessibility and outcomes of care across the State;

•moststatewideserviceswillcontinuetobelocatedattheRHHbecauseithasthe highest level of infrastructure, necessary associated services and access to important non-health organisations that aid in quality service provision and attraction and retention of professional staff for those types of services; and

•ifastatewideservicedoesnotdependoncriticalinternalorexternalrelationshipsthat are more achievable at the RHH, the service may be located at the LGH.

Ongoing

5 The Department will implement mandatory policies and procedures regarding the introduction of new services and technologies to Tasmania’s public acute hospitals. These policies and procedures also will cover the recruitment, credentialling, and scope of clinical practice of senior clinical staff. The objective will be to ensure that recruitment and service development initiatives of individual hospitals do not jeopardise the sustainability of existing services; do not undermine the planned development of services in other regions; and are not likely to lead to inappropriate pressure in the future for the development of complex services where these are likely to be unsustainable.

By October 2008

6 The Department will ensure that, where feasible:

•arrangementsforoutreachservicesaremadebetweenhospitalsratherthanclinical units or individual clinicians; and

•theLGHassumesamoreformalandcomprehensiveregionalsupportroletothe North West region. Services which are viable only on an outreach basis in the North West region will be provided by arrangement with the LGH where possible, rather than with individual clinicians or the RHH.

Ongoing

7 The Department will develop and implement standard governance, funding and accountability arrangements for regional and statewide services, commencing with the following services:

•adultandpaediatriccysticfibrosis;

•bonemarrowtransplantation;

•cancer;

•specialistcardiology;

•infectiousdiseases;

•neonatalintensivecare,paediatricintensivecare,neonatalandpaediatricretrieval;

•renalmedicine;and

•vascularsurgery.

The allocation to a hospital of funding for outreach services will carry with it responsibility to ensure the quality and reliability of those services and to demonstrate accountability for service accessibility and quality to providers and consumers from the outreach areas. The performance management framework for each hospital chief executive officer will incorporate accountability for ensuring that statewide service responsibilities are fulfilled.

By July 2010

8 The Department will oversee the development and implementation of a plan for the provision of bariatric surgery by the RHH and will develop an integrated statewide multidisciplinary strategy for the management of patients with morbid obesity.

Complete bariatric surgery plan by January 2009

Complete integrated plan for the management of morbid obesity by December 2009



9 The Department will complete a feasibility study into the development of cardiac electrophysiology services.

By June 2010

10 The Department will complete an expert review of hyperbaric oxygen therapy. By June 2009

11 The Department will complete feasibility studies of statewide services in medical imaging and pathology.

By December 2009

12 The Department will formalise the establishment of a rehabilitation and aged care network and publish an implementation plan for rehabilitation services.

Establish network by August 2008 and publish implementation plan by February 2009

13 The Department will facilitate:

•formalagreementbetweentheLGH,theNWRH(Burnie)andtheRHHonthescope of and accountability arrangements for vascular surgery provision to the LGH and the NWRH (Burnie); and

•thedevelopmentofformalprotocolsfortherapidtransferfromtheNorthandNorth West regions, direct to theatre at the RHH, of patients with time-critical vascular emergencies who are considered suitable for surgery.

By December 2008

14 The Department will convene a multidisciplinary ICC policy and planning group to develop, consult on and finalise a policy and planning framework for ICCs that will support a subsequent detailed model of care and facility planning.

Convene immediately

Complete policy and planning framework by July 2008

15 The Department will monitor and report annually on a range of benchmarking data including lengths of stay and the rate of admissions for Ambulatory Care Sensitive Conditions.

Commence mid-2009

16 As well as investing strategically in public admitted and non-admitted services for the communities of the North West region, the Department will work with the private sector to determine ways to develop appropriate private sector inpatient services for the region’s communities.

Ongoing

17 The Department will establish a Health Industry Forum with participation by the private sector, and work with the private sector to facilitate the cooperative development of Tasmania’s health services for the overall benefit of the community.

By February 2009

18 The Department will monitor and publish regional utilisation rates regularly. Commence mid-2009

19 The Department will aim to maintain and improve equity of resource distribution between regions; accountability of hospitals for their efficient operation; and regional self-sufficiency of public acute hospital services. A detailed study of cost modelling and resource allocation benchmarks will be completed to establish a mechanism to ensure equity in future resource allocations. The Department’s aim will be to ensure that each hospital accesses a fair proportion of the State’s overall hospital investment and uses it efficiently for the best benefit of the community.

Annual self-sufficiency targets will be established immediately in all regions and performance against targets will be monitored and reported annually.

Commence immediately with annual reporting

20 The Department will collaborate with the Australian Government, Divisions of General Practice and other relevant organisations to develop a ‘whole-of-state’ strategy for general practice. Key objectives of the strategy will be recruitment of general practitioners to the North West region to ensure more equitable access to general practice services; and the development of new models of support for general practice – including community-based and practice-based nurses – to ensure service sustainability.

Complete by December 2009



21 The Tasmanian Government adopts the following principles to underpin planning and delivery of hospital services in the North West region:

•Abalancedmixandappropriatevolumeofhighqualitypublicacutehospitalservices should be available to all residents of the North West region. Responsibility for providing these services will be shared by the Australian and Tasmanian Governments.

•TheAustralianGovernmentwillberesponsibleforprovidinganappropriaterange and volume of safe, high quality community hospital services to the residents of the referral area of the Mersey Community Hospital. The Tasmanian Government will license the Mersey Community Hospital in accordance with its usual licensing standards for private hospitals, but otherwise recognises that the Australian Government (or its delegates) will plan and be accountable for the role and service profile of the Mersey Community Hospital.

•ResidentsoftheMerseyCommunityHospitalreferralregionwhoneedcomplexacute services which do not fit within the agreed service profile of the Mersey Community Hospital will be able to access such services through the State hospital system in Burnie, Launceston or Hobart. It will be important for the Mersey Community Hospital to deliver an agreed range and volume of services to its referral community, however, so that the Tasmanian Government can deliver the necessary complementary higher complexity services in a planned and equitable manner.

•TheTasmanianGovernmentwillberesponsibleforprovidinganappropriaterange and volume of public acute hospital services to the referral communities of the NWRH (Burnie).

•Resourcessuchasspecialiststaff;diagnosticservices;theatrefacilities;clinicalgovernance functions such as audit; and purchasing functions could be shared between the NWRH (Burnie) and the Mersey Community Hospital, if such sharing would benefit the community and can be agreed between the Department and the operators of the Mersey Community Hospital.

•Someservicesmaybedevelopedonawhole-of-regionbasisbyagreementbetween the Australian and Tasmanian Governments.

Ongoing

22 The Department will develop a detailed clinical service profile for the NWRH (Burnie) in consultation and cooperation with the Australian Government and/or the operator of the Mersey Community Hospital, with the objective of ensuring sustainable services on a whole-of-region basis.

By December 2008 (but will depend on timeframes for completion of a service plan for the Mersey Community Hospital)

23 The Tasmanian Government will seek to agree on a robust performance monitoring and reporting framework with the Australian Government to ensure that both the NWRH (Burnie) and the Mersey Community Hospital contribute equitably to the provision of an integrated health service for the region.

By December 2008

24 The Department will:

•developashortconsultationpaperdefiningtheroleanddrafttermsofreference of the Clinical Advisory Council and presenting more detail about the proposed number and type of clinical networks to be established; the roles and responsibilities of network members; methods of supporting networks; and principles for network operation;

By July 2008

•establisharehabilitationandagedcarenetwork; By August 2008

•establishachronicdiseasenetwork; By December 2008

•selectthemembershipofandconvenetheClinicalAdvisoryCouncil; By October 2008

•ensurethatfairandtransparentarrangementsareinplacetofundandotherwisefacilitate the provision of adequate back-up and clinical support for clinicians who assume leadership positions, particularly those who are not full-time employees in the public hospital system;

Ongoing



•convenecardiacandrenalforums.Theseforumswillbepresentedwithdataandopinion about current and future service delivery challenges and opportunities and consensus will be sought about the most appropriate method to facilitate ongoing clinical interaction across the State. Convening regular planning forums may be an alternative to establishing ongoing clinical networks for these sub-specialty services; and

By December 2009

•convenestatewideclinicalconsultativemeetingstwiceyearlyineachofwomen’sand children’s services; adult surgery; adult medicine; and critical care, trauma, emergency and retrieval services until formal ongoing networking structures have been agreed on and implemented.

Commencing by July 2009 and ongoing until networks convened

25 The Department will continue to work with the University of Tasmania and the tertiary and further education sector to develop and implement a long-term strategic plan that links Tasmania’s health care education and workforce needs. The strategic plan will link with this Clinical Services Plan update. In particular, the Department will undertake a workforce modelling exercise, based on the activity projections in this Clinical Services Plan update, to establish clear targets for workforce numbers in each health care professional category over the life of the Clinical Services Plan and identify key workforce risks and/or the need to redesign care pathways.

Publish workforce plan by December 2009

26 The Department will work with the chief executive officers of each public acute hospital to define explicit performance agreements incorporating targets for clinical activity within agreed budgets and a requirement that they document a clinical engagement strategy and monitor and report on its effectiveness over time.

Develop clinical engagement strategies by December 2008

Summary of implementation commitments by date

Date Commitment

Immediate Establish annual self-sufficiency targets, monitor and report

Work with the Australian Government to:

•progressplanningforanICC(includingarenaldialysisservice)inLauncestonandaradiation oncology unit in Burnie or Launceston; and

•progresstheinstallationofMRIsattheLGHandinBurnie,andaPETscannerattheRHH as a priority

Convene an ICC policy and planning group to develop a policy and planning framework

Commence working with the private sector to determine ways to develop appropriate private sector inpatient services for the North West region

June 2008 Complete a transport strategy

Complete an accommodation strategy

Publish an implementation plan for a sustainable medical retrieval service

July 2008 Publish a consultation paper on the role and responsibilities of the Clinical Advisory Council and the clinical networks

Finalise a policy and planning framework for ICCs to support a subsequent detailed model of care and facility planning

August 2008 Establish a rehabilitation and aged care network

October 2008 Implement mandatory policies for the introduction of new services and technologies and the recruitment, retention, credentialling and scope of practice of senior medical staff

Select members and convene the Clinical Advisory Council

December 2008 Complete the business case for redevelopment of the RHH

Finalise implementation of statewide bone marrow transplantation and vascular surgery services

Establish a chronic disease network

In collaboration with the Australian Government and/or the operator of the Mersey Community Hospital develop a detailed clinical services profile for the NWRH (Burnie)

Seek to agree on a robust performance monitoring and reporting framework with the Australian Government for the NWRH (Burnie) and the Mersey Community Hospital

Document clinical engagement strategies for all acute public hospitals


Date Commitment

January 2009 Develop and implement a plan for bariatric surgery

February 2009 Establish a Health Industry Forum to progress public/private cooperation

Publish an implementation plan for rehabilitation services

Mid-2009 Commence publishing public acute hospital benchmarking data

Monitor and publish regional utilisation rates

June 2009 Complete a review of hyperbaric oxygen therapy

July 2009 Commence convening clinical consultative meetings twice yearly in areas in which clinical networks are not yet established

December 2009 Complete a ‘whole-of-state’ general practice strategy

Complete feasibility studies of statewide services in pathology and medical imaging

Convene cardiac and renal forums

Develop a strategic workforce plan

Develop a statewide strategy for the management of patients with morbid obesity

June 2010 Complete redevelopment of the LGH emergency department

Complete a feasibility study for cardiac electrophysiology

July 2010 Complete implementation of standard governance, funding and accountability arrangements for regional and statewide services


Tasmania’s community and its health statusTasmania’s populationTasmania’s estimated resident population at June 2006 was 489,922 people.1

For planning purposes for its public acute hospitals, Tasmania has three main geographic regions consisting of the following Local Government Areas (Table 1):

Table 1: Tasmania’s planning regions

South North North West

Brighton, Central Highlands, Clarence, Derwent Valley, Glamorgan/Spring Bay, Glenorchy, Hobart, Huon Valley, Kingborough, Sorell, Southern Midlands, Tasman

Break O’Day, Dorset, Flinders, George Town, Launceston, Meander Valley, Northern Midlands, West Tamar

Burnie, Central Coast, Circular Head, Devonport, Kentish, King Island, Latrobe, Waratah/Wynyard, West Coast

There are some variations in the characteristics of Tasmania’s regional communities which impact on the health care needs of residents.

For example, the North and North West regions have a higher percentage of 5 to 14 year olds and of 55 to 74 year olds than the South, and a lower percentage of 15 to 34 year olds (Figure 1).

Figure 1: Tasmanian population age structure in 2006

0

1

2

3

4

5

6

7

8

9

Source: ABS Population by Age and Sex, Australia, 2006, cat. no. 3235.0.

Projections based on the 2001 census data suggest that over the planning period to 2016, Tasmania’s population will remain relatively stable with an overall increase of fewer than 1,000 people. The population of the South region is projected to increase by more than 3,000 people, the population

9%

8%

7%

6%

5%

4%

3%

2%

1%

0

% o

f pop

ulat

ion

00-04 05-09 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+

Age group

North

North West

South

1 ABS 3235.0 Population by Age and Sex, Australia, 2006.


of the North region is projected to increase by more than 2,000 people and the population of the North West region is projected to decrease by just fewer than 5,000 people (Figure 2). For reasons which are explained below, however, Tasmanian population projections to 2016 are likely to represent a significant underestimation of the actual population.

Figure 2: Changes in population by region 2006 to 2016

-6000-5000-4000-3000-2000-1000

01000200030004000

Source: ABS, DoHA. Projected Resident Population on 2001 statistical local area (SLA) Boundaries (ASCG 2001) as at 30 June 2002–2022.

In this report, Estimated Resident Populations at 30 June 2006 are used to calculate current service utilisation rates, but the convention of using official population projections based on census data has been followed for the purposes of estimating future demand. It should be noted that those official population projections are based on ABS projections which in turn are based on 2001 census data. The ABS projections significantly underestimated population growth between 2001 and 2006 – Tasmania’s actual population at 30 June 2006 was 489,922,2 whereas the ABS, on the basis of 2001 census data, had projected a 2006 population of 476,493. Clearly, that underestimation of population growth between 2001 and 2006 will result in a continuing underestimation of population projections to 2016. In addition, a number of positive economic factors may further exacerbate the underestimation of the 2016 population. For example, confirmed major developments in the mining and paper industries will result in new employment opportunities, which in turn may result in additional population growth beyond that predicted in 2001.

The main differences in the projected compared with actual population in 2006 were in children and in 30–50 year olds, which in terms of requirements for health services in the future will impact most on maternity and paediatric services.

The population projections used in this Clinical Services Plan update will require revision when the ABS projections based on the 2006 census are available. This will be simple to perform as the planning model is now well established. In addition it is important to recognise that while actual population numbers may vary from those predicted, the major trends described in this Clinical Services Plan update will not alter – the basis for the Plan, therefore, remains sound.

Implementation commitment 1

The Department will revise and publish the population and demand projections in this Clinical Services Plan update when population projections based on 2006 census data are published by the ABS, recognising that while those population and demand projections will be more accurate than those available at present, the underlying trends in demand which form the basis for the Plan will not change.

4,000

3,000

2,000

1,000

0

-1,000

-2,000

-3,000

-4,000

-5,000

-6,000

Cha

nge

in p

opul

atio

n

North West

North

South

Tasmania

2 ABS Estimated Resident Population at 30 June 2006 (which was the most accurate available estimate of the actual population on that date).


The Local Government Area (LGA) populations which are projected to grow the most during the planning period are Kingborough (3,083), Meander Valley (2,193), West Tamar (1,372) and Hobart (1,270). The LGAs projected to decline in population include Glenorchy (-1,421), Burnie (-1,090) and Devonport (-1,088). Meander Valley and Kingborough populations are expected to experience the greatest percentage increase over the period, while Derwent Valley and West Coast are expected to experience the greatest percentage decrease in population (Table 2).

Table 2: Projected population growth by Local Government Area

Region LGA 2006 2016 Difference %

North West Burnie 18,640 17,550 -1,090 -6%

Central Coast 20,702 19,641 -1,061 -5%

Circular Head 7,860 7,240 -620 -8%

Devonport 24,048 22,960 -1,088 -5%

Kentish 5,526 5,451 -75 -1%

King Island 1,667 1,579 -88 -5%

Latrobe 8,720 9,428 708 8%

Waratah/Wynyard 13,452 12,892 -560 -4%

West Coast 5,144 4,346 -798 -16%

Total North West 105,759 101,087 -4672 -4%

North Break O’Day 5,916 6,008 92 2%

Dorset 7,288 7,000 -288 -4%

Flinders 852 785 -67 -8%

George Town 6,437 6,187 -250 -4%

Launceston 62,368 61,356 -1,012 -2%

Meander Valley 19,167 21,360 2,193 11%

Northern Midlands 12,211 12,514 303 2%

West Tamar 21,165 22,537 1,372 6%

Total North 135,404 137,747 2343 2%

South Brighton 13,294 13,580 286 2%

Central Highlands 2,273 2,143 -130 -6%

Clarence 49,892 49,645 -247 0%

Derwent Valley 9,106 8,306 -800 -9%

Glamorgan/Spring Bay 3,946 3,749 -197 -5%

Glenorchy 43,708 42,287 -1,421 -3%

Hobart 47,955 49,225 1,270 3%

Huon Valley 14,432 15,291 859 6%

Kingborough 31,319 34,402 3,083 10%

Sorell 11,326 11,743 417 4%

Southern Midlands 5,841 5,987 146 2%

Tasman 2,238 2,196 -42 -2%

Total South 235,330 238,554 3,224 1%

Grand Total 476,493 477,388 895 0%



It should be noted that predictions of population decline in the West Coast and George Town are likely to be inaccurate because of the significant economic growth which is expected in these areas as a result of developments in the mining and paper industries.

Population changes across the three regions are predicted to follow a similar pattern by age group with particular increases in the number of people aged 60–69 (Figure 3).

Figure 3: Changes in population by age group and region 2006 to 2016

-8000-6000-4000-2000

02000400060008000

1000012000


People aged 60 and over represent 20 per cent of the Tasmanian population currently. It is projected that in only 10 years this will increase to 30 per cent. People aged 70 and over represent 11 per cent of the Tasmanian population currently – this will increase to 14 per cent by 2016. The size of this age group is expected to grow in each region by approximately 30 per cent (Table 3).

Table 3: Growth in 70+ age group by region 2006 to 2016

Region 2006 2016 Difference % growth% of the 70+

population in 2016

North West 11,660 15,147 3,487 30% 23%

North 14,619 19,119 4,500 31% 30%

South 24,404 31,403 6,999 29% 47%

Grand Total 50,683 65,669 14,986 30% 100%


12,000

10,000

8,000

6,000

4,000

2,000

0

-2,000

-4,000

-6,000

-8,000

Cha

nge

in p

opul

atio

n

0-19 20-29 30-39 40-49 50-59 60-69 70-79 80+

Age group

North

North West

South


The number of females of childbearing age is projected to decrease in all regions (Table 4).

Table 4: Change in females 15 to 39 age group by region 2006 to 2016

Region 2006 2016 Difference % growth % population 2016

North West 15,839 13,775 -2,064 -13% 20%

North 21,512 20,219 -1,293 -6% 29%

South 38,244 35,598 -2,646 -7% 51%

Grand Total

75,595 69,592 -6,003 -8% 100%


These figures need to be taken into account in health planning – because older people have more chronic disease and greater need for health services.

The socio-economic and health status of TasmaniansTasmania has a greater index of disadvantage3 than all other Australian states and territories other than the Northern Territory, correlating with the population’s high need for health care services (Table 5).

Table 5: Economic index of disadvantage, state and territory, 2001

State/territory Index of Disadvantage

Australian Capital Territory 1078.7

Victoria 1014.6

Western Australia 1003.6

New South Wales 1000.5

South Australia 995.2

Queensland 991.5

Tasmania 969.7

Northern Territory 952.3

Source: ABS, Census of Population and Housing: Socio-Economic Indexes for Areas (SEIFA) 2001, cat. no. 2033.6.55.001.

Only seven LGAs in Tasmania score average or above average in socio-economic status (Northern Midlands, King Island, Meander Valley, Clarence, West Tamar, Kingborough and Hobart).

There are considerable opportunities to improve the health status of the Tasmanian community. For example, in 2006, the life expectancy at birth of Tasmanian males was 77.4 years, compared with an Australian average of 78.7 years. In the same period, the life expectancy at birth of Tasmanian females was 82.3 years compared with an Australian average of 83.5 years. Only residents of the Northern Territory have, on average, a lower life expectancy than Tasmanians (Table 7).

3 The Index of Disadvantage is based on a number of factors including income, educational attainment and unemployment. The index has a baseline of 1,000. A score above 1,000 indicates an area of socio-economic advantage and a score below 1,000 indicates an area of disadvantage. The level of deviation from 1,000 indicates the level of advantage or disadvantage.


Table 6 shows that the standardised death rate in Tasmania in 2006 was the second highest of any Australian state or territory.

Table 6: Standardised death rate per 1,000 population, all causes by state and territory of usual residence, 2006

Sex NSW Vic Qld SA WA Tas NT ACT Australia

Males 7.4 7.1 7.3 7.3 7.2 8.2 9.8 6.4 7.3

Females 5.0 4.9 4.9 5.0 4.7 5.6 7.4 4.8 4.9

Persons 6.1 5.9 6.0 6.0 5.8 6.8 8.7 5.5 6.0

Age standardised to the total Australian population as of 30 June 2001.Source: ABS, Deaths, Australia, 2006, cat. no. 3302.0.

Table 7 shows relative life expectancy for Tasmanians as a whole and Table 8 shows life expectancy at birth by sex and by region.

Table 7: Life expectancy at birth by sex and state and territory, 2006

State/territory Males Females

Australian Capital Territory 80.0 83.9

Western Australia 79.1 83.8

Victoria 79.3 83.7

New South Wales 78.6 83.4

South Australia 78.6 83.6

Queensland 78.5 83.4

Tasmania 77.4 82.3

Northern Territory 72.1 78.1

Australia 78.7 83.5

Source: ABS, Deaths, Australia, 2006, cat. no. 3302.0.

Table 8: Life expectancy at birth by sex, Tasmanian regions, 2006

Statistical divisions Males Females

Greater Hobart 77.7 82.3

Southern 77.0 81.5

Northern 77.1 81.4

Mersey-Lyell 76.5 82.9

Tasmania 77.4 82.3



Table 9 shows comparative death rates for selected conditions.

Table 9: Age-standardised death rates, selected causes of death, Tasmania and Australia, 2006

Cause of death Tasmanians Australians

Malignant neoplasms 193.1 176.3

Diabetes mellitus 27.7 16.4

Mental and behavioural disorders 27.7 22.4

Diseases – nervous system 28.1 21.9

Diseases – circulatory system 221.3 201.9

Diseases – respiratory system 47.5 48.4

Diseases – digestive system 22.8 20.2

Accidents 30.6 24.9

Intentional self-harm 14.7 8.6

On average:

•MoreTasmaniansreportalong-termhealthconditionthanotherAustralians

•MoreTasmanianssmokethanotherAustralians

•TasmanianseatfewervegetablesthanotherAustralians

•MoreTasmaniansareobesethanotherAustralians

•TasmaniansdieatahigherratethanotherAustralians–theleadingcausesofdeatharediseasesofthecirculatory system and cancer

Source: ABS, Causes of Death, Australia, 2006, cat. no. 3303.0 and ABS, National Health Survey, 2004–05.

Table 10 shows that the infant mortality rate in Tasmania in 2006, however, was the lowest of any Australian state or territory other than South Australia.

Table 10: Infant mortality rate per 1,000 live births, state and territory, 2006

Sex NSW Vic Qld SA WA Tas NT ACT Australia

Males 5.7 4.7 6.6 2.7 4.7 4.8 8.1 5.2 5.3

Females 4.0 3.9 4.0 3.8 5.1 2.9 9.8 5.0 4.1

Persons 4.9 4.3 5.3 3.2 4.9 3.9 8.9 5.1 4.7


Implications for Tasmania’s health care systemThe older age of the population and the poorer health status of the community place relatively higher demands on Tasmania’s health care system compared with those in other states and territories.

As well as ensuring that there are adequate acute hospital services in Tasmania, there needs to be an increased emphasis on prevention, early intervention and self-management of chronic disease, rehabilitation, coordination of care for people with chronic ill-health and the provision of care in community settings.


Tasmania’s public acute hospital systemIntroductionTasmania has three major state-owned and -operated public acute hospitals – the RHH, the LGH and the NWRH (Burnie). The location of these hospitals, and the location of the Mersey Community Hospital, are shown in Figure 4. Together, they make up Tasmania’s public acute hospital system.

Figure 4: Location of hospitals by statistical local area

The Royal Hobart HospitalThe RHH is a major teaching and research hospital with linkages to the University of Tasmania. It is the principal referral hospital for Tasmania and provides services primarily at role delineation4 levels 5 and 6 in medicine, surgery, critical care, aged care, rehabilitation, mental health, obstetrics and paediatrics. It provides the majority of statewide services including cardiothoracic surgery, neurosurgery, high risk obstetric care, neonatal and paediatric intensive care, hyperbaric medicine, complex paediatric surgery, gynaecological oncology and complex burns management.

The RHH operates from a base of 540 beds including 437 overnight beds and 103 day beds. The RHH also has a contract with the private sector for the provision of public ophthalmology services and a partnership with the Hobart Private Hospital for some patient care and support services.

Circular Head

Waratah/Wynyard

Central Highlands

West Coast

Derwent Valley

Huon Valley

Southern Midlands

Northern Midlands

Break O’Day

Dorset

Kentish Meander Valley

NWRH Burnie Mersey

Community Hospital

Launceston General Hospital

Royal Hobart Hospital

4 Role delineation is a process that designates levels of services and capacity to ensure that clinical services are provided safely and have appropriate support services, staffing, safety standards and other requirements. Role delineation levels range from 1 to 6, with level 1 services being the most simple and level 6 being the most complex.


The Launceston General HospitalThe LGH is a significant teaching and research hospital with linkages to the University of Tasmania. It is the major referral hospital for the residents of the North and North West of Tasmania and provides services primarily at role delineation levels 4 and 5 in medicine, surgery, critical care, aged care, rehabilitation, mental health, obstetrics and paediatrics. It is Tasmania’s only provider of brachytherapy.5

The LGH operates from a base of 342 beds including 296 overnight beds and 46 day beds. The LGH also has contracts with the private sector for the provision of public patient services, including ophthalmology and nuclear medicine services.

The North West Regional Hospital (Burnie) and the Mersey Community HospitalThe NWRH (Burnie) is the regional public acute hospital for residents of the North West. It provides services primarily at role delineation levels 3 and 4 in medicine, surgery, critical care, obstetrics, paediatrics, mental health, drug and alcohol, and aged care and rehabilitation. It is a teaching and research hospital with linkages to the University of Tasmania. The Rural Clinical School of the University of Tasmania is located at the NWRH (Burnie).

The NWRH (Burnie) operates from a base of 179 beds including 146 overnight beds and 33 day beds. The NWRH (Burnie) also has contracts with the private sector for the provision of public patient services including maternity, ophthalmology and diagnostic pathology and imaging services.

Until November 2007, the NWRH operated under a ‘one hospital two campuses’ model, with the Burnie campus and the Mersey campus at Latrobe (approximately 60 km apart) operating under a single management structure.

The 2007 Clinical Services Plan notes that continuing efforts to duplicate services across both campuses had created major sustainability problems and had compromised the quality of health care for the entire community. A change in role for both campuses was planned, with each campus complementing the other, allowing the NWRH in conjunction with primary health services to provide a comprehensive service to the entire community. It was proposed that high acuity intensive care, medical, surgical and emergency services would be consolidated on the Burnie campus and the Mersey campus at Latrobe would refocus on high-volume medical and surgical day-only services including chemotherapy, renal dialysis, booked surgery with admissions of up to 23 hours’ duration, low risk maternity and paediatrics, specialist aged care and rehabilitation and a full range of non-inpatient consulting services. A 24-hour emergency service was to be provided at both campuses with the Mersey retaining the capacity to resuscitate and support patients prior to transfer if required. Enhancement of ambulance and paramedic support also was proposed.

On 1 August 2007, the then Australian Prime Minister announced that the Australian Government would guarantee the continued funding of a wide range of inpatient and outpatient services at the Mersey campus and support its re-establishment as the Mersey Community Hospital, managed by a community controlled and federally funded trust. The Australian Government’s intention was that the hospital would continue to provide a full range of services to the local community.

On 20 August 2007, the Tasmanian Government agreed to sell the hospital to the Australian Government for a nominal $1.00, subject to a number of conditions. On 24 September 2007, the Australian and Tasmanian Governments signed a binding agreement to transfer ownership of the Mersey campus of the NWRH to the Australian Government. On 25 September 2007 the then federal opposition committed to honour the agreement if it were elected to government, and to work with the Latrobe and Devonport communities to implement it.

5 Brachytherapy is a type of radiation therapy in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near a tumour – see the National Cancer Institute definition at <http://www.cancer.gov/Templates/db_alpha.aspx?CdrID=45151>.


On 23 November 2007, the Australian Government assumed control of the Mersey Community Hospital. The 2007 federal election was held on 24 November. Consistent with the commitment it had made when in opposition, the new Australian Government reaffirmed its intention to ensure the provision of a full range of services to the local community, as long as services could be provided safely and to an acceptable level of quality.

In January 2008 the Australian Government announced a further independent review of the feasibility and safety of retaining an intensive care unit at the Mersey Community Hospital. The review concluded that a high dependency unit is the most suitable model for the Mersey Community Hospital for the present and foreseeable future.

On 7 March 2008 the Australian Government announced that it was seeking a religious and charitable or private sector organisation experienced in managing public hospitals to operate the Mersey Community Hospital as a public hospital from 1 July 2008.

Tasmania’s public acute hospital system now consists, therefore, of three public hospitals which are owned and operated by the State (the LGH, the NWRH (Burnie) and the RHH) and one public hospital which is owned by the Australian Government and will be operated by a religious and charitable or private sector organisation from 1 July 2008.

Together, these hospitals will be responsible for providing high quality, accessible and sustainable public acute hospital services to the entire Tasmanian community.

The Tasmanian Government believes that the 2007 Clinical Services Plan provides the most appropriate framework for delivery of public acute hospital services to the residents of the North West and that the decision to provide a full range of services from the Mersey Community Hospital is likely to diminish service sustainability and reduce opportunities for service development which would have benefited all residents of the region.

Nevertheless, the Tasmanian Government acknowledges the Australian Government’s intention to support the Mersey Community Hospital to provide a full range of services, and confirms its intention to ensure that the NWRH (Burnie) works collaboratively with the Mersey Community Hospital to provide the most comprehensive and integrated public acute hospital services for the region that are achievable in the circumstances.

Table 11 summarises Tasmania’s public acute hospital facilities as at February 2008.

Table 11: Facility profiles – major hospitals Tasmania

RHH LGH NWRH (Burnie) MCH

Facilities Capacity In use March

08

Capacity In use March

08


08


08

Overnight beds

Medical 94 88 114 106 34 30 34 24

Surgical 103 102 64 60 54 36 38 20

Total medical, surgical 197 190 178 166 88 66 72 44

Critical care beds

Intensive care 9 9 6 6 8 4

Coronary care 3 3 5 5 4

Cardiothoracic ICU 3 3

High dependency 8 8 4 4

Total critical care 23 23 11 11 8 8 4 4

TOTAL MEDICAL, SURGICAL AND CRITICAL CARE

220 213 189 177 96 74 76 48




08


08


08


08

Rehab and elder care

IP rehab and elder care 23 23 18 18 12 8

NHP care (Strathcare) 8 0

Karingal 24 24

Transitional care unit 22 22

Geriatric evaluation unit 20 20 0 0

TOTAL REHAB AND ELDER CARE

97 89 18 18 12 8 0 0

Mental health

Psychiatric ICU 8

Psychiatric medicine 34 20 20 24 24

TOTAL MENTAL HEALTH

42 0 20 20 24 24 0 0

Women’s and children’s

Maternity 18 18 26 26 15 15

Gynaecology 11 5

NICU and SCN 16 16 9 9

Paediatrics 25 25 26 20 14 14 6 4

Birthing suites 8 8 8 8 4 4

TOTAL WOMEN’S AND CHILDREN’S

78 72 69 63 14 14 25 23

TOTAL OVERNIGHT 437 374 296 278 146 120 101 71

Day beds

Oncology day treatment

18 18 12 12 9 9 6 6

Oncology day beds 2 2 2 2 1 1 1 1

Ambulatory care centre

24 24

Renal dialysis unit offsite

20 20 15 15

Renal dialysis onsite 5 5 12 12

Emergency department beds

1 1 3 3

Dental 1 1

Day surgery unit 12 12 20 20 8 8 10 10

Perioperative unit 9 9

Hyperbaric unit 2 2

Prenatal assessment centre

3 3

Paediatric assessment unit

6 6

Radiology 1 1

Specialist clinics 1 1

TOTAL DAY 103 103 46 46 33 33 20 20

TOTAL BEDS 540 477 342 324 179 153 121 91




08


08


08


08

Other facilities

Recovery 13 13 6 6 8 6 4 4

Linac 3 bunkers

2 linacs

2 2

Cath lab/procedural imaging room

1 1 1 1

Theatres 7 7 7 4 4 3 2 2

Procedure rooms 2 2 2 2 1

Emergency department

ED resuscitation bay 4 4 2 2 2 2 1 1

ED treatment bay 31 31 14 14 10 8 4 4

ED consultation rooms 4 4 3 3

ED safe/seclusion rooms 2 2

Short stay unit 10 5

TOTAL ED SPACES 47 42 20 20 12 10 8 8

Imaging equipment MRI, CT, US, Nuc Med, vascular lab

CT, US, Nuc Med, vascular/interventional laboratory, screening procedure room

CT, US, Nuc Med, angiography

CT, US, general screening and image intensification

Comments Planned PET in 2008

MRI to be installed July 2008

Planned MRI in 2008

Notes: Numbers exclude delivery rooms and ‘beds’ for qualified newborns. Consulting and ambulatory facilities rooms are not documented in this table. NWRH (Burnie) paediatric unit has 10 beds + 4 cots. RHH dialysis has 18 chairs + 2 training chairs. Dialysis for Burnie residents is provided by LGH at the Parkside site in Burnie. Maternity and neonatal services for Burnie residents are provided by North West Private Hospital under a public contract. Three NWRH (Burnie) emergency department consulting rooms are used for outpatient visits during the day. Some inpatient wards in the NWRH (Burnie) currently are used for non-acute activities. When these are required for inpatient use,

alternative accommodation will need to be provided for those occupying the space.


Principles for Tasmania’s health servicesIn endorsing Tasmania’s Health Plan, the State Government adopted the following key principles for Tasmania’s health services:

Tasmania’s health services will be:

• accessibleascloseaspossibletowherepeoplelive,ifservicescanbedeliveredsafely,effectively and at acceptable cost;

• appropriatetocommunityneeds;

• clientandfamily-focused;

• integratedthrougheffectiveservicecoordinationandpartnershipsbetweenproviders;and

• designedforsustainability.

Where services cannot be delivered safely, effectively and at acceptable cost locally, access will be facilitated through service coordination, transport assistance and other appropriate support.

The Department has adopted the following definitions to support these principles:

Accessible – ensuring care is available when (at the time) and where (in the location) people need it

Safe – minimising risks, so that patients are safe from unintended harm

Effective – providing care that results in a good outcome

Efficient – using available health care resources wisely

Appropriate – providing the ‘right’ care at the ‘right’ time, including health promotion and integrated community-based and hospital-based services

Patient and family-focused – designed to meet the needs of patients and their families/carers, respectful of patients as individuals and enabling them to access information and be engaged as active participants in their own care

Consistent with the 2007 Clinical Services Plan, this update has a particular focus on sustainability, which requires public acute hospital services to:

• havesufficientpatientvolumetosupportandmaintainthecompetenceofhealthcareprofessionals;

• supportastaffinginfrastructurethatcanwithstandtemporaryshortageswithoutexcessivecostor operational burden;

• havequalityequipmentandfacilities,andappropriateaccesstonecessaryclinicalandnon-clinicalsupport services;

• havecoststhatarereasonableandmanageableovertime,inthecontextofcompetingdemandsfor limited resources; and

• havetransparentandpredictablefundingallocations.

Implementation commitment 2The Tasmanian Government re-endorses its commitment to the principles defined in the 2007 Clinical Services Plan and in particular to:

• serviceaccessibilitywhereservicescanbedeliveredsafely,effectivelyandefficiently;and

• designingTasmania’spublichealthservicestoensuretheirsustainability.


Progress since publication of the Clinical Services PlanInpatient activityTasmania’s public acute hospital system has continued to provide a high level of service to the community (Table 12).

Table 12: Admissions to Tasmanian public acute hospitals

Hospital 2004–2005 2005–2006 2006–2007 Diff 2004–2007

% change 2004–2007

2000–01 % change 2000–2007

RHH 53,618 54,623 54,881 1,263 2% 43,263 27%

LGH 33,403 35,310 35,399 1,996 6% 23,930 48%

NWRH (Burnie)

11,808 12,346 11,951 143 1% 11,580 3%

NWRH (Mersey)

3,934* 7,735 7,134

Interstate public

1,359 1,813 2,267 908 67%

Other 6,275 6,063 8,978 2,703 43%

Grand Total

110,397 117,889 120,610 7,013 6%

Notes: *NWRH (Mersey) submitted data for only part of 2004–05, from 1 December 2004 to 30 June 2005.Renal dialysis separations in Burnie are included in the NWRH (Burnie) separations. There were 3,618 such separations in 2006–07.

Table 12 shows that there was modest growth in inpatient activity at the RHH and the LGH and a small reduction in activity at the Burnie and Mersey campuses of the NWRH in the year to June 2007. Overall, the rate of growth in admissions slowed over the three-year period to June 2007 compared with the previous four-year period. There was considerably more growth in admissions in the North (48%) than the South (27%) over the period 2000–2007 while there was very little growth in admissions to the NWRH (Burnie) over that period.

Emergency activityOver the past three years, emergency department presentations across Tasmania have increased by 6 per cent. There has been significant growth in emergency activity at the NWRH (Burnie) and the LGH (Table 13).

Table 13: Emergency department presentations

Hospital 2004–05 2005–06 2006–07 Diff % Change % of total (2006–07)

NWRH (Burnie) 22,054 23,155 24,438 2,384 11% 20%

NWRH (Mersey) 12,462* 22,044 21,753 18%

LGH 30,941 32,050 34,409 3,468 11% 29%

RHH 37,922 39,277 39,062 1,140 3% 33%

Total 103,379 116,526 119,662 6,992 6% 100%

Note: *NWRH (Mersey) submitted data for only part of 2004–05, from 1 December 2004 to 30 June 2005.


Community-based servicesThere has been continued improvement in a number of indicators relating to community-based services. These indicators are published in Your Health and Human Services: Progress Chart and include an increase of more than 37.5 per cent in occasions of service for adult dental care.

Clinical Services Plan initiativesA number of the initiatives identified in the Clinical Services Plan have been progressed (Table 14). Because of the change of ownership of and operational responsibility for the Mersey Community Hospital, initiatives relating to the Mersey Community Hospital and the NWRH (Burnie) are not included in this table but are addressed separately in this report.

Table 14: Progress in implementing Clinical Services Plan initiatives

Health system initiatives Progress

New infrastructure

Redevelop the RHH The Hobart Railyards has been confirmed as a suitable site for a hospital development. A draft service plan has been developed and development of master plans, a feasibility study and an investment evaluation are progressing. This information will underpin the development of a business case which will be completed by the end of 2008.

Develop new ICCs at Hobart (within or adjacent to the RHH) and Launceston (close to the LGH); on Hobart’s eastern shore; and in the Kingborough areas; and enhance existing services at a range of sites

The Australian Government has committed $15 million towards the establishment of an ICC, including a renal dialysis unit, in Launceston. The Department will initiate planning with the Australian Government Department of Health and Ageing, as a priority, to progress the implementation of this initiative.

An ICC is being planned as a component of the new RHH. It will be collocated with the RHH and will focus on the delivery of both acute and complex chronic health services to an ambulatory client group that may need access to tertiary hospital backup and support. The focus will be on day-only episodes of care. The ICC service will have three key functions:

•betheportalforelective,non-urgentdaysurgeryandotherprocedures;

•deliverawiderangeofambulatorycareservices,includingdiagnosticservices; and

•providespecificservicesforpeoplewithchronicandcomplexco-morbid conditions, including cancer, diabetes/renal, cardio-respiratory and gastroenterology.

Undertake a feasibility study to assess the appropriate location for a 5th linear accelerator

The Australian Government has committed up to $7.7 million towards the establishment of an additional radiation oncology unit in the North or North West. The new radiation oncology service will be located at either the NWRH (Burnie) or the LGH.

Adopt a planned and coordinated approach to medical imaging infrastructure development

The Australian Government has approved Medicare eligibility for two magnetic resonance imaging units – one in North West Tasmania and one at the LGH. Purchase of the LGH unit has been approved.

New models of care

Develop new models of care for emergency departments – short stay/medical assessment units, fast track units, psychiatric emergency care centre, collocated GP clinics

Detailed planning has commenced for the redevelopment of the RHH. New models of care are being planned, including an emergency short stay unit and a fast-track clinic (already in the new emergency department of the existing RHH) together with an emergency mental health zone and medical assessment and planning units.

Planning for the redevelopment of the LGH emergency department also has commenced, including planning for new models of care consistent with this recommendation.

Service enhancement

Review the business case for introduction of a PET/CT scanner to the RHH and consider introducing the service

The Australian Government has committed $3.5 million in support of a PET scanner at the RHH.


Health system initiatives Progress

Service reviews/redesign

Review adult medical retrieval services

Adult medical retrieval services have been reviewed with the assistance of an independent advisor. An implementation plan for a sustainable service is being developed.

Review patient transport and accommodation services

The Department currently is undertaking a comprehensive review of all health transport services, including ambulance services, medical retrieval and patient transport arrangements, as well as patient accommodation arrangements. The review is expected to be completed by mid-2008 and its findings will be factored into development of transport and retrieval services and accommodation arrangements across the State. The Department will complete a transport strategy which will address issues such as integration of modes of transport and will complement Tasmania’s Health Plan such that improved transport options are harmonised with the development of new models of care for health services. The Australian Government has committed $10 million for patient transport services including the purchase of community buses. The Department also will complete a strategy for patient accommodation services.

Maintain the RHH as the statewide provider of autologous bone marrow transplantation, subject to independent review

An independent review has been completed and has confirmed the recommendation of the Clinical Services Plan, which is now being implemented. Clinicians from Launceston will be engaged in a statewide service to be based at the RHH.

Relocate vascular surgery from the NWRH (Mersey) to the LGH

The major vascular surgery service previously provided at the NWRH (Mersey) has ceased. A statewide vascular service is now provided from the RHH with outreach to the LGH.

Clinical leadership and engagement

Establish clinical networks in a range of clinical areas and a Clinical Advisory Council

A clinical leader has been appointed to the cancer clinical network and establishment of the network is progressing. An interim Clinical Advisory Council has been convened.

Aligning the Department’s structure with service delivery objectivesDuring consultation for the development of the 2007 Clinical Services Plan, many stakeholders suggested that the allocation of responsibility for acute and primary health care to separate divisions of the Department was a major barrier to integrating care at an operational level.

In March 2008 the Minister and the Secretary of the Department announced a reorganisation of the Department to increase its focus on patients and clients and better reflect priorities under Tasmania’s Health Plan. Key features of the reorganisation include:

• bringingtogetheracutehospitalandprimaryhealthfunctions;

• delegatinggreaterautonomytothemajorhospitalswithinaclearlydefinedaccountabilitystructure;

• reorganisingresourcestoestablishaStatewideSystemsDevelopmentTeam,focusingontheimplementation of Tasmania’s Health Plan, development of ICCs and GP Superclinics, consumer engagement and university partnership;

• creatinganewapproachtomentalhealthbybringingtogetherStatewideSpecialistServicesandMental Health Services;

• appointingaDirectorofCommunitySectorDevelopmenttoworkwiththenon-governmentsector, recognising its large and growing role in service delivery (currently around 10% of the Department’s budget);

• elevatingtheimportanceofclinicalandprofessionaladvice,withtheDirectorofPublicHealthandChief Nursing Advisor both reporting directly to the Secretary;

• creatinganewHealthandWellbeingOperationalUnitincorporatingOralHealthandkeyservicedelivery elements in Population Health;


• developinganewseniorCareReformroletofocusonimprovementsinsafetyandquality,workforce strategy and development, change management, and public engagement;

• elevatingtheroleofChiefFinanceOfficertoreportdirectlytotheSecretary,reflectingthecritical issue of effective budget management and improved financial strategy;

• newrolesofFinancialDirector,initiallyintheRHHandtheLGH,withresponsibilitytoensureeffective financial management;

• movingsupportingbusinessservicessuchashumanresourcesandinformationtechnologyintoaclient-focused operational unit with oversight from service areas; and

• openinganofficeinLauncestontoassistinrespondingtocommunityneedsintheNorthandNorth West.

The Department has created an Aged, Rehabilitation and Palliative Care Directorate to enhance leadership and focus for rehabilitation, aged care and palliative care across the State.


The Department will:

• completethebusinesscasefortheredevelopmentoftheRHH(includinganICC)byDecember 2008;

• workwiththeAustralianGovernmentto:

– progress planning for an ICC (including a renal dialysis service) in Launceston and a radiation oncology unit in Burnie or Launceston; and

– progress the installation of MRIs at the LGH and in Burnie, and a PET scanner at the RHH as a priority;

• completetheredevelopmentoftheLGHemergencydepartmentbyJune2010;

• publishanimplementationplanforasustainablemedicalretrievalservicebyJune2008;

• completeatransportstrategybyJune2008toenablethedevelopmentofacomprehensive,coordinated service that is client-focused and timely and provides clinically appropriate transport options;

• completeapatientaccommodationstrategybyJune2008;and

• byDecember2008finaliseimplementationofstatewideservicesforbonemarrowtransplantation and vascular surgery, including identifying a specific statewide services budget and facilitating agreement about the extent of outreach services and the role of LGH clinicians.


The service capability frameworkPrinciplesSome health services depend for their viability on a critical mass of professionals and/or patients, costly infrastructure and/or scarce support services. Many complex services cannot be established in isolation from other complex services. In most health care systems, this results in ‘clustering’ of complex services within a small number of institutions. Not all hospitals can provide all services to all patients and it is not in the interests of the community for them to attempt to do so.

With a population of less than 500,000 people, there are several services which can be provided safely, efficiently and effectively in Tasmania only if they are provided from one or two main sites in the State.

The 2007 Clinical Services Plan presents a service capability framework for acute hospital services based on local, regional referral and statewide service designations. The planning principles reiterated earlier in this report, together with the service capability framework, can be applied to all service development proposals to ensure that rational decisions about the configuration of health services are made for the benefit of the entire community.


The Department endorses and clarifies the following principles for regional referral and statewide services:

• apatient-focused,system-wideapproachwillbetaken,basedontheneedsofallTasmanians.Services will not be designed or developed around the needs of individual clinicians, individual regions or individual hospitals;

• criticalclinicalinter-dependencieswillbetakenintoaccountwhenplanningthelocationofregional and statewide services;

• fundingtoenableregionalandstatewideservicestofulfiltheiradditionalresponsibilities (e.g. to enable the provision of outreach services) will be provided as appropriate, through funding streams independent of normal hospital budgets;

• regionalandstatewideserviceswillberequiredtoparticipateintheusualclinicalandmanagement quality and accountability processes that apply at their host hospital;

• regionalandstatewideservicesthatareprovidedwithadditionalinfrastructurefundingtosupport an outreach role will be required to account for their performance to their broader communities of interest, addressing issues such as accessibility and outcomes of care across the State;

• moststatewideserviceswillcontinuetobelocatedattheRHH,becauseithasthehighestlevel of infrastructure, necessary associated services and access to important non-health organisations that aid in quality service provision and attraction and retention of professional staff for those types of services; and

• ifastatewideservicedoesnotdependoncriticalinternalorexternalrelationshipsthataremore achievable at the RHH, the service may be located at the LGH.


Cooperative service development and supportCompetition between Tasmania’s public acute hospitals has the potential to lead to harmful duplication and to diminish the quality of services for all Tasmanians. Competition needs to be replaced by cooperation and all of Tasmania’s public acute hospitals need to work within the service capability framework to ensure that services are developed in a planned and rational way.

To ensure transparency and to foster collaboration, the chief executive officers of each of the NWRH (Burnie), the LGH and the RHH will be required to submit all service development (including senior staff recruitment) proposals to the Department, which will consult with all public acute hospital chief executive officers. Proposals will not be approved if they:

• jeopardisethesustainabilityofexistingservices;

• underminetheplanneddevelopmentofservicesinotherregions(particularlytheNorthand/orNorth West); and/or

• mayleadtoinappropriatepressureinthefutureforthedevelopmentofcomplexserviceswherethese are likely to be unsustainable.

Flexibility will be required, of course, to ensure that clinicians who are interested in working in Tasmania are not discouraged because their residential and/or professional preferences are inconsistent with the Clinical Services Plan. Innovative arrangements to ensure appropriate service access may be necessary if it is not possible to recruit clinicians to specific locations within the State. The key point is that each of the public acute hospitals must work together, supported by the Department, to take a ‘whole-of-state’ approach to service development, and recognise that service development initiatives in one hospital may have an unintended negative effect on another part of Tasmania’s health care system.


The Department will implement mandatory policies and procedures regarding the introduction of new services and technologies to Tasmania’s public acute hospitals. These policies and procedures also will cover the recruitment, credentialling, and scope of clinical practice of senior clinical staff. The objective will be to ensure that recruitment and service development initiatives of individual hospitals do not jeopardise the sustainability of existing services; do not undermine the planned development of services in other regions; and are not likely to lead to inappropriate pressure in the future for the development of complex services where these are likely to be unsustainable.

Statewide services – governance, funding and accountabilityWhen service quality and/or sustainability requires concentration of services, funding will be provided to enable outreach services to other parts of the State, if it is possible to provide these on a sustainable basis.

Outreach services may be provided to the North West region from either the RHH or the LGH, but in the longer term the development of a strong regional referral relationship between the NWRH (Burnie) and the LGH will be in the overall community interest.


The Department will ensure that, where feasible:

• arrangementsforoutreachservicesaremadebetweenhospitalsratherthanclinicalunitsorindividual clinicians; and

• theLGHassumesamoreformalandcomprehensiveregionalsupportroletotheNorthWest region. Services which are viable only on an outreach basis in the North West region will be provided by arrangement with the LGH where possible, rather than with individual clinicians or the RHH.


Accountability for the delivery of outreach services is a critical feature of the capability framework and will be promoted and enforced by the Department. The Department will enter into formal service agreements with the relevant hospital in relation to each service for which funding is provided to enable outreach services. These service agreements will define transparent accountability arrangements, engaging stakeholders from across the State as appropriate.

While most people choose to access health services close to where they live, for various reasons relating to their personal circumstances and/or service availability some eligible patients may elect to access services in areas remote from their place of residence. This is particularly the case for services which are not offered in all geographic regions. The Australian Health Care Agreement between Tasmania and the Australian Government obliges all public hospitals to offer their services (including regional and statewide services) to all eligible patients equitably on the basis of clinical need (rather than the patient’s place of residence). The Department will remind all hospitals of this requirement.

Regional and statewide services that are required to deliver services from multiple sites (through either outreach or dual-site arrangements) will be funded to enable them to develop those arrangements across the State on a sustainable basis and to implement appropriate arrangements to demonstrate their accountability to clinicians and consumers.

The capability framework is described in Table 15 below and its application to existing services is described in Table 16 below.

Supporting local clinicians in their delivery of specialist services is a key responsibility for regional and statewide services. In most circumstances, a collaborative arrangement between regional/statewide services and local clinicians will provide the best patient care – for example, patients with cystic fibrosis not only benefit from highly specialised care provided on an outreach basis, but also depend on the care provided by local teams which include GPs, nurses, community allied health practitioners and general physicians. Cancer patients also may receive a combination of specialist care in a statewide unit, specialist care provided on an outreach basis and generalist care provided by GPs, nurses, allied health professionals and general physicians and surgeons closer to where they live. In some circumstances formal shared care arrangements may be appropriate, but in other circumstances informal liaison and support arrangements will apply.

Implementation commitment 7The Department will develop and implement, by July 2010, standard governance, funding and accountability agreements for regional and statewide services, commencing with the following services:

• adultandpaediatriccysticfibrosis;

• bonemarrowtransplantation;

• cancerservices(LGHtoNWRH);

• specialistcardiology(LGHtoNWRH);

• infectiousdiseases;

• neonatalintensivecare,paediatricintensivecare,neonatalandpaediatricretrieval;

• renalmedicine(LGHtoNWRH);and

• vascularsurgery.

The allocation to a hospital of funding for outreach services will carry with it responsibility to ensure the quality and reliability of those services and to demonstrate accountability for service accessibility and quality to providers and consumers from the outreach areas. The performance management framework for each hospital chief executive officer will incorporate accountability for ensuring that statewide service responsibilities are fulfilled.


Tabl

e 15

: Ser

vice

cap

abili

ty fr

amew

ork

Cha

ract

eris

ticLo

cal a

cute

hos

pita

l ser

vice

Reg

iona

l acu

te h

ospi

tal

refe

rral

ser

vice

Stat

ewid

e se

rvic

e, s

ingl

e si

te

Stat

ewid

e se

rvic

e, s

ingl

e si

te

wit

h ou

trea

ch

Stat

ewid

e se

rvic

e, d

ual s

ite

Serv

ice

base

LGH

, NW

RH

and

RH

H

If un

able

to

recr

uit

loca

lly, m

ay

be s

uppo

rted

on

an o

utre

ach

basis

from

ano

ther

site

LGH

, pro

vidi

ng s

ervi

ces

to

patie

nts

from

the

Nor

th W

est

Eith

er L

GH

or

RH

H, p

rovi

ding

se

rvic

es lo

cally

to p

atie

nts

who

at

tend

from

all

regi

ons

Eith

er L

GH

or

RH

H, p

rovi

ding

se

rvic

es lo

cally

and

via

out

reac

h to

pat

ient

s fr

om a

ll re

gion

s

Both

LG

H a

nd R

HH

Out

reac

hA

s ab

ove,

and

also

may

pr

ovid

e ou

trea

ch in

co

mm

unity

set

tings

or

to

Mer

sey

Com

mun

ity H

ospi

tal

via

serv

ice

leve

l agr

eem

ents

May

be

fund

ed t

o pr

ovid

e ou

trea

ch in

com

mun

ity o

r in

patie

nt s

ettin

gs in

the

N

orth

Wes

t

Not

obl

iged

/exp

ecte

d to

pr

ovid

e ou

trea

ch in

com

mun

ity

or in

patie

nt s

ettin

gs a

lthou

gh

loca

l arr

ange

men

ts m

ay a

pply

by

agr

eem

ent

Fund

ed t

o pr

ovid

e su

stai

nabl

e se

rvic

es t

o on

e or

mor

e re

gion

s on

an

outr

each

bas

is

Fund

ed t

o pr

ovid

e se

rvic

es a

t bo

th L

GH

and

RH

H.

May

also

be

fund

ed t

o pr

ovid

e se

rvic

es

via

outr

each

to

patie

nts

from

th

e N

orth

Wes

t. G

ener

ally

ou

trea

ch t

o th

e N

orth

Wes

t w

ould

be

from

LG

H

Com

plex

ityLo

w

Med

ium

H

igh

Hig

h H

igh

Infr

astr

uctu

re

and

supp

ort

requ

irem

ents

Not

dep

ende

nt o

n hi

gh c

ost

tech

nolo

gy o

r ot

her

high

ly

spec

ialis

ed s

ervi

ces

May

req

uire

exp

ensiv

e te

chno

logy

(bu

t no

t ve

ry

high

cos

t) a

nd/o

r co

lloca

ted

spec

ialis

t su

ppor

t se

rvic

es

May

req

uire

ver

y hi

gh c

ost

tech

nolo

gy a

nd/o

r co

lloca

ted

spec

ialis

t su

ppor

t se

rvic

es

May

req

uire

ver

y hi

gh c

ost

tech

nolo

gy a

nd/o

r co

lloca

ted

spec

ialis

t su

ppor

t se

rvic

es

May

req

uire

exp

ensiv

e te

chno

logy

(bu

t no

t ve

ry

high

cos

t) a

nd/o

r co

lloca

ted

spec

ialis

t su

ppor

t se

rvic

es

Volu

me/

qual

ity

rela

tions

hip

No

appa

rent

vol

ume/

qual

ity

rela

tions

hip

or s

uffic

ient

vo

lum

e at

eac

h si

te t

o m

eet

stan

dard

s

May

hav

e a

dem

onst

rate

d vo

lum

e/qu

ality

rel

atio

nshi

p w

hich

just

ifies

con

cent

ratio

n of

ser

vice

s on

2 s

ites

May

hav

e a

dem

onst

rate

d vo

lum

e/qu

ality

rel

atio

nshi

p w

hich

just

ifies

con

cent

ratio

n of

ser

vice

s on

1 s

ite

May

hav

e a

dem

onst

rate

d vo

lum

e/qu

ality

rel

atio

nshi

p w

hich

just

ifies

con

cent

ratio

n of

ser

vice

s on

1 s

ite

May

hav

e a

dem

onst

rate

d vo

lum

e/qu

ality

rel

atio

nshi

p w

hich

just

ifies

con

cent

ratio

n of

ser

vice

s on

2 s

ites

Thr

ough

put

Suffi

cien

t to

sup

port

at

leas

t 3

prac

titio

ners

at

each

hos

t si

te

if fr

eque

nt o

ut-o

f-ho

urs

reca

ll

Suffi

cien

t to

sup

port

at

leas

t 3

prac

titio

ners

at

each

of L

GH

an

d R

HH

if fr

eque

nt o

ut-o

f-ho

urs

reca

ll

Suffi

cien

t t

o su

ppor

t at

le

ast

3 pr

actit

ione

rs a

t sin

gle

site

if fr

eque

nt o

ut-o

f-ho

urs

reca

ll, u

nles

s sp

ecia

l ar

rang

emen

ts a

pply

Suffi

cien

t to

sup

port

at

leas

t 3

prac

titio

ners

at

singl

e si

te if

fr

eque

nt o

ut-o

f-ho

urs

reca

ll,

and

to s

uppo

rt s

usta

inab

le

outr

each

ser

vice

s

Suffi

cien

t to

sup

port

at

leas

t 3

prac

titio

ners

at

each

of L

GH

an

d R

HH

if fr

eque

nt o

ut-o

f-ho

urs

reca

ll

Man

agem

ent

Res

pons

ibili

ty o

f the

hos

t si

te

(NW

RH

, LG

H a

nd R

HH

)R

espo

nsib

ility

of t

he h

ost

site

(L

GH

and

RH

H)

Res

pons

ibili

ty o

f the

hos

t si

te

(LG

H o

r R

HH

)R

espo

nsib

ility

of t

he h

ost

site

(L

GH

or

RH

H)

Resp

onsib

ility

of t

he d

esig

nate

d ho

st s

ite –

sin

gle

poin

t of

man

agem

ent c

ontr

ol fo

r th

e St

ate

(eith

er L

GH

or

RH

H)

Acc

ount

abili

ty fo

r se

rvic

e ac

cess

ibili

ty

and

qual

ity (

clin

ical

go

vern

ance

)

Acc

ount

able

to

the

host

site

(N

WR

H, L

GH

and

RH

H)

Led

by t

he h

ost

site

s (L

GH

an

d R

HH

) w

ith L

GH

en

surin

g en

gage

men

t of

and

ac

coun

tabi

lity

to N

WR

H

Acc

ount

able

to

the

host

site

(L

GH

or

RH

H)

Led

by t

he h

ost s

ite (

LGH

or

RH

H)

with

eng

agem

ent o

f and

ac

coun

tabi

lity

to a

ll re

gion

s

Led

by t

he m

anag

emen

t si

te w

ith e

ngag

emen

t of

and

ac

coun

tabi

lity

to a

ll re

gion

s

Net

wor

king

ar

rang

emen

tsM

ay b

e a

spec

ific

clin

ical

ne

twor

k in

corp

orat

ing

each

si

te (

NW

RH

, LG

H, R

HH

) or

pa

rt o

f a b

road

er T

asm

ania

n cl

inic

al n

etw

ork

May

be

a sp

ecifi

c cl

inic

al

netw

ork

inco

rpor

atin

g ea

ch

site

(LG

H a

nd R

HH

) or

par

t of

a b

road

er T

asm

ania

n

clin

ical

net

wor

k

Sing

le T

asm

ania

n se

rvic

e, m

ay

be n

etw

orke

d in

ters

tate

or

part

of a

bro

ader

Tas

man

ian

clin

ical

net

wor

k

Sing

le T

asm

ania

n se

rvic

e, m

ay

be n

etw

orke

d in

ters

tate

or

part

of a

bro

ader

Tas

man

ian

clin

ical

net

wor

k

Sing

le T

asm

ania

n se

rvic

e, m

ay

be n

etw

orke

d in

ters

tate

or

part

of a

bro

ader

Tas

man

ian

clin

ical

net

wor

k


App

lyin

g th

e se

rvic

e ca

pabi

lity

fram

ewor

k to

exi

stin

g se

rvic

es

Tabl

e 16

: App

licat

ion

of s

ervi

ce c

apab

ility

fram

ewor

k to

exi

stin

g se

rvic

es

Serv

ice

Serv

ice

type

Req

uire

men

t fo

r sp

ecifi

c fu

ndin

g fo

r ou

trea

ch a

nd/

or s

tate

wid

e ac

coun

tabi

lity

arra

ngem

ents

Man

aged

by

Clin

ical

gov

erna

nce

acco

unta

bilit

yR

equi

rem

ent

to

part

icip

ate

in a

cl

inic

al n

etw

ork

Serv

ice

char

acte

rist

ics

Adu

lt an

d pa

edia

tric

cy

stic

fibr

osis

Stat

ewid

e, s

ingl

e si

te

with

out

reac

hYe

sR

HH

(st

atew

ide

dire

ctor

)W

hole

of s

tate

Shou

ld n

etw

ork

with

in

ters

tate

spe

cial

ty

serv

ices

The

RH

H is

the

ser

vice

pro

vide

r an

d pr

ovid

es o

utre

ach

clin

ics

in t

he

Nor

th a

nd N

orth

Wes

t

Adu

lt m

edic

al

retr

ieva

l ser

vice

Stat

ewid

e, s

ingl

e si

te

with

out

reac

hYe

sLG

H (

stat

ewid

e di

rect

or)

Who

le o

f sta

tePa

rtic

ipan

ts in

the

em

erge

ncy,

criti

cal

care

and

tra

uma

serv

ices

net

wor

k

The

LG

H is

the

ser

vice

pro

vide

r w

ith s

taffi

ng s

uppo

rt a

lso p

rovi

ded

by t

he R

HH

Baria

tric

sur

gery

Stat

ewid

e, s

ingl

e si

teN

oR

HH

R

HH

Part

icip

ants

in t

he

adul

t su

rgic

al s

ervi

ces

netw

ork

Serv

ice

scop

e to

be

revi

ewed

Bone

mar

row

tr

ansp

lant

atio

nSt

atew

ide,

sin

gle

site

fo

r tr

ansp

lant

atio

n,

dual

site

for

harv

estin

g

Yes

RH

H (

stat

ewid

e di

rect

or)

RH

H a

nd L

GH

Part

icip

ants

in t

he

canc

er n

etw

ork.

R

HH

and

LG

H

haem

atol

ogis

ts t

o w

ork

toge

ther

to

ensu

re c

omm

on

appr

oach

to

BMT.

Sh

ould

net

wor

k w

ith

inte

rsta

te s

peci

alty

se

rvic

es

The

RH

H is

the

sta

tew

ide

prov

ider

of

aut

olog

ous

BMT.

The

LG

H

prov

ides

ste

m c

ell h

arve

stin

g on

ly,

and

tran

sfer

s st

em c

ells

to t

he R

HH

fo

r cr

yopr

eser

vatio

n an

d tr

ansf

usio

n

Brac

hyth

erap

ySt

atew

ide,

sin

gle

site

No

LGH

LGH

Part

icip

ants

in t

he

canc

er n

etw

ork

The

LG

H is

the

sol

e pr

ovid

er o

f br

achy

ther

apy

for

the

Stat

e

Can

cer

serv

ices

(m

edic

al o

ncol

ogy,

mal

igna

nt

haem

atol

ogy

and

radi

atio

n on

colo

gy)

Reg

iona

l ref

erra

lYe

s –

for

outr

each

se

rvic

es p

rovi

ded

by

LGH

to

NW

RH

LGH

and

RH

HR

HH

LGH

ser

vice

has

dua

l ac

coun

tabi

lity

to L

GH

an

d N

WR

H

Part

icip

ants

in

canc

er n

etw

ork.

Su

b-sp

ecia

lists

(r

adia

tion

onco

logy

, m

edic

al o

ncol

ogy,

haem

atol

ogy)

from

bo

th s

ervi

ces

need

to

wor

k co

llabo

rativ

ely

Aus

tral

ian

Gov

ernm

ent

fund

ing

is av

aila

ble

for

a 5t

h lin

ear

acce

lera

tor

in

the

Nor

th o

r th

e N

orth

Wes

t. T

he

serv

ice

will

be

prov

ided

by

the

LGH


Serv

ice

Serv

ice

type

Req

uire

men

t fo

r sp

ecifi

c fu

ndin

g fo

r ou

trea

ch a

nd/

or s

tate

wid

e ac

coun

tabi

lity

arra

ngem

ents

Man

aged

by

Clin

ical

gov

erna

nce

acco

unta

bilit

yR

equi

rem

ent

to

part

icip

ate

in a

cl

inic

al n

etw

ork

Serv

ice

char

acte

rist

ics

Car

diac

el

ectr

ophy

siolo

gyTo

be

deve

lope

d as

a

stat

ewid

e, s

ingl

e si

te s

ervi

ce

No

LGH

or

RH

HLG

H o

r R

HH

(h

ost

site

)Pa

rtic

ipan

ts in

the

ca

rdia

c ne

twor

k.

May

ben

efit

from

pa

rtic

ipat

ion

in

inte

rsta

te o

utco

me

data

base

s

Con

sider

intr

oduc

tion

of c

ardi

ac

elec

trop

hysio

logy

as

part

of a

te

rtia

ry c

entr

e fo

r th

e de

liver

y of

th

e fu

ll ra

nge

of c

ardi

ac s

ervi

ces

acco

rdin

g to

inte

rven

tiona

l ca

rdio

logy

inpa

tient

dem

and

Spec

ialis

t ca

rdio

logy

incl

udin

g in

terv

entio

nal

Reg

iona

l ref

erra

lYe

s –

for

outr

each

se

rvic

es p

rovi

ded

by

LGH

to

NW

RH

LGH

and

RH

HR

HH

LGH

ser

vice

has

du

al a

ccou

ntab

ility

to

LG

H a

nd N

WR

H

Part

icip

ants

in t

he

card

iac

netw

ork.

M

ay b

enefi

t fr

om

part

icip

atio

n in

in

ters

tate

out

com

e da

taba

ses

The

re a

re t

wo

inte

rven

tiona

l ca

rdio

logy

ser

vice

s in

the

pub

lic

sect

or –

at

the

LGH

and

the

RH

H.

The

re is

no

elec

trop

hysio

logy

ser

vice

in

Tas

man

ia

Car

diot

hora

cic

surg

ery

Stat

ewid

e, s

ingl

e si

teN

o, u

nles

s ou

trea

ch

arra

ngem

ents

are

de

velo

ped

RH

HR

HH

Part

icip

ants

in t

he

card

iac

netw

ork.

M

ay b

enefi

t fr

om

part

icip

atio

n in

in

ters

tate

out

com

e da

taba

ses

The

RH

H is

the

sol

e pr

ovid

er o

f ca

rdio

thor

acic

sur

gica

l ser

vice

s fo

r th

e St

ate

Com

plex

EN

T he

ad

and

neck

sur

gery

Stat

ewid

e, s

ingl

e si

teN

o, u

nles

s du

al

site

or

outr

each

ar

rang

emen

ts

are

deve

lope

d

RH

HR

HH

Part

icip

ants

in t

he

adul

t su

rgic

al s

ervi

ces

netw

ork

Serv

ice

scop

e to

be

revi

ewed

Com

plex

mat

erno

-fo

etal

med

icin

eSt

atew

ide,

sin

gle

site

No

RH

HW

hole

of s

tate

Part

icip

ants

in

the

wom

en’s

and

child

ren’

s ne

twor

k

The

RH

H is

the

onl

y pr

ovid

er o

f co

mpl

ex o

bste

tric

and

leve

l 3

NIC

U s

ervi

ces

Com

plex

upp

er

gast

roin

test

inal

su

rger

y in

clud

ing

panc

reat

ic, m

ajor

oe

soph

agea

l and

he

pato

bilia

ry s

urge

ry

Stat

ewid

e, s

ingl

e si

teN

o, u

nles

s du

al

site

or

outr

each

ar

rang

emen

ts

are

deve

lope

d

LGH

LGH

Part

icip

ants

in t

he

adul

t su

rgic

al s

ervi

ces

netw

ork

The

LG

H s

urge

ons

have

dev

elop

ed

a sp

ecia

l int

eres

t in

thi

s se

rvic

e.

Con

tinue

d co

ncen

trat

ion

of t

his

spec

ialis

t se

rvic

e on

one

site

is

appr

opria

te


Serv

ice

Serv

ice

type

Req

uire

men

t fo

r sp

ecifi

c fu

ndin

g fo

r ou

trea

ch a

nd/

or s

tate

wid

e ac

coun

tabi

lity

arra

ngem

ents

Man

aged

by

Clin

ical

gov

erna

nce

acco

unta

bilit

yR

equi

rem

ent

to

part

icip

ate

in a

cl

inic

al n

etw

ork

Serv

ice

char

acte

rist

ics

Fore

nsic

pat

holo

gySt

atew

ide,

sin

gle

site

Yes

Hos

ted

by R

HH

, m

anag

ed b

y St

atew

ide

Fore

nsic

Pa

thol

ogy

Serv

ice

DH

HS

Path

olog

y ne

twor

k

(if e

stab

lishe

d)

Gen

etic

s se

rvic

esSt

atew

ide,

sin

gle

site

w

ith o

utre

ach

Yes

Hos

ted

by R

HH

, m

anag

ed b

y th

e Ta

sman

ian

Clin

ical

G

enet

ics

Serv

ice

DH

HS

The

TC

GS

will

pa

rtic

ipat

e in

a

num

ber

of n

etw

orks

as

rel

evan

t (e

.g.

canc

er n

etw

ork,

ad

ult

med

ical

ser

vice

s ne

twor

k)

The

Tas

man

ian

Clin

ical

Gen

etic

s Se

rvic

e (T

CG

S) is

the

sta

tew

ide

prov

ider

of c

linic

al g

enet

ics

serv

ices

. TC

GS

prov

ides

gen

etic

s ou

trea

ch

serv

ices

to

the

Nor

th a

nd N

orth

W

est

with

con

trac

tual

arr

ange

men

ts

with

Gen

etic

s H

ealth

Ser

vice

s V

icto

ria fo

r vi

sitin

g cl

inic

al g

enet

icis

ts

and

gene

tic t

estin

g. G

enet

ics

Hea

lth

Serv

ices

Vic

toria

con

duct

s te

stin

g of

ne

w b

orn

babi

es o

n a

cont

ract

bas

is.

The

Tas

man

ian

Gov

ernm

ent

assu

med

re

spon

sibili

ty fo

r th

e Ta

sman

ian

Fam

ilial

Bow

el C

ance

r R

egis

try

in

Janu

ary

2008

Gyn

aeco

logi

cal

onco

logy

Stat

ewid

e, s

ingl

e si

teN

o, u

nles

s ou

trea

ch

arra

ngem

ents

are

fo

rmal

ised

RH

HR

HH

Part

icip

ants

in

the

wom

en’s

and

child

ren’

s ne

twor

k

Cur

rent

ly p

rovi

ding

out

reac

h se

rvic

es b

ut s

usta

inab

ility

is n

ot

clea

r w

ith s

ingl

e pr

actit

ione

r se

rvic

e. R

evie

w s

cope

of s

ervi

ce

to d

eter

min

e w

heth

er s

econ

d pr

actit

ione

r ca

n be

rec

ruite

d an

d se

rvic

e su

stai

nabi

lity

impr

oved

Hyp

erba

ric m

edic

ine

Stat

ewid

e, s

ingl

e si

teN

oR

HH

RH

HPa

rtic

ipan

ts in

the

ad

ult

med

ical

ser

vice

s ne

twor

k

Dem

and

and

oppo

rtun

ities

for

inte

grat

ion

with

oth

er s

peci

altie

s to

be

rev

iew

ed

Infe

ctio

us d

iseas

esSt

atew

ide,

sin

gle

site

w

ith o

utre

ach

Yes

RH

H (

stat

ewid

e di

rect

or)

RH

H a

nd L

GH

Part

icip

ants

in t

he

adul

t m

edic

al s

ervi

ces

netw

ork

Dev

elop

men

t to

a s

tate

wid

e se

rvic

e on

dua

l site

s or

a r

egio

nal a

cute

ho

spita

l ref

erra

l ser

vice

sho

uld

be

cons

ider

ed


Serv

ice

Serv

ice

type

Req

uire

men

t fo

r sp

ecifi

c fu

ndin

g fo

r ou

trea

ch a

nd/

or s

tate

wid

e ac

coun

tabi

lity

arra

ngem

ents

Man

aged

by

Clin

ical

gov

erna

nce

acco

unta

bilit

yR

equi

rem

ent

to

part

icip

ate

in a

cl

inic

al n

etw

ork

Serv

ice

char

acte

rist

ics

Maj

or b

urns

Stat

ewid

e, s

ingl

e si

teN

o, u

nles

s ou

trea

ch

arra

ngem

ents

are

de

velo

ped

RH

HR

HH

Part

icip

ants

in t

he

adul

t su

rgic

al s

ervi

ces

netw

ork

Exte

nsiv

e bu

rns

case

s ar

e re

ferr

ed to

V

icto

ria fo

r sp

ecia

lised

trea

tmen

t.

LGH

and

NW

RH

man

age

min

or b

urns

Maj

or n

euro

surg

ery

Stat

ewid

e, s

ingl

e si

teN

o, u

nles

s ou

trea

ch

arra

ngem

ents

are

de

velo

ped

RH

HR

HH

Part

icip

ants

in t

he

adul

t su

rgic

al s

ervi

ces

netw

ork

Con

solid

ate

and

form

alise

ag

reem

ents

with

inte

rsta

te h

ospi

tals

to e

nsur

e on

goin

g co

ver

Med

ical

imag

ing

Loca

l acu

te h

ospi

tal

serv

ice,

mov

ing

to

stat

ewid

e se

rvic

e

Not

at

pres

ent,

but

wou

ld b

e re

quire

d

if st

atew

ide

serv

ice

is

deve

lope

d

Loca

l acu

te h

ospi

tal

(LG

H, N

WR

H,

RH

H),

mov

ing

to

stat

ewid

e di

rect

orat

e

Loca

l acu

te h

ospi

tal

(LG

H, N

WR

H,

RH

H),

mov

ing

to s

tate

wid

e ac

coun

tabi

lity

Med

ical

imag

ing

netw

ork

to b

e es

tabl

ished

if

stat

ewid

e se

rvic

e is

not

esta

blish

ed

Con

sider

est

ablis

hing

a s

tate

wid

e se

rvic

e co

ordi

nate

d th

roug

h a

singl

e ad

min

istr

ativ

e st

ruct

ure

Neo

nata

l int

ensiv

e ca

re/p

aedi

atric

in

tens

ive

care

/pa

edia

tric

and

ne

onat

al r

etrie

val

Stat

ewid

e, s

ingl

e si

teN

oR

HH

Who

le o

f Sta

tePa

rtic

ipan

ts in

th

e w

omen

’s an

d ch

ildre

n’s

netw

ork

Serv

ices

are

all

prov

ided

from

the

R

HH

and

sho

uld

not

be d

uplic

ated

in

the

Stat

e

Paed

iatr

ic s

urge

rySt

atew

ide,

sin

gle

site

No,

unl

ess

outr

each

ar

rang

emen

ts a

re

form

alise

d

RH

HR

HH

Part

icip

ants

in

the

wom

en’s

and

child

ren’

s ne

twor

k

Cur

rent

ly p

rovi

ding

out

reac

h se

rvic

es

but

sust

aina

bilit

y no

t cl

ear

with

sin

gle

prac

titio

ner

serv

ice.

Rev

iew

sco

pe o

f se

rvic

e to

det

erm

ine

whe

ther

sec

ond

prac

titio

ner

can

be r

ecru

ited

and

serv

ice

sust

aina

bilit

y im

prov

ed

Path

olog

y se

rvic

esLo

cal a

cute

hos

pita

l se

rvic

e, m

ovin

g to

st

atew

ide

serv

ice

Not

at

pres

ent,

but

wou

ld b

e re

quire

d

if st

atew

ide

serv

ice

is

deve

lope

d

Loca

l acu

te h

ospi

tal

(LG

H, N

WR

H,

RH

H)

mov

ing

to

stat

ewid

e di

rect

orat

e

Loca

l acu

te h

ospi

tal

(LG

H, N

WR

H, R

HH

) m

ovin

g to

sta

tew

ide

acco

unta

bilit

y

Path

olog

y ne

twor

k to

be

esta

blish

ed if

st

atew

ide

serv

ice

is no

t es

tabl

ished

Con

sider

est

ablis

hing

a s

tate

wid

e se

rvic

e co

ordi

nate

d th

roug

h a

singl

e ad

min

istr

ativ

e st

ruct

ure


Serv

ice

Serv

ice

type

Req

uire

men

t fo

r sp

ecifi

c fu

ndin

g fo

r ou

trea

ch a

nd/

or s

tate

wid

e ac

coun

tabi

lity

arra

ngem

ents

Man

aged

by

Clin

ical

gov

erna

nce

acco

unta

bilit

yR

equi

rem

ent

to

part

icip

ate

in a

cl

inic

al n

etw

ork

Serv

ice

char

acte

rist

ics

PET/

CT

scan

ning

Stat

ewid

e, s

ingl

e si

teN

oR

HH

RH

HPa

rtic

ipan

t in

med

ical

im

agin

g ne

twor

k if

deve

lope

d

Aus

tral

ian

Gov

ernm

ent

fund

ing

confi

rmed

Phar

mac

yLo

cal a

cute

hos

pita

l se

rvic

eN

ot a

t pr

esen

t, bu

t w

ould

be

requ

ired

if

stat

ewid

e se

rvic

e

is de

velo

ped

Loca

l acu

te h

ospi

tal

(LG

H, N

WR

H,

RH

H)

Loca

l acu

te h

ospi

tal

(LG

H, N

WR

H,

RH

H)

Phar

mac

y ne

twor

k to

be

esta

blish

ed if

st

atew

ide

serv

ice

is no

t es

tabl

ished

Con

sider

est

ablis

hing

a s

tate

wid

e se

rvic

e co

ordi

nate

d th

roug

h a

singl

e ad

min

istr

ativ

e st

ruct

ure

Ren

al m

edic

ine

Reg

iona

l ref

erra

l Ye

s, fo

r ou

trea

ch

serv

ices

pro

vide

d by

LG

H t

o N

WR

H

LGH

and

RH

HR

HH

LGH

ser

vice

has

dua

l ac

coun

tabi

lity

to L

GH

an

d N

WR

H

Part

icip

ants

in a

dult

med

ical

net

wor

k,

but

clin

icia

ns fr

om

both

ser

vice

s ne

ed t

o w

ork

colla

bora

tivel

y

Ren

al m

edic

ine

is pr

ovid

ed fr

om

two

node

s, on

e at

the

LG

H a

nd

one

at t

he R

HH

. The

LG

H p

rovi

des

a sig

nific

ant

outr

each

ser

vice

to

patie

nts

who

res

ide

in t

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Specific service issuesAutologous bone marrow transplantation

The 2007 Clinical Services Plan recommends that there should be a statewide service with an appointed director and the development of protocols for early transfer back to Launceston for appropriate patients. An independent review has been conducted and has supported these recommendations, which are being implemented.

Adult medical retrieval

The LGH oversees the medical coordination and escort components of the retrieval service and a part-time director is appointed to manage the service. The service evolved on a voluntary ‘opt-in’ basis with critical care consultants, anaesthetists and registrars to provide support to the retrieval service.

A statewide working party (comprising the Deputy Secretary, Acute Health Services and senior clinicians from each of the major hospitals and Tasmanian Ambulance Service) identified the need to strengthen the service to ensure its future sustainability, including taking into account the recommendations from Tasmania’s Health Plan. External advice was sought from Dr Peter Sharley, Royal Adelaide Hospital Mediflight Director 2002–07, to assist that process.

Workforce shortages threatened the sustainability of the service in 2007. In order to maintain the service, locum medical staff were engaged on an interim basis pending a longer term solution to be identified by the Sharley Report. The Sharley Report is being considered by the Department and an implementation plan is being developed.

Included in this approach will be the results of negotiations between the Australian Government and the Royal Flying Doctor Service for funding to enhance the retrieval service through employment of 2.5 full-time equivalent medical specialists and recurrent funding for training of medical and flight paramedic staff on aeromedical service provision.

Implementation commitment

As noted in implementation commitment 3 (see page 31), the Department will publish an implementation plan for adult medical retrieval services by June 2008 and will finalise implementation of a statewide service for bone marrow transplantation by October 2008.

Bariatric surgery The 2007 Clinical Services Plan recommends that:

•bariatricsurgeryshouldbeconductedonlyattheRHHasasinglesiteservice;

•surgeonsshouldundergospecificcredentiallinganddefinitionofscopeof clinical practice;

•onlypeoplewhomeetagreedcriteriashouldbeadmittedtotheprogram;

•thenumberofpeopletobeofferedsurgeryeachyearshouldbedetermined by the Division of Surgery, taking into account demand;

•waitinglistsandotherindicatorsofdemandshouldbemonitored;and

•outcomesshouldbeaudited.

In most developed health services, bariatric surgery is recommended as a treatment option for adults with morbid obesity if a number of health-related criteria are met.

A significant relationship between volume of cases and outcomes has been demonstrated for bariatric surgery.6

The 2007 Clinical Services Plan recommendations are reiterated. In addition, there is an opportunity for the Tasmanian health care system to take a more integrated approach (incorporating a broader range of medical and surgical disciplines) to the increasing challenge of managing patients with morbid obesity.

6 Nguyen NT, Paya, M, Stevens CM, Mavandadi S, Zainabadi K, Wilson SE. The Relationship Between Hospital Volume and Outcome in Bariatric Surgery at Academic Medical Centers. Ann Surg. 2004 October; 240(4): 586–594.



The Department will oversee the development and implementation of a plan for the provision of bariatric surgery by the RHH by January 2009, and by December 2009 will develop an integrated statewide multidisciplinary strategy for the management of patients with morbid obesity.

Cardiac electrophysiology

The 2007 Clinical Services Plan recommends that it is clinically appropriate for a single site electrophysiology service to be developed in Tasmania and that the service could be located at either the LGH or the RHH.

The 2007 Clinical Services Plan recommendations are reiterated.


The Department will complete a feasibility study into cardiac electrophysiology services by June 2010.

Hyperbaric medicine

There is continuing debate about the facilities that should be developed at the RHH to support Hyperbaric Oxygen Therapy (HBOT) for various conditions.

A large number of reviews of this treatment have been conducted. Evidence of effectiveness is limited to defined clinical indications.

The Medical Services Advisory Committee (MSAC) of the Australian Government has recommended continuation of public funding for a limited range of indications.

It is recommended that:

•theRHHserviceisdesignedforthemanagementofpatientssufferingfromconditionsin which HBOT has been shown to be effective – in particular decompression illness, gas gangrene, air or gas embolism, diabetic wounds including diabetic gangrene and diabetic foot ulcers, necrotising soft tissue infections including necrotising fasciitis and Fournier’s gangrene and the prevention and treatment of oteoradionecrosis. In addition, in the absence of new evidence of lack of effectiveness, it would be reasonable to design the service to provide treatment of non-healing, refractory wounds in non-diabetic patients and refractory soft tissue radiation injuries;

•theserviceisreviewedwithafocusonensuringthatasustainableserviceisavailable for patients suffering from conditions for which there is evidence of the effectiveness of the treatment. This may require consideration of workforce support arrangements with interstate units; and

•ifHBOTistobeprovidedforabroaderrangeofclinicalconditionsitshouldbeprovided under research conditions, in clinical areas in which a need for further research has been identified. In these circumstances, consideration needs to be given to the research priority of this service and potential sources of funding to ensure that funding is not diverted from other areas of clinical priority.


The Department will complete an expert review of hyperbaric oxygen therapy by June 2009.

Medical imaging The 2007 Clinical Services Plan recommends consideration of statewide services for both pathology and medical imaging. Although these services are operating cooperatively across the State, it is considered that upcoming workforce challenges will require a single statewide management focus to ensure sustainable service delivery. The Clinical Services Plan recommendations are reiterated.

Pathology



The Department will complete feasibility studies of statewide services in medical imaging and pathology by December 2009.

Rehabilitation A review of Tasmania’s rehabilitation services, which was completed in April 2007, confirmed that relative to national standards there is a current shortfall of 50–60 beds across the State, with the North and North West having the most significant need for resources. The review proposed a strategy containing nine elements:

•formalisetheestablishmentofaTasmanianrehabilitationnetworktoenhancethestatusof rehabilitation and provide statewide policy direction, service planning and training;

•re-balancetheinvestmentininpatientservicesbyincreasingprovisionforrehabilitation and other sub-acute care;

•establishintegratedrehabilitationprogramsandorganisationalstructureswithineachregion, linking acute care, sub-acute care and community rehabilitation programs;

•promoteanintegrated,patient-focusedmodelofservicedeliverythatextendsacross settings and includes patient identification/referral, assessment, care planning, case management and discharge planning;

•changecurrentutilisationpatternstomakemoreeffectiveuseofavailablerehabilitationresources and improve patient outcomes;

•alignrehabilitationservicedevelopmentandspecialisationwithrelevantacuteclinicalservice planning and delivery;

•developandimplementarehabilitationworkforcestrategyincluding:

– leadership and team building;

– recruitment/retention;

– training;

– making more efficient use of available resources; and

– investment;

•supportthedevelopmentofspecialistrehabilitationprogramsinbraininjury,spinaland amputee; and

•addressinfrastructuredeficienciesthatrestrictservicecapacityandeffectivenessinfacilities, equipment and transport.

The review proposed the following strategic investment priorities:

•builda32-bedinpatientunitintheNorth;

•increasethenumberofalliedhealthstaffworkingintheLGHrehabilitationunit;

•developstep-downfacilitiesintheNorth,includingacommunityrehabilitationservice as well as Geriatric Evaluation and Management and transition care beds and transition care packages;

•improvemedicalcoverageintheNorthWest,includingaccesstoconsultation–liaison services provided from Launceston or Hobart;

•developstep-downfacilitiesintheNorthWestincludingacommunityrehabilitationservice as well as transition care beds and transition care packages. The location of such services at the Mersey Hospital should be considered as part of the Clinical Services Plan; and

•workforcedevelopment.

These recommendations are supported. In particular, there is a critical need for service development in the North and North West of the State and significant investment in community-based resources is required to prevent inappropriate hospitalisation.



The Department will formalise the establishment of a rehabilitation and aged care network by August 2008 and publish an implementation plan for rehabilitation services by February 2009.

Vascular surgery The 2007 Clinical Services Plan recommends the following structure for vascular surgery:

•designationasastatewideservice,ledfromHobart;

•theexistingsurgeonintheNorthWesttobeofferedtheopportunitytomovehispractice to Launceston and be appointed to the LGH as a member of the statewide vascular surgical team;

•thestatewidevascularsurgicalteamtoprovideback-upandsupportfortheLaunceston service through visiting consultancy services and on-call, professional and locum support;

•outreachservicestocontinuetobeprovidedfromHobartand/orLauncestontothe North West, by arrangement with the statewide service; and

•allvascularsurgeons,asaconditionoftheirappointment,toparticipateinastatewide audit.

After the 2007 Clinical Services Plan was published the Mersey Community Hospital’s major inpatient vascular surgical unit closed, but the surgeon did not relocate his practice to Launceston. Public acute hospital services currently are based in Hobart and the Hobart vascular surgeons provide an outreach service (consulting and low complexity operating) to Launceston.

The Australian and New Zealand Society for Vascular Surgery considers that for a population catchment of 500,000 people there should be a unit of four surgeons and that a minimum of two or more surgeons is required in any one location to sustain a resident specialist service.

Hospitals that perform high volumes of complex vascular surgical procedures have lower mortality rates than hospitals that perform low volumes.7

Mortality following a ruptured abdominal aortic aneurysm is high – the case fatality from rupture is 80 per cent, with most patients dying before admission or within 30 days of surgery. The outcome in women is worse than in men.8

A study which examined the resource use and outcomes of patients transferred from community centres to tertiary care centres following the diagnosis of ruptured abdominal aortic aneurysms found that the transferred group took a median of 7.2 hours to reach the operating room compared with 1.8 hours for the non-transferred group. The non-transferred group had a 41 per cent incidence of mortality within 24 hours of surgery compared with 10 per cent in the transferred group. The authors speculated that this difference might indicate that transferred patients were pre-selected with sufficient cardiac reserve to survive the initial transfer period. However, no data on the rate of death during transfer were available. The overall 30-day mortality rates were not statistically different between those transferred (65%) and those not transferred (69%), (p>0.05). Transferred patients had more than a twofold increase in intensive care unit use, however, and a substantial increase in total costs.9

The options for Tasmania are to develop two public acute hospital units each with two surgeons (one in Launceston and one in Hobart) or a single public acute hospital unit, with an outreach service to the North as currently applies.

7 Dimick J, Pronovost PJ, Cowan JA, Ailawadi G, Upchurch GR Jnr. The volume-outcome effect for abdominal aortic surgery. Arch Surg. 2002;137:828-832.

8 Norman PE, Semmens JB, Lawrence-Brown MMD, Holman CDJ. Long term relative survival after surgery for abdominal aortic aneurysm in Western Australia: population based study. BMJ 1998;317:852-856.

9 Vogel T R, Nackman G B, Brevetti L S, Crowley J G, Bueno M M, Banavage A, Odroniec K, Ciocca R G, Graham A M. Resource utilisation and outcomes: effect of transfer on patients with ruptured abdominal aortic aneurysms. Annals of Vascular Surgery 2005;19(2):149-153.


Vascular surgery (continued)

There is no doubt that from a sustainability perspective the optimal service configuration is a unit of four surgeons located in a single unit in Hobart. This configuration avoids the well-recognised problems associated with single- or dual-surgeon practice. On the other hand, it jeopardises access for residents of the North and North West regions, particularly for time-critical emergencies including ruptured abdominal aortic aneurysm and for urgent surgery including vascular access procedures for patients undergoing renal dialysis, and increases travel distances for elective surgery.

On balance, the existing arrangement of four vascular surgeons located in Hobart and providing outreach service to the North (and, if possible, the North West) should be maintained. Appointment of a single surgeon to the LGH would not create a sustainable service, and disruption of the established Hobart service, which is well-structured, in order to provide a local service in the North may result in two unsustainable services and a diminution of service to the entire State.

Where possible, patients with medical complications of vascular illness (e.g. ulcers) should be managed within their local services with vascular specialist oversight.


By December 2008 the Department will facilitate:

•formalagreementbetweentheLGH,theNWRH(Burnie)andtheRHHonthescopeofandaccountability arrangements for vascular surgery provision to the LGH and the NWRH; and

•thedevelopmentofformalprotocolsfortherapidtransferfromtheNorthandNorthWestregions directly to theatre at the RHH of patients with time-critical vascular emergencies who are considered suitable for surgery.


Integrated care centresCommitment to develop purpose-built facilities for integrated careTasmania’s Health Plan announced the proposed development of four ICCs in the following locations:

• collocatedwiththeRHH;

• onHobart’seasternshore;

• inLaunceston,closetotheLGH;and

• inKingborough.

ICCs were described in the Plan as facilities which:

• accommodatearangeofhealthservicesthatprovideefficient,integratedcareregardlessofwhofunds, owns or provides each element of the services;

• operateunderaphilosophywhichislessinterventionalandorientedtowardscareinthecommunity rather than institutional care; and

• providegreatercertaintyofaccessforclientsbecausetheyfocusonnon-emergencyservicesincluding a broad range of non-admitted primary, secondary and tertiary services, short stay elective services and specialised sub-acute services.

These purpose-built facilities will enable distinctive physical, funding and administrative arrangements to be implemented to support a desired model of care. The first step in the detailed planning of Tasmania’s ICCs, however, requires precise definition of the concept of ‘integrated care’ and clear specification of the objectives of developing purpose-built facilities for its delivery to ensure that the opportunities presented by these developments are captured optimally.

Integrated care – a definitionSome definitions of integrated care focus on the organisation of services across different sectors, for example:

‘…a coherent set of methods and models on the funding, administrative, organisational, service delivery and clinical levels designed to create connectivity, alignment and collaboration within and between the cure and care sectors.’10

Other definitions focus on the provision of a broad range of health and/or social care services:

‘…a concept bringing together inputs, delivery, management and organisation of services related to diagnosis, treatment, care, rehabilitation and health promotion.’11

The need for integrated careThe following trends highlight the need for better integrating care:

• theTasmanianpopulationisageingandsuffersfromarelativelyhighincidenceofchronicconditions which require different health care solutions than do acute conditions. The emphasis is shifting from acute interventions to monitoring and from cure to care. There is a requirement for multidisciplinary teamwork in order to optimally manage these conditions; and

• increasingly,hospitalsareprovidingshortstay,hightechnologytreatment,withaneedforanincreasing range of services to be provided in non-hospital settings.

10 Kodner, DL.; Spreeuwenberg, C. Integrated care: meaning, logic, applications, and implications – a discussion paper. International Journal of Integrated Care , Vol 2 < http://www.ijic.org/>.

11 Gröne, Garcia-Barbero. WHO European Office for Integrated Health Care Services. International Journal of Integrated Care [serial online]. 2001 Jun 1;1 < http://www.ijic.org/>.


Integrated care has been identified as a means of addressing a number of failings of modern health care systems including:

• lackof‘ownership’ofpatientsandtheirproblems,sothatinformationgetslostaspatientsnavigate the system;

• lackofinvolvementbytheuser/patientinthemanagementandstrategyofcare;

• poorcommunicationwiththeuser/patientaswellaswithhealthandsocialcareproviders;

• treatingpatientswithoneconditionwithoutrecognisingotherneedsorconditions,therebyundermining the overall effectiveness of treatment; and

• decisionsmadeinthesocialcaresettingaffecttheimpactofhealthcaretreatment,andviceversa.12

Patient care is increasingly encompassing more technologically sophisticated multidisciplinary care which is provided in multiple settings, requiring more and better coordination and integration. Vulnerable groups who have difficulty accessing the health care system (e.g. people with chronic disabling conditions who are isolated, dependent, frail and/or mentally ill) are recognised as having particular needs for integrated care.

Increasingly, governments are seeking to integrate health and social care, with the system of care designed around the patient rather than the organisations that deliver care. Integrated care has the objective of providing seamless, coordinated care from the perspective of the patient.

Types of integration of health careShortell distinguishes integration at various levels:

• functional integration occurs on the macro-level of a health care system, for example through mainstreaming of the financing and regulation of cure, care, prevention and social services;

• organisational integration occurs on the meso-level of a health care system, for example in the form of mergers, contracting or strategic alliances between health care institutions;

• professional integration occurs on the meso-level of a health care system, for example in the form of mergers (e.g. group practices), contracting or strategic alliances between health care professionals; and

• clinical integration occurs on the micro-level of a health care system, for example continuity, cooperation and coherence in the primary process of care delivery to individual patients.13

Depending on its philosophy, funding models and structure, an ICC may have a range of characteristics. For example it may be a facility:

• inwhichasingleorganisationownedandoperatedbytheTasmanianGovernment(e.g.ahospitalor community health service) provides a broad range of health and/or social care services, enabling the coordinated provision of prevention, treatment and care in a non-hospital setting;

• inwhichmultipleproviders(e.g.publiclyandprivatelyemployedprofessionalsinthehealthandsocial care sectors) collocate and practise their professions, not changing their organisational arrangements or methods of service delivery, but creating enhanced referral opportunities and enabling consumers to access multiple types of care in a single setting; or

• inwhichmultipleprovidersworktogetherinacoordinatedmannertoenablethedeliveryof‘seamless’ care to patients.

12 Lloyd J and Wait S. Integrated care: a guide for policymakers. Alliance for Health and the Future, London. Accessed on 13 April 2008. <http://ns1.siteground169.com/~healthan/healthandfuture/images/stories/Documents/integrated%20care%20-%20a%20guide%20for%20policy%20makers.pdf>.

13 Shortell SM, Gillies RR, Anderson DA, Erikson KM, Mitchell JB. Remaking Health Care in America. San Francisco, Jossey Bass Publishers. 2000.


The outcomes of such arrangements may be integration from the perspective of providers; integration from the perspective of consumers (who experience ‘seamless’ care); or integration from the perspective of both providers and consumers (see Figure 5 below).

Figure 5: Types of integrated care

Source: Lloyd J and Wait S. Integrated care: a guide for policymakers14

There is an opportunity for the Tasmanian health care system to develop physical facilities and governance and management arrangements that best support integrated care, complementing the current acute and primary health care systems while ensuring that patient access to existing resources is maintained.

Early work has identified the following key objectives in relation to ICCs in Tasmania:

• provisionofwell-integrated,multidisciplinary,patient-centredcareacrosstheprimaryand acute sectors;

• responsivenesstolocalcommunityneedsandpriorities;

• accessible,culturallyappropriateandaffordablecare;

• moreeffectivepreventionandmanagementofchronicconditions;

• aworkingenvironmentandconditionsthatattractandretainworkforce;and

• provisionofhighqualityeducationandtrainingopportunitiestosupportthefuturehealthworkforce.

ICCs will improve the patient’s experience and outcome of care by:

• divertingpatientsfromanacutecaredestination/facilitytoamoreappropriatesettingofcare;and

• providingmoreeffectivepreventionandmanagementofchronicconditions,throughplanned,managed and proactive care that reduces complications and prevents or delays relapse.

A number of issues need to be considered as detailed planning for the ICCs progresses:

• whatisthepurposeofeachICC?Optionsincludedirectservicedeliveryfromacentralsite;theprovision of a ‘front door’ to a number of diverse providers who may or may not be located on site; the coordination of services for target patient groups; and/or the provision of support to health care professionals to enable them to provide better integrated care for their patients.

14 Lloyd J and Wait S. Integrated care: a guide for policymakers. Alliance for Health and the Future, London. Accessed on 13 April 2008. <http://ns1.siteground169.com/~healthan/healthandfuture/images/stories/Documents/integrated%20care%20-%20a%20guide%20for%20policy%20makers.pdf>.

15 ibid.

Provider integration

User integration

High

Low

Low High

Models of integrated care can be located in different parts of the matrix


As an example of a ‘front door’ model, in the Netherlands a ‘one window’ model applies to users of health and social care, which provide advice, information and support in accessing and utilising health and social care services;15

• whoarethetargetpatientgroups?Peoplewithchronicillness(especiallythosewhoareatriskofhospitalisation or who require intermittent acute care in the management of a chronic condition) are a clear target group. Other target groups may include elderly people; people with defined health and/or social vulnerabilities; and/or people recently discharged from hospital;

• whattypesofprovidersshouldbeengagedandwhatisthepurposeoftheengagement? For example, provision of a broad range of care, facilitation of referral pathways, or influencing changes in practice;

• whichspecificprovidersshouldprovideservicesfromeachICC?Optionsincludestate-ownedand funded providers only (e.g. public acute hospitals and/or community health centres) through to providers of privately owned and operated services including general practice, allied heath, health promotion/illness prevention organisations and/or local government;

• whatprocesseswilllinkthoseproviderstogether?Forexample,commonphilosophies, funding streams, employment arrangements, reporting/accountability arrangements, contractual agreements;

• whoshouldbeengagedinplanningandmanagingeachICC?

• whatorganisationalstructureisappropriate,recognisingthatthestructurecandefinethewaysinwhich professionals and patients are engaged in achieving each ICC’s objectives?

Decisions about these and other relevant issues will need to be reached as planning for Tasmania’s ICCs proceeds.

Effective planning and management of these facilities will enable many patients, particularly those with chronic and complex conditions, to receive multidisciplinary care that will reduce their need for inpatient care and enable better management of their health and wellbeing.


The Department will convene a multidisciplinary ICC policy and planning group immediately to develop, consult on and finalise a policy and planning framework for ICCs by July 2008, that will support a subsequent detailed model of care and facility planning.


Efficiency and accessibility of hospital servicesIntroductionWhen planning for the future, it is usual to start from a baseline of current activity and adjust it for expected changes in a range of parameters including population growth and ageing and changes in models of care.

It is also useful to consider the following questions before assuming that the current baseline of service delivery is appropriate:

• Istheoverallinvestmentinhealthservicesreasonable?

• Isthatinvestmentappliedefficiently,togetthebestvalueforthecommunity?

• Isthatinvestmentdistributedfairly,sothatallmembersofthecommunityhavereasonableopportunities to access services according to their needs?

This section of the report considers Tasmania’s health investment compared with other states and territories; indicators of whether resources are used efficiently; and the way in which resources are distributed within Tasmania.

Benchmarking Tasmania’s resourcesThe Australian Institute of Health and Welfare publishes a range of benchmarking data, the most recent of which relates to public acute hospitals for the financial year 2005–06. These data show that Tasmania has:

• thehighesttotalbeds(public,privateandpsychiatric)per1,000populationofanyAustralianjurisdiction (it should be noted that these figures include the relatively large number of beds in very small rural hospitals in Tasmania, a model which is uncommon in other jurisdictions);

• anaveragenumberofpublicacuteandpsychiatrichospitalbedsper1,000residentpopulation;

• thelowestnumberofpublichospitalseparationsandarelativelylownumberofpatientdaysper1,000 population;

• ahighaveragelengthofstay,bothoverallandwhensamedaypatientsareexcluded;

• ahighaveragecostweightperseparation;

• ahigher-than-averagecostpercasemix-adjustedseparation;

• anaveragerateofpotentiallypreventablehospitalisations;and

• higher-than-averageaccesstoagedcareplacesandpackages(Table17).


Table 17: Benchmarking data, Tasmania’s hospitals 2005–06

NSW Vic Qld WA SA Tas ACT NT Total

Total beds per 1,000 population(1)

3.9 3.7 4.1 4.2 4.6 4.6 3.4 3.5 4.0

Avail. beds to 1,000 resident population(2)

2.9 2.4 2.5 2.5 3.2 2.7 2.2 2.8 2.7

Separations per 1,000 population(3)

199.8 243.7 187.9 195.7 228.4 185.8 238.4 483.0 212.8

Patient days per 1,000 population(3)

780.8 810.4 661.3 703.1 838.3 716.3 823.2 1,504.7 768.8

Average length of stay (days)(3)

4.0 3.4 3.5 3.6 3.9 4.0 3.4 2.9 3.7

Average length of stay excluding same day(3)

6.3 6.4 5.9 6.2 6.6 6.9 6.3 5.8 6.3

Average cost weight of separations(3)

1.06 0.95 1.00 0.98 1.00 1.05 1.03 0.74 1.00

Total cost per casemix-adjusted separation (including depreciation)(4)

4,006 3,785 3,738 3,842 3,334 4,109 4,380 4,223 3,839

Teaching hospitals cost per casemix-adjusted sep (including depreciation)

4,150 3,802 3,902 3,841 3,444 4,063 4,380 4,135 3,940

Residential aged care and transition care places, CACPs and EACH packages per 1,000 persons aged 70+

101.0 105.6 101.8 100.5 111.0 105.1 96.1 108.3 103.3

(1) Public acute, public psychiatric and private hospitals.(2) Public acute and psychiatric hospitals.(3) Public acute hospitals only.(4) Psychiatric hospitals, drug and alcohol services, mothercraft hospitals, unpeered and other, hospices, rehabilitation facilities, small

non-acute hospitals and multi-purpose services are excluded from this table. The data are based on hospital establishments for which expenditure data were provided, including networks of hospitals in some jurisdictions. Some small hospitals with incomplete expenditure data were not included.

Source: AIHW Australian Hospital Statistics 2005–06. AIHW Residential Aged Care in Australia 2005–06.

Using resources efficiently – benchmarking length of stayInter-jurisdictional data from 2006–07 were used to compare the average length of stay at Tasmanian hospitals with interstate peer hospitals.

If each Tasmanian public acute hospital was able to achieve the length of stay of the best-performing peer hospitals for high volume diagnosis-related groups (DRGs), 15,307 fewer overnight bed days would be required. In total, this would equate to 49.7 beds at 85 per cent occupancy with 16.5 beds at the NWRH (Burnie), 12.1 beds at the Mersey Community Hospital, 7.9 beds at the LGH and 13.2 beds at the RHH.

In terms of the best practice hospital, the NWRH (Burnie) had 1 DRG, Mersey Community Hospital had no DRGs, the LGH had 9 DRGs and the RHH had 5 DRGs of their top 25 DRGs as best practice.

The same analysis was performed at the state level. This analysis shows 10,011 fewer overnight bed days would be required if Tasmanian hospitals were able to achieve best practice. In total, this would equate to 32.3 beds at 85 per cent occupancy. Tasmania had no DRGs of its top 25 as best practice, while Queensland, Victoria and the ACT each had 8 and the Northern Territory had 1.


Using resources efficiently – potentially avoidable hospital admissionsAmbulatory Care Sensitive Conditions (ACSCs) are those for which hospitalisation is thought to be avoidable if preventive care and early disease management are applied, usually in an ambulatory setting.16 In theory, access to timely and effective ambulatory care can reduce the risks of hospitalisation, thereby ensuring that care is provided in appropriate settings and that scarce hospital resources are used appropriately.

Tasmania’s rate of potentially preventable hospitalisations is comparable to rates in other jurisdictions (Table 18).

Table 18: Potentially preventable hospitalisations, age-standardised, per 1,000 population

NSW Vic Qld WA SA Tas ACT NT Total

Separation rates for potentially preventable hospitalisations

27.83 31.70 32.07 46.76 32.71 31.23 21.86 47.29 31.98

Source: AIHW Australian Hospital Statistics 2005–06.

In 2006–07, Tasmania had 17,922 admissions for ACSCs, a reduction of 282 or two per cent compared with 2005–06. There was growth in ACSC admissions in both the NWRH (Burnie) and the LGH between 2005 and 2007. Each of the LGH and the RHH accounted for more than 40 per cent of the total ACSC admissions in Tasmania in 2006–07 (Table 19).

Table 19: ACSC admissions by hospital 2006–07

Hospital 2005–06 2006–07 Diff % Change % of total (2006–07)

NWRH (Burnie) 1,496 1,629 133 9% 9%

NWRH (Mersey) 1,328 1,250 -78 -6% 7%

LGH 7,227 7,340 113 2% 41%

RHH 8,153 7,703 -450 -6% 43%

Grand Total 18,204 17,922 -282 -2% 100%

The greatest numbers of ACSC admissions were for diabetes complications, chronic obstructive pulmonary disease and angina.

The length of stay and ACSC analyses suggest there are opportunities to improve the efficiency of Tasmania’s public acute hospitals. The Department will work with each of the acute hospitals and other relevant stakeholders to ensure that public acute hospital resources are used efficiently and to enhance secondary preventive care, thereby systematically reducing admissions for the management of ACSC.


Commencing mid-2009, the Department will monitor and report annually on a range of benchmarking data including lengths of stay and the rate of admissions for Ambulatory Care Sensitive Conditions.

16 Chronic Disease Surveillance & Epidemiology Section, Public Health, Department of Human Services (2006). Ambulatory care sensitive conditions 2004–05 update: (including Primary Care Partnerships and Local Government Areas). Melbourne, Victoria. Victorian Government.


Regional utilisation ratesWithin Tasmania, residents from different regions do not appear to have equal access to acute hospital resources (see Table 24 on page 58). Analysis of separation rates confirms that:

• inabsolutetermsresidentsoftheNorth(259separationsper1,000persons)andNorthWest(249 separations per 1,000 persons) enjoyed better access to public hospital inpatient services in Tasmania than residents of the South (224 separations per 1,000 persons) in 2006–07;

• thereisrelativelyhigheraccessintheSouthtoprivatehospitalservices,followedbytheNorthand North West; and

• overall,residentsoftheSouth(406separationsper1,000persons)hadbetteraccesstohospitalservices than residents of the North (364 separations per 1,000 persons) and residents of the North West (318 separations per 100 persons) in 2006–07.

The Victorian public hospital utilisation rate for 2006–07 was 264 admissions per 1,000 population. The comparable Tasmanian rate was 239 admissions per 1,000 population. Only residents of the North (259 separations per 1,000 persons) have similar access to Victorians. More than 12,000 additional public hospital separations (and approximately an additional 100 beds) across the State would be required to achieve a public hospital utilisation rate comparable to that of Victoria.

It is likely that differential investment will be required to improve access by residents of the North West to inpatient services. Approximately 6,200 additional admissions of people from the North West (an increase of almost 18%) annually would be required to achieve the current statewide average of 375 separations (public and private) per 1,000 persons per year in the North West region. Some of this investment may occur in the private sector and some also may be appropriate in the North and South regions to enable the LGH and the RHH to provide more services to patients from the North West. Development of services locally is consistent with the principles underpinning this Plan and should be the goal providing that they can be developed on a sustainable basis.

The 2007 Clinical Services Plan recognises the critical role that the private sector plays in the overall provision of health services to Tasmanians. A reduction in service capability by the private sector results in increasing demand pressure on the public sector. The Clinical Services Plan proposes a strategic approach to private sector relationships with a focus on the way the public and private sectors work together for the overall benefit of the community.

Alternatively (and recognising that Victoria has had a higher public hospital utilisation rate than almost all other jurisdictions) Tasmania could choose to invest differentially in out-of-hospital care, particularly for people with chronic diseases, limiting the need for additional inpatient services.


As well as investing strategically in public admitted and non-admitted services for the communities of the North West region, the Department will work with the private sector to determine ways to develop appropriate private sector inpatient services for the region’s communities.


By February 2009 the Department will establish a Health Industry Forum with participation by the private sector, and work with the private sector to facilitate the cooperative development of Tasmania’s health services for the overall benefit of the community.



Commencing mid-2009, the Department will monitor and publish regional utilisation rates regularly.

Regional self-sufficiencySelf-sufficiency refers to the extent to which patients who require health services access them in their region. It is an indicator of the degree to which services are accessible to people close to where they live – one of the important principles on which the 2007 Clinical Services Plan is based and to which the Tasmanian Government maintains a strong commitment (providing services are able to be designed for sustainability).

In 2006–07 a number of services had low self-sufficiency within the North West region including interventional cardiology, haematology, medical oncology, chemotherapy and radiotherapy, renal medicine, cardiothoracic surgery, neurosurgery, urology, extensive burns, tracheostomy and sub-acute services. In some clinical areas this low level of self-sufficiency is appropriate – for example interventional cardiology, cardiothoracic surgery, neurosurgery and extensive burns services require a much larger population base to support a quality service than exists in the North West, and it is appropriate that residents travel to Launceston, Hobart or interstate for these services. In other clinical areas, such as urology, chemotherapy and sub-acute services, it should be possible to improve self-sufficiency through the development of new services on either a local or outreach basis. The Clinical Services Plan supports the development of these services.

The North region has a high self-sufficiency for most specialties. Self-sufficiency for cardiothoracic surgery and neurosurgery appropriately is low as these services are provided from the RHH. Vascular surgery also has low self-sufficiency. There is debate about whether complex vascular surgery should be available locally in the North of the State – this issue is discussed earlier in this report (see pages 44–45).

The South catchment had high self-sufficiency for all specialties.

Despite relatively low levels of self-sufficiency in some sub-specialty services in some regions, Tables 22 and 23 demonstrate that in 2006–07:

• 76percentofpublichospitalseparationswithinTasmaniaand74percentofallpublichospitalseparations (within Tasmania and interstate) utilised by residents of the North West in 2006–07 were provided by the NWRH (Burnie or Mersey campuses or via public contracts) or to dialysis patients treated by the LGH in the North West region. If services such as renal dialysis, chemo/radiotherapy and obstetrics are excluded from this analysis (the high volume of these services and in some cases multiple episodes per patient tend to distort the analysis) the level of self-sufficiency in the North West is approximately 70 per cent;

• almost90percentofallpublichospitalseparationswithinTasmaniaand87percentofallpublichospital separations (within Tasmania and interstate) utilised by residents of the North West were provided in the North West or North;

• theLGH(includingthepubliccontractforophthalmologyservices)provided13percentoftheseparations within Tasmania utilised by residents of the North West;

• fewerthan6peopleinevery100fromtheNorthWestandfewerthan4peopleinevery100from the North who received public acute hospital inpatient care in the State accessed that care at the RHH – and 29 per cent of these patients from the North and 32 per cent of these patients from the North West were admitted to the RHH as emergencies;


• theLGH(includingthepubliccontractforophthalmologyservices)providedalmost88percentof public hospital separations within Tasmania and 86 per cent of all public hospital separations (within Tasmania and interstate) utilised by residents of the North;

• therewasaveryhighlevelofself-sufficiencyforpublicacutehospitalservicesintheSouthofthe State – the RHH (including the public contract for ophthalmology services) provided almost 96 per cent of public hospital separations within Tasmania and 94 per cent of all public hospital separations (within Tasmania and interstate) utilised by residents of the South;

• justover300patientsfromtheSouthwereadmittedtotheLGHforelectivecare.Incontrast,more than 1,900 patients from the North West and North of the State were referred to the RHH for elective admission; and

• therewaslittle‘leakage’fromanyregionforpublicacutehospitalservicesinterstate–fewerthan2 in 100 Tasmanian patients received their public hospital care from interstate public hospitals.

Tables 22 and 23 demonstrate that:

• mostTasmanianresidentsreceivedtheirpublichospitalinpatientcareduring2006–07intheregion in which they live. The most significant out-of-region provision of care was by the LGH to residents of the North West; and

• veryfewTasmanianresidentsaccessedpublichospitalcareininterstatehospitals.

The existing self-sufficiency of the North and combined North and North West, which approaches 90 per cent, and the self-sufficiency of the South in the mid-90 per cent compare favourably with a commonly accepted benchmark of 85 per cent self-sufficiency for public hospital inpatient services in regional areas.

There are opportunities to improve self-sufficiency levels in the North West by increasing services in key areas such as short stay surgery, chemotherapy, radiotherapy, renal dialysis, sub-acute care and rehabilitation as proposed in the 2007 Clinical Services Plan. Many of these services could be provided locally or on an outreach basis from Launceston if workforce challenges can be overcome. Outreach services need to be planned and negotiated as services are developed, and each service development opportunity in Hobart and Launceston needs to be reviewed to determine whether an element of the service could be provided on an outreach basis to improve self-sufficiency in the North West.

There are no proposals in the 2007 Clinical Services Plan which would reduce self-sufficiency. The Plan provides for all existing services to be maintained in existing locations. Where new services are developed, self-sufficiency will be a priority if services can be provided safely, efficiently and at acceptable cost in more than one region. If, however, services need to be concentrated for sustainability, then it is in the community interest that this occurs.

Equity of regional investmentDuring the consultation for this Clinical Services Plan update, many clinicians from the LGH expressed concern about equity of funding between the LGH and the RHH.

A detailed review of the equity of funding between Tasmania’s acute hospitals was beyond the scope of this Clinical Services Plan update. Ensuring equity of funding is a complex matter that depends on a range of factors including community need, variation in the complexity of services provided (which is highest for same day patients in the LGH and highest for multi-day patients in the RHH – see Tables 20 and 21 below); the costs of providing services on an outreach basis by the RHH and the LGH; cost burdens associated with recruitment and retention (which are significant in the North West); the cost of teaching and training (which varies between hospitals depending on their roles); and the cost of delivering non-admitted patient services (which also varies considerably between hospitals).


Table 20: % of same day patients by complexity number and hospital 2006–07

Complexity No

NWRH (Burnie)

NWRH (Mersey)

LGH RHH Tasmania Victoria

0 6% 5% 2% 3% 3% 11%

1 70% 64% 57% 59% 59% 60%

2 17% 23% 23% 28% 25% 23%

Non-complex 94% 92% 82% 89% 87% 94%

3 5% 6% 13% 8% 9% 5%

4 1% 1% 4% 3% 3% 1%

5 0% 0% 1% 0% 0% 0%

6 0% 0% 0% 0% 0% 0%

7 0% 0% 0% 0% 0% 0%

8 0% 0% 0% 0% 0% 0%

Complex 6% 8% 18% 11% 13% 6%

Table 21: % of multi-day patients by complexity number and hospital 2006–07

NWRH (Burnie)

NWRH (Mersey)

LGH RHH Tasmania Victoria

Complexity No

% seps

ALOS % seps

ALOS % seps

ALOS % seps

ALOS % seps

ALOS % seps

ALOS

0 1% 1.7 8% 2.9 7% 3.2 5% 2.7 5% 4.2 5% 3.3

1 50% 4.0 49% 3.5 46% 4.8 38% 3.9 45% 5.6 41% 3.5

2 22% 5.0 20% 5.4 22% 5.5 25% 5.2 23% 6.5 22% 4.6

Non-complex 73% 4.3 77% 3.9 75% 4.8 68% 4.3 73% 5.8 68% 3.8

3 13% 9.2 12% 9.7 11% 11.0 15% 10.8 13% 11.6 13% 6.8

4 7% 11.7 6% 13.5 6% 15.6 8% 12.6 7% 13.5 8% 9.4

5 4% 17.4 3% 15.5 3% 21.4 4% 16.4 4% 18.4 5% 12.3

6 2% 17.3 1% 21.1 2% 26.1 2% 20.6 2% 22.1 3% 15.3

7 1% 32.7 1% 28.1 1% 29.2 1% 33.3 1% 31.8 2% 19.0

8 1% 31.7 0% 32.8 1% 36.5 1% 37.6 1% 36.4 2% 30.4

Complex 28% 10.0 23% 10.0 25% 13.4 32% 11.4 28% 12.7 32% 11.0

There is a clear need for funding to be both equitable and transparent and for hospital managers and clinicians to be accountable for using resources efficiently.


The Department will aim to maintain and improve equity of resource distribution between regions; accountability of hospitals for their efficient operation; and regional self-sufficiency of acute hospital services. Annual self-sufficiency targets will be established immediately in all regions and performance against targets will be monitored and reported annually. A detailed study of cost modelling and resource allocation benchmarks will be completed to establish, after factors such as patient complexity and region-specific costs have been taken into account, a mechanism to ensure equity in future resource allocations.

The Department’s aim will be to ensure that each hospital accesses a fair proportion of the State’s overall hospital investment and uses it efficiently for the best benefit of the community.


Tabl

e 22

: 200

6–07

adm

issi

on fl

ows

to T

asm

ania

n ho

spit

als

by r

egio

n

Cat

chm

ent

NW

RH

(B

urni

e)

17

NW

RH

(M

erse

y)N

W

publ

ic

cont

ract

LGH

Nor

th

publ

ic

cont

ract

RH

HSo

uth

publ

ic

cont

ract

Oth

er

Tas

All

publ

ic

seps

% s

elf-

suffi

-ci

ency

Inte

r-st

ate

publ

ic

Priv

ate

% p

ublic

Tota

l

Burn

ie6,

888

348

1,70

31,

052

4072

517

1,42

512

,198

72.6

%30

23,

287

79%

15,7

87

Cen

tral

Coa

st

(Bur

nie)

2,72

440

756

813

208

415

3,94

011

51,

591

77%

7,00

2

Cen

tral

Coa

st

(Mer

sey)

1,07

819

65

712

51,

356

58.4

%M

erse

y1,

969

5,41

411

81,

640

4951

913

349,

756

214

2,13

882

%12

,108

Tota

l Nor

th

Wes

t11

,581

6,84

02,

228

3,45

610

71,

523

361,

479

27,2

5075

.8%

631

7,01

680

%34

,897

Nor

th18

321

36

31,0

4944

71,

273

162,

784

35,9

7187

.6%

581

13,9

6472

%50

,516

Tota

l Nor

th/

Nor

th W

est

11,7

647,

053

2,23

434

,505

554

2,79

652

4,26

363

,221

88.8

%1,

212

20,9

8075

%85

,413

Sout

h64

334

577

6651

,638

176

1,53

154

,089

95.8

%1,

054

36,8

2459

%91

,967

Inte

rsta

te12

348

1031

73

447

679

1,03

36,

525

14%

7,55

8

To

tal

Sep

arat

ion

s11

,951

7,13

42

,248

35,3

9962

354

,881

234

5,87

311

8,34

388

.6%

2,2

6764

,329

65%

184,

939

Not

e: O

f the

Cen

tral

Coa

st r

esid

ents

who

pre

sent

ed t

o th

e N

WR

H, 2

5.6%

pre

sent

ed t

o th

e N

WR

H (

Mer

sey)

and

74.

4% p

rese

nted

to

the

NW

RH

(Bu

rnie

). Fo

r th

e pu

rpos

es o

f cal

cula

ting

curr

ent

self-

suffi

cien

cy it

has

bee

n as

sum

ed t

hat

25.6

% o

f Cen

tral

Coa

st r

esid

ents

res

ide

in t

he M

erse

y ca

tchm

ent

and

74.4

% r

esid

e in

the

Bur

nie

catc

hmen

t.

17 R

enal

dia

lysi

s se

para

tions

per

form

ed in

Bur

nie

in 2

006–

07 a

re a

ttri

bute

d to

NW

RH

(Bu

rnie

).


Tabl

e 23

: 200

6–07

acu

te a

dmis

sion

flow

s to

Tas

man

ian

hosp

ital

s by

reg

ion18

Cat

chm

ent

NW

RH

(B

urni

e)N

WR

H

(Mer

sey)

NW

pu

blic

co

ntra

ct

LGH

Nor

th

publ

ic

cont

ract

RH

HSo

uth

publ

ic

cont

ract

Oth

er

Tas

All

publ

ic

seps

% s

elf-

suffi

-ci

ency

Inte

r-st

ate

publ

ic

Priv

ate

% p

ublic

Tota

l

Nor

th W

est

7,35

45,

457

157

2,77

110

21,

315

361,

223

18,4

1570

.4%

542

6,48

974

%25

,446

Nor

th79

161

118

,970

444

1,09

216

2,27

923

,042

84.3

%46

312

,683

64%

36,1

88

Sout

h48

3234

566

32,8

9016

11,

015

34,5

5795

.6%

900

29,5

2054

%64

,977

Inte

rsta

te78

4825

03

333

575

792

14,

212

16%

5,00

5

To

tal

Sep

arat

ion

s7,

559

5,69

815

822

,336

615

35,6

3021

84,

592

76,8

0686

.1%

1,90

652

,904

59%

131,

616

18 A

cute

adm

issi

ons

excl

udin

g re

nal d

ialy

sis,

chem

o/r

adio

ther

apy,

obst

etri

cs, q

ualifi

ed a

nd u

nqua

lified

neo

nate

s be

caus

e th

eir

very

hig

h nu

mbe

rs t

end

to d

isto

rt u

nder

lyin

g tr

ends

. Men

tal h

ealth

, pal

liativ

e ca

re, n

ursi

ng h

ome-

type

car

e,

geri

atri

c ev

alua

tion

and

man

agem

ent

and

reha

bilit

atio

n se

rvic

es a

re a

lso

excl

uded

bec

ause

the

y te

nd t

o be

pro

vide

d on

a r

egio

nal b

asis

and

requ

ire

a di

ffere

nt p

lann

ing

appr

oach

.

Tabl

e 24

: 200

6–07

util

isat

ion

rate

s by

reg

iona

l pop

ulat

ion

Cat

chm

ent

Popu

latio

nPu

blic

se

para

tions

Priv

ate

sepa

ratio

nsTa

sman

ian

resi

dent

s tr

eate

d in

inte

rsta

te

publ

ic h

ospi

tals

All

sepa

ratio

nsPu

blic

se

para

tions

/ 1,

000

pers

ons

Priv

ate

sepa

ratio

ns/

1,00

0 pe

rson

s

All

sepa

ratio

ns/

per

1,00

0 pe

rson

s

Nor

th W

est

109,

570

27,2

507,

016

631

34,8

9724

964

318

Nor

th13

8,70

235

,971

13,9

6458

150

,516

259

101

364

Sout

h24

1,65

054

,089

42,9

971,

054

98,1

4022

417

840

6

LGA

unr

ecor

ded

352

135

3

Tota

l48

9,92

211

7,31

064

,329

2,26

718

3,90

623

913

137

5

Inte

rsta

te

resid

ents

tre

ated

in

Tas

man

ian

hosp

itals

1,03

3

Gra

nd

To

tal

489,

922

118,

343

64,3

292

,267

184,

939


Access to emergency department servicesAnalysis of emergency department attendances and the availability of general practitioners (GPs) demonstrates significant differences across the State (Table 25).

Table 25: Emergency department utilisation and general practitioner availability

Hospital Referral Population

2006

ED presentations

2006–07

Presentations /1000

population 2006–07

Relative ED utilisation 2006–07

No. of ED presentations

above or below average

2006–07

Relative GP availability 2005–06

NWRH (Burnie)

57,114 24,438 428 1.7 10,102 0.83

NWRH (Mersey)

48,645 21,753 447 1.8 9,543

LGH 135,404 34,409 254 1.0 423 0.88

RHH 235,330 39,062 166 0.7 -20,006 1.15

Total 476,493 119,662 251 1.0

The North West region has a significantly higher rate of service utilisation than the average for the State.

Application of resources to emergency department presentations which could be provided more effectively in other settings is not an efficient use of acute hospital resources. Emergency department utilisation rates correlate negatively with the availability of GPs. There is a relative shortage of 22 GPs in the North West and 20 GPs in the North and a relative excess of 41 GPs in the South. If an additional 22 GPs were available in the North West, each would need to undertake only 893 consultations per year (approximately 19 per week) to eliminate the ‘excess’ presentations to the emergency departments of the North West hospitals.

The Australian Government’s commitment to fund GP Superclinics in Devonport and Burnie provides a significant opportunity to develop facilities which will enable GPs to practise within supportive multidisciplinary primary health care teams.


The Department will collaborate with the Australian Government, Divisions of General Practice and other relevant organisations to develop a ‘whole-of-state’ strategy for general practice. Key objectives of the strategy will be recruitment of general practitioners to the North West region to ensure more equitable access to general practice services; and the development of new models of support for general practice – including community-based and practice-based nurses – to ensure service sustainability. The strategy will be completed by December 2009.


Predicting future demandPlanning on the basis of current patient flow patterns, self-sufficiency levels and hospital service profiles provides base predictions about the overall number of beds and other facilities that are likely to be required across the system.

Assumptions can then be made about changes in service profiles and patient flows to provide a prediction of the resources that will be required in each of Tasmania’s public acute hospitals in the future, as each of the hospital’s roles and referral populations changes.

If current patient flow patterns, self-sufficiency and hospital service profiles remain constant, population growth and ageing are the main factors that will influence future hospital service requirements.

Projection datasets for this project were developed for the Department by Hardes and Associates.19

Planning on this basis demonstrates that there will be a steady increase over the coming years in admissions to Tasmania’s public acute hospitals (Figure 6).

It should be noted that predictions made using this methodology do not take into account any existing maldistribution of resources within Tasmania’s health care system.

Figure 6: Predicted admissions to Tasmania’s public acute hospitals

0

20000

40000

60000

80000

100000

120000

140000

160000

180000

200000

Sepa

ratio

ns

2003 2005 2007 2009 2011 2013 2015 2017 2019 2021

Year

200,000

180,000

160,000

140,000

120,000

100,000

80,000

60,000

40,000

20,000

0

19 Hardes and Associates, January 2008.


Table 26: Projected separations 2006–07 – 2021–22

Hospital 2006–07 2011–12 2016–17 2021–22 Difference % change % p.a.

NWRH (Burnie)

11,951 13,488 15,127 16,937 4,986 42% 2.4%

NWRH (Mersey)

7,134 7,656 8,157 8,666 1,532 21% 1.3%

LGH 35,399 42,348 48,261 54,339 18,940 54% 2.9%

RHH 54,881 63,611 71,745 80,378 25,497 46% 2.6%

Other public hospitals

8,978 9,763 10,551 11,431 2,453 27% 1.6%

Interstate 2,267 2,755 3,094 3,411 1,144 50% 2.8%

Grand Total 120,610 139,621 156,935 175,162 54,552 45% 2.5%

Note: Renal dialysis separations performed in Burnie in 2006–07 are attributed to the NWRH (Burnie).

The largest number of additional separations will be for residents of Launceston, Clarence and Hobart. The LGAs with the largest expected percentage growth in separations are Kingborough and Meander Valley.

The need for services for older people (nursing home-type care, rehabilitation and geriatric evaluation and management) is predicted to grow the most, whereas the service categories of gynaecology, obstetrics and unqualified (normal) neonates are expected to decline the most.

A requirement for an additional 67 same day beds and an additional 345 multi-day beds across the State by 2016–17 is predicted.

Figure 7: Actual and projected multi-day beds by specialty (top and bottom 10)

0

50

100

150

200

250

300

Cal

cula

ted

mul

ti-da

y be

ds

300

250

200

150

100

50

0

2006–07 2016–17

NH

T R

ehab

ilita

tion

GEM

Ps

ychi

atry

O

rtho

paed

ics

Res

pira

tory

Med

icin

e N

euro

logy

G

ener

al M

edic

ine

Car

diol

ogy

Pallia

tive

Car

eR

enal

Dia

lysis

Che

mo

& R

adio

ther

apy

Rhe

umat

olog

y D

erm

atol

ogy

Hea

d &

Nec

k Su

rger

yEa

r, N

ose

& T

hroa

tN

euro

surg

ery

Unq

ualifi

ed N

eona

teG

ynae

colo

gyO

bste

tric

s


Under this model, increases of 34 multi-day beds at the NWRH (Burnie), 17 at the Mersey Community Hospital; 87 at the LGH; and 130 at the RHH are predicted (Table 27). Five additional same day beds will be required at the NWRH (Burnie); 2 at the Mersey Community Hospital; 26 at the LGH; and 33 at the RHH.

Table 27: Calculated beds by hospital

2006–07 2016–17 Difference

Hospital Same day beds

Multi-day beds

Same day beds

Multi-day beds

Same day beds

Multi-day beds

NWRH (Burnie) 15 105 20 139 5 34

NWRH (Mersey) 8 82 10 99 2 17

LGH 53 319 79 406 26 87

RHH 87 451 120 581 33 130

Other 3 288 4 365 1 77

Grand Total 166 1,245 233 1,590 67 345


Tasmania is projected to require 17.6 operating theatres by 2016–17. This represents an increase of 2 theatres over the number of theatres utilised in 2006–07 (Table 28). Access to an additional 0.4 elective multi-day and 0.7 emergency multi-day theatres, 0.2 endoscope suites and 0.7 same day suites will be required over the next ten years. There is spare theatre capacity available across the State, however, and existing physical operating theatre space is expected to be sufficient to meet these future requirements.

Table 28: Calculated theatres by hospital

2016–17 Difference 2006–07 to 2016–17

Operating Theatres

NWRH (Burnie)

NWRH (Mersey)

LGH RHH NWRH (Burnie)

NWRH (Mersey)

LGH RHH

Elective MD 0.6 0.7 1.8 2.6 0.0 0.1 0.2 0.1

Emergency MD 0.6 0.3 2.2 2.3 0.0 0.0 0.4 0.3

Endoscopy Suites 0.2 0.2 0.8 1.0 0.0 0.0 0.1 0.1

SD 0.5 0.6 1.4 1.8 0.0 0.1 0.3 0.3

Grand Total 1.9 1.8 6.2 7.7 0.0 0.2 1.0 0.8

Across the State, emergency department activity is projected to increase by more than 25,000 presentations in the next ten years (Table 29):

Table 29: Emergency department forecast presentations by hospital

Hospital 2006–07 2016–17 Difference % p.a. growth

NWRH (Burnie) 24,578 27,847 3,269 1.3%

NWRH (Mersey) 21,894 24,935 3,041 1.3%

LGH 34,409 42,071 7,662 2.0%

RHH 38,848 50,611 11,763 2.7%

Grand Total 119,729 145,464 25,735 2.0%

Methods of estimating acute treatment spaces in emergency departments vary between the States. NSW uses one treatment space per 1,460 presentations,20 whereas Victoria uses one treatment space per 1,300 presentations as a benchmark.

20 Activity Planning Guideline for Emergency Department Services, NSW Health, Statewide Services Development Branch, Planning Series, November 2006.


Treatment spaces also can be estimated by the number of patients who are admitted from the emergency department.21 The NSW benchmark is one treatment space per 400 admissions through the emergency department excluding renal dialysis, chemotherapy and unqualified neonates. While this may be an appropriate benchmark for the RHH and the LGH it is not appropriate for the NWRH (Burnie) or the Mersey Community Hospital because of their known high rate of presentations of non-admitted patients.

Table 30 demonstrates the number of emergency department spaces which would be required according to the different benchmarks that could be applied (one treatment space per 1,460 presentations; one treatment space per 1,300 presentations; or one treatment space per 400 admissions from the emergency department). Regardless of which method of estimating future resource requirements is used, it appears that there will not be enough actual emergency department spaces to meet the projected demand. By 2016–17, approximately 20 additional treatment spaces will be required.

Table 30: Emergency department calculated treatment spaces

2006–07 2016–17 Difference Available spaces 2008

Benchmark 1460 1300 400 1460 1300 400 1460 1300 400

NWRH (Burnie) 17 19 11 19 21 13 2 2 2 12

NWRH (Mersey) 15 17 6 17 19 8 2 2 2 8

LGH 24 26 29 29 32 37 5 6 8 20

RHH 27 30 38 35 39 46 8 9 8 41

Total 83 92 84 100 111 104 17 19 19 81

The NSW benchmark of one treatment space per 1,460 presentations is appropriate for the RHH and the LGH, suggesting that in 2016–17 they will require 35 and 29 emergency department treatment spaces respectively, compared to a current calculated requirement of 27 and 24 spaces respectively. The LGH emergency department is shown to be under the greatest pressure and, depending on the configuration of services that is agreed for the ICC, expansion may be warranted.

The high proportion of low complexity presentations at the NWRH (Burnie) and the Mersey Community Hospital means that these benchmarks are not appropriate – in those settings a higher number of presentations per treatment space is feasible and it may be more appropriate to design multi-purpose consulting spaces to accommodate a higher throughput of patients.

21 Australasian College for Emergency Medicine, Emergency Department Design Guidelines, October 1998.


Meeting the needs of the community – the future service systemIntroductionThe 2007 Clinical Services Plan is based on a fundamental redesign of Tasmania’s public acute hospital services in the North West. In broad terms, it proposes consolidation on the Burnie campus of all high acuity services for the North West, with the Mersey campus providing a viable mix of complementary services and the two campuses, in aggregate, providing a comprehensive range of services for the population of the North West.

The service configuration for the North West region proposed in the 2007 Clinical Services Plan is presented in Table 31.

Table 31: 2007 Clinical Services Plan proposals, NWRH

NWRH (Burnie) NWRH (Mersey)

Intensive care Theatre recovery and emergency resuscitation support

Inpatient acute medical Specialist aged care (admitted and non-admitted), subacute, rehabilitation and transition care

Inpatient acute surgical Up to 23-hour acute elective surgical

Low and medium risk obstetrics Low risk obstetrics

Ante-natal and post-natal care (admitted and non-admitted)

Ante-natal and post-natal care (admitted and non-admitted low risk)

Inpatient paediatrics Short stay paediatrics (12 hours)

Emergency medicine Emergency care centre, 24 hours, 7 days a week

Satellite renal dialysis (Parkside) Satellite renal dialysis (new service)

Day chemotherapy Day chemotherapy

Specialty and sub-specialty consulting Specialty and sub-specialty consulting

Key proposals in the 2007 Clinical Services Plan also include the development of new and the expansion of existing services at the NWRH (Mersey) including cancer services, day surgery, renal dialysis, aged care and rehabilitation.

The Tasmanian Government believes that the changes proposed in the 2007 Clinical Services Plan represent the most appropriate approach to meeting the health needs of Tasmanians generally and the communities of the North West in particular. Given the intervention of the Australian Government in the North West it is, however, necessary to adapt the Clinical Services Plan to accommodate the changed ownership arrangements for the Mersey Community Hospital.

If the new operators are unable to deliver health care services of an acceptable range and quality, the Tasmanian Government would consider resuming responsibility for the Mersey Community Hospital. This would be on the basis of a service model consistent with the principles of the 2007 Clinical Services Plan, with the addition of extra services described in Model 1 (outlined on page 70) providing these services continue to be sustainable.

Nevertheless, in the context of the current ownership and proposed operating arrangements for the Mersey Community Hospital, the Australian and Tasmanian Governments have expressed a firm commitment to working together to develop an integrated and sustainable service system for the community of the entire North West region.


Planning sub-catchments for the North West regionFor planning purposes, the catchment of the North West region has been further categorised as the catchment of the NWRH (Burnie) (comprising Burnie, Circular Head, King Island, Waratah/Wynyard, West Coast and 50% of Central Coast) and the catchment of the Mersey Community Hospital (comprising Devonport, Kentish, Latrobe and 50 per cent of Central Coast).

The predicted population changes in these sub-regions are presented in Table 32 (noting that predicted populations are likely to be underestimated – see discussion commencing on page 5).

Table 32: Population changes in North West sub-catchments

NWRH (Burnie) sub-catchment Mersey Community Hospital sub-catchment

LGA 2006 popl’n

2016 popl’n

Diff % LGA 2006 popl’n

2016 popl’n

Diff %

Burnie 18,640 17,550 -1,090 -6% Central Coast 50%

10,351 9,821 -530 -5%

Central Coast 50%

10,351 9,821 -530 -5% Devonport 24,048 22,960 -1,088 -5%

Circular Head

7,860 7,240 -620 -8% Kentish 5,526 5,451 -75 -1%

King Island 1,667 1,579 -88 -5% Latrobe 8,720 9,428 +708 +8%

Waratah/Wynyard

13,452 12,892 -560 -4%

West Coast 5,144 4,346 -798 -16%

Total 57,114 53,428 -3,686 -6% 48,645 47,660 -985 -2%

It should be noted that both the NWRH (Burnie) and the LGH have been meeting a significant proportion of the public acute hospital needs of the residents of the Mersey Community Hospital referral area. Excluding residents of the Central Coast, the NWRH (Burnie) provided almost 2,000 admissions for residents of the Mersey sub-catchment in 2006–07. In the same period, the NWRH (Mersey) provided less than 350 admissions for residents of the Burnie sub-catchment and the LGH provided 1,640 admissions for residents of the Mersey sub-catchment, compared with 1,052 admissions for residents of the Burnie sub-catchment (see Table 22 on page 57).

If the Australian Government is successful in maintaining the Mersey Community Hospital as a full service community hospital, current levels of regional self-sufficiency would be expected, at a minimum, to be maintained and an aim of improving regional self-sufficiency would be reasonable.

A single hospital for the North West regionMany stakeholders are concerned that the Mersey Community Hospital will remain unsustainable as a full service general community hospital. Some stakeholders believe that a new single campus regional hospital in a central location between Burnie and Mersey, possibly at Ulverstone, is now the only achievable solution to the problems of sustainability of health services in the North West.

There is no doubt that a single regional public acute hospital complemented by a distributed service system of community-based services serving a regional community of more than 100,000 people would be positioned to provide more efficient, effective and sustainable services, enabling concentration of scarce human and physical resources on a single site for the benefit of the community.

There are a number of issues that need to be considered carefully in relation to this proposal. The NWRH (Burnie) is housed in a modern, purpose built and functional building and is collocated with the University of Tasmania’s Rural Clinical School which provides a critically important hub for clinical


teaching and research in the North West. Community reaction to a potential relocation of the NWRH (Burnie) and the Mersey Community Hospital has not been tested. To progress the proposal for a single hospital, detailed consideration would need to be given to the most appropriate location to meet the needs of a very dispersed regional community extending to the far West and North West coasts. A site which is chosen mainly because it is in a ‘neutral’ geographic area may not be the most appropriate site to meet the health needs of the community.

Should the Tasmanian Government decide to progress the development of a single-site regional hospital in the future, a full planning assessment of the best location for that hospital and the potential operational benefits that would be achieved should be conducted.

The 2007 Clinical Services Plan was developed on the basis of a continuation of the two campus model for the NWRH. In the absence of identified capital for the development of a new single hospital with complementary community-based services, this update assumes that both the NWRH (Burnie) and the Mersey Community Hospital will continue to deliver inpatient services from their current sites.

Planning for an integrated service system in the North West regionThe 2007 Clinical Services Plan was designed to address the challenges facing Tasmania’s health care system in a systematic and sustainable manner. The change in ownership of the Mersey Community Hospital, however, has hampered implementation of the Plan in the North West and necessitated a review of the strategies proposed in that Plan.

The fragmentation of ownership of the public acute hospitals in the North West region increases the potential for service duplication, service gaps and cost-shifting between the parties with potential impacts on the NWRH (Burnie) and the LGH. The Tasmanian Government is committed to minimising potential problems related to hospital ownership by planning and delivering services carefully in accordance with the agreed roles of the hospitals and in a spirit of cooperation and accountability.

As well as their responsibilities for providing hospital services, both the Australian and Tasmanian Governments fund and/or provide a vast range of community-based services – the Australian Government via programs such as Medicare and the Pharmaceutical Benefits Scheme and the Tasmanian Government via hospital outreach programs and community health programs. Ensuring appropriate clinical integration across all community- and hospital-based programs in the North West is a key objective for the Tasmanian Government.

Detailed, hospital-specific service plans will need to be developed for the NWRH (Burnie), the LGH and the Mersey Community Hospital with the objective of providing an appropriate range and volume of services for the communities of the North and North West regions. Service sustainability will be a priority.

It is likely to be in the community interest for some services to be consolidated on one site in the North West region, by agreement between the governments and/or hospitals – for example:

• the2007ClinicalServicesPlanproposesconsolidatedsub-acuteinpatientrehabilitation,agedcareand transition care services for the North West region, based at the NWRH (Mersey);

• theregion’sorthopaedicsurgeonsalreadyareworkingtogethertoprovideawhole-of-regionservice,with low complexity patients being treated at both the Mersey Community Hospital and the NWRH (Burnie) and patients needing a higher level of support being treated at the NWRH (Burnie);

• forsometime,mediumriskobstetricserviceshavebeenprovidedinBurniealone,whilelowriskobstetric services have been provided in both communities; and

• recently,managersandcliniciansattheNWRH(Burnie)haveagreedtoprovideanaestheticservices to support some surgical services at the Mersey Community Hospital.


This shared services concept was the basis of the 2007 Clinical Services Plan for the North West region and should continue to be explored where it may be beneficial to the community and where it is consistent with the Australian Government’s aspirations for the Mersey Community Hospital and the Tasmanian Government’s aspirations for the NWRH (Burnie) and the Tasmanian health system generally.


The Tasmanian Government adopts the following principles to underpin planning and delivery of hospital services in the North West region:

• Abalancedmixandappropriatevolumeofhighqualitypublicacutehospitalservicesshouldbe available to all residents of the North West region. Responsibility for providing these services will be shared by the Australian and Tasmanian Governments.

• TheAustralianGovernmentwillberesponsibleforprovidinganappropriaterangeandvolume of safe, high quality community hospital services to the residents of the referral area of the Mersey Community Hospital. The Tasmanian Government will license the Mersey Community Hospital in accordance with its usual licensing standards for private hospitals, but otherwise recognises that the Australian Government (or its delegates) will plan and be accountable for the role and service profile of the Mersey Community Hospital.

• ResidentsoftheMerseyCommunityHospitalreferralregionwhoneedcomplexacuteservices which do not fit within the agreed service profile of the Mersey Community Hospital will be able to access such services through the State hospital system at Burnie, Launceston or Hobart. It will be important for the Mersey Community Hospital to deliver an agreed range and volume of services to its referral community so that the Tasmanian Government can deliver the necessary complementary higher complexity services in a planned and equitable manner.

• TheTasmanianGovernmentwillberesponsibleforprovidinganappropriaterangeandvolume of public acute hospital services to the referral communities of the NWRH (Burnie).

• Resourcessuchasspecialiststaff;diagnosticservices;theatrefacilities;clinicalgovernancefunctions such as audit; and purchasing functions could be shared between the NWRH (Burnie) and the Mersey Community Hospital, if such sharing would benefit the community and can be agreed between the Department and the operators of the Mersey Community Hospital.

• Someservicesmaybedevelopedonawhole-of-regionbasisbyagreementbetweentheAustralian and Tasmanian Governments.

When a patient presents to a Tasmanian hospital, their access to treatment should not be influenced by where they live. Patients from the Mersey Community Hospital referral area who elect to access services in Burnie or Launceston, or vice versa, should be treated solely in accordance with their clinical need.

At the same time, both the Tasmanian and Australian Governments will wish to improve self-sufficiency in the North West region and demonstrate appropriate accountability to the community for their investments in public acute hospitals in the North West region.

It is not possible to define, up to a decade in advance, the exact range and volume of services that will be required by the communities of the North West – all planning predictions will be subject to modification over time as local circumstances change. Nevertheless, this Plan provides the basis by which the performance of both the NWRH (Burnie) and the Mersey Community Hospital can be monitored and reported to the Australian Government, the Tasmanian Government and the community.


The Tasmanian Government, in collaboration with the Australian Government, will develop a performance monitoring and reporting framework for the NWRH (Burnie) and the Mersey Community Hospital which will ensure that each party provides a suitable range and volume of public acute hospital services of an appropriate level of complexity, consistent with their commitments to the community. The framework will include measures of:

• therangeandvolumeofservicesineachMajorClinicalRelatedGroup(MCRG)providedbythe NWRH (Burnie), the Mersey Community Hospital and other providers and compared with predicted need. For example, actual activity can be tracked against predicted activity shown in Table 34 on page 72 and Table 35 on page 73;

• trendsinthemixofsimpleandcomplexservicesprovidedbyNWRH(Burnie),theMerseyCommunity Hospital and other providers. A hospital could, for example, provide a high volume of simple surgical procedures but not meet its community’s need for lower volume, higher complexity services, even though such services could be provided appropriately in that setting. Services can be monitored for complexity in a variety of ways. Tables 20 and 21 on page 56 describe the relative complexity of same day and multi-day services provided by Tasmania’s public acute hospitals in 2006–07, an indicator which can be monitored over time. Other measures of complexity include the percentage of same day and multi-day patients, and ‘weighted’ separations where the resource usage of each episode is calculated using a standardised weighting measure;22 and

• theextenttowhicharegionorsub-regionisself-sufficientforhospitalservices.Thisisahelpfulaggregate measure of whether a suitable range and volume of services of appropriate complexity is being provided. Table 22 on page 57 provides a basis for monitoring whether the NWRH (Burnie) and the Mersey Community Hospital are maintaining acceptable levels of self-sufficiency for their sub-catchment populations.

For each indicator, the Mersey Community Hospital and the NWRH (Burnie) performance will be compared with underlying trends in demand and service provision and with the performance of other Tasmanian public acute hospitals and peer hospitals to ensure that their performance is consistent with contemporary practice.


The Department will develop a detailed clinical service profile for the NWRH (Burnie) in consultation and cooperation with the Australian Government and/or the operator of the Mersey Community Hospital with the objective of ensuring sustainable services on a whole-of-region basis. Subject to the timely completion by the Australian Government of a service plan for the Mersey Community Hospital, the NWRH (Burnie) clinical service profile will be developed by December 2008.


The Tasmanian Government will seek to agree on a robust performance monitoring and reporting framework with the Australian Government to ensure that both the NWRH (Burnie) and the Mersey Community Hospital contribute equitably to the provision of an integrated health service for the region.

22 A weighted separation is a measure of the complexity of a hospital separation using average weights for episodes that have the same diagnosis and treatment, based on nationally accepted Diagnosis Related Groups (DRGs).


Planning assumptions for the North and North West regionsThe planning projections presented earlier in this report (commencing on page 60 under the heading ‘Predicting Future Demand’) assume that current patterns of activity will continue at each of Tasmania’s public acute hospitals, changing only in response to population growth and ageing.

In the following section some activity is redistributed on the assumption that the service system will develop in a different direction from the past as a result of the change in ownership of the Mersey Community Hospital and implementation of the access and sustainability principles underpinning the 2007 Clinical Services Plan.

Two models are presented. In the context of the current fragmented ownership of the public acute hospitals in the North West, the Tasmanian Government prefers the first model (Model 1). It is similar to the service model proposed in the 2007 Clinical Services Plan, but in addition to providing for the Mersey Community Hospital to be a regional centre for certain services for residents of the North West (including high volume day surgery, rehabilitation and aged care), it enables medical patients with low to medium complexity conditions and paediatric patients with low complexity conditions to be cared for as inpatients at the Mersey Community Hospital. Inpatient surgery is not conducted at the Mersey Community Hospital under this model.

The second model (Model 2) provides for the Mersey Community Hospital to become a full service community hospital. This model is not preferred by the Tasmanian Government because, for reasons explained in the 2007 Clinical Services Plan and earlier in this report, it is likely to be unsustainable. Nevertheless it has been modelled because it is consistent with announcements made by the Australian Government about the future of the Mersey Community Hospital.

The two models present revised projections of activity at each of the public acute hospitals in the North West and the LGH. Both are based on the following common assumptions about where patients will access care:

• totaldemandisthatprojectedbytheHardesandAssociatesforecastmodelbasecase (January 2008);

• theallocationmodelincludesseparationswithinTasmania,includinginterstateinflowsandpubliccontracts with private services. Private sector separations not funded by public agencies and interstate separations are not included in the following figures;

• nochangesaremadetoflowsinpubliccontracts;

• flowpercentagestotheprivatesectorandinterstateinflowsandoutflowswillnotchange;

• flowpercentagestosmallerfacilitiesandtheRHHwillnotchange,withtheexceptionthatmajorvascular surgery will be concentrated at the RHH;

• servicesprovidedundertheNWRHcontractareconsideredtobeservicesoftheNWRH(Burnie);

• dialysisservicesprovidedcurrentlyinBurniebytheLGHaremodelledasservicesofthe NWRH (Burnie);

• lowriskobstetricserviceswillbeprovidedattheMerseyCommunityHospitalwithhigherriskobstetric patients referred to Burnie;

• lowriskpaediatricinpatientserviceswillbeprovidedattheMerseyCommunityHospitalwithhigher risk paediatric patients referred to Burnie;

• vascularsurgicalproceduresprovidedtoresidentsoftheNorthWestregionwillbeprovidedatthe RHH. It is anticipated that some procedures, for example amputations, will be undertaken by vascular surgeons visiting the LGH and the NWRH (Burnie) and incorporated within year-to-year planning and resource allocations;


• theMerseyCommunityHospitalwillhaveahighdependencyunit;

• hipandkneejointreplacementsforresidentsoftheNorthWestregionwillbeprovidedattheNWRH (Burnie); and

• mostinterventionalcardiologyservicesforresidentsoftheNorthWestregionwillbeprovidedat the LGH.

Model 1 incorporates the following additional assumptions:

• theMerseyCommunityHospitalwillbecomeareferralcentreforsamedaysurgery.Servicesfor40per cent of same day surgery patients from the NWRH (Burnie) referral area, 15 per cent of same day surgery patients from the LGH referral area and 90 per cent of same day surgery patients from the Mersey Community Hospital referral area will be provided by the Mersey Community Hospital. Although not incorporated into Model 1, there is also potential for some patients from the RHH referral area to receive their same day surgery at the Mersey Community Hospital, consistent with the principles established in the 2007 Clinical Services Plan;

• allspecialistagedcare,sub-acute,rehabilitationandtransitioncareforresidentsoftheNorthWest region will be provided at the Mersey Community Hospital;

• generalmedicalinpatientswithconditionsrequiringcareoflowcomplexitywillbeadmittedtothe Mersey Community Hospital. Medical patients requiring care of higher complexity will be referred to the NWRH (Burnie) or the LGH as appropriate; and

• allpatientsfromthereferralareaoftheMerseyCommunityHospitalrequiringinpatientsurgerywith a length of stay of more than 24 hours will be referred to the NWRH (Burnie) (with the exception of a small number of patients who will require referral to the LGH or the RHH).

Model 2 incorporates the following additional assumptions:

• theMerseyCommunityHospitalwillprovideafullrangeoflowtomediumcomplexitymedicaland surgical inpatient services to residents of its referral area;

• theBurnieandMerseysub-catchmentswillbeself-sufficientforrehabilitationservices.Itshouldbe noted that on current demand projections, both the NWRH (Burnie) and the Mersey Community Hospital will require fewer than 10 beds. Further planning is required to determine appropriate service capacity and models of care for rehabilitation services;

• nochangeshavebeenmadetothelocationsofgeriatricevaluationandmanagementandnursinghome-type patients in the North West region;

• theNWRH(Burnie)willprovidehighercomplexityservicesforresidentsoftheNorthWestregion with the Mersey Community Hospital focusing on sub-regional community hospital-type services for the Mersey Community Hospital catchment (Devonport, Kentish, Latrobe and 50 per cent of Central Coast). The LGH will provide regional high complexity and specialist services for the North West and North regions; and

• thedistributionsarethesameforsamedayandmulti-dayseparations.

Table 33 demonstrates the differences between the three planning models (the 2007 Clinical Services Plan model and the two new planning models, Model 1 and Model 2).


Table 33: Mersey Community Hospital and NWRH (Burnie) assumed service profile

2007 Clinical Services Plan Model 1 Model 2

NWRH (Burnie)

Mersey Community Hospital

NWRH (Burnie)


NWRH (Burnie)


Intensive care Theatre recovery and emergency resuscitation support

Intensive care Theatre recovery and high dependency unit

Intensive care Theatre recovery and high dependency unit

Inpatient acute medical

Regional specialist aged care (admitted and non-admitted), sub-acute, rehabilitation and transition care

Inpatient acute medical

Low complexity inpatient acute medical, regional specialist aged care, sub-acute, rehabilitation and transition care

Inpatient acute medical, local specialist aged care, sub-acute, rehabilitation and transition care

Low to medium complexity inpatient acute medical, local specialist aged care, sub-acute, rehabilitation and transition care

Inpatient acute surgical

Up to 23-hour acute elective surgical


Up to 23-hour acute elective surgical


Low to medium risk inpatient acute surgical

Low and medium risk obstetrics

Low risk obstetrics


Low risk obstetrics


Low risk obstetrics







Inpatient paediatrics

Short stay paediatrics (12 hours)


Low risk inpatient paediatrics


Low risk inpatient paediatrics

Emergency medicine

Emergency care centre, 24 hours, 7 days a week

Emergency medicine


Emergency medicine


Satellite renal dialysis (Parkside)

Satellite renal dialysis (new service)





Day chemotherapy

Day chemotherapy

Day chemotherapy

Day chemotherapy

Day chemotherapy

Day chemotherapy

Specialty and sub-specialty consulting






It should be noted that these assumptions are made for planning purposes only – the Australian Government is responsible for planning the range and volume of services to be provided by the Mersey Community Hospital, but these assumptions are necessary because that planning was not concluded at the time this Clinical Services Plan update was completed.

The figures labelled ‘2006–07 reallocated’ represent a theoretical distribution of current services if they were to be distributed according to the allocation model, and are intended to distinguish volume changes due to shifts in service locations from volume changes due to future growth of service demand.


Planned acute hospital activity, 2016–17Tables 34 and 35 (below) present expected acute hospital activity under Model 1 and Model 2.

Table 34: Modelled activity, 2016–17, Model 1

MCRG NWRH (Burnie)

NW public

contract

Mersey Comm-

unity Hospital

LGH North public

contract

RHH South public

contract

Other Grand Total

Breast Surgery

59 68 135 165 <5 429

Cardiology 1,056 6 584 2,110 2,899 <5 604 7,261

Cardiothoracic Surgery

38 448 486

Chemo & Radiotherapy

511 570 2,497 6,103 121 9,801

Colorectal Surgery

195 130 398 321 <5 <5 1,046

Dentistry 65 62 182 <5 413 724

Dermatology 39 59 132 312 40 582

Diagnostic GI Endoscopy

541 680 2,464 3,091 6,776

Drug & Alcohol

252 <5 84 617 1,073 462 2,489

Ear Nose & Throat

169 115 540 <5 778 88 1,690

Endocrinology 212 105 511 9 1,116 196 2,149

Extensive Burns

29 70 6 105

Gastro-enterology

265 <5 289 1,283 1,546 431 3,815

GEM 108 19 74 849 113 1,163

Gynaecology 444 464 777 <5 953 <5 17 2,656

Haematology 190 302 1,641 3,018 174 5,325

Head & Neck Surgery

31 7 68 119 226

Immunology & Infections

174 <5 87 690 14 1,048 197 2,212

Interventional Cardiology

2,098 1,381 3,479

Medical Oncology

219 96 725 <5 1,425 224 2,690

Mental Health <5 <5 <5

Neurology 497 <5 404 1,571 26 2,535 505 5,539

Neurosurgery 58 <5 33 146 425 <5 31 697

NHT 149 96 220 677 422 1,565

Non Subspecialty Medicine

583 19 660 1,953 16 4,981 247 683 9,142

Non Subspecialty Surgery

776 <5 449 2,002 3,286 394 6,910


MCRG NWRH (Burnie)

NW public

contract

Mersey Comm-

unity Hospital

LGH North public

contract

RHH South public

contract

Other Grand Total

Non-acute <5 <5

Obstetrics 195 1,118 422 2,580 <5 3,280 <5 140 7,737

Ophthalmology 26 131 319 515 516 710 8 2,226

Orthopaedics 1,420 658 2,162 <5 3,044 <5 208 7,496

Pain Management

232 250 473 1,275 155 2,385

Palliative care 32 10 140 16 434 632

Plastics/Reconstructive Surgery

189 <5 304 554 <5 890 9 1,949

Psychiatry 570 59 926 8 1,931 12 418 3,924

Qualified Neonate

29 248 43 466 0 814 <5 29 1,631

Rehabilitation Acute

<5 <5 <5

Rehabilitation Sub-acute

<5 294 558 1,083 56 1,993

Renal Dialysis 2,751 2,541 9,549 11,851 26,692

Renal Medicine

53 91 470 789 67 1,470

Respiratory Medicine

737 <5 472 1,694 88 2,068 <5 699 5,761

Rheumatology 45 55 113 <5 664 48 928

Tracheostomy 41 89 168 298

Unallocated 12 6 81 <5 113 23 236

Unqualified Neonate

50 429 287 1,013 <5 1,207 53 3,039

Upper GI Tract Surgery

223 96 533 620 63 1,534

Urology 156 182 1,469 78 1,339 14 90 3,327

Vascular Surgery

34 118 363 1,028 74 1,618

Grand Total 13,387 1,962 11,572 46,648 772 71,924 285 7,292 153,842

Table 35: Modelled activity, 2016–17, Model 2

MCRG NWRH (Burnie)

NW public

contract

Mersey Comm-

unity Hospital

LGH North public

contract

RHH South public

contract

Other Grand Total

Breast Surgery

59 55 148 165 <5 429

Cardiology 969 6 647 2,116 2,899 <5 623 7,261

Cardiothoracic Surgery

38 448 486

Chemo & Radiotherapy

511 570 2,497 6,103 121 9,801

Colorectal Surgery

153 144 426 321 <5 <5 1,046

Dentistry 67 62 180 <5 413 724


MCRG NWRH (Burnie)

NW public

contract

Mersey Comm-

unity Hospital

LGH North public

contract

RHH South public

contract

Other Grand Total

Dermatology 48 52 130 312 40 582

Diagnostic GI Endoscopy

602 816 2,267 3,091 6,776

Drug & Alcohol

239 <5 87 625 1,073 464 2,489

Ear Nose & Throat

136 122 564 <5 778 89 1,690

Endocrinology 198 126 503 <5 1,116 198 2,149

Extensive Burns

<5 28 70 6 105

Gastro-enterology

284 <5 239 1,308 1,546 436 3,815

GEM 73 21 104 849 115 1,163

Gynaecology 512 317 853 <5 953 <5 19 2,656

Haematology 175 169 1,776 3,018 187 5,325

Head & Neck Surgery

18 12 77 119 226

Immunology & Infections

145 <5 137 669 14 1,048 197 2,212

Interventional Cardiology

2,098 1,381 3,479

Medical Oncology

131 107 798 <5 1,425 229 2,690

Mental Health <5 <5 <5

Neurology 456 <5 398 1,584 26 2,535 540 5,539

Neurosurgery 39 <5 39 153 425 <5 37 697

NHT 130 125 208 677 424 1,565

Non Subspec Medicine

567 19 593 2,024 16 4,981 247 695 9,142

Non Subspec Surgery

592 <5 569 2,058 <5 3,286 401 6,910

Non-acute <5 <5

Obstetrics 110 1,118 657 2,412 3,280 <5 157 7,737

Ophthalmology 59 131 195 606 516 710 8 2,226

Orthopaedics 1,259 726 2,244 4 3,044 <5 218 7,496

Pain Management

289 183 482 1,275 157 2,385

Palliative care 13 18 151 16 434 632

Plastics/Reconstructive Surgery

374 <5 60 613 <5 890 9 1,949

Psychiatry 546 66 940 8 1,931 12 421 3,924

Qualified Neonate

19 248 74 444 814 <5 29 1,631

Rehabilitation Acute

<5 <5 <5

Rehabilitation Sub-acute

137 139 567 1,083 67 1,993


MCRG NWRH (Burnie)

NW public

contract

Mersey Comm-

unity Hospital

LGH North public

contract

RHH South public

contract

Other Grand Total

Renal Dialysis 2,751 2,541 9,549 11,851 26,692

Renal Medicine 57 57 500 789 67 1,470

Respiratory Medicine

553 <5 515 1,839 88 2,068 <5 695 5,761

Rheumatology 55 39 111 <5 664 55 928

Tracheostomy 18 <5 109 168 298

Unallocated 9 <5 92 <5 113 20 236

Unqualified Neonate

32 429 364 955 <5 1,207 52 3,039

Upper GI Tract Surgery

145 149 557 620 63 1,534

Urology 272 128 1,403 78 1,339 14 93 3,327

Vascular Surgery

34 93 394 1,020 76 1,618

Grand Total 12,838 1,962 11,418 47,200 772 71,916 285 7,451 153,841

Note: Figures differ by one separation compared to Model 1, due to rounding.

Planning outcomes for the North West Regional Hospital (Burnie)Under both models, it is envisaged that the service profile of the NWRH (Burnie) will remain unchanged from that proposed in the 2007 Clinical Services Plan. The hospital will continue to provide intensive care, inpatient and day-stay acute medical and surgical care (including all joint replacements for patients from the North West region), low and medium risk obstetric, ante-natal and post-natal care, inpatient paediatric care, emergency medicine, a satellite renal dialysis service (supported on an outreach basis by clinicians from the LGH), chemotherapy and a broad range of specialist and sub-specialist consulting.

Both models predict significant growth in the number of patients requiring overnight admissions to the NWRH (Burnie) and an associated growth in total beds, to 183 beds under Model 1 and 163 beds under Model 2. In comparison to Model 2, Model 1 provides for almost 1,750 more multi-day admissions, 24 more multi-day beds, almost 1,200 fewer same day admissions and 4 fewer same day beds in the NWRH (Burnie).

The NWRH (Burnie) currently has a substantial number of acute bed spaces used for non-clinical purposes, and spare theatre capacity. On these estimates, the facility will have capacity to meet inpatient growth needs for the near future, but may have capacity limitations towards the end of the planning period, particularly under Model 1. It should be noted that the assumed development of sub-acute services at the Mersey Community Hospital will relieve pressure on the largest demand growth area. There is no change in same day bed requirements under Model 1 and a modest increase under Model 2, but it should be noted that same day chemotherapy activity is not reported in the NWRH (Burnie) data and growth would be anticipated in this service under both models.

The modelled distribution of services under both models also does not take into account the relatively lower access to inpatient services for residents of the North West which was identified earlier in this report. While additional growth in inpatient services may be necessary, there is an opportunity for the Tasmanian Government to invest differentially in community-based services for people with chronic disease to redress this apparent inequity in access over the planning period.


Table 36: Modelled distribution NWRH (Burnie) 2006–07 and 2016–17, Model 1

2006–07 actual

NWRH (Burnie)

2006–07 re-

allocated NWRH (Burnie)

2006–07 NW

public contract

2006–07 Total

NWRH (Burnie)

2016–17 NWRH (Burnie)

2016–17 NW

public contract

2016–17 Total

NWRH (Burnie)

Seps Day Only 6,333 3,851 584 4,435 5,702 625 6,327

Seps Overnight

5,618 7,102 1,664 8,766 7,685 1,337 9,022

Total 11,951 10,953 2,248 13,201 13,387 1,962 15,349

Bed days Day Only

6,333 3,851 584 4,435 5,702 625 6,327

Bed days Overnight

32,686 39,280 5,659 44,939 48,074 4,459 52,533

Total 39,028 43,131 6,243 49,374 53,776 5,084 58,860

Same day beds

15 9 2 11 13 2 15

Multi-day beds 105 126 19 145 154 14 168

Total Beds 120 135 21 156 167 16 183

Note: Bed totals have been rounded for clarity.

Table 37: Modelled distribution NWRH (Burnie) 2006–07 and 2016–17, Model 2

2006–07 actual

NWRH (Burnie)

2006–07 re-

allocated NWRH (Burnie)

2006–07 NW

public contract

2006–07 Total

NWRH (Burnie)

2016–17 NWRH (Burnie)

2016–17 NW

public contract

2016–17 Total

NWRH (Burnie)

Seps Day Only 6,333 4,894 584 5,478 6,891 625 7,516

Seps Overnight

5,618 5,438 1,664 7,102 5,947 1,337 7,283

Total 11,951 10,332 2,248 12,580 12,838 1,962 14,799

Bed days Day Only

6,333 4,894 584 5,478 6,891 625 7,516

Bed days Overnight

32,686 31,820 5,659 37,479 40,731 4,459 45,190

Total 39,028 36,714 6,243 42,957 47,622 5,084 52,706

Same day beds 15 13 2 15 17 2 19

Multi-day beds 105 102 18 120 129 15 144

Total Beds 120 115 20 135 146 17 163

Planning outcomes for the Mersey Community HospitalModel 1 provides for the Mersey Community Hospital to deliver a high proportion of day surgery for the region together with regional specialist aged care, sub-acute, rehabilitation and transition care services, consistent with the planned service profile under the 2007 Clinical Services Plan. In contrast with the 2007 Clinical Services Plan it also provides for inpatient care for medical and paediatric patients who require low complexity care and a high dependency unit consistent with the recommendation of the recent review. This is the preferred model.

Model 2 assumes that the Mersey Community Hospital will provide a full range of community hospital-type services, as described earlier in this report, supported by a high dependency unit.


Both models assume that all joint replacement surgery will be conducted at the NWRH (Burnie) and that most specialist vascular procedures will be undertaken at the RHH.

Under both models, there is a modest growth in beds at the Mersey Community Hospital – to 95 under Model 1 and to 118 under Model 2. The number of patients treated at the Mersey Community Hospital is approximately equal under both models, but Model 2 provides for a greater focus on multi-day patients while Model 1 provides for a greater focus on same day patients.

Under both models there appears to be sufficient demand to support a small satellite or home dialysis service for the referral population of the Mersey Community Hospital, as proposed in the 2007 Clinical Services Plan.

Table 38: Modelled distribution Mersey Community Hospital 2006-07 and 2016-17, Model 1

2006–07 Actual 2006–07 Re-allocated 2016–17 Total

Seps Day Only 2,224 5,997 8,468

Seps Overnight 4,910 2,641 3,105

Total 7,134 8,638 11,572

Bed days Day Only 2,224 5,997 8,468

Bed days Overnight 26,248 15,223 23,573

Total 28,472 21,220 32,041

Same day beds 8 18 23

Multi-day beds 81 46 72

Total Beds 89 64 95

Table 39: Modelled distribution Mersey Community Hospital 2006-07 and 2016-17, Model 2

2006–07 Actual 2006–07 Re-allocated 2016–17 Total

Seps Day Only 2,224 4,036 6,102

Seps Overnight 4,910 4,768 5,316

Total 7,134 8,804 11,418

Bed days Day Only 2,224 4,036 6,102


Total 28,472 28,927 38,897



Total Beds 89 87 118

Planning outcomes for the Launceston General HospitalIn both models, by 2016–17, the LGH shows strong growth in same day and overnight separations.

Total separations at the LGH in both models are comparable with the 2007 Clinical Services Plan which predicted 45,898 total separations compared with approximately 47,000 in these models, but a longer average length of stay has resulted in an overall increase in bed requirements compared with those predicted in 2007. In both models there is a requirement for more than 20 additional same day beds and almost 100 additional multi-day beds.

Detailed service-level planning for the Launceston ICC will commence shortly after the publication of this Clinical Services Plan update. It is likely that some same day beds which are included in projections for the LGH will be provided in the ICC, leading to a reduction in same day bed requirements for the LGH.


Table 40: Modelled distribution LGH 2006–07 and 2016–17, Model 1

2006–07 Actual 2006–07 Re-allocated 2016–17 Total LGH

Seps Day Only 20,834 19,700 29,315

Seps Overnight 14,565 15,187 17,332

Total 35,399 34,887 46,647

Bed days Day Only 20,834 19,700 29,315


Total 122,399 124,412 162,008





Table 41: Modelled distribution LGH 2006–07 and 2016–17, Model 2

2006–07 Actual 2006–07 Re-allocated 2016–17 Total LGH

Seps Day Only 20,834 20,462 30,265

Seps Overnight 14,565 14,807 16,934

Total 35,399 35,269 47,199

Bed days Day Only 20,834 20,462 30,265


Total 122,399 123,650 161,416





Planning outcomes for the Royal Hobart Hospital

The core objectives of the new RHH are:

• focusondeliveryofacutecareservices(non-acuteandsupportserviceswillbecollocatedonly where this is the most appropriate and sustainable option);

• bepartofandsupportanintegratedhealthsystem(includingpublicacutehospitals,ICCs,statewide clinical services networks, and primary health and community care);

• provideacontemporarystandardofacutepatientcare(throughdeliveryofqualityservicesin a healing environment that is adaptable to need and recognises patients as individuals);

• supportclinicaleducationandadvanceclinicalresearch;

• bedesignedforasustainablefuture;and

• beanintegralpartofthecommunity.

The redistribution model applied above alters the patient flows in the North of the State but does not impact on planning projections for the South, except for an additional requirement to provide for vascular procedures for the North West region, estimated at 170 separations or three multi-day beds.

Demand growth in the South will relate to population growth and ageing rather than to changes in patient flows, unless there are significant changes in flows of patients from the private to the public sector or vice versa.


As noted earlier in this report (see discussion commencing on page 60), a major increase in demand for services is predicted in the South, with separations increasing by 31 per cent from 54,881 in 2006–07 to 71,745 in 2016–17. Increases of 33 same day beds and 130 multi-day beds are predicted to be required to meet this demand.

A large component of the predicted increased demand relates to non-acute inpatient services – including rehabilitation, geriatric evaluation and management, transition care and palliative care – which are projected to increase dramatically over the planning period. The most significant growth will be seen in rehabilitation (including transition care), geriatric management and other non-acute inpatient activity (Table 42).

Table 42: Actual and projected non-acute inpatient activity in the RHH

Year Change

Bed type 2006–07 2011–12 2016–17 No %

Separations 1,120 2,728 3,503 2,383 213%

Bed days 28,289 44,826 56,994 28,705 101%

It should be noted that NSW Health no longer uses the acute activity modelling tool as the basis for planning sub-acute services.23 It is understood that this is because the tool is thought to over-estimate bed requirements. Nevertheless, it is clear that demand for sub-acute services will increase substantially as the population ages.

Detailed planning for sub-acute services including rehabilitation, geriatric evaluation and management, transition care and palliative care is continuing. The location of sub-acute services in relation to the new RHH is yet to be determined. It is recognised, however, that providing adequate facilities for these services will be critical to accommodating the needs of the referral population of the RHH into the future. As noted earlier in this report, the Department will publish an implementation plan for rehabilitation services by February 2009.

Modelled demand increases are being taken into account in planning for the new RHH. As well as incorporating additional facilities to accommodate predicted growth, the new RHH will be designed for highly efficient service delivery, including the following facilities and services:

• Anintegratedcancercareserviceprovidingacomprehensiverangeofservicescoveringconsultation, treatment (including therapies such as chemotherapy, haematology and radiation oncology) and ongoing care (including palliative care information and counselling), as well as cancer surgery.

• Acomprehensiverangeofsurgery,bothasinpatient(dayonlyorovernight)andoutpatientservices. One of the major strategies for delivering responsive surgery services will be the use of surgical short-stay units and a 23-hour care suite, as the majority of surgical care can be undertaken within a 24-hour period in a non-ward environment.

• ThestatewidecardiothoracicsurgicalservicewillcontinuetobebasedatthenewRHH.TheDepartment, in consultation with the RHH and with cardiology services in Tasmania’s North, will consider strategies for potential flow reversal from interstate to the new RHH to enhance future service volumes.

• Interventionalservicesprovidediagnostic,interventional,proceduralandsurgicalservices.This service will form a major suite in the new RHH, with access via the hospital for acute and emergency interventions and via the Hobart ICC for booked and elective interventions, including same day surgery.

23 NSW Health Statewide Services Development Branch Planning Series. Activity Planning Guideline for Subacute Inpatient Care Services. December 2006. p3.


• TheRHHprovidesastatewideburnsserviceforadults.Theburnsclinicwillbelocatedinthenew RHH. Major and complex burns cases will continue to be referred interstate for specialised treatment. Children with major burns are currently referred interstate for care and treatment and these arrangements will also continue with the new RHH.

• RenaldialysisservicesforpatientsinTasmania’sSouthincludeanacuteunitatthemaincampusofthe RHH, a non-acute satellite service at St John’s Park for patients establishing dialysis or who are in need of further supervision and management, and additional home dialysis. The acute dialysis service will continue at the new RHH, in both inpatient and acute ambulatory locations. It is proposed to continue providing non-acute dialysis from chairs in the St John’s Park site, as well as examining in the future the option of providing more satellite chairs at proposed Tier 3 ICCs.

• TheRHHistheStatereferralhospitalforwomen’sandchildren’sservices(WACS).WACSdelivers comprehensive services to women and children in inpatient, outpatient and community settings, including maternity, neonatology, paediatric and gynaecology services. The new RHH will continue this role and level of service for WACS.

• TheacutementalhealthinpatientserviceinthenewRHHwillprovidecomprehensivecareandtreatment of adult and adolescent patients in a collocated service. There will be 46 inpatient beds, including an adult unit; a statewide psychiatric intensive care unit (PICU); a statewide adolescent mental health unit; and a psychiatric emergency care zone in the emergency department.

• MedicalimagingatthenewRHHwillbeexpandedtoincludeaPETscanner.TheAustralianGovernment has committed $3.5 million in support of a PET scanner at the RHH. A business case for the PET is to be reviewed as the 2008–09 State Budget is developed.

• Medi-hotelsprovidealternativepatientaccommodationforpeoplewhoneedtobeclosetonursing or medical support but do not require direct nursing supervision. A 15-bed medi-hotel is included within the scope of the New Royal Project.

• TheHobartICCwillfocusonthedeliveryofbothacuteandcomplexchronichealthservices to an ambulatory client group that may need access to tertiary hospital backup and support. The focus will be on day-only episodes of care. The ICC will have three key functions:

– to be the portal for elective, non-urgent day surgery and other procedures;

– to deliver a wide range of ambulatory care services, including diagnostic services; and

– to provide specific services for people with chronic and complex co-morbid conditions, including cancer, diabetes/renal, cardio-respiratory and gastroenterology.

• Demandforallnon-acuteinpatientservicesisprojectedtoincreasedramaticallyoverthenext15 years. The most significant growth will be seen in rehabilitation (including transition care), geriatric management and other non-acute inpatient activity.

• Non-acuteagedcareandrehabilitationserviceswillremainintegrated,bothphysicallyandoperationally, but these services will not be brought onto the main campus of the new RHH. There is a clear opportunity with the New Royal Project to consider new site/s for what will need to be greatly expanded services.

• DecisionsontheoptimumconfigurationandlocationofalcoholandotherdrugservicesinHobart, including the preferred location of the detoxification service and pharmacotherapy program, will await the outcome of the current Alcohol, Tobacco and Other Drug Treatment Services Review. The review also will canvass the optimum range of in-reach services to be provided to new RHH.


Enablers of a sustainable service systemThe 2007 Clinical Services Plan proposes a number of enablers of a sustainable service system including the development of a stable and skilled workforce; a number of teaching and research strategies; the formation of a Clinical Advisory Council; the development of clinical networks; the development of a statewide system for credentialling and approving the introduction of new technology; the development of more effective patient transport systems; and the provision of more accommodation options for patients and their families and carers.

These initiatives continue to be a priority, to support the implementation of the 2007 Clinical Services Plan.

Clinical networksClinical networks, which have been developed in many health care systems nationally and internationally, are formal groups of clinicians who work together across organisational boundaries to improve the performance of the health care system. They provide a valuable platform for service planning, communication, system-wide coordination and improving quality in complex clinical service systems. They foster clinician cooperation and engagement in the health care system and create a vehicle for service development.

The 2007 Clinical Services Plan proposes the development of clinical networks in adult medical services; adult surgical services; aged care and rehabilitation; cancer services; cardiology/cardiac surgery; diabetes and chronic disease; emergency, critical care and trauma services; renal medicine; and women’s and children’s services incorporating maternal and perinatal services and paediatric medicine and surgery. It proposes that there be a clinical chair/leader of each clinical network and each network will:

• bemultidisciplinary;

• meetregularlyanddevelopandworkinaccordancewithanagreedworkplan;and

• beprovidedwithprojectofficersupportbytheDepartment.

The clinical networks will be led and coordinated by the Clinical Advisory Council, which will be the principal vehicle of advice to the Department about the structure and performance of the health care system. An interim Clinical Advisory Council has been convened.

Some concerns were raised during consultation for this Clinical Services Plan update that:

• therole,termsofreferenceandmanagementauthorityoftheclinicalnetworksareunclear;

• clinicalnetworkleadershipshouldreflecttheneedsandinterestsofallregions.Meetingthenecessarycommitments of a clinical network leader will be more achievable for clinicians who are employed on a full-time basis in the hospital system because those clinicians have specific time allocations for non-clinical duties. The majority of full-time medical practitioners in Tasmania are employed at the RHH, resulting in a concern that medical leadership of the clinical networks will be ‘Hobart-centric’;

• theallocationofclinicaldisciplinesandstreamstoeachclinicalnetworkrequiresreviewandfurther consultation;

• theadministrativeburdenofsupportingalargenumberofclinicalnetworksinasmallhealthcaresystem may be excessive; and

• theclinicalgroupingsproposedfortheclinicalnetworksmaynotbethemostappropriate.


The engagement of clinicians in service development needs to continue. In Tasmania’s small health care system, clinical networking may take different forms, depending on the size and level of support required for a particular specialty area. Clinical networks often are engaged in the development of guidelines for clinical care; monitoring performance and advising on how it may be enhanced; and advising on policy development and planning. They usually do not have operational responsibility or management authority, however, and it will be important to ensure that the terms of reference of the clinical networks and the Clinical Advisory Council do not create confusion with respect to the operational responsibility of the hospital chief executive officers to implement agreed planning outcomes and ensure the delivery of quality services.

While it will be a fundamental responsibility for network leaders to recognise their statewide responsibilities and not adopt an organisation-specific orientation, the Department agrees that the network leadership group should incorporate clinicians from all areas of the State.

The cancer network is established and the Department has committed to developing a rehabilitation and aged care network by August 2008. Consistent with the priority health care needs of the Tasmanian community, a chronic disease network, which will have a strong focus on diabetes services, will be established before the end of 2008.

If the opportunity for Tasmanian clinicians to join an interstate network arises, it should be considered seriously. Participating in a clinical network with greater critical mass and the potential to access a larger pool of networking resources could be very beneficial to Tasmanian clinicians.


The Department will:

• develop,byJuly2008,ashortconsultationpaperdefiningtheroleanddrafttermsofreference of the Clinical Advisory Council and presenting more detail about the proposed number and type of clinical networks to be established; the roles and responsibilities of network members; methods of supporting networks; and principles for network operation;

• selectthemembershipofandconvenetheClinicalAdvisoryCouncilbyOctober2008;

• establisharehabilitationandagedcarenetworkbyAugust2008andachronicdiseasenetwork by December 2008;

• ensurethatfairandtransparentarrangementsareinplacetofundandotherwisefacilitatethe provision of adequate back-up and clinical support for clinicians who assume leadership positions, particularly those who are not full-time employees in the public acute hospital system;

• convenecardiacandrenalforumsbyDecember2009.Theseforumswillbepresentedwithdata and opinion about current and future service delivery challenges and opportunities and consensus will be sought about the most appropriate method to facilitate ongoing clinical interaction across the State. Convening regular planning forums may be an alternative to establishing ongoing clinical networks for these sub-specialty services; and

• convene,commencingbyJuly2009,statewideclinicalconsultativemeetingstwiceyearlyin each of women’s and children’s services; adult surgery; adult medicine; and critical care, trauma, emergency and retrieval services until formal ongoing networking structures have been agreed on and implemented.


WorkforceThe availability of a competent workforce in sufficient numbers and distributed according to service delivery needs will be critical to the development and success of Tasmania’s health care system.

There is a national and international shortage of health care professionals.

The 2007 Clinical Services Plan makes a number of commitments in the areas of education, training, recruitment and retention, designed to strengthen Tasmania’s health care workforce.


The Department will continue to work with the University of Tasmania and the tertiary and further education sector to develop and implement a long-term strategic plan that links Tasmania’s health care education and workforce needs. The strategic plan will link with this Clinical Services Plan update. In particular, the Department will undertake a workforce modelling exercise, based on the activity projections in this Clinical Services Plan update, to establish clear targets for workforce numbers in each health care professional category over the life of the Clinical Services Plan and identify key workforce risks and/or the need to redesign care pathways. The workforce plan will be developed by December 2009.

Stakeholder engagement and distributed governanceTasmania’s health care system will continue to strive to meet the increasing health care needs of an ageing population with a high prevalence of chronic disease. Preferential investment by all levels of government and the community in the maintenance of good health and prevention of illness, as well as reconfiguring the system to support more sustainable service delivery, will alleviate some pressures. Ultimately all health care systems have finite budgets within which they must operate, requiring decisions to be made about where and how resources should be applied to achieve the best value from public expenditure and the best health outcomes for the community.

Such decisions can be challenging. Inevitably, there are competing demands and opportunities.

The challenges that confront the health care system are not just challenges for the Minister or the Department and there is a critical need to engage a broad group of stakeholders in their resolution. All stakeholders including hospital managers, health care professionals, acute hospital patients and the broader community have an interest in (and ability to contribute to) effective decision-making about how and where scarce health care resources should be invested to best meet the needs of the community. Engagement of clinicians is a critical prerequisite to ensure that relevant clinical implications are taken account of in all significant decisions.

The Tasmanian health care system has been characterised in the past by a ‘top down’ governance approach which has tended to centralise decision-making within the Department. In the future, a more distributed system of governance will be adopted, so that more decisions can be made locally, with full engagement of the clinicians who are responsible for patient care, according to local needs and priorities.

Distributed governance requires clinicians and managers who assume local decision-making authority to assume corresponding accountability for working within agreed budgets and in accordance with agreed system-wide policies and strategies.


The Department’s commitment to undertaking a review to ensure that funding allocations between Tasmania’s public acute hospitals are equitable and transparent (see Implementation commitment 19 on page 56) will support greater delegation of decision-making authority and accountability. Building on this base, performance agreements with hospital chief executive officers will define:

• expectationsoforganisationalperformanceincludingclinicalactivitytobeachievedwithinagreedbudget allocations; and

• arequirementthattheydocumentandregularlyreportonprogresstowardsachievingaclinicalengagement strategy.

At a system-wide level, clinicians and other stakeholders will be engaged in decision-making through a variety of structures and processes including the clinical networks and the Clinical Advisory Council. A number of the structural changes detailed in this Plan (see discussion commencing on page 30) will enable greater stakeholder input into decision-making. The Department opened a regional office in Launceston recently and also intends to develop specific advisory structures to strengthen regional governance in the North and North West.

Ministerial community forums to discuss implementation of Tasmania’s Health Plan have enabled community input and will continue.

These engagement strategies reflect the need for priorities to be set in the overall community interest and the fact that better decisions will be made if the professionals who deliver health care services to our community also are engaged in planning those services and accounting to the community for the health care system’s performance.


The Department will work with the chief executive officers of each public acute hospital to define explicit performance agreements incorporating targets for clinical activity within agreed budgets and a requirement that they document a clinical engagement strategy and monitor and report on its effectiveness over time. Clinical engagement strategies will be developed by December 2008.


Glossary of abbreviationsABS Australian Bureau of Statistics

ACSC Ambulatory Care Sensitive Conditions

ACT Australian Capital Territory

AIHW Australian Institute of Health and Welfare

ALOS Average Length of Stay

BMT Bone Marrow Transplantation

CACP Community Aged Care Packages

CT Scanner Computed Tompgrahy Scanner

DoHA Department of Health and Ageing (Commonwealth)

the Department Department of Health and Human Services (Tasmania)

ABS Australian Bureau of Statistics

DRGs Diagnosis Related Groups

ENT Ear, Nose and Throat

ED Emergency Department

ERP Estimated Resident Population

GEM Geriatric Evaluation and Management

GP General Practitioner

HBOT Hyperbaric Oxygen Therapy

ICC Integrated Care Centre

ICU Intensive Care Unit

Linac Linear Accelerator

LGA Local Government Area

LGH Launceston General Hospital

MCRG Major Clinical Related Group

MRI Magnetic Resonance Imaging

MSAC Committee Medical Services Advisory Committee

NHT Nursing Home Type

NICU Neonatal Intensive Care Unit

NSW New South Wales

NT Northern Territory

NW North West

NWRH North West Regional Hospital

PET Positron Emission Tomography

PICU Psychiatric Intensive Care Unit

QLD Queensland

RACP Residential Aged Care Places

RHH Royal Hobart Hospital

SA South Australia

SCN Special Care Nursery

SEIFA Socio-Economic Indexes for Areas

SLA Statistical Local Area

TAS Tasmania

TCGS Tasmanian Clinical Genetics Service

VIC Victoria

WA Western Australia


Glossary of termsAdmitted patient (or inpatient)

A patient who undergoes a hospital’s formal admission process to receive treatment and/or care. This treatment and/or care is provided over a period of time and can occur in hospital and/or in the person’s home (for hospital-in-the-home patients).

Ambulatory care sensitive conditions

Hospitalisations that are thought to be avoidable if timely and adequate non-hospital care, such as GP or primary care, is provided. Also referred to as avoidable hospitalisations.

Average length of stay

The average number of patient days for admitted patient episodes. Patients admitted and separated on the same day are allocated a length of stay of one day.

Casemix adjusted separation

A patient separation (see below) which has been adjusted using AR-DRG cost weights for the relative complexity of the patient’s clinical condition and for the hospital services provided.

Collocated (Services) physically placed near one another, especially side by side.

Overnight Overnight and multi-day stays.

Paediatric Refers to children generally aged 14 years or under.

Patient episode The period of admitted patient care between a formal or statistical admission and a formal or statistical separation, characterised by only one care type.

Separation An episode of care for an admitted patient, which can be a total hospital stay (from admission to discharge, transfer or death), or a portion of a hospital stay beginning or ending in a change of type of care (for example, from acute to rehabilitation). Separation also means the process by which an admitted patient completes an episode of care either by being discharged, dying, transferring to another hospital or changing type of care.

Clinical Services Plan: Update Incorporating changes to ownership of the

Mersey Community Hospital May 2008

Tasmania’s HealTH Plan

Depar tment of Health and Human Ser vices

For more information on Tasmania’s Health Plan visit www.health.tas.gov.au

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