Part B (11)

Service Profile for Thursday Island Hospital Infrastructure Renewal Planning Project for Rural and Remote Areas

July 2010

“PRINTED COPIES ARE UNCONTROLLED” Endorsed by IPPEC—does not represent Queensland Health policy at this time.

Infrastructure Renewal Planning Project for Rural and Remote Areas Service Profile for Thursday Island Hospital Paper 2, July 2010

Contents

1 Executive summary ...... 3 2 Service Profile for Thursday Island Hospital ...... 5 2.1 Geographic profile...... 5 2.2 Demographic profile...... 6 2.2.1 Catchment population...... 6 2.3 Thursday Island Hospital ...... 8 2.3.1 Hospital inpatient activity ...... 9 2.3.2 Projected activity...... 11 2.4 Core services...... 12 2.4.1 Surgical and procedural...... 12 2.4.2 Maternity...... 13 • Maternity beds/rooms ...... 13 • Accommodation for families...... 13 • Paediatrics ...... 13 2.4.3 Emergency Department...... 14 2.4.4 General medical...... 14 • Non-admitted occasions of services ...... 15 • Visiting specialist services ...... 16 • Medical Specialist Outreach Assistance Program ...... 16 2.4.5 Current support services...... 16 • ...... 16 • Medical imaging ...... 17 • Pharmacy...... 17 • Dental/oral health services...... 17 2.5 Primary health care and community health services...... 17 • Primary health care...... 17 • Allied health services ...... 18 3 Current and future bed requirements ...... 20 3.1.1 Summary of projected bed requirements...... 20 • Other treatment spaces ...... 20 4 List of figures and tables...... 21 5 References ...... 22

“PRINTED COPIES ARE UNCONTROLLED” Endorsed by IPPEC—does not represent Queensland Health policy at this time. 2

Infrastructure Renewal Planning Project for Rural and Remote Areas Service Profile for Thursday Island Hospital Paper 2, July 2010

1 Executive summary The Infrastructure Renewal Planning Project for Rural and Remote Areas has been identified by the Deputy Premier as a priority project aimed at providing a comprehensive and prioritised health infrastructure program for rural Queensland. The need to address health inequities and access to hospitals in remote areas has also been identified by the Commonwealth Government’s National Health and Hospital Network Agreement 2010. This Service Profile for Thursday Island Hospital is one of 12 profiles developed for each of the Queensland prioritised rural sites. The profile identifies the current level (draft CSCF v3.0 Level 3) and mix of clinical services provided at each site with a focus on the core services of surgical and procedural, maternity, Emergency Department and general medical. Table 1 details current beds and future bed requirements for Thursday Island Hospital. To improve the efficiency of current service delivery, infrastructure upgrades will be required for the Hospital. The Emergency Department has a lack of space, including inappropriate consultation, triage and treatment spaces. The Hospital currently has one recovery bay for its major Operating Theatre and an additional recovery bay is required to provide surgical services at draft CSCF v3.0 Level 3. To provide an efficient maternity service an additional two consultation rooms and a child-friendly waiting area are required. These improvements to the infrastructure are necessary to enhance the safety and efficiency of patient services at Thursday Island Hospital. Rural hospitals rely on visiting clinicians to provide a range of specialist services. Dysfunctional layouts and insufficient treatment spaces make it difficult to attract specialists to the Hospital to provide these services. As Thursday Island Hospital currently does not have sufficient consultation and treatment rooms for outpatient clinics, there is a negative impact on the provision of routine services and compromises to patient safety and privacy. The Chronic Disease Centre being planned for the District will cater for a range of primary health care services. The future activity of this Centre is not within the scope of this service profile. The projected requirements for outpatient consultation and treatment rooms in this service profile are for the provision of acute-related outpatient services, not the provision of primary health services which will be met by the Chronic Disease Centre. Rural hospitals typically have difficulty recruiting staff, and the age and condition of accommodation provided is a major barrier to attracting and retaining a skilled workforce. If staff cannot be recruited and retained, patient access to safe and sustainable services will be compromised.

“PRINTED COPIES ARE UNCONTROLLED” Endorsed by IPPEC—does not represent Queensland Health policy at this time. 3

Infrastructure Renewal Planning Project for Rural and Remote Areas Service Profile for Thursday Island Hospital Paper 2, July 2010

Table 1: Summary of current and future bed requirements for Thursday Island Hospital Bed and treatment spaces Current number Number required by 2021/22

Overnight beds 36 29

Same day beds 0 0

Bed alternatives 0 12 renal chairs

Emergency Department 2 7 treatment spaces Multipurpose consultation rooms 7 multipurpose + 2 (for outpatients) 2 maternity

“PRINTED COPIES ARE UNCONTROLLED” Endorsed by IPPEC—does not represent Queensland Health policy at this time. 4

Infrastructure Renewal Planning Project for Rural and Remote Areas Service Profile for Thursday Island Hospital Paper 2, July 2010

2 Service Profile for Thursday Island Hospital

2.1 Geographic profile The Torres Strait and Northern Peninsula Area Health Service District (the District) covers a large geographical area that extends from the international border of Papua New Guinea to the northern tip of Cape York Peninsula (Figure 1). The District comprises 18 inhabited islands and five communities located in the Northern Peninsula Area of Cape York. It encompasses the councils of Torres Shire Council (TSC), the Torres Strait Island Regional Council (TSIRC) and the Northern Peninsula Area Regional Council (NPARC). Thursday Island Hospital is a primary hub providing support to all health services in the District. The District has two rural hospitals, one located on Thursday Island and one in Bamaga in the Northern Peninsula Area. There are also Primary Health Centres in both Thursday Island and Bamaga which serve as a base for outreach teams. According to the Australian Statistical and Geographical Categories, Thursday Island and the District are classified as ‘very remote’ with a remote area score of RA5 1. Figure 1: Map of Torres Strait and Northern Peninsula Area Health Service District

Source: http://www.tsra.gov.au/the-torres-strait/regional-map.aspx

“PRINTED COPIES ARE UNCONTROLLED” Endorsed by IPPEC—does not represent Queensland Health policy at this time. 5

Infrastructure Renewal Planning Project for Rural and Remote Areas Service Profile for Thursday Island Hospital Paper 2, July 2010

2.2 Demographic profile

2.2.1 Catchment population The primary catchment for Thursday Island Hospital encompasses the entire District and includes 21 Statistical Local Areas (SLAs) as shown in Table 2. The 2007/08 Estimated Resident Population of the District was 10,635 people. Population numbers are likely to be underestimated as issues with registration and census data collection in the District are well documented. Table 2: Torres Strait and Northern Peninsula Area Health Service District associated population SLA for TSPNPA Health Service District 2006^ 2008 2011 2016 2021 Bamaga 864 899 959 1082 1210 Injinoo 454 477 477 477 477 New Mapoon 374 390 390 390 390 Seisia 183 191 191 191 191 Umagico 263 278 278 278 278 Torres (S) 3496 3596 3654 3716 3757 Badu 884 906 984 1125 1279 Boigu 285 274 274 274 274 Dauan 164 159 159 159 159 Erub 341 354 354 354 354 Hammond 229 232 232 232 232 Iama 336 337 337 337 337 Kubin 216 223 223 223 223 Mabuiag 269 274 274 274 274 Mer 523 535 547 573 598 Poruma 178 185 185 185 185 Saibai 364 380 380 380 380 St Pauls 258 263 263 263 263 Ugar 81 83 83 83 83 Warraber 264 272 272 272 272 Yorke 321 327 327 327 327 Total 10,347 10,635 10,843 11,195 11,543

Source: http://www.health.gov.au/internet/main/publishing.nsf/Content/ageing-stats-lapp.htm It is expected that population growth in the District will remain steady at 3 per cent for the years 2011–2016 to 2016–2021. Figure 2 details the population projections for the District by age group in years for the period 2011–2016. Significant percentage increases are projected for the 70 years and over age group (115%) and the 50–69 years age group (27%); although the total numbers of people in these age groups by 2021 (809 and 1963 respectively) remain relatively small.

“PRINTED COPIES ARE UNCONTROLLED” Endorsed by IPPEC—does not represent Queensland Health policy at this time. 6

Infrastructure Renewal Planning Project for Rural and Remote Areas Service Profile for Thursday Island Hospital Paper 2, July 2010

Figure 2: Population projections for Torres Strait and Northern Peninsula Area Health Service District 2011–2021

6000

5000 2011 4000 2016 2021 3000

2000

Number of people (M &F) people of Number 1000

0 0-14 15-49 50-69 70+ Age Groups

Source: Population Projections (Medium Series) by Age and Sex, 2006 for Health Service Districts (v2008), Queensland (based on 2006 census figures; ASGC 2008 reformed LGAs) August 2008 Produced by Dept of Infrastructure & Planning (Produced by Planning Information & Forecasting Unit) (District groupings added by Health Information Centre) Oct 9, 2008 In 2007, Aboriginal and Torres Strait Islander residents in the District represented six per cent of the total Queensland Aboriginal and Torres Strait Islander population, and 0.25 per cent of the total Queensland population. It is estimated that 83 per cent of District residents are of Aboriginal and/or Torres Strait Islander origin (Table 3). Table 3: Estimated Aboriginal and Torres Strait Islander resident population, as at 30 June 2007 Aboriginal and Non-Aboriginal % Aboriginal Torres Strait and Torres and Torres Residence Islander Strait Islander Total Strait Islander Torres Strait and Northern Peninsula Area Health 8803 1746 10,549 83 Service District Total Queensland 150,529 4,030,902 4,181,431 4 % District v. Queensland 6 0.04 0.25

Source: 2007 Experimental Indigenous Estimated Resident Populations by Age groups, Sex and Health Service Districts (2008) - Queensland as at 30 June. Prepared by Statistical Output, Health Statistics Centre Ph: 3234 0911 (20 January 2009)

“PRINTED COPIES ARE UNCONTROLLED” Endorsed by IPPEC—does not represent Queensland Health policy at this time. 7

Infrastructure Renewal Planning Project for Rural and Remote Areas Service Profile for Thursday Island Hospital Paper 2, July 2010

2.3 Thursday Island Hospital The Thursday Island Hospital is the main referral hospital for District residents, providing health services to approximately 10,849 people (2008 Estimated Resident Population) and is the base for the District’s administration positions and support functions. The existing Hospital opened in December 1997, is a 36 bed facility and has a 28 bed general ward which contains two high dependency, one isolation and four paediatric beds. There is an eight bed Maternity Unit and an Emergency Department service. The basis for identifying gaps in service capability against the core service profile is to secure and consolidate services provided at Thursday Island Hospital, identified as a primary hub service. This may involve the enhancement of existing service roles and staffing levels to support its role as the primary hub service in the District. The current service capability at Thursday Island Hospital is outlined below. The minimum suite of core services aims to ensure surgical and procedural services, maternity services, emergency services and general medical services are able to be provided. Table 4: Draft CSCF v3.0 service gap analysis Draft CSCF v3.0 Current Core services Level Current services CSCF Level Gaps Emergency services 3 Emergency services 3 Medical services 3 Medical services 3

Surgical services 3 Surgical services 3

Peri-operative services 3 Peri-operative 3 Services Anaesthetics services 3 Anaesthetics 3 services Maternity services 3 Maternity services 3

Neonatal services 3 Neonatal services 3

Mental health services 2 Mental health 2 services Rehabilitation services 3 Rehabilitation 3 services Palliative care services 2 Palliative care 2 services Pathology services 3 Pathology services 3

Medical imaging 3 Medical imaging 3 services services Pharmacy services 3 Pharmacy services 3

Source: Queensland Health, February 2010

“PRINTED COPIES ARE UNCONTROLLED” Endorsed by IPPEC—does not represent Queensland Health policy at this time. 8

Infrastructure Renewal Planning Project for Rural and Remote Areas Service Profile for Thursday Island Hospital Paper 2, July 2010

2.3.1 Hospital inpatient activity The Hospital has an average annual occupancy rate of 62.6 per cent for all age services. In 2008/09, 44 per cent of all adult separations for District residents were provided at District facilities. Between 2004/05 and 2008/09, the number of separations of resident adults at District facilities decreased by 16 per cent (Table 5). Table 5: Adult separations for District residents, Torres Strait and Northern Peninsula Area Health Service District, 2004/05–2008/09 % Growth HSD of treatment 2004/05 2005/06 2006/07 2007/08 2008/09 Over 5 Years Cairns and 933 1423 907 925 1650 77 Hinterland Other HSD 84 183 97 98 29 -65 Torres Strait– 1562 1572 1443 1272 1311 -16 Northern Peninsula Total 2579 3178 2447 2295 2990 16

Source: Queensland Health Admitted Patient Data Collection 2010 Table 6 summarises all inpatient activity and average occupancy for Thursday Island Hospital for the five years from 2004/05 to 2008/09. During this period, separations decreased by 19 per cent, while beddays declined by six per cent. Table 6: Summary of overnight inpatient activity at Thursday Island Hospital 2004/05–2008/09 % Average Years Separations Beddays ALOS^ Bed Numbers Occupancy 2004/05 1750 8651 4.9 36 66 2005/06 1798 8510 4.7 36 65 2006/07 1601 7277 4.5 36 55 2007/08 1473 8476 5.8 36 65 2008/09 1440 8099 5.6 36 62

Source: Queensland Hospital Admitted Patient Data Collection, Queensland Health Extracted 1 Oct 2009) ^ Average length of stay In 2008/09, the top three reasons for adult overnight separations at Thursday Island Hospital were , non-subspecialty surgery and cardiology. For the same period, the top two reasons for adult same day separations were and (Table 7). Table 7: Top 10 adult Service Related Groups at Thursday Island Hospital 2008/09 Same day Separations Overnight Separations Beddays Ophthalmology 52 Obstetrics 214 944 Gynaecology 32 Non-subspecialty surgery 88 381 Orthopaedics 15 Cardiology 82 601 Immunology and Obstetrics 14 infections 62 560 Non-subspecialty Diagnostic GI endoscopy 14 medicine 60 737 Plastic and reconstructive surgery 12 58 421 Non-subspecialty medicine 6 Orthopaedics 52 325 6 Respiratory medicine 48 390

“PRINTED COPIES ARE UNCONTROLLED” Endorsed by IPPEC—does not represent Queensland Health policy at this time. 9

Infrastructure Renewal Planning Project for Rural and Remote Areas Service Profile for Thursday Island Hospital Paper 2, July 2010

Same day Separations Overnight Separations Beddays Cardiology 5 Vascular surgery 29 490 Non-subspecialty surgery 4 Non-acute 32 354

Source: Queensland Health Admitted Patient Data Collection 2010 Over the past five years, all of the top 10 adult same-day Service Related Groups (SRGs) have decreased in activity (Table 8), except for non-subspecialty medicine (increased by 100%) and ophthalmology (increased by 30%). The largest decreases have been in non-subspecialty surgery (-76%) and endoscopies (-52%). Table 8: Five year trend of adult same day activity at Thursday Island Hospital, 2004/05–2008/09, descending order by 2008/09 % Growth Over 5 Same day separations 2004/05 2005/06 2006/07 2007/08 2008/09 Years Ophthalmology 40 35 24 58 52 30 Gynaecology 44 37 24 21 32 -27 Orthopaedics 17 20 10 15 15 -12 Obstetrics 23 17 13 7 14 -39 Diagnostic GI endoscopy 29 43 37 22 14 -52 Plastic and reconstructive surgery 16 9 11 12 12 -25 Non-subspecialty medicine 3 4 6 3 6 100 Urology 8 11 4 2 6 -25 Cardiology 7 13 2 7 5 -29 Non-subspecialty surgery 17 15 16 5 4 -76 Source: Queensland Health Admitted Patient Data Collection, April 2010 Over the past five years, only four of the top 10 adult overnight SRGs have increased in activity (Table 9). The largest increase has been in non-subspecialty surgery (17%), while the largest decreases in activity have been in immunology and infections (22%), respiratory medicine (20%) and non-acute (20%). The major decreases in activity have been in immunology and infections (-22%), and non-acute and respiratory medicine (- 20%). Table 9: Five year trend of adult overnight activity at Thursday Island Hospital, 2004/05–2008/09, descending order by 2008/09 % Growth Overnight separations 2004/05 2005/06 2006/07 2007/08 2008/09 Over 5 Years Obstetrics 254 251 218 226 214 -16 Non-subspecialty surgery 75 65 91 63 88 17 Cardiology 77 92 74 81 82 7 Immunology and infections 80 91 74 85 62 -22 Non-subspecialty medicine 71 62 48 49 60 -15 Endocrinology 55 51 42 32 58 6 Orthopaedics 56 72 63 54 52 -7 Respiratory medicine 60 87 75 81 48 -20 Vascular surgery 27 43 15 28 29 7 Non-acute 40 36 52 33 32 -20

Source: Queensland Health Admitted Patient Data Collection, April 2010

“PRINTED COPIES ARE UNCONTROLLED” Endorsed by IPPEC—does not represent Queensland Health policy at this time. 10

Infrastructure Renewal Planning Project for Rural and Remote Areas Service Profile for Thursday Island Hospital Paper 2, July 2010

2.3.2 Projected activity In rural hospitals beds are classified as multipurpose as they are not designated into specific bed type categories, because in Level 3 services (draft CSCF v3.0) there are no specialist clinical units. When projecting overnight beds, bed type categories have been limited to multipurpose beds only. The profile of projected activity in rural hospitals is not expected to change, however, with improved infrastructure, including modernised layouts or refurbished buildings, service provision could be enhanced. Maternity, emergency services, surgical and outpatient services could continue to grow and provide more efficient services. The bed types and treatment spaces set out in Table 22 and Table 23 reflect the categories from the Draft Review of the More Beds for Hospitals Strategy. 2 It should be noted that many of the categories outlined in the Draft Review of the More Beds for Hospitals Strategy 2 are not applicable for rural hospitals. The projections have been calculated using aIM data and data templates developed by the Planning and Coordination Branch Statewide (Data) Team. The benchmarks and methodology used for calculating the projected bed categories are described in the Statewide Implications for Service Provision Section 4. Thursday Island Hospital currently has 36 overnight beds, which are sufficient to meet activity requirements until 2021/22. Projections indicate that 25 overnight beds will be required, applying an 85 per cent occupancy rate, and 29 overnight beds at a 70 per cent occupancy rate. There are no Stage 2 recovery chairs and no further recovery chairs will be required to meet scheduled day surgery activity to 2021/22 unless the model of service delivery is changed. The number of Emergency Department treatment spaces will need to increase from two to seven by 2021/22. These treatment spaces will need to include a mix of acute treatment trolley spaces (including a resuscitation cubicle), consultation rooms and specific treatment rooms (e.g. plaster, procedure and isolation rooms). In addition, seven consultation rooms will be required for acute-related outpatient activity. The projected outpatient activity identified in this profile is additional to the primary health outpatient activity which will take place at the planned Chronic Disease Centre. Future treatment space projections have also attempted to account for the under-reporting of acute-related outpatient activity to date. Thursday Island Hospital currently has one Operating Theatre. The number of Stage 1 recovery bays needs to increase from one to two to meet benchmark requirements. There is currently one delivery suite. An additional consultation room, multipurpose/staff/education room and a child-friendly waiting area are also required. Table 10 indicates that the projected births for the District will increase by four per cent for the period to 2021/22. However, the District Service Plan indicates that it is likely for the current trend of residents birthing at Cairns Base Hospital to continue. As such, admissions for obstetrics at the Thursday Island Hospital are projected to decline by 22 per cent between 2004/05 and 2021/22. 3 Table 10: Projected births for Torres Strait and Northern Peninsula Area Health Service District, 20011/12–2021/22 2011/12 2016/17 2021/22 Total births for TSNPA HSD as a district of residence 261 281 279

Source: Projections developed by Office of Economic and Statistical Research using Perinatal Data Collection.

“PRINTED COPIES ARE UNCONTROLLED” Endorsed by IPPEC—does not represent Queensland Health policy at this time. 11

Infrastructure Renewal Planning Project for Rural and Remote Areas Service Profile for Thursday Island Hospital Paper 2, July 2010

2.4 Core services Outlined below is a description of the four core services provided at Thursday Island Hospital: surgical and procedural, maternity, Emergency Department and general medical.

2.4.1 Surgical and procedural Thursday Island Hospital provides routine services for elective and emergency caesarean sections, closed orthopaedic, dilation and curettes and minor gynaecological procedures for low to medium risk patients. The Hospital currently has one Operating Theatre, with one recovery bay. An additional recovery bay is required for the provision of surgical services at draft CSCF v3.0 Level 3. The visiting surgeon visits approximately every three months to perform a variety of elective procedures. Allowance must be made for adequate bed numbers to accommodate scheduling and case numbers on theatre lists on these days. From 2004/05 to 2008/09, adult surgical separations decreased for both same day (-12%) and overnight (-19%) separations (Table 11). Table 11: Adult surgical separations at Thursday Island Hospital 2004/05–2008/09 % Change Stay Type 2004/05 2005/06 2006/07 2007/08 2008/09 Over 5 Years Same day 149 133 100 122 131 -12 Overnight 334 338 291 260 269 -19 Total 483 471 391 382 400 -17

Source: Queensland Health Admitted Patient Data Collection 2010 During 2008/09, the highest number of surgical separations (Table 12) was related to ophthalmology (same day activity), and vascular surgery and obstetrics (overnight activity). Table 12: Current top 10 adult surgical/procedural Service Related Groups at Thursday Island Hospital for 2008/09 Same Day Separations Overnight Separations Beddays Ophthalmology 50 Vascular Surgery 26 438 Gynaecology 24 Obstetrics 24 166 Diagnostic GI Endoscopy 14 Non-subspecialty Surgery 23 100 Orthopaedics 14 Gynaecology 18 50 Plastic & Reconstructive Surgery 12 Orthopaedics 14 211 Non-subspecialty Surgery 3 Diagnostic GI Endoscopy 9 50 Plastic & Reconstructive Ear, Nose & Throat 2 Surgery 7 67 Urology 1 Ophthalmology 4 5 Extensive Burns 1 Ear, Nose & Throat 3 3 Colorectal Surgery 1 Unallocated 3 78

Source: Queensland Health Admitted Patient Data Collection, April 2010

“PRINTED COPIES ARE UNCONTROLLED” Endorsed by IPPEC—does not represent Queensland Health policy at this time. 12

Infrastructure Renewal Planning Project for Rural and Remote Areas Service Profile for Thursday Island Hospital Paper 2, July 2010

2.4.2 Maternity Maternity services are provided at Thursday Island Hospital, with support from four- monthly visits from the specialist Obstetrics and Gynaecological Service from the Cairns Base Hospital. Antenatal care is provided throughout the District by medical staff, an outreach midwife for the Outer Islands and a part time Sexual Health position in the Northern Peninsula Area. Ultrasounds are performed at Thursday Island Hospital. Women identified as high risk are transferred to Cairns Base Hospital for birthing. There is an eight bed maternity ward at Thursday Island Hospital and one delivery suite. Low-risk and medium-risk birthing is carried out at the Thursday Island Hospital, with the Northern Peninsula Area (Bamaga) Hospital and the District Primary Health Care Centres providing a service for emergency births. Maternity beds/rooms In 2008, there were 301 births for women who stated residence in the District. Of these births, 38 per cent occurred in the Cairns and Hinterland Health Service District and 60 per cent within the District. At Thursday Island Hospital, the average length of stay after a vaginal delivery was 4.3 days, after a caesarean section was 6.5 days, for a postnatal stay was 1.8 days and for an antenatal admission was 2.7 days. From 2004/05 to 2008/09, maternity separations decreased by six per cent (Table 13). Table 13: Maternity separations at Thursday Island Hospital 2004/05–2008/09 % Change Type 2004/05 2005/06 2006/07 2007/08 2008/09 Over 5 Years Vaginal 161 166 140 159 152 -6 Caesarean 27 18 18 15 25 -7 Total 188 184 158 174 177 -6

Source: Queensland Health Admitted Patient Data Collection 2010 Accommodation for families Women are brought to Thursday Island prior to delivery (36 weeks) from the various islands in the Torres Strait and accommodated by the District at the Mothers in Waiting accommodation. Paediatrics Paediatric inpatient services at Thursday Island Hospital consist of low risk non- specialty paediatrics. The District is currently meeting 84 per cent of demand for same day paediatric services and 64 per cent of demand for overnight paediatric services. Table 14 lists the top five paediatric SRGs at Thursday Island Hospital in 2008/09 for both same day and overnight stays. The highest number of separations was for dentistry for same day admissions and respiratory medicine for overnight activity.

“PRINTED COPIES ARE UNCONTROLLED” Endorsed by IPPEC—does not represent Queensland Health policy at this time. 13

Infrastructure Renewal Planning Project for Rural and Remote Areas Service Profile for Thursday Island Hospital Paper 2, July 2010

Table 14: Top five paediatric Service Related Groups at Thursday Island Hospital 2008/09 Same Day Separations Overnight Separations Beddays Dentistry 47 Respiratory Medicine 30 339 Ear, Nose and Throat 17 Orthopaedics 28 138 Orthopaedics 6 Renal Medicine 14 76 Urology 5 Non-Subspecialty Surgery 13 73 Qualified Neonate 3 Qualified Neonate 12 73

Source: Queensland Health Admitted Patient Data Collection 2010 Note: Top 10 not included as low numbers may be identifiable Between 2004/05 and 2008/09, paediatric overnight separations decreased by 12 per cent for the District, with much of this activity transferred to Cairns and Hinterland Health Service District (Table 15). Table 15: Five year trend in paediatric overnight separations for Torres Strait and Northern Peninsula Area residents, 2004/05–2008/09 % Growth Stay Type 2004/05 2005/06 2006/07 2007/08 2008/09 Over 5 Years Cairns and 70 68 96 78 90 29 Hinterland Other HSD 16 36 21 31 29 81 Torres Strait– 241 221 274 212 211 -12 Northern Peninsula

Source: Queensland Health Admitted Patient Data Collection 2010

2.4.3 Emergency Department Thursday Island Hospital provides 24 hour emergency care. Between 2004/05 and 2008/09, there was a 13 per cent decrease in emergency presentations. Much of the decrease can be attributed to a 45 per cent decrease in discharged Category 5 presentations (from 4047 to 2219). Table 16: Percentage of Emergency Department presentations admitted/transferred at Thursday Island Hospital 2004/05–2008/09 % Growth 2006/07 2007/08 2008/09 Over 3 Years Number of Presentations 6860 5879 5943 -13 % of admitted transferred 19 26 35 16 % of triage 11 8 13 2 Category 1, 2 and 3 % of triage 89 92 87 -2 Category 4 and 5

Source: Queensland Hospital Admitted Patient Data Collection, April 2010

2.4.4 General medical From 2004/05 to 2008/09, medical separations for adults decreased for both same day and overnight activity (Table 17). Geriatric management consistently accounted for over 60 per cent of overnight non-acute beddays.

“PRINTED COPIES ARE UNCONTROLLED” Endorsed by IPPEC—does not represent Queensland Health policy at this time. 14

Infrastructure Renewal Planning Project for Rural and Remote Areas Service Profile for Thursday Island Hospital Paper 2, July 2010

Table 17: Five year trend for non-acute activity at Thursday Island Hospital 2004/05– 2008/09 Non-acute 2004/05 2005/06 2006/07 2007/08 2008/09 Separations Same day 3 3 4 3 1 Overnight 52 48 63 36 33 Beddays Overnight 642 340 728 483 358

Source: Queensland Health Admitted Patient Data Collection, April 2010 Non-admitted occasions of services Between 2004/05 and 2008/09, there was a 15 per cent decrease in non-admitted occasions of service at Thursday Island Hospital. During 2008/09, the largest numbers of occasions of service were for medical (7408) and allied health/nurse (1257) clinics. Table 18: Non-admitted occasions of service, Thursday Island Hospital, 2004/05– 2008/09 % Growth over 3 Outpatient Occasions of Service 2006/07 2007/08 2008/09 years Allied Health/Nurse 666 1193 1257 89 Dental Medical 9333 7787 7408 -21 Obstetrics/Gynaecology 1156 1915 1529 32 Paediatric/Medical 150 Paediatric/Surgical 73 131 184 152 74 Surgical 1350 202 404 -70 Total 12,728 11,302 10,782 -15

Source: Panorama Only limited hospital-based outpatient clinics are provided at Thursday Island Hospital. In conjunction with medical and specialist clinics held at the Thursday Island Primary Health Centre, ambulatory-based clinics tend to be around visiting specialists or the permanent medical officers. The medical officers provide a general practitioner type drop-in and appointment-based clinic at the Centre. There are no private general practitioner services within the District. Where there are gaps in the data in Table 18, the data was either not available or staff did not provide the service. Specialty services at the Hospital and Primary Health Centre include:

• diabetes management • obstetrics • paediatric medicine • adult mental health • general surgery.

Challenges for the Hospital’s outpatient’s clinics and the Thursday Island Primary Health Centre include a lack of space, particularly when visiting specialists are present, as well as limited clinic space for allied health at the Hospital.

“PRINTED COPIES ARE UNCONTROLLED” Endorsed by IPPEC—does not represent Queensland Health policy at this time. 15

Infrastructure Renewal Planning Project for Rural and Remote Areas Service Profile for Thursday Island Hospital Paper 2, July 2010

Visiting specialist services Visiting specialist services are generally provided from Cairns Base Hospital, largely funded through the Medical Specialist Outreach Assistance Program (Table 19) and through historical service arrangements. Visiting specialists include:

• general physician • ophthalmologist • chest physician • gynaecologist • general surgeon • vascular surgeon • psychiatrist • paediatrician.

Medical Specialist Outreach Assistance Program Table 19 shows specialist services provided through the Medical Specialist Outreach Assistance Program (MSOAP). Table 19: Medical Specialist Outreach Assistance Program, 2009/10 No of Clinical Provider Specialty Trips Sessions Cairns and Hinterland Paediatrics, general 8 24 Health Service District Physician, endocrinology (diabetes) 3 6 Physician, 4 16 Physician, general (cardiology, renal) 16 56 Physician, geriatric medicine 2 4 Physician, respiratory 6 6 Psychiatry, adult 12 48 Psychiatry, child and adolescent 2 8 Surgery, orthopaedic 7 40 Surgery, ear nose and throat 2 16 Surgery, general 4 22 Qld Children’s Health Service Physician, respiratory 3 24 Not recorded Obstetrics and gynaecology, general 4 24 Total 73 294

Source: MSOAP Project Manager, Brisbane

2.4.5 Current support services Pathology The pathology service at the Thursday Island Hospital is coordinated by the Cairns Base Hospital laboratory and employs four scientists and two support staff.

“PRINTED COPIES ARE UNCONTROLLED” Endorsed by IPPEC—does not represent Queensland Health policy at this time. 16

Infrastructure Renewal Planning Project for Rural and Remote Areas Service Profile for Thursday Island Hospital Paper 2, July 2010

Medical imaging Thursday Island Hospital radiology services include plain x-ray, mobile image intensifier, contrast media and a full ultrasound service. The service is staffed by one permanent full time radiographer and a sonographer. The Thursday Island Hospital service oversees the other District services at Bamaga, Saibai and Boigu Islands. Pharmacy The pharmacy at Thursday Island Hospital is staffed by one permanent full-time pharmacist, supported by a pharmacist assistant, and provides service to the two hospitals and Primary Health Centres in the District. The staff are also responsible for inventory systems and quality control reviews at all District sites. The Hospital pharmacy manages all high cost drugs across the District. A private pharmacy on Thursday Island is contracted to provide Webster Packs and S100 drugs. Dental/oral health services Dental/oral health services are provided at the Thursday Island Primary Health Centre, which has intra-oral x-ray facilities available. Oral surgery is performed at Thursday Island Hospital. Table 20: Medical imaging and pharmacy occasions of service Thursday Island Hospital, 2004/05–2008/09 % Growth Services 2004/05 2005/06 2006/07 2007/08 2008/09 Over 5 Years Medical imaging 3986 3532 1635 632 595 -85 Pharmacy 5769 1959 2277 2182 1990 -65

Source: Queensland Health Admitted Patient Data Collection, May 2010

2.5 Primary health care and community health services One of the major challenges for health services in the catchment is to effectively implement evidence-based interventions aimed at addressing preventable disease. The growth in the population, the travel required to access health services and the need to provide services to sparsely populated regions has created a need to reconsider current models of care and look for alternative service delivery models. Implementation of alternative models of care, such as Hospital in the Home, Hospital in the Nursing Home, integrated models of care across primary health care and acute services, and Nurse Practitioner led clinics, may achieve some efficiency in service delivery. A key strategy in achieving these efficiencies will be expanding community-based resources for targeting, identifying and managing key chronic diseases and common conditions of ageing, in collaboration with other local agencies. Future community-based service requirements have been broadly considered in the context of the catchment and opportunities for enhancing community-based services. Detailed consideration of future community health services and capacity requirements will occur if the preliminary evaluation progresses to a Business Case. Primary health care Primary health care programs based on Thursday Island provide outreach services to all District service sites. Traditional community based primary health care services are also located on Thursday Island, at the Thursday Island Primary Health Centre.

“PRINTED COPIES ARE UNCONTROLLED” Endorsed by IPPEC—does not represent Queensland Health policy at this time. 17

Infrastructure Renewal Planning Project for Rural and Remote Areas Service Profile for Thursday Island Hospital Paper 2, July 2010

Primary Health services are provided throughout the District through its Primary Health Centre services. The Improved Primary Health Care Initiative (IPHCI) is a Commonwealth funded program initiated to address the burden of chronic disease in the Aboriginal and Torres Strait Islander communities of Far North Queensland. The aim of the Initiative is to improve health outcomes for residents of Cape York through the provision of additional health services specifically targeted to address the prevention and treatment of chronic disease. The project utilises a primary health care approach, which aims to make services more accessible, appropriate and sustainable, and to facilitate community participation in health service planning and delivery. Each Primary Health Centre is managed by an Aboriginal and Torres Strait islander Health Centre Manager. Usual staffing includes a mix of registered nurses and health workers. Medical officer positions are located at Bamaga, Yorke and Thursday Island Primary Health Centres. The Thursday Island Primary Health Centre is located Thursday Island and provides the following services and programs:

• maternal and child health • men’s and women’s health • environmental health • public health nurse • Post Acute/Rehabilitation/and Aged Care (PARAC) • Alcohol Tobacco and Other Drugs • mental health - adult and child • family support team • primary medical care • oral health/dentist • hearing health • renal prevention.

The Thursday Island Primary Health Centre currently accommodates all program staff in the limited space available. It has good access and visibility for clients, but is limited due to overcrowding, limited clinical areas and program organisation. Allied health services Allied health services include occupational therapy, physiotherapy and cardiac rehabilitation. Speech therapy services are only available through an Education Queensland position. There is one small gym space at Thursday Island Hospital, with a new Chronic Disease Centre due to be operational in 2012.

“PRINTED COPIES ARE UNCONTROLLED” Endorsed by IPPEC—does not represent Queensland Health policy at this time. 18

Infrastructure Renewal Planning Project for Rural and Remote Areas Service Profile for Thursday Island Hospital Paper 2, July 2010

Table 21: Allied health occasions of service at Thursday Island Hospital 2004/05– 2008/09 % Growth Services 2004/05 2005/06 2006/07 2007/08 2008/09 Over 5 Years Nutrition 15 Occupational Therapy 163 118 27 7 23 -86 Physiotherapy 1356 1051 396 1106 1234 -9 Prosthetics 32 Psychology 5 80 Speech Pathology 235 Total 1551 1424 423 1193 1257 -19

Source: Queensland Health Admitted Patient Data Collection, May 2010 Where there are data gaps in Table 21 it is because either the data was not available or staff could not be recruited to provide the service.

“PRINTED COPIES ARE UNCONTROLLED” Endorsed by IPPEC—does not represent Queensland Health policy at this time. 19

Infrastructure Renewal Planning Project for Rural and Remote Areas Service Profile for Thursday Island Hospital Paper 2, July 2010

3 Current and future bed requirements

3.1.1 Summary of projected bed requirements Table 22 and Table 23 present a high-level summary of the projected bed and other treatment space requirements for the Thursday Island Hospital to 2021. Table 22: Current and projected bed requirements for Thursday Island Hospital Current Projections using Projections using numbers 85% occupancy rates 70% occupancy rates

Beds/Alternatives 2010 2011 2016 2021 2011 2016 2021 Overnight Beds Total multipurpose 36 22 23 25 26 27 29 overnight beds Same day beds/bed alternatives Same day beds 0 1 1 1 Stage 2 recovery chairs 0 0 0 0 Chemotherapy chairs 0 0 0 0 Renal dialysis chairs 0 0 9 12 (In centre) Other medical 0 0 0 0 (inc. Discharge Lounge) Total same day beds/ 0 1 1 1 bed alternatives

Other treatment spaces Projected requirements for recovery spaces, delivery suites, outpatient clinic rooms and Emergency Department spaces currently exceed the current built capacity at Thursday Island Hospital. Table 23: Current and projected other treatment space requirements for Thursday Island Hospital 2010 2011 2016 2021

Operating Theatres 1 1 1 1

Procedure rooms 0 0 0 0

Stage 1 recovery spaces 2 2 2 2

Delivery Suites 2 2 2 2

Outpatient clinic rooms 0 7 7 7

ED treatment spaces 2 6 6 7

X-ray rooms 2 2 2 2 Ultrasound, plain film x-ray

CT scanner 0 0 0 0

“PRINTED COPIES ARE UNCONTROLLED” Endorsed by IPPEC—does not represent Queensland Health policy at this time. 20

Infrastructure Renewal Planning Project for Rural and Remote Areas Service Profile for Thursday Island Hospital Paper 2, July 2010

4 List of figures and tables

Table 1: Summary of current and future bed requirements for Thursday Island Hospital ...... 4 Figure 1: Map of Torres Strait and Northern Peninsula Area Health Service District...... 5 Table 2: Torres Strait and Northern Peninsula Area Health Service District associated population ...... 6 Figure 2: Population projections for Torres Strait and Northern Peninsula Area Health Service District 2011–2021 ...... 7 Table 3: Estimated Aboriginal and Torres Strait Islander resident population, as at 30 June 2007 ...... 7 Table 4: Draft CSCF v3.0 service gap analysis ...... 8 Table 5: Adult separations for District residents, Torres Strait and Northern Peninsula Area Health Service District, 2004/05–2008/09...... 9 Table 6: Summary of overnight inpatient activity at Thursday Island Hospital 2004/05–2008/09 ...... 9 Table 7: Top 10 adult Service Related Groups at Thursday Island Hospital 2008/09 ...... 9 Table 8: Five year trend of adult same day activity at Thursday Island Hospital, 2004/05–2008/09, descending order by 2008/09 ...... 10 Table 9: Five year trend of adult overnight activity at Thursday Island Hospital, 2004/05–2008/09, descending order by 2008/09 ...... 10 Table 10: Projected births for Torres Strait and Northern Peninsula Area Health Service District, 20011/12–2021/22...... 11 Table 11: Adult surgical separations at Thursday Island Hospital 2004/05–2008/09...... 12 Table 12: Current top 10 adult surgical/procedural Service Related Groups at Thursday Island Hospital for 2008/09 ...... 12 Table 13: Maternity separations at Thursday Island Hospital 2004/05–2008/09 ...... 13 Table 14: Top five paediatric Service Related Groups at Thursday Island Hospital 2008/09 ...... 14 Table 15: Five year trend in paediatric overnight separations for Torres Strait and Northern Peninsula Area residents, 2004/05–2008/09...... 14 Table 16: Percentage of Emergency Department presentations admitted/transferred at Thursday Island Hospital 2004/05–2008/09 ...... 14 Table 17: Five year trend for non-acute activity at Thursday Island Hospital 2004/05–2008/09 ...... 15 Table 18: Non-admitted occasions of service, Thursday Island Hospital, 2004/05– 2008/09 ...... 15 Table 19: Medical Specialist Outreach Assistance Program, 2009/10...... 16 Table 20: Medical imaging and pharmacy occasions of service Thursday Island Hospital, 2004/05–2008/09...... 17 Table 21: Allied health occasions of service at Thursday Island Hospital 2004/05– 2008/09 ...... 19 Table 22: Current and projected bed requirements for Thursday Island Hospital...... 20 Table 23: Current and projected other treatment space requirements for Thursday Island Hospital ...... 20

“PRINTED COPIES ARE UNCONTROLLED” Endorsed by IPPEC—does not represent Queensland Health policy at this time. 21

Infrastructure Renewal Planning Project for Rural and Remote Areas Service Profile for Thursday Island Hospital Paper 2, July 2010

5 References

1. Australian Bureau of Statistics. Australian Statistical and Geographical Categories. Australian Standard Geographical Classification (ASGC) 2009 (cat. no. 1216.0); Australian Standard Geographical Classification (ASGC) - Electronic Structures 2009 (cat. no. 1216.0.15.001) and Australian Standard Geographical Classification (ASGC) Correspondences 2009 (cat. no. 1216.0.15.002); 2009. 2. Queensland Government. Draft Review of the More Beds for Hospitals Strategy. Queensland Health; 2009. 3 Queensland Government. Draft Torres Strait and Northern Peninsula Area Health Service District Clinical Service Plan. Queensland Health; 2007.

“PRINTED COPIES ARE UNCONTROLLED” Endorsed by IPPEC—does not represent Queensland Health policy at this time. 22