THE PROJECTS ...... 8 PRIMARY HEALTH CARE CENTRES - ABORIGINAL COMMUNITIES ...... 8 Definition of the Facilities...... 8 Present Facilities...... 9 Site Selection...... 11 The Design...... 11 Procurement...... 12 Co-ordination Between Departments and the Planning Process ...... 13 Consultation...... 14 Cultural Education of Department Staff ...... 15 Staff Accommodation...... 16 COMMUNITY HEALTH CENTRE - COOKTOWN ...... 16 Introduction ...... 16 History of Existing Facilities, Including Hospital Design...... 18 Lack of Local Control...... 18 Consultation...... 20 REDEVELOPMENT OF THURSDAY ISLAND HOSPITAL ...... 20 Introduction ...... 20 The Community Role...... 21 Existing Facilities ...... 21 Need ...... 21 Land Availability and Suitability...... 22 Consultation...... 22 Design Parameters ...... 22 Community Facilities in CBD ...... 23 Proposed Life of Redevelopment...... 23 Sewerage...... 23 PRINCIPAL ELEMENTS ...... 24 CAPITAL EXPENDITURE ...... 24 Budget ...... 24 PLANNING AND CO-ORDINATION...... 25 Effectiveness of Capital Works Planning ...... 25 Department's Assessment Evaluation/Criteria ...... 26 Consultation Procedures, Use of Consultants ...... 27 Timetabling of Consultation and Ramification on Quality of Response ...... 27 Interdepartmental Co-ordination...... 28 Intradepartmental Co-ordination...... 28 MAINTENANCE AND LIFESPANS ...... 28 Existing Facilities ...... 28 LOCAL EMPLOYMENT AND TRAINING ...... 29 LAND TENURE ...... 29 Need for Guaranteed Tenure...... 29 CONTRACT PROVISIONS ...... 30

CONCLUSION ...... 31

RECOMMENDATIONS...... 32

APPENDIX A - Call for Submissions...... 34

APPENDIX B - List of Submissions Received ...... 35

APPENDIX C - List of Witnesses ...... 36

APPENDIX D - Health Flow Chart...... 38

APPENDIX E - Health Timeline...... 39 Chairman's Summary Health Facilities in Far North Queensland

CHAIRMAN'S SUMMARY

The issue of Aboriginal and Torres Strait Islander health has been a priority of Governments throughout Australia and the poor health status of these people has been the subject of extensive research and Government attention over the last two decades. Despite this attention the standard of health of Aboriginal and Torres Strait Islander communities is far lower than for the majority of Australians and would not be tolerated in the community at large.

The Committee is pleased that the level and standard of health facilities previously provided on Aboriginal and Torres Strait Islander communities is now being improved and widened and the Government's allocation of some $34 million is welcomed by these communities.

The construction of the new Health Centres and new Hospital facilities will not on its own affect the health status of residents in Aboriginal and Torres Strait Islander communities but it is an important first step in a process of improving the level of health status for the communities involved.

The Committee undertook this inquiry to determine whether the construction of these facilities would provide maximum returns on the funds appropriated by the Parliament. In particular, the Committee sought to review the process of capital works procurement used by Queensland Health to assess its effectiveness. As outlined in the Committee's Preliminary Report into Health Facilities in Far North Queensland, tabled in Parliament on 3 December 1993, the Committee believes that the on-going development of appropriate public works within Aboriginal and Torres Strait Islander communities should be a matter of highest priority for the Government.

The Committee has raised a number of concerns which are examined throughout this Report and issues such as the provision of local employment and training associated with new works are examined. The Committee has recommended that the generation of local employment be included as a mandatory element of tender evaluations for work done in Aboriginal and Torres Strait Islander communities.

In the course of its inquiry the Committee also considered the extent of co-ordination and co-operation between the different Departments and the relationships between central and regional offices. The Committee was concerned that there had been minimal consultation between Queensland Health and the Department of Family Services and Aboriginal and Islander Affairs in relation to the construction of these facilities. The Committee believes that it is essential that the greatest range of expertise possible is employed in ensuring that appropriate facilities are provided in response to community needs and take into account community views. Such an outcome is jeopardised when Departments adopt an insular approach to the problem.

1 Chairman's Summary Health Facilities in Far North Queensland

The Committee believes that these new facilities will make a significant contribution to the communities involved. However, to effect further meaningful changes to the underlying issues of disadvantage in these communities a considerable amount of on-going effort is required by each of the Departments involved.

Ms Judy Spence MLA Chairman

2 Introduction Health Facilities in Far North Queensland

INTRODUCTION

THE COMMITTEE

1 The Committee was established by the Public Works Committee Act 1989, and consists of seven Members of the Legislative Assembly. Four Members are nominated by the Leader of the House and three by the Leader of the Opposition. The resultant all-party Committee adopts a non-partisan approach in the conduct of its inquiries.

2 In its inquiries, the Committee may have regard to such issues as the suitability and necessity of works, the value for money achieved, the impact on the economy, community and environment and the general performance of the constructing authority. While the Committee does not inquire into all works, it aims to ensure a level of scrutiny across all Departments involved in the Capital Works Program.

TERMS OF REFERENCE

3 Pursuant to Section 18 of the Public Works Committee Act 1989, the Committee resolved to inquire into and report on the provision of Health Facilities in Far North Queensland. The facilities reviewed include the redevelopment of Thursday Island Hospital and the provision of Primary Health Care Centres at Aurukun, Kowanyama and Lockhart River. The program also includes the construction of Centres at Wujal Wujal, Pormpuraaw, Napranum, Mapoon and Horn Island. In addition to these the Community Health Centre proposed for Cooktown has been reviewed.

4 These projects are the first element of the Government's Health Capital Works Program which is aimed at improving the level of health care facilities to all residents of Queensland. Ultimately, some $1.5 billion will be expended by the Government on Queensland Health projects over a ten year period.

5 The Committee has undertaken reviews of these projects for two major reasons. First, to ensure the suitability of these particular projects to the needs of the communities in which they are to be located and, second, to ensure that the planning, co-ordination and implementation procedures which are utilised by the Health Capital Works Program and the Administrative Services Department are effective and provide a suitable process for future capital works within Queensland Health.

3 Introduction Health Facilities in Far North Queensland

APPROACH TO THE INQUIRY

6 As outlined in the Committee's Preliminary Report into Health Facilities in Far North Queensland, tabled in Parliament on 3 December 1993, the Committee believes that the on-going development of appropriate public works within Aboriginal and Torres Strait Islander communities should be a matter of highest priority for the Government.

7 The Committee recognises that such developments impose a range of requirements and considerations which are unique to these communities and which may not necessarily be applicable to other areas of capital works throughout the State. Most notably, these requirements demand a continued commitment to an on-going high-level consultation process to ensure that facilities are appropriate to the communities' needs. Further, that in providing basic infrastructure in these communities, a maximum number of subsidiary benefits should be extracted from any Government capital works expenditure involved. These benefits should include, but not be limited to, the development of local ownership of the process, the development of community pride in the new facilities, the development of new skills, the inclusion of local labour and the stimulus of the local economy.

8 The inquiry has been undertaken in parallel with the development by the Departments involved of the planning and tendering arrangements associated with the construction of the new facilities. By undertaking its inquiry at this stage the Committee has been able to gather evidence as to the manner and appropriateness of the consultation that has occurred and while meaningful decisions affecting the final design and implementation of the facilities were still able to be made. To an extent the decision to tender the Primary Health Care Centres as a design and construct project also enables a further opportunity to allow for alterations to aspects of the design and for the suitability of prefabricated buildings to be assessed.

9 The Committee conducted inspections of the existing facilities in mid-October 1993. Subsequently, the Committee sought and received extensive documentation from Queensland Health and the Administrative Services Department, as well as information of a more specific nature from the Department of Lands and the Department of Family Services and Aboriginal and Islander Affairs. The Committee has also sought public response by placing advertisements calling for public submissions in relevant newspapers (see Appendix A). In addition, the Committee has written to numerous individuals and organisations requesting additional information and submissions.

10 A Public Hearing was held on 9 February 1994 at Parliament House, Brisbane, when a number of witnesses, including the Directors-General of the Administrative Services Department and Family Services and Aboriginal and Islander Affairs, and the Acting Director-General of Queensland Health, as well as other senior officers from these and other Departments were examined.

4 Background Health Facilities in Far North Queensland

BACKGROUND

11 The issue of Aboriginal and Torres Strait Islander health has been a priority of Governments throughout Australia over the past two decades and the subject of a multitude of Reports. A host of Government and non-government organisations now deal with issues involving Aboriginal health. As the House of Representatives Standing Committee on Aboriginal Affairs noted in its 1988 Interim Report on The Effectiveness of Support Services for Aboriginal and Torres Strait Islander Communities, the "service delivery to Aboriginal communities, characterised as it is by a plethora of government and non-government funding and delivery agencies, marked cultural differences between deliverers of services and the recipients, and the structures which exist in Aboriginal communities to interact with service agencies, is anything but uncomplicated".

12 In more general terms, the complexity of dealings between Aboriginal Councils and external agencies is demonstrated by Kowanyama which has relationships with at least 18 State authorities, 13 Commonwealth and 13 other service organisations.

13 In the provision of health services, some of the organisations involved include ATSIC, Commonwealth Department of Health, Commonwealth Department of Employment, Education and Training and the Health Rights Commission. At the State level, Departments and agencies involved include Family Services and Aboriginal and Islander Affairs, Lands, Administrative Services Department, various Regional Health Authorities, the Queensland Tripartite Health Forum, various formal Health Advisory Groups and a wide range of interdepartmental committees. At the local level, various Shire Councils, Community Councils, Co-ordinating Councils and Community-based Groups are involved.

14 In short, Aboriginal and Torres Strait Islander health is an area which is presided over and complicated by the wide range of agencies which act on behalf of Aboriginal and Torres Strait Islanders. To this extent, the development of a whole of Government approach to the issues involving Aboriginal and Torres Strait Islanders is problematic. Final responsibility effectively rests with no-one: sadly, perhaps least of all with the communities involved.

15 The poor health status of Aboriginal and Torres Strait Islanders has been the subject of extensive research and Government attention over the past two decades. However, improvements in health status for these communities have not yet reached that of the general Australian community. Indeed, as the House of Representatives Standing Committee on Aboriginal Affairs 1979 "Aboriginal Health Report" states: "The standard of health of Aboriginals is far lower than that of the majority of Australians and would not be tolerated if it existed in the Australian community as a whole." While significant improvements have been made to improve health status, the basic conclusions of that 1979 Report are still valid some 15 years later. The Committee

5 Background Health Facilities in Far North Queensland

was also surprised to learn that, despite the best intentions of numerous organisations, the life expectancy of Torres Strait Islanders has actually fallen over recent years. In the period 1970-79 the average age at death of females was 53.6 years and of males was 57.7 years. In the period 1980-89 these had fallen to 48.8 for females and 55.7 for males. In addition, Aboriginal and Torres Strait Islander communities in remote Queensland have death rates three times higher than for the total population, hospital admission rates that are twice as high, use of out-patient services at almost five times the rates for non-indigenous populations, and yet have fewer doctors and only two- thirds of the nurses on a per capita basis. These figures indicate the enormity of the challenge facing these communities.

16 Some of the health problems evident in Aboriginal and Torres Strait Islander communities include high mortality and morbidity rates, chronic diseases which relate to alcohol abuse, increased incidence of domestic violence, sexually transmitted diseases, and diseases attributable to poor diet. The poor health conditions of Aboriginals in the Cape Sector and of Torres Strait Islanders in the Torres Sector of the Peninsula and Torres Strait Regional Health Authority have previously been extensively documented.

17 The Committee is aware that the Project Definition Plan for Primary Health Centres for Cape York Peninsula and Torres Strait states that the causes of high mortality and morbidity in these communities is multi-factored and that the capital works being undertaken will address some of these essential factors. However, other causes also need to be addressed to help move towards the ultimate goal of bringing Aboriginal and Torres Strait Islander health status at least to that of the general Australian population.

18 In 1991, priority within Queensland Health was given to improvement of health facilities in Aboriginal and Islander communities throughout Queensland. As part of this, the decision was taken to construct a number of Primary Health Care Centres in communities in Far North Queensland. The Committee notes that expenditure on hospital services has been 30% lower for Aboriginal and Torres Strait Islander populations than for remote non-indigenous populations.

19 The Committee is pleased that the level and standard of health facilities previously provided in Aboriginal communities is now being improved and widened. It should be noted, however, that these new facilities are only the first step in a process of improving the level of health status for the communities involved. In evidence, the Committee was told that these new facilities, on their own, will not improve health status within these communities. A fully integrated health program involving community education programs, the development of a system of community health workers and increased levels of medical services (including resident medical officers and improved visiting consultant services) will need to be implemented in order to achieve significant improvements in health status in these communities. The Committee also notes that a range of other considerations which fall outside the scope of "Health Department" functions must also be considered if substantial improvements

6 Background Health Facilities in Far North Queensland

are to be made other than of a band-aid nature. Included in these "other considerations" are the structural difficulties faced by people in these communities, including the existing cycle of poverty and the interface between their own and European cultures.

20 The Committee believes that an appropriate level of resourcing priorities is now being given to meet these needs. It also notes the significant positive shifts in the attitudes held by Departments in regard to Aboriginal and Torres Strait Islander issues over recent years. However, the Committee is aware that substantial further changes are required in order to effect the most appropriate solutions. In particular, the Committee has seen a number of difficulties in regard to the process of establishing new programs to facilitate the improvement of existing conditions. These will be addressed throughout this Report.

21 As already mentioned, the construction of new Health Care Centres and new hospital facilities will not, on its own, affect the health status of residents in Aboriginal and Torres Strait Islander communities. These new facilities will provide greater functionality in terms of service delivery from the health professionals' perspective. It will not, of itself, improve the health of members of these communities. In order to improve health status the overwhelming evidence of health research concludes that education and community development is the principal area through which gains in the health quality of communities can be attained. The Committee is pleased that the planning associated with these new facilities has been predicated upon assumptions of continued funding for new education programs and the use of community health workers. The Committee also believes that issues of a whole of Government nature must also be addressed before residents' health status will improve significantly.

7 The Projects Health Facilities in Far North Queensland

THE PROJECTS

PRIMARY HEALTH CARE CENTRES - ABORIGINAL COMMUNITIES

22 It would be remiss of the Committee if it did not note its appreciation for the input received from members of the communities which it visited and from those who work with the communities. The Committee also seeks to acknowledge the positive attitudes that members of these communities expressed. Similarly, the Committee itself gained by visiting these communities and experiencing the obvious community pride and hope which exists for on-going improvements in facilities and services. The Committee believes these communities have much to contribute to the cultural and economic development of the State.

23 However, the Committee does note that conditions in these communities are far below what would be expected in predominantly European towns and communities throughout the rest of Queensland. In this respect, evidence was received from the Acting Director-General of Health that as much as 30% less is spent on health per capita in Aboriginal communities than in remote non-indigenous communities. The causes and remedies of these problems have been the subject of intensive public debate throughout Australia's recent past. In Queensland, the matter is being addressed through the provision of infrastructure which is not only appropriate to the health needs of the communities but which will also act as a stimulus for further investment and which will help in attracting an additional range of services and providers to remote areas.

Definition of the Facilities

24 The Project Definition Plans for Primary Health Care Centres throughout the Cape York Peninsula and Torres Strait states that the objective is to construct:

"Modern well equipped and maintained Primary Health Care Centres providing expanded and more comprehensive community health services to selected remote communities in the Peninsula and Torres Strait region. This development will result in the following outcomes:

Culturally valid and appropriate services in community settings for Aboriginal people and Torres Strait Islanders.

Improved health status for clients.

Safer, improved working conditions benefitting staff recruitment and retention.

Longer-term operational and funding efficiencies."

8 The Projects Health Facilities in Far North Queensland

25 The cost of each of these facilities ranges from $1.0 million at the communities involved. These include:

Horn Island, Wujal Wujal, Lockhart River, Napranum, Kowanyama, Pormpuraaw, Aurukun and Mapoon

The estimated overall capital cost outlined in the Project Definition Plan of July 1993 was $13.6 million. The Committee notes the awarded tender price to Prentice Builders Limited was of the order of $16.25 million and that additional recurrent costs per annum are estimated to be of the order of $1 million.

26 The approximate area for each of these new Centres is over 400m2, and most contain provision for four two-bed wards, waiting area, reception, patient record room, treatment rooms, up to three consultation rooms, x-ray facilities, a dental clinic, pharmacy, toilets, meeting room, dialysis room, equipment room, quiet room, laundry, maternal and child health room, a general office and associated staff facilities. However, the facilities are designed to allow internal rearrangement, thus providing the flexibility to meet changing needs and priorities in the provision of health services.

27 The Committee understands that a number of communities are strongly in favour of appointing permanent medical officers where appropriate. The Committee has been informed that the new facilities and staff accommodation are such that they will enable the appointment of permanent officers and in evidence the Committee was told that Medical Officers would be appointed to the Kowanyama and Aurukun communities in the near future.

28 The Committee is aware that some of the treatment areas listed above may not be usefully employed unless or until medical officers are appointed. In the most likely case, severely injured patients will continue to be air lifted to the nearest suitable large hospital which in most cases would be the Cairns Base Hospital. Many of those with whom the Committee spoke could not stress too highly the need for treatment to be carried out locally for cultural reasons. This is both understandable and valid.

Present Facilities

29 In its Preliminary Report the Committee noted that the existing facilities at Aurukun, Kowanyama and Lockhart River show evidence of superficial rundown. They do, however, appear to be of a generally adequate standard for existing levels of service and are structurally sound. The Committee has also received evidence that the existing facilities in other communities which are to have new Centres constructed are in similar condition. Many of these facilities were constructed in the late 1970's or early 1980's and have a further economic life.

30 In spite of the foregoing, the existing facilities are dysfunctional in terms of configuration and some equipment use. There is insufficient floor space for proper

9 The Projects Health Facilities in Far North Queensland

service provision and maintenance is high. In short, implementation of the desired health care strategy would not be possible in the existing facilities. The Preliminary Report sought that, where possible, existing buildings not be demolished but rather be available to the communities for future alternative usages. Subsequent to that Preliminary Report the Director-General of the Administrative Services Department presented a Report to the Committee containing four recommendations. The second of these states:

"The Government should not, as a matter of principle, hand over to the local council buildings which contain asbestos-contaminated products or that require substantial up-grading or rectification costs so as to be a financial burden to the local council."

31 On 9 December 1993 the Committee resolved that no objection would be raised to tenders being let, having satisfied itself that the issues it raised in its Preliminary Report either had been or would continue to be addressed by the Departments involved.

32 A key element of the Director-General's Report was that of asbestos contamination of the existing facilities and that they were thus potentially unsafe for community use. The Committee accepts his opinion that it would be inappropriate to donate what is a possible hazard to the communities. However, it does not accept that other courses of action were not available to deal with such hazards. The fact remains that whether or not the buildings were passed to the communities, the asbestos would need to be disposed of.

33 The Committee also notes that the Functional Brief does not specifically mention the danger of asbestos cement sheeting in regard to the demolition of the existing structures. In fact, at page 15 of the Brief it appears to take the contrary approach when it states:

"All material from the demolition of existing structures is to be offered to the local community in the first instance."

The Committee is concerned that such a seemingly important issue was not addressed by Q-Build in this document, particularly as later in the process it became more significant. The Committee trusts that in future works involving demolition adequate care will be taken to identify such matters and the costs and risks associated with them.

34 In the consultants' reports for the Regional Health Authority, inadequate attention appeared to have been paid to undertaking condition assessments of the existing facilities. The Committee has been informed that Q-Build Cairns was unable to sufficiently resource the Department of Health's needs associated with the development of these projects and that consultants were therefore engaged to review the facilities. The Committee considers that greater attention should have been paid in these

10 The Projects Health Facilities in Far North Queensland

processes to assessment of the condition of the existing buildings. The widespread use of consultants is dealt with later in this Report.

35 The Committee believes that one cause of these difficulties was the process adopted by Health which placed officers and staff of the Regional Health Authority under extreme time pressures in the initial development of the projects. This aspect is also further considered later in this Report.

Site Selection

36 The Committee is concerned that many options and assessments were neither adequately considered nor considered at an early enough stage in these projects. This has resulted in it being feasible to construe that assessments and reviews were conducted even though it had already been decided that new facilities were to be constructed, no matter what the condition of existing buildings was found to be. The decision to demolish the existing facilities appears to be premature in the light of the urgent needs of communities for adequate infrastructure and the amount of information available at the time the decision was taken. In particular, the Committee is also concerned that alternative sites for the developments were not, as a matter of course, considered by Queensland Health. This is considered to be indicative of the lack of early consultation to properly determine the needs and wishes of the communities. This has also been exacerbated by advice received by Queensland Health that in the light of uncertainty created by the Mabo decision, secure tenure could only be guaranteed on reserves where native title had been extinguished. However, little investigation or awareness appears to be evident of the consequences of adopting an alternative approach as was done in the case of Wujal Wujal and Napranum.

The Design

37 The Committee was informed that the design of the facilities was a multistage process. As the Acting Director-General of Health informed the Committee in relation to the place of capital works in health service delivery, "For us, capital works is an end point of the planning process. It is about establishing a health need, considering all the options by which that need might be met, and one of those options... may be building a new building... Capital Works is of itself not of any intrinsic value to us: it is simply a mechanism by which we can deliver a positive health benefit".

38 The actual process involves such matters as determination of need, economic evaluations, functional plans, determination of sites, project definition plans, consultation and construction. These are all part of a detailed planning and implementation process, a copy of which is attached as Appendix D.

39 In relation to the design of these facilities, the Committee sought further clarification in regard to a number of issues. The first was that of the general appropriateness of the facilities to the cultural needs of the communities involved. For example, the use of

11 The Projects Health Facilities in Far North Queensland

air conditioning in these communities in preference to natural and mechanical ventilation can mean that, of necessity, buildings are closed and have relatively low ceilings. This is in marked contrast to using natural ventilation which carries with it a more open and inviting building which ensures accessibility to all residents. The Committee received evidence that air conditioning was to be limited to the critical areas such as drug stores and emergency areas. Where appropriate the designs are being made open and inviting to encourage use by the target population. Other matters such as placement of waiting areas and certain culturally important matters have also been the subject of comment and subsequent modification.

40 In conducting its inquiry the Committee examined the level and extent of consultation between the Department of Family Services and Aboriginal and Islander Affairs and Queensland Health in relation to design. It appears that consultation in regard to the appropriateness of the design of the facilities was minimal between these two Departments. The Committee considers that this is an example of an approach to Aboriginal health issues which is focused from a single Department's perspective as opposed to a broader perspective. To further demonstrate this, the Committee was advised that there was no need for the Department of Health to involve other agencies because it was only providing health-related facilities. The Committee was also advised that the Department of Family Services had declined to be involved for the very same reason. While such views reflect responsibility and ownership of functional areas, they can also hinder the provision of adequate and appropriate facilities in the communities.

Procurement

41 The Committee notes that Q-Build, as the Government's construction authority, acts as principal for all health construction contracts. Q-Build assumes the role of Risk Manager for construction, provides advice and normally recommends consultants, procurement methods, tendering processes, construction, commissioning and also post- occupancy evaluations. To manage the process a service agreement is being developed which expands on a 1993 decision of Cabinet which delineated the roles of the Administrative Services Department and Queensland Health respectively.

42 In terms of planning, consultation and the timetabling of consultation, the Committee is concerned that the planning processes adopted by the central Capital Works Branch of Queensland Health may have produced a number of unintended consequences. For example, the restrictive timeframe imposed required the Regional Health Authority to produce a capital works planning study (later referred to as the Functional Plan) at short notice and in great detail. A copy of the timetable followed in adopting that plan is attached as Appendix E. It would not be unreasonable to suggest that such pressures do little to improve the quality of the end product. Similar restraints were imposed on consultants and the overall timeframe resulted in an apparent lack of attention to detail in some areas, particularly the future use of existing buildings.

12 The Projects Health Facilities in Far North Queensland

43 The Committee considers that the level of ancillary benefits available from these projects have not been as great as perhaps they could have been had the planning process been more appropriate. Significantly, the Committee notes that the tender documents provide little encouragement for the employment of Aboriginal community labour. The only reference provided is: "Where possible, consideration shall be given to the use of local trades, materials and services". The Committee considers such a statement to be so vague as to be of little or no value. The Committee has received advice from the Director-General of Administrative Services that these types of contract are not the most effective device for the generation of local labour-type schemes. This is reflected by the low weighting given to this factor in the evaluation of tenders. In this respect, the Committee disagrees with the Director-General and notes that there is a high level of community expectation that major capital works projects will provide substantial subsidiary benefits to the communities in which they are to be constructed. This should be effected wherever possible so that the construction dollar produces flow-on benefits.

Co-ordination Between Departments and the Planning Process

44 This inquiry has revealed limited co-ordination between certain of the Departments involved. Principally, the Committee has noted a lack of communication between the Regional Health Authority and the Department of Family Services and Aboriginal and Islander Affairs. The Committee considers that such a lack of communication has resulted in a lack of co-ordination and the possible development of facilities which may not be as well suited to community needs as would be ideal. The Committee has received assurances from the Departments involved that in future better co-ordination processes will be implemented.

45 At a meeting with the Director-General of Administrative Services and the then Director-General of Health, the Committee was informed that the capital works process for Queensland Health had not yet reached its final level of development. The Director-General of Administrative Services Department also suggested that on-going negotiations between his Department and Queensland Health would be required to ensure that the facilities to be constructed are appropriate. The Committee was told that attention to the planning process would be enhanced in the future as a result of lessons learned from the present projects.

46 One issue raised with the Committee was the concern of the Regional Health Authority at its role, responsibilities and relationship with respect to Queensland Health's Central Capital Works Division. In particular, some dissatisfaction was expressed from the Regional Authority at the timetabling pressures which accompanied the introduction of the current capital works planning process. The Committee notes the difficulty in effectively implementing the required planning in such a tight timetable.

47 The Committee notes that a further difficulty has arisen in regard to the high expectations from central office of regional offices' abilities to provide necessary information on short notice to support the planning process. For example, Q-Build's

13 The Projects Health Facilities in Far North Queensland

office in Cairns may not have had sufficient staff to fulfil the expectations outlined in Cabinet's decision of May 1993 in regard to the planning processes and delineation of roles and responsibilities of Queensland Health and Administrative Services Department. This applies even though a great deal of planning for this project had begun prior to the decision by Cabinet to involve the Administrative Services Department as risk managers for the Health Capital Works Program.

48 The decision recently taken to relocate certain of the existing facilities has resulted in significant savings in demolition and removal costs for Prentice Builders Limited. The Committee questioned both the Director-General of Administrative Services and the Acting Director-General of Health to ascertain whether such savings would be passed on to the Government or allocated to the communities to assist in relocating the facilities. An undertaking was given to the Committee by Queensland Health that this matter would be negotiated with the Councils, where appropriate.

Consultation

49 The Committee draws attention to the Preliminary Report into Queensland Health Projects in Far North Queensland, presented to it by the Administrative Services Department, that "Accountability for the consultative process from initial identification of the clinical or service need... through to completion of the post-occupancy evaluation process... rests with the Regional Health Authority". The Committee agrees with other submissions received that consultation is a term which means different things to different people dependent upon the particular perspectives of those involved.

50 The submission further notes that "The Administrative Services Department's role is to ensure that 'whole of Government' interests are properly protected and that the client achieves value for money". The Committee accepts that the Administrative Services Department acknowledges its responsibility to protect whole of Government interests. It is significant that a whole of Government perspective is applied to the development of infrastructure, particularly so in these communities. The Committee is concerned, however, that economic issues are not weighted too highly in the assessment of whole of Government needs, especially when the social needs of these communities are so high.

51 The Committee accepts that considerable efforts have been made to ensure on-going consultation with the affected communities. The Committee notes the comments of Queensland Health's witnesses who have stated that consultation has been extensive and on-going over a period of a number of years. The Committee has also examined a schedule prepared by Queensland Health setting out the extensive nature of "consultation" which took place. Unfortunately that schedule treats visits as consultation, and does not identify either the number of people "consulted" or the time taken. It does, though, show that the great majority of meetings were with staff and councils as distinct from the community. It is also interesting to note that such matters as technical site visits have been included. Given the number of times the Committee was told of fleeting visits and lack of information it can only be assumed that the

14 The Projects Health Facilities in Far North Queensland

Department's view of consultation is somewhat different to that of those in the communities.

52 The Committee is concerned about two other matters. First, that despite Queensland Health's indications that sufficient consultation has occurred, that consultation has failed to address a number of issues. These included the utilisation of new sites and the failure to provide existing buildings to the communities. The Committee notes that the issue of asbestos contamination was only raised subsequent to the tabling of its Preliminary Report into Health Facilities in Far North Queensland in December 1993 and was not previously a cause of concern to the Departments involved. These issues have not been the subject of any significant community consultation.

53 The Committee also believes, in relation to consultation, that it is important that those being consulted are fully aware of the processes involved. For example, evidence was received of numerous trips made throughout the Cape area by consultants, Health Department staff and regional staff on a "fly-in-fly-out" basis. In one case, some six officers visited twelve locations throughout the Cape in a two day period. Instances such as this have created a local perception that the consultation process is rushed and has little regard for local input. The Committee was initially informed that many of these trips were not "consultation" as such, but rather were either familiarisation tours for consultants or an assessment of the adequacy of the consultation process. If this is the case, then the purpose of such visits must be made clear to those visited to ensure that incorrect perceptions do not arise.

Cultural Education of Department Staff

54 The Committee sought to inform itself as to the extent of training which officers of the various Departments involved in the procurement of these new facilities had received. The Committee received evidence from the Director-General of the Department of Family Services and Aboriginal and Islander Affairs that her Department does not have an on-going standard education program for departmental officers on the most appropriate methods of consultation with Aboriginal communities. However, the Committee does note that the Bureau of Ethnic Affairs has established a cross-cultural awareness training unit which is available to departmental staff. The Committee has also been informed that a "Protocol for Consultation with Aboriginal and Torres Strait Islander People and Communities in Queensland" is being developed by the Division of Aboriginal and Islander Affairs within the Department of Family Services and Aboriginal and Islander Affairs.

55 The Committee also sought details of the level of training currently available to officers of the Department of Health. The Acting Director-General of Health informed the Committee that his Department had established a cultural awareness program within the Aboriginal and Torres Strait Islander Health Policy Unit.

56 The Committee considers that it is vital that departmental officers are fully aware of the cultural requirements of dealing with Aboriginal communities to ensure that

15 The Projects Health Facilities in Far North Queensland

consultation is effective. Further, the Committee believes that Departments, as a matter of principle, should provide councils and communities with a high level of timely information so as to enable real and meaningful input into departmental plans. In this respect, consultation is not possible unless all parties have timely access and properly comprehend all the information available and the implications of decisions and opinions offered.

Staff Accommodation

57 These projects also encompass the construction of improved staff accommodation in the communities. The Committee has received evidence that retaining staff in these locations is difficult and is exacerbated by the poor standard of accommodation which currently exists. The Committee understands that Q-Build has recently been given responsibility for remote accommodation property management for all Government Departments throughout Queensland. This policy will result in the provision of standardised levels of accommodation and help ensure that resources are used efficiently. In practice, this will mean that a shortfall in one Department's housing needs will be able to be met from the surplus in another Department's.

COMMUNITY HEALTH CENTRE - COOKTOWN

Introduction

58 Currently, the health status of people who live in rural and remote areas has caused them to be identified as a disadvantaged group. This has resulted in Queensland Health endeavouring to improve equity in access to health services. However, the current Cooktown facility is seen as a barrier to providing enhanced services and is therefore to be replaced.

59 The cost of the proposed new Centre is $1.01 million and it is to be constructed on land adjacent to the existing Cooktown Hospital. The Regional Health Authority's stated objective is to provide a modern health care facility which will accommodate a comprehensive primary health care service for the people of Cooktown.

60 There are also two Aboriginal communities, Hope Vale and Wujal Wujal, located close to Cooktown. The Committee understands that plans are under way for the construction of Primary Health Care Centres in both of these communities, with the Wujal Wujal facility being constructed as part of the current tender.

61 The Project Definition Plan for the Cooktown Community Health Centre states that:

"This development will result in the following outcomes:

Community health care services complementing the role of the Cooktown Hospital.

16 The Projects Health Facilities in Far North Queensland

Culturally valid and appropriate services in community settings for a culturally diverse community which includes peoples of European, Aboriginal and Asian descent.

Improved health status for clients.

Safer, improved working conditions benefiting staff recruitment and retention.

Longer-term operational and funding efficiencies."

62 The Committee received a number of submissions from various interested individuals and organisations throughout Cooktown in relation to the construction of the new Community Health Care Centre. The Committee also drew on the local knowledge of a Health Action Group based in Cooktown which has acted as a vehicle for community input. This Group was able to provide a submission to the Committee and the Group's representatives provided evidence to the Committee at a public meeting held in Cooktown on 20 October 1993.

63 The Committee appreciates the thoughtfulness and thoroughness of the submissions made to it by the residents of Cooktown. However, a number of the issues addressed in some submissions fall beyond the scope of the Committee's role and therefore have not been pursued by the Committee.

64 The Committee is pleased to note that wide-ranging consultation has occurred in the planning for this new facility with the development and resourcing of the Health Action Group. However, the Committee has witnessed a level of dissatisfaction regarding the effectiveness of this consultation as, while people are consulted and opinions sought, it is argued by some that in practice little attention is paid by the Departments involved to the views offered and that the value of local knowledge is not appreciated nor taken advantage of. Examples of this cited to the Committee include helipad location and the possible use of barges to transport material.

65 The Committee also received evidence that the level of functionality between the Hospital and the community health care services may not be developed to the appropriate level. The Committee notes that the current Community Health Care Centre building is located within the centre of Cooktown, whereas the planned facility will be located adjacent to the Hospital. The Committee sought and received assurances that community access to the new facility would be as easily effected at the new site as it has been at the old.

66 The Committee, in the course of its inquiries, was told of the construction of a similar, though smaller, facility at Mareeba. This facility was constructed without the use of Q- Build or significant advice from Queensland Health's Capital Works Branch in Brisbane. The cost of this facility was borne by the Regional Authority and was

17 The Projects Health Facilities in Far North Queensland

available as a result of regional efficiencies and demonstrates that regionally-managed construction can sometimes offer a viable alternative to a centralised procurement process.

67 As a further example of regional capabilities, in its inspection of facilities at Cooktown the Committee viewed the construction of dormitory accommodation for students attending the local high school. These buildings were recently constructed and demonstrate to the Committee the abilities of local contractors to undertake relatively substantial constructions at an apparent low cost.

68 The Committee is aware that significant costs were incurred in the preparation of the various plans for this project, including consultants' reviews, visits and associated documentation costs from Q-Build. The Committee was informed that the fees for outside of Government consultancies on these types of projects, which include fees for a preliminary design followed by full design and documentation, would normally be of the order of 10-12% of the total out-turn cost.

History of Existing Facilities, Including Hospital Design

69 The Committee has been informed of the inadequacies of the design and materials used at the existing Cooktown Hospital. The Committee considers that the Hospital provides examples of inappropriate design in an area which is relatively remote and subject to harsh climatic conditions. Some of the alleged shortcomings in this Hospital include the use of unserviceable materials, the lack of functionality of design and the lack of adequate ventilation. The Committee notes that this is a relatively new Hospital, having been constructed in the mid 1980s. Since its construction, considerable maintenance work has been undertaken including the reconstruction of bathing facilities which had badly deteriorated. The Committee urges that a similar situation not be allowed to occur with the Health Centre and has received assurances that an inappropriate facility will not be developed.

Lack of Local Control

70 It may be that the ability to decentralise levels of responsibility for capital works projects would, in the future, provide substantial cost savings to the Government for certain individual projects. This is particularly the case for projects involving some remote area locations. The Committee questions the necessity for high levels of centralisation for projects involving small to medium-size capital works and considers that decentralisation of responsibility for minor capital works should, where it achieves the most economic and appropriate solutions, be vested at the local level.

71 The use of a single contract for all of the eight projects involving Primary Health Care Centres was extended to include the Community Health Care Centre, Cooktown. The Committee has not been convinced that appropriate evaluation was given in the determination that this project should proceed as part of a single contract and believes

18 The Projects Health Facilities in Far North Queensland

that the resources available within Cooktown are quite different to those which exist in the various Aboriginal communities. Not only does Cooktown have a well established and proven building industry, it also possesses a major material source in the concrete block works. It is therefore considered, in this instance, that an estimate should have been made of the cost of having the facility constructed locally. While there may be economies of scale to be achieved through letting a contract for numerous facilities, it is not believed that the separation of the Cooktown Centre would have impacted on these economies to any great extent. The Committee therefore considers that it is essential that where decisions involving tax payers' money are made the chief motivation should be economic efficiency. However, these decisions need to be carefully considered in regard to the maximisation of community benefit.

72 The Committee also accepts that difficulties can arise in ensuring that local requirements are properly met by and accord with those of the head offices, whether they be regional or central. It would appear to the Committee that it is the requirements and needs of central and regional offices, as opposed to local requirements, which can too easily take priority if sufficient checks and balances are not in place.

73 In its Public Hearing the Committee sought details of the level of local work input in terms of labour and services which are to be utilised under this contract. The Director- General of Administrative Services Department stated that where appropriate, and required skills are available, the contractor would utilise local labour. The Committee does not accept the adequacy of existing tender documentation to achieve this but has noted that the Administrative Services Department will, in future documentation, implement a stronger requirement for tenderers to provide a schedule of how they propose to utilise local labour and the costs of doing so. Such an approach should also identify other costs such as the accommodation of non-local labour on the project which may have been unnecessary if a locally-based approach to the construction had been developed.

74 Because of the above, the Committee has questioned the appropriateness of using Administrative Services Department's Q-Build for this construction. It was suggested to the Committee that the cost of construction to Q-Build was some $2,500 per m2 as opposed to a local construction cost estimated (by the locals) to be in the order of $700 per m2. It should be noted, however, that this latter local figure is based upon different materials than are intended to be used in the approved construction. The Committee therefore questions the appropriateness and cost of departmental requirements for standardisation and uniformity in these projects. It considers that useability and functionality of a particular Health Centre does not require either an advanced and intricate planning process to develop all details or a commonality with other facilities, as is the case for this project. It is possible that the Cooktown facility may well have been better implemented by providing a general brief of the Regional Health Authority's overall expectations for new facilities and the remainder, where appropriate to community ability, be developed at that level. Not only does the possibility arise

19 The Projects Health Facilities in Far North Queensland

that lower costs could have been achieved, but such an approach would ensure strong community links and sense of ownership in the final facility.

75 The Committee has noted a level of reticence on the part of some Departments involved to involve themselves fully in the local communities in which they are intending to construct facilities. The lack of information flow which results can be detrimental to both the local communities' interests and the interests of the Departments involved. Contrary to this, at Cooktown the consultation with the Health Authorities was so successful that a high sense of community ownership in the new facility was generated. This high level of involvement was such that a desire existed to continue that ownership by being allowed to tender.

Consultation

76 Departmental efforts at consultation in this community have, as noted earlier, generally been of an acceptable standard. However, the Committee considers that, apart from the Health Authorities, further efforts are required to change departmental organisational cultures to information provision. While not immediately obvious, the present often limited information flow is the result of Departments' concentration on their own systems and processes in producing a product moulded from their own expertise. Too often that expertise results in local knowledge and experience being ignored. This comment is made as part of this Committee's on-going interest in improving the consultation processes of the Departments which construct capital works projects. Consultation, in the Committee's view, is not telling the community what it is you are about to do, but rather a more open and two-way process whereby not only needs but also alternative and perhaps better options can be incorporated into the projects. The Committee wishes to ensure sufficient flexibility exists in projects to enable meaningful community input. This may necessitate consultation occurring at an earlier stage than has been undertaken in this case.

REDEVELOPMENT OF THURSDAY ISLAND HOSPITAL

Introduction

77 The Committee inspected the Hospital facilities at Thursday Island on Wednesday, 20 October 1993. The Hospital is located in a variety of buildings spread throughout a large site. These buildings are of a variety of ages and types and a number including the stores building, community health building and the pathology building are obviously in need of urgent attention. The Committee notes that the main ward of the Hospital is a relatively new building constructed in 1977. It is structurally sound and is in generally good condition. Similarly the maternity ward, though physically located some distance from the general ward, is in good condition having recently been refurbished.

20 The Projects Health Facilities in Far North Queensland

The Community Role

78 There has been a high level of interest from the local community in regard to its inquiry into these facilities. The Committee met with representatives of a number of organisations, including the Port Kennedy Association and the local Health Council. Individuals consulted were enthusiastic in regard to the proposed new facilities and have sought to make further contributions when more detailed plans are made available to them. A public meeting was held in the afternoon of Wednesday, 20 October 1993, at the TAFE College on Thursday Island. At this meeting a number of individuals raised questions in regard to the necessity of the construction vis a vis the development of alternative projects of a non-capital works nature which may more effectively address issues of health status of Torres Strait Islander communities.

Existing Facilities

79 The Committee understands that building assessments for these facilities were carried out at an early stage by the original consultants. Further building assessments were subsequently carried out following a request from this Committee but are still by no means comprehensive. The Committee is concerned that there are such issues as asbestos contamination which should have been more fully addressed early in the process through the conduct of such assessments. In this respect, the Committee draws attention to advice provided by the Administrative Services Department that it is unlikely that any of the Hospital buildings will be provided to the community due to asbestos contamination.

80 The Committee also expresses its concern at the proposed demolition of the general ward. That a building constructed only some 17 years previously should now need to be demolished is unacceptable. While it is understood that this arises partly from a lack of site space and dysfunctional arrangements it represents a poor return on past investments in capital works.

Need

81 As mentioned above, the justification of the need for these new facilities is largely based upon the lack of functionality of current facilities. Queensland Health has identified a number of staffing inefficiencies which result from the haphazard design which has arisen at this Hospital over a period of years. The Committee was informed that benefits of the new facilities would be increased operational efficiencies achieved through decreases in the level of staffing required and an expected saving in on-going capital works maintenance work.

82 In the course of its inspection and Public Hearing on Thursday Island, the Committee was repeatedly informed of the Islanders' desires to improve the level of suitable facilities for the elderly, and, in particular, to establish a nursing home on the Island. The overall strategy being adopted for the Hospital will decrease bed numbers from 60

21 The Projects Health Facilities in Far North Queensland

to 38. The Committee notes that the success of this project is therefore dependent on the construction of other facilities including a Community Health Centre in the Central Business District of Thursday Island.

83 Another strong motivation for the redevelopment is the strategy of Queensland Health to improve the retention rates of its staff in remote areas such as Thursday Island. One particular aspect of remote area projects is the quality of staff accommodation. In particular, the accommodation for doctors and nurses has been consistently criticised over an extended period of time as being the primary reason for high levels of staff turnover. The Committee has been informed that Thursday Island has a chronic housing shortage with inappropriate levels of accommodation for Hospital staff.

Land Availability and Suitability

84 The Committee is aware that land availability is limited on Thursday Island and that the construction of a new Hospital was most easily able to be undertaken on the existing site. The Committee notes a number of alternative sites had been considered, including possible relocation to Horn Island and the redevelopment of the Hospital on a new site on Thursday Island.

Consultation

85 In general, the Committee accepts the adequacy of consultation undertaken in regard to this project. Departmental officers had been involved in the local community and through its representatives it has been well informed and able to comment upon the on- going developments. Similarly, staff have been informed in an appropriate and timely manner.

Design Parameters

86 The final design parameters of the Hospital have not yet been decided and there are a number of issues which are important. For example, it is often considered appropriate to air condition a facility in a tropical environment. However, the majority of patients at the Hospital do not come from air conditioned environments and full air conditioning of all the Hospital may not be in the best interests of the clients. The Committee believes and has received assurances that consideration will be given to including mechanical ventilation such as ceiling fans and providing an environment which is open and inviting.

22 The Projects Health Facilities in Far North Queensland

Community Facilities in CBD

87 An essential ingredient in improving health status is that of an on-going contact with a relatively stable General Practice service. In conjunction with the Hospital redevelopment, an associated Community Health Centre may be constructed in the Central Business District of Thursday Island. The region has submitted a proposal for this at an indicative cost of $2.8 million. The Committee fully supports this new facility and recognises its essential importance as part of the overall health strategy and the part it will play in attracting other services to the community.

Proposed Life of Redevelopment

88 As mentioned, the Committee is concerned that some of the existing facilities which are to be demolished are relatively new with construction dates as late as 1977. As such, the Committee sought details of the proposed life of the new facility. It was informed that Government buildings of this type would have a life expectancy of around 30 years. However, the Committee was advised that, due to the advent of new materials, new processes and the inability to change the style and layout of a building to conform with new practices in the health area, it is very difficult to project what health needs will be in 20 years.

Sewerage

89 During its inspection the Committee saw the current poor arrangements for sewage disposal at the Hospital. In evidence at its Public Hearing, a Health Department official indicated that the possibility of developing a stand-alone sewage treatment plant was being investigated.

23 Principal Elements Health Facilities in Far North Queensland

PRINCIPAL ELEMENTS

CAPITAL EXPENDITURE

Budget

90 The Indicative Project Capital Cost for the Primary Health Care Centres in the Peninsula and Torres Strait region, as approved by Cabinet in May 1993, was $10.022 million, and $4.992 million for Remote Area Accommodation. The contract, awarded to Prentice Builders Ltd, to design and construct both Primary Health Care Centres and Remote Area Accommodation in the Cape region was awarded at a building cost of $16,250,000. The total design, construction and fitout cost is estimated at $20,675,500. This includes the building costs (tender), necessary variations, contingency allowance, professional fees, clerk of works charges, statutory charges, professional fees for site surveys, geotechnical surveys and architect fees, loose furniture and equipment, and relocation and commissioning costs. In addition to these costs, consultancy fees have been incurred against the projects for the preparation of the Functional Plans and Project Definition Plans, and for the Project Management of the projects. These fees are:

Functional Plans (includes all PHC and CHC proposals submitted) $32,200 Project Definition Plans (includes TI Hospital and Accommodation Plans) $129,466 Project Management (for all projects: 1 Sept 1993 - 30 June 1994) $124,160

Post Occupancy Evaluations will be undertaken following commissioning of these facilities. The indicative cost for Post Occupancy Evaluations of these facilities is $50,000. Costs to be incurred in the redevelopment of the Thursday Island Hospital include:

Functional and Project Definition Plans $52,000 Design, Construction and Fitout $13.642 million Post Occupancy Evaluation $20,000

91 The Committee was informed that none of these funds were provided in the form of tied grants from the Commonwealth, but rather were based upon the general Capital Works Program for the next ten years within Queensland Health.

92 The Committee was also informed that, in the event of these funds not being expended within the 1993/94 financial year, a mechanism exists whereby such funds not expended are provided for the next financial year without any detrimental effects upon the program.

24 Principal Elements Health Facilities in Far North Queensland

93 The Committee is aware, however, that some reticence exists on the part of Departments in retaining large elements of their Capital Works Program funds unspent to the next financial year. To an extent this factor may motivate Departments to expend funds quickly. The Committee considers that such quick expenditure is appropriate, particularly in the context of an accelerated Capital Works Program, as has been undertaken by the Queensland Government in the 1991-93 period. However, such expenditure must be judicious and ensure that it achieves the most appropriate level and type of facilities. This places extra pressures upon Departments and their officers to cope with accelerated expenditure programs and some compromise may have to be expected in delivering the end product. The Committee, however, does not consider these effects to be unduly severe.

PLANNING AND CO-ORDINATION

Effectiveness of Capital Works Planning

94 It is essential that adequate planning and co-ordination of the capital works projects within Queensland Health's budget are undertaken and these appear to have increased in focus and priority for Queensland Health over the last few years. The processes of the past have been replaced by a system which focuses heavily upon initial planning and ensuring the functionality of new capital works projects. To this extent, the Committee congratulates Queensland Health on its forward thinking approach.

95 The present capital works planning process was initially established in 1992 to enable the most appropriate facilities to be developed in the context of Queensland Health's ten year Capital Works Program. At this stage all associated planning measures, including the three and ten-year rolling capital works plans, have not been fully implemented. Obviously the program is at an early stage and is, therefore, able to be reviewed, to a limited extent, by the Committee. A chart which sets out the planning process is attached as Appendix D.

96 As these facilities in Far North Queensland have been the first to be developed under this new approach, the Committee has sought to review them in terms of a case study approach which may ultimately produce benefits not only for the local communities involved but also to help refine the process for future capital works projects to be developed by Queensland Health.

97 The Committee considers that a number of problems exist with the current process. Principally, the process itself is complicated, and this is exacerbated by the number of agencies which have roles to play. The process, while incorporating a host of inputs, checks and balances, places the provision of capital works in a highly structured and relatively inflexible environment where the process is paramount. As already mentioned, an undesirable by-product of this is the strict and short time frames which have to be met to ensure that the "process" can continue.

25 Principal Elements Health Facilities in Far North Queensland

98 In this context, the Committee received evidence from the Regional Health Authority that extensive pressure had been forced upon it by the requirements of the latter part of the process. Evidence of this is contained in Appendix E which shows the timeline followed by the Regional Health Authority in developing the capital works planning studies document. The Committee considers that this timeframe did not aid the process of consultation. If anything, it may have given rise to yet another problem, that of an over-use of consultants with consequent additional costs to the tax payers.

99 Other problems include the determination of responsibility for health planning and facility planning and the delineation of these areas. For example, at what stage should a facility provider such as Administrative Services Department accept responsibility - before or after plans (an area of their expertise) have been prepared? And in conjunction with that, which organisation (if only one) should therefore take the lead role in the consultation process?

100 The Committee was also surprised to find that not all consultants actually produced a report of their work and that, in some cases, their inputs were incorporated into a more encompassing document either in a workshop scenario or by others. Such a situation is not acceptable. The Committee believes that the employment of consultants must be on set terms and conditions with a clearly defined output from them which is capable of independent evaluation.

101 Similarly, there appears to have been little consideration given to the costs associated with the use of consultants. Evidence to the Committee to the effect that consultancy costs were not individually budgeted for as they were simply recouped by the Regional Health Authority from the Health Department at the end of the project is worrying. So too was evidence received that such costs would probably not be fully identified or evaluated until the projects were completed. Such an approach indicates that costs are not being properly assessed early in the process and that budgets are incomplete. Again, this could be perceived as the end result of a process which encourages haste and which is aimed at expending funds in providing a physical facility rather than meeting the service needs of a community.

Department's Assessment Evaluation/Criteria

102 In the Committee's view, a significant issue is how Queensland Health can determine if its planning process has been effective in reaching its goal. For instance, while the current process of planning used by Queensland Health has some limited evaluation of activities, this only occurs at the end of the process through the use of post-occupancy evaluation. The Committee considers it essential that some form of additional performance and evaluation criteria be developed at an early stage of the process. Currently any evaluation of a particular project which is undertaken is based upon the unstructured feedback of officers involved in the program. The Committee suggests a more developed formal system of evaluation be utilised to act as a check on both the process and its outcomes.

26 Principal Elements Health Facilities in Far North Queensland

Consultation Procedures, Use of Consultants

103 From its inquiries, it was obvious to the Committee that some consultation difficulties have occurred. A common theme in these was the use of consultants to provide the department with information and options for redevelopment. The Committee understands that the cost of these consultants to Queensland Health was in the order of $300,000. In addition to this, costs were also incurred by Administrative Services Department for similar reasons. The Committee considers that the use of consultants should be minimised where possible and that, wherever possible, properly trained and culturally aware departmental officers should undertake the preparation of a greater percentage of these proposals.

Timetabling of Consultation and Ramification on Quality of Response

104 As has been stated earlier in this Report, consultation for some of these projects occurred under the pressure of tight timetables. While acknowledging that in many cases previous consultation had occurred with communities, that previous consultation did not specifically provide the community with the likely details of new health facilities. In fact, communities were often left with only a matter of weeks to comment upon the final plans before tenders were awarded. One justification given to the Committee for this was that the moment plans are produced "people immediately want to draw lines on paper" and that the plans are the easy final culmination of many months of work. Unfortunately, the "word pictures" which lead up to this stage are not recognised by many as being a legitimate part of the planning and consultation process. It is probably true to say that the value of consultation is enhanced when some physical evidence (such as plans) exist so that change and needs identified by and coming from consultation can be seen.

105 The Committee also considers that the timeframe used was inappropriate to the needs of Aboriginal and Torres Strait Islander communities, particularly when, in some areas, council meetings occur on an irregular basis. The Committee considers that the quality of responses to this process were therefore not as high as they could have been had a more realistic timeframe been adopted and had those consulted had a better understanding of the process and what was expected of them. The Committee, however, notes that consultation now appears to have become a major issue which is now a priority for all of the Departments involved.

27 Principal Elements Health Facilities in Far North Queensland

Interdepartmental Co-ordination

106 The Committee is of the opinion that interdepartmental communication has been too limited between the agencies which should be involved in the provision of these facilities. This is particularly the case when the justification for these works is the improvement of health status of the affected communities. The Committee is surprised and concerned that the Department of Family Services and Aboriginal and Islander Affairs was not involved, to any real degree, in discussions surrounding these projects. The fact that Queensland Health considers the project to be exclusively its own highlights either a lack of understanding or unwillingness to adopt a whole of Government approach to many of the issues involved.

107 The Committee is also aware of co-ordination difficulties in the development of the new capital works planning process and current difficulties in delineating the respective roles of Queensland Health and the Administrative Services Department. In this regard the Committee notes the development of a service agreement between the two Departments which is aimed at improving the definition of the roles of each.

Intradepartmental Co-ordination

108 The issue of intradepartmental co-ordination is particularly appropriate to Queensland Health as it is a large regionalised department which has strong central control. To a large extent central office may not have fully understood the difficulties of implementing such projects in such a timeframe.

109 Similarly, Q-Build appears to be somewhat under-resourced in the Cairns region, particularly in the light of its responsibilities under the Cabinet decision of May 1993 regarding Health capital works projects. In evidence to the Committee it was advised that Q-Build currently had only five architectural staff in Cairns to service Far North Queensland.

MAINTENANCE AND LIFESPANS

Existing Facilities

110 The Committee noted in a number of cases that existing facilities were still of good quality and may be suitable for alternative uses. While the facilities may be categorised as dysfunctional it must be remembered that these facilities have been serviceable for a significant number of years and the demolition of such facilities in a wholescale manner can not necessarily be regarded as either the most appropriate or only solution to dysfunctionality. The Committee was also concerned that previous planning could have been so poor as to construct buildings which so easily and quickly became dysfunctional.

28 Principal Elements Health Facilities in Far North Queensland

LOCAL EMPLOYMENT AND TRAINING

111 In advice to the Committee, the Director-General of Administrative Services Department has outlined his Department's strong emphasis on the training of local labour, both from Aboriginal communities and from the Torres Strait, to provide maintenance services throughout the Far North. The Committee intends to review the numbers and appropriateness of training which future maintenance programs will achieve and the impact on the quality, extent and cost of maintenance of State assets in the region.

112 The Committee was concerned, as noted above, at the paucity of local employment and training in these communities. The Committee notes that the contract provisions for the Primary Health Care Centre facilities did not provide any significant reference to local employment and training. The Committee notes the difficulties associated with the effective generation of a local employment scheme by its inclusion in specific contracts. The Committee believes, however, that a high level of community expectation has arisen that these projects will do more than just provide buildings. Significant flow-on effects must be achieved in any works in disadvantaged communities.

113 Further, the Committee considers that this is an issue that goes beyond economic rationalist arguments and that a whole of Government approach must be adopted. This approach should also link in other levels of Government to ensure that local employment and training becomes an integral part and not just a side issue in these types of constructions. The Committee draws attention in this regard to the potential for such employment in the Thursday Island Hospital redevelopment.

LAND TENURE

114 The Committee is generally concerned at the importance placed upon ensuring that these new facilities were constructed on existing departmental reserves in Aboriginal communities. The Committee notes that a majority of new Primary Health Care Centres will now be constructed on existing Health Department reserves. The Committee questions the appropriateness of this decision and seeks to ensure that future developments will be guided by their appropriateness to community needs.

Need for Guaranteed Tenure

115 While the Committee understands the reticence on the Department's behalf of building while not having guaranteed land tenure, it also notes that the overall thrust of Government policy is that this land is to be controlled by the local committees.

116 To a large extent, issues associated with Mabo land claims have also clouded the decisions associated with siting of new facilities. The Committee is disappointed that a more flexible approach could not have been developed.

29 Principal Elements Health Facilities in Far North Queensland

CONTRACT PROVISIONS

117 There seems to be an apparent conflict between economic needs of controlling expenditure and ensuring the lowest cost and the social needs of ensuring the most appropriate facilities in the most appropriate locations and the highest level of benefit to the communities involved. The Committee considers that a whole of Government approach would be more appropriate and more in line with the wider public's expectations of how to deal with issues of Aboriginal and Torres Strait Islander health. The areas of disadvantage in these communities are wide-ranging and it therefore seems inappropriate to attempt to deal with them from the perspective of a single department. Despite many years of research and arguments it would appear that a full understanding of Aboriginal and Torres Strait Islander community needs has not been fully integrated into departmental thinking. A considerable amount of further effort is required in order to bridge the gap between community needs and current departmental systems and processes in the development of infrastructure in these communities.

118 The Committee notes the current developments in cross-Government co-ordination being developed by the Department of Family Services and Aboriginal and Islander Affairs. The Committee hopes that such developments will improve the level of services and facilities in these communities.

30 Conclusion Health Facilities in Far North Queensland

CONCLUSION

119 The Committee has been concerned about a number of problems evidenced throughout its inquiry into the proposed construction of these facilities. These have been addressed throughout the Report but principally involve the general approach to consultation undertaken by the Departments involved. In this respect the Committee is of the opinion that while extensive consultation was undertaken many of the key decisions involved in these projects have not sufficiently involved the local communities.

120 Similarly, the Committee is concerned at the apparent lack of co-ordination between the Departments involved. It would appear that the bureaucracy is still developing the means of dealing effectively with the requirements of Aboriginal and Torres Strait Islander communities and has demonstrated a limited consideration of bringing about a whole of Government approach to the development of these facilities.

121 It is hoped that there will be a number of benefits flowing from the new health facilities, including in the medium term an improvement in the level of health status of residents. The Committee is concerned, however, that the potential for other subsidiary benefits has been limited by the rigidly structured approach which has been taken under certain existing practices. For example, the Committee considers that this has resulted in local employment and training being given a relatively low priority.

122 The Committee has also gained the impression that both the planning process and the manner in which it has been implemented has been more attuned to the bureaucracy than to the needs of the communities involved.

123 Undoubtedly, Aboriginal and Torres Strait Islander issues have increased in priority over recent years and considerable changes in attitudes have taken place. However, further change, greater co-ordination and co-operation and an improved awareness of the implications of processes used are still needed. This can only be achieved over time.

31 Recommendations Health Facilities in Far North Queensland

RECOMMENDATIONS

124 The Committee recommends:

(1) (a) That the new Health Facilities be maintained by the Administrative Services Department's Q-Build Maintenance and Operations.

(b) That a review be undertaken of Queensland Health's current maintenance practices and procedures to determine their efficiency and economy and that if gains can be made by outsourcing such works to agencies such as Q-Build then action be taken to achieve such changes.

(2) That Queensland Health's Capital Works Branch be fully reviewed against performance criteria no later than 30 June 1995 to evaluate its effectiveness as part of the Government's capital works planning and implementation process.

(3) That budgetary allocation for all aspects of the planning process be made as transparent as practicable to ensure that expenditure on these processes is appropriate to the works planned.

(4) That guidelines for the employment of consultants be reviewed to ensure proper budgetary processes and standards of accountability and reporting are achieved.

(5) (a) That the general approach outlined to it by the Director-General of the Family Services and Aboriginal and Islander Affairs Department for the co-ordination of the provision of infrastructure in Aboriginal and Islander communities be endorsed, and

(b) That current negotiations with the Commonwealth for a bilateral arrangement in regard to the co-ordination of the provision of services in Aboriginal and Torres Strait Islander communities be widened to include Education and Health and be completed and implemented as quickly as possible.

(6) That where infrastructure is to be provided in Aboriginal and Torres Strait Islander communities the generation of local employment and skill development be included as a mandatory element of tender evaluations.

32 Recommendations Health Facilities in Far North Queensland

(7) That single contracts for multiple works only be used where all facilities and localities are similar in nature and where it can be demonstrated that cost savings can be effected at all centres through such an approach.

(8) That evaluation of consultation be made an integral part of the consultation process, and that action be taken to ensure that all participants are aware of the Government's stated guidelines on consultation procedures and the assessment process.

(9) That in future the selection of sites for facilities developed on Aboriginal and Torres Strait Islander communities be the subject of direct consultation with local community councils to ensure that all alternatives are fully considered and that the ultimate decision appropriately reflects community needs and desires.

(10) That the model of interdepartmental consultation suggested by Administrative Services Department, in which it would play an integral role in design aspects, be further assessed and adopted if demonstrated to offer improved service delivery.

33 Appendix A Health Facilities in Far North Queensland

APPENDIX A - Call for Submissions

34 Appendix B Health Facilities in Far North Queensland

APPENDIX B - List of Submissions Received

C/o Mr Wayne Brogan Dr Mick McLoughlin The Shire Clerk Medical Superintendent Council of the Shire of Aurukun C/o The Hospital AURUKUN QLD 4871 COOKTOWN QLD 4871

Mr L Collins Mr A Neilan PO Box 4897 Kowanyama Aboriginal Community CAIRNS QLD 4870 Council, Post Office KOWANYAMA QLD 4871 Mr Ross Dunning Director-General Ms Helen O'Loughlin Administrative Services Department President GPO Box 2217 Cooktown District Family Resource BRISBANE QLD 4001 Centre, PO Box 370 COOKTOWN QLD 4871 Ms Pauline Grey Health Action Group Cr John O'Sullivan PO Box 150 PO Box 333 COOKTOWN QLD 4871 COOKTOWN QLD 4871

Mr David Martin Mr Peter Read Consulting Anthropologist Acting Director-General THORNBURY VIC 3071 Queensland Health GPO Box 48 Ms R L Matchett BRISBANE QLD 4000 Director-General Dept of Family Services and Mr G Richardson Aboriginal and Islander Affairs A/State Manager GPO Box 806 ATSIC - Qld BRISBANE QLD 4001 GPO Box 2472 BRISBANE QLD 4001 Ms Bev McDonald State Representative Ms V Thompson CRANA Inc Cooktown Pensioners League PO Box 183 COOKTOWN QLD 4871 FRESHWATER NQ 4870

Dr Peter McKenna PO Box 391 THURSDAY ISLAND QLD 4875

35 Appendix C Health Facilities in Far North Queensland

APPENDIX C - List of Witnesses

Dr Ross Brandon Mr Michael Higgs Acting Regional Director Project Manager Peninsula and Torres Strait Regional Peninsula and Torres Strait Regional Health Authority Health Authority PO Box 5465 PO Box 5465 CAIRNS QLD 4870 CAIRNS QLD 4870

Mr Ross Dunning Mr Les Malezer Director-General Divisional Head Administrative Services Department Division of Aboriginal and Islander GPO Box 2217 Affairs BRISBANE QLD 4001 Department of Family Services and Aboriginal and Islander Affairs Ms Grace Fisher GPO Box 806 Peninsula and Torres Strait Regional BRISBANE QLD 4001 Health Authority PO Box 5465 Ms Ruth Matchett CAIRNS QLD 4870 Director-General Department of Family Services and Mr Rob Gray Aboriginal and Islander Affairs Assistant Regional Director GPO Box 806 (Finance and Administration) BRISBANE QLD 4001 Peninsula and Torres Strait Regional Health Authority Mr Philip Mills PO Box 5465 Executive Officer CAIRNS QLD 4870 Thursday Island Hospital PO Box 391 Mr Merv Handlin THURSDAY ISLAND QLD 4875 Lands Department Landcentre Mr Steve Bredhauer MLA Cnr Main and Vulture Streets Member for Cook WOOLLOONGABBA QLD 4102 PO Box 2080 CAIRNS QLD 4870 Mr Harold Haydon Client Services Manager Mr Michael Moodie Q-Build Project Services Director Administrative Services Department Capital Works Branch GPO Box 2457 Queensland Health BRISBANE QLD 4001 GPO Box 48 BRISBANE QLD 4001

36 Appendix C Health Facilities in Far North Queensland

Mr Barry O'Connor Lands Department Landcentre Cnr Main and Vulture Streets WOOLLOONGABBA QLD 4102

Mr Peter Read Acting Director-General Queensland Health GPO Box 48 BRISBANE QLD 4001

Mr Gavin Shanks Lands Department Landcentre Cnr Main and Vulture Streets WOOLLOONGABBA QLD 4102

Mr Jim Wauchope Assistant Divisional Head Co-ordinating and Resourcing Branch Department of Family Services and Aboriginal and Islander Affairs GPO Box 806 BRISBANE QLD 4001

37 Appendix D Health Facilities in Far North Queensland

APPENDIX D - Health Flow Chart

38 Appendix E Health Facilities in Far North Queensland

APPENDIX E - Health Timeline

23.12.92 Capital Works Workshop in Brisbane: Ian Northcott and Barbara Schmidt of this office attended. This was first notification that a major planning study was required for a number of facilities in the Cape and Torres areas. This study was to include:

• Identifying objectives and scope • Assessment of need • A review of existing services and facilities • An assessment of development needs/evaluation of options • An economic evaluation of all options using net present value methods

Even in normal circumstances this is a very substantial task for our very remote area Health Centre localities; Thursday Island Hospital and remote area accommodation. This is a very large region and many are only accessible by small aircraft. Qld Health at this workshop indicated to regions that if their submissions were to be considered they must meet the deadline of 5 February 1993. While this allowed little time for the extensive work required, this region is committed to improving conditions in remote areas and demonstrated this by accepting the challenge.

With the 5 February deadline, and the Christmas/New Year Building shut down period, this meant consultants had only three weeks in which to complete this task.

24.12.92 In-house review of localities and first assessment of health needs.

Christmas/ In-house review and preparation of consultant lists, skills and New Year capabilities. Preliminary specification for consultants. Break • Preliminary consultant specifications to Health sector offices to forewarn them of coming intense consultant involvement.

04.01.93 Review of submission of Expressions of Interest for Regional Capital Works by consultants. Development of program necessary for completion by 05.02.93.

39 Appendix E Health Facilities in Far North Queensland

05.01.93 Discussions with Q-Build seeking assistance with the intensive program, in assessing facilities and engaging consultants.

Teleconference with Thursday Island Hospital on assessment of existing hospital facilities and current needs.

Shortlisting of consultant list for Thursday Island Hospital study.

Write up specification for consultants for Thursday Island Hospital Functional Plan.

06.01.93 Confirmation by consultants of possible assessment team members for TI Hospital.

Write up specification for consultants for Cape & Torres Primary Health Care Centres and Remote Area Accommodation.

07.01.93 Specification forwarded to consultants to submit a fee proposal for TI Hospital study.

Confirmation of consultants list for Cape & Torres Primary Health Care Centres and Remote Area Accommodation. Issue documents for TI consultant fee proposal.

08.01.93 Consultants fee proposals received for Thursday Island Hospital Functional Planning Study. Assessment, further inquiry, engagement of additional necessary specialist architects, and confirmation of appointment the same day.

09.01.93 Issue of documents for tender for Cape & Torres Primary Health Care Centres and Remote Area Accommodation.

10.01.93 Close of tenders for Cape & Torres Primary Health Care Centres and Remote Area Accommodation. Immediate review, confirmation and engagement of consultants.

11.01.93 Tenders awarded for Cape & Torres Primary Health Care Centres and Remote Area Accommodation, separate consultants for Cape Region and Torres Region.

11.01.93 to Consultants visit Thursday Island Hospital for one week review of 15.01.93 existing buildings, discussing with staff and start of masterplanning.

13.01.93 to Cape York consultant starts five day review of all Cape locations for 17.01.93 Primary Health Care Centres and Accommodation.

40 Appendix E Health Facilities in Far North Queensland

18.01.93 to Consultants four day review of Torres Islands and Bamaga localities 21.01.93 for Cape & Torres Primary Health Care Centres and Remote Area Accommodation.

18.01.93 to Bi-weekly meetings with Regional Health Authority during 02.02.93 development of masterplan and write up of report.

25.01.93 Consultants revisit Thursday Island to review proposals with Thursday Island Health Council and Hospital.

01.02.93 Submission of Thursday Island Draft Functional Planning Study to Peninsula and Torres Strait Regional Health Authority.

03.02.93 Submission of Cape & Torres Primary Health Care Centres and Remote Area Accommodation Functional Plans to Peninsula and Torres Strait Regional Health Authority.

05.02.93 Submission of all Planning Studies for Thursday Island and Cape and Torres Regions to Queensland Health.

41 PARLIAMENTARY COMMITTEE OF PUBLIC WORKS

No. Report Date Tabled

1 Annual Report for the Period Ending 30 June 1989 6 July 1989 2 Inquiry into the Proposed Construction by the Brisbane and 28 September 1989 Area Water Board of a Dam on the Albert River at Wolffdene (September 1989) Report for the Period 1 July to 19 October 1989 19 October 1989 3 No Public Works Committee Report No. 3 was issued 4 Annual Report for the Period 6 March to 30 June 1990 23 August 1990 5 Bundaberg Hospital Redevelopment - Stage Two (October 24 October 1990 1990) 6 Aboriginal and Torres Strait Islander Housing - The Future 28 May 1991 (May 1991) 7 Annual Report for the Period 1 July 1990 to 30 June 1991 18 July 1991 8 Building Another Mental Institution or Housing a New Mental 24 October 1991 Health Service? - A Report on Community Debate Concerning Construction of the New Kirwan Psychiatric Rehabilitation Unit (October 1991) 9 Consultation and Planning for Schools and Colleges between 5 December 1991 State and Local Authorities (November 1991) 10 The Proposal to Build a 33-Level Office Block at 111 George 5 December 1991 Street (November 1991) Annual Report for Year 1991 - 1992 25 November 1992 11 Kirwan Psychiatric Rehabilitation Centre 2 March 1993 12 The Proposed Upgrade of the Townsville Correctional Centre 3 March 1993 13 Public Housing in Toowoomba 19 March 1993 14 The Development of the Sciencentre - the Old Government 13 May 1993 Printery 15 Queensland Centre for Advanced Technologies 13 May 1993 16 Cairns Courthouse, Police Headquarters and Watchhouse 20 May 1993 Complex 17 Replacement Schools for Herberton and Mission Beach 15 July 1993 Annual Report for Year 1992 - 1993 1 September 1993 18 Brisbane Convention and Exhibition Centre 13 October 1993 19 The Construction of New Government Office Accommodation 18 November 1993 in Rockhampton 20 Health Facilities in Far North Queensland - 3 December 1993 Preliminary Report

This Committee tables transcripts of evidence; however, they are not numbered and they are not included in this list.

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