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ISSN 2202-7130

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© Central West Hospital and Health Service 2013 Contents

Letter of Compliance 1 Chair’s introduction 2 2 Overview of the Central West Hospital and Health Service 4 2.1 Agency role and main functions 5 2.2 Operating environment 6 2.3 Machinery of government changes 6 3 The year in review 7 3.1 Strategic planning and engagement 7 3.2 Building and developing our workforce 7 3.3 Better healthcare for patients 7 3.4 Upgrading and maintaining our facilities 8 3.5 Accountability to the community 8 4 Our performance 9 4.1 Central West Hospital and Health Service Strategic Plan 2012–16 9 4.2 Service delivery statements 16 4.3 Other plans and measures 17 5 2012–13 financial highlights 20 5.1 Summary of financial performance 20 5.2 Chief finance officer statement 21 6 Corporate governance – management and structure 22 6.1 Central West Hospital and Health Service board and committees 22 6.2 Related entities 25 6.3 Executive management team 25 6.4 Senior management structure 27 6.5 Public Sector Ethics Act 1994 27 7 Governance – risk management and accountability 28 7.1 Risk management 28 7.2 External scrutiny 29 7.3 Audit committee 29 7.4 Internal audit 29 7.5 Information systems and record keeping 29 8 Governance – human resources 30 8.1 Workforce overview 30 8.2 Workforce governance 30 8.3 Workforce planning, attraction and retention and performance 31 8.4 Training and development 31 8.5 Early retirement, redundancy and retrenchment 32 8.6 Voluntary separation program 32 9 Open data 33 Abbreviations 34 Glossary 35 Attachment A: Compliance checklist 37 Financial statements 39

Contents i Letter of Complaince 1

1 Chair’s introduction 2012–13 saw one of the most significant changes The board also established a governance structure to the way public health services in Queensland and four committees to ensure accountability and are organised, regulated, funded and managed for the effective and efficient delivery of healthcare many years. services. Following the 2012 state election, the Queensland Under the leadership of the health service chief government embarked on a significant change executive, the health service has implemented an agenda to transform and renew the Queensland operational improvement program to restore the public sector. budget and focus on the safety and effectiveness of healthcare services provided in our communities. In line with the introduction of the Hospital and The health service has returned a modest budget Health Boards Act 2011 on I July 2012, the Central surplus in 2012–13, reduced reliance on agency West Hospital and Health Board was established staff and locums, maintained all existing healthcare with a mandate to control the Central West Hospital services in the region and embarked on strategies and Health Service. to improve access to specialist services and embed The board has reflected the principles and telehealth as a regular component of patient care. objectives of the reform agenda, which included the The board is delighted to report that progress Public Sector Renewal Program, a six month action towards delivering on the priorities of its strategic plan to ‘Get Queensland back on track’, a statement plan is on track as detailed in this annual report. of health priorities and ultimately the Blueprint for better healthcare in Queensland, in its strategic In 2013–14, the board will build on the success planning and engagement activities. achieved in its foundation year and work with our communities and healthcare partners to complete a One the highest priorities of the board in 2012–13 comprehensive healthcare plan for the central west has been to establish a relationship of openness and explore opportunities to ensure every dollar and trust as a foundation for ongoing community is well spent and delivers improvements to the capacity building and engagement. It began health and well being of the community. The health a monthly schedule of meetings in individual service will continue to expand telehealth services communities across the central west and convened and secure additional specialist and surgical visits public meetings to talk with communities about to reduce the disadvantage and travel burden their current and future healthcare needs and experienced by patients and their families. priorities. Board meetings were conducted in six communities, Alpha, Aramac, Barcaldine, Blackall, The board also intends to deliver a community Longreach and Winton and at each community dividend through the re-investment of the 2012–13 visited, the board engaged with local residents and budget surplus to upgrade hospital and health stakeholders to hear their views in a public forum. facilities and address the back-log of maintenance Communiqués outlining the matters discussed and works across the region. The investment will remove key decisions were circulated to all stakeholders residual safety risks for patients and staff and and posted in each facility for public access ensure facilities are fit for purpose to support our following each public meeting. healthcare services. The Central West Hospital and Health Service I wish to acknowledge the excellent work of our Strategic Plan 2012–16, Clinician Engagement dedicated staff right across the health service for Strategy 2013–15, Consumer and Community their energy and commitment throughout 2012–13. Engagement Strategy 2013–15 and a protocol Whether their role has been to deliver nutritious with Central and North West Queensland Medicare meals to our patients, manage the upkeep of Local, were all developed in consultation with key our facilities, perform medical and nursing stakeholders to maintain and develop existing services, safely deliver our babies or manage the healthcare services and standards. administrative services that keep the machine running, I thank our staff for their consistent level of performance.

2 Central West Hospital and Health Service Annual Report 2012–13 I also take this opportunity to thank my fellow board The board looks forward to working with the members for their support in governing the health Minister for Health, the health service chief service and taking the time to engage and listen to executive and his executive management team the views and aspirations of our local communities. over the next year to continue to build the best Their hard work, dedication and vision in the pursuit possible regional healthcare service for the benefit of health outcomes for the region was recognised of Queenslanders who live in, work in or visit the in May 2013 when the government re-appointed central west. all seven foundation members of the board for a further 3 year term.

Map of the Central West Hospital and Health Service area

1. Chair’s introduction 3 Overview of the Central West 2 Hospital and Health Service Central West Hospital and Health Service Central West Health serves an estimated population, (Central West Health) was established as an as at 30 June 2012, of 12,417 persons. At June 2011, 8.3 per cent of the service’s population independent statutory body on 1 July 2012 identified as of Aboriginal or Torres Strait Islander under the provisions of the Hospital and origin, 5.6 per cent of the total population were born Health Boards Act 2011 (the Act). overseas and 0.6 per cent of the total population speak a language other than English at home.3 Central West Health is the principal provider of public health services to the communities of In 2012–13, Central West Health employed a total Queensland’s central west and works in partnership of 352 clinical, administrative and operational with the Central and North West Queensland staff (full-time, part-time and casual) and had an Medicare Local (the Medicare Local), the Royal operating budget of $54.4 million. Flying Doctor Service (RFDS) and local general practices to provide comprehensive healthcare Hospitals – Longreach, Barcaldine, Blackall, services to central west residents and visitors. Winton and Alpha Central West Health is governed by the Central Central West Health operates five public hospitals West Hospital and Health Board (the board) which delivering 24 hour accident and emergency care, controls the health service and is responsible to acute inpatient services, pharmacy, physiotherapy the Minister for Health for the performance and and radiology services and outpatient clinics. compliance of the health services it oversights. Longreach Hospital is the region’s procedural hub The board has appointed a health service chief offering surgical and elective procedures as well as executive to implement its strategic plans and gynaecological and obstetric services through its manage the day to day performance of the health regional maternity service. Three of the hospitals service in line with the principles and objectives of provide high care residential aged care services the national health system. under a multipurpose health service model. The central west service area covers 396,650 Primary Health Centres – Aramac, Boulia, square kilometres or 22.9 per cent of the total Isisford, Jericho, Jundah, Muttaburra, Tambo area of Queensland. It comprises the seven local and Windorah government areas of Barcaldine Regional Council, In smaller communities, Central West Health Barcoo Shire Council, Blackall-Tambo Regional operates primary healthcare centres providing Council, Diamantina Shire Council, Longreach 24 hour accident and emergency services, local Regional Council, Winton Shire Council and the local nursing and primary healthcare and regular visiting government area of Boulia Shire Council other than medical, community, allied and mental health the community of .1 The health service services. Each primary healthcare centre operates area of the central west falls largely within the a hospital based ambulance in conjunction with state electoral district of Gregory, with Birdsville, community volunteer drivers. Aramac also has a Bedourie, Boulia and Winton falling within the state Queensland Ambulance Service station. electoral district of Mt Isa. Federally, the health service area is largely within the federal electoral The health service also auspices a bush nursing division of Maranoa, with Boulia falling within the service in Jericho, operating three days per week, federal electoral division of Kennedy.2 which is funded by the Commonwealth and State Home and Community Care program. Regional visiting services All hospital and primary health centres are supported by visiting community, allied and mental health services based in Longreach, providing outreach support for managing chronic disease,

1 Queensland Regional Profile for Central West Health Region, Government Statistician, July 2013. 2 Australian Electoral Commission, www.aec.gov.au/profiles/ 3 Queensland Regional Profile for Central West Health Region, index.htm Government Statistician, Queensland Government July 2013.

4 Central West Hospital and Health Service Annual Report 2012–13 rehabilitation following hospitalisation and The health service is also responsible for community mental health case managers. Visiting maintaining the state’s health infrastructure and medical services are provided by doctors from the undertaking minor capital works. region’s hospitals or the RFDS. Allied health services Central West Health’s Strategic Plan 2012–16 are also provided through the Medicare Local. outlines the board’s vision and strategic objectives Telehealth for the delivery of healthcare in the central west. The plan aligns with the government’s health priorities All sites are equipped to support telehealth for revitalising services for patients, focusing consultations to enable clinicians and consumers resources on frontline services and restoring to speak with a general practitioner, consult a accountability and confidence in the health system. specialist, and in each hospital, access emergency department support from the Queensland Retrieval Vision Service. Excellence in healthcare for remote Queenslanders. General practice Purpose All doctors employed by Central West Health Central West Health’s purpose is to deliver a service have rights to private practice and work in private system that keeps our residents healthy and acts practices or in medical centres operated by Central swiftly and with safety to treat ill-health. In order to West Health. This arrangement ensures that achieve this purpose, Central West Health builds communities of the central west continue to have partnerships to enhance coordination efforts and access to community general practice services. embrace technologies that will promote its vision. 2.1 Agency role and main functions Values The values that guide our behaviours and practices The service agreement between the Central West and hold us accountable to our community are: Health and the Department of Health identifies • quality and safety first the healthcare services to be provided, the • respect, care and compassion for our patients funding arrangements for those services and the and staff performance indicators and targets required to • innovation and change, always striving to ensure the identified outputs and outcomes are improve being achieved. • professionalism and integrity, being open, fair Section 19 of the Hospital and Health Boards Act and honest 2011 sets out the main functions of a health service • connection with our community, keeping which include: patients at the centre of what we do. • ensuring the operations of the service Central West Health’s strategic objectives for are carried out efficiently, effectively and 2012–13 were identified by the board as priority economically areas for action and were confirmed by central • complying with health service directives that west communities through consultation and apply to the health service engagement activities. These strategic priorities are • aligning heath service plans with statewide open to ongoing community consultation regarding service plans emphasis, prioritisation and future refinement. • improving the quality of health services These strategic objectives are to: delivered • developing local clinical governance • ensure patients have access to safe and high arrangements quality healthcare services • engaging with clinicians, health consumers and • sustain existing healthcare services to our local communities about the provision of health communities in a financially responsible services manner • cooperating with other providers of health • encourage innovation and the use of health services in planning for, and delivering, health technologies to improve access to specialised services services • managing service performance against the • attract and retain a skilled and motivated performance measures stated in the service healthcare workforce to meet the future needs agreement. of our communities • engage with our communities and stakeholders.

2. Overview of the Central West Hospital and Health Service 5 2.2 Operating environment meeting service delivery targets and compliance obligations and delivering a moderate operating While the infrastructure through which we deliver surplus for 2012–13. many of our healthcare services has been relatively fixed for many years, the models of healthcare and Risks and challenges the expectations of our patients and communities Central West Health’s strategic plan identifies are constantly changing. key risks and challenges for 2012–13 which are considered by the board when making decisions In common with other very remote parts of on issues such as future models of service Queensland, health services in the central west face delivery, workforce capability and infrastructure a number of challenges associated with distance requirements. and isolation, increasing levels of chronic disease, workforce retention, and providing sustainable The key risks and challenges include: services to a small and geographically remote • service demand - coal and gas resource population. development in the region is expected to add At a national level, healthcare is expected to continue significant pressure to local emergency and to be a significant component of national gross healthcare services domestic product due to the ageing population, • effective engagement – consulting with our increases in chronic diseases, co-morbidity communities, clinicians and other stakeholders complexities and health technology development. to ensure health services are effectively planned, designed and delivered On 2 August 2011, Queensland, as a member of the • health workforce – recruiting and maintaining a Council of Australian Governments (COAG), signed flexible health workforce and reducing reliance the National Health Reform Agreement committing on external staffing to major changes in the way that health services in • health infrastructure – many buildings have Australia are funded and governed. These changes serious defects and are costly to maintain in took effect from 1 July 2012 and include: order to meet compliance standards • agreed roles in managing the hospital and • effective governance – existing governance primary healthcare systems by state and federal systems need strengthening to be effective in government’s respectively monitoring performance and compliance • national funding models and national efficient • balancing the budget – strategies are needed to pricing to foster the best use of resources and sustain services and improve efficiency without sustain the health system into the future adversely impacting on standards, patient • establishing independent hospital and health safety and staff services to deliver services under a purchaser- • implementing health reform – the new provider agreement paradigm requires new relationships to be • increasing local community and clinical developed with the Minister for Health, the engagement and input to decision making Department of Health, the Medicare Local and about the planning, design and performance of regional councils. health services. The Hospital and Health Boards Act 2011 2.3 Machinery of government changes established the 17 Hospital and Health Services, Central West Health, established under the defining the role and functions of health boards and provisions of the Act on 1 July 2012, became the chief executive of the Department of Health. responsible for the delivery of health services in the It is a key expectation that the board exercise central west service area previously undertaken by financial prudence and business acumen to enable the Department of Health. Central West Health to meet the healthcare needs Section 307 of the Act permits the responsible of its communities within the funding available in Minister to make a Transfer Notice to transfer its service agreement. The board has conducted the functions, assets, liabilities, contracts and public meetings in order to listen carefully to the agreements and regulatory instruments associated community when developing the priorities for with the former health service district within the action of its strategic plan. It has committed to Department of Health to Central West Health. The leverage technologies and partnerships that would Transfer Notice also contained a lease provision best deliver healthcare services in a financially relating to the State’s interest in land and building. responsible manner. An initial Transfer Notice was made effective on In its first year of operation, the board has demonstrated the value of local leadership by 30 June 2012.

6 Central West Hospital and Health Service Annual Report 2012–13

3 The year in review

2012–13 was the foundation year for the central west. By 30 June 2013, Central West the health service, having successfully Health had reduced external staffing by 35 per cent completed the transition from a health on the previous year and delivered savings to the budget in excess of $2 million. service district within the Department of Health to becoming one of 17 The nursing workforce was augmented by increasing opportunities to attract graduate independent hospital and health services nurses, introducing them to life in the bush and in Queensland. developing their skills on their first job rotation. The establishment of Central West Health provided The strategy was boosted with additional funding central west with new opportunities to build a more from the Department of Health to assist in finding adaptive and responsive healthcare service with a work placements for 2012 graduating nurses. At focus on local decision making and performance 30 June 2013, Central West Health had employed accountability. 20 graduate nurses across its hospitals and other health service facilities. 3.1 Strategic planning and A medical workforce strategy was developed during the year to tackle barriers to the attraction and engagement retention of doctors. The strategy proposed the establishment of a new role of executive director The board launched the Central West Hospital of medical services (EDMS) to provide clinical and Health Service Strategic Plan 2012–16 in leadership, recommend changes to the medical September 2012, outlining the board’s vision workforce staffing profile, outline an aggressive for providing excellence in healthcare for remote marketing plan for recruiting doctors and commit Queenslanders. the health service to developing a pipeline for Following consultation with central west the future by supporting medical students, junior communities, the health service published its doctors and registrars. Consumer and Community Engagement Strategy The Health Service announced the appointment of 2013–15 in December 2012, outlining plans for Dr David Rimmer, as inaugural executive director enabling health consumers and local communities of medical services for the central west, in April to make informed input to decisions affecting 2013. A permanent appointment was made to their local health services. The health service also the long-vacant post of medical superintendent in published a health protocol with the Medicare Barcaldine Hospital on 1 July 2013. Central West Local that defines the ways in which the two health Health has also appointed four rural generalist bodies work together to engage communities, provisional senior medical officers to commence in develop health plans and coordinate primary February 2014, as well as a principal house officer healthcare services. at Barcaldine. Continuity of care has also been In February 2012, the health service published its enhanced through providing permanent part-time Clinician Engagement Strategy 2013–15 outlining positions with ongoing responsibility to individual how clinicians would be involved in the planning, communities. design and delivery of health services, contribute to healthcare policy and contribute to community 3.3 Better healthcare for patients understanding about safe models of care. High quality patient care was rewarded in the 3.2 Building and developing our central west with the health service receiving workforce $118,620 in clinical practice incentive payments, demonstrating improved clinical outcomes in areas The health service continued to make progress such as diabetic foot care, maternity services, towards reducing reliance on agency nurses mental health and radiology reporting. The payment and locum doctors by building a skilled clinical reflects the commitment of Central West Health’s workforce to meet the current and future needs of staff to improve patient care.

3. The year in review 7 Mothers of the central west are also receiving the 3.4 Upgrading and maintaining our highest quality of care at the region’s award winning facilities maternity service at Longreach Hospital. Central West Health’s maternity service was awarded the Improving the standard of hospital and health ‘Maternity Service of the Year’ by the College of infrastructure in the central west is a specific priority Midwives Queensland and was also a finalist in of the board with many ageing facilities requiring the ‘Promotion of Normal Birth’ category. Mothers investment to ensure the maintenance of services. also gave Central West Health’s maternity service high praise in the 2012 Queensland Consumer As part of the government’s $51 million Rural and Evaluation of Maternity Care Performance, with the Remote Infrastructure Rectification Works Program, service at Longreach Hospital being rated equal Longreach Hospital will undergo major upgrades or best facility in six of the 24 indicators. These to ensure continuing fire and electrical safety indicators included engagement with mums before compliance. The infrastructure upgrade will invest and after birth, mother’s involvement in decision $7 million and is due for completion in June 2014. making and the quality of our wards and meals. $0.9 million will also be spent on upgrading Barcaldine Hospital’s fire sprinkler system to Patients and their families have embraced the comply with fire safety standards. The upgrade is increased accessibility of telehealth services in due for completion in December 2013. the central west. Over the past 12 months, Central West Health has established a wide range of new Central West Health welcomed the additional telehealth clinics including cardiology, geriatrics, government investment of $3.2 million over four respiratory, vascular, paediatrics, orthopaedics, years to remediate back-log maintenance to haematology, maternity, hepatology, renal/urology, facilities and staff housing announced in the June rheumatology, endocrinology, general medicine 2013 State budget. These works are additional to and dermatology. These add to existing uses of $114,728 approved under the Critical Maintenance telehealth in psychiatry, pre-admission and medical and Infrastructure Works Program to renovate the retrievals. deteriorating director of nursing’s residence in Blackall and $519,291 from the Housing Upgrade Telehealth services in Central West Health have Program to renovate the doctor’s residence and increased from 477 occasions of service in 2011–12 nurse’s quarters at Winton. to 1,486 occasions in 2012–13. The expanded use of telehealth has significantly reduced the travel burden on families and patients and saved the 3.5 Accountability to the community health service in excess of $700,000 on air and road travel costs. The board is committed to engaging with local communities and has convened a number of In April 2013, the health service completed the meetings across the region to share information transfer of auspice for the Jericho Bush Nursing about the health system, the budget allocated to Service, funded by Home and Community Care Central West Health, and how the health service has (HACC), after the existing service provider withdrew performed against its targets. Communiqués are from the delivery of the service. The facility operates released to communities following meetings of the three days per week and hosts a range of outreach board to alert communities and other stakeholders primary health services and medical clinics. to the matters being discussed by the board and the The health service has also been working with local key decisions made. communities to develop a healthcare plan for the Increasingly, health performance information is Alpha-Jericho communities. The region is expected being published on the Department of Health’s to be impacted by coal mining developments which website, allowing consumers to compare the are forecast to significantly increase the resident performance of hospitals across the state. Central and fly-in workforce and place pressure on existing West Health has plans to develop its own website in health services. Central West Health is working with the future. the community, the Barcaldine Regional Council and other government agencies to explore co-location Statewide reporting of dental wait lists commenced options for the Department of Community Safety in November 2012 and showed that Central and Central West Health facilities in Alpha. West Health’s patients experienced some of the lowest wait times in the state. In May 2013, the Rural Emergency Department Information System was implemented in Longreach and Barcaldine Hospitals, enabling public reporting of emergency department performance for the first time.

8 Central West Hospital and Health Service Annual Report 2012–13

4 Our performance

4.1 Central West Hospital and Health Increases in incident reporting Service Strategic Plan 2012–16 The patient safety system aims to minimise unintended patient harm occurring as a result of the provision of healthcare services. This Strategic Objective 1: goal is reached through an understanding and Ensure patients have access to safe implementation of human factors principles, understanding weaknesses in systems and and high quality healthcare processes and developing interventions to Strategies: strengthen these weaknesses. • invest in the patient safety and quality Reporting and investigating clinical incidents and system near misses forms an integral part of risk mitigation • rigorously investigate all incidents in a and continuous improvement. Around 400 incidents timely manner and disseminate findings are reported each year with slightly higher reporting • ensure all health professionals are rates achieved in 2012–13, demonstrating Central registered and credentialed to their scope West Health has developed a sound reporting of practice. culture.

Measures of success: Cumulative incident reporting

• increased rate of incident reporting 450 • all heath professionals are credentialed for 400 their scope of practice 350 • high level of patient/consumer satisfaction 300 with healthcare. 250 200 150 Accreditation 100 50 An effective patient safety and quality system is 0 a pre-requisite for accreditation as a healthcare DecNovOctSepAugJul FebJan Mar MayApr Jun service. The system supports effective clinical July 2011–June 2012 July 2012–June 2013 governance over the clinical workforce, clinical practices, health outcomes achieved and the Incidents are analysed based on their severity records maintained for a patient. and the area of health practice affected. The most common incidents reported relate to medication Central West Health is accredited under the safety. The health service has responded to this by Australian Council on Health Care Standards introducing standard medication safety awareness (ACHS) EQuIP5. A survey (audit) was conducted training for all new graduate nurses, monitoring the by the ACHS in June 2013 which confirmed the correct use of the national inpatient medication chart unconditional accreditation of Central West Health’s and enabling patients to use their own medication hospitals and healthcare centres. which they are familiar with whilst in hospital. In 2014 Central West Health will begin the transition Only a few per cent of incidents reported each year to ACHSs new EQuIPNational program which has have a severity rating of 1 or 2 (may contribute to been developed to meet the Australian Commission the death, serious injury or temporary harm of a on Safety and Quality in Health Care’s national patient). The more severe incidents are investigated safety and quality health service standards. using root cause analysis or other investigative methods to provide independent recommendations for improvements. In 2012–13, investigations resulted in changes to the way bedside handover was conducted by involving patients in the process. The implementation of the inpatient Adult Detecting Deterioration System and inpatient Child

4. Our performance 9 Early Warning Tool also allowed for the improved Health service complaints 2012–13 detection and management of patient deterioration. 35%

Surgical safety 30% 25% The 2012 Surgical Safety Checklist Audit found that Central West Health had fully met compliance 20% requirements and exceeded targets and statewide 15% averages for sign-in, time-out and sign-out 10% observations for surgical procedures. A formal 5% audit of Longreach Hospital demonstrated that the 0% highest standards of care were being met when care Communication Administration Treatment is provided by visiting specialists. Access to services Fees / Costs Other

Practitioner credentialing Consumer evaluation of maternity care In addition to registration through the Australian Longreach Hospital fared well in the 2012 Consumer Heath Practitioner Regulation Agency (AHPRA), Evaluation of Maternity Care Survey conducted doctors, specialists, midwives and health by the Department of Health. The hospital met professionals working in Central West Health are or exceeded targets and performed above the required to demonstrate the currency of their state average. The report assesses feedback qualifications and recent practice experience to an from mothers about their overall experience, appropriately convened credentialing committee. interpersonal engagement, care during birth and after birth, level of decision making, the extent Central West Health collaborates with other health to which mother’s preferences were met and the services towards the maintenance of a central quality of the post-natal environment, including database through the Rural and Remote Clinical food and cleanliness. In six of the 24 indicators, Unit hosted by the Cape York Hospital and Health Longreach Hospital was solely or equally the best Service, which lists the scope of practice endorsed facility in Queensland. for all doctors, specialists and other health professionals. During 2012–13, all health professionals working in Central West Health were correctly credentialed.

Consumer feedback Feedback from patients is an important element in improving our services. Although every effort is made to resolve complaints informally, all formal feedback from patients is recorded in the Department of Health’s PRIME database. Complaints are generally acknowledged within 5 days, investigated and a response provided to the complainant. The total number of complaints and compliments fell in 2012–13 from 230 in 2011–12 to 183. Twenty six complaints, or 15 per cent, of total feedback were received. This included nine issues relating to limited access to healthcare, including specialists, and three issues identifying concerns with the healthcare they received.

10 Central West Hospital and Health Service Annual Report 2012–13 Multipurpose health services Strategic Objective 2: Multipurpose Health Services (MPHS) are approved Sustain existing healthcare services by the Australian Government Department of Health to our communities in a financially and Ageing (DoHA) for a period of three years. In responsible manner order to continue to receive funding, services must submit an operational plan for the next three years Strategies: and provide a report on their operation over the • support clinicians by ensuring resources are past three years. prioritised into preventative and primary Three Central West Health services completed the care contract renewal process in 2012–13 in Alpha, • develop a strategic health infrastructure Barcaldine and Winton. The contract renewal strategy to guide healthcare planning and process provides an opportunity for services to prioritising resource investment re-evaluate the need for aged care services and, • consult with the Alpha-Jericho and if justified, include a proposal for a change in the Diamantina communities to develop mix or level of flexible care places. No significant a shared service plan for the future of changes have been proposed. healthcare services • review all service models to eliminate The new agreement between the DoHA and inefficiencies and the duplication of Central West Health is due to commence on services with other health and aged care 1 October 2013. providers Alpha-Jericho service redesign • build organisational governance to strengthen performance, compliance, In consultation with the Barcaldine Regional financial capability and public Council and representatives from the two local accountability. communities, Central West Health has embarked on a planning process to underpin the redesign of Measures of success: health and aged care services available in Alpha • better resource investment through health and the nearby town of Jericho. infrastructure planning • service plans for Alpha-Jericho and The Alpha-Jericho Multipurpose Health Service Diamantina Shire provides accident and emergency care, radiology • balanced year-end budget and pharmacy services together with a 5 bed high • increase in own source revenue. care residential aged care service. Central West Health also operates a hospital based ambulance with volunteer driver support from the facility. Sustaining health services Maintaining local health services is a key priority for The region has significant resource deposits and the board. there are 4 separate mining lease applications at various stages of approval. Population forecasts Hospital and healthcare services provide suggest a large fly-in fly-out workforce and a communities of the central west with 24 hour care, resident population increase of around 500 seven days per week, including acute hospitalisation, representing 48 per cent growth by 2026.4 emergency department and associated radiology, pharmacy and allied health services. Where a Government agencies are exploring a council patient’s care needs extend beyond the clinical submission to co-locate health and community service capability of the facility at which they present, safety services in purpose built facilities in Alpha. patients are referred to a higher level of facility in the Planning health services in partnership service area, or if necessary, for evacuation. Central West Health and the Medicare Local entered In 2012–13 Central West Health was contracted to into a health protocol committing both agencies provide 4,272 weighted activity units, which is a to collaborate in health service planning and standardised measure of activity reflecting the cost engagement with communities. The health protocol and complexity of different health interventions. was completed in December 2012 and has been Actual activity achieved for the year was 4,229 published on the Department of Health’s website. representing less than a 1 per cent variation. From 1 April 2013, the health service also became the auspice body for the Home and Community Care funded Jericho Bush Nursing Service. The transfer ensured continuing access to nursing care to 4 Central West Hospital and Health Service Population residents in Jericho. and Activity Baseline Paper, Policy and Planning Branch, Department of Health, July 2013

4. Our performance 11 A collaboration is being formed to include Central West Health, the Medicare Local, the RFDS and Strategic Objective 3: representatives of the seven regional and shire Encourage innovation and the use councils in order to commence health planning of health technologies to improve across the service area in the second half of 2013–14. access to specialised services Strategies: Infrastructure planning • expand telehealth services A large number of health facilities in the central • re-establish specialist cardiac services and west were built more than fifty years ago, are in poor establish new services in areas of high condition and would fail to meet current design patient travel standards. • improve coordination of referrals to The board engaged Carramar Consulting to enhance patient care and reduce undertake a strategic asset investigation and re-presentation prepare an infrastructure strategy to identify • increase patient transport aid. building renewal priorities and guide maintenance Measures of success: investment over the next five years. The study is • double telehealth clinics expected to be concluded in August 2013. • telehealth cardiac clinics established across the health service Infrastructure rectification works • reduce patient transports by 10 per cent. Major rectification works were commissioned by the Queensland Government during 2012–13, allocating $7 million towards fire and electrical Expanding telehealth services safety works in Longreach Hospital and additional It has long been recognised that rural and remote funds to upgrade fire sprinkler systems at the Queenslanders face significant access barriers to Barcaldine Hospital. routine specialist and other healthcare services. In the June 2013 State Budget, the government Over the past 12 months, Central West Health has allocated $247 million over 4 years towards backlog opened access to a wide range of new telehealth maintenance works across Queensland, matched clinics including cardiology, geriatrics, respiratory, with $80 million by hospital and health services. vascular, paediatrics, orthopaedics, haematology, Central West Health has been allocated $3.2 million maternity, hepatology, renal/urology, rheumatology, with the investment commencing in July 2013. endocrinology, general medicine and dermatology. These add to existing uses of telehealth in Fiscal repair psychiatry, pre-admission and medical retrievals. The government’s 2012 budget delivered a Telehealth services in Central West Health have comprehensive response to the Independent increased from 477 occasions of service in 2011–12 Commission of Audit and included substantial to 1,486 occasions in 2012–13. An additional ten expenditure and revenue measures. telehealth units have been installed over the year, Central West Health’s budget position, in line with ensuring all sites have access to telehealth facilities. other hospital and health services, required a focus on finding better ways to deliver services, It is estimated that the use of telehealth has reduce unnecessary costs and increase own- source reduced the travel burden on families and patients revenue. and saved an estimated $0.8 million on air and road travel costs. Budget strategies targeted avoidable use of external staffing and building sustainability into each of the Patient and family feedback for telehealth has been health services and programs provided. overwhelmingly positive. In 2012–13, Central West Health delivered cost Increase to patient travel assistance savings of more than $2.7 million from contractors, The government‘s election commitments in 2012 advertising, staff travel and consultants and included the doubling of patient transport and improved revenue collecting from private patient accommodation subsidies, representing the first fees by around $0.7 million. major increase in travel subsidies in over a decade. Whilst further budget contraction is expected in From January 2013, accommodation rates have 2013–14, the board is confident measures to increased to $60 per night and vehicle mileage replace locum doctors and agency nurses with rates were doubled to 30 cents per kilometre. These permanent health staff will deliver the required cost changes have reduced the cost burden on patients reductions. accessing specialist services.

12 Central West Hospital and Health Service Annual Report 2012–13 Central West Health aims to ensure all eligible patients accessing eligible specialist services are Strategic Objective 4: provided information and assistance to access Attract and retain a skilled and these subsidies. motivated healthcare workforce to Notwithstanding the doubling of subsidies, overall meet our communities future needs patient travel costs only rose by 14 per cent in 2012–13, reflecting the saving from the availability Strategies: of telehealth services. • develop a recruitment strategy to address health workforce shortages Enhancing specialist services • Involve staff in the planning, design and Central West Health commenced the development delivery of services of a strategy for specialist services aimed at building • establish a culture that promotes and new patient pathways with specialists offering both encourages innovation, leadership and visiting services and telehealth consultations. The collaboration strategy will leverage the new Rural Health Outreach • improve the ‘liveability’ of staff housing. Fund administered by CheckUP Queensland. Measures of success: Central West Health also re-established the • 50 per cent reduction in external staffing Indigenous Cardiac Outreach Program which levels provides visiting cardiac assessment to • high level of staff satisfaction communities throughout the central west in • a leadership strategy is developed. partnership with the region’s general practices.

Improving clinical information systems Strategic plan for medical workforce Increasingly, improvement in patient healthcare The shortage of doctors working in the bush is well requires the operation of effective information documented. Factors include professional isolation, systems. excessive on-call demand, the absence of reliable relief, poor community infrastructure, lack of a Central West Health uses a suite of patient and career pathway and family. The current situation has clinical management systems made available left many rural communities reliant on irregular fly-in through the Department of Health. This ensures fly-out locum doctors. patients’ health records are visible across the public health system to support their healthcare. Although Central West Health operates under a multi-disciplinary model with many nurse-led During 2012–13, Central West Health invested clinics, medical practitioners provide the clinical in increasing the use and functionality of these oversight and leadership needed in both hospital systems to support best practice clinical care and and primary health settings. facilitate service improvements and performance. Tackling the workforce challenge required a re- The Viewer was implemented to enable clinicians to think about how Central West Health recruited and see a patients’ health information that resides on employed doctors. The concept of working as a several individual databases, including pathology, single service-wide, mutually supportive medical radiology, and inpatient care. group has the potential to turn around negative A scheduling feature was configured to enable perceptions about the rewards of a career serving specialist and telehealth clinic lists to be created, the needs of rural communities. supporting patient appointments and providing The board approved plans to establish additional visibility of relevant waitlists. medical positions and increasingly engage salaried The emergency department information system senior doctors. An aggressive marketing plan was was implemented in Longreach and Barcaldine developed to demonstrate the attraction of working to monitor the assessment and treatment of in the central west and contracts were established emergency room presentations and enable online with placement agencies to source permanent hospital performance reporting. Planning is doctors. underway to add Winton and Blackall Hospitals in The final element of the plan was achieved with the late 2013. appointment of central west’s first executive director Longreach Hospital also implemented the operating of medical services, providing clinical leadership room management information system which will locally and engagement with the wider medical strengthen patient safety and streamline patient community and professional training bodies. administration and discharge.

4. Our performance 13 The results are starting to show with the Safety in the workplace appointment of a permanent medical The workplace safety system aims to ensure a superintendent in Barcaldine, a senior resident safe and productive workplace for all. The system medical officer in Longreach and at least four rural involves awareness raising, regular workplace generalists who will commence the final phase of assessment and audits, incident reporting, risk their professional training as rural generalists in assessment and statutory compliance reviews. Longreach in January 2014. Reporting and investigating workplace incidents Graduate nursing opportunities forms an integral part of risk mitigation and Central West Health, in collaboration with the continuous improvement. In 2012–13 there Department of Health’s Office of the Chief Nurse, were 180 workplace incidents reported. Whilst created eight part time positions to place graduating there was a 25 per cent increase on 2011–12, nurses in 2013. this demonstrates that Central West Health has developed a safe reporting culture. Graduating nurses had a bleak outlook for 2013 as economic factors reduced the usual number of The majority of incidents related to manual vacancies. Graduates are vital to the longer term handling, motor vehicle accidents and occupational succession of nurses within the health system. violence. Actions taken in response to these incidents included up-skilling nurses to become Central West Health has already developed a key patient handling trainers, arranging driver training strategy of recruiting graduating registered nurses, programs, and increasing awareness and training bringing the total to 20 graduate nurses employed about acceptable workplace behaviours. as at 30 June 2013. The additional nurses will be provided with experience, additional to the Organisational redesign roster across the health service and will cover staff The chief executive initiated an organisational leave relief later in the year. Ultimately, Central redesign program in September 2012 in West Health hopes to be able to offer permanent consultation with staff and unions. The redesign employment to those electing to remain in the bush. was aimed at clarifying accountabilities and responsibilities and devolving operational decision Reduction in external staffing costs making to ensure the agency was capable of In recent years, remote area health services have operating as an independent statutory authority. relied on agency nurses and medical locums to fill long term vacancies. Apart from the obvious The changes established regional health hubs, additional cost of this temporary workforce, there is linking smaller primary health centres to each of the a loss of continuity in managing the care needs of region’s hospitals, releasing executive managers residents. to undertake strategic planning and governance functions. During 2012–13 the health service continued to focus on recruitment planning with an emphasis The redesign was approved in December 2012 and to increase graduate and junior positions, as well has been fully implemented. as students, who would develop into the core of Clinician engagement strategy the future workforce. Establishments (required positions) in all facilities were reviewed to remove Section 40(1)(a) of the Hospital and Health Boards positions above required staffing levels. Agency Act 2011 requires each health service to produce a agreements were revised to reduce the financial clinician engagement strategy. incentives that kept staff working in agencies rather Clinicians within the health service were consulted than within the health service. in the preparation of the strategy and comment was As a result of these steps, reliance on all external sought from clinicians employed by other agencies staff fell from 32 FTE positions to 21, a reduction of working in the central west. 34 per cent. The strategy aims to provide flexible ways for These actions generated an overall saving in clinicians to contribute to patient safety and quality external labour costs of more than $2.7 million and improvement, involve clinicians in the planning, made a considerable contribution to balancing the design and delivery of healthcare services, build budget. opportunities to input to healthcare policy and support clinicians to develop skills and conduct to have access to professional development that supports best practice healthcare. The Clinician Engagement Strategy 2013–15 was published in February 2012, slightly outside the required timeframe in s313 of the Act.

14 Central West Hospital and Health Service Annual Report 2012–13 Board engagement in communities Strategic Objective 5: To ensure the board was accessible to communities Engage with our community and and stakeholders, the board resolved to convene stakeholders its meetings in locations around the central west. This provides the opportunity for members of Strategies: local communities and local service provider • develop community and clinician representatives to meet and talk informally with the engagement strategies board. There is also scope to have items placed on • give a voice to our communities through the board’s agenda. consultation and feedback Following each board meeting, a communiqué is • be open and transparent with communities produced to outline the matters discussed and key on the activities and performance of the decisions made. The communiqué is circulated health service to stakeholders including health service staff, • build partnerships with local health and councils, local members of parliament and the aged care providers media. Copies are posted in each facility for public • collaborate with resource developers to access. contribute to the capacity of local health services Notices have recently been posted in all sites to • launch a new website. provide information about the board. ‘Getting Measures of success: to know your health board’ was inspired from community feedback about knowing who the • health service plans and engagement members of the board were and how communities strategies are published on the internet could contact the board. All enquiries are • consumers actively participating in facility able to be directed to the board secretary at meetings and direction. [email protected]. In line with the objectives of the consumer and Consumer and community engagement community engagement strategy, the board strategy commenced a program of public meetings across Section 40(1)(b) of the Hospital and Health Boards the central west to raise understanding of the Act 2011 requires each health service to produce a health system and the services received in each consumer and community engagement strategy. community. Following consultations across the region, the Meetings were held in Barcaldine, Aramac, Alpha, board published its Consumer and Community Longreach, Windorah, and Blackall involving Engagement Strategy 2013–15 in December 2012. members of these communities, local service providers and council representatives attending. The The engagement strategy adopts the International Longreach meeting was co-hosted with the Medicare Association for Public Participation core values to Local. Further meetings are planned for the remaining support open and meaningful engagement with communities in July and August 2013. health consumers and communities. The objectives of the strategy are to build Community advisory networks community understanding about healthcare Community advisory networks (CANs) have been systems, provide mechanisms for communities established in Alpha, Barcaldine and Winton where to have direct input to decision making, harness the health service operates a multipurpose health consumer feedback to improve services, and service (MPHS). ensure communities are satisfied with the level of The CANs review the operation of the integrated engagement undertaken. health and aged care services delivered in the The strategy has been welcomed by communities community, monitor policy developments, and and reflects the strong support for local input into contribute to the planning and implementation of decision making in healthcare. MPHS services. The board appreciates the important role undertaken by the CANs and is exploring establishing engagement arrangements in other communities in partnership with the Medicare Local which has established local health advisory groups in several communities. Both agencies are committed to joint engagement and collaboration.

4. Our performance 15 Health protocols 4.2 Service delivery statements In line with Section 42 of the Hospital and Health Boards Act 2011, Central West Health and Budget Paper 5 – Service Delivery Statements for the Medicare Local entered into a partnership 2012–13 outlines the strategic directions, resources agreement in December 2012. and performance standards for Central West Health, forming an integral part of the Queensland The health protocol recognises the important Government’s annual budget plan. relationship between the two health agencies in providing comprehensive primary and acute During 2012–13, Central West Health’s activity healthcare to the central west. The protocol sets performance targets were corrected to better match out action to build collaboration, undertake joint the annual budget allocation for the year from 4,945 community engagement and healthcare planning, to 4,272 weighted activity units. improve information sharing and enhance services Actual activity achieved for the year was 4,229 in the region, including out of hours care. representing less than a 1 per cent variation. The board plans to develop a similar agreement Outpatient activity was expected to decline as with the RFDS over the next 12 months. the capacity of general practices in the region has increased. This is anticipated to decline further in 2013–14. Community (ambulatory) mental health service contacts almost doubled the target completing 3,938 contacts, reflecting the stabilisation of the mental health workforce and growing community need. Central West Health did not have National Emergency Access Targets (NEAT) and National Elective Surgery Targets (NEST) in 2012–13. Many rural hospitals lack the information systems to track emergency department wait times and generally patients experience very prompt attention. However, in May 2013, the Rural Emergency Department Information System was implemented in Longreach and Barcaldine Hospitals, enabling future public reporting of emergency department performance. Elective surgery is performed by visiting specialists who maintain wait lists for their patients.

Performance statement Central West 2012–13 2012–13 2012–13 Hospital and Target/ Adjusted Actual Health Service Est Total weighted activity units: Inpatients 1,483 1,286 1,217 (including critical care) Outpatients 1,529 1,463 1,321 Sub acute 314 220 297 Emergency 1,556 1,263 1,326 Department Mental health 63 40 68 Number of 1,984 1,984 3,938 ambulatory service contacts (mental health)

16 Central West Hospital and Health Service Annual Report 2012–13 MOHRI target Central West Health has established mechanisms Central West Health operated within the Minimum engage with Aboriginal and Torres Strait Islander Obligatory Human Resource Information (MOHRI) communities and attends the twice annual sitting of staffing targets approved within its service the Barcaldine Negotiation Table. The health service agreement with the Department of Health. During also supports Indigenous leaders in convening a 2012–13, the MOHRI full time equivalent staffing health and well-being committee to explore cultural target was increased from 277 to 310 as a result of safety and health outcome improvements to health the purchase of additional services and the transfer services. functions from the Department of Health to Central Further data relating to Central West Health’s West Health. reporting against the core outcomes for the Queensland Multicultural Action Plan 2011–14 is Central West 2012–13 2012–13 2012–13 accessible through the Queensland Government’s Hospital and Target/ Adjusted Actual open data website. Health Service Est 277 310 293 Mental health action plan The Queensland Plan for Mental Health 2007–17 4.3 Other plans and measures was developed utilising the framework provided by the National Mental Health Strategy and the COAG Disability action plan National Action Plan for Mental Health 2006–11. The whole of government action plan 2011–14, Priority areas under the plan are: Absolutely everybody: enabling Queenslanders • promotion, prevention, and early intervention with a disability, sets the priority areas for ensuring • improving and integrating the care system that Queenslanders with a disability have every • participation in the community opportunity to fully participate in the economic, civil • coordinating care and social life of the community. • workforce, information, quality and safety. Central West Health is committed to ensuring Central West Health’s mental health service is appropriate access to services for Queenslanders guided by the Fourth National Mental Health Plan with a disability, many of whom may present with a 2009–14, the Queensland Plan for Mental Health related chronic health condition or require support 2007–17 and the National Standards for Mental to access specialist services. Health Services 2010. The Central West Health Consumer and Community During 2012–13, Central West Health’s recovery Engagement Strategy 2013–15 was developed in program provided education and case management consideration with principles adapted from the core support to adults and children and their families to values of the International Association for Public promote wellness and prevent further deterioration Participation. The design of engagement processes of mental health, and provided in-school support includes consideration of smaller communities and to teachers and guidance officers to facilitate early supports the involvement of seniors, young people, intervention. people with a disability and Aboriginal and Torres Strait Islander people to enable all Queenslanders Several health promotion events were held around in the central west the opportunity to exercise their the region provide information, increase community rights and responsibilities. awareness of available services and to offer opportunistic screening. Central West Health recognises the need to better engage with people with a disability and their carers In-service training sessions were also held with so that they may contribute to future healthcare nursing and medical staff to increase knowledge planning and will ensure engagement strategies and clinical safety in working with clients at risk of extend to better enable this in 2013–14. suicide. The mental health program strengthened links with Multicultural action plan other local service providers provided through the The Queensland Multicultural Policy – RFDS, Anglicare, and the Medicare Local, ensuring A multicultural future for all of us – promotes the best outcomes for clients who have often a wide unity in our society and a sense of belonging range of complex needs that cannot be met by any for all Queenslanders, regardless of cultural, one service. linguistic, religious and ethnic backgrounds. The policy celebrates the traditions and values of all Work has also advanced in partnership with the Queenslanders and advances our state’s social, Medicare Local to develop an after-hours mental economic and civic identity. health orientation package for the central west, including a DVD format teaching aid.

4. Our performance 17 Closing the gap on indigenous health to develop cultural awareness and also be able to In December 2007 the Council of Australian identify clients of Aboriginal and/or Torres Strait Governments (COAG) agreed to six targets for closing Islander origin. the gap between Indigenous and non-Indigenous In 2012–13, Central West Health delivered cultural Australians. Of the six, the two health-specific practice training to 86 staff, or about one quarter targets are to close the gap in the life expectancy of all staff employed in Central West Health, in a of Aboriginal and Torres Strait Islander people variety of locations. In part, this contributed to a within a generation (by 2033); and to halve the gap further improvement in identification at hospital in mortality rates for Aboriginal and Torres Strait admission with only 9.2 per cent not stating status Islander children under five within a decade (2018). on admission this year compared with 11.8 per cent The National Partnership Agreement on Closing the last year. Gap in Indigenous Health Outcomes focuses on Health Quality and Complaints Commission evidence based priority areas within a scope agreed by all jurisdictions. These priority areas are: (HQCC) The commission was established under the Health • tackling smoking Quality and Complaints Commission Act 2006 • healthy transition to adulthood (HQCC Act). The HQCC Act gives the commission • making Indigenous health everyone’s business responsibility for monitoring quality and safety in • primary healthcare services that can deliver all public and private health services and for the • fixing the gaps and improving the patient management and review of complaints in relation to journey. health service delivery. Central West Health contributes to improving health In 2012–13, there were five new complaints to outcomes for the 997 persons who stated they were the HQCC of which four found the health service of Aboriginal or Torres Strait Islander origin at the had no case to answer and one was referred for 5 time of the 2011 Census. conciliation. As at 30 June 2013, there were two Central West Health has improved the collection complaints awaiting resolution or investigation of data pertaining to smoking habits over the past including the complaint referred for conciliation. 24 month period and has identified a 35 per cent increase in the ‘non-smoking’ population as at 30 Anti Discrimination Commission Queensland June 2012. A reduction has also been recorded in (ADCQ) the proportion of Indigenous mothers smoking prior The commission was established under the Anti- to, and during pregnancy. Discrimination Act 1991 (ADCQ Act). The legislation Health screening, education, health promotion aims to protect people in Queensland from unfair and preventive measures continue to be part of discrimination, sexual harassment and other everyday business in the central west. There has objectionable conduct and through the commission been an increase in the number of events arranged provides a means to bring a complaint and have it at local shows and in local communities, with a rise resolved. Matters not resolved in the commission in the total number of clients screened compared may be referred to the Queensland Civil and to last year. In 2012–13, 47 events were arranged Administrative Tribunal (QCAT) for hearing and screening an average of 13 clients. determination. Evidence based national guidelines recommend There were two complaints to the ADCQ in 2012–13 that type II diabetics have a dilated eye check every and one of these was referred to QCAT. At 30 June 12 months rather than every 24 months; effectively 2013, the second matter was in the process of doubling the service need. The introduction of a being referred to QCAT. local program which includes dilated retinal camera, Crime and Misconduct Commission screening tools and trained staff now delivers best- practice within local communities. This program Any matter giving rise to the potential for official initially targeted clients with type II diabetes misconduct is reported to the Crime and Misconduct however there is scope in the future to include Commission (CMC), which may elect to investigate clients with hypertension as per best-practice the matter if it is not satisfied with the agency’s guidelines. investigation. In order to provide culturally capable healthcare to In 2012–13, one matter relating to the loss of our Aboriginal and/or Torres Strait Islander patients, pharmacy medications was reported to the CMC. clients, their families and communities, staff need The matter was independently investigated with a finding that staff had no case to answer.

5 Queensland Regional Profile for Central West Health Region, Government Statistician, Queensland Government July 2013.

18 Central West Hospital and Health Service Annual Report 2012–13 Right to information The Right to Information Act 2009 (RTI Act) and the Information Privacy Act 2009 (IP Act) commenced on 1 July 2009 and are designed to provide the community with greater access to information held by the Queensland Government, its agencies and statutory authorities. Under the RTI Act, the community has a right to access information held by government unless the information is exempt from release or if released, would be contrary to the public interest. The RTI Act governs access applications that are considered ‘non personal’ in nature as they relate to the applicant. In 2012–13, four applications were processed under the RTI Act which was one more than the previous year. As all applications contain personal information relating to an individual, none of the applications were published to a public disclosure log.

Information privacy The Information Privacy Act 2009 (IP Act) governs access and amendment applications for documents that are considered ‘personal’ in nature as they relate to the applicant. It also provides the legislative basis for compliance with a modified version of the National Privacy Principles (NPPs). In addition to the NPPs, Central West Health must comply with the confidentiality provisions within the Hospital and Health Boards Act 2011. Generally, the health service supports the right of patients to see what information is held about them by a health facility or service. In 2012–13, thirty applications for access to health records were processed administratively which was three more than the previous year. If an application cannot be processed administratively it is generally referred for processing under the IP Act. In 2012–13, two applications were processed under the IP Act which was two fewer than were processed the previous year. An important component of compliance with the IP Act is the role of the Privacy and Confidentiality Contact Officer (PCCO). The PCCO provides education and resources and is available to answer queries from staff and community members. Complaints about breaches of privacy are dealt with through the complaints management system. In 2012–13, there were no complaints specifically relating to breaches of privacy or confidentiality.

4. Our performance 19 2012–13 5 financial highlights

5.1 Summary of financial performance health service largely comprise land, buildings and equipment, clinical inventories and cash and Income receivables. Liabilities comprise staffing accruals and accounts payable on hand. Central West Health’s total income received for 2012–13 was $54.4 million. This was comprised of: The net value of assets increased over 2012–13 by $3.4 million to $49.2 million and included • State Government contributions of $2.4 million in retained surpluses, $1.9 million $39.0 million. in contributed equity associated with a further • Australian Government contributions of transfer of buildings and health equipment; and an $11.6 million, largely for aged and community asset revaluation increase of $1.8 million. These care services. were offset by an equity withdrawal of $2.8 million • User charges of $3.7 million, including fees relating to non-cash depreciation expense. from aged residents, private health insurance recoveries and private practice billings. Income sources Total income was $3.3 million higher than reported 6% 1% in the 2012–13 Service Delivery Statement, User charges Other revenue despite a $0.6 million cut in national health reform 21% Commonwealth agreement funding by the Australian Government. funding The net increase was due to additional health service funding allocated by the Department of Health and a $0.7 million increase in user charges. 72% State funding Expenditure The total expenditure for 2012–13 was $52.0 million, some $0.9 million higher than reported in the 2012–13 service delivery statement. The money Key expenses was spent on: 11% 8% Other supplies Depreciation, repairs • $36.3 million for staff wages and on-costs and maintenance • $3.6 million for patient travel and retrieval 4% • $2.3 million for clinical supplies, including Clinical supplies drugs and pathology • $5.6 million on other supplies and services • $4.1 million on maintaining facilities. 7% 70% Aeromedical and Labour and Central West Health successfully implemented key patient travel consultancy budget strategies to contain growth in services costs. An overall reduction was achieved in consultant, contractor, travel and advertising Assets ($ million) expenditure of $2.7 million compared to the previous year, including $0.9 million reduction in 6% 1% Cash and receivables Inventories agency nursing costs. An estimated $0.7 million and other was also saved in patient travel costs through better 4% use of telehealth services. Plant and equipment Financial Position A machinery of government transfer occurred 43% between the Department of Health and Central Land and West Health on 1 July 2012. The net value of assets buildings transferred was $45.9 million. The assets of the

20 Central West Hospital and Health Service Annual Report 2012–13 5.2 Chief finance officer statement • Due to machinery of government changes, new functions have been transferred to Central West Section 77(2)(b) of the Financial Accountability Act Health. While there has been insufficient time to 2009 states that the chief finance officer must give assess in detail the application of appropriate to the accountable officer for each financial year, internal controls over the acquired functions, no a statement about whether the financial internal significant issues have been identified. controls for Central West Health are operating • A Department of Health assurance statement efficiently, effectively and economically. has been received to provide assurance over Based on a professional assessment of Central functions provided. These functions include West Health’s systems of internal controls and other payroll, accounts payable and information governance mechanisms, in my opinion, Central systems. West Health’s financial internal controls have • All issues and recommendations raised by operated efficiently, effectively and economically external audit functions are being rectified and: and have been presented to the audit and risk • In all material aspects, internal compliance committee. and control systems relating to the financial Based on the results of my assessment of Central management of the department have operated West Health’s financial controls and processes efficiently, effectively, and economically for the financial year ended 30 June 2013, it is my throughout the period under review. opinion that a reasonable assurance can be given • Ongoing assessments have not identified any that: significant risks that have impacted on, or • The financial records of Central West Health may impact on, Central West Health’s financial have been properly maintained throughout the management systems. period. • Central West Health’s audit and risk committee • The financial statements for the year are fairly has not identified any significant risks that have stated. impacted, or may impact, on the achievement of Central West Health’s targets and goals. Central West Health has complied with the financial requirements mandated in the Financial • No known matter or circumstance has arisen Accountability Act 2009, the Financial and subsequent to the reporting date that would Performance Management Standard 2009, and have a material effect on Central West Health’s other prescribed requirements, including internal financial position, internal control systems, risk governance policies and Australian Accounting management or fraud mitigation processes. Standards, where relevant. • Appropriate assurances have been received from external service providers undertaking services on behalf of Central West Health. ArkAeon reviewed and documented new financial processes. Melissa Schröffel IPA, BCom, MIIA, ASA Chief Finance Officer • The results of ongoing reviews of Central West Central West Hospital and Health Service Health’s operations have not disclosed any material errors, omissions or departures from internal policies.

5. Financial highlights 21 Corporate governance – 6 management and structure

6.1 Central West Hospital and Health directorships in the region, including the Board Service board and committees Chair of Remote Area Planning and Development (RAPAD) for the same five year period as he was mayor. The Hospital and Health Boards Act 2011 defines the role of the Central West He is a current director of RAPAD and the Queensland Tourism Association. Ed recently Hospital and Health Board which is to resigned from directorships of Australian Age of control the health service. The board Dinosaurs and Waltzing Matilda Centre. A keen functions under the authority of the Act racing enthusiast, Ed is also past‐president of the and the requirements of the Hospital and Winton Race Club, Chair of the North West Racing Health Boards Regulation 2012. Association and a member of the Queensland Country Racing Committee. The board consists of seven members appointed by the Governor in Council on the recommendation of Mr David Arnold (Deputy Chair) the Minister for Health. Board members are persons David Arnold is the General Manager of the Central the Minister considers to have the skills, knowledge Remote Area Planning and and experience required for a service to perform its Development (RAPAD) Board, a position he has functions effectively and efficiently. held since 2003. He is also a member of Regional Development Australia, Fitzroy and Central West. Board members Prior to his current role, David worked for the Mr Edward Warren (Chair) former Queensland Department of Primary Mr David Arnold (Deputy Chair) Industries in rural community development and Ms Jane Williams planning and environment roles. He has also Dr John Douyere been a member of the former community health Mr William Ringrose networks and community sporting groups. More Mr Bruce Scott recently David has been involved in the aged care Mr Peter Skewes sector, as the president of the Longreach Home The board members were appointed on the basis and Community Care service; a position he has of their qualifications, specialist expertise and now held for six years. capabilities, knowledge and experience. They have a combined wide range of specialist and David has a Graduate Certificate of Science in complementary skills which include demonstrated Strategic Foresight, a Bachelor of Business and an strategic capability, auditing, accounting and Associate Diploma of Applied Science. He has been financial management skills, legal expertise, clinical awarded the Longreach Shire Council Australia expertise, governance experience, community Day Administrators Award in 2004 and the Senior development and media relations skills. Sportsman of the Year in 2008. The skill mix of the board has enabled sound Jane Williams (member) governance, effective strategic planning and sound Jane Williams is a registered nurse with 19 years financial and risk management during 2012–13. experience in rural and remote health provision in Mr Edward Warren (Chair) Queensland. Jane holds qualifications in rural and remote health, nursing, midwifery, immunisation Ed Warren has strong board experience and local and rural isolated practice. Jane has an extensive knowledge of the central western Queensland range of experience in nursing and in financial region along with a background in rural planning and operational management for both clinics and and development. He served as the Mayor of community organisations. Winton Shire Council for five years from 2008–12 and as the Chair, Central West Regional Group of She commenced her career as a student nurse Local Governments. He was a councillor on the in 1986 at Rockhampton Base Hospital and was Winton Shire Council between 1997–2001 and appointed Director of Nursing for Alpha Hospital, 2004–07. Ed has also held a number of company Queensland Health in 1993. Jane is currently the

22 Central West Hospital and Health Service Annual Report 2012–13 Rural Family Support Officer for the Barcaldine Mr Bruce Scott (member) Regional Council providing support and referral for Bruce Scott owns and operates a cattle station families in Alpha, Jericho, Barcaldine, Aramac and in the . Dedicated to regional Muttaburra. She is strongly involved with the local development and rural communities, he was Mayor community and was the 2011 Citizen of the Year of Barcoo Shire for 12 years, before retiring in April for Alpha and Jericho, received a 2011 Flood Hero 2012, and is currently Chair of Desert Channels Award for work during the 2010/2011 floods and Queensland. He was formerly a director of the won the 2011 Tidy Towns Outstanding Achievers Remote Area Planning and Development (RAPAD) Award. Board. Dr John Douyere (member) His interest in improved regional and remote John Douyere is the Medical Superintendent at telecommunication services and in the Longreach Hospital and has special interest in environment, particularly renewable energy rural obstetrics, general practice, anaesthesia, and zero emissions technology, compliments dermatology and medical education. He has more his commitment to sustainable development in than 15 years experience as a general practitioner in regional and remote areas that is demonstrated by rural Queensland working with communities in Ayr, the key roles he has played in his community as Charleville, Kilcoy and Longreach. member of Cooper’s Creek Catchment Committee, Geothermal Energy Working Group, Queensland John began his professional career as a medical State Government Single Wire Earth Return (SWER) officer at Hospital before taking on a Reference Group, Central West Regional Planning role as house officer at the Cunningham Centre, and Advisory Committee, the Outback Regional Toowoomba, which provides training, education, Roads Group and the Regional Telecommunications research and support to health professionals in Independent Review Committee. rural and remote Queensland where he gained advanced skills in anaesthetics, intensive care and Mr Peter Skewes (member) obstetrics and gynaecology. Peter Skewes has 30 years professional experience He is a member of the Rural Doctors Association of as a solicitor and accountant and has served on Queensland, Australian Medical Association and local government as both Deputy Mayor of the Australian College of Rural and Remote Medicine. Blackall-Tambo Regional Council and as a councillor of the Blackall Shire Council. William Ringrose (member) He currently owns and operates a dual legal and Bill Ringrose is a chartered accountant with accounting practice, as well as being a partner extensive business experience in the areas of in the Duthie Park Grazing Company. As a local auditing, taxation, corporate governance, probity business owner and grazier, Peter also has a long and propriety. He is a partner in a chartered standing record of community service across central accounting firm based in Longreach, Queensland. western Queensland. Peter has worked with various Bill’s area of expertise is in the provision of health and arts organisations to help communities taxation advice, business services and auditing. achieve progress and development. He has a Bachelor of Commerce and is a chartered Peter’s qualifications include a Bachelor of Laws, accountant with the Institute of Chartered Graduate Diploma of Legal Practice, Bachelor of Accountants of Australia. Business, Certified Practising Accountant, Notary Bill has previously been a registered local Public and Solicitor of the Supreme Court of government auditor for the Queensland Audit Queensland and High Court of Australia. Office, which oversees public sector audit work in Queensland. During Bill’s time in his practice, he has conducted local government audits as a contract auditor for the Queensland Audit Office. He regularly travels the region and has forged strong relationships with local people to address community issues. Bill has previously held various community positions including treasurer for the Longreach Local Ambulance Committee and Longreach State School Parents and Citizens’ Association and has volunteered his skills and time for local sporting clubs and Meals on Wheels.

6. Corporate governance – management and structure 23 Appointment terms and meeting attendance Name Office Number of Initial term of Current term of meetings attended appointment appointment Mr Edward Warren Chair 11 of 12 18/05/12 – 17/05/13 18/05/13 – 17/05/16 Mr David Arnold Deputy Chair 10 of 12 29/06/12 – 17/05/13 18/05/13 – 17/05/16 Ms Jane Williams Member 12 of 12 29/06/12 – 17/05/13 18/05/13 – 17/05/16 Dr John Douyere Member 5 of 9 07/09/12 – 17/05/13 18/05/13 – 17/05/16 Mr Bill Ringrose Member 10 of 12 29/06/12 – 17/05/13 18/05/13 – 17/05/16 Mr Bruce Scott Member 8 of 9 07/09/12 – 17/05/13 18/05/13 – 17/05/16 Mr Peter Skewes Member 12 of 12 29/06/12 – 17/05/13 18/05/13 – 17/05/16

The Governor in Council approves the remuneration Audit and risk committee arrangements for Hospital and Health Service The purpose of the audit and risk committee board chairs, deputy chairs and members. Chairs, is prescribed in regulation 31 of the Hospital deputy chairs and members are paid an annual and Health Boards Regulation 2012 as an audit salary consistent with the Government policy titled: committee under section 35 of the Financial and Remuneration of part-time chairs and members Performance Management Standard 2009. The of government boards, committees and statutory committee provides independent assurance and authorities, 26 February 2010. advice to the board on the health service’s risk management, internal control and compliance Committees of the board frameworks and its external accountability The Hospital and Health Boards Act 2011 and responsibilities as prescribed in the Financial Hospital and Health Boards Regulation 2012 require Accountability Act 2009, the Auditor-General Act boards to establish a range of committees to assist 2009, the Financial Accountability Regulation 2009 them in carrying out their responsibilities. Central and the Financial and Performance Management West Hospital and Health Board has established Standard 2009. The committee met five times in four committees to assist it in carrying out its 2012–13. responsibilities. Audit and risk committee members The committees are: Mr William Ringrose (Chair) • Executive committee Mr David Arnold • Audit and risk committee Dr John Douyere • Finance committee • Patient safety and quality committee. Finance committee Executive committee The finance committee is a prescribed committee under regulation 31 of the Hospital and Health The executive committee is established under Boards Regulation 2012. In accordance with section 32A of the Hospital and Health Boards Act regulation 33, the committee’s purpose is to 2011 to work with the health service chief executive provide strategic advice and recommendations to progress strategic issues identified by the board to the board regarding the efficient, effective and strengthen the relationship with the chief and economical operation of the health service executive to ensure accountability in the delivery of and the appropriateness of resource allocations services. The committee met 13 times in 2012–13. and investments. The committee met six times in Executive committee members 2012–13 and includes members of the executive management team (designated *). Mr David Arnold (Chair) Mr Edward Warren Finance committee members Mr Bruce Scott Mr Peter Skewes (Chair) Ms Jane Williams Mr William Ringrose Mr Bruce Scott Ms Lorraine Mathison* Ms Melissa Schröffel*

24 Central West Hospital and Health Service Annual Report 2012–13 Patient safety and quality committee • refocusing the executive team to provide The patient safety and quality committee is a leadership to support the board in prescribed committee under regulation 31 of the implementing the strategic plan, developing Hospital and Health Boards Regulation 2012. In service models, strengthening agency accordance with regulation 32, the committee’s governance and building the health workforce. purpose is to provide assurance and strategic Health Service Chief Executive advice to the board on matters relating to: – Michel Lok • patient safety and quality improvement, The position of health service chief executive is including accreditation Central West Health’s accountable officer and • clinical governance systems, including health responsible to the board for the implementation professional credentialing of policy and strategic direction, compliance • health partnerships and clinician engagement with legislation and healthcare standards, the • the performance and accountability of the achievement of performance targets and the health service. management of risk. The health service chief The committee met ten times in 2012–13 and has executive takes a leadership role in communicating operated in parallel with the existing management and consulting with communities, stakeholders, committee on patient safety and quality (staff health partners and staff of the central west. members designated *). Michel Lok was appointed as the Health Service Chief Executive on 30 July 2012. He has worked Patient safety and quality committee members extensively at both the commonwealth and state Ms Jane Williams (Chair) levels in healthcare planning and delivery. Prior to Dr John Douyere (Board member) taking his appointment, Michel was acting Chief Robyn Scanlan* (Patient Safety Officer – Secretary) Operating Officer and Chief Financial Officer with the David Rimmer* (EDMS) Cape York Hospital and Health Service and guided Lorraine Mathison* (EDoNMS) the former health district through national health Henry Willersdorf* (Quality Coordinator) reforms and the establishment of the independent Caroline Brown* (Infection Control Officer) health service. Karen McLellan* (DoN Longreach) Jill Mazdon* (Mental Health Team Leader) Michel has previously led the Australian Jessica Rumph* (Allied Health Team Leader) Government’s international manufacturing David Gwillim* (Senior Pharmacist) inspectorate program at the Therapeutic Goods Administration, provided strategic advice on 6.2 Related entities Australia’s research investment at the National Health and Medical Research Council, and led Central West Health does not control any other financial services and governance at several entities. commonwealth departments. He also has experience in developing Aboriginal health services and supporting the implementation of patient 6.3 Executive management team information systems. Central West Health has a small and dynamic Michel is a member of the Australian Institute of executive management team charged with the Company Directors and is a Certified Practicing responsibility of implementing the board’s strategic Accountant. plans and oversighting the performance and quality of the central west’s health services. Executive Director Medical Services – Dr David Rimmer Central West Health completed an organisational redesign process during the latter part of 2012 The position of executive director medical services aimed at aligning accountabilities and streamlining was established in April 2013 to take overall operational management. Two key features emerged responsibility for clinical governance, direct the from the realignment: medical workforce, facilitate all phases of medical staff development, manage the performance of • primary health centres were formally linked with general practices operated by the health service and their supporting hospital and formed regional provide oversight of allied health services. The role health hubs through which planning, clinical takes strategic leadership in clinical redesign and services and administrative support could be promotes the adoption of telehealth and establishes shared and maintains effective clinical business tools.

6. Corporate governance – management and structure 25 Dr David Rimmer graduated from The University of an endorsed mental health nurse and is Queensland in 1977. After 5 years of broad hospital currently undertaking a Masters in Health Service experience, he established a private general Management. practice with his brother in Toowoomba providing Lorraine was a recipient of the Premier’s Award in a wide range of services including obstetrics, Excellence for ‘Developing workplace culture of palliative care and inpatient management. excellence’ in 2009. In 1997 he moved to and pursued further training in emergency medicine, working at Mater Chief Finance Officer Private Emergency Centre for 3 years, then with – Melissa Schröffel RFDS as medical officer in Kowanyama for 3 years, The chief finance officer (CFO) is responsible for and then as emergency visiting medical practitioner promoting the efficient, effective and economic at Wesley Emergency Centre. He continued to use of resources, maintaining the internal control provide intermittent locum services for RFDS system, budget planning across the health until 2009 and since then has provided locum service and ensuring accurate and timely financial services to rural practices through Queensland reporting. The role has oversight responsibility for Country Practice’s senior reliever, predominantly to building, engineering and maintenance services Longreach. and operational services. The chief finance officer is also responsible for liaising with audit and advises He holds Fellowship of Royal Australian College of the board’s finance committee and audit and risk General Practitioners (FRACGP), Fellowship of the committee. Australian College of Rural and Remote Medicine (FACRRM) and Diploma of the Royal Australian and Melissa has over twelve years’ accounting New Zealand College of Obstetrics and Gynaecology experience across a broad range of organisations (DRANZCOG). He also holds current certificates and has previously operated her own accountancy in Emergency Management of Severe Trauma, and consultancy firm. She has extensive experience Advanced Life Support Obstetrics, Advanced in both internal and external auditing in the private Paediatric Life Support, Emergency Life Support and and public sector. Her experience in auditing has Advanced Cardiac Life Support. provided her with a diverse exposure to internal and financial controls. Melissa currently holds the Executive Director of Nursing and Midwifery position of independent audit member for the South Services – Lorraine Mathison Burnett Regional Council. The position of executive director of nursing and Melissa holds a Bachelor of Commerce, is a member midwifery services provides strategic leadership for of the Institute of Public Accountants, the Australian the nursing profession, including recruitment and Institute of Internal Auditing and is an associate retention strategies and growing the local workforce member of CPA. through training and development opportunities to expand knowledge and skills. Additionally, the Director Corporate Services role has line management responsibility for health (until 25 November 2012) services in the district and plays a key leading role in The position of director of corporate services was patient care and safety and the development of new responsible for managing the corporate functions models of care to better meet the changing health of Central West Health. This position ceased in needs of the community. December 2012 following the organisational Lorraine Mathison is a registered nurse who has redesign. worked in the healthcare industry for 32 years. Wendy held the position of director of corporate During this time she has worked in a wide variety of services until November 2012. She has 30 years services within the healthcare system. experience with the Department of Heath, in a Positions have ranged from specialist clinical variety of management and senior leadership roles nurse consultant and educator in the health and in human resources, corporate services and quality tertiary sectors to executive management positions and safety management. Wendy acted as health requiring knowledge across the fields in human service chief executive from 1 to 30 July 2012. resource management, finance, education, quality Wendy holds a Bachelor of Business HR and safety. Her specific areas of interest are Management and Management and Leadership, maternity and emergency nursing. a Diploma of Occupational Health and Safety and Lorraine holds a Masters in Advanced Clinical is a graduate member of the Australian Institute of Practice, a Graduate Certificate in Management, Company Directors and an associate member of the a Bachelor of Nursing, is an endorsed midwife, Australian Safety Institute.

26 Central West Hospital and Health Service Annual Report 2012–13 6.4 Senior management structure

The following chart outlines the senior management positions and the functions for which they hold responsibility.

Central West Hospital and Health Board

Health Service Chief Executive Michel Lok

Executive Director Executive Director Chief Medical Services Nursing and Midwifery Finance Officer Dr David Rimmer Lorraine Mathison Melissa Schröffel

Hospitals and Health Finance and Safety and quality Board secretary Services accounting

Medical services Community health Support services People and culture

Building, engineerging Occupational health General practices Indigenous health and maintenance and safety

Allied health Mental health and dental

6.5 Public Sector Ethics Act 1994 High standards of ethical behaviour are also expected of Central West Health employees. Upholding ethical standards of behaviour is a The health service works to ensure all employees priority for the board. Central West Health adheres are aware of the principles and values of ethical to the Code of Conduct (the Code) for public sector behaviour, know their obligations under the Code, agencies set out in part 4 of the Public Sector Ethics and are encouraged to take personal responsibility Act 1994. in upholding the Code. For many, these will reflect The board promulgated policies to oversight the professional obligations they have with their declaration of interests and managing conflicts of registration bodies. All employees are expected to interest and to ensure transparency of gifts and display a commitment to integrity and accountability benefits. The policy applies to all board members, in the way in which they undertake their duties. executives and staff working in Central West Health. New employees attend an orientation program Board members and executive members employed which includes a session on the Code as part of by the health service complete an annual their induction. Existing employees are similarly declaration of interests and must inform the chair expected to undertake periodic refresher training of any changes in their relevant interests over the on the Code through face to face or on-line training. year. The board chair is responsible for ensuring the The on-line training module is always available and declared conflicts are appropriately managed. At is readily utilised. the beginning of each board or committee meeting, The Code has been incorporated in health service members declare any conflict of interest, whether policies and procedures to ensure the principles actual, potential, apparent, or that appears likely of accountability, transparency, equality and to arise and manage those in consultation with the fairness guide decision making and promote ethical chair. behaviour in the workplace.

6. Corporate governance – management and structure 27 Governance – risk management 7 and accountability

The Hospital and Health Boards Act 2011 Risk management is an integral part of Central West provides that the Hospital and Health Health’s corporate governance framework. Central Services are statutory bodies under the West Health has adopted the Queensland Health Integrated Risk Management Policy Framework Financial Accountability Act 2009. based upon the Australian/New Zealand ISO The Financial Accountability Act 2009 imposes Standard 31000:2009 for risk management and has significant responsibilities on statutory bodies, implemented a risk management process. including the duty to manage the statutory body Central West Health recognises that an effective risk efficiently, effectively and economically and to management system: establish and maintain appropriate systems of internal control and risk management. • improves planning processes and focus on quality and continuity of service Central West Health is an independent statutory • reduces the likelihood of potentially costly body with seven board members appointed by ‘surprises’ the Governor in Council who have a significant • contributes to improving resource, efficiency role in providing astute leadership, setting and general performance strategic direction, financial accountability and • contributes to the development of a positive in maintaining a client focus on excellence in organisational culture healthcare for remote Queenslanders. • enhances accountability, responsibility, and Governance refers to the system, policies and decision-making. practices that ensure an organisation meets its Central West Health’s risk management process mission and objectives. Corporate governance is provides a systematic and consistent approach to the framework of rules, relationships, systems and managing risks. This process has been integrated processes within and by which authority is exercised into Central West Health’s corporate governance and controlled in organisations. It involves framework through its strong links with Central West strategic and operational planning, monitoring and Health’s strategic objectives. reporting systems, setting corporate culture and expectations and ensuring the establishment and The board’s audit and risk committee has specific implementation of risk and compliance systems to responsibility to oversight risk management and protect the integrity of the organisation, safety of assess risk threats on behalf of the board. The patients and secure the long term viability of the board’s patient safety and quality committee works health service. in conjunction with the audit and risk committee to assess clinical risks and review risk treatment, risk Central West Health has completed the transition mitigation and communication with clinicians. from a health service district and continues to build its performance and assurance systems to meet the Operationally, Central West Health has a highly governance expectations and requirements of the developed culture of patient and staff safety and board and executive. quality established through a deliberate focus on team building in this area across the health service. Patient and staff safety, clinical and corporate 7.1 Risk management governance and quality activities are planned, monitored and evaluated by the patient safety and Risk is present within all organisations, including quality committee. Risk registers are maintained to in hospital and health systems. Effective risk support operational risk management, treatment management enables Central West Health to and communication, with each facility maintaining have increased confidence that it can deliver its a risk register. Identified risks that cannot be services, manage risks and threats to an acceptable managed at facility level are escalated to the health degree and make informed decisions about the service’s risk register for review by the board’s opportunities and challenges that risks create. patient safety and quality committee and audit and risk committee.

28 Central West Hospital and Health Service Annual Report 2012–13 7.2 External scrutiny The QAO has completed its examination of the 2012–13 financial statements and its opinion is The Queensland Audit Office (QAO) tabled an contained in this report. interim performance audit, the first of two reports, The audit and risk committee reviewed and of the right of private practice arrangements in the endorsed the QAO audit strategy and met with QAO public health system. The purpose of the audit officials regularly during the audit engagement was to examine whether the intended health and period for the audit of Central West Health financial financial benefits of the scheme were being realised statements in 2012–13. and administered effectively. Whilst Central West Health was not specifically 7.4 Internal audit examined in the audit, the observations and findings of the audit, and the government’s The Financial and Performance Management response, are of relevance in relation to the Standard 2009 requires that a statutory body have administration of private practice arrangements in an internal audit function if directed by the Minister, the central west and the remuneration framework or if the statutory body considers it is appropriate to for doctors engaged by the health service. establish the function (s29). Central West Health has not established an internal 7.3 Audit committee audit function and was not directed to do so by the Minister. As required under Section 35 of the Financial and Performance Management Standard 2009, The board’s audit and risk committee recognises Central West Health has an established audit and the importance of a robust internal audit function risk committee with direct responsibility to the and has resolved to establish a unit to identify board. Regulation 31 of the Hospital and Health and improve the efficiency, effectiveness and Boards Regulation 2012 requires that each health compliance of the health service. service establish an audit committee with functions outlined in regulation 34. 7.5 Information systems and record The Central West Health audit and risk committee keeping meets at least four times each year to provide independent assurance and advice to the board on: Under the Public Records Act 2002, Central West Health is regarded as a separate public authority • the health service’s risk management, internal with responsibility for managing records in its control and compliance frameworks health service. These responsibilities include: • the health service’s external accountability • ensuring that full and accurate records are responsibilities as prescribed in the Financial made and kept of Hospital and Health Service Accountability Act 2009, Financial and (HHS) activities Performance Management Standard 2009 and the Auditor-General Act 2009, including the • having regard for the policies, standards and preparation and certification of the annual guidelines issued by the state archivist about financial statements. the making and keeping of public records. The chair of the committee is a principal of an During 2012–13, Central West Health completed the accounting practice in the central west, holds transfer of all medical and administrative records professional accounting qualifications and has from the Department of Health following machinery relevant experience in the audit of government of government changes to implement national agencies. health reforms. The health service chief executive and chief finance The health service also continued to implement the officer attend audit and risk committee meetings to Business Classification System for the codification assist members with their enquiries and respond to and naming of official records and has continued requests. to provide training and support to staff to give administrative effect to the system. Implementation The Queensland Audit Office is Central West of records policy and systems is the responsibility of Health’s external auditor. The external audit function aims to promote public sector the manager of executive services. accountability to the Queensland Parliament Central West Health will explore the implementation and assist the board to improve operations in an of an electronic document records management efficient and economical manner. system in 2013–14.

7. Governance – risk management and accountability 29

8 Governance – human resources

8.1 Workforce overview More than nine per cent of Central West Health’s operational staff identify as being an Aboriginal Central West Health is a major employer and/or Torres Strait Islander person, as do more in the region and an integral part of the than five per cent of administrative staff and three per cent of nursing staff. communities in which it operates. Maintaining a skilled and committed frontline 8.2 Workforce governance workforce is vital to supporting communities maintain good health and respond to emergencies The executive management team is responsible when they occur. to the health service chief executive for the development and performance of Central West Central West Health employs more than 350 Health’s workforce. The team is supported by a employees, which includes doctors, nurses, staff development and education workgroup and health professionals and support staff across an occupational health and safety committee. It the region, the vast majority performing frontline engages the clinical workforce through a medical roles delivering health services and supporting advisory committee and directors of nursing forum. patient care. Nurses and operational support staff represented the largest employment groups at The health service chief executive reports to 45 per cent and 30 per cent of the total workforce the board regarding the status of the health respectively. workforce, compliance with the requirements the service agreement, key performance indicators for Full time equivalent (FTE) staffing 2012–13 occupational health and the workforce and progress 160 on the delivery of the workforce plan. 140

120 The health service has complied with all relevant

100 obligations owed to health service employees under relevant legislation, directives, policies and 80 industrial instruments applicable. Health service 60 employees remain employees of the Department 40 of Health until Central West Health becomes a 20 prescribed employer in accordance with section 0 Nursing Operational Medical Health Administration 20(4) of the Hospital and Health Boards Act 2011. and trades professional The health service chief executive has issued External Internal human resource management sub-delegations in Total full-time staffing numbers fell from 322 accordance with section 46 of the Act, which have in 2011–12 to 314 in 2012–13 as the health been reviewed and updated twice during the year. service worked to improve roster management Being spread over such a vast geographic area, and focus resources to frontline operations. Over Central West Health operates under a devolved the same period, external staffing fell from 32 model of workforce oversight and decision full time equivalents to 21, a reduction of 34 per making processes to ensure staff are provided cent, reflecting improvements to recruitment and with appropriate local guidance and performance retention. management. During 2012, the health service Women represented 85 per cent of central west completed an organisational redesign to re-align staff, occupying most of the frontline positions. responsibilities and clarify accountabilities and Women were far more likely to be employed on formally establishing regional health hubs to make a part time or casual basis to balance work and local clinical and operational decisions, consistent family, with women working on average 62 hours with approved delegations. per fortnight compared to 70 hours for men. The health service has established a small people 8.3 per cent of the central west population and culture team that provide services and support has identified as being an Aboriginal and/or Torres to management and staff in implementing the Strait Islander Australian. health service’s vision and values.

30 Central West Hospital and Health Service Annual Report 2012–13 The main functions of the people and culture team prospectus was developed to ‘talk’ to doctors and are to: other health professionals about working in the bush and training and support elements were built • ensure that contemporary and strategic into the model to support interest under the rural frameworks, policies and systems are generalist program. The strategy, being delivered developed and implemented to align and guide through the central west’s inaugural executive the delivery of people management. The Central director of medical services, has made a promising West Health workforce plan 2012–13 supports start with at least six new doctors due to commence the work of the team. by February 2014. • provide a range or personnel services to support Central West Health works in partnership with effective workplace management practices, Rockhampton Recruitment unit of the Central assist with recruitment and complex case Queensland Hospital and Health Service to ensure management, coordinate advice on industrial recruitment processes meet the requirements of and workplace reform, and oversight payroll health service directives and policy. Rockhampton and recruitment services provided by Central assists applicants and employees with all phases of Queensland Hospital and Health Service under the employment process, including pre-employment a separate service agreement. and police checks. Central West Health retains responsibility for identifying the recruitment strategy 8.3 Workforce planning, attraction and for vacancies, developing suitable job descriptions retention and performance and completing all stages of the selection process. In 2012–13: Recruitment and retention of a professional health workforce represents one of the health service’s • 38 permanent recruitment processes were major challenges. Historical reliance on an external undertaken workforce of agency nurses and locum doctors has • 28 positions were filled resulted in poor workforce development, loss of • the average time to fill an advertised position continuity of care to the patient and significantly was 50 days. higher labour costs. Turnover rates in 2012–13 were highest in medical and nursing streams, 29 per cent 8.4 Training and development and 18 per cent respectively, due to the reliance on external staffing. Training and development of the health workforce In early 2012, action was taken to develop and is a cornerstone for the delivery of high quality, safe implement a Central West Health workforce plan and patient centred care. 2012–13. The plan identified the barriers to All health staff are required to maintain their attraction and retention and built strategies to professional skills and competencies in line with redesign service models, promote the profile of their registration requirements with the Australian working in the bush, improve recruitment planning Health Professionals Regulatory Agency and their and develop a future workforce pipeline by credentialing and scope of practice. Staff complete supplying students and graduates. an annual performance and development plan The results have seen a substantial reduction in with their supervisor to identify training needs external staffing and an over-subscription to most and monitor compliance with mandatory training vacancies. The central west is now regarded as a obligations. A nurse educator is employed within place providing an opportunity to start a career and the region to conduct professional training to develop rural generalist skills on a number of programs and support graduate nurses through training pathways. The health service has a positive their first year rotations. perception amongst prospective candidates. Professional development and career management In late 2012, Central West Health commenced an is guided by the executive leadership team for each aggressive program to tackle the largely transient of the health streams as well as for administration locum medical workforce. The medical workforce and operational staff. strategy was based on a review of the medical Central West Health’s people and culture unit offers workforce model and resulted in changes to the a variety of training and development opportunities structure and support arrangements, moving for managers and employees including: towards a single regional medical workforce model. Professional employment agencies were engaged • recruitment and selection training to recruit permanent doctors, an employment • rerformance and development training for managers

8. Governance – human resources 31 • understanding the position occupancy report • performance and development information session for employees • developing and maintaining a supportive and safe workplace culture • resolving informal complaints at the local level • performance management • human resource training for managers and supervisors. The people and culture unit also provides a range of occupational health and safety training opportunities, including on manual handling and managing aggressive behaviours. District orientation is held on the first Monday of every month. 50 new employees attended these sessions in 2012–13. Central West Health continued to implement the Queensland Health Aboriginal and Torres Strait Islander Cultural Capability Framework. 86 staff attended training sessions in 2012–13 to build their cross-cultural knowledge and skills, helping to improve access to delivery of mainstream health services and programs to the Aboriginal and/or Torres Strait Islander people of the central west service area.

8.5 Early retirement, redundancy and retrenchment

A program of redundancies was implemented during 2012–13. Affected employees who did not accept an offer of a redundancy were offered case management for a set period of time, where reasonable attempts were made to find alternative employment placements. At the conclusion of this period, and where it was deemed that continued attempts of ongoing placement were no longer appropriate, employees yet to be placed were terminated and paid a retrenchment package. During the period, no employees within Central West Hospital and Health Service received either a redundancy or retrenchment package.

8.6 Voluntary separation program

A Voluntary Separation Program was undertaken during 2011–12. The program ceased during 2011–12; however, one employee received their voluntary separation package during 2012–13 at a cost of $34,238.73.

32 Central West Hospital and Health Service Annual Report 2012–13

9 Open data

The Queensland Government is committed to opening up opportunities to allow Queenslanders to develop innovative services and solutions through making more government data available to the public. The open data initiative is part of the Queensland Public Sector Renewal Program and its vision is to create the best public service in the nation, truly focused on the end customer—Queenslanders. Open data is focused on the basic or ‘raw’ data that is collected, generated and stored by government. The annual reporting requirements for reporting data on consultancies, overseas travel and the Queensland Multicultural Policy – Queensland multicultural action plan: 2011–14 are required to be reported online. Data relating to Central West Health’s reporting against these areas is accessible through the Queensland Government’s open data website.

9. Open data 33 Abbreviations

Abbreviations used throughout this report

ACHS Australian Council on Healthcare Standards AHPRA Australian Heath Practitioner Regulation Agency CAN Community Advisory Network CFO Chief finance officer COAG Council of Australian Governments DoHA Department of Health and Ageing DON Director of nursing EDMS Executive director medical services EDoNMS Executive director of nursing and midwifery services FTE Full time equivalent QGIF Queensland Government Insurance Fund GST Goods and Services Tax HACC Home and Community Care HHNA Health and Hospitals Network Act 2011 HHS Hospital and Health Service HR Human resources HSCE Health service chief executive IHPA Independent Hospital Pricing Authority KPI Key performance indicators MOHRI Minimum Obligatory Human Resource Information MORoPP Medical officer right of private practice MPHS Multipurpose health service MSRoPP Medical superintendent right of private practice NEAT National Emergency Access Target NEST National Elective Surgery Target NHFB National Health Funding Body PHC Primary healthcare centre QTC Queensland Treasury Corporation RFDS Royal Flying Doctor Service RoPP Right of private practice SMO Senior medical officer VMO Visiting medical officers WAU Weighted activity unit

34 Central West Hospital and Health Service Annual Report 2012–13 Glossary

Ambulatory care The care provided to hospital patients who are not admitted to the hospital, such as patients of emergency departments and outpatient clinics. Can also be used to refer to care provided to patients of community-based (non hospital) healthcare services. Australian Commission on Safety The Australian Commission on Safety and Quality in Health Care was and Quality in Health Care created by Health Ministers in 2006, and funded by all governments on a cost sharing basis, to lead and coordinate healthcare safety and quality improvements in Australia. Australian Council on Healthcare The Australian Council on Healthcare Standards (ACHS) is an Standards authorised accreditation agency with the Australian Commission on Safety and Quality in Health Care. The ACHS is authorised to accredit healthcare organisations to the National Safety and Quality Health Services Standards (NSQHSS). These standards form the basis of many of the accreditation programs provided by the ACHS. CheckUP CheckUP Australia is a not-for-profit industry body dedicated to advancing primary healthcare by fostering innovation and integration and working collaboratively to deliver practical solutions focused on best practice outcomes for a better primary healthcare sector and better health for all. EQuIP5 EQuIP5 is the 5th edition of the ACHS Evaluation and Quality Improvement Program and is a four-year continuous quality assessment and improvement accreditation program for healthcare organisations that supports excellence in consumer/patient care and services. EQuIPNational EQuIPNational is the four year evaluation and quality improvement accreditation program for health services to ensure a continued focus on quality across the healthcare organisation. Home and Community Care Home and Community Care provides assistance to frail older people, their carers and younger people with a disability who are at risk of premature or inappropriate admission to long term residential care to receive assistance in their own homes. Hospital and Health Service Hospital and Health Service is a separate legal entity established by the Queensland government to deliver public hospital services. Hospital and Health Services replaced the former health service districts. Indigenous Cardiac Outreach The Indigenous Cardiac Outreach Program aims to improve early Program diagnosis, management and clinical care of patients who have or are at risk of cardiovascular disease in remote Aboriginal and Torres Strait Islander communities. International Association for Public The International Association for Public Participation is the Participation preeminent international organisation advancing the practice of public participation which seeks to promote and improve the practice of public participation or community engagement, incorporating individuals, governments, institutions and other entities that affect the public interest throughout the world.

Glossary 35 National Safety and Quality Health The National Safety and Quality Health Services Standards Service Standards (NSQHSS). These standards form the basis of many of the accreditation programs provided by the Australian Council on Healthcare Standards. National Partnership Agreement This agreement was established to address targets set by the on Closing the Gap in Indigenous Council of Australian Governments and sets out specific action to be Health Outcomes taken by the Australian Government and complementary action by State/Territory governments to address the gap in health outcomes experienced by Aboriginal and Torres Strait Islander people. National Emergency Access Target The National Emergency Access Target (NEAT) is based on the proportion of patients who present to a public emergency department to be admitted, referred for treatment to another hospital or discharged within four hours. National Elective Surgery Target The National Elective Surgery Target (NEST) requires an increase in the percentage of elective surgery patients seen within the clinically recommended time. Primary care First level healthcare provided by a range of healthcare professionals in socially appropriate and accessible ways and supported by integrated referral systems. It includes health promotion, illness prevention, care of the sick, advocacy and community development. Service Delivery Statements The Service Delivery Statements form part of the suite of state budget papers and provide budgeted financial and non-financial information for the budget year. Telehealth Telehealth involves the use of telecommunications and information technology to provide access to health assessment, diagnosis, intervention, consultation, supervision and information across distance. Royal Flying Doctor Service The Royal Flying Doctor Service of Australia is a not-for-profit organisation delivering extensive primary healthcare and 24-hour emergency service to those who live, work and travel throughout Australia.

36 Central West Hospital and Health Service Annual Report 2012–13 ATTACHMENT A: Compliance checklist

Summary of requirement Basis for requirement Annual report reference Letter of A letter of compliance from the ARRs – section 8 Page 1 compliance accountable officer or statutory body to the relevant Minister Accessibility Table of contents ARRs – section 10.1 Page i Glossary Page 35 Public availability ARRs – section 10.2 Inside front cover Interpreter service statement Queensland Government Inside front Language Services Policy cover ARRs – section 10.3 Copyright notice Copyright Act 1968 Inside front cover ARRs – section 10.4 Information licensing Queensland Government Inside front Enterprise Architecture – cover Information licensing ARRs – section 10.5 General Introductory Information ARRs – section 11.1 Page 4 information Agency role and main functions ARRs – section 11.2 Page 5 Operating environment ARRs – section 11.3 Page 6 Machinery of Government changes ARRs – section 11.4 Page 6 Non-financial Government objectives for the ARRs – section 12.1 Page 2 performance community Other whole-of-government plans ARRs – section 12.2 Page 17 / specific initiatives Agency objectives and ARRs – section 12.3 Page 9 performance indicators Agency service areas, service ARRs – section 12.4 Page 17 standards and other measures Financial Summary of financial performance ARRs – section 13.1 Page 20 performance Chief finance officer (CFO) ARRs – section 13.2 Page 21 statement

Attachment A: Compliance checklist 37 Summary of requirement Basis for requirement Annual report reference Governance – Organisational structure ARRs – section 14.1 Page 27 management Executive management ARRs – section 14.2 Page 25 and structure Related entities ARRs – section 14.3 Page 25 Boards and committees ARRs – section 14.4 Page 22 Public Sector Ethics Act 1994 Public Sector Ethics Act 1994 Page 27 (section 23 and Schedule) ARRs – section 14.5 Governance Risk management ARRs – section 15.1 Page 28 – risk External Scrutiny ARRs – section 15.2 Page 29 management and Audit committee ARRs – section 15.3 Page 29 accountability Internal Audit ARRs – section 15.4 Page 29

Public Sector Renewal Program ARRs – section 15.5 Page 2

Information systems and ARRs – section 15.7 Page 29 recordkeeping Governance Workforce planning, attraction ARRs – section 16.1 Page 30 – human and retention and performance resources Early retirement, redundancy and Directive No.11/12 Page 32 retrenchment Early Retirement, Redundancy and Retrenchment ARRs – section 16.2 Voluntary Separation Program ARRs – section 16.3 Page 32

Open data Open data ARRs – section 17 Page 33

Financial Certification of financial FAA – section 62 Page 37 statements statements of the FPMS – sections 42, 43 and 50 financial ARRs – section 18.1 statements Independent Auditors Report FAA – section 62 Page 38 of the FPMS – section 50 financial ARRs – section 18.2 statements Remuneration disclosures Financial Reporting Page 35 Requirements for Queensland of the Government Agencies financial statements ARRs – section 18.3

38 Central West Hospital and Health Service Annual Report 2012–13 Central West Hospital and Health Service Financial statements for year ended 30 June 2013

Department of the Health, Queensland

2012–13 Annual Report www.health.qld.gov.au