Part B (2)

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

July 2010

“PRINTED COPIES ARE UNCONTROLLED” Endorsed by IPPEC—does not represent Queensland Health policy at this time Infrastructure Renewal Project for Rural and Remote Areas Service Profile for Biloela Hospital Paper 2, July 2010

Contents

1 Executive summary ...... 3 2 Service profile for Biloela Hospital ...... 4 2.1 Geographic profile...... 4 2.2 Demographic profile ...... 5 2.2.1 Catchment population...... 5 2.2.2 Services in the secondary catchment...... 7 2.3 Biloela Hospital...... 8 2.3.1 Hospital inpatient activity including current beds...... 9 • Current activity ...... 9 2.3.2 Projected activity ...... 10 2.4 Core services ...... 12 • Surgical and procedural ...... 12 • Maternity ...... 12 • Emergency Department ...... 13 • General medical ...... 14 • Non-admitted occasions of services...... 14 2.4.1 Visiting specialist services...... 15 • Medical Specialist Outreach Assistance Program...... 15 2.4.2 Current support services ...... 16 • Pathology ...... 16 • Medical imaging ...... 16 • Pharmacy...... 16 • Dental/oral health services...... 16 2.5 Primary health care and community health services...... 17 • Other Service Providers ...... 17 • Integrated mental health services ...... 18 • Allied health services ...... 18 3 Current and future bed requirements ...... 19 3.1 Summary of projected bed requirements ...... 19 4 References...... 20 5 List of figures and tables ...... 21

“PRINTED COPIES ARE UNCONTROLLED” Endorsed by IPPEC—does not represent Queensland Health policy at this time. 2 Infrastructure Renewal Project for Rural and Remote Areas Service Profile for Biloela Hospital Paper 2, July 2010

1 Executive summary The Infrastructure Renewal Planning Project for Rural and Remote Areas has been identified by the Deputy Premier as a priority project aimed at providing a comprehensive and prioritised health infrastructure program for rural Queensland. The need to address health inequities and access to hospitals in remote areas has also been identified by the Commonwealth Government’s National Health and Hospital Network Agreement 2010. This Service Profile for Biloela Hospital is one of 12 profiles developed for each of the Queensland prioritised rural sites. The profile identifies that the current level (draft CSCF v3.0 Level 3) and mix of clinical services provided at each site, with a focus on the core services of surgical and procedural, maternity, Emergency Department and general medical. Table 1 outlines the current and future bed requirements for Biloela Hospital. To improve the efficiency of current service delivery at Biloela Hospital, infrastructure upgrades will be required for the Emergency Department and maternity services area. In addition, an Outpatients Department is required so that services can be relocated from their current location in an unused ward. Biloela Hospital Emergency Department does not currently have an appropriate resuscitation bay or acute treatment spaces—monitored beds located in the ward are used for this purpose. The layout of the maternity services area requires improvement, and specific maternity consultation rooms and a child-friendly waiting area are needed. Infrastructure improvement to these two services would enable growing levels of emergency activity to be safely accommodated and provide an enhanced environment for women to access maternity care close to where they live. Rural hospitals rely on visiting clinicians to provide a range of specialist services. Dysfunctional layouts and insufficient treatment spaces make it difficult to attract specialists to the hospital to provide these services. Without the services provided by visiting specialists rural communities will continue to experience health inequities. Rural hospitals typically have difficulty recruiting staff, and the age and condition of accommodation provided is a major barrier to attracting and retaining a skilled workforce. If staff cannot be recruited and retained, patient access to safe and sustainable services will be compromised. Table 1: Summary of current and future bed requirements for Biloela Hospital Bed and treatment spaces Current number Number required by 2021/22 Overnight beds 25 16 Same day beds 0 2 Bed alternatives 0 0 Emergency Department 6 5 treatment spaces Multipurpose consultation rooms 0 5 + (for outpatients) 3 maternity consultation rooms

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2 Service profile for Biloela Hospital

2.1 Geographic profile Biloela Hospital is located in the Central Queensland Health Service District (the District), which extends from the central Queensland Coast west to the Central West Health Service District between Emerald and Alpha. It incorporates four distinct areas: Rockhampton, Gladstone, Banana (Biloela) and Central Highlands (Emerald). Central West Health Service District (neighbouring to the west) also flows into the District for higher level services (Figure 1). Banana The main town in the Banana area is Biloela, located 146 kilometres south of Rockhampton and 121 kilometres west of Gladstone. The rural area includes the smaller towns of Moura, Theodore and Baralaba. Figure 1: Map of Central Queensland Health Service District

Source: http://www.health.qld.gov.au/maps/mapto/centralQld.asp

According to the Australian Statistical and Geographical Categories, Biloela is classified as ‘outer regional’ with a remote area score of RA3. 1 Other areas in the District, such as Springsure and Gemfields, are classified as ‘remote’ with a remote area score of RA4. 1

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2.2 Demographic profile

2.2.1 Catchment population In 2006, approximately 56 per cent of the District population resided in the Rockhampton Base Hospital primary catchment area, 24 per cent in Gladstone, 12 per cent in Emerald and eight per cent in Biloela. Rockhampton is the main population centre, accommodating more than half of the District’s population. The second largest population centre is Gladstone and surrounds, supporting approximately one quarter of the District population. As Rockhampton Base Hospital provides a higher level of service, its secondary catchment area covers the whole of the District and includes some flows from Central West Health Service District. The proportion of District activity provided by hub sites is shown in Table 2. These proportions are a better indication of demand for services by site and for assessing distribution of resources. Table 2: Proportion of inpatient activity provided in Central Queensland Health Service District by hub hospitals 2006/07 District Hospital % Inpatient Separations Rockhampton and Yeppoon 60 Gladstone 19 Emerald 8 Biloela 3 Other District hospitals 10 Total 100

Source: Hardes Associates, May 2008 Note: Excludes Chemotherapy and Renal Dialysis

Based on the 2001 Census projections for Statistical Local Areas (SLAs), the populations of Gladstone and Emerald are expected to increase most sharply between 2006–2026 (62% and 55% respectively), with a 35 per cent increase for the Rockhampton Base Hospital catchment population and only eight per cent for the Biloela catchment. Current and projected resident population by SLA is shown in Table 3. Table 3: Estimated population in the District by SLAs (2006) and percentage projected change 2006–2026 % Change % Change SLA 2006^ 2006–2016^^ 2006–2026^^ Banana 14,224 2 5 Bauhinia 2,324 9 18 Calliope 17,538 34 73 Duaringa 7,187 20 38 Emerald 15,364 34 68 Fitzroy* 11,213 34 60 Gladstone 31,028 29 55 Livingstone 30,637 30 61 Mount Morgan 3,170 10 15 Peak Downs 3,401 18 37

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% Change % Change SLA 2006^ 2006–2016^^ 2006–2026^^ Rockhampton 62,610 11 18 Taroom – CQ Part 1,399 N/A N/A Woorabinda 928 N/A N/A Total 201,023 21 41

Source: Medium Series Population Projections, based on 2006 Census, Dept of Infrastructure & Planning (PIFU) ^ PIFU 2006 Edition, Area Grouping Created by Queensland Health ^^ PIFU, 2008 Edition, LGA boundaries. * Excludes Balance of Fitzroy SD (c) – 918 people (2006).

In 2006, the majority of residents in the District were born in Australia, with residents born in other countries mostly originating from New Zealand or the United Kingdom. In 2006, statistics indicated that 97–98 per cent of residents spoke English at home, reflecting the predominantly Australian and English-speaking population. Table 3: Estimated Aboriginal and Torres Strait Islander population in Central Queensland District 2006 Census Age Group in Years 2006 % Aboriginal and Torres Strait Islander Population 0–14 4,153 40.1 15–44 4,718 45.6 45–64 1,218 11.8 65+ 261 2.5 Total 10,350 100

Source: Office of Economic and Statistical Research (March 2008) Note: Aboriginal and Torres Strait Islander splits have been synthetically estimated and should be used with caution.

In 2006, five per cent of the District population identified as Aboriginal and Torres Strait Islander. It is a very young population, with 86 per cent of Aboriginal and Torres Strait Islander people being under 44 years and 40 per cent under 14 years and only 2.5 per cent of people over 65 years in 2006. Of that population, 4.8 per cent resided in the SLA of Banana (493 persons). In the Biloela area, the meat industry has attracted immigrants from South America, some of whom have specific health problems, including respiratory tuberculosis.

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2.2.2 Services in the secondary catchment Rockhampton Base Hospital is the main referral hospital for the District, and to some extent the Central West Health Service District. In addition to Rockhampton Base Hospital, there are three other hub hospitals that provide services for local areas of the District and some support smaller facilities within their area. These include: Gladstone, Emerald and Biloela Hospitals. Hub hospitals and smaller hospitals/outpatient clinics included in their areas are as follows: • Rockhampton Base Hospital and Yeppoon, Mount Morgan, Woorabinda, and Duaringa Outpatient Clinics • Gladstone Hospital • Emerald Hospital and Blackwater, Springsure, Clermont, Dysart, Rolleston, Middlemount, Tieri, Capella and Gemfields Outpatient Clinics • Biloela Hospital and Baralaba, Moura, Theodore, Taroom and Cracow Outpatient Clinics.

The District provides a range of hospital services and has a District-wide total self sufficiency of:

• 66 per cent for adult overnight separations • 53 per cent for adult same day separations • 61 per cent for paediatric overnight separations • 80 per cent for paediatric same day separations.

The majority of patients (90%) from the SLA of Banana, who were admitted to a hospital other than Biloela Hospital, were admitted to a hospital in Central Queensland, with a total of 3344 separations. The next highest Health Service District used by Banana residents was Metro North, with smaller numbers scattered across the state. The highest numbers of separations were for obstetrics and non-subspecialty medicine and surgery, with similar numbers for both same day and overnight separations.

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2.3 Biloela Hospital Biloela Hospital is a 25 bed facility that provides a range of general medical, low risk surgical procedures and birthing services. There are two general practitioners in Biloela who currently provide anaesthetics and obstetrics services to the Hospital. However, the District advises that one general practitioner is retiring in September and the other is reducing his general practitioner clinic to one day per week. Two locums with obstetrics and gynaecology skills are commencing employment at Biloela Hospital in July and September for six months. Clinical support services include x-ray services and simple pathology testing via iSTAT machine provided by licensed medical and nursing staff. There is a pharmacist on site at Biloela Hospital (the pharmacist position is currently filled by locum staff). There are also two private pharmacies located in town. The basis for identifying gaps in service capability against the core service profile is to secure and consolidate services provided at Biloela Hospital, identified as the primary hub service in the District. This may involve enhancing existing service roles and staffing levels to support its role in the District. The current level of service capability at Biloela Hospital is outlined in Table 4. Services provided should align with the draft CSCF v3.0 Level 3 or lower. Gaps are identified against this level of service in Table 4. Providing the minimum suite of core services aims to ensure the provision of surgical and procedural, maternity, Emergency Department and general medical services at Biloela Hospital. Table 4: Draft CSCF v3.0 service gap analysis for Biloela Hospital Current Draft CSCF CSCF Core services v3.0 Level Current services Level Gaps Emergency services 3 Emergency services 3 Medical services 3 Medical services 3 Surgical services 3 Surgical services 3 Peri-operative services 3 Peri-operative Services 3 Currently no permanent staff– services provided by locums Anaesthetics services 3 Anaesthetics services 3 Maternity services 3 Maternity services 3 Neonatal services 3 Neonatal services 3 Mental health Services 2 Mental health services 2 Rehabilitation services 3 Rehabilitation services 3 Palliative care services 2 Palliative care services 2 Pathology services 3 Pathology services 2 No laboratory on site – specimens transferred to Gladstone and Rockhampton Medical imaging 3 Medical imaging 2 No ultrasonographer services services on site – visiting service only Pharmacy services 3 Pharmacy services 3

Source: Queensland Health, February 2010

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2.3.1 Hospital inpatient activity including current beds Current activity Biloela Hospital has an annual average occupancy rate of around 40 per cent for all age services. Patients from the District account for 95.4 per cent of separations. The remaining five per cent of patients are predominantly from the Sunshine Coast–Wide Bay Health Service District. Table 5: All age activity at Biloela Hospital by separations and district of residence 2008/09 District of residence Separations %* Beddays Central Queensland 1154 95.4 3101 Sunshine Coast-Wide Bay 33 2.7 75 Other States and Overseas 7 0.6 6 Metro South 5 0.4 2 Darling Downs-West Moreton 2 0.2 4 Gold Coast 2 0.2 4 Mackay 2 0.2 2 Metro North 2 0.2 2 Townsville 1 0.1 1 South West 1 0.1 1 Mt Isa 1 0.1 0 Total 1210 100 3198

Source: Queensland Health Admitted Patient Data Collection, April 2010 *Rounded to nearest 0.1 per cent

The acute ward at Biloela Hospital is a 25 bed unit. As a hub service, Biloela Hospital should provide draft CSCF v3.0 Level 3 services. Table 6 shows the top overnight Service Related Group (SRG) in 2008/09 was obstetrics with 133 separations, closely followed by non-subspecialty medicine with 118 separations. Medical separations, including non-acute, non-subspecialty medicine and respiratory medicine, accounted for the highest number of beddays. Non-subspecialty surgery was the top same day SRG, closely followed by gynaecology and orthopaedics. As there is minimal paediatric activity at Biloela Hospital, this has been combined with the adult activity (Table 6). Table 6: Top 10 all age Service Related Groups at Biloela Hospital 2008/09 SRG Same Day SRG Overnight Separations Beddays Non-subspecialty Surgery 47 Obstetrics 133 321 Gynaecology 33 Non-subspecialty Medicine 118 371 Orthopaedics 33 Non-subspecialty Surgery 98 230 Cardiology 25 Respiratory Medicine 89 486 Ophthalmology 21 Cardiology 75 172 Non-subspecialty Medicine 19 Orthopaedics 73 238 Obstetrics 14 Gastroenterology 50 132 Neurology 11 Neurology 33 211 Urology 11 Endocrinology 25 181 Respiratory Medicine 8 Non-acute 23 265

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As shown in Table 7 and Table 8, the five year trend in all age separations for Biloela Hospital was for a slight increase (10%), whereas total beddays decreased slightly (9%). Table 7: Five year trend for separations for combined medical surgical and procedural activity (all age) at Biloela Hospital 2004/05–2008/09 % Change Separations 2004/05 2005/06 2006/07 2007/08 2008/09 Over 5 Years

All age activity 1254 1347 1007 982 1377 10

Source: Queensland Hospital Admitted Patient Data Collection, Queensland Health, Oct 2008 # Preliminary data, subject to change Note: Includes chemotherapy, renal dialysis and qualified neonates (if applicable)

Table 8: Trend in bed utilisation (beddays) for combined medical surgical and procedural activity (all age), Biloela Hospital 2004/05–2008/09 % Change Bed utilisation 2004/05 2005/06 2006/07 2007/08 2008/09 Over 5 Years

All age activity 3808 3611 3432 3952 3472 -9

Source: Queensland Hospital Admitted Patient Data Collection, Queensland Health, Oct 2008 # Preliminary data, subject to change Note: Includes chemotherapy, renal dialysis and qualified neonates

2.3.2 Projected activity In rural hospitals providing a draft CSCF v3.0 Level 3 service, beds are not designated into specific bed type categories as there are no specialist clinical units. This arrangement also provides flexibility at the local District/facility level to use beds as needed dependent on local activity. The profile of projected activity in rural hospitals is not expected to change, however, with improved infrastructure—including modernised layouts and or refurbishment of current buildings—strengthening of current services would occur. Maternity, emergency services, surgical and outpatient services could continue to grow and provide more efficient services. The bed types and treatment spaces set out in Table 20 and Table 21 reflect the categories from the More Beds for Hospitals Strategy.2 It should be noted that many of the categories outlined in the More Beds for Hospitals Strategy 2 are not applicable for rural hospitals. The projections have been calculated using aIM data and data templates developed by the Planning and Coordination Branch Statewide (Data) Team. The benchmarks and methodology used for calculating the projected bed categories are described in the Methodology Section of the Statewide Implications for Rural Service Provision. Biloela Hospital currently has 25 multi-purpose overnight beds, which are sufficient to meet activity requirements until 2021/22. Projections indicate that by 2021/22, 16 overnight beds will be required (applying an 85 per cent occupancy rate) and 19 overnight beds (applying a 70 per cent occupancy rate). Currently, there are no same day beds, but it is projected that two will be required by 2011/12, with no further increase to 2021/22. There are currently no designated Stage 2 recovery chairs at Biloela Hospital as ward beds are utilised for this purpose.

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Unlike inpatient activity, detailed projections are not available for Emergency Department activity. As a result, future emergency demand has been assessed using current activity data by facility, projected population growth and an application of previous trends in activity. While the current number of Emergency Department treatment spaces is sufficient up to 2021/22, the current Emergency Department at Biloela Hospital does not have an appropriate resuscitation bay or acute treatment spaces—monitored beds located in the ward are used for this purpose. Biloela Hospital also requires an isolation/decontamination room and psychiatric treatment space. There is currently no defined Outpatient Department—an unused ward is utilised for this purpose—so there are no designated outpatient consultant rooms. A minimum of five consultation rooms are required to meet demand for visiting specialist outpatient clinics up to 2021/22. Biloela Hospital currently has one Operating Theatre, which is sufficient to meet needs up to 2021/22 based on current activity levels. Using the Victorian Normative Benchmarks, Biloela Hospital currently requires an additional Stage 1 recovery bay. Biloela Hospital has sufficient delivery and treatment suites to meed expected demand up to 2021/22. However, three maternity consultation rooms, a multipurpose/staff/education room and a child-friendly waiting area are currently required. Table 9 details total birth projected for residents of the District, regardless of where the birth takes place. It is estimated that Central Queensland will account for 5.3 to 5.5 per cent of total births (4387) in Queensland during the period of 2005/06 and 2021/22. Total births for the Central Queensland Health Service District as a district of residence are projected to increase significantly (107%) by 2021. The primary catchment area for Biloela Hospital is the Banana Statistical Local Area (SLA). Projections for the Banana SLA estimate there will be 259 births in 2021/22. There is expected to be a 21 per cent increase in births at Biloela between 2007/08 and 2021/22. Table 9: Current and projected births 2007/08–2021/22 % of change 2007/08 2011/12 2016/17 2021/22 2007/08–2021/22 Total births for the Central Queensland Health Service 2120 3650 4080 4387 107 District as a district of residence Biloela 214 236 258 259 21 (including Banana SLA)^

Source: Queensland Hospital Admitted Patient Data Collection, April 2010 ^Projections developed by Office of Economic and Statistical Research (OESR) using Perinatal Data Collection and SLA using high series birth projections

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2.4 Core services Outlined below is a description of the four core services provided at Biloela Hospital: surgical and procedural, maternity, Emergency Department and general medical. Surgical and procedural Biloela Hospital provides surgical and procedural services at a draft CSCF v3.0 Level 3 service. In rural hospitals, allowance must be made for adequate bed numbers to accommodate scheduling and case numbers on the theatre list on the days specialists visit. Currently, Biloela Hospital uses its overnight beds for day surgery admissions as there are no Stage 2 recovery chairs. In 2008/09, gynaecology (same day activity) and obstetrics (overnight activity) accounted for the highest number of surgical separations at Biloela Hospital. Obstetrics also accounted for the highest number of beddays, with an average length of stay of three days. Table 10: Top 10 surgical and procedural Service Related Groups same day and overnight for Biloela Hospital for 2008/09 Same Day Overnight Surgical and procedural SRGs Separations Separations Beddays Obstetrics - 28 83 Plastic and Reconstructive Surgery 7 11 38 Non-subspecialty Surgery 5 7 22 Colorectal Surgery - 6 11 Ophthalmology 17 9 9 Gynaecology 24 7 8 Vascular Surgery - 1 8 Urology 3 2 7 Extensive Burns - 1 2

Source: Queensland Hospital Admitted Patient Data Collection, Queensland Health, April 2010

Maternity In the District, 98 per cent of births occur at Rockhampton, Gladstone, Emerald or Biloela Hospitals, with 80 per cent being at Rockhampton or Gladstone Hospitals. Biloela has the least births per year amongst the hub hospitals, with around 130–150 per year. The Maternity Unit at Rockhampton Base Hospital is the main hub for obstetrics in the District, supporting lower level services at Gladstone, Emerald and Biloela. Maternity services are provided at Rockhampton Base Hospital for low, medium and high risk pregnancies and deliveries for 32 weeks gestation or later. Biloela Hospital had on average 137 births per year between 2003/04–2007/08, and received women from outlying towns of Moura, Baralaba, Theodore, Monto and Taroom (Table 11).

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Table 11: Births at Biloela Hospital 2003/04–2007/08 2003/04 2004/05 2005/06 2006/07 2007/08^ Births 140 131 143 151 120

Source: Perinatal Data Collection, Queensland Health, October 2008 ^Data for July-Dec 07 extrapolated to full year.

Based on current patterns of use by 2021, 56 per cent of births will be at Rockhampton Base Hospital (1302), 27 per cent at Gladstone (633), 12 per cent at Emerald (278) and five per cent at Biloela (126). The average length of stay for caesarean sections is 4.8 days and for vaginal births is three days. Over the last five years, there has been a 59 per cent decrease in maternity outpatients at Biloela Hospital (Table 12). Table 12: Gynaecology and maternity occasions of service at Biloela Hospital 2004/05–2008/09 Clinics 2004/05 2005/06 2006/07 2007/08 2008/09 Gynaecology 129 124 92 107 67 Maternity 231 48 7 138 94

Source: Queensland Hospital Admitted Patient Data Collection, Queensland Health, April 2010

Paediatrics Monthly paediatric outreach clinics are conducted at Woorabinda, Emerald, Biloela and Yeppoon, supplemented by telehealth consultancy advice. Paediatric activity is low, with the total number of beddays for 2008/09 at 173, including both same day and overnight separations. Only one bed will be required to manage future paediatrics activity at Biloela Hospital based on current activity. Emergency Department Overall, emergency activity at Rockhampton, Gladstone, Emerald and Biloela Hospitals has increased by 11 per cent over the past five years. The total number of Emergency Department presentations at Biloela Hospital has increased by 17 per cent in the period between 2004/05 and 2008/09 (Table 13). This is despite the fact that Biloela Hospital does not have a functional Emergency Department. Monitored beds in the ward are currently used as a resuscitation treatment space. The other acute treatment spaces are also dysfunctional as there is inadequate space to manoeuvre trolleys. In the period 2004/05 to 2008/09, the majority of Emergency Department activity was for Triage Categories 4–5 (approximately 75% of all Emergency Department activity) and there was a slight increase in activity for Triage Categories 1–5. During this period the number of patients admitted and transferred decreased by 55 per cent (Table 13). Where percentages do not total 100 per cent, this is due to patients who did not wait for treatment for reasons unknown (these patients are reflected in Table 13).

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Table 13: Percentage of Emergency Department presentations admitted/transferred, Biloela Hospital 2004/05–2008/09 % Change Presentations 2004/05 2005/06 2006/07 2007/08 2008/09 Over 5 Years Total number of 4000 3440 3357 4324 4676 17 Presentations % of admitted transferred 20 15 12 15 9 -55 % of Triage Categories 1– 7 7 13 9 13 86 3 % of Triage Categories 4– 72 78 74 76 77 7 5

Source: Queensland Hospital Admitted Patient Data Collection, Queensland Health, April 2010

General medical General medical services at Biloela Hospital are routinely provided by nursing, medical (general practitioner and senior medical officers) and allied health staff. In addition, there are visiting medical specialists who provide services on a regular basis. Between the years 2004/05 and 2008/09, utilisation of beds for non-acute activity at Biloela Hospital increased slightly (10%), the number of beddays decreased by 21 per cent during this period. This follows significant peaks in activity for the years 2005/06 to 2007/08 (685 and 603 bed days respectively), which may be due to the change in workforce or availability of aged care beds. There was no same day activity recorded for non-acute care. Table 14: Five year trend for non-acute activity at Biloela Hospital 2004/05–2008/09 % of Change Non-acute 2004/05 2005/06 2006/07 2007/08 2008/09 Over 5 Years Separations Same day 0 0 0 0 0 0 Overnight 21 33 14 28 23 10 Beddays Overnight 335 685 446 603 265 -21

Source: Queensland Health Admitted Patient Data Collection, April 2010

Non-admitted occasions of services Outpatient services at Biloela Hospital provide a range of non-admitted services. These include the following clinics: general practice (provided by hospital medical officers or visiting general practitioners), minor operations, pre- admission/anaesthetic, dressing/wound management, gynaecology and maternity, and ophthalmology. There is also a range of allied health services provided at the Hospital. An unused ward is used for outpatient clinics and ward spaces are used for consultation rooms. Although Central Queensland has experienced an average annual increase in specialist outpatient services of around six to seven per cent per year over the past five years, Biloela Hospital has experienced a decline in overall outpatient activity. The decrease was across all specialist categories, except for increases in pre- admission clinic and clinical haematology activity.

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Table 15: Specialist outpatient clinic attendances, Biloela Hospital 2003/04–2007/08 % Change Specialty 2003/04 2004/05 2005/06 2006/07 2007/08# Over 5 Years Clinical Haematology 59 141 200 275 141 139 Ear Nose and Throat - - - 70 62 - Paediatrics - - - 9 - - General Surgery - - 62 100 15 - Gynaecology 136 129 124 92 107 -21 Maternity 376 231 48 7 138 -63 Ophthalmology 403 428 410 379 293 -27 Orthopaedics 89 4 8 - - - Pre-admission 136 301 486 540 512 276 Psychiatry 359 288 286 227 176 -51 Wound Management 498 417 412 350 327 -34 Total 2056 1939 2036 2049 1771 -14

Source: Monthly Activity Collection, Queensland Health (Extracted Oct 14, 2008) # Preliminary data, subject to change

2.4.1 Visiting specialist services Services provided by visiting/external specialists are shown in Table 17. In addition, a private gynaecologist (funded under the Medical Specialist Outreach Assistance Program), a private sonographer and the Royal Flying Doctor Women’s Health Services provide services in Biloela. The main referral hospital is Rockhampton Base Hospital or Brisbane hospitals for higher level services. Table 16: Services provided by visiting/external specialists to Biloela Hospital Specialty Frequency Provider Public/private Obstetrics and Gynaecology Monthly Flying O&G, Roma Public Ophthalmology Monthly (2 days) Munduberra Public & Private Psychiatry Fortnightly Rockhampton Public Ear, Nose and Throat 3 monthly Rockhampton Public General Physician Monthly Private Rockhampton Private only Dermatology Bi-monthly Private Rockhampton Private only Orthopaedics Fortnightly Private Rockhampton Private only

Source: Biloela Hospital for draft Central Queensland Health Service Plan, August 2008

Medical Specialist Outreach Assistance Program Where there is a demonstrated need in rural and remote areas, the Medical Specialist Outreach Assistance Program provides a range of Commonwealth-funded visiting services. The program funds the following services to the District:

• Ear, Nose and Throat specialist (eight times per year) • Flying Obstetrician and Gynaecologist visits monthly, treating public patients.

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2.4.2 Current support services Pathology There is no pathology laboratory in Biloela. All pathology testing is done using an iSTAT machine provided by licensed medical and nursing staff, or specimens are transferred to Rockhampton. Table 17: Pathology Occasions of Service for outpatient clinics at Biloela Hospital, 2003/04–2007/08 % Change Pathology 2003/04 2004/05 2005/06 2006/07 2007/08 Over 5 Years Occasions of Service 1248 1414 1124 1274 3893 212

Source: Monthly Activity Collection, Queensland Health (Extracted Oct 14, 2008) from draft Central Queensland Health Service Plan # Preliminary data, subject to change

Medical imaging Biloela Hospital currently provides x-ray, ultrasound and processing services on site. Medical imaging occasions of service have decreased by 20 per cent between 2004/05 and 2008/09. Table 18: Medical imaging and pharmacy Occasions of Service at Biloela Hospital, 2004/05–2008/09 % Change Services 2004/05 2005/06 2006/07 2007/08 2008/09 Over 5 Years Medical imaging 2028 1625 1312 1699 1620 -20 Pharmacy 1454 813 744 1220 1030 -29

Source: Queensland Health Admitted Patient Data Collection, April 2010

Pharmacy There is a pharmacist on site at Biloela Hospital (the pharmacist position is currently filled by locum staff). There are also two private pharmacies in town. Pharmacy occasions of service decreased by 29 per cent between 2004/05 and 2008/09 (Table 18). Dental/oral health services Dental technician services are provided at Biloela Hospital which currently has one dental chair. Specialised dental/oral health services are provided from Rockhampton Hospital.

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2.5 Primary health care and community health services One of the major challenges of health services in the catchment is to effectively implement evidence-based interventions aimed at addressing preventable disease. The growth in population, the travel required to access health services and the need to provide services to sparsely populated regions has created a need to reconsider current models of care and look for alternative service delivery models. Implementation of alternative models of care such as Hospital in the Home, Hospital in the Nursing Home, integrated models of care across primary health care and acute services, and nurse practitioner led clinics may achieve some efficiency in service delivery. A key strategy in achieving these efficiencies will be expanding community-based resources for identifying, targeting, and managing key chronic diseases and common conditions of ageing, in collaboration with other local agencies. Future community-based service requirements have been broadly considered in the context of the catchment and opportunities for enhancing community-based services. Detailed consideration of future community health services and capacity requirements will occur if the preliminary evaluation progresses to a Business Case. A range of primary heath care and community health services are available in Biloela. Community health services are provided by Queensland Health, including a community health nurse, two Aboriginal and Torres Strait Islander health workers, a child protection liaison officer, child health nurse and a school based youth heath nurse. A range of community health services are also provided from Rockhampton, Gladstone, Emerald, Biloela and Yeppoon. These include:

• child and family health (including child protection, but not allied health child development) services – provided from Biloela • Alcohol, Tobacco and Other Drugs – a single position based in Biloela.

Other Service Providers Division of General Practice There are two Divisions of General Practice within the District boundaries. The Capricornia Division covers the Rockhampton, Gladstone and Capricornia Coast (Yeppoon) areas. The Central Queensland Rural Division covers Biloela, Emerald and surrounding areas. Central Queensland Rural Division of General Practice The Central Queensland Rural Division of General Practice has staff based in Biloela, Emerald and Woorabinda. The area has 57 general practitioners (100% membership) within 24 practices. Twenty five per cent operate on a solo basis, with 75 per cent operating with two general practitioners or more. Seventy five per cent of practices have practice nurses.

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The Division offers a number of programmes, including:

• Chronic Disease Program, part of Queensland Health’s Health Lifestyle programmes, alcohol and drugs, Aboriginal and Torres Strait Islander young parents’ support worker • Partners in Mind (mental health initiative) • mental health support in drought areas • Immunisation programme support • Prevention of type 2 diabetes • Aged Care Access Initiative.

The Division supports approximately six full time equivalent staff under the More Allied Health Services programme, including a dietician, diabetes educator, speech pathologist, occupational therapist, social worker, psychologist, drug and alcohol counsellor, mental health nurse and counsellor. Coverage is provided to all communities, although not all services are provided to all communities. Integrated mental health services Non-medical community mental health staff teams are based at Gladstone, Yeppoon, Emerald, Biloela and Rockhampton. They provide the basic range of community mental health services for adults, older people, children and youth, and Aboriginal and Torres Strait Islander residents, and increasingly provide drug and alcohol (dual diagnosis) support. Other more specialised community mental health positions are generally based at Rockhampton. Regular psychiatrist sessions are provided from Gladstone (four days per week) and less frequently to Yeppoon, Emerald and Biloela (generally fortnightly). Consultations are provided from other smaller sites as required. Allied health services Biloela Hospital offers a basic range of allied health therapy services, including: physiotherapy, occupational therapy, social work and speech pathology. The largest increase in occasions of service in the years 2004/05 to 2008/09 has been in physiotherapy (44%). Over the past five years, allied health services have decreased by 17 per cent, with nutrition, psychology and social work services no longer provided at Biloela Hospital. Table 19: Allied Health Occasions of Service at Biloela Hospital 2004/05–2008/09 % Change Services 2004/05 2005/06 2006/07 2007/08 2008/09 Over 5 Years Nutrition 39 28 1 - - - Physiotherapy 1091 1023 1176 1319 1573 44 Psychology - 252 141 - - - Social Work 718 1336 342 - - - Wound Management 417 412 350 327 311 -25 Total 2265 3051 2010 1646 1884 -17

Source: Queensland Health Admitted Patient Data Collection, April 2010

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3 Current and future bed requirements

3.1 Summary of projected bed requirements Table 20 and Table 21 present a high-level summary of the projected bed and other treatment space requirements for Biloela Hospital to 2021. Table 20: Current and projected bed requirements for Biloela Hospital Current Projections using Projections using numbers 85% occupancy rates 70% occupancy rates

Beds/Alternatives 2010 2011 2016 2021 2011 2016 2021 Overnight Beds Total multipurpose 25 15 15 16 17 18 19 overnight beds Same day beds/bed alternatives Same day beds 0 2 2 2 Stage 2 recovery chairs 0 0 0 0 Chemotherapy chairs 0 0 0 0 Renal dialysis chairs 0 0 0 0 (in centre) Other medical 0 0 0 0 (inc. Discharge Lounge) Total same day beds/ 0 2 2 2 bed alternatives

Other treatment spaces Projected requirements for recovery spaces, delivery suites, Outpatient Clinic rooms and Emergency Department spaces currently exceed the current built capacity at Biloela Hospital. Table 21: Current and projected other treatment space requirements for Biloela Hospital 2010 2011 2016 2021 Operating Theatres 1 1* 1* 1* Procedure rooms 0 0 0 0 Stage 1 recovery 1 2 2 2 spaces Delivery Suites 2 2 2 2 Outpatient clinic 5 + 5 + 5 + 0 rooms 3 maternity 3 maternity 3 maternity ED treatment spaces 6 4 5 5 X-ray rooms, 1 x-ray room 1 x-ray room 1 x-ray room 1 x-ray room Ultrasound, plain film 1 ultrasound 1 ultrasound 1 ultrasound 1 ultrasound x-ray room room room room 1 processing 1 processing 1 processing 1 processing room room room room CT scanner 0 0 0 0

*May require an additional theatre if surgical needs are expected to increase.

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4 References

1 Australian Bureau of Statistics. Australian Statistical and Geographical Categories. Australian Standard Geographical Classification (ASGC) 2009 (cat. no. 1216.0); Australian Standard Geographical Classification (ASGC) - Electronic Structures 2009 (cat. no. 1216.0.15.001) and Australian Standard Geographical Classification (ASGC) Correspondences 2009 (cat. no. 1216.0.15.002); 2009. 2 Queensland Government. More Beds for Hospitals Strategy. Queensland Health; 2006. 3 Australasian Health Infrastructure Alliance and University of New South Wales. Australasian Health Facilities Guidelines Revision v.3.0. Centre for Health Assets Australasia; 2009.

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5 List of figures and tables

Table 1: Summary of current and future bed requirements for Biloela Hospital...... 3 Figure 1: Map of Central Queensland Health Service District ...... 4 Table 2: Proportion of inpatient activity provided in Central Queensland Health Service District by hub hospitals 2006/07 ...... 5 Table 3: Estimated population in the District by SLAs (2006) and percentage projected change 2006–2026 ...... 5 Table 3: Estimated Aboriginal and Torres Strait Islander population in Central Queensland District 2006 Census...... 6 Table 4: Draft CSCF v3.0 service gap analysis for Biloela Hospital ...... 8 Table 5: All age activity at Biloela Hospital by separations and district of residence 2008/09...... 9 Table 6: Top 10 all age Service Related Groups at Biloela Hospital 2008/09...... 9 Table 7: Five year trend for separations for combined medical surgical and procedural activity (all age) at Biloela Hospital 2004/05–2008/09...... 10 Table 8: Trend in bed utilisation (beddays) for combined medical surgical and procedural activity (all age), Biloela Hospital 2004/05–2008/09...... 10 Table 9: Current and projected births 2007/08–2021/22 ...... 11 Table 10: Top 10 surgical and procedural Service Related Groups same day and overnight for Biloela Hospital for 2008/09 ...... 12 Table 11: Births at Biloela Hospital 2003/04–2007/08 ...... 13 Table 12: Gynaecology and maternity occasions of service at Biloela Hospital 2004/05–2008/09 ...... 13 Table 13: Percentage of Emergency Department presentations admitted/transferred, Biloela Hospital 2004/05–2008/09...... 14 Table 14: Five year trend for non-acute activity at Biloela Hospital 2004/05– 2008/09 ...... 14 Table 15: Specialist outpatient clinic attendances, Biloela Hospital 2003/04– 2007/08 ...... 15 Table 16: Services provided by visiting/external specialists to Biloela Hospital ...... 15 Table 17: Pathology Occasions of Service for outpatient clinics at Biloela Hospital, 2003/04–2007/08 ...... 16 Table 18: Medical imaging and pharmacy Occasions of Service at Biloela Hospital, 2004/05–2008/09 ...... 16 Table 19: Allied Health Occasions of Service at Biloela Hospital 2004/05–2008/09...... 18 Table 20: Current and projected bed requirements for Biloela Hospital...... 19 Table 21: Current and projected other treatment space requirements for Biloela Hospital ...... 19

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