Images: © The State of Queensland, © Queensland Rail Ltd
Response to the Green Paper on
Developing Northern Australia
Submission from the Cairns and Hinterland Hospital and Health
Board
7 August 2014
About the Cairns and Hinterland Hospital and Health Service
The Cairns and Hinterland Hospital and Health Service is responsible for the delivery of Health Services
in a geographical area of 141,000 square kilometres ranging from Cairns to Tully in the south, Cow Bay
in the north and Croydon in the west. The Health Service’s outer western region encompasses extremely
remote communities.
The Health Service supports a population of 283,197 which is forecast to grow by 9% by 2026, with the
highest level of growth occurring within the 65 and over age group. Tourism is a key industry and
contributes to a relatively high transient population. It is estimated that 9% of the population are
Indigenous Australian, compared to 3.5% for Queensland as a whole.
The Health Service delivers health services across the continuum of care and also provides services to
Torres and Cape Hospital and Health Service. Some higher level acute services are provided outside the
Health Service’s area in Townsville or Brisbane.
For further information visit the website: http://www.health.qld.gov.au/cairns_hinterland/.
Health Service Vision, Purpose and Values
The vision of the Cairns and Hinterland Hospital and Health Service is to provide world-class
health services to improve the social, emotional and physical wellbeing of people in the Cairns
and Hinterland and the North East Australian Region.
The purpose of the Health Service is to:

Provide holistic, innovative and responsive models of patient care.

Enable caring, highly skilled and dedicated staff.

Facilitate partnerships providing internationally recognised education and research.

Provide equitable, integrated and sustainable services.
The Health Service has adopted the values of the Queensland Public Service. These are:

Customers first

Ideas into action

Unleash potential

Be courageous

Empower people
For further information regarding this submission please contact:
Dr Garnett Hall, BVSc (Hons)| Director, Office of the Chief Executive | Cairns and Hinterland Hospital and
Health Service
T: xxxx xxxx E: xxxxxxxxxxxxxxxx
Contents
ABOUT THE CAIRNS AND HINTERLAND HOSPITAL AND HEALTH SERVICE ............... 2
EXECUTIVE SUMMARY ...................................................................................................... 4
LIST OF RECOMMENDATIONS .......................................................................................... 5
INTRODUCTION .................................................................................................................. 6
POLICY DIRECTIONS TO CAPITALISE ON THE REGION’S STRENGTHS....................... 8
POLICY DIRECTIONS TO PROVIDE THE BEST REGULATORY AND ECONOMIC
ENVIRONMENT FOR BUSINESS ...................................................................................... 13
POLICY DIRECTIONS IN CRITICAL INFRASTRUCTURE FOR LONG-TERM GROWTH 19
CONCLUSION .................................................................................................................... 22
Executive Summary
Access to effective, sufficient and appropriate health services is a key requirement to
develop sustainable and financially stable communities. Ongoing policy and political
commitment can allow Northern Australia to capitalise on the opportunities for development
and address the barriers, particularly in relation to population health outcomes, that are
preventing this development from occurring.
Northern Australia is a sparsely populated geographic area with significant potential for
economic development. The disparity of health outcomes across the region is a significant
barrier to development, however opportunities exist to improve liveability and prosperity.
The Cairns and Hinterland Hospital and Health Service has prepared this response to the
Green Paper on Developing Northern Australia in order to guide the creation of policy on
health-related matters within the sphere of influence of the Commonwealth Government.
The following paper provides suggestions on how the Commonwealth Government could
support economic development in Northern Australia through enhancing health services in
across three categories, namely:

Capitalising on the region’s strengths;

Providing the best regulatory and economic environment for business; and

Critical infrastructure for long-term growth.
List of Recommendations
Policy directions to capitalise on the region’s strengths
 Establish a Centre for Communicable Disease Control in Northern Australia.
 Establish a Northern Australia Disaster Health Institute in Cairns.
 Establish programs that will improve population health outcomes across Northern
Australia.
Providing the best regulatory and economic environment for business
 Ensure appropriate numbers of aged care beds are funded and provided by operators
across Northern Australia.
 Evaluate and implement the recommendations of the Report on the Inquiry into
Registration Processes and Support for Overseas Trained Doctors submitted to
parliament in March 2012.
 Diversify the funding models for provision of health services across Northern Australia.
 Investigate, resource and coordinate a TB control program in the western province of
PNG.
 Fund healthcare costs incurred by PNG nationals within Australia’s primary and referral
healthcare services.
 Fund a public health physician and support team to provide ongoing detection, response
and coordination of treatment across Northern Australia.
Critical infrastructure for long-term growth
 Ensure that reliable broadband internet is available to all communities across Northern
Australia.
 Enhance health research, education and training networks across Northern Australia.
 Enhance and focus community assistance programs, including the Army Aboriginal
Community Assistance Program, in areas of Northern Australia.
Introduction
Significant opportunities exist for development in Northern Australia, notably in areas of
Commonwealth influence such as biosecurity, education training and research, Indigenous
economic development, and technology and innovation.
Health outcomes play a significant role in the economic development of any region. Poor
health outcomes hinder individual capacity and motivation to participate in the economy of
the local community. A healthy community, in addition to reducing the requirements for
medical treatment costs, is better able to make a productive contribution to the economy in
which they live.
The relatively substandard levels of population health across Northern Australia constrain
the development of communities both economically and socially. This disparity in health
outcomes is linked to a lack of available health services which is in turn hindered by:

difficulty in attracting and retaining a skilled health workforce;

the high cost of providing health services in regional and remote areas;

small and dispersed populations unable to support private-sector primary health
services;

transportation challenges; and

a lack of reliable and available broadband internet for provision of telehealth services.
Ongoing and inter-generational health problems, particularly among the Aboriginal and
Torres Strait Islander population sub-groups, contribute to a lack of economic participation.
Some remote communities are fundamentally underserviced with basic community
infrastructure, resulting in problems with food security, water, sanitation, housing and
facilities to support physical activity. In Northern Queensland, the median age of death for
Aboriginal and Torres Strait Islander people has been reported as being more than 20 years
earlier than non-Indigenous people.1 This burden of excess mortality significantly reduces
the productive adult lifespan and therefore limits productivity.
The Cairns and Hinterland Hospital and Health Service is one of the largest healthcare
providers in Northern Australia. It employs 2774 Full Time Equivalent staff, including 412
doctors and 1370 nurses, with an annual budget of approximately $670m. By comparison,
Queensland Health’s total annual expenditure across the state is $18.713b2, the annual
expenditure of the Northern Territory’s Department of Health is $2.01b3, and Western
Australia’s Department of Health $4.75b4.
Like all Hospital and Health Services in Queensland, it is a statutory body reporting to a local
Hospital and Health Board (See Figure 1). The organisation includes facilities such as Cairns
Hospital, which is the major referral hospital for patients across the Atherton Tablelands,
Cape York, Northern Peninsula Area and Torres Strait. Although Townsville Hospital is the
largest hospital in Northern Australia, the next largest hospital after Cairns is the Royal
Darwin Hospital, which offers a comparable suite of services to a population of
Queensland Health. Health Indicators 2009 – North Queensland. Tropical Population Health
Service. Cairns 2009.
1
2
QLD Department of Health 2012-13 Annual Report
3
NT Department of Health Annual Report 2012-13
4
WA Department of Health Annual Report 2012-13
approximately 150,000. A comparison between these two facilities is included in the table
below.
Category
Cairns Hospital
Darwin Hospital
Total overnight beds
374
363
Same-day admissions
29,043
33,971
Overnight admissions
21,574
20,604
ED attendances
58,427
66,278
Elective surgeries
5,063
4,875
Outpatient occasions of
service
131,827
122,890
Table 1 - Comparison of Cairns Hospital and the Royal Darwin Hospital. Data obtained from
http://www.myhospitals.gov.au/ for financial year 2012-13
Figure 1 - Queensland's Hospital and Health Services
Policy directions to capitalise on the Region’s strengths
Controlling Communicable Disease outbreaks in Northern Australia
The socio-economic conditions of Northern Australia and high proportion of vulnerable
population sub-groups make the area especially amenable to the transmission of endemic
communicable diseases. The international border with Papua New Guinea and close
proximity of other nations such as Indonesia and East Timor increase the likelihood for
incursion of exotic communicable diseases.
Diseases of poverty and tropical diseases relevant to Northern Australia include:
1. Rheumatic Heart disease;
2. Mosquito-borne disease / illnesses (Dengue and various genus of flavivirus);
3. Tuberculosis; and
4. Sexually transmitted diseases such as syphilis and HIV
Climatic and socio-economic conditions across much of Northern Australia provide ideal
conditions for incursion, establishment and spread of exotic tropical diseases endemic to
Australia’s tropical neighbours. If these diseases became established in Northern Australia
they would trigger costly eradication programs, inhibit trade and tourism and result in
significant negative health outcomes for the resident population.
A coordinated approach to detecting and responding to outbreaks of relevant tropical
diseases is required across Northern Australia. The need for such a function is exemplified
by the response mounted to the current outbreak of syphilis across Indigenous communities
in Northern and Central Queensland and the Northern Territory. This outbreak started in the
Mount Isa region in 2010 and attempts were made to manage it at a local level. The
response had limited success in controlling the outbreak which has now spread to areas of
the Northern Territory and Cape York, with two further outbreaks declared in 2014. It is of
significant concern that there have been 18 cases of syphilis in pregnant Indigenous women
in Northern Queensland since 2009 and approximately five cases of congenital syphilis in
infants in the same time period including some deaths5.
Response to this syphilis outbreak has been hampered by the following cross-regional
issues:
1.
2.
3.
4.
5.
Differing case definitions in different states;
Lack of communication of risk across adjacent geographic areas;
Differing levels of access to expertise in some areas;
Lack of laboratory and pathology resources in some areas.
Lack of co-ordination in response to the outbreak, leading to delays in notification
and duplication of resources.
A Northern Australia Centre for Communicable Disease Control would significantly benefit
the whole of Northern Australia by coordinating epidemiological surveillance and laboratory
networking, harmonizing surveillance methodologies and increasing the comparability and
compatibility of the surveillance data collected. It would also provide early warning of and
response to outbreaks of communicable disease and provide expertise to health services in
relation to communicable disease management.
Recommendation: Establish a Centre for Communicable Disease Control in Northern
Australia.
5
Data provided by Tropical Public Health Service (Cairns), Pers. Comm. 04 August 2014.
Case Study – Aedes albopictus
In the past five years, both Townsville and Cairns have experienced incursions of exotic
mosquitoes transported within earth-moving equipment transported from Papua New Guinea.
While there are any number of potential pest plants and animals that would impact significantly
on Australian agro-industry, from a health perspective, one of the most concerning would be the
introduction of exotic mosquito species, including Aedes albopictus, which is capable of
transmitting dengue fever.
Dengue fever is the leading arboviral health issue in Australia, with hundreds of imported cases
reported annually. Outbreaks are common in northeastern Queensland and the Torres Strait.
There is no effective vaccine or anti-viral treatment. Only carefully targeted mosquito control can
prevent transmission.
Originally from South East Asia, Ae. albopictus has colonised tropical and temperate regions
around the world including Africa, Europe and the Americas. Ae. albopictus can thrive in colder,
more seasonal conditions and is theoretically capable of colonising most of Australia’s population
centres. It is also the primary vector of other exotic viral diseases such as chikungunya. The
2007 chikungunya outbreak in Northern Italy demonstrates that recently colonized temperate
areas are vulnerable to disease transmission by this vector.
Although often intercepted at mainland ports, Ae. albopictus is yet to establish in any Australian
territory except the Torres Strait. The impact of a mainland invasion would be dramatic. The
presence of a new competent dengue and chikungunya vector would require the establishment
of expert response teams around the country.
Moreover, wherever this aggressive mosquito has appeared among human populations, it has
caused a significant biting nuisance. In Rome, Italy, the invasion of this mosquito has had an
impact on the community’s use of outdoor spaces such as the botanical gardens and the main
cemetery. People are regularly bitten indoors in their (mostly unscreened) homes and
apartments. Prior to the invasion there was no day-biting nuisance and little vector control
activity but the city now employs a large vector control team of almost 50 operators. The
public/private partnership that implements this program costs the city in excess of 1.5 m Euros
per annum in personnel alone (Alessandra de la Torre, University of Rome, pers. Comm)
Disaster Management across Northern Australia
Northern Australia is vulnerable to several different types of natural and man-made
disasters. The level of disaster preparedness, resilience and ability to respond to local and
regional disasters would be significantly enhanced through the establishment of an institute
specifically responsible for providing the health expertise necessary to prepare and respond
to disasters. Establishing a Northern Australia Disaster Health Institute in Cairns would
significantly enhance regional capability and reduce the impact of future disaster events.
Cairns is ideally placed for such an institute due to its geographical location, international
airport and disaster experience. The region has arguably the most vulnerable population in
the country and recently experienced Cyclones Larry (2006); Yasi (2011); and Ita (2014).
Natural disasters are a feature of the climate and landscape and this threat will continue 6,7.
Also, 88% of all deaths from natural disasters in Australia are related to cyclones, storms
and flooding8.
The infrastructure, research capacity and mitigation strategies developed through a Northern
Australia Disaster Health Institute would allow the risks to the region to be mitigated. The
Institute could be formed in collaboration with the Cairns and Hinterland Hospital and Health
Service and other key stakeholders such as the National Critical Care and Trauma Centre in
Darwin and academic institutions. It would include disaster health professionals and
academics, researchers and a purpose-built training facility for healthcare (including a field
hospital). The purpose-built training facility may also be used in the event of a severe
cyclone or natural disaster. The field hospital would be deployable across the region during
times of need.
This initiative will significantly reduce replacement and redevelopment costs from a disaster.
For every dollar invested in disaster preparedness there is an estimated seven dollar
reduction in disaster-related economic losses15. This initiative will also provide a disaster
health tourism opportunity for northern Australia.
Recommendation: Establish a Northern Australia Disaster Health Institute in Cairns.
6
McMichael, A. J., R. E. Woodruff, et al. (2006). Climate change and human health: present and future risks The Lancet
367(9513): 859-869.
7
COAG (2011). National Strategy for Disaster Resilience – Building the resilience of our nation to disasters. Barton, ACT,
Commonwealth of Australia.
8
Blong, R. (2005). Natural hazards risk assessment: An Australian perspective. Issues in risk science series, Benfield
Hazard Research Centre, London.
Case-study – Cairns Hospital Campus Storm
Tide Risk
Cairns Hospital is the only public hospital and
emergency department in Cairns. It is situated 120
metres from the high water mark of Trinity Bay (the
Coral Sea). The floor level of most buildings on the
hospital campus is approximately 4.05 m Australian
Height Datum (AHD).
Research suggests that “Analysis of the prehistoric
record near Cairns, Queensland show that during
the period 1800-1870, three cyclone events
occurred producing storm tides between 2.52 m and
4.51 m AHD.” (Nott, J (2006). Extreme Events A
Physical Reconstruction and Risk Assessment.
Cambridge University Press ).
Several cyclones in the past 100 years have had
the potential to produce a similar impact if they
crossed the coast closer to and/or north of Cairns.
These include the 1920 Port Douglas cyclone,
Cyclone Winifred in 1986 and Cyclone Joy in 1990.
If the 4.51 m AHD event referred to by Nott (2006)
were to be replicated today, the floor level of the
hospital would be inundated by approximately 450
mm of salt water, with significant loss of assets.
Given past occurrences and the potential effects of
climate change it would not be unrealistic to suggest
that it is a matter of when, not if, such an event will
reoccur.
The vulnerability of Cairns Hospital to storm tide
inundation also raises concerns of substantial
financial loss and the diminution of health services
to the broader community via the loss of essential
medical equipment. Hospital-style care would not be
available for a significant period of time. For
example, hospitals without mitigation strategies in
New York were still recovering one year after
Hurricane Sandy.
The Queensland Fire and Emergency Services
operational mapping system provides indicative
storm surge mapping. The graphics in Figure 3 do
not include the latest additions to the hospital
buildings, but still effectively serve as an indication
of the magnitude of the problem.
Figure 2 - Storm Surge Mapping at Cairns Hospital
Population Health
The World Health Organisation has documented the clear link between health and economic
development.9 A healthy community, in addition to reducing the requirements for medical
treatment costs, is better able to make a productive contribution to the economy in which
they live. Poor health outcomes hinder the individual’s capacity and motivation to participate
in the economy of the local community.
Long-term health outcomes will play a significant role in the economic development of the
North.
In general, the non-Indigenous population of northern Queensland experience health
outcomes that are comparable with their southern counterparts. 10 11
In northern Queensland, the median age of death for Aboriginal and Torres Strait Islander
people has been reported as being more than 20 years earlier than non-Indigenous
people.12 As much of this burden of excess mortality has been due to chronic conditions,
this suggests that the productive adult life of many citizens of northern Queensland is
significantly reduced.
Poor health outcomes among Aboriginal and Torres Strait Islanders have been reported as
being largely due to a range of factors that have been globally demonstrated to be
associated with social and economic disadvantage, being 13:

High rates of tobacco smoking;

Excessive alcohol consumption;

High overweight/obese; and

Poor nutrition.
While the non-Indigenous population of remote and very remote Australia have mortality
similar to that of broader Australia, this is at least in part due to a healthy worker effect,
whereby non-Indigenous people who choose to live in remote parts of Australia are generally
self-selected based on employment and are healthier than the average Australian. People
who have (or whose dependents have) high health care needs will not generally relocate to
remote Australia. In addition, when these workers become unhealthy, they will often
relocate to where services are available.
This, of course, does not mean that this group lives a healthy and balanced lifestyle.
Anecdotal evidence is that alcohol and tobacco use amongst remote workers is higher than
the national average, and tailored prevention and support programs are needed.
Recommendation: Establish programs that will improve population health outcomes
across Northern Australia.
9
World Health Organisation. Macroeconomics and Health. http://www.who.int/macrohealth/en/.
Accessed 15/07/2014
Queensland Health. Health Indicators 2009 – North Queensland. Tropical Population Health
Service. Cairns 2009.
10
11
Australian Institute of Health and Welfare. Rural, regional and remote health. A study on mortality
(2nd ed). 2007. http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442459836
Queensland Health. Health Indicators 2009 – North Queensland. Tropical Population Health
Service. Cairns 2009.
12
13
Australian Institute of Health and Welfare. Life expectancy and mortality of Aboriginal and Torres
Strait Islander people. 2011.
http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=10737418955
Policy directions to provide the best regulatory and economic
environment for business
Lack of Aged Care Beds
Residential aged care facilities in Northern Australia are in critical shortage. Barriers to
increasing the availability of facilities include:
a)
lack of investment from business for construction and ongoing operation of
facilities;
b)
lack of an appropriately trained workforce to staff facilities; and
c)
lack of culturally appropriate facilities located close to where residents live.
It is recommended that residential aged care policies be developed to support measures to
address these barriers by providing incentives to business to invest capital into the
construction of facilities in Northern Australia and providing incentives via funding packages
to ensure such facilities are financially sustainable.
It is also essential to implement workforce policies that ensure sufficient incentives and
supports are included to attract appropriately qualified staff and consult appropriately with
local communities to ensure that facilities meet the cultural, social and spiritual needs of the
population.
Recommendation: Ensure appropriate numbers of aged care beds are funded and
provided by operators across Northern Australia
Case Study – Bed Block at Cairns Hospital
On Friday 18 July 2014 the Cairns Post ran a
front page story on the impact that a lack of
available aged care beds in the region was having
on Cairns Hospital. As at August 2014, there are
approximately 70 long stay patients who would be
more appropriately accommodated in aged care
or disability care facilities, taking up beds across
the Cairns and Hinterland Hospital and Health
Service
Cairns Hospital has limited ability to draw on
nearby hospitals as the next nearest major
regional hospital is four hours drive away at
Townsville.
Above and right:
Newspaper
clippings from
The Cairns Post
on 18 July 2014
Faster, more efficient registration for International Medical Graduates
The accreditation of overseas-trained medical specialists has been problematic for the
Health Service and these issues are common to the health services across Northern
Australia. This issue has been investigated at length and a report entitled “Lost in the
Labyrinth: Report on the inquiry into registration processes and support for overseas trained
doctors” was submitted to the House of Representatives Standing Committee on Health and
Ageing in March 2012. This report suggests ways to remove impediments and promote
pathways for Overseas Trained Doctors to achieve full Australian qualification, particularly in
regional areas, without lowering the necessary standards required by Colleges and
Regulatory Bodies.
Recommendation: Evaluate and implement the recommendations of the Report on the
Inquiry into Registration Processes and Support for Overseas Trained Doctors
submitted to parliament in March 2012.
Diversification of Funding Models for Health Services
The Commonwealth can assist the health sector to better meet the needs of Northern
Australia by enacting policies that diversify or otherwise enhance Health Service funding
models. This includes:


Implementing an Activity Based Funding (ABF) model for the provision of primary
healthcare.
Providing incentives for universities across Northern Australia to sustain and grow
the local health workforce. This would ideally focus on the delivery of flexible training
designed to extend the scope of practice for all
elements of the workforce (medical, nursing,
Case Study: Cairns Hospital
midwifery, allied health professionals and Indigenous
Emergency Presentations
health workers).
A recent study conducted jointly
 Expanding the Medicare Benefits Schedule (MBS) to
by the Health Service, James
include items delivered by care coordinators and
Cook University and Far North
relevant primary care team staff. This would enhance
Queensland Medicare Local has
the flexibility of both private and public sector health
shown that 22% of patients who
workforces and enable increased use of telehealth
present to the Cairns Hospital
services.
Emergency Department could be
appropriately treated by a
 Considering incentive co-payments to health services
General Practitioner.
who demonstrably reduce Emergency Department
admissions.
Diverting these patients in an
appropriate manner would
 Ensuring that a portion of all health and medical
significantly reduce the burden
research grant money is directed towards
on regional hospital Emergency
investigating appropriate models of care and funding
Departments and result in
incentives for Northern Australia.
improved outcomes and
Recommendation: Diversify the funding models for
satisfaction for patients.
provision of health services across Northern Australia.
Enhancing control and surveillance programs targeting Tuberculosis in PNG
Tuberculosis (TB) is one of the world’s most prevalent infectious killers. High rates of TB,
including strains of Multi-Drug Resistant TB (MDR-TB) and Extensively Drug-Resistant TB
(XDR-TB) exist in nearby countries such as Papua New Guinea (PNG).
Although Australia’s rate of TB infection is low by international standards, quarantine
challenges exist in Northern Australia because of cultural linkages between Indigenous
population groups in Papua New Guinea and Torres Strait. Traditional people are permitted
to conduct visit and trade in traditional goods between our nations in accordance with the
Torres Strait Treaty. Therefore, the failure to control TB in PNG poses a public health threat
to Australia, Transmission of MDR-TB has been recognised among PNG nationals
accessing health care in the Torres Strait Islands. From 2004 to 2007, 24 cases of MDR-TB
were diagnosed among these visitors14, imposing a substantial demand on health resources.
There is a need for significant investment in public health physicians and TB control officers
to assist with the control and eradication of TB in PNG.
Recommendation:
a) Investigate, resource and coordinate a TB control program in the western
province of PNG;
b) Fund healthcare costs incurred by PNG nationals within Australia’s primary
and referral healthcare services; and
c) Fund a public health physician and support team to provide ongoing detection,
response and coordination of treatment across northern Australia.
14
Lumb R, Bastian I, Carter R, Jelfs P, Keehner T, Sievers A. Tuberculosis in Australia:
Bacteriologically confirmed cases and drug resistance, 2007. Commun Dis Intell. 2009;33(3)298–303.
Case Study: Media clip from The Courier-Mail 15 March 2015
Case Study: Media clip from The Courier-Mail 15 March 2015
Policy directions in critical infrastructure for long-term
growth
Availability of broadband internet
By comparison to the balance of Australia, the region defined as Northern Australia is
sparsely populated, with islands of population dispersed across vast distances. The critical
mass of population required to support many services is not achieved within reach of most of
the land mass of the region. In addition, due to the low population numbers in many parts of
the region, commercial scheduled air services are either not available or prohibitively
expensive.
In order to provide access to services across this
environment it is essential that health and other
service providers maximise their use of
videoconferencing and other technologies that allow
connection with clients without the need for one to
travel (at very high cost) to the other.
While this is not appropriate for all patient episodes,
many reviews and other occasions of service are
principally matters of information exchange.
In many cases, the ranges of services that may be
offered in remote locations is limited by the skills,
experience and qualifications of the staffing models
that are reasonable to station within that locality.
By allowing senior clinicians to undertake remote
supervision of local staff, services can be permitted
to operate outside what would be their normal scope
of practice and undertake more complex procedures
or treatments. A case study of this is presented.
Case Study: Chemotherapy in Atherton
The drugs that combat cancers are, by their
very nature, substances that are highly toxic
to human tissue, as cancers are rapidly
growing bundles of what would ordinarily be
normal human cells. The ordering,
preparation and administration of cytotoxic
chemotherapy agents is a complex and
dangerous process, and is performed up to
three times per week per patient.
Traditionally, this would have meant that
people who live outside of a major regional
setting who require chemotherapy would
need to leave their homes, families and
support structures during treatment courses.
With the use of videoconferencing, patients
on the Atherton Tablelands are able to
receive services in Atherton. The process is
as follows:
In the future, electronic medical records that can be
remotely viewed and advances in telemetry and telemonitoring will allow even greater capacity for health
services to access the expertise of larger centres
while providing more services close to patients’
homes.

The specialist oncologist meets via
videoconference with the patient on
the day of treatment and, based on
the information gained in this
process, approves the administration
of treatment.
Underpinning all of these advances is increased
capacity to transmit data. High speed data
connectivity in remote and very remote locations to
major centres is a critical enabler of future
innovation.

The pharmacist in Atherton prepares
the chemotherapy medication under
videoconference supervision from
the specialist oncology pharmacist in
Cairns.
Recommendation: Ensure that reliable
broadband internet is available to all
communities across Northern Australia.

The administration of the
chemotherapy to the patient is
undertaken under videoconference
supervision from the Nurse
Practitioner based in Cairns.
Health research, education and training networks
Appropriate Commonwealth policy directions and support of existing capacity in health,
education and research sectors can position Northern Australia as a leader in health
systems innovation and health workforce training in the Tropics. This would result in
significant health, social and economic benefit to both Australia and its neighbours. Such
policy support may include:

Development of a collaborative Northern Australian Tropical Academic Health
Centre. Such an institution would build research capacity and better inform health
decision making;

Extension of the Northern Clinical Training Network;

Resourcing of the Greater Northern Australia Regional Training Network (GNARTN)
to provide coordination, co-investment and productivity in health professional training;

Ensuring that grants issued to educational institutions and specialist colleges are
conditional upon the implementation of strategies to address inconsistencies in
workforce distribution.
Recommendation: Enhance health research, education and training networks across
Northern Australia
Commonwealth directed community assistance programs
Commonwealth capability enhancement programs should be focused to deliver significant
enhancements to health, training and community wellbeing outcomes in Northern Australia.
One such program, the Army Aboriginal Community Assistance Program, has been
delivered annually since 1997 resulting in tangible benefits to the communities in which it
has been conducted. Army provides soldiers and equipment to deliver construction, health
care and training opportunities to remote Indigenous communities.
AACAPs are directed and coordinated in consultation with the Department of Families,
Housing, Community Services and Indigenous Affairs (FaHCSIA), the Australian Army, and
other Government agencies.
Recommendation: Enhance and focus community assistance programs, including the
Army Aboriginal Community Assistance Program, in areas of Northern Australia.
Case Study: About the Army Aboriginal Community Assistance Program
Text obtained directly from Defence.gov.au
The Army Aboriginal Community Assistance Program (AACAP) is a co-operative
initiative between the Department of Families, Housing, Community Services and
Indigenous Affairs (FaHCSIA) and Army to improve environmental health
conditions within remote Aboriginal communities.
A steering committee with representation from all key organisations runs the
program, identifying appropriate locations for project delivery.
Each project has a construction component, a health component and a training
component. The construction component focuses on the provision of
environmental health infrastructure such as housing, water, sewerage and
electrical services as well as improving access to primary health care facilities by
constructing or upgrading roads and airfields. The health component focuses on
augmenting existing community medical, dental and veterinary programs. The
training component focuses on specific skills required within the community and
includes courses on construction and building maintenance, vehicle and small
engine maintenance, welding, concreting and cooking.
Army is involved with AACAP at the direction of the Australian Government. Army
involvement is based on its suitability to meet priorities and works proposals as
determined by the steering committee. Army undertakes projects only after close,
culturally sensitive consultation with the indigenous communities concerned.
Works are not undertaken without the approval of the communities involved and
the steering committee. Army coordinates support from across the ADF and
participation from other nations.
The AACAP objectives are consistent with those of the National Aboriginal Health
Strategy (NAHS) program.
The AACAP seeks to maximise benefit to Indigenous communities by focusing on
projects that allow Army to make best use of its construction expertise and
capability, by capitalising on Army’s ability to holistically deliver a range of services
to remote Indigenous communities, that would not normally be available in a single
project.
Conclusion
Northern Australia requires access to effective health services in order to develop
sustainable and financially stable communities.
By implementing appropriate health policy at the national level and delivering appropriate
health services now and into the future we can ensure that the residents of Northern
Australia are able to fully participate in the workforce without a disparate burden of disease.
The final White Paper on Developing Northern Australia will be better able to achieve its
objectives if it incorporates and prioritises the opportunities and initiatives discussed in this
response.