www.pwc.com.au
Evaluating the
Health & Hospitals
Fund (HHF)
Detailed Evaluation
Findings
30 June 2014
The Department of Health
Disclaimer
This report represents an evaluation of the Health and Hospitals Fund (HHF) for the
Department of Health (the Department) in accordance with the contract agreement dated 17
March 2014, agreed between the Department and PricewaterhouseCoopers (PwC).
This report is not intended to be utilised or relied upon by any organisation, or its employees,
other than the Department, nor is it to be used for any purpose other than that articulated in
the agreement above. Accordingly, PwC accepts no responsibility in any way whatsoever for
the use of this report by any other persons or for any other purpose.
PwC has prepared this report primarily based on information collected from consultations,
site visits, desktop research, HHF project reports, data collection tools, workshops and
document reviews. PwC has not sought any independent confirmation of the reliability,
accuracy or completeness of this information. It should not be construed that PwC has
carried out any form of audit of the information which has been relied upon. Accordingly,
whilst the statements made in this report are given in good faith, PwC accepts no
responsibility for any errors in the information provided by the Department or HHF funding
recipient teams, nor the effect of any such errors on the analysis, suggestions or report
comments.
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Contents
Disclaimer
i
1
Introduction
2
2
Acute care domain evaluation
7
3
Primary care domain evaluation
33
4
Workforce domain evaluation
71
5
Medical research domain evaluation
99
6
Recommendations
134
Appendix A Measures list
138
Appendix B Selected projects
141
Appendix C Sampling matrix
142
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1
Introduction
PwC has been engaged by the Department of Health (the Department) to undertake the
evaluation of the Health and Hospitals Fund (HHF). The $5.0 billion HHF Program was
established on 1 January 2009 by the Australian Government as part of its broader nationbuilding infrastructure program. The overall objectives of the HHF Program, while not
replacing state and territory efforts, were:

to invest in major health infrastructure programs that will make significant progress
towards achieving the Commonwealth's health reform targets; and

to make strategic investments in the health system that will underpin major
improvements in efficiency, access or outcomes of healthcare.
There are 224 HHF projects across all states and territories however contracts have not been
executed for 33 projects. HHF funding recipients include all state and territory governments
and a range of non-government agencies (non-government organisations, not-for profit and
for-profit) in all states and territories.
1.1
Scope of the evaluation
The evaluation covers the HHF Program as a whole in four distinct domains that have been
identified by the Department. These domains represent groups in which projects with similar
characteristics (such as healthcare settings) can be clustered together. The selected domains
are:
1.
Acute care
2.
Primary/integrated care
3.
Workforce
4.
Medical research
The Department selected 24 projects spread across these four domains, with 15 being
nominated as case studies (requiring a detailed assessment) and nine being nominated as
‘domain samples’ which were subject to a high-level project assessment.
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Introduction
1.2
Methodology
PwC have applied the following methodology for the evaluation approach:
1.2.1
Evaluation Plan
The Institute of Social Science Research at the University of Queensland (ISSR) developed an
Evaluation Framework to evaluate the impact of the HHF Program. The Framework was
based on an analysis of funding applications, project reports and other documents from
funding recipients. PwC worked closely with the ISSR team to adapt the Framework for this
review and develop the Evaluation Plan which provided the structure for this evaluation.
Based on the program logic (described below) and the ISSR Evaluation Framework, four
themes and a series of measures were developed as part of the Evaluation Plan.
Approximately eight to ten of these measures were used to assess each project and evaluate
the extent to which the HHF Program has achieved its desired objectives for those projects. A
detailed list of these measures, by the respective themes can be found in Appendix A.
For each measure, PwC tried to obtain data at multiple points in time to enable a comparison
both before and after the completion of the selected projects (depending on what was
available). This required the identification of relevant baselines where the facility or project
resulted in newly established services. These baselines were discussed and agreed upon
during consultations with each project team.
1.2.2 Themes for Evaluation Measures
A list of 31 measures were identified, from which eight to ten relevant measures were
selected for each project. In order to provide a structure around the evaluation, PwC have
identified four themes which have been used to categorise each of the measures.
These themes were selected based on the program logic to help measure each project’s
outcomes and impacts as part of the evaluation. The themes have provided a structure upon
which to measure the performance of individual projects against the overall objectives set by
the HHF Program.
The four themes are:
1.
Appropriateness - how well projects relate to overarching strategies and how
they have addressed the needs of its local community.
2.
Efficiency - how efficiently the outputs of a service were produced, as well as
how well resources were used to achieve these outcomes.
3.
Utilisation - how the local population have used the services provided by the
sample projects or have increased the use of community resources.
4.
Effectiveness - how well the services have achieved the objectives, focusing on
accessibility, equity and quality of the services provided by the sample project.
A detailed list of the measures by theme can be found in Appendix A.
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Introduction
1.2.3 The Program Logic
The Program Logic is part of PwC’s evaluation methodology and sets out what a project will
do and how it will do it – it represents how a project expects to achieve change. The Program
Logic does this by visually representing a linear sequence of steps that need to occur for a
program to meet its desired outcomes. It captures the rationale behind a program, outlining
the anticipated cause and effect relationships between program inputs, activities, outputs,
intermediate outcomes and longer term desired outcomes.
The development of an Evaluation Framework starts with the Program Logic and intended
outcomes of the program. It then builds a series of measures that indicate the performance,
impacts and outcomes of the program. Figure 1 below shows an example of the linkages
between the elements that guide the Program Logic model and how the themes of
appropriateness, process, efficiency, utilisation and effectiveness can be examined.
Figure 1: Program Logic – assessment of HHF themes
Using this Program Logic enabled the themes and measures captured in the Evaluation Plan
to be linked to the specific data and information that needed to be collected to complete the
evaluation.
1.3
Approach
Our approach to the evaluation was carried out through the following processes, which are
discussed in further detail below:

Obtain information on selected projects

Select appropriate measures for selected projects

Conduct consultations

Review data supplied by project teams

Conduct workshops with subject matter experts

Generate the report and process feedback
1.3.1
Obtain information on selected projects
Following the Department’s selection of the 24 sample projects, it provided restricted access
to the online Capital Works Reporting Portal and provided other relevant information for
each selected project. This included the initial application, a summary of the reporting
against each milestone throughout the construction of each facility and where available, the
final report when the construction was completed.
1.3.2 Selection of appropriate measures for selected projects
As explained in section 1.2 above, a set of eight to ten measures for each selected project were
selected from the Evaluation Framework. These were selected based on the relevance to the
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Introduction
project domain and characteristics, for example measures around cultural awareness were
selected for projects that serviced a highly diverse or Indigenous community.
An initial briefing call was held with each project, discussing the measures selected to ensure
they were appropriate and could be measured against.
A data collection template was designed, populated with the specific measures selected for
each project.
1.3.3 Conducting consultations
Consultations were held with each project team to discuss the selected measures and to
obtain qualitative evidence that could be combined with the quantitative data provided in a
data collection tool. This was performed so that a comprehensive assessment could be made
in line with the Evaluation Plan developed.
The three sets of stakeholder consultations that were held were:

Case Study - for the selected 15 case study projects, face to face meetings were
organised with project managers/representatives. These provided qualitative data
from a set of semi-structured interview questions. The sessions also provided an
opportunity for the PwC team to clarify any of the data that had been reviewed so far
and to collect additional data.

Domain Sample - for the remaining nine projects in the sample, telephone
consultations were held with project managers/representatives. These had the
similar purpose of collecting additional data and creating a better understanding of
the project’s contextual information and outputs/outcomes to date. They were
however less detailed than the case study consultations.

Jurisdictional - stakeholder consultations were also undertaken with jurisdictions
that were responsible for certain projects. These were a mix of face to face or
teleconference consultations, with the purpose of discussing the extent to which the
respective projects align to jurisdictional health infrastructure priorities and
obtaining information against the selected measures.
1.3.4 Reviewing data supplied by project teams
Following the consultations, the project teams completed and submitted the data collection
templates providing information against each of the selected measures. These templates
were reviewed and compared for consistency to the points discussed during the
consultations; however no validation of the responses was undertaken.
1.3.5 Workshops with Subject Matter Experts
Five half day workshops were held, one for each of the domains and one for the overall HHF
Program evaluation with relevant members from the panel of experts invited to participate.
During these workshops, PwC presented a summary of each of the projects within the
domain including the project profile and objectives, selected measures and qualitative and
quantitative data received from the consultations and data collection templates. The aim of
the workshops was to collectively assess the data and form an initial view on the evaluation
of each domain and the HHF Program overall.
1.3.6 Generating the report and feedback process
The initial views from the workshops were used in drafting the report, which includes a
section on the overall evaluation and a section for the evaluation of each domain. The
domain sections contain a summary profile of each selected project and a summary of the
data collected against each of the measures.
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Introduction
A copy of each project’s profile, commentary and the data against each selected measure was
provided to each project manager to confirm the accuracy of the content. A copy of the report
was also provided to each of the subject matter experts to ensure the evaluation was
consistent with that discussed in the workshops.
1.3.7
Review limitations
There are a number of assumptions or data limitations that are relevant in interpreting the
findings of this report:

Our evaluation was based on only 24 out of the 224 projects within the HHF
Program, although only 56 (in scope) of the 224 had been completed at the time of
commencing the review. About 27% of the 224 projects were out of scope as they did
not fall under the four assessed domains of acute care, primary/integrated care,
workforce and medical research.

The sample of projects selected in the evaluation was selected by the Department,
however PwC confirmed that this was fairly represented based on coverage of
different elements such as location, state/territory, funding amount and body.

Most projects received some sort of co-contributor funding, however this review
assessed the outcomes from the project as a whole, not just the portion covered by
the HHF funding.

Information provided from the project teams was accepted at face value and not
validated against any third party source.

Projects provided varying levels of quantitative data based on what was available
with some of the measures referring to qualitative and anecdotal information where
quantitative data was not provided.

Due to the differences between project objectives, community needs, locations and
funding size, it was not possible to compare performance across projects within the
same domain, and so the evaluation was performed compared to how the project
performed against the baseline and objectives.

Most projects have been completed for less than two years, a relatively short time
frame to assess infrastructure success or health outcomes for certain domains such
as medical research.
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2 Acute care domain
evaluation
The acute care domain consists of four projects selected by the Department. These projects
cover facilities constructed to provide admitted hospital services, such as emergency
departments (EDs), specialised hospital wards or clinics.
Acute care projects received $1.8 billion or 37% of the total HHF program funding. There are
43 projects that fall under the acute care category, of which all but two projects were
delivered in regional or remote areas. Of the total 43 projects, seven have been completed to
date and four were selected by the Department for this review.
The projects selected have all been from regional and remote regions, and in most cases have
been the redevelopment of already existing facilities in areas of high need. The acute care
projects selected for this evaluation were:
1.
Alice Springs Hospital ED, Northern Territory
2.
Replacement Paediatrics Unit Broome & Kimberley, Western Australia
3.
Kimberley Renal Services, Western Australia
4.
Tennant Creek Emergency Department, Northern Territory
2.1.1
Overall Evaluation
The projects in the acute care domain have presented strong cases of having addressed the
needs of the community and surrounding catchment areas. Although most of the projects in
this domain have only recently opened (most being opened for less than a year), they all have
had immediate impacts on access for the respective communities.
The improvement to existing, or introduction of new services to the remote areas has had a
considerable positive impact on patients, particularly those who would have previously
needed to travel long distances, or even relocate, to obtain relevant treatment.
Improved working conditions and the potential to further staff training has seen many of the
locums and casual staff in the various facilities change to more permanent contracts, or in
some cases extend the duration at the facilities. This has been particularly important as it is
often difficult to attract staff to these remote locations.
Anecdotal evidence provided from the project teams shows that patients, particularly those
from Indigenous communities have recognised the positive change, due partly to the
continuity in staff, and have become more accepting of receiving treatment. The new
facilities are now better equipped to provide for the increasing demand, particularly for the
Indigenous people that comprise the largest proportion of patients with a high burden of
disease.
The facilities have been designed to cater for the diverse culture and needs of the
communities in the respective catchment areas. From incorporating artwork to conducting
cultural awareness programs, the project teams have worked towards the new facilities being
more accessible to the needs of the local communities.
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Acute care domain evaluation
Theme evaluation
Summary of findings
Appropriateness
All of the acute care projects evaluated have
addressed the respective community needs
by providing much needed services targeted
to treating critical illnesses prevalent in these
remote areas.
Efficiency
The acute projects have increased the
services available in these remote areas,
allowing for patients to be treated closer to
home.
The new facilities are more capable of
handling the increased volume of patients,
with evidence showing a reduction in both
waiting time and Did Not Wait (DNW)1 rates.
Utilisation
The new acute facilities have increased the
number of relevant services to the area and
have had large increases in volume of
services delivered.
Most of these projects utilising local services
where appropriate in the construction of the
facility.
Effectiveness
Facilities have demonstrated improved
services, resulting in an increased permanent
workforce in areas of need and benefits to
local residents through reduced waiting times
and patients who DNW.
Teaching and training facilities have been
established to further support future growth.
Facilities are culturally accessible through the
design and all provide cultural awareness
programs.
Overall
Acute projects all addressed the
community needs.
Projects have retained and attracted
staff, providing additional services to
areas of high need.
Services have reduced patients’ need to
travel for treatment and have provided
an increase in accessibility by
accommodating for the community’s
cultural needs.
Limited Evidence
(low achievement)
Objectives achieved
(high achievement)
2.1.2 Appropriateness
The projects evaluated in the acute domain have all provided considerable evidence to show
that they have addressed an overarching strategy of the state/territory or government body,
whilst addressing the community’s need.
1 Metadata Online Registry defines “Did Not Wait” as being a patient that did not wait to be seen by a health care professional.
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Acute care domain evaluation
The projects evaluated were all based in remote communities, where the main strategic focus
was centred on providing treatment to the local community, particularly Indigenous people
that comprise the largest proportion of patients with the a burden of disease.
The impact that these new facilities have had on the community has been almost
instantaneous. All of the projects evaluated in this domain category were able to provide
substantial evidence towards the improvement in health benefits to the community, with
some of the projects only being open for a short period of time. This goes to support the
notion that these facilities were much in need of upgrades or redevelopments in these
communities.
In all the projects evaluated prior to the developments, patients that required specialised
care would have to travel or relocate to other cities for treatment (for example patients
requiring dialysis in Kununurra or high acuity paediatric patients in Broome). Thus treating
patients, particularly those from Indigenous communities, closer to home became a priority,
which has been addressed with the construction of these new facilities.
Case study evaluation
Summary of findings
Alice Springs Hospital ED
The new Alice Springs ED was a much needed investment
that has performed extremely well in enhancing the
accessibility of the ED to the local residents, addressing the
needs of the local community.
Replacement Paediatrics Unit
Broome & Kimberley
The new paediatric unit has helped address local objectives
and community needs by developing a facility that has
attracted skilled practitioners and is able to treat patients
closer to home rather than transferring them to
metropolitan hospitals.
Kimberley Renal Services
The renal facility is providing treatment of patients closer to
their home, improving the health of the Indigenous patients
in the community and providing screening and early
detection for chronic diseases.
Tennant Creek ED
The redevelopment of the Tennant Creek ED was a much
needed project that is providing care to critically ill patients
in remote areas and is able to accommodate for the
increasing demand.
Overall
All of the acute projects evaluated have all
addressed the respective community needs by
providing much needed services targeted to
treating critical illnesses prevalent in these remote
areas.
2.1.3 Efficiency
The acute care projects have presented strong cases of improving the efficiency of services
provided by these facilities. Nearly all of the new facilities are now capable of providing
services which patients would previously have required travelling to metropolitan hospitals
to receive. The facilities have also improved the waiting time and reduced the number of
patients who left before receiving treatment.
Prior to the redevelopment of these facilities patients would need to be transferred to
metropolitan hospitals to obtain relevant treatment. Certain patients presenting to the Alice
Springs ED would be transferred to either Royal Darwin Hospital or Royal Adelaide Hospital,
both approximately 1,500km from Alice Springs. Patients in Tennant Creek and paediatric
patients in Broome would similarly need to transfer to Alice Springs or metropolitan
hospitals as the existing facilities were unable to accommodate the needs of the patients. In a
more extreme case, patients living in the Kimberley region requiring renal dialysis would
need to relocate to Perth for regular treatment as the available facilities in Broome and
Fitzroy Crossing were already operating at capacity. The new facilities have provided the
appropriate treatment closer to local communities.
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Acute care domain evaluation
The new EDs in Alice Springs and Tennant Creek have seen improvements in both the
patient waiting times and the number of patients that DNW. Even though both facilities have
only been open for less than a year, they have both recorded reductions in the waiting time,
with the Alice Springs ED decreasing by 8.9% and Tennant Creek by 6%.
The new facilities have all been furnished with the latest equipment, which has increased the
services being provided in the local area. The new renal dialysis centre in Kununurra has
brought the capability for patients with kidney disease to be treated, where previously they
had no option but to relocate. The service provided by the centre was not even available to
the local hospital as specialised equipment is required for such treatment.
Case study evaluation
Summary of findings
Alice Springs Hospital ED
The project has presented strong evidence that the Alice
Springs ED has reduced waiting times and to some extent
the number of patients who DNW at the ED.
Replacement Paediatrics Unit
Broome & Kimberley
The new unit is provisioned for high acuity paediatric
patient care. Patients can now receive treatment closer to
home rather than being transferred to metropolitan
hospitals or being treated in the general ward.
Kimberley Renal Services
Renal dialysis is now available in Kununurra and additional
chairs are now available in the Derby facility, reducing the
need to relocate patients.
Tennant Creek ED
Regardless of having an overall increase in presentations,
the Tennant Creek ED has been able to reduce the average
waiting time as well as the number of patients that DNW.
Overall
The acute projects have increased the services
available in these remote areas, allowing for
patients to be treated closer to home.
The new facilities are more capable of handling the
increased volume of patients, with evidence
showing a reduction in both waiting time and DNW
rates.
2.1.4 Utilisation
The projects in the acute domain have evidenced high utilisation both in the increased
number of patients using the facilities and through the use of local contractors for the
construction.
Since opening the EDs in Alice Springs and Tennant Creek, the number of presentations has
increased. These new facilities have increased the capacities to accommodate for this
increase, with the Alice Springs ED increasing the capacity by 47% and Tennant Creek
increasing by two additional beds. Kununurra has six chairs in the new renal centre and an
additional ten chairs have been added to the Derby centre, bringing the total number to 19
for the area.
The use of local services in the construction of the facilities was particularly difficult to
measure for the acute projects. This was mainly due to two key factors. Firstly, due to the
remoteness of these facilities, there would not be any local service providers that would be
able to cater to such large demands. As a result, major contractors from outside of the region
were brought from nearby major cities. This being said, in all four projects, local services
were used where appropriate, from minor tasks such as the electrical or security for the
construction site, to sourcing of materials.
The second factor to consider is the specialised equipment and set up relating to the new
facilities. For instance, the specialised plumbing system required for the renal centre is
specific to the equipment provided by Fresenius. As such, they were the ones to design and
install the plumbing system for the facility. As with the other facilities, the renal centre did
incorporate local services where appropriate in the construction phase.
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Acute care domain evaluation
Case study evaluation
Summary of findings
Alice Springs Hospital ED
The new ED has been well utilised in servicing the
community, as well as supporting the community by
incorporating local services in the construction phase.
Replacement Paediatrics Unit
Broome & Kimberley
No evidence has been provided to support this measure.
Kimberley Renal Services
New services are being well utilised by patients, with
potential to expand subject to funding from the
state/national government, although there are currently no
unfilled waiting lists of patients requiring dialysis.
Local services assisted in construction where appropriate.
Tennant Creek ED
The new ED is being well utilised by the community as seen
in the increase in the number of presentations.
Additionally, local services were used where appropriate in
the construction of the new building.
Overall
The new acute facilities have increased the number
of relevant services to the area and have had large
increases in the volume of services delivered.
Most of these projects utilised local services where
appropriate in the construction of the facility.
2.1.5 Effectiveness
The projects have performed very well in increasing accessibility and the quality of the
services in the respective communities.
Patient transfers have reduced since the development of the new facilities. Alice Springs ED
is now better equipped to treat patients locally rather than sending them to metropolitan
hospitals for treatment. This is a similar situation for the new paediatric unit in Broome and
Tennant Creek ED.
The new equipment and facilities have contributed to an increase in morale for the staff at
these facilities. Being based in remote areas, one of the key issues faced by these services is
the ability to attract and retain the staff. In most of these facilities, the workforce would
either be predominantly dependent on locum or part time staff. Many, if not all, of the
facilities struggled to hire and retain staff with the required skill sets. The improved working
environment has provided the incentive required to see many of the locums changing to
permanent positions. The Broome unit has been able to attract new nursing staff, as well as
commence training programs for future paediatric doctors and nurses.
One of the more important outcomes of retaining staff has been through enhanced continuity
of care for the patients, particularly those from the Indigenous communities. This continuity
of doctors and nursing staff has been seen to encourage patients to attend or make regular
check-ups at the facility, allowing for early prevention.
All the projects in the acute care domain sample were based in remote areas; this meant that
they were accommodating the needs of small local communities, with a focus on Indigenous
patients. To make the facilities more culturally accessible, some of these facilities
incorporated Indigenous art works in the design, others like the paediatric unit created an
outdoor area for the children to play and rest in whilst receiving treatment. Most of the
facilities had Indigenous health workers on staff as well as conducted cultural awareness
course for the staff members.
Case study evaluation
Summary of findings
Alice Springs Hospital ED
The Alice Springs ED has effectively incorporated new
services in a more culturally acceptable manner that has
increased the utilisation of the community’s use of the ED.
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Acute care domain evaluation
Case study evaluation
Summary of findings
Replacement Paediatrics Unit
Broome & Kimberley
The project has provided strong evidence of improving
access to specialised health services, attracting and retaining
staff in a remote area and providing more culturally
acceptable services.
Kimberley Renal Services
The new renal service has allowed patients to be treated
closer to home, reducing the need to relocate. Having
Indigenous health workers on staff hosting cultural
programs has made services more culturally accessible.
Limited training and support provided by facility due to this
being contracted out by the Western Australia government
to a third party.
Tennant Creek ED
The new ED has improved the quality and accessibility of
services provided as evidenced through the reduction in
patient transfers and increase in permanent staff.
Overall
Facilities have demonstrated improved services,
resulting in an increased permanent workforce in
areas of need and benefits to local residents
through reduced waiting times and patients who
DNW.
Teaching and training facilities have been
established to further future growth.
Facilities are culturally accessible through the
design and all provide cultural awareness
programs.
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Acute care domain
Case study evaluations
The acute care projects selected have all been from regional and
remote regions, and in most cases have been the redevelopment of
already existing facilities in areas of high need.
The acute care projects selected for this evaluation were:
1. Alice Springs Hospital ED, Northern Territory
2. Replacement Paediatrics Unit Broome & Kimberley, Western
Australia
3. Kimberley Renal Services, Western Australia
4. Tennant Creek ED, Northern Territory
2.2
Alice Springs Hospital ED
The Northern Territory Department of Health and Families received $13.6 million for the
construction of a new ED at the Alice Springs Hospital to provide acute care services to the
Central Australian region. An additional $11.3 million was received from co-contributors to
achieve the total estimated cost of $24.9 million.
The original ED was not fit for purpose, nor had it kept pace with the demand growth in the
region nor with clinical or technological developments. The Alice Springs Hospital is the
largest ED and acute facility within 1,500 kilometres.
The new two storey ED was built within the Alice Springs Hospital grounds, and includes
treatment cubicles, including three resuscitation bays, a fast track area, assessment areas for
paediatric and psychiatric services, isolation rooms, amenities for staff and the relocation of
Medical Imaging to retain the co-location with the ED.
Co-contributor funding: $11.3 million.
The facility opened in June 2013 (operating for less than one year at the time of this
evaluation).
2.2.1 Overall Evaluation
The redevelopment of the Alice Springs ED was a valuable investment under the HHF
Program that has addressed all the needs of not only its local community, but the wider
communities within its vast catchment area. The original ED was not fit for purpose, nor
could it cater to the growing demand in the region in either space or clinical equipment.
Previously the ED was restricted by space, so much so that beds were set up in corridors to
accommodate the volume of patients being treated.
The objectives outlined in the original funding application reflected the needs of the
community, and the redevelopment of the ED has been highly utilised.
The new ED reduced overall waiting times in the ED, as well as a reduction in the number of
non-alcohol related patients that DNW. The new services have been more accessible and
culturally accepted by the community, which has resulted in increased use of the ED by local
residents. The new open plan layout has provided the structure to support the staff being
able to provide this increase in volume.
Theme evaluation
Summary of findings
Appropriateness
The new Alice Springs ED was a much needed investment
that has performed extremely well in enhancing the
accessibility of the ED to the local residents, addressing the
needs of the local community.
Efficiency
The project has presented strong evidence that the Alice
Springs ED has reduced waiting times and to some extent
the number of patients who DNW at the ED.
Utilisation
The new ED is being well utilised by the community, and
local services were used in the construction of the facility.
Effectiveness
The ED has effectively incorporated new services in a more
culturally acceptable manner that has increased the
utilisation of the communities use of the ED.
Overall
The ED was a valuable investment by the HHF
Program that has addressed the needs of the
community, whilst providing a safer and better
supported facility for staff to treat patients.
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Acute care domain evaluation
2.2.2 Appropriateness
The redevelopment of the Alice Springs hospital ED has been successful in increasing the
number of health professionals in the region and catering for the ED demand in a more
culturally acceptable manner.
The Alice Springs Hospital is the referral hospital for the Barkly region and for the Tennant
Creek Hospital, and many remote health centres in Central Australia. The nearest tertiary
hospital, Royal Darwin Hospital, is a several hours flight away from Alice Springs. As a
result, the Alice Springs Hospital provides services beyond those normally expected of a
hospital of its size and population catchment.
The redevelopment of the ED has resulted in an increase in full time equivalent (FTE) staff.
Since opening, the ED has had an increase of 28.8 nursing FTEs, 6.0 patient care assistant
FTEs, 1.5 housekeeping FTEs, 5.5 clinical support administration officer FTEs, 5.0 medical
FTEs and 4.0 radiographer FTEs.
The introduction of the new paediatric area has allowed children to be treated in a safer and
more appropriate environment where they are not exposed to the other traumas taking place
in the ED. This particularly addresses the cultural needs of Indigenous children and the
families.
The new psychiatric assessment area and a new isolation facility provide safer conditions for
staff and patients who present to the new ED. The ED staff is able to confidently deal with
the increasing demand.
Measure evaluation
Summary of findings
Project has increased health professionals in
regional areas
Increase in FTE in remote areas where
recruitment is difficult:
(e.g. GPs, nurses, allied health)

Medical 5.0 FTEs,

Nursing 28.8 FTEs,

Patient Care Assistants 6.0 FTEs,

Housekeeping 1.5 FTEs,

Clinical Support administration
Officers 5.5 FTEs and

Radiographers 4.0 FTEs.
Project addresses community needs
The new ED can confidently deal with
increased demand.
The design provided a treatment area
tailored specially for children.
Male/female segregation addressing gender
and cultural accessibility in community.
Overall
The new Alice Springs ED was a much
needed investment that has performed
extremely well in enhancing the
accessibility of the ED to the local
residents, addressing the needs of the
local community.
2.2.3 Efficiency
The new ED has demonstrated reduced overall waiting time in the ED as well as improving
the numbers of patients that DNW end status for non- alcohol related presentations.
The total number of patients presenting to the ED has increased from 39,669 in 2010 prior to
the redevelopment to 43,279 in 2013. Despite this increase of 9.1% in volume, the new facility
has been able to reduce the time these patients spent in the ED by 6%. During this time, the
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average time spent by a patient has decreased by 14%, dropping from 5.6 hours to 4.8 hours.
Much of this has been attributed to the fast track service which has allowed staff to diagnose
and treat patients with less serious conditions quicker, resulting in faster discharge. NEAT 2
targets for these respective periods have remained relatively constant, which is a
considerable achievement given that the number of patients presenting at the ED has
increased. In 2010, the NEAT target for the ED was 39.7%; this has reduced slightly to 38.5%
in 2013.
Although the number of staff has not increased dramatically since the new construction, the
new layout of the ED is better equipped to support and treat the patients. This has been
particularly important as the overall volume of patients being admitted to the ED has
increased by 9% since 2010. Patients are now being brought into the ED for drunken or
disorderly misconduct. Most of these patients would leave soon after the arresting officers
have left the premises and therefore may be recorded as DNW if they were triaged on arrival.
Since 2010, the portion of patients admitted to the ED due to alcohol has increased from 1%
of the total patients brought in to 6% in 2013. The total number of patients recorded as DNW
increased slightly from 4,048 patients in 2010 to 4,074 in 2013. Removing patients brought
in for alcohol related presentations from these numbers, the DNW results actually reduced
by 4% going from 3,988 patients to 3,826 since the development of the new ED.
Measure evaluation
Summary of findings
Project has reduced ED waiting times
NEAT targets have decreased slightly from
39.7% in 2010 prior to the redevelopment to
38.5% in 2013. However ED presentation
increased by 9% and overall waiting time
reduced by 6%.
Project has reduced the number of patients
that DNW (end status)
There was a slight increase in general DNWs
from 4048 patients prior to the
redevelopment of the ED in 2010 to 4074
patients in 2013.
Decrease in DNW for (non-alcohol related
patients) from 3988 in 2010 to 3826 in 2013.
Overall
The project has presented strong
evidence that the Alice Springs ED has
reduced waiting times and to some
extent the number of patients who
DNW at the ED.
2.2.4 Utilisation
The Alice Springs ED project has demonstrated that not only has the new facility been well
utilised by the community in terms of the services it is providing, but has also supported the
general economy of the local community by using local service providers in the majority of
the construction phase.
Since opening in 2013, the number of patients being admitted has increased. However, the
new ED has allowed for the staff to more easily manage the increase in volume. The original
ED in Alice Springs had 17 official beds. This was later expanded to include four unofficial
beds that the staff would set up in vacant areas to accommodate for the volume of patients
being admitted. The new ED has been equipped with 31 official beds, with additional space
for future expansion. This is an increase of 47% from the previous capacity.
2 National Emergency Access Target
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Currently the only barrier to treating more patients is limited by staffing resources. Staffing
is very seasonal, with most recruitments taking place in the winter months.
Lahey Constructions, a construction group based in Darwin, were the main contractors
assigned to the development of the new ED. Local service providers were approached for
materials and support.
Measure evaluation
Summary of findings
Project has increased remote/regional
activity
There was a considerable increase in ED
presentations – increase has been
attributable to new anti-alcohol initiatives.
Increase from 17 beds prior to
redevelopment to 31 in 2013.
The construction/development of the new
facility was done through the use of local
services in the community
Local service providers were used for
construction where appropriate.
Main contractors were Darwin based Lahey
Construction.
Overall
The new ED has been well utilised in
servicing the community, as well as
supporting the community by
incorporating local services in the
construction phase.
2.2.5 Effectiveness
The new ED has been effective in improving the accessibility and quality of services by
increasing capabilities and capacity of the ED. The design of the new ED takes into account
the cultural needs of the local community.
There has been a slight improvement in the NEAT target going from 37.2% in 2011 to 38.5%
in 2013. This slight increase of 1.3% becomes more noteworthy when it is aligned to the
overall increase in volume of ED patients.
The cultural accessibility has been well integrated into the design of the ED from the separate
male and female waiting rooms, which are distinguished by the Indigenous artworks, to the
more appropriate settings to treat the patients. It is clearly evident that the building was
designed to accommodate the local community needs, which in turn has resulted in a more
accessible ED from a cultural point of view.
The layout of the ED is tailored for the different patients that are admitted to the ED. The
children no longer need to wait with the other patients, but rather are able to wait and be
treated in their own area. Where previously the children would be exposed to the traumas
taking place in the ED, they now are able to be treated in a more secure area away from other
patients.
The general layout of the ED has also been arranged so that no beds are facing each other.
This creates a more private atmosphere which has made the ED more accessible by the older
generation of patients, particularly with those from the Indigenous communities.
All these general improvements have also resulted in attracting and retaining staff. The more
favourable work environment has seen a number of the doctors extend, or even change to
more permanent contracts.
Measure evaluation
Summary of findings
Project has achieved a NEAT
Slight increase in NEAT target from 37.2% in
2011 to 38.5% in 2013, but volume of
admissions has increased.
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Measure evaluation
Summary of findings
Services provided by the project are more
culturally accessible
Doctors converting from casual to
permanent staff has improved the
consistency of staff and resulted in an
increase in continuity of care.
There is now a more appropriate setting to
see and treat patients with separate waiting
areas for males and females.
The ED layout was designed so that beds are
not facing one another.
Services provided by the project have
reduced the number of avoidable
hospitalisations
Short stay ward consists of eight beds to
accommodate patients.
Fast track treating patients with less severe
cases.
Overall
The Alice Springs ED has effectively
incorporated new services in a more
culturally acceptable manner that has
increased the utilisation of the
community’s use of the ED.
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2.3
Replacement Paediatrics Unit Broome &
Kimberley
The Western Australian Department of Health received $7.9 million from HHF to construct
a new paediatric unit at the redeveloped Broome Regional (the Resource Centre). The
previous paediatric facility was over 20 years old and consisted of a rapidly deteriorating
asbestos clad demountable building which was increasingly costly to maintain and restricted
the capacity to deliver enhanced paediatric services.
The region is vast and remote, meaning that extensive travel and access are key
considerations for the effective provision of health services. The Indigenous paediatric health
profile for the Kimberley is characterised by low birth weight and high infant mortality and
level of hospitalisations.
The facility was opened in June 2012 (operating for less than two years at the time of this
evaluation).
2.3.1 Overall Evaluation
The new paediatric unit of the Broome Hospital has achieved the objectives as set out in the
original funding application. The new unit has provided a more suitable environment not
only for the paediatric patients receiving treatment in the unit, but also for the staff
providing the treatment.
The new unit is better equipped to treat patients with high acuity needs and is staffed with
paediatric specialists whereas previously these patients were either treated in the general
ward or were transferred to metropolitan hospitals in Darwin (1,900km away) and Perth
(2,200km away). Not only has this reduction in transfer been a cost saving, but it has also
meant that the paediatric patients are able to stay closer to home for treatment, which is
particularly important for Indigenous patients.
The development of the new paediatric unit has been successful in attracting and retaining
staff. Improved working conditions and contemporary environment with supported training,
has attracted a number of skilled practitioners to the hospital.
The unit’s design has also factored in cultural values and needs of the local community.
Design ideas such as large outdoor play rooms and adult size baths; have helped to increase
the accessibility of the unit to its young patients.
Theme evaluation
Summary of findings
Appropriateness
The new paediatric unit has helped address local objectives
and community needs by developing a facility that has
attracted skilled practitioners and is able to treat patients
closer to home rather than transferring to metropolitan
hospitals.
Efficiency
The new unit is provisioned for high acuity paediatric
patient care. Patients can now receive treatment closer to
home rather than being transferred to metropolitan
hospitals or being treated in the general ward.
Effectiveness
The project has provided strong evidence of improving
access to specialised health services, attracting and
retaining staff in a remote area and providing more
culturally acceptable services.
Overall
The new paediatric unit addresses the needs of the
paediatric patients in the region. The facility has
attracted and retained skilled staff that they
previously struggled to recruit. These specialised
services have meant the patients can be treated
closer to home, in a suitable environment for the
young patients.
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2.3.2 Appropriateness
The new paediatrics unit in the Resource Centre has been successful in addressing the
objectives set out in the original funding application. The new development has also
increased the number of health professionals in the region. The project has also achieved a
number of additional objectives that were not originally planned for through the provision of
respiratory support services.
The new paediatric unit is achieving the previous government’s commitment as outlined in
the National Strategic Framework for Aboriginal and Torres Strait Islander Health 2003 –
2013. This commitment aims to reduce the 17 year disparity in the life expectancy between
the Indigenous and non-Indigenous communities living in the area. The improved services
offered as a result of the new paediatric unit will focus on addressing concerns of the
Indigenous paediatric health profile in the Kimberley that is characterised by low birth
weights, high infant mortality.
Prior to the redevelopment, the resource centre struggled to recruit nurses with specific
paediatric experience. The nurses on staff for the unit had minimal paediatric experience and
none had post graduate qualifications required to nurse paediatric patients in the Broome
Hospital. In the two years since opening the new unit, the hospital has been able to recruit
one FTE acute care paediatric nurse practitioner and one FTE community ambulatory care
paediatric nurse practitioner. The operation of the unit and expansion of paediatric services
has ensured an increase in paediatric registrar FTE funding. The calibre of the service
delivery has allowed the Broome Hospital to be recognised as an advance trainee site for
paediatric medical staff.
Without advanced paediatric clinical expertise on site, all paediatric patients requiring
ventilation and those with high acuity needs, sick neonates and paediatric patients were
transferred by Royal Flying Doctor Service (RFDS) to Royal Darwin (and King Edward
Memorial Hospital for treatment. The new paediatric unit now has a Nursery that is able to
provide for advanced respiratory support in the form of Continuous Positive Airway Pressure
(CPAP) and High Flow Oxygen Therapy. This has only been made possible by the opening of
the paediatric unit which enabled recruitment of Paediatric acute care Nurse Practitioner
with Consultant Paediatrician support on site.
The new paediatric unit provides care closer to home which is a key objective for the Western
Australian Country Health Services (WACHS). The opening of the paediatric unit has also
enabled the separation of the general ward into two departments providing specialist
leadership and governance over the two wards.
Measure evaluation
Summary of findings
Project addresses an overarching strategy of
a state/ territory/ Commonwealth body
Aligns with Commonwealth Government’s
commitment to reducing the 17 year
disparity in life expectancy between
Indigenous and non-Indigenous Australians.
Project has increased health professionals in
regional areas (e.g. GPs, nurses, allied
health)
An additional FTE paediatric nurse
practitioner acute care has been recruited
since the new unit opened.
An additional FTE community paediatric
nurse practitioner ambulatory care has
joined the new unit.
The Broome Hospital now recognised as an
advanced trainee site for paediatric medical
staff.
Project has achieved additional objectives,
that were not planned in original scope
Nursery provides advanced respiratory
support in the form of CPAP and High Flow
Oxygen Therapy.
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Measure evaluation
Summary of findings
Overall
The new paediatric unit has helped
address local objectives and
community needs by developing a
facility that has attracted skilled
practitioners and is able to treat
patients closer to home rather than
transferring to metropolitan hospitals.
2.3.3 Efficiency
The new paediatric unit in the Broome Hospital has performed well in terms of improving its
efficiency through the introduction of a number of new services. The new unit has enabled
additional high acuity patients to be treated in the region at the Broome Hospital, rather than
be transferred to Perth or Darwin. The psychological trauma, cost and cultural impact of
relocation (particularly for Indigenous patients and the families) has been reduced with
access to comprehensive paediatric care now available in Broome.
The new unit can now provide for high acuity paediatric patients. This includes patients
admitted for sepsis, gastroenteritis, bronchiolitis, renal, rheumatic heart disease and
rheumatic fever. These patients previously would have been transferred to a tertiary centre in
either Perth or Darwin for higher level care.
Measure
Summary of findings
Project has increased the number of relevant
services delivered or research capabilities /
topics
The new unit is provisioned for high acuity
paediatric patient care. Patients can now
receive treatment closer to home rather than
being transferred to metropolitan hospitals
or being treated in the general ward.
2.3.4 Effectiveness
The project has provided sufficient evidence in demonstrating the effectiveness of improving
the accessibility and quality of the services offered in the new paediatric unit. This
improvement has resulted in additional services, an increased workforce and being more
culturally appropriate for local Indigenous community members.
The new unit has improved paediatric cardiac and renal services by the provision of on-site
cardiography, renal imaging, specialist dietetic support, specialist physiotherapy and
occupational therapy support. The development of these specialised links has enabled
paediatric patients to remain in the region with tertiary telehealth input. This has also
increased the Paediatric Unit’s ability to improve the level of care provided to outlying
remote sites.
The new “Rapid Response” unit allows children presented at the ED to be more quickly
assessed. If the child’s condition is not serious (which is often the case), then they can be sent
home and be seen then next morning with an appointment. This has reduced ED waiting
times for other children and families with more serious conditions.
Prior to the development, the Paediatric Unit was unable to recruit paediatric registered
nursing staff. The hospital advertised for two years with only one applicant with neonatal and
paediatric post graduate qualification and paediatric/neonatal experience applying. Since
opening the paediatric unit, Broome Hospital has had a more stable workforce for both
medical and nursing paediatric staff. The Paediatric Unit no longer has a reliance on agency
or locum medical or nursing staff.
The new unit also recognises the needs of the local community, and have done well to
incorporate features into the design of the new unit to accommodate for these needs.
Recognising local residents’ tolerance to the warmer climates, one of the design features is an
outdoor area, away from the air-conditioned hospital, where patients and the families could
feel more comfortable and at home.
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More recently, the Paediatric Unit has made some amendments to the children’s shower
room to include an adult sized bath tub. This new addition was made through understanding
some of the older children may not be accustomed to taking showers, or preferred to be
bathed in a tub.
Measure
Summary of findings
Project has improved access to specialised
health services and specialist facilities
Improved paediatric cardiac and renal
services.
Paediatric patients are able to remain in the
region with tertiary telehealth input.
Rapid Response unit treating paediatric
patients more efficiently.
Project has improved attraction and
retention of staff
Paediatrician recruitment has improved
dramatically.
No reliance on agency or locum medical or
nursing staff.
Services provided by the project are more
culturally accessible
Outdoor areas included in design feature to
accommodate local resident’s preferences.
Bathroom redesigned to accommodate older
children.
Overall
The project has provided strong
evidence of improving access to
specialised health services, attracting
and retaining staff in a remote area
and providing more culturally
acceptable services.
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2.4
Kimberley Renal Services
The Western Australian Department of Health received $8.6 million to expand renal dialysis
services in the Kimberley region of Western Australia, including satellite, community and
home dialysis.
Before the project, there were no services provided in Kununurra, two dialysis chairs in
Derby and the Broome site was operating at capacity. Without expansion of regional services
these patients would have to be relocated so they can receive treatment in Perth.
Funding provided under the HHF Program resulted in a facility being constructed in
Kununurra, consisting of six dialysis stations and a new facility in Derby consisting of ten
chairs. Changes to the base clinic in Broome were outside of the scope of the HHF project.
The clinic was opened in May 2013 (operating for approximately one year at the time of this
evaluation).
2.4.1 Overall Evaluation
The construction of a new renal dialysis centre in Kununurra and provision of the additional
equipment, to the existing facility in Derby provided a well needed service to the remote
population.
The new services provide treatment for many patients, most from the Indigenous community
where kidney disease is prevalent. Prior to the development of these sites, these patients
would be required to relocate to Perth for regular treatment. With the development of these
new sites, patients are able to receive treatment closer to home which is of considerable
cultural importance to Indigenous communities.
The facility is addressing its objectives of providing clinical based treatment to renal patients,
however has not provided any home based services nor training due to these services being
provided by a third party as part of a contractual arrangement set up by the local
government.
Theme evaluation
Summary of findings
Appropriateness
The renal facility is providing treatment of patients closer
to the homes, improving the health of the Indigenous
patients in the community and providing screening and
early detection for chronic diseases.
Efficiency
Renal dialysis now available in Kununurra and additional
chairs now available in the Derby facility, reducing the
need to relocate patients.
Utilisation
New services are being well utilised by patients, with
potential to expand subject to funding from the
state/national government, although there are currently no
unfilled waiting lists of patients requiring dialysis.
Local services assisted in construction where appropriate.
Effectiveness
The new renal service has allowed patients to be treated
closer to home, reducing the need to relocate. Having
Indigenous health workers on staff hosting cultural
programs has made services more culturally accessible.
Limited training and support provided by facility due to
this being contracted out by the Western Australia
government to a third party.
Overall
The new centres provide a necessary service for
patients closer to home in a culturally appropriate
manner.
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2.4.2 Appropriateness
The development of the Kimberley Renal Service in Kununurra and expansion of additional
chairs in Derby have addressed a much needed service required in these communities. The
funding provided to these two sites has assisted in achieving the state/territory’s overarching
strategy targeted towards improving access for Indigenous patients to such services. The
development of these sites provides the ability for patients to be treated closer to home,
which is particularly important to Indigenous patients.
The introduction of this service in Kununurra has created an opportunity for patients to be
screened for early detection. This is particularly important when considering that the
incidence of kidney disease in the Kimberley is one of the highest in the country.
Measure
Summary of findings
Project addresses an overarching strategy of a
state/ territory/ Commonwealth body
Introduction of a comprehensive renal
program in the Kimberley.
Improving access for the Indigenous people
allowing them to remain close to home.
Project addresses community needs
Improved screening and early detection for
chronic disease, and reduced need to
relocate patients in order to receive dialysis.
Overall
The renal facility is providing
treatment of patients closer to their
home, improving the health of the
Indigenous patients in the community
and providing screening and early
detection for chronic diseases.
2.4.3 Efficiency
The construction of the new renal dialysis centre in Kununurra and the addition of new
chairs in Derby have increased the number of relevant services to the area. Prior to the new
development, patients would need to be permanently relocated to Perth as the facility in
Broome was operating at capacity and dialysis treatment is provided multiple times a week.
Relocation has proven challenging for Indigenous community, as remaining close to home is
seen as being extremely important. In some cases the patients end up suffering from
depression as a result of the relocation. In other cases, patients would travel home from the
relocated city to attend funerals or other community events and become ill through missing
dialysis appointments as the service was not available in that area.
Having access to treatment in areas such as Kununurra and Derby has reduced the need for
relocation and if patients who have previously been relocated to Perth travel home for
funerals, the new sites can arrange for temporary treatment to be provided for the duration
of the visit.
Measure evaluation
Summary of findings
Project has increased the number of relevant
services delivered or research capabilities /
topics
Renal dialysis now available in Kununurra
and additional chairs now available in the
Derby facility, reducing the need to relocate
patients.
2.4.4 Utilisation
The Kimberley Renal Service has performed well in regards to increasing activity in the
region, as well as utilising local services for the construction of the new facility.
The new Kimberley Renal Services has increased remote activity by adding six new dialysis
chairs in Kununurra and ten new chairs to the Derby centre. This equates to 13 patients
being treated per week in the Kununurra centre and 19 in Derby.
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Although the Kununurra centre can accommodate more patients to be treated, with one of
the six chairs not yet being utilised, they are limited to the funding provided by WACHS as to
how many patients they can treat. Currently, WACHS has provided funding for only 12
patients, but have been able to add an additional patient due to the timing of the funds. On
average, it costs about $500 per treatment per person. There are no unmet waiting lists of
patients requiring treatment.
The construction of the facility utilised minimal local service providers. This was due to two
main factors. First, the plumbing and filtration system for the facility was specific to the
dialysis machines provided by Fresenius. As a result, they had to be brought in to set up the
plumbing system required. The remote location of the centre also meant that most of the
major construction was also conducted by Ricon, a construction group based in Queensland.
Some tasks, such as the electrical and security were sourced from the local community.
Measure evaluation
Summary of findings
Project has increased remote/regional
activity
Kununurra – six new dialysis chairs, treating
13 patients per week.
Derby – ten new dialysis chairs (in addition
to the nine they had prior to funding)
treating 19 patients per week.
The construction/development of the new
facility was done through the use of local
services in the community
Plumbing needed to be done by Fresenius.
Main contractor was not locally based.
Local services were used where possible.
Overall
New services are being well utilised by
patients, with potential to expand
subject to funding from the
state/national government, although
there are currently no unfilled waiting
lists of patients requiring dialysis.
Local services assisted in construction
where appropriate.
2.4.5 Effectiveness
The development of the Kimberley Renal Services in both Kununurra and Derby has been
effective in improving the accessibility of renal dialysis to the community, and has
considered cultural requirements in the provision of the services. They have not provided
much training or home dialysis, as these services were outsourced by the Western Australian
government to a third party. Since the construction of the new facilities, there has been a
corresponding increase in the number of avoidable hospitalisations in the area, as most of
the patients that are requiring dialysis often need treatment for other chronic diseases.
As mentioned previously, the new facilities have reduced the number of patients needing to
relocate to receive treatment. The centres are aware of ~27 patients that have moved to Perth
prior to this redevelopment for treatment. As the new centres are already at capacity and can
only accommodate the 13 and 19 patients respectively for the Kununurra and Derby clinics,
the centres are in the process of organising a trade system, where patients receiving
treatment in Perth would temporarily swap with a patient in one of the other centres for a
defined period of time so that they can receive treatment closer to the place of origin.
With services now being provided in Kununurra, patients are able to receive the relevant
treatment closer to the community. With relocation being a must in order to receive
treatments, studies showed that a large number of the patients would become depressed, or
refuse to attend the appointments as a result of being away from the families, community
and land. With patients having access to treatment much closer to the land, the level of
patients refusing treatment has decreased considerably. Also, as allocations in Kununurra
are limited, patients are also more diligent about attending the appointments so as to not
risk losing the allocation.
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Indigenous workers are employed to facilitate cultural awareness programs and also to
provide assistance when treating Indigenous patients. It is important for the clinicians
treating the patients to be aware of cultural rules. For instance, in some cultures it is
prohibited for the mother-in-law to speak, or in some instances, even be in the same room as
the son-in-law. In such cases, these patients need to be treated on separate days to abide by
the customs.
Also, recognising the important roles cultural ceremonies play in the spiritual lives of
Indigenous patients, the centre has accommodated temporary treatment for visiting patients
that have flown from Perth or Broome to attend events such as funerals. Prior to the centres
being established, Indigenous patients would not be able to take part in such ceremonies as
they can last to up to a week, in which time the patients would have missed a number of
required treatments. Having temporary access to the new centres has allowed patients to
received treatments whilst attending such events.
Although there are facilities and equipment set aside for training patients and providing
dialysis services through in-home care, they are not currently in use as contractual
agreements with another party were reached by the state government. The centre provides
no other outreach program to teach the community how to prevent kidney disease. The
reason for this is that such support programs are provided by Kimberley Renal Support
Services, a partnering entity that focus on diagnosis and pre-dialysis care.
Patients requiring dialysis treatment are often prone to more severe chronic conditions. With
the centres attracting more patients to the area, there has been an increase in the number of
hospitalisations through the local ED.
Measure evaluation
Summary of findings
Project has reduced travel time and referrals
to a health service
Reduction in number of patients being sent
to Perth for treatment.
Swapping service allows patients to return
home for treatment for a given period of
time.
Services provided by the project are more
culturally accessible
Patients are treated closer to home and
communities.
Cultural awareness programs held for staff.
Indigenous health workers on staff.
Patients can receive treatment when
returning for cultural ceremonies i.e.
funerals.
Project has improved outreach services to
educate communities to better manage
diseases
Training facility is not currently in use.
Other support and education programs are
conducted through the Kimberley Renal
Support Services.
Services provided by the project have
reduced the number of avoidable
hospitalisations
Patients can now receive dialysis treatment
where previously hospitals could only
provide short term treatments.
As more renal patients are being treated
closer to home, hospitalisations have
increased because they often have other
chronic diseases.
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Measure evaluation
Summary of findings
Overall
The new renal service has allowed
patients to be treated closer to home,
reducing the need to relocate. Having
Indigenous health workers on staff
hosting cultural programs has made
services more culturally accessible.
Limited training and support provided
by facility due to this being contracted
out by the Western Australia
government to a third party.
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2.5
Tennant Creek - ED
The Northern Territory Department of Health and Families received $3.7 million to
redevelop the ED of the Tennant Creek Hospital. The previous Tennant Creek Hospital ED
was over 40 years old and the layout no longer met the needs of the community or the ED
design guidelines.
The Tennant Creek Hospital is the only ED in the Barkly Region and is the only afterhours
service available for nursing and medical attention. The majority of ED presentations are a
result of alcohol related violence with a high rate of domestic and family violence.
The main objective of this project was to improve utilisation of the floor space making the
facility safer, more practical and efficient in its operations, leading to improved health
outcomes in the community.
The facility was opened in June 2013 (operating for less than one year at the time of this
evaluation.
2.5.1 Overall Evaluation
The redevelopment of the Tennant Creek ED has produced strong health outcomes for the
community despite the short time it has been opened. The ED is more capable of addressing
the high acuity needs of the local community, which is made up of predominantly Indigenous
patients who tend to be admitted for more serious health issues.
The new facility has converted a number of its casual staff to become permanent, and so they
are better able to meet the increased demand of patients without being dependant on
locums. The facility has allowed for some of the rooms freed up from the new construction to
be equipped with added training facilities to train the doctors and nursing staff.
Improvements and upgrade to the hospital equipment have resulted in a decrease to the
number of patients being transferred to the Alice Springs Hospital. This number could be
further reduced when Tennant Creek obtains the relevant accreditation (in the process)
required to allow them to perform surgeries. Until this has been obtained, patients requiring
such treatments still need to be transferred.
Theme evaluation
Summary of findings
Appropriateness
The redevelopment of the Tennant Creek ED was a much needed
project that is providing care to critically ill patients in remote areas
and is able to accommodate for the increasing demand.
Efficiency
Regardless of having an overall increase in presentations, the
Tennant Creek ED has been able to reduce the average waiting time
as well as the number of patients that DNW.
Utilisation
The new ED is being well utilised by the community as seen in the
increase in the number of presentations.
Additionally, local services were used where appropriate in the
construction of the new building.
Effectiveness
The new ED has improved the quality and accessibility of services
provided as evidenced through the reduction in patient transfers
and increase in permanent staff.
Overall
The redevelopment of the Tennant Creek ED has
successfully achieved the objectives detailed in its funding
application.
The ED is not only catering to a larger demand, in an area
of extreme need, but has demonstrated improvements in
services, reducing transfers and retained staff in the short
time that it has been opened.
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2.5.2 Appropriateness
The redevelopment of Tennant Creek’s ED has performed very well in addressing the local
government’s overarching strategy to care for the increasing demand in the local community.
Indigenous health is a major issue for the region, especially with regards to Indigenous
patients being treated closer to home. There has been a noticeable reduction in the number
of patients transferred by the RFDS to other facilities (such as Alice Springs). The
redevelopment of the ED has increased the capability to care for the critically ill patients by
providing more modern equipment that has allowed the doctors to respond and treat
patients quicker.
The new layout has provided improved safety and security for the patients that are admitted
to the ED. The original layout had multiple entry/exit points, with patients able to leave
without permission or formal discharge. The new layout and increase in staff has allowed for
better supervision and triage to be performed.
The new ED has been fitted out with contemporary equipment, more suited to addressing the
higher acuity needs of the patients. This has not only meant reducing the number of patients
requiring transfers to Alice Springs ED, but has also improved staff retention. It has also
provided an avenue to teach and train medical students, as the old structure has been
converted into training rooms. Approximately 70% of the nursing staff in the ED are now
permanent compared to prior the redevelopment where it was only 50%.
Measure evaluation
Summary of findings
Project addresses an overarching strategy of
a state/ territory/ Commonwealth body
Increase the capability to care for critically ill
patients locally in a remote area.
Provide for increasing demand, particularly
Indigenous people that comprise the largest
proportion of patients with a high burden of
disease.
Project addresses community needs
Facility has contributed to equity of access
through a contemporary facility with
enhanced capability to treat the critically ill.
Facility has contributed to a greater ability to
treat Indigenous patients ‘in country’ (close
to homes) demonstrated by a considerable
reduction of RFDS transfers.
Increased retention of hospital staff with the
above medical staff all on contract as
opposed to locums.
Permanent nursing staff makes up more than
70% of total nursing staff, up from less than
50% prior to the redevelopment.
Overall
The redevelopment of the Tennant
Creek ED was a much needed project
that is providing care to critically ill
patients in remote areas and is able to
accommodate for the increasing
demand.
2.5.3 Efficiency
The new ED has improved the efficiency in how the staff is able to see, triage and treat the
patients that are presented. The improved working conditions have seen a decrease in the
waiting times for patients seeking treatment, as well as a decrease in the number of patients
that DNW.
Even though the ED has only been opened for less than a year, it has seen a considerable
increase in patients for a remote hospital. Admissions to the Tennant Creek Hospital have
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increased by 8.3% YTD (April 2014) from 6,596 to 7,144. Despite this increase in volume, the
average waiting time for the period in question has decreased by 6%; this is made up of
patients waiting on average 33.8 minutes prior to the redevelopment to 31.8 minutes after it
opened. This slight improvement in the waiting time, after such a short period since opening,
especially for such a small remote town is reflective of the design and achievements of the
new facility.
One of the most important improvements is in relation to the number of patients who DNW,
with the ED seeing a reduction of 50% of patients since the development. During the period
prior to the development, there was on average 77 patients that resulted in a DNW end
status, since opening less than a year ago, Tennant Creek ED has reduced this number to 38
patients.
Measure evaluation
Summary of findings
Project has reduced ED waiting times
Waiting time has decreased slightly from
33.8 minutes 2013, prior to the development
of the new ED to 31.8 minutes in 2014.
Project has reduced the number of patients
that DNW (end status)
DNW has reduced by 50%, decreasing from
77 patients in April of 2013 to 38 patients in
2014.
Overall
Regardless of having an overall
increase in presentations, the Tennant
Creek ED has been able to reduce the
average waiting time as well as the
number of patients that DNW.
2.5.4 Utilisation
Since opening less than a year ago, the new ED has evidenced a high utilisation both in
activity for the area, as well as through the use of local contractors for the construction of the
new building.
The development of the new ED has seen non-admitted outpatient activity increase by 40%
from 870 to 1,473. The ED upgrade included two additional private consulting rooms that are
used by visiting outreach specialists and for conducting telehealth appointments with Alice
Springs Hospital specialists. These new facilities have allowed for a considerable reduction in
travel time for patients and resulted in an increase in the number of referrals to the hospital.
This increase has largely been due to the telehealth service being used to provide local
clinicians with guidance on how to treat presenting patients.
Data captured by the hospital shows a considerable reduction of patients retrieved to Alice
Springs Hospital - with previous transfers at around 60-70 per month to current data
showing 30-40 transfers per month.
Tennant Creek Hospital is much better equipped to manage emergency patients through the
modern equipment now available. The new design of the ED is more than sufficient to
accommodate for the current needs of the community, with the option to expand in the
future if required.
Although MPH carpentry, an Alice Springs based contractor, was the main source for
construction, local services were used were appropriate to support in the construction of the
new ED. Taking into account the remoteness of the location, hiring a contractor based for the
major works from Alice Springs was deemed to be sufficient in this case. They are supporting
the local community by employing local services for security and electrical fit outs.
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Measure evaluation
Summary of findings
Project has increased remote/regional
activity
Non-admitted outpatients have increased by
40% from 870 to 1,473 as the space that was
previously available for these services was
being used by the ED overflow.
The number of presentations have increased
by 8.3%.
The construction/development of the new
facility was done through the use of local
services in the community
MPH carpentry from Alice Springs was the
major contractor.
Local sub-contractors used where
appropriate.
Overall
The new ED is being well utilised by
the community as seen in the increase
in the number of presentations.
Additionally, local services were used
where appropriate in the construction
of the new building.
2.5.5 Effectiveness
The new Tennant Creek ED has improved the effectiveness of its services as reflected by a
reduction in travel time for patients, improving the retention of the clinical staff, as well as
producing a more culturally accessible facility for the local community.
Since opening, the new ED has reduced its number of patient transfers to the nearby Alice
Springs Hospital through the upgrade in equipment, particularly in regards to its telehealth
service which has been used to help local clinicians get guidance on how to treat presenting
patients. Data provided by the RFDS has shown a considerable reduction in the number of
patients that are being transferred from approximately 60 to 70 patients being transferred a
month to ~30 to 40. This number could be further reduced if not for the fact that Tennant
Creek ED is currently unable to perform surgeries on site due to accreditation requirements.
The new ED is fitted to be able to perform such procedures and the relevant steps are
currently being taken for the hospital to obtain the accreditation to allow them to perform
these surgeries. However until this been achieved, patients will need to continue to be
transferred to receive relevant treatment.
The new ED’s modern equipment has utilised the staff’s skills and has contributed to the
boost in overall morale. This has been one of the key factors that has resulted in having a
hospital that was previously staffed only by locums to having more staff members converting
to permanent contracts. This conversion of locums to permanent staff has been an important
factor in improving accessibility to the Indigenous patients. The continuity in doctors and
nursing staff has seen patients returning more regularly for treatment, rather than waiting
until the condition has worsened before visiting the ED. The new facility also has a greater
potential to train remote nurses, rural generalists and emergency physicians, creating more
stability of the medical service provided at Tennant Creek Hospital.
Measure evaluation
Summary of findings
Project has reduced travel time and referrals
to a health service
The number of patients transferred to Alice
Springs Hospital has decreased from ~60-70
month to ~30-40 per month.
Project has improved attraction and
retention of staff
70 of staff now on permanent contract.
Services provided by the project are more
culturally accessible
Continuity of doctors and nursing staff.
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Measure evaluation
Summary of findings
Overall
The new ED has improved the quality
and accessibility of services provided
as evidenced through the reduction in
patient transfers and increase in
permanent staff.
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3 Primary care domain
evaluation
The projects evaluated in this domain relate to primary/integrated care facilities. Primary
care is categorised as being the first level of contact for healthcare services such as general
practitioner services and integrated care which involves the coordination of care across
different care settings (hospital acute setting, GP primary care setting, outpatient setting
etc.).
Primary/integrated care projects received $426.3 million or 9% of the total HHF funding.
There are 79 projects that fall under the primary/integrated care category in the HHF
Program of which only 2% were delivered in major cities and the rest are in regional or
remote areas. Of the total 79 projects, 38 have been completed to date and seven were
selected by the Department for this review of which all were in regional or remote areas.
The seven projects selected for this review relate to the construction or redevelopment of
primary healthcare centres or the co-location of healthcare services. Four of the projects were
case studies for which there was a more in depth evaluation of the project outcomes which
included a site visit. The primary/integrated case study projects reviewed were:
1.
Toowoomba Primary Healthcare Centre, Queensland
2.
Narrabri District Health Service, New South Wales
3.
RFDS Mount Isa Base Redevelopment, Queensland
4.
Kentish Health Centre, Tasmania
The remaining three domain sample projects were reviewed at a higher level and did not
include site visits. The domain sample projects helped to increase the sample size and
provide more information for the overarching themes of the domains and overall evaluation.
The primary/integrated domain sample projects reviewed were:
5.
Kincraig Clinical Development, South Australia
6.
Expanded Integrated Primary Healthcare Facility, Shepparton, Victoria
7.
Wallaroo Community Dental Clinic, South Australia
3.1.1
Overall Evaluation
The seven reviewed primary/integrated care projects have demonstrated strong evidence
that they are providing considerable benefits to the respective communities. The majority of
the projects appeared to be well aligned to the community’s healthcare needs and the local
government’s healthcare objectives or the government health reform targets such as
providing integration of care and improved access for communities in need. Most of the
projects were able to realise almost immediate increases in the healthcare service volumes
which also helped demonstrate an appropriate link to the community need.
Almost all of the projects were able to offer new services from the facilities with some
offering completely new services to the community. These new services can have a great
impact in remote and rural communities, reducing travel time to neighbouring towns and
reducing waiting times between referral and treatment for patients to receive specialised
healthcare. In some cases given the increased capacity, there is an opportunity for new and
expanded health services to be provided should appropriate operational funding be made
available. However, allowances must be made for factors such as the difficulty of attracting
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health professionals to regional and remote areas and availability of operational funding
from the state government to support the positions.
The review showed that the new facilities have allowed teams to operate more effectively. The
co-location of services has supported better integration of care and enhanced ability to
attract and retain staff which can be a critical challenge in remote and regional areas.
Theme evaluation
Summary of findings
Appropriateness
Most projects delivered well against the
objectives which appeared to be in line with
the community needs and/or local
government objectives. The infrastructure
provided additional capacity to teams which
allowed for new and increased volumes of
services for the community and better
integration of care. One project has had
challenges meeting some of its objectives due
to changes in the demand for services in the
area.
Efficiency
The majority of projects were able to reduce
waiting times between referral and provision
of care by providing new services or
increasing service capacity. All projects
except for one (and this was less relevant in a
dental clinic) were able to offer new services,
however for some projects there is an
opportunity for new and expanded health
services to be provided should appropriate
operational funding be made available.
Utilisation
Most of the projects were able to show good
evidence of increased healthcare service
volumes. Where practicable, all of the
projects used local businesses to some extent
in construction and development of the new
facilities.
Effectiveness
There was strong evidence that the new
facilities allow for more effective healthcare
service provision. They support better
integration of care for all projects however
some teams could be more actively
promoting collaboration. All assessed
projects saw an increase in staff numbers and
some were also able to demonstrate good
retention levels.
Overall
Overall the primary/integrated care
projects have demonstrated strong
evidence that they are providing a
considerable benefit to the community.
They have delivered well against the
objectives and were well aligned to the
community need with one exception –
the Mount Isa project which is a
separate case that had challenges
which impacted its ability to meet
objectives.
Limited Evidence
(low achievement)
Objectives achieved
(high achievement)
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3.1.2 Appropriateness
The majority of projects provided strong evidence that the objectives of the new
infrastructure were in line with local and government health reform targets and the
community need and that they had delivered well against these objectives. The HHF funding
helped provide much needed capacity for some projects such as those in Wallaroo and
Kincraig which allowed them to immediately provide more services to the community and
reduce waiting times. All of the projects had a major focus on better integration of care for
the community and the new infrastructure funded under the HHF Program, helped to bring
teams together to support this.
Most of the projects delivered well against the funding application objectives (although
specific quantifiable targets were often not set) and some were even able to articulate
additional, unexpected benefits such as operational efficiencies (e.g. better staffing or lower
costs from solar panels) or the attraction of additional staff. Also, many of the facilities
provided additional benefits to the public like wellness sessions (e.g. yoga or a gym) or
education through other community groups.
For the projects in Shepparton and Mount Isa, it seems that the community need changed
during construction, therefore making it difficult for the teams to immediately deliver against
the objectives. It may have been beneficial for these projects to more thoroughly assess the
community need in the application phase and monitor the expansion of other local
healthcare services during the development stages.
Case study evaluation
Summary of findings
Toowoomba Primary
Healthcare Centre
Overall strong evidence that the project objectives were
appropriate and have been met.
Narrabri District Health
Service
The project was well aligned to the New South Wales health
plans and addressed the community need with a more
appropriate hospital capable of providing integrated care
and increased service volumes.
RFDS Mount Isa Base
Redevelopment
The project created a facility to deliver the needs of the
RFDS team and provided for a more integrated work
environment. However the project has struggled to meet its
original objectives around increasing local primary
healthcare services with a reduction in overall service
volumes and limited additional service offerings provided.
External factors (outside of RFDS’ control) have
contributed to these challenges.
Sheffield Multipurpose Health
Precinct
The project addresses community needs and local
government objectives by providing more integrated care
and additional services locally, reducing the need for
patients to travel.
Overall
Most projects delivered well against the objectives
which appeared to be in line with the community
needs and/or government objectives. The
infrastructure provided additional capacity to
teams which allowed for new and increased
volumes of services for the community and better
integration of care. One project had challenges
meeting its objectives due to changes in the
demand for services in the area.
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3.1.3 Efficiency
Overall the projects did well in delivering against the key primary/integrated care efficiency
measures which are around reducing waiting times from referral to provision of care and
increasing the number of services delivered.
All projects except for the one at Mount. Isa did well against the measure for reducing
waiting times between referral and provision of care. Some projects were able to accomplish
this through increased capacity and volumes of existing services particularly with the
projects at Toowoomba, Wallaroo and Kincraig. Other projects provided new services to the
community meaning locals therefore do not have to travel for these services. Data was not
available for actual patient travel; however the additional services and capacity provided is
likely to have reduced the need for patients to travel. The project at Mount Isa had unique
challenges with changes in demand and other local providers which impacted the services
offered.
All of the projects were able to offer new services from the facilities, except the one in
Wallaroo (for which this was not a project objective). In addition, projects at Narrabri,
Sheffield, Kincraig and Shepparton were able to offer new services to the area that were not
there previously, a clear benefit to the community.
For the projects at Mount Isa, Narrabri and Sheffield, considering the new capacity available
and how long they have been operating, there is an opportunity for new and expanded health
services to be provided should appropriate operational funding be made available. For some
of the more remote locations it can be difficult to attract new full time employees however for
many of these communities it is more feasible to use the services of a visiting specialist. For
these communities, new visiting specialists can make a big impact and be easier to attract.
Case study evaluation
Summary of findings
Toowoomba Primary
Healthcare Centre
There was an increase in services provided by the
Toowoomba project which has led to increased capacity in
the local area and reduced waiting times.
Narrabri District Health
Service
Four new services being provided that has led to reduced
referral and travel times for patients, consistently exceeded
NEAT targets and a slight increase in DNW rates
(potentially due to a coding issue). Given the additional
capacity in the building, there is an opportunity for new
and expanded health services to be provided should
appropriate operational funding be made available.
RFDS Mount Isa Base
Redevelopment
Since opening, the base has provided a new men’s forum
service, which is conducted twice a year. The base also
supports the staff working on the mobile dental unit (which
is a separate HHF funded project).
Sheffield Multipurpose Health
Precinct
Six new services being provided to the community in one
location, however considering the capacity of the building,
there is an opportunity for new and expanded health
services to be provided should appropriate operational
funding be made available. Anecdotal evidence shows that
this has led to reduced waiting times for referrals.
Overall
The majority of projects were able to reduce
waiting times between referral and provision of
care by providing new services or increasing
service capacity. All projects except for one (and
this was less relevant in a dental clinic) were able
to offer new services. The facilities built were all
designed for the long term, and at the time of the
evaluation and for some projects there was an
opportunity for new and expanded health services
to be provided, should operational funding be
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Case study evaluation
Summary of findings
made available.
3.1.4 Utilisation
Overall the projects did very well in delivering against the key primary/integrated care
utilisation measures which are around increasing the volume of services provided and using
local resources during construction of the new facilities.
All of the projects except for the one at Mount Isa provided strong evidence of being able to
increase service volumes in the new facilities. Sheffield and Shepparton were not able to
provide pre and post build service volume data however the availability and utilisation of the
new service offerings in the community means a likely increase in overall service volumes.
Some projects saw dramatic volume increases such as the ones at Wallaroo with triple the
monthly average items of care or Toowoomba with a 50-70% increase in GP appointments
per day. The project at Mount Isa saw a drop in service volumes after the new base was built
for various reasons including funding challenges and community need changes.
The use of local services and suppliers in remote and regional areas helps to inject capital
into the community and support local businesses. All of the projects used local businesses at
some level during construction and fit out of the new facilities. Some projects made this a
very high priority such as the project at Toowoomba where they even changed some of the
elements of design so that materials could be sourced locally. The project in Narrabri used
local suppliers for some of the accommodation fittings, outdoor furniture and art but it
seems that there could have been more of a focus on this during development.
Case study evaluation
Summary of findings
Toowoomba Primary
Healthcare Centre
Evidenced high utilisation both of the training facilities and
the use of local contractors.
Narrabri District Health
Service
The building and services are clearly being utilised by the
community which can be seen in increased volumes of
activity for both new and existing services. Some local
services/contractors were used for the construction.
RFDS Mount Isa Base
Redevelopment
There was an overall decrease in service volumes by
approximately 18% (mainly for Indigenous patients). This
could in part be due to changes in the structure of
Indigenous healthcare funding, population decreases and
demand changes. Local suppliers and staff were engaged for
the construction of the new base.
Sheffield Multipurpose Health
Precinct
Anecdotal evidence shows an increase in service volumes
however data was not provided as this is held by private
providers. Local contractors were used for the construction
of the health centre.
Overall
Most of the projects were able to show good
evidence of increased healthcare service volumes.
Where practicable all of the projects used local
businesses to some extent in construction and
development of the new facilities.
3.1.5 Effectiveness
There are multiple measures that assess effectiveness for the primary/integrated care
domain but the two that applied to the majority of projects were around better integration of
care and improved attraction and retention of staff.
All of the reviewed projects had a focus on better integration of care in the funding
applications and the new facilities have helped by enabling the teams co-locate. Some of the
projects such as those in Narrabri, Toowoomba and Shepparton, are actively promoting and
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managing the integration of different services/providers through multidisciplinary teams or
case review meetings. Projects such as those in Sheffield and Kincraig have experienced
examples of better integration of care (e.g. increased collaboration between individuals)
however could be more actively managing and promoting integration of the healthcare
professionals.
All of the projects except for the one in Shepparton were assessed against the improved
attraction and retention measure. All of these projects were able to successfully increase the
staff levels, or in the case of the one in Sheffield, increase the number of providers in the
community. The project in Mount Isa was the only one with limited or marginal staff level
increase due to challenges with funding and recruitment. The projects at Toowoomba,
Narrabri and Kincraig were also able to demonstrate good retention of staff rates as well.
Additional measures captured under the effectiveness theme include improved access to
specialised services, staff development and training, outreach programs, treatment and
diagnosis for diseases that are prevalent in the Indigenous population and reduced travel
times to access health services. The projects assessed against each of these measures
performed well.
Case study evaluation
Summary of findings
Toowoomba Primary
Healthcare Centre
Operating effectively across staff attraction, integration and
the provision of cultural services.
Narrabri District Health
Service
Evidence provided shows that the new building allows for
more effective provision of care with better integration of
care, an increased complexity of service, better telehealth
technology and usage, increased community health
outreach contacts and better attraction and retention of
staff.
RFDS Mount Isa Base
Redevelopment
The new base was designed to be more culturally accessible
and provides an enhanced functional work environment
with ample room for training and staff development. Due to
operational funding and recruitment challenges and
changes in healthcare demand, staff numbers have
increased marginally.
Sheffield Multipurpose Health
Precinct
The co-location of healthcare services supports integration
of care however more integration could be provided. There
are two new outreach programs and additional local
services reducing the need for local residents to travel for
healthcare services.
Overall
Strong evidence that the new facilities allow for
more effective healthcare service provision. They
support better integration of care for all projects
however some teams could be more actively
promoting collaboration. All assessed projects saw
an increase in staff numbers and some were also
able to demonstrate good retention levels.
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domain
Case study evaluations
The seven projects selected for this review relate to the construction or
redevelopment of primary healthcare centres or the co-location of
healthcare services. Four of the projects were case studies for which
there was a more in depth evaluation of the project outcomes which
included a site visit.
The primary/ integrated case study projects reviewed were:
1.
2.
3.
4.
Toowoomba Primary Healthcare Centre, Queensland
Narrabri District Health Service, New South Wales
RFDS Mount Isa Base Redevelopment, Queensland
Kentish Health Centre, Tasmania
3.2
Toowoomba Primary Healthcare Centre
The Toowoomba primary healthcare centre received $7.0 million for the construction of a
new primary healthcare centre that combined four of the local primary care providers into
one location. The HHF funding allowed for the construction of the multidisciplinary
healthcare centre including 35 consult/treatment rooms, a training facility, accommodation
for visiting specialists and IT systems. The healthcare centre includes space for GP
consulting, allied health, community events and a pharmacy.
The objectives of the new healthcare centre were to provide a more integrated approach,
increase efficiency, enhance access (18,000 to 24,000 patients WPE3), improve healthcare
outcomes for the community and support the recruitment and retention of health
professionals by:

the creation of 18 to 20 FTE health professional jobs within the first five years,

13 to 20 General Practice FTEs over seven years,

one FTE Nurse per year,

one FTE Administrator per year and

230 student rotation placements in five years.
Co-contributor Project Funding: $9.4 million.
Practical completion was on 19 August 2013 for the clinic and 28 Feb 2014 for the training
centre (operating for nine months).
3.2.1 Overall Evaluation
The Toowoomba primary healthcare centre has performed well against the measures
assessed in the evaluation, despite the short time frame of nine months that they have been
opened. The project objectives appear well aligned to the community needs - increasing
health professionals in the region; focusing on integration within the practice and training of
the medical workforce locally.
The number of services they offer and clinicians they have recruited have contributed
towards providing additional capacity and choice to patients in the local area and reducing
waiting times for patients compared to before the centre existed. They are addressing the
objectives around training, having secured a high number of student allocations across a
range of disciplines.
The project has exceeded the objectives of increasing health professionals, almost reaching
the five and seven year targets within a nine month period and the team is working within
the community providing culturally appropriate services.
Theme evaluation
Summary of findings
Appropriateness
Overall strong evidence that the project objectives were
appropriate.
Efficiency
There was an increase in services provided by the
Toowoomba project which has led to increased capacity in
the local area and reduced waiting times.
3 Whole Patient Equivalents
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Theme evaluation
Summary of findings
Utilisation
Evidenced high utilisation both of the training facilities and
the use of local contractors.
Effectiveness
Operating effectively across staff attraction, integration and
the provision of cultural services.
Overall
The Toowoomba project has performed well
against the measures assessed in the evaluation,
despite the short time frame of nine months that
they have been opened.
3.2.2 Appropriateness
The Toowoomba project has performed well against the objectives of increasing health
professionals in the region and addressed the community needs of being more integrated
within the practice and focusing on training of the medical workforce locally.
They managed to increase the staff numbers by ~54% from August 2012 (before construction
for the facility commenced) to May 2014. This increase was made up of an 80% increase in
GP FTEs (from ten to 18), a 71% increase in nurse FTEs (from seven to 12), a 22% increase in
allied health and support staff (from 11.5 to 14.0), and additional sessional specialists
covering the areas of endocrinology, audiology, dietetics and exercise physiology. These staff
numbers show considerable achievement against the target of 18 to 20 FTE health
professionals within the first five years and 13 to 20 GP FTEs within seven years despite the
short period they have been open.
The opening of the facility has increased the number of GP services available to the
community from 302 per day prior to the opening, to around 460 - 520 a day. In addition,
the facility has provided 100 new nurse practitioners, 40 dental and 55 pathology
appointments available per day. The other benefits provided to the local community have
been through the establishment of an education committee that meets monthly focusing on
training and development of clinicians in the region; the provision of a yoga class twice a
week and an ‘after hours’ service where they answer phones for patients and doctors that
need assistance after hours. The design of the facility also included a central treatment room,
where they have been able to perform emergency sutures and plastering for approximately
four patients a day.
Measure evaluation
Summary of findings
Project has increased health professionals in
regional areas
(e.g. GPs, nurses, allied health)
Increase from 28.5 FTE staff before the
project to 44 FTEs as at May 2014 and
considerable achievement against target
measures of staff numbers within five years.
Project addresses community needs
Higher number of GP appointments, use of
central treatment room (emergency sutures)
and provision of yoga classes and after hour’s
service.
Overall
Overall strong evidence that the
project objectives were appropriate
and have been met.
3.2.3 Efficiency
The construction of the new facility has resulted in a number of additional services being
available to local residents with benefits being seen in reduced waiting times for certain
services and more patient choice in the local area.
There are three services provided by the Toowoomba project which previously had long
waiting times within the Toowoomba region. The additional provision of these services
within the area has reduced the time between referral and provision of service. These
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services include dental (six new chairs were created offering up to 40 appointment a day);
radiology services (X-rays where previously available only at one local provider who had a
ten day waiting list); and pathology services (where CT and Ultrasounds previously had a two
week waiting list).
None of the services provided by the Toowoomba project are new to the region; however the
four primary care providers (that merged) did not previously offer some of these services and
so have created additional capacity within Toowoomba. This has led to reduced waiting times
and greater choice for patients for some services including pathology, radiology and dental
services as well as services provided by a GP focusing on skin specialty, a mental health
nurse, a podiatrist, physiotherapist, endocrinologist, audiologist, dietician and exercise
physiologist. These practitioners are providing a range from 7 to 80 new appointments a
week.
Measure evaluation
Summary of findings
Project has reduced the length of time
between referral and provision of service
Reduction in waiting times of approximately
ten days mainly for pathology, radiology and
dental services.
Project has increased the number of relevant
services delivered or research capabilities /
topics
The merged primary care providers are able
to offer new services that none of them did
before. These services are not new in the
region but have led to increased capacity and
choice for patients.
Overall
There was an increase in services
provided by the Toowoomba project
which has led to increased capacity in
the local area and reduced waiting
times.
3.2.4 Utilisation
Since it opened, the Toowoomba project has evidenced high utilisation both in the number of
student rotations based on site and through the use of local contractors for the construction.
The construction of the centre was done using local builders, with 90% of the materials
sourced locally. The project team actually changed some elements of the design and fit out of
the building to be able to use more locally sourced materials, rather than procuring these
from larger metropolitan suppliers.
Prior to the merger of the four primary care centres, two of these practices were designated
training centres and had one nursing, three registrar and two medical students being trained
on site. Since the site opened, they have secured the following student allocations:

Nursing – four annual rotations with six students per rotation (20 students based at
the Toowoomba project to date)

Medical students – four annual rotations with eight year three or four students per
rotation (seven students based at the Toowoomba project to date)

Post graduate certificate in patient practice - two annual rotations with two students
per rotation (four students based at the Toowoomba project to date)

Registrars – six rotations twice a year (six students based at the Toowoomba project
to date)
Measure evaluation
Summary of findings
The construction/development of the new
facility was done through the use of local
services in the community
Construction was carried out using almost all
local resources and materials.
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Measure evaluation
Summary of findings
Project has increased number of student
applications (be it international or domestic)
Large increase in student rotations at the
Toowoomba project.
Overall
Evidenced high utilisation both of the
training facilities and the use of local
contractors.
3.2.5 Effectiveness
The Toowoomba project is operating effectively across attracting and retaining staff, the
integration of staff both within and external to the centre and in the provision of appropriate
cultural services in the local area.
The clinicians at the facility work together in a number of ways. They utilise one practice
management system called “Medical Director” facilitating shared patient information where
required. They hold case conferences with multidisciplinary teams; perform ground rounds
on a weekly basis that includes both the GPs and the allied health providers on site; hold
journal clubs for all staff, and undertake a significant event analysis that includes all services
providers when necessary. In addition, the use of the central treatment room to provide
trauma services such as emergency sutures and plastering of broken bones demonstrates
collaboration with the local hospital and ambulance service.
As mentioned previously, they have increased the staff numbers by ~54% from 28.5 FTE staff
before the project to 44 FTEs as at May 2014. As mentioned previously, these numbers show
considerable achievement against the target within the short timeframe they have been
opened. Factored into these numbers are two doctors who left the practice after the merger,
which was below the anticipated merger driven reduction estimate of 20% of staff
(approximately five FTEs).
With respect to cultural accessibility, the Toowoomba project provides mentoring and GP
supervision to Carbal (the Indigenous Health Centre in Toowoomba). When Carbal is closed,
or is operating at full capacity, the Toowoomba project assists in taking on the overflow
patients. For example, the Toowoomba project managed Carbal’s full client load during the
two weeks the centre was closed over Christmas 2013. The Toowoomba project has also been
named the general practitioners for 12 refugee patients in detention in Toowoomba and one
of the clinicians provides services to the RFDS in Tara and Miles in Western Queensland.
Measure evaluation
Summary of findings
Project resulted in better integration of
locally available medical services
Use of central treatment room to provide
trauma services, ground rounds, case
conferences and significant event analysis for
all clinical staff on site.
Project has improved attraction and
retention of staff
Increase of 54% of FTEs and only two
doctors leaving as a result of the merger,
considerable progress made against five year
target set in the budget.
Services provided by the project are more
culturally accessible
Mentoring and GP supervision provided to
the local aboriginal health centre in
Toowoomba, managing the workload when
at capacity.
Overall
Operating effectively across staff
attraction, integration and the
provision of cultural services.
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3.3
Narrabri District Health Service
The Department of Health (NSW) received $27.0 million to construct a single storey
integrated acute, primary and community healthcare centre (on the previous hospital site)
including the co-location of the ambulance service in Narrabri (catchment of about 14,000 at
the time of application). The new facility includes inpatient beds, a community health area,
consultation/treatment rooms, an ED, a helipad, an ambulance services station and addition
staff accommodation.
The objectives of the new facility were to enable implementation of more contemporary
models of care (health promotion, early intervention, effective chronic disease management
etc.), provide an increased range of services, support a more integrated and coordinated
health service delivery (particularly with primary and community care), improved access for
aged, Indigenous and rural populations, allow for resource sharing and efficiencies and
promote staff recruitment and retention.
Co-contributor funding $11.0 million.
Practical completion was on February 2012 (operating for more than two years at the time of
this evaluation).
3.3.1 Overall Evaluation
Based on information provided, the Narrabri District Health Service is performing well in
relation to the community’s healthcare needs and many of the Commonwealth’s health
reform targets including integration of care. The new building and equipment have led to a
better and more efficient work environment.
The building and existing healthcare services are clearly being utilised by the community and
now there is an enhanced service offering with better integration of care, more complex
services, enhanced outreach services and better attraction and retention of staff. The hospital
has maintained above target NEAT rates and has been able to provide additional services
with more clinical staff without the need to increase administration staff. Some new
specialised services have been introduced however given the relative increase in building
capacity there is an opportunity for new and expanded health services to be provided should
appropriate operational funding be made available.
Theme evaluation
Summary of findings
Appropriateness
The project was well aligned to the New South Wales
Health plans as well as health reform targets around
integrated care, and addressed the community need with a
more appropriate hospital capable of providing integrated
services.
Efficiency
Four new services being provided that has led to reduced
referral and travel times for patients, consistently exceeded
NEAT targets and a slight increase in DNW rates
(potentially due to a coding issue). Given the additional
capacity in the building, there is an opportunity for new
and expanded health services to be provided should
appropriate operational funding be made available.
Utilisation
The building and services are clearly being utilised by the
community which can be seen in increased volumes of
activity for both new and existing services. Some local
services/ contractors were used for the construction.
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Theme evaluation
Summary of findings
Effectiveness
Strong evidence provided shows that the new building
allows for more effective provision of care with better
integration of care, an increased complexity of service,
better telehealth technology and usage, increased
community health outreach contacts and better attraction
and retention of staff.
Overall
Strong evidence that new Narrabri District Health
Service is well aligned to New South Wales
healthcare strategies, addresses community needs
through new services, increased service volumes,
better outreach and integration of care.
3.3.2 Appropriateness
The Narrabri District Health Service appears to have appropriately addressed community
needs and is in line with New South Wales healthcare objectives.
The previous Narrabri Hospital was no longer adequate with safety concerns as staff had
difficulties due to security in the previous hospital, the roof was falling in, doors could not be
locked and birds could enter the building which led to contamination risks. The Mehi Health
Cluster (Hunter New England health region) had failed accreditation because of issues with
the Narrabri Hospital. The community health service and ambulance station also had
outdated, limited facilities and were in separate locations in town. The New South Wales
Health Narrabri District Health Services Plan 2007-2011 recommended the hospital
redevelopment and co-location and integration of health services. At the time of the
application, this plan was in line with the Commonwealth health reform agenda and other
New South Wales plans (e.g. New South Wales State Health Plan, New South Wales Rural
Health Plan and Hunter New England Area Healthcare Strategic Plan).
The new, modern and secure Narrabri District Health Service brings together the acute,
primary, community and ambulance health services into one location allowing for better
integration of care. The previously cramped community health service now has more than
double the number of rooms available. There are some new services available to the
community and although the ED and inpatient beds have not increased, there has been an
overall increase in the volume of services provided.
Measure evaluation
Summary of findings
Project addresses an overarching strategy of
a State/ Territory/ Commonwealth body
The project objectives were very well aligned
to New South Wales health plans.
Project addresses community needs
The new hospital is a more appropriate
facility which resulted in more integrated
care and increased service volumes.
Overall
The project was well aligned to the
New South Wales health plans and
addressed the community need with a
more appropriate hospital capable of
providing integrated care and
increased service volumes.
3.3.3 Efficiency
The new Narrabri District Health Service is demonstrating efficiencies through an increase in
the services available and some decreases in ED and provision of service waiting times. Since
the new building opened, the Narrabri District Health Service now provides new cardiac
stress testing and mental health telehealth services, has a consistent visiting rheumatologist
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(previously had periods of no service), has expanded eye procedures and has increased the
respiratory clinic for the Indigenous community from three participants in 2011 to 56.
Additionally, superior equipment was sourced as part of the project funding including more
sophisticated audiometry equipment, new palliative care and negative pressure rooms,
mechanical lifting devices (for patient transfers by nurses and allied health staff ), new
physio equipment and a play room for children which have all led to a better service and
work environment.
Previously patients had to travel to Tamworth (172 km or about two hours drive) for cardiac
stress testing. As of May 2014, there have been 271 stress tests performed in Narrabri saving
patients over 1,000 hours of driving time. Patients also used to have to travel to Tamworth or
Moree (100km or more than one hours drive) for rheumatology services and eye health
services, both of which are now provided at the Narrabri District Health Service.
Overall NEAT averages showed a slight increase in 2013 with the number of ED
presentations remaining constant compared to the previous few years however data shows
that Narrabri had been operating well above the target of 90% since 2009.
The Narrabri Hospital also performs well when it comes to overall DNW averages, especially
when compared to peer group C2 District Hospitals such as Moree, Muswellbrook, Singleton
and Cessnock that have rates sometimes twice that of Narrabri’s. However, Narrabri’s overall
DNW average increased post build (02/2012-06/2013) to 0.95% from 0.67% (07/201101/2012) with most of the increase resulting from higher Indigenous DNW rates. This could
have been attributed to a coding issue (can code DNW or left at own risk).
In the New South Wales Health Service Plan, chronic disease care was identified as a priority
health issue for the Narrabri catchment and the plan suggested that services be enhanced or
provided to target chronic care. The community health space is now more than twice the size
of the former location and although it offers increased volumes there is a similar breadth of
services being offered. With the additional capacity and the local need around chronic care,
there is an opportunity for new and expanded health services to be provided should
appropriate operational funding be made available.
The co-location of services and the new building have led to some operational efficiencies.
For example, despite increases in medical staff, services and volumes, the administration
FTEs did not need to increase from 2010 as they are now sharing responsibilities across the
services. Also through the use of microfibre cleaning (laundry capability on site) they are able
to save about $3,000 per year in cleaning chemical costs. Despite the larger building they did
not need to hire more cleaning staff and there is no chemical smell, making the environment
better for patients and staff.
Measure evaluation
Summary of findings
Project has reduced the length of time
between referral and provision of service
Reduced travel time for patients who used to
travel to Tamworth or Moree for cardiac
stress testing, rheumatology services or
certain eye procedures provided locally.
Maintained an achievement of above 90% of
NEAT targets.
Project has increased the number of relevant
services delivered
The facility is providing four new or
expanded services and has new service
equipment which are being well utilised by
patients. Considering the increase in capacity
of the building, there is an opportunity for
new and expanded health services to be
provided should appropriate operational
funding be made available.
Project has reduced ED waiting times
Slightly better overall NEAT averages
however these averages were already well
above targets leaving little room for
improvement.
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Measure evaluation
Summary of findings
Project has reduced the number of patients
that DNW (end status)
Slight increase in DNW rates which could be
due to a nursing coding issue.
Overall
Four new services being provided that
has led to reduced referral and travel
times for patients, consistently
exceeded NEAT targets and a slight
increase in DNW rates (potentially due
to a coding issue). Given the additional
capacity in the building, there is an
opportunity for new and expanded
health services to be provided should
appropriate operational funding be
made available.
3.3.4 Utilisation
With the data provided it is clear that all services (new and existing) are being well utilised by
the community. Acute services increased by 6.2% and other services increased by 15.2% from
2010/2011 to 2012/2013. There was a particularly strong increase in maternity related
services such as births (20%), antenatal clinics (29%) and post natal clinics (800%). Data
provided for some of the other services (e.g. preoperative clinic attendance, audiometry
services, dementia advisory services) showed a consistent increase in service volumes as well
except for the physio gym which had a 5% drop in service contacts.
New services such as cardiac stress testing (271 tests) and telehealth mental health services
(estimated at 30 per month) are clearly being utilised. Service volumes for the new
rheumatology (four visits per year) and eye procedure offerings were not available as they are
conducted by private providers however it is unlikely that these providers would continue
service if there were issues with low utilisation.
With respect to the construction of the building, Richard Crookes was the building company
and Thomson Adsett was the principal design company, both based out of Sydney. Given the
capabilities of local suppliers in the region, and the complexity of the design, this seems to be
appropriate. Local suppliers were used for some of the construction, accommodation fittings,
outdoor furniture and art (some through local Indigenous artists).
Measure evaluation
Summary of findings
The construction/development of the new
facility was done through the use of local
services in the community
Builder and design company were sourced
from Sydney and local suppliers provided a
small amount of the fit out.
Project has increased rates/number of
screening, diagnosis and treatment
Clear increase in volumes with a 6.2%
increase in acute care and a 15.2% increase in
other services.
New services offerings are being utilised.
Overall
The building and services are clearly
being utilised by the community which
can be seen in increased volumes of
activity for both new and existing
services. Some local
services/contractors were used for the
construction.
3.3.5 Effectiveness
The Narrabri District Health Service effectively provides healthcare services with more
integrated care, more specialised services, enhanced access to telehealth technology and
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more community health contacts. The new building, accommodation and equipment have
helped to attract and retain staff.
The new Narrabri District Health Service brings together acute, primary and community
health services which has led to enhanced collaboration among the different health
professionals (e.g. maternity care and GPs or midwives and the child and family health staff).
There are now daily multidisciplinary patient flow meetings which have increased
communication between the teams including visiting specialists showing an overall better
integration of care.
Role delineation is used in New South Wales as part of health service planning and
budgeting. The role level of a service describes the complexity of clinical activity undertaken
by that service, and is influenced by the presence and credentials of the whole medical team.
These levels range from Level 0 (no service), Level 1 (the lowest complexity of care) up to
Level 6 (high acuity or complexity). The previous Narrabri Hospital had a level 2 role
delineation for clinical services such as general medicine, cardiology, gastroenterology,
respiratory medicine, general surgery, orthopaedics, palliative care and geriatrics. The last
review in late 2013 recommended that these services be increased to a level 3 and some
community based services (e.g. community nursing) be increased from level 3 to level 4.
These increases show an enhanced level of complexity of care provided. Additionally the new
specialist mental health telehealth and visiting rheumatologist services are now available and
there is better specialist equipment in the new building (e.g. new audiometry or physio
equipment).
Since the new building, there has been an increase from three to seven GPs, the nursing staff
has increased by 3.5 FTEs, the percent of Indigenous staff has increased from 9% to 11.5%
(compared to an average of 4-7% at peer hospitals) and permanent staff turnover rates have
reduced from about 9% to about 2%. In the old hospital there were four FTE vacancies that
were difficult to fill (two-three year long vacancies) and the hospital was able to recruit 2.5
FTEs of these vacancies since the new building.
The additional staff accommodation has been helpful in attracting students and visiting
specialists as good, temporary accommodation is expensive and difficult to secure in
Narrabri. Additionally the better environment and new mechanical lifting equipment
appears to have led to a reduction in staff manual handling incidences from 13 (January 2010
- January 2012) to four (February 2012-May 2014).
Telehealth capabilities in Narrabri have improved from two videoconference units and one
clinical care camera to five videoconferencing rooms and five clinical care cameras with
enhanced technology and systems. Activity data from the previous system is not available but
post build activity data shows that the new technology is being utilised with 31 retrieval
clinical care camera bookings (does not include other acute uses) since the new building and
105 telehealth sessions from the videoconferencing rooms over March and April 2014.
Community health staff have increased outreach services considerably since the opening of
the new building. In 2010/2011 there were 4,373 home visits and 1,836 phone calls to
patients. The home visits increased by 28% to 5,610 and phone calls by 83% to 3,363 in
2012/2013.
Measure evaluation
Summary of findings
Project resulted in better integration of
locally available medical services
Improved collaboration opportunities with
previously separate services brought into one
location and daily multidisciplinary team
meetings being held.
Project has improved access to specialised
health services and specialist facilities
New specialist services available such as
rheumatology and mental health
(telehealth).
Recommended increase in role delineation
levels shows enhanced service complexity.
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Measure evaluation
Summary of findings
Project has improved attraction and
retention of staff
Increases from three to seven GPs, slight
increase in nursing staff, higher proportion
of Indigenous staff and able to staff 2.5 FTE
of long term vacancies.
Considerable drops in staff turnover rates
and manual handling incidences.
New facility has improved accessibility
through better telecommunication and eHealth services
Enhanced technology with a considerable
increase in the number of videoconference
units and clinical care cameras.
Activity data shows good utilisation with 105
telehealth sessions over 6o days.
Project has improved outreach services to
educate communities to better manage
diseases
Increase of community health home visits by
28% and phone contacts by 83%.
Overall
Evidence provided shows that the new
building allows for more effective
provision of care with better
integration of care, an increased
complexity of service, better telehealth
technology and usage, increased
community health outreach contacts
and better attraction and retention of
staff.
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3.4
RFDS Mount Isa Base Redevelopment
The Queensland branch of the RFDS received $2.7 million to redevelop its existing base at
Mount Isa. The base is 7km from the RFDS hangar where the aeromedical on call doctor and
nurse, the planes and supplies are based. The previous base spread across multiple old
houses, was too small and not fit for purpose. The new base is modern and includes a private
telehealth consultation space for the on-call doctor, an administration block,
meeting/training rooms, three primary care consultation rooms (previously there was one)
and amenities rooms. The building can provide working space for up to 75 employees.
At the time of application, the objectives of the new base were to help provide additional
primary care, mental health and health promotion services to the local community and
region, help attract and retain healthcare professionals to support growth (target of 24 to 75
employees in five years), promote effective multidisciplinary team integration and provide
better training facilities.
The total cost of the RFDS base redevelopment was approximately $8.5 million. Xstrata
Mount Isa Mines (now owned by Glencore) subleases (until 2091) the base land to RFDS and
provided approximately $2.8 million in co-contributor funding towards the project. The
RFDS provided the remaining funding needed.
Under a separate HHF project, the RFDS (Queensland) also received $1.1 million in funding
for a mobile oral health unit that helps provide improved access to dental health services in
the region. The mobile unit staff are based out of the Mount Isa redeveloped RFDS base
where they complete the administrative tasks and logistics/travel planning.
Co-contributor funding - $5.8 million.
Practical completion of the base was on 17 February 2012 (operating for over two years at the
time of this evaluation).
3.4.1 Overall Evaluation
The new RFDS base allows for the entire team to work from one location, creating a much
more effective work environment. The RFDS base is now more modern and has won
architectural design awards. However, the project has struggled to meet some of its original
objectives with a reduction in overall service volumes and limited additional service offerings
being provided. The RFDS has come across some challenges in meeting its original objectives
(many of which are out of its control such as decreased demand in the region due to
population changes and the persisting drought), changes in the structure of funding for
Indigenous healthcare, new healthcare providers in the region, difficulties sourcing
operational funding (from various sources) and attracting new staff.
The RFDS base redevelopment HHF funding application, specified a clear need to re-locate
teams to a newer, larger building, however the capacity of the new building appears larger
than required for current operations. Whilst the change in demand could not have been
predicted, it is unclear whether investigations were made into plans for other primary care
providers in the region (for example, plans for a GP clinic expansion started in 2007) and the
resulting impact on the RFDS base design.
Theme evaluation
Summary Findings
Appropriateness
The project created a facility that met the needs of the
RFDS team and provided a more integrated work
environment.
However, the project has struggled to meet its original
objectives around increasing local primary healthcare
services with a reduction in overall service volumes and
limited additional services provided. Some external factors
(outside of RFDS’ control) have contributed to these
challenges.
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Theme evaluation
Summary Findings
Efficiency
Since opening, the RFDS base is providing a new men’s
forum service (conducted twice a year). The RFDS base is
also supporting the staff working on the mobile dental unit
(which is a separate HHF funded project).
Utilisation
There was an overall decrease in service volumes by
approximately 18% (mainly for Indigenous patients). This
could in part be due to healthcare coverage funding cuts,
population decreases and demand changes. Local suppliers
and staff were engaged for the construction of the RFDS
base.
Effectiveness
The RFDS base was designed to be more culturally
accessible and provides for an enhanced and more
functional work environment with ample room for training
and staff development. Staff numbers have increased
marginally due to limited operational funding, recruitment
challenges and changes in primary healthcare demand.
Overall
The RFDS base provides a much improved work
environment allowing easier integration within the
team. However, the decrease in local demand and
marginal increases in service offerings has limited
the ability of the project to meet its objective of
increasing primary healthcare services.
3.4.2 Appropriateness
The Mount Isa RFDS team provides services for aeromedical evacuations, conducts outreach
clinics and telehealth consultations. Previously the base functioned out of multiple houses
that were outdated, not fit-for-purpose and at full capacity. The HHF application, submitted
in 2010, expressed community need for the new RFDS base as it expected an increase in
demand for healthcare services (particularly mental health) in the local region with the RFDS
team expected to triple in size to respond to this within five years. This was driven by the
number of patient consultations which increased by 55% between 2004 and 2010.
According to the RFDS team, there has been a change in both the demand for the services
(number of people requiring healthcare) and the level of primary care provided in the
community where there are multiple medical centres, GP services and a new GP Super Clinic
(17 consultations rooms) in the local area. As a result of the change in demand since the
original funding application, the RFDS team has seen reduced service volumes and struggled
to expand the services they are offering out of the new base and as a result, the additional
consulting rooms are not being fully utilised (other than a limited amount of follow ups with
patients from the outreach clinics and staff immunisations).
With respect to assessing achievement against the community need, there was a clear need to
re-locate teams to a newer, larger building. This has improved the environment for both staff
and patients, however there remains capacity to increase services should the need arise.
As a result of the reduction in demand for primary healthcare services and challenges with
obtaining operational funding, RFDS have not been able to recruit additional healthcare
staff. Overall FTEs increased from 25.1 in 2011 to 27.1 in 2014, however the increase was
from non-medical staff (pilots, support services and a regional manager). Medical officers
slightly reduced from 8.6 to 8.1 FTEs and nurses remained at six FTEs.
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Measure evaluation
Summary of Findings
Project addresses community needs
A new RFDS base was required as the
previous base was too small and not fit-forpurpose to deliver services. However, the
community need to build consulting rooms
to deliver services locally and to
accommodate a considerable staffing
increase has not yet eventuated due to
changes in demand and the extent of other
available primary healthcare providers in the
community.
Project has increased health professionals in
regional areas (e.g. GPs, nurses, allied
health)
The number of healthcare professional FTEs
has decreased slightly from 14.6 to 14.1
however this is impacted by challenges with
operational funding for positions, local
accommodation and changes in community
need.
Overall
The project created a facility to deliver
the needs of the RFDS team and
provided for a more integrated work
environment. However the project has
struggled to meet its original
objectives around increasing local
primary healthcare services with a
reduction in overall service volumes
and limited additional service
offerings provided. External factors
(outside of RFDS’ control) have
contributed to these challenges.
3.4.3 Efficiency
Overall, there have been limited new services provided to the community as a result of the
redeveloped base. One of the objectives of the redeveloped base in the HHF funding
application was to provide additional healthcare services to the Mount Isa community,
especially around mental health and social and emotional wellbeing services. Since opening,
the new base is providing a new ‘men’s forum’ service which focuses on raising awareness
around local services and making activities “father friendly”. This forum is conducted twice a
year. There has been no increase in the number of outreach clinic locations in the two year
period.
The mobile dental unit is part of a separate HHF project, however the staff are based out of
Mount Isa (when not traveling). The unit provides more than $1.3 million in dental services
free of charge to the region and they are currently up to the 3,000th patient. The redeveloped
base is supporting this service and its employees.
Measure evaluation
Summary Findings
Project has increased the number of
relevant services delivered
Since opening, the base has provided a
new men’s forum service, which is
conducted twice a year. The base also
supports the staff working on the
mobile dental unit (which is a separate
HHF funded project).
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3.4.4 Utilisation
Since 2010, the health services volumes provided by RFDS have reduced and parts of the
new base are not being utilised to capacity. Local services and suppliers were planned into
the development of the new RFDS base and used during construction.
The majority of RFDS funding supports outreach clinics which are being provided to ten
communities in north west Queensland where there have been shifts in demand which have
had an impact on the need for local healthcare. For example, the RFDS observed decreased
demand in McKinlay due to a new, successful GP practice in Cloncurry and increased
demand in Camooweal because of a new work camp established in the area.
The overall volume of services provided has decreased by about 18% since 2010, particularly
for Indigenous patients (self-declared). Total telehealth consults have decreased by about
17% from 5,489 in 2010 to 4,562 in 2013. Aeromedical evacuations (primary response and
inter-hospital transfers) have decreased by about 26% from 1,114 retrievals in 2010 to 828 in
2013. Overall clinic consultations have decreased by about 17% from 6,577 in 2010 to 5,435
in 2013. The number of non-Indigenous consults reduced slightly, while the number of
Indigenous consults dropped by 42% in that time. It should be noted that there was a
considerable increase in the number of ‘non-specified’ consults between 2010 and 2013 (37
to 632) and if they had been Indigenous, the reduction would have been about 26% (instead
of 42%) between 2010 and 2013.
The RFDS team believe that these reductions are due to changes in the structure of funding
for Indigenous healthcare that started in 2013 and new service guidelines that now restrict
some communities from services that were available before. The RFDS team also mentioned
that there has been a reduction in overall healthcare demand in Mount Isa and north west
Queensland because of a higher ratio of Fly In, Fly Out (FIFO) mining workers and that these
workers are more likely to seek primary care services when they are at home. Finally, the
reduction of retrieval services is linked to the drought in the north west of the state because
there are fewer people in the area, less farming and heavy machinery usage and so fewer
emergencies.
The construction company committed to using local suppliers wherever possible in the
construction of the new base. Local suppliers provided some of the fittings and furniture, and
local electricians and gardeners were used in the construction of the base. Approximately five
local FTEs were used during construction (recognising that it can be difficult to use local
contractors in mining towns as the mining positions have more lucrative compensation
packages.)
Measure evaluation
Summary of Findings
Project has increased remote/regional
activity (volume)
There has been an overall decrease in service
volume by approximately 18% (mainly for
Indigenous patients). This could in part be
due to changes in the structure of Indigenous
healthcare funding, population decreases
and demand changes.
The construction/development of the new
facility was done through the use of local
services in the community
As part of the builder’s contract, local
suppliers and staff (five FTEs) were used for
the construction.
Overall
There was an overall decrease in
service volumes by approximately 18%
(mainly for Indigenous patients). This
could in part be due to changes in the
structure of Indigenous healthcare
funding, population decreases and
demand changes. Local suppliers and
staff were engaged for the
construction of the new base.
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Primary care domain evaluation
3.4.5 Effectiveness
The new base has improved the work environment for staff with increased room for training,
meetings and more suitable work areas which allows the team to more effectively work and
collaborate.
Previously, the base was overcrowded and there were no facilities available to conduct team
meetings or training sessions. The new base has two meeting rooms with one being quite
large and well equipped with video conferencing capability. These rooms are being utilised
by the RFDS teams with 127 meetings, workshops and training sessions held in the last two
years and 71 additional ‘other’ bookings. Also, first aid training is provided to the community
through external providers in these rooms. The facility has also been used for events such as
the launch of the mobile dental health service, the RFDS anniversary and re-launch of the
RFDS Auxiliary.
The team facilities are more suitable with a specific ‘on call’ area, superior maps and GPS
coding and sound proof rooms for telehealth consultations. It is a much better work
environment that supports integration of the teams and healthcare services.
In its funding application, the Mount Isa RFDS team was expected to grow to 75 employees
in the first five years. With a stable increase this would equate to ten new employees per
year. In the first two years they have increased from 25.1 to 27.1 budgeted staff FTEs. These
staff numbers do not include any FIFO staff that have worked out of the base in times of
increased need..
The RFDS has had difficulties recruiting new staff as operational funding needs to be secured
for each new role and contracts are usually for less than a year. Even when funding becomes
available, it can be difficult to attract medical staff to the Mount Isa region, due to factors
such as suitable accommodation. The Mount Isa RFDS team currently has a few funded
roles that they are trying to fill. Information on staff turnover rates for previous years was
not available however there was no staff turnover in 2013. To ease the accommodation
pressures in Mount Isa, $10.9 million has been provided to the Queensland Government
through the HHF to purchase accommodation for healthcare professionals. This project was
completed in February 2014 and this incentive may help to attract medical professionals to
the region.
The new building was designed to be more culturally accessible with a landscaped outdoor
seating space. There is a watering system for the garden that also helps to naturally keep the
air cool for waiting patients (currently turned off because of the drought). The staff cultural
capability training was previously conducted in Brisbane and now staff can complete this
training at the new base, which provides better context for the training and reduces travel
costs.
Measure evaluation
Summary of Findings
Project has increased staff development,
availability and access to local training
research infrastructure and shared research
training facilities
There is now a more integrated and
enhanced learning and development
environment for staff with specific areas for
training.
Project has improved attraction and
retention of staff
Increase from 25.1 to 27.1 FTEs, below the
FTE growth targets. Challenges with
operational funding have limited the number
of new team members.
Services provided by the project are more
culturally accessible
The building was designed to be more
culturally accessible – providing an outdoor
waiting area for patients.
Overall
The new base was designed to be more
culturally accessible and provides an
enhanced functional work
environment with ample room for
training and staff development. Due to
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Measure evaluation
Summary of Findings
operational funding and recruitment
challenges and changes in healthcare
demand, staff numbers have increased
marginally.
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3.5
Sheffield Multipurpose Health Precinct
The Kentish Council received $1.7 million to expand a recently built multipurpose health
precinct to include an additional health centre wing for allied health services. The
multipurpose health precinct already had an established, separately managed medical centre.
The health centre renovations included six consultation rooms (including dentistry), a
community meeting room, the upgrade and expansion of the day service centre room, a
parking lot, an ambulance entrance and a gym room. The building is managed by the Kentish
Council and the rooms are rented out to various private service providers.
The objectives of the additional renovations were to attract more allied health service
offerings to the community, provide enhanced services for patients, support better health
outcomes, reduce the need for Kentish residents to travel for healthcare and support the
better integration of health and community services.
Co-contribution funding of $91,310 was received from the National Rural and Remote
Infrastructure Program for the provision of a low-rise platform lift and a fit out of a second
dental room
Practical completion was on 22 March 2013 (operating over a year at the time of this
evaluation).
3.5.1 Overall Evaluation
The Sheffield Health Centre allows for more integrated care, addresses community needs and
is line with the Tasmanian government’s healthcare objectives. New health and community
wellbeing services are being provided locally which reduces waiting and travel times for local
residents. Anecdotal evidence suggests the services that were previously being provided in
different locations have seen an increase in volumes since relocating to the health centre.
Considering the capacity of the building, there is an opportunity for new and expanded
health services to be provided should appropriate operational funding be made available and
the integration of the different private service providers could more proactively managed.
Theme evaluation
Summary of findings
Appropriateness
The project addresses community needs and local
government objectives by providing more integrated care
and additional services locally reducing the need for
patients to travel.
Efficiency
Six new services being provided to the community in one
location, however there is an opportunity for new and
expanded health services to be provided should
appropriate operational funding be made available.
Anecdotal evidence shows that this has led to reduced
waiting times for referrals.
Utilisation
Anecdotal evidence shows an increase in service volumes
however data was not provided as this is held by private
providers. Local contractors were used for the construction
of the health centre.
Effectiveness
The co-location of healthcare services supports integration
of care however integration could be more proactively
managed. There are two new outreach programs and
additional local services, reducing the need for local
residents to travel for healthcare services.
Overall
The health centre addresses the community needs
and supports Tasmanian healthcare objectives.
There is better integration of care, new services
available and a likely increase in previously
existing services resulting in reduced waiting times
and the need for travel.
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3.5.2 Appropriateness
The Sheffield Health Centre was designed to address the community need and the
Tasmanian Government’s objectives outlined in the Department of Health and Human
Services 2009-2012 Strategic Directions for Tasmania.
Previously health services in Sheffield were delivered in isolation from several different
locations that were out of date and not fit for purpose. Residents would have to travel to
Devonport (30min away) or further for some of the healthcare needs. Public transportation
was extremely limited and so at risk residents that did not have a car would at times forego
healthcare services. Since the new multipurpose health precinct was built, the majority of
healthcare services (medical and health centre) are provided from one location which is more
convenient for the community (especially those without a car) and supports better
integration of care. The new health centre is providing six new allied health and community
services to the community and provides room for further community activities such yoga and
a gym (new to Sheffield). The new services and additional capacity of previously existing
services (in the community) has reduced the need for residents to travel to Devonport.
In addition, the Kentish Healthcare Centre Advisory Committee is looking to conduct a
Health Needs Assessment to justify additional funding for local services and are planning to
continue to increase the number of services over the next five years.
The additional allied health and wellbeing services now available to the community supports
some of the strategic objectives in the Department of Health and Human Services 2009-2012
Strategic Directions for Tasmania. These objectives are: promoting health and wellbeing and
intervening early when needed, developing responsive, accessible and sustainable services,
and creating collaborative partnerships to support the development of healthier
communities. The new centre promotes health and wellbeing in Sheffield, provides more
local access to services and has allowed for better integration between services.
Measure evaluation
Summary of findings
Project addresses community needs
Healthcare services are now provided from
one location. Improved access through new
services and additional capacity of previously
existing services, reducing the need for travel
to neighbouring cities.
Project addresses an overarching strategy of
a State/ Territory/ Commonwealth body
The new health centre is addressing the
Tasmanian Health’s Strategic Directions
objectives.
Overall
The project addresses community
needs and local government objectives
by providing more integrated care and
additional services locally reducing
the need for patients to travel.
3.5.3 Efficiency
The health centre is providing six new services to the community and has increased the
volumes of previously existing services which has led to reduced referral waiting times for
patients.
Anecdotal evidence from the Kentish Council shows that overall, average referral waiting
times have reduced for services provided at the health centre. The multipurpose health
precinct is more convenient for Sheffield residents with the majority of healthcare services
now in one location. There is reduced travel between the different healthcare providers in
Sheffield and to other towns for the new services which are now provided in Sheffield. The
new and increased capacity of previously existing services means reduced waiting times for
appointments.
The new services provided in Sheffield are osteopathy (one day per week), a forensic mental
health service (four times per year), Salvation Army Bridge Program (one day per week),
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Mums & Bubs Group (one day per week), play therapy (one session per fortnight) and a new
gym (opening soon). The Kentish Council has been successful in attracting new services to
Sheffield, however many of the new and existing allied healthcare professionals are providing
services on a part time basis (once a week) meaning that there is a considerable amount of
additional capacity during the week. Further services could be provided for the community in
this extra capacity however funding for additional health services is out of the control of the
Kentish Council. Given the additional capacity in the building, there is an opportunity for
new and expanded health services to be provided should appropriate operational funding be
made available.
Dietetics, dental and physiotherapy services are provided by both the medical and health
centres (separately managed). The Kentish Council was not able to provide service volume
data as this information is held by the various private providers however through the
observations and conversations with providers they were confident in stating that volumes
for previously existing services have increased and new services are being utilised.
Measure evaluation
Summary of findings
Project has reduced the length of time
between referral and provision of service
The location of services in one building, and
the new services provided has led to reduced
waiting times for patients.
Project has increased the number of relevant
services delivered
Six new services are being provided to the
community. There is capacity to be providing
more, however this is dependent on
additional funding being made available.
Overall
Six new services being provided to the
community in one location, however
considering the capacity of the
building, there is an opportunity for
new and expanded health services to
be provided should appropriate
operational funding be made
available. Anecdotal evidence shows
that this has led to reduced waiting
times for referrals.
3.5.4 Utilisation
Anecdotal evidence shows an increase in service volumes provided to the community
through previously existing and new services however there is capacity in the building to
provide more. Local service providers from north west Tasmania were used for the
construction of the health centre.
The Kentish Council was not able to provide service volume data as this information is held
by the various private providers however through the observations and conversations with
providers they were confident in stating that volumes for previously existing services have
increased and new services are being utilised. The Kentish Council estimated the increase in
service volumes from new services by using the frequency of services (e.g. weekly) and the
projected number of consult/visits that normally take place in during that time (e.g. 12
patients per day). Based on this, a conservative estimate is that there are 552 osteopath
consultations, four forensic mental health, 92 Salvation Army Bridge Program visits, 312
Mums & Bubs Group visits (one count each for mom and child per weekly sessions) and 12
play therapy sessions per year which is about 972 new sessions/visits per year.
The gym is not yet being utilised however the lease has been signed and they are just waiting
for delivery of the equipment. The facility was built for the long term, with ability to grow to
accommodate potential future demand. In particular the dental and podiatry rooms seemed
to be unused for the majority of the week. There is an opportunity for new and expanded
health services to be provided should appropriate operational funding be made available.
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In construction, all of the builders and contractors were from the Tasmanian north west
coast and so considered local. ARTAS in Launceston provided the architects and contract
managers. The builders were from Spreyton and the subcontractors were Palmers Plumbing
(East Devonport), Harding Hot Mix (Ulverstone) and Shane Hill Electrical (Devonport).
Measure evaluation
Summary of findings
Project has increased rates/number of
screening, diagnosis and treatment
Data could not be provided to support
volume increases of certain services because
the Kentish Council does not have access to
the private provider’s information, however
anecdotal evidence and an estimate of new
services provided (per year) shows an
increase in service volumes.
The construction/development of the new
facility was done through the use of local
services in the community
All contractors for the development were
from North and North West Tasmania.
Overall
Anecdotal evidence shows an increase
in service volumes however data was
not provided as this is held by private
providers. Local contractors were
used for the construction of the health
centre.
3.5.5 Effectiveness
The co-location of Sheffield healthcare services into the multipurpose health precinct allows
for better integration of care and interaction between providers however this could be more
proactively managed. The Kentish Council have attracted new services to the area and this
has led to reduced need for residents to travel for healthcare services.
Some of the healthcare professionals in turn (did not know each other before) have now
started to build professional relationships, which supports internal referrals. The Home and
Community Care day centre attendees can find out about and book appointments for other
services while they are at the health precinct. Emergency medical care is available down the
hall from the day centre in case it is needed (there has already been one incidence of this).
The Kentish Healthcare Centre Advisory Committee meets every two months to discuss
healthcare services in Kentish and one of the areas that they advise the Council on is how to
improve coordination of system delivery. Committee members include the mayor, some
health service providers and local businessmen. The health centre’s model of contracting
with various private providers means it is difficult for healthcare professionals to share
patient data and discuss cases (before an official referral is made) which limits integration.
Other than the Kentish Healthcare Centre Advisory Committee meetings there is limited
evidence to demonstrate a focus on promoting integration of care at the health centre.
The new local services provided at the health centre means reduced travel for Sheffield
residents. They previously would have had to travel to Devonport (30km) for osteopathy, the
Mums & Bubs group and the Salvation Army Bridge Program and Launceston (100km) for
forensic mental health services. Although Devonport (30km) is relatively close to Sheffield,
this is a clear benefit to the community especially for those that do not have a car because of
the lack of public transport.
The Kentish Council was able to attract the new private service providers to Sheffield. There
has been no change in service staff. Two of these programs are outreach programs (forensic
mental health and Salvation Army Bridge Program).
Measure evaluation
Summary of findings
Project resulted in better integration of
locally available medical services
Integration is supported by the co-location of
health service however this could be more
proactively managed. There a challenges to
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Primary care domain evaluation
Measure evaluation
Summary of findings
integration with patient data confidentiality.
Project has reduced travel time and referrals
to a health service
Reduced need for travel because of new
services being provided locally.
Project has improved attraction and
retention of staff
Council attracted new private service
providers to the local area.
Project has improved outreach services to
educate communities to better manage
diseases
Two of the new services are outreach
programs.
Overall
The co-location of healthcare services
supports integration of care however
integration could be more proactively
managed. There are two new outreach
programs and additional local
services, reducing the need for local
residents to travel for healthcare
services.
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Primary/integrated care
domain
Domain sample studies
The remaining three domain sample projects were reviewed at a
higher level and did not include site visits. The domain sample
projects helped to increase the sample size and provide more
information for the overarching themes of the domains and overall
evaluation.
The primary/ integrated care domain sample projects reviewed were:
1.
Kincraig Clinical Development, South Australia
2.
Expanded Integrated Primary Healthcare Facility,
Shepparton, Victoria
3.
Wallaroo Community Dental Clinic, South Australia
3.6
Kincraig Clinical Development (SA)
The Limestone Coast Division of General Practice received $1.4 million for the construction
of a new medical clinic on the grounds of the Naracoorte Hospital, South Australia. The clinic
used to operate from two locations that were not fit-for-purpose being an old house and a
rented room. The new clinic has almost twice the space available with 12 multifunction
rooms and much larger nursing and treatment areas.
The objectives of the new clinic were to improve access to integrated primary healthcare,
provide further allied health services, support a better work environment for staff, attract
prospective medical staff, provide modern training facilities for students and allow for easy
access to hospital facilities (e.g. radiologists or visiting specialists).
Co-contributor Project Funding: $918,676.
Practical completion on 1 October 2013 (operating for about eight months at the time of this
evaluation).
3.6.1 Appropriateness
Measure evaluation
Summary of findings
Project addresses community needs
The medical clinic used to operate from two
locations which were not fit for purpose; GPs
and allied health were in separate locations
which led to communication challenges.
There was no capacity for growth and a
shortage of doctors in the community, with
many appointments being double booked
and locums were used to try and maintain
services.
The new clinic is about 2.5 times larger and
all staff are working from the same site near
the hospital. There has been an increase in
the number of staff and services (10% of
existing services).
Project has achieved additional objectives,
that were not planned in original scope
The medical clinic was able to attract allied
health workers, a registrar and an intern
which would have not been possible in the
old clinic because of the capacity issues.
An unexpected benefit the project has seen is
more efficient nursing operations with all the
doctors working from one location.
The project team were able to use unspent
funds to purchase solar panels for the
building leading to lower energy costs.
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3.6.2 Efficiency
Measure evaluation
Summary of findings
Project has reduced the length of time
between referral and provision of service
Waiting times for non-urgent appointments
have decreased in the eight months since the
medical centre has been operational:
Project has increased the number of relevant
services delivered

Previously at least three weeks for
staff GPs and registrars (now two
weeks)

Previously four weeks for senior
doctors (now three to four weeks)
There is now a dietician and hypnotherapist
which are new to the community.
The new services provided in the clinic (not
new to the community) from a pathologist,
child psychologist and dental technician
providing increased choice and capacity for
patients.
There are negotiations with a paediatrician
to join the clinic, with none currently
available in the community.
3.6.3 Utilisation
Measure evaluation
Summary of findings
Project has increased remote/regional
activity (volume)
In the 2011/2012 fiscal year there were about
6370 Medicare items billed per month.
In April 2014 there were about 7028 items
billed by GPs (~ 10% increase).
This does not include volume increases from
the new services.
The construction/development of the new
facility was done through the use of local
services in the community
Approximately 75% of construction funds
were spent using contractors within 150km
radius. The main contractors were from
Naracoorte. Purchases for furniture and
equipment were made locally where possible.
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Primary care domain evaluation
3.6.4 Effectiveness
Measure evaluation
Summary of findings
Project resulted in better integration of
locally available medical services
The staff now operate from one location
instead of two and there is additional allied
health in the clinic which supports a more
collaborative environment.
The Medicare Local is now providing mental
health services at the clinic.
No specific integration meetings are
organised.
Project has improved attraction and
retention of staff
Overall larger and better work environment
for staff, the nursing triage area is about
three times larger now. Fewer double
bookings and a less stressful environment.
Went from seven GP, one registrar, 3.9 nurse
and 9.4 administration staff FTEs in 2011 to
7.7 GP, three registrar, 1.0 intern, 3.9 nurses
and 10.0 administration FTEs in 2014. In
that time they were able to retain most of the
staff.
New facility has improved accessibility
through better telecommunication and eHealth services
Previously doctors had to be out of their
office for staff to partake in teleconferences.
Now there is a dedicated training room for
this with enhanced technology.
For the 2012/2013 fiscal year there were 120
nurse telemed items billed. In the six months
between Nov 2013 and April 2014 there were
199 nurse telemed items billed.
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3.7
Expanded Integrated Primary Healthcare
Facility, Shepparton
Primary Care Connect (PCC) received $3.8 million for the renovations and connection of the
previous centre with an adjoining building to create an expanded integrated primary
healthcare facility in Shepparton (catchment of 100,000 at time of application). Funding
included a second story addition to the facility, new treatment and consultation rooms,
meeting rooms and office space.
Originally the intention was to expand GP services, preventative health and chronic care
services however between the time of the funding application and project completion there
was no longer a GP workforce shortage in Shepparton. To account for this, PCC shifted focus
to community health where they felt there was more community need. Other objectives of the
renovations were enhanced services for patients in drug treatment programs, support of
education and training of healthcare professionals and reduced ED presentations at the local
hospital.
Co-contributor Project Funding of $110,000
Practical completion on 15 April 2013 (operating for more than a year at the time of this
evaluation)
3.7.1
Appropriateness
Measure evaluation
Summary of findings
Project addresses community needs
The previous healthcare centre was outdated
and had limited space to provide further
services. At the time of application
Shepparton had no bulk billing clinics and
was identified as area with too few GPs.
According to the funding application, there
are Indigenous and refugee communities in
the catchment area and chronic diseases
such as cardiovascular disease and diabetes
were particular challenges for the
community.
By the time the PCC healthcare centre was
built there were multiple bulk billing clinics
in town. The PCC team showed flexibility,
deciding to focus on community health needs
and enhance the drug treatment services.
The new facility was designed to support
more integrated care with enhanced space
for secondary consultations, combined
sessions and clinic type rooms. Since the
renovation there are five new specialist
services and four new chronic condition selfmanagement groups available to the
community however according to the CEO
there is still capacity for a lot more
healthcare activity to be provided.
Overall it appears that the community need
could have been more thoroughly assessed at
the time of the application by the applicant
through inquiry of other healthcare
professionals and understanding the plans
for the area; however the flexibility in
changing objectives has kept the centre’s
operations relevant to the community.
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Primary care domain evaluation
Measure evaluation
Summary of findings
Project has achieved objectives as set out in
the funding application
Expand GP services:

PCC shifted away from GP services
due to changed circumstances in
local area
Preventative health and chronic care
services:

Running new LIFE Diabetes
program

New partnership with Goulburn
Valley Health for type 2 Diabetes

Four new chronic conditions selfmanagement groups

Co-location with Red Cross for
refugee population

In discussions with aged care
providers to offer services

Immunisation clinics and weight loss
support groups to start in new
financial year
Support of education and training:

New teleconference equipment to
access webinars

New clinical “Open Practice Forums”
(best practice information, feedback
and sometimes guest speakers)
Reduced ED presentations at hospital

No information provided
3.7.2 Efficiency
Measure evaluation
Summary of findings
Project has reduced the length of time
between referral and provision of service
PCC now has a 24 hour turnaround response
for patients seeking care. This used to be
three to four days.
Insufficient information provided to assess
the impact on reduced travel for the
community.
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Measure evaluation
Summary of findings
Project has increased the number of relevant
services delivered
New services to the community (except
psychiatry which was only new to the clinic
but was previously provided elsewhere in the
local area) and volumes for the last year:

Mental health nurse – 332 sessions

Paediatric clinic – two clinics, four
children seen

Pharmacotherapy – 157 patients

Psychologist (only bulk billed) – 18
patients

Psychiatrist – 68 patients

Pain management support group
(external group using for free) – five
to ten participants
3.7.3 Utilisation
Measure evaluation
Summary of findings
Project has increased remote/regional
activity
Overall service volumes were not provided
however there is a clear increase from the
new services.
The construction/development of the new
facility was done through the use of local
services in the community
There was a local building designer who was
also the principle consultant. Construction
completed by a local commercial building
company.
3.7.4 Effectiveness
Measure evaluation
Summary of findings
Project resulted in better integration of
locally available medical services
The building brings many different services
together. GPs in the drug and alcohol clinic
have more allied health options for referrals.
PCC is linked with the alcohol and other
drugs nurse in the local ED for follow up care
and referrals. There are new clinical “Open
Practice Forums” to support staff
development, quality and integration of care.
Topic examples include case reviews, client
journey discussions, best practice ideas etc.
New collaboration/partnerships with Red
Cross and Goulburn Valley Health.
Project has improved access to specialised
health services and specialist facilities
Monthly peri natal emotional support service
teleconference with a psychiatrist in
Melbourne.
New services provided are specialised.
Project has increased staff development,
availability and access to local training
research infrastructure and shared research
training facilities
New teleconference equipment to access
webinars.
New clinical “Open Practice Forums” (best
practice information, feedback and
sometimes guest speakers).
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Primary care domain evaluation
Measure evaluation
Summary of findings
New facility has improved accessibility
through better telecommunication and eHealth services
New teleconference equipment.
New peri natal emotional support service
tele-conference.
Services have increased testing, diagnosis
and treatment of diseases that are prevalent
in the Indigenous population
The CEO estimates a 20% increase in
services provided to the Indigenous
community but no data was provided.
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3.8
Wallaroo Community Dental Clinic (SA)
The Department for Health and Ageing (SA) received $3.3 million for the construction of a
new five-chair public dental clinic on the grounds of the Wallaroo Hospital, replacing the
Kadina Dental Clinic (70m2) which had three chairs and some of the longest waiting times in
South Australia. The funding provided for a new dental clinic (350m2) including five dental
chairs, a reception area, a waiting room, a sterilisation area, a dental radiography cubicle, a
staff room and amenities.
The objectives of the new dental clinic were to provide increased access (target of 61%
increase in volume) to public dental services and support oral health in the Wallaroo
community (specifically children and financially disadvantaged/vulnerable adults), improved
access for local Indigenous communities, reduce waiting times for adult general dental care
from 25 months to average waiting times, reduce average recall periods for children, help
reduce avoidable hospitalisations (dental conditions were ranked third in terms of
potentially avoidable hospitalisations in South Australian Hospital admission 2005/06 and
2006/07 data) and increase the emphasis on oral healthcare with general healthcare.
Co-contributor Project Funding: none
Practical completion on 06 September 2013 (operating for more than eight months at the
time of this evaluation)
3.8.1 Appropriateness
Measure evaluation
Summary of findings
Project addresses community needs
The previous clinic was outdated (health and
safety issues) and had one treatment area
with very little privacy for clients. Wallaroo
had some of the highest waiting times in
South Australia and there was no capacity to
increase service volumes with the three chair
clinic.
The new, larger clinic has separate
consultation rooms and has allowed for a
considerable increase in the service volumes,
reduced waiting times and children’s recall
rates.
3.8.2 Efficiency
Measure evaluation
Summary of findings
Project has reduced the length of time
between referral and provision of service
The average waiting time used to be 24.9
months and has now (May 2014) reduced to
18.2 months, a positive outcome considering
that the clinic has only been open for eight
months however still well below the target of
meeting the state average wait times of 8.3
months overall or 13 months in rural
locations4.
4 SA state government Dental Service reports
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Primary care domain evaluation
3.8.3 Utilisation
Measure evaluation
Summary of findings
Project has increased remote/regional
activity (volume)
In the year from Nov 2009 - Oct 2010 there
were 1,052 clients seen and 6,595 items of
care provided. In the six month from Nov
2013 to 30 April 2014 the clinic had already
seen about 20% more clients (1,265 clients)
and provided about 66% more items of care
(10,075 items).
The construction/development of the new
facility was done through the use of local
services in the community
About two thirds of the development services
were contracted from local providers
(Wallaroo civil contractor, Gawler head
contractor and Verdun plumber).
3.8.4 Effectiveness
Measure evaluation
Summary of findings
Project resulted in better integration of
locally available medical services
The new clinic enables increased
opportunities for Indigenous and elderly
people to access oral Healthcare due to
increased capacity at the new clinic. Links
have been developed with local community
Aboriginal Health Workers and aged care
service provider 'Helping Hand'. These care
workers now include oral health assessments
as part of the routine client assessments and
have been provided with basic oral health
education, enabling them to assist clients
with the daily oral healthcare and where
necessary make referrals to the local clinic.
Project has improved attraction and
retention of staff
The clinic has gone from 1.1 to 3.7 dentist
FTEs and 1.7 to 5.8 dental assistant FTEs.
Services have increased testing, diagnosis
and treatment of diseases that are prevalent
in the Indigenous population
In the year from Nov 2009 - Oct 2010, 38
Indigenous patients were seen and provided
with 256 items of care. In the six month from
Nov 2013 to 30 April 2014 the clinic had seen
more than twice as many Indigenous
patients (86 patients) with almost three
times the items of care (750 items).
Project has improved outreach services to
educate communities to better manage
diseases
The new capacity has allowed the team to
enhance community efforts with the
Aboriginal Liaison program and Helping
Hand to identify community need and
educate case managers about the importance
of oral health.
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4 Workforce domain
evaluation
The projects evaluated in this domain relate to workforce needs around attraction and
retention of healthcare staff and the training and development of healthcare professionals.
Workforce projects received $151.0 million or 3% of the total HHF funding. There are 26
projects that fall under the workforce category in the HHF Program of which about 20% are
in major cities and the rest are in regional and remote areas. Of the total workforce projects,
13 have been completed to date and six of these were selected by the Department for this
review of which three were located in major cities and three were in regional or remote areas.
These projects related to the construction of clinical schools, healthcare centres and
workforce accommodation. Three of the projects were case studies for which there was a
more in depth evaluation of the project outcomes which included site visits. The workforce
case study projects reviewed were:
1.
WAMS Multidisciplinary Healthcare Centre and Accommodation, New South
Wales
2.
Blacktown Clinical School, Research & Education Centre, New South Wales
3.
Retention of GPs in the McKinlay & Julia Creek region, Queensland
The remaining three domain sample projects were reviewed at a higher level and did not
include site visits. The domain sample projects helped to increase the sample size and
provide more information for the overarching themes of the domains and overall evaluation.
The workforce domain sample projects reviewed were:
4.
Nepean Clinical School, New South Wales
5.
Clinical Medical Education and Best Practice in Ambulatory Care, Victoria
6.
Nebo Medical Centre, Queensland
4.1.1
Overall evaluation
The six reviewed workforce projects have demonstrated varying levels of success in meeting
project objectives and community needs. The clinical schools appear to have performed
consistently well against the project objectives and the evaluation measures and two of the
smaller, primary care style focused projects are providing considerable benefits to the
community with the third project providing marginal benefits at this stage.
The objectives of all the funding applications appeared to be well suited to the community
needs or relevant state/territory government healthcare strategies.
All of the projects except for the one at Julia Creek have been able to use the new
infrastructure to support workforce related objectives of attracting relevant staff, educating
future healthcare professionals and developing research that benefits the community.
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Workforce domain evaluation
Theme evaluation
Summary of findings
Appropriateness
All of the assessed projects appeared to have
objectives that are well suited to the
community needs or relevant state/territory
government healthcare strategies and the
majority have provided evidence that they are
delivering against these.
Efficiency
The large clinical schools have been able to
provide considerable increases in research
capabilities and support local healthcare
services (bulk billed clinics). The smaller
primary care style facilities have delivered
some increases in healthcare service
offerings.
Utilisation
The projects have evidenced increased
healthcare service volumes and additional
students in areas of need. Half of the projects
assessed (for this measure) used a good
proportion of local services in the
construction and development of the
facilities.
Effectiveness
The new facilities have supported the
attraction and retention of important
healthcare or academic staff that then led to
additional community benefits such as
increased number of services, enhanced
access to healthcare or capability and
additional research projects and grants.
Overall
The projects appeared to be well
aligned with community need and
relevant state/territory government
objectives. The clinical schools
performed very well against the
measures assessed while the two
smaller primary care related projects
had challenges with attracting
healthcare professionals to more
remote areas.
Limited Evidence
(low achievement)
Objectives achieved
(high achievement)
4.1.2 Appropriateness
Overall the objectives of the new infrastructure projects appeared to be in line with the
community need however there were varying levels of success in meeting these objectives
with the clinical schools performing well and the smaller primary care related projects
running into some challenges.
All of the six projects were assessed on whether they address community needs or an
overarching government strategy. Five of the projects have shown strong evidence that the
objectives are in line with community need and/or government healthcare strategies and
they are delivering well against these. The objectives of the Julia Creek project seem to have
been appropriate as the community would benefit from having a local GP. The new
infrastructure was not a sufficient incentive to attract a GP to the community to date however
the buildings are being utilised by locums and other healthcare staff. The Nebo project
application also appeared to have had appropriate objectives that were aligned to community
need but had difficulties attracting a healthcare service provider to Nebo and so the facility
was unoccupied for two years. Now there is a healthcare provider in Nebo and healthcare
access has considerably improved for the community. The project in Walgett has been
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successful in attracting new healthcare professionals and providing new services to the
community.
The three clinical schools are providing enhanced teaching and research opportunities to
students and staff and working to attract researchers and healthcare professionals to areas of
high need. Two of the schools are also supporting new healthcare service (bulk billed) in
these communities.
Case study evaluation
Summary of findings
WAMS Multidisciplinary
Healthcare Centre and
accommodation, Walgett
The new building has allowed WAMS to better address
local community needs, by having a more strategic focus on
chronic care, providing new services, increasing service
volumes and attracting new staff.
Blacktown Clinical School,
Research & Education Centre
The clinical school has delivered well against the objectives
and the needs of the community.
Retention of GPs in the
McKinlay & Julia Creek region
Both houses are being utilised and have helped to attract
two medical students, but has not achieved the original
objective to recruit a permanent GP.
Overall
All of the assessed projects appeared to have
objectives that are well suited to the community
needs or relevant state/territory government
healthcare strategies and the majority have
provided evidence that they are delivering against
these.
4.1.3 Efficiency
Four projects were assessed under the efficiency theme with the increased number of
relevant services delivered or research capabilities measured. The larger, clinical school
projects at Nepean and Blacktown have considerably increased research areas and are
providing bulk billed services.
The two primary care centres, in Walgett and Nebo have shown some success in providing
new services however for the project at Walgett there is an opportunity for new and
expanded health services to be provided should appropriate operational funding be made
available. The project in Nebo is providing a considerable amount of new services, however
after a two year delay. It is difficult to compare the successes of the projects with as the small
primary care facilities had limited resources compared to the clinical schools.
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Workforce domain evaluation
Case study evaluation
Summary of findings
WAMS Multidisciplinary
Healthcare Centre and
accommodation, Walgett
Three of the four new services had not yet started at the
time of review. There is an opportunity for new and
expanded health services to be provided should
appropriate operational funding be made available.
Blacktown Clinical School,
Research & Education Centre
Provision of bulk bill services to 150-200 patients a week
and increase in research areas from a baseline of zero.
Overall
The large clinical schools have been able to provide
considerable increases in research capabilities and
support local healthcare services (bulk billed
clinics). The smaller primary care style facilities
have delivered some increases in healthcare
service offerings.
4.1.4 Utilisation
All of the new clinical school buildings, primary care facilities and accommodation projects
are being used to support the healthcare or education objectives.
Two of the primary care centres have provided evidence of increased local healthcare
services. The project in Nebo now has basic primary care where there was none before and
the project in Walgett had an increase in overall average service volumes from existing
services and new capacity. Julia Creek also experienced increased local service volumes
however it is not clear how this is linked to the new accommodation provided.
The clinical school’s ability to attract medical students are all limited by the Commonwealth
Supported Placement (CSP) caps so there have been no considerable increases in the number
of medical students at the respective schools however the students have been shifted to areas
of high need. Based on estimates provided, the schools are fairly well utilised at
approximately 70-80% capacity (for students) and have room for growth should the CSP
caps change or should the school attract additional international students. Additionally the
clinical schools and Walgett project facilities are being utilised by other community
organisations for things like meetings or learning and development.
Local services were used in the construction of the Walgett and Nebo project facilities. The
majority of the construction costs did not go to local businesses for the development of the
Blacktown Clinical School or the accommodation in Julia Creek.
Case study evaluation
Summary of findings
WAMS Multidisciplinary
Healthcare Centre and
accommodation, Walgett
Overall increase in service volumes and twice as many
medical student rotations. Local providers were used for
the construction.
Blacktown Clinical School,
Research & Education Centre
Increase in the number of students undertaking training
and internships at the Blacktown Hospital but actual CSP
numbers remain unchanged and local construction
contractors not used.
Retention of GPs in the
McKinlay & Julia Creek region
Increased local healthcare volumes and use of new medical
clinic however it is not clear that this is linked to the
project. Local services not used for construction.
Overall
The projects have evidenced increased healthcare
service volumes and additional students in areas of
need. Half of the four projects assessed (for the
measure) used a good proportion of local services
in the construction and development of the
facilities.
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4.1.5 Effectiveness
The new infrastructure from the HHF funding supported almost all of the projects in their
workforce goals with the clinical schools doing especially well. The clinical schools were able
to attract new staff, postgraduate students and funding. Two of the primary care services had
some challenges in attracting needed healthcare professional which impacted the ability to
provide more effective services to the community.
There are ten measures that have been used to assess the new infrastructure’s impact on
effectiveness with the majority of measures rating well. The measure around attraction and
retention of staff was used to assess most of the projects. The new clinical school buildings
and research infrastructure have helped attract new staff and research capabilities to the
schools. This has in turn supported increases in the number of research
publications/projects developed at the schools and grants funding.
The project in Walgett was able to fill long term staff vacancies with the new chronic disease
building and accommodation provided and the project in Nebo now has a local healthcare
service provider. The additional staff and corresponding extra services have reduced the need
to travel for residents in Walgett and Nebo. The project in Julia Creek has not yet been able
to attract a local GP however there are two new medical students starting a rotation there in
the near future (as of May 2014) because of the new accommodation. The smaller, more rural
projects struggled the most to attract needed healthcare professionals.
Case study evaluation
Summary of findings
WAMS Multidisciplinary
Healthcare Centre and
accommodation, Walgett
WAMS is supporting integration with new chronic disease
programs and the new services are likely to lead to reduced
patient travel. There are three new GP registrars and long
term vacancies have been filled. There has been a slight
increase in the number of training sessions offered and
WAMS is promoting the building’s services to the
Indigenous community.
Blacktown Clinical School,
Research & Education Centre
The school has increased the staff numbers and research
projects and is focusing on cultural differences in the
training and research projects.
Retention of GPs in the
McKinlay & Julia Creek region
Unclear how the accommodation has supported the
effectiveness (for identified measures) of healthcare
provision for the community.
Overall
The new facilities have supported the attraction
and retention of important healthcare or academic
staff that then led to additional community
benefits such as an increased number of services,
enhanced access to healthcare or capability and
additional research projects and grants.
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Workforce domain
Case study evaluations
These projects related to the construction of clinical schools,
healthcare centres and workforce accommodation. Three of the
projects were case studies for which there was a more in depth
evaluation of the project outcomes which included site visits.
The workforce case study projects reviewed were:
1.
WAMS Multidisciplinary Healthcare Centre and
accommodation,, New South Wales
2.
Blacktown Clinical School, Research & Education Centre,
New South Wales
3.
Retention of GPs in the McKinlay & Julia Creek region,
Queensland
4.2
WAMS Multidisciplinary Healthcare Centre
and Accommodation, Walgett
WAMS received $2.9 million to build a multidisciplinary healthcare centre with a focus on
treatment and prevention of chronic disease. The new facility sits next to and complements
other WAMS buildings and services (acute, dental, outreach and allied care). Funding
provided for the purchase of the land, construction and fit out of the new centre including
three consulting rooms, a treatment room, multiple offices, an exercise therapy room and
four new relocatable homes for staff accommodation.
The objectives of the new healthcare centre were to improve access to services for treatment
and prevention of chronic disease, deliver additional health service capacity, recruit medical
specialists including GP registrars, enable WAMS to provide further training opportunities
and reduce the need for people to travel to access specialists. Practical completion of the
centre was in June 2013 however the centre was fully functional in October 2013 (operating
for about eight months at the time of this evaluation).
4.2.1 Overall Evaluation
The new chronic disease building in Walgett has provided needed capacity for WAMS which
has allowed them to increase service volumes and organise new specialist services (reducing
the need for patients to travel).
The chronic disease services are now provided in one location in a more strategic way. New
chronic disease programs available and health checks are being conducted on site which
helps the team to promote the new building and services to Indigenous patients.
The additional capacity and accommodation has allowed WAMS to take on more medical
students and three new GP registrars. They have also been able to fill most of the previous
long term vacancies.
Theme evaluation
Summary of findings
Appropriateness
The new building has allowed WAMS to better address
local community needs, by having a more strategic focus on
chronic care, providing new services, increasing service
volumes and attracting new staff.
Efficiency
Three of the four new services had not yet started at the
time of review. There is an opportunity for new and
expanded health services to be provided should
appropriate operational funding be made available.
Utilisation
Overall increase in service volumes and twice as many
medical student rotations. Local providers were used for
the construction.
Effectiveness
WAMS is supporting integration with new chronic disease
programs and the new services are likely to lead to reduced
patient travel. There are three new GP registrars and long
term vacancies have been filled. There has been a slight
increase in the number of training sessions offered and
WAMS is promoting the building’s services to the
Indigenous community.
Overall
The new building allows for a more strategic focus
on chronic care and there is now room for
additional service provision, medical students, and
three new registrars. WAMS has been able to fill
long term vacancies.
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Workforce domain evaluation
4.2.2 Appropriateness
In less than a year WAMS has been able to source new specialist services for the community,
increase average service volumes and attract new staff. The co-location of chronic disease
treatment and prevention services supports better integration of care and allows for a more
strategic focus on the complex care of chronic disease in the community.
WAMS has been providing the residents of Walgett and surrounding areas with healthcare
services for almost 30 years and about 60% of the patients are Indigenous. At the time of the
HHF application, services were provided from various locations in town and the WAMS
clinic was at full capacity. They were not able to increase the number of specialists or visits
and had to cancel GP clinics on some occasions because there was not sufficient space or
equipment. Private accommodation is expensive and difficult to find in Walgett and the
WAMS team felt that this influenced the ability to attract new staff.
Some of the WAMS community and allied healthcare services (early childhood care, Healthy
for life and family centred primary healthcare teams, exercise therapy, nutrition, eye clinic,
psychology, speech pathology etc.) were brought together into the new chronic disease
building to better focus on chronic disease treatment and prevention. The chronic disease
building has provided WAMS with addition space to deliver new services (endocrinology,
liver clinic, occupational therapy and adolescent health checks) and conduct more services
‘in house’ (weekly sexual health clinic and yearly adult health checks were previously
provided offsite).
WAMS has been providing services through the chronic disease building for less than a year
and has been able to increase the overall average services per month provided and attract
staff for longer term vacancies. WAMS can now take on another medical student rotation and
three new GP registrars.
Measure evaluation
Summary of findings
Project addresses community needs
The building provides needed capacity and
allows for a focus on chronic care
management. Four new services (three of
which should be commencing in June 2014)
are being provided, overall increased
volumes of service and attraction of staff.
Project has increased health professionals in
regional areas (e.g. GPs, nurses, allied
health)
Additional medical student and three new
GP registrars.
New endocrinology and liver clinic
specialities available.
Overall
The new building has allowed WAMS
to better address local community
needs, by having a more strategic
focus on chronic care, providing new
services, increasing service volumes
and attracting new staff.
4.2.3 Efficiency
Four new services have been organised for the community however three of these were
planned to start in June 2014, and the fourth is a yearly service. Given the additional
capacity, there is an opportunity for new and expanded health services to be provided should
appropriate operational funding be made available.
The new building and additional capacity has allowed WAMS to organise new services for the
community which include a bimonthly liver clinic, bimonthly endocrinologist visit,
fortnightly occupational therapist visit and yearly adolescent health checks. The liver clinic,
endocrinologist and occupational therapy visits are organised to start in June (as of May
2014). The adolescent health checks started earlier in the year and 62 checks were
completed.
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Given the increased building capacity and the HFF application goals of increasing access and
health service capacity for the community, there is an opportunity for new and expanded
health services to be provided should appropriate operational funding be made available.
Measure evaluation
Summary of findings
Project has increased the number of relevant
services delivered or research capabilities /
topics
Three of the four new services had not
yet started at the time of review. There
is an opportunity for new and
expanded health services to be
provided should appropriate
operational funding be made
available.
4.2.4 Utilisation
The new building has allowed WAMS to increase the number of patients seen and double the
number medical student rotations.
Service volume data is available for April to September 2013 (six months pre building) and
October 2013 to mid-May 2014 (7.5 months functioning as the chronic disease building).
WAMS has a new information management system and so comparable data for before 2013
is not available. The average monthly number of clients seen increased by about 41 clients in
total for the more regular services (yearly clinic volumes removed) including:
cardiology, dermatology, optometry, podiatry, speech therapy, diabetic educator
clinics, dietician/exercise physiology, respiratory clinics, midwifery clinics
Cardiology and optometry monthly patient averages reduced slightly (-0.7 and -2.0 fewer
patients per month respectively since the building). The rest of the services increased in that
time with the largest increases in dermatology, sexual health clinics (role was previously
vacant) and exercise physiology (role was previously vacant). Additionally, there were 62 new
adolescent health checks (new service). PwC are not able to compare the yearly clinic (men’s
and women’s health checks) volumes or immunisations as that service is temporarily on hold
while the accredited immuniser is on maternity leave.
A Dubbo builder was selected for the construction of the chronic disease building and
approximately six Walgett carpenters were used as part of the construction.
The additional capacity at the WAMS medical clinic and new staff accommodation has
allowed WAMS to take on another set (previously had one with the John Flinders Placement
Program) of five week final year medical student rotations. The additional medical students
are coming from University of Western Sydney (UWS) which is a new partnership for
WAMS. There are 14 rotations planned for 2014.
Measure evaluation
Summary of findings
Project has increased remote/regional
activity
Increase in overall service volumes and
monthly averages for most services.
The construction/development of the new
facility was done through the use of local
services in the community
Local Dubbo builder used for construction
and employed approximately six Walgett
carpenters.
Project has increased number of
enrolments/placements to medical and
academic schools
Now able to take on a new set of five week
rotations (doubled student exposure) and set
up a new collaboration with UWS.
Overall
Overall increase in service volumes
and twice as many medical student
rotations. Local providers were used
for the construction.
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Workforce domain evaluation
4.2.5 Effectiveness
The new chronic disease building and additional staff accommodation has helped to attract
staff, provide slightly more training opportunities, promote services in the Indigenous
community and better integrate the chronic disease services.
With the increased capacity in the new building, multiple specialists can now visit at the
same time and WAMS have organised chronic disease programs so that patients can see
multiple relevant specialist in one day. For example a patient with diabetes can see the
podiatrist, dietician optometrist and diabetes educator in one day. This is more convenient
for patients and supports interaction between the different healthcare professionals. WAMS
management is also working to set up a case conference format for the clinical chronic
disease and acute teams and are in the process of implementing a specialist coordinator role
to support coordination between the different specialist services.
WAMS provide transportation services for the community but were not able to discern if
there were any direct reductions in travel from new services yet. The liver clinic,
endocrinology and occupational therapy services had not started yet but WAMS estimates
that six to ten patients can be seen per visit when they do. Walgett patients mostly travel to
Dubbo (275 km away), Tamworth (355km away) and Orange (427km away) for specialist
services. If it is assumed that at least six patients can be seen per visit and that people would
have travelled to at least Dubbo, there would be a savings of about 125,000km per year.
WAMS is now able to provide slightly more clinical and practice training sessions with the
additional space in the building. In 2013 through September, WAMS had 14 training sessions
and 17 training sessions from October 2o13 to June 2014.
Since the opening of the building and additional accommodation, WAMS was able to fill five
roles that were previously vacant for more than 12 months (Family Centred Primary
Healthcare team leader, Healthy for Life registered nurse, dual qualified exercise
physiologist/dietician and sexual health registered nurse) and attract three new GP
registrars. Information on staff retention was not provided.
The majority of WAMS patients are Indigenous. Previously the adult health checks were
conducted in the community (e.g. at the local RSL). WAMS now offers these at the chronic
disease building and used the opportunity to promote the new building and services available
to the community during these clinics.
Measure evaluation
Summary of findings
Project resulted in better integration of
locally available medical services
WAMS have implemented chronic disease
programs and have plans for increased
collaboration through case conferencing and
a specialist coordinator role.
Project has reduced travel time and referrals
to a health service
Anecdotal evidence shows that new services
could reduce patient travel.
Project has increased staff development,
availability and access to local training
research infrastructure and shared research
training facilities
There has been a slight increase in the
number of training sessions provided.
Project has improved attraction and
retention of staff
WAMS was able to fill five long term
vacancies and attract three GP registrars.
Services provided by the project are more
culturally accessible
Adult health checks now provided at the
chronic disease building and staff using this
opportunity to promote the new building and
services.
Project has improved outreach services to
educate communities to better manage
diseases
New adolescent health checks.
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Measure evaluation
Summary of findings
Overall
WAMS is supporting integration with
new chronic disease programs and the
new services are likely to lead to
reduced patient travel. There are three
new GP registrars and long term
vacancies have been filled. There has
been a slight increase in the number of
training sessions offered and WAMS is
promoting the building’s services to
the Indigenous community.
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Workforce domain evaluation
4.3
Blacktown/Mt Druitt Clinical School,
Research and Education Centre
Sydney West Area Health Service (now Western Sydney Local Health District) and the UWS
received funding of $13.1 million to build a clinical school, research & education centre as
part of the UWS’s School of Medicine (the clinical school). This supplemented the $7.5
million contributed by UWS thus making a total of $20.6 million for the construction of the
building.
The clinical school has two allocated teaching hospitals (Campbelltown/ Camden and
Blacktown/ Mt. Druitt). Prior to the Blacktown/ Mt. Druitt Clinical School opening, student
teaching and tutorials were held in whatever meeting rooms were available in the Hospital.
Prior to 2007, there were eight students attending Blacktown/Mt. Druitt Hospital as part of
clinical attachments from Westmead Hospital. With the establishment of the UWS School of
Medicine there are now approximately 140 students attending the clinical school at
Blacktown/Mt. Druitt Hospital each day, receiving tuition either in the hospital or in the
various teaching spaces in the clinical school.
The new clinical school building contains tutorial rooms, an auditorium, a student common
room, laboratories for translational and clinical research, academic and administration office
space, a medical library and overnight student accommodation.
The objectives of the new clinical school were to support the education and training of the
medical students, encourage an integrated and interdisciplinary learning environment,
support research and enhance the attraction and retention of healthcare professionals to the
hospital. These objectives will assist in addressing the changing demographics in the
Blacktown Local Government Area where there is a projected 35% increase in population to
over 450,000 by 2025 and wherein there are considerable areas of socioeconomic
disadvantage.
Co-contributor Project Funding: $7.0 million from UWS
Practical completion on 1 April 2011 (operating for more than three years at the time of this
evaluation)
4.3.1 Overall Evaluation
The clinical school has performed well against the objectives and in addressing the needs of
the community – providing a local school to train and retain medical students in the Western
Sydney area.
There is an increased number of staff across educators and researchers and there are
approximately 15 research projects and four clinical trials spanning a number of areas. The
clinical school runs a bulk bill clinic which is delivering services to the local community and
have built cultural awareness programs into the curriculum and research projects.
With respect to utilisation, they did not restrict the construction suppliers to local
contractors, and are unable to influence the number of CSP placements allocated by the
Commonwealth Government. However the construction of the school has resulted in an
increase of students and interns based at Blacktown Hospital supporting the objective of
retaining healthcare professionals in the region.
Theme evaluation
Summary of findings
Appropriateness
The clinical school has delivered well against the objectives
and the needs of the community.
Efficiency
Provision of bulk bill services to 150-200 patients a week
and increase in research areas from a baseline of zero.
Utilisation
Increase in the number of students undertaking training
and internships at the Blacktown Hospital but actual CSP
allocations remain unchanged and local construction
contractors not used.
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Theme evaluation
Summary of findings
Effectiveness
The clinical school has increased the staff numbers and
research projects and is focusing on cultural differences in
the training and research projects.
Overall
The clinical school has delivered against the
objectives and community needs of training and
retaining local students in the region, however
there is still capacity in the building for future
growth.
4.3.2 Appropriateness
The clinical school has performed well against the objectives that were set in the application
form and in addressing the needs of the community, by providing training opportunities at
Blacktown and Mt Druitt Hospitals and by attracting local health professionals to remain in
the region post the studies.
The Blacktown Local Government Area is the fastest growing geographical area in New South
Wales with this being reflected, for example, in the highest number of presentations to an ED
in New South Wales.
The New South Wales Government has responded to the obvious clinical need and has also
taken into consideration future growth projections as seen in the allocation of $324.0 million
for Stage 1 of the expansion. One of the community needs resulting from this expected
growth will be to grow the local intern network. The goal is that they will decide to undertake
postgraduate specialisation and progress their career paths in Western Sydney.
The clinical school runs up to 20 clinics per week providing services to 150-200 local
patients. These clinics cover a range of specialities such as osteoporosis, gastroenterology,
cardiology, allergy and immunology.
The HHF investment also covered a purpose built library available for use by the broader
hospital community with library visits increasing from ~400 visits in the first few months of
2011 to approximately 1,900 in early 2013.
The clinical school is addressing the objectives of providing the necessary infrastructure to
train staff and supporting the education and training of medical students through having an
established intern network based at Blacktown/Mt. Druitt Hospital. Whilst the CSP
allocation has not changed since before the school was opened (100 places), the new clinical
school has resulted in Blacktown Hospital providing over 120,000 hours of clinical training
onsite for latter year students.
With respect to improving research capabilities in western Sydney, the research centre is
now undertaking four clinical trials and two longitudinal cohort studies with eight other
clinical research projects in development, compared to a baseline of zero before the clinical
school was opened.
Measure evaluation
Summary of findings
Project addresses community needs
Attraction of high proportion of local
students, provision of bulk-billed clinic for
local residents and library facilities.
Project has achieved objectives as set out in
the funding application
Achieved objectives around providing
training and research opportunities and
retaining local health professionals in the
area.
Overall
The clinical school has delivered well
against the objectives and the needs of
the community.
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Workforce domain evaluation
4.3.3 Efficiency
The project has demonstrated efficiency both in the delivery of services offered through the
bulk-bill clinics, and through the research projects that are currently being undertaken in
different areas.
Prior to the clinical school opening, no bulk-bill clinic existed and no research projects were
undertaken at Blacktown. As mentioned previously, the clinics provide services to
approximately 150-200 patients a week.
With respect to research areas, the facility is being used by multiple clinical specialities and
research projects are being undertaken on topics including: effectiveness of weight loss
interventions; decreasing incidence of gestational diabetes; the prevalence of overweight and
obesity in paediatric patients; prevalence of functional gastrointestinal disorders in Greater
Western Sydney; rubella immunity and awareness amongst Australian born and immigrant
first time pregnant women.
Measure evaluation
Summary of findings
Project has increased the number of relevant
services delivered or research capabilities /
topics
Provision of bulk bill services to 150-200
patients a week and increase in research
areas from a baseline of zero.
4.3.4 Utilisation
The clinical school increased the number of students undertaking the training and internship
at the Blacktown Hospital, however actual placements to the clinical school did not change
and construction of the facility did not rely solely on local contractors.
The project team did not restrict the construction suppliers to the local Western Sydney
region, and used a range of suppliers from across Sydney – a construction company based in
St Leonards, architects from Sydney CBD, car park construction from Picton and fixtures
coming from Castle Hill, Alexandria, Richmond and Kurrajong Hills.
As mentioned previously, the number of CSP allocations for the UWS clinical school is
determined by the Commonwealth Government and did not change from 100 as a result of
the clinical school being opened. The school has approximately 25 international students and
a number of nursing and allied health program students who attend the facility on an ad-hoc
basis for specific teaching programs. Whilst the overall number of placements is controlled
by the Commonwealth Government, the construction of the school provided an additional
facility (the Blacktown Hospital) for the clinical students to be based at.
The creation of the school has also impacted the number of interns allocated to Blacktown
Hospital – zero before the school was opened compared to 40 in 2013.
It was difficult to gather information on the total available and current capacity of the
building, however it appears that there is sufficient space should allocated CSP numbers be
increased in the future.
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Measure evaluation
Summary of findings
The construction/development of the new
facility was done through the use of local
services in the community
Construction was done using suppliers from
across Sydney and was not limited to the
south west region.
Project has increased number of
enrolments/placements to medical and
academic schools
No change to CSP allocations (out of the
project’s control), but increase in the number
of medical students and interns allocated to
Blacktown Hospital during the training.
Overall
Increase in the number of students
undertaking training and internships
at the Blacktown Hospital but actual
CSP numbers remain unchanged and
local construction contractors not
used.
4.3.5 Effectiveness
The school has demonstrated effectiveness in attracting staff, undertaking research projects
and clinical trials and focusing on cultural diversity in the training and research projects.
Prior to the school opening, there were approximately ten university staff and three hospital
staff, which increased to approximately 55 FTE university and hospital staff after opening.
(one medicine and one surgery professor, six lecturers, 80 conjoint staff undertaking
lectures, two laboratory scientists and research and administrative support staff).
One of the head researchers recently joined the clinical school from the Garvan Institute,
bringing with her National Health and Medical Research Council (NHMRC) funding she had
been awarded.
Due to the broad cultural diversity of the Western Sydney population with approximately
half the students coming from non-English speaking backgrounds, the curriculum
incorporates elements of cultural awareness and all students are required to spend five weeks
providing Indigenous focused services at ‘satellite’ rural clinics.
One of the teaching and research projects currently being conducted at Blacktown is
assessing medical students' clinical communication in culturally diverse settings and GP
cultural competence in Indigenous Health settings. They are also conducting clinical
research of different ethnic communities for pregnant African women in the Blacktown
community.
With respect to research projects, there were no dedicated research facilities at Blacktown
Hospital prior to the completion of the clinical school, hence no projects or publications were
completed. Since the school opened in 2011, there is a small research team made up of 1.5
FTE senior research academics, two research fellows, three clinical research nurses and two
hospital scientists who have established four clinical trials, five research projects, ten student
research projects and been awarded one NHMRC grant in 2014. The facility is being used by
multiple clinical departments including mental health, cardiology, infectious diseases,
surgery, gastroenterology, diabetes and endocrinology, toxicology, forensic medicine and
oncology and the first PhD student will commence in 2015.
Measure evaluation
Summary of findings
Project has improved attraction and
retention of staff
Increase in staff from 13 to 55 FTEs.
Services provided by the project are more
culturally accessible
Cultural awareness is incorporated in the
curriculum, and a number of cultural specific
research projects are being undertaken.
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Workforce domain evaluation
Measure evaluation
Summary of findings
Project has increased number of research
projects/publications completed at the
school/facility
Increase from no research activities being
undertaken before the school was built,
compared to ~15 projects and four clinical
trials being driven by a small research team
of approximately 8.5 staff.
Overall
The school has increased the staff
numbers and research projects and is
focusing on cultural differences in the
training and research projects.
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4.4
Retention of GPs in the McKinlay and Julia
Creek region
The McKinlay Shire Council received $529,217 for the construction of residential
accommodation in Julia Creek to house a local GP and visiting locums. The previous
accommodation was built in the 1960s and outdated. Funding was provided for two houses.
The objectives of the new accommodation were to enhance the ability to attract and retain a
medical practitioner in the region leading to improved access to essential health services in
the area, reduced travel for residents to obtain healthcare services and improved continuity
of healthcare for the residents of McKinlay Shire and surrounds.
Co-contributor Project Funding: $148,775
Practical completion on 19 April 2013 (operating for a little more than one year at the time of
this evaluation)
4.4.1 Overall Evaluation
McKinlay Shire Council has not been able to attract a new local GP to Julia Creek to date.
However, the new houses are being utilised by the visit locums and Queensland health for
hospital staff. The new accommodation has also helped to attract two new medical students
to Julia Creek.
It was reported that the locums have commented on how the new accommodation is of a
much higher standard however a schedule from 2012 through to 2014 of locum visits does
not suggest that the new houses have increased locum consistency or continuity of care for
the community.
There was an increase in local healthcare volumes and a new medical clinic is open but it is
not clear that the new accommodation is linked to these changes or if there has been reduced
need for travel for residents that are looking for more consistent healthcare.
The new accommodation was needed in the community as the old house was very outdated
however there was limited evidence provided to show that the investment has translated into
positive community healthcare outcomes yet.
Theme evaluation
Summary of findings
Appropriateness
Both houses are being utilised and have helped to attract
two medical students, but has not achieved the original
objective to recruit a permanent GP.
Utilisation
Increased local healthcare volumes and use of new medical
clinic however it is not clear that this is linked to the
project. Local services not used for construction.
Effectiveness
Unclear how the accommodation has supported the
effectiveness (for identified measures) of healthcare
provision for the community.
Overall
The main goal of attracting a local GP has not yet
been achieved. There does not appear to be a more
consistent rotation of locums and so it is difficult
to establish enhanced continuity of care or reduced
travel for residents.
4.4.2 Appropriateness
McKinlay Shire Council has not yet been able to attract a new local GP to Julia Creek. There
is no evidence that fewer locums (leading to enhanced continuity of care) are rotating
through Julia Creek because of the better accommodation available. Both houses are being
utilised and have helped to attract two medical students to the area.
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Workforce domain evaluation
In 2008 the local GP left Julia Creek and the Council has had a difficult time recruiting a new
one since. Feedback from potential candidates and locums was that the previous
accommodation was very poor and not suitable for families. Local accommodation options
were otherwise very limited.
The new accommodation has not been enough of an incentive to attract a new GP to date. A
new private medical centre had also recently been built in Julia Creek and was not being
used. The Council commented that there are further challenges (other than outdated
facilities) to attracting a GP such as the fact that doctors prefer cities, they would need a
doctor with ED and GP skills and interest, the doctor would need to be on call all of the time,
there have been changes in state funding and the new medical centre is not set up for profit.
Some of these points are out the Council’s control, however some probably have not changed
considerably in the last five years and could have been taken into consideration when
drafting the HHF funding application.
One of the new houses is used for the current locum and the other is being rented out to
Queensland Health. The additional house has helped accommodate nursing staff and now
allows for regular rotations of medical students which have not been in Julia Creek for many
years. Two new medical students are planned to start in July (as of May 2014).
Council mentioned that some locals feel there is more consistent care now, trust the regular
locums and are traveling less for healthcare. A review of the provided locum schedule from
2012 through 2014 showed that on average doctors are staying a couple of days longer but
there has not been an decrease in the number of different doctors rotating through Julia
Creek and there has been considerable turnover between locums pre and post build which
suggests that there has not been an improvement in continuity of care.
Julia Creek has relied on locum care since 2008. Apparently some of the local residents
would travel to Cloncurry to get more consistent healthcare. A recent increase in local
healthcare service volumes could suggest fewer residents traveling to other towns for
healthcare.
Measure evaluation
Summary of findings
Project has increased health professionals in
regional areas (e.g. GPs, nurses, allied
health)
Two new medical students are planning to
start in July.
Not yet able to attract a local GP.
No evidence provided to show enhanced
continuity of care.
Recruitment challenges are outside the
control of the Council.
Project addresses community needs
No evidence of improved continuity of care.
Second house is being rented to Queensland
Health and has helped attract two new
medical students.
Project has achieved objectives as set out in
the funding application
A local GP has not been recruited and
insufficient evidence provided to show
improved continuity of care or reduced travel
for residents.
Overall
Both houses are being utilised and
have helped to attract two medical
students, but has not achieved the
original objective to recruit a
permanent GP.
4.4.3 Utilisation
Local healthcare service volumes (medical, surgical and diagnostic) increased by about 23%
from 2,027 in 2012 to 2,498 in 2013. It is unclear why this increase has occurred but could
suggest fewer residents traveling to other towns for healthcare. The Shire Council mentioned
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that there were also increases in healthcare referrals and local allied health volumes however
no information was provided to support this. Additionally, the private medical clinic is now
open for 11 hours per week.
The construction contract (92% of costs) went to Nomad Eastern State from Wacol (Brisbane
suburb) after a competitive tender process. Local services were only used for 8% of the
project cost however this may have been the most cost effective and reasonable option.
Measure evaluation
Summary of findings
Project has increased remote/regional
activity (volume)
There has been an increase in local
healthcare service volumes and the new
medical clinic is starting to be utilised
however it is not clear that this is linked to
the project.
The construction/development of the new
facility was done through the use of local
services in the community
Local services were not used for the majority
of the construction however this may have
been the most reasonable option.
Overall
Increased local healthcare volumes
and use of new medical clinic however
it is not clear that this is linked to the
project. Local services not used for
construction.
4.4.4 Effectiveness
It is difficult to show increased healthcare effectiveness (for identified measures) for the
community based on the information provided, however the project is planning to attract
two new medical students.
There are now weekly meetings with the Community Nurse, Council, HACC representative,
Director of Nursing, Physio and the locum where they discuss patients, recent discharges,
problematic patients and any needed health promotional events. The locum generally will
not attend if they don’t know the patients or are only visiting for a short rotation. The
meetings are being organised through the hospital and it is difficult to see how the new
accommodation has supported this initiative.
It is unclear why there was a 23% increase in local service volumes between 2012 and 2013
however if it were assumed that the addition 471 services in 2013 were from fewer local
residents traveling to Cloncurry (137 km away) then there would be a savings of about
130,000km in travel.
Measure evaluation
Summary of findings
Project resulted in better integration of
locally available medical services
New weekly case meetings with different
health professionals however inconsistent
attendance by locums and difficult to link to
the new accommodation.
Project has reduced travel time and referrals
to a health service
Unclear if there are fewer residents traveling
for healthcare and why there were increased
local service volumes. Assuming the volume
increase is from fewer locals traveling for
care, then there would be a considerable
savings of 130,000km.
Project has improved attraction and
retention of staff
No information provided to support this
other than the two new medical students.
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Workforce domain evaluation
Measure evaluation
Summary of findings
Overall
Unclear how the accommodation has
supported the effectiveness (for
identified measures) of healthcare
provision for the community.
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Workforce domain
Domain sample studies
The remaining three domain sample projects were reviewed at a
higher level and did not include site visits. The domain sample
projects helped to increase the sample size and provide more
information for the overarching themes of the domains and overall
evaluation.
The workforce domain sample projects reviewed were:
1.
Nepean Clinical School, New South Wales
2.
Clinical medical education and best practice in
ambulatory care, Victoria
3.
Nebo Medical Centre, Queensland
4.5
Nepean Clinical School (NSW)
The University of Sydney received $17.2 million for a new Clinical School building at Nepean
Hospital to strengthen clinical education, clinical research and healthcare in Western
Sydney. This new facility allows clinicians teach medical students and provide ‘bulk-billed’
clinical services for outer western Sydney and rural patients to encourage students to learn
about clinical practice in a functioning outpatient practice environment. Funding was
provided for the construction of the new clinical school which included areas for clinical
services, clinical research and training, academic pods, administration, staff facilities and
basement parking.
The objectives of the new clinical school were to provide an increased capacity for clinical
teaching and research, enhance regional access to high-quality healthcare, increase the
number of students, increase research grants (expected to double), address unmet health
service needs in the community and enable Nepean Hospital to become a major New South
Wales and national site for clinical research and clinical research training.
Co-contributor Project Funding: none
Practical completion on 26 March 2012 (operating for more than two years at the time of this
evaluation)
4.5.1 Appropriateness
Measure evaluation
Summary of findings
Project addresses community needs
At the time of application, the catchment
population in Nepean had a high prevalence
of socio-economic disadvantaged residents
with chronic health problems.
There was a high level of unmet need for
health services. The school had to vacate the
hospital (capacity issues) and was operating
out of a costly private medical centre so there
was no room for growth.
The new building has allowed for expansion,
the school is able to support new bulk billed
clinics and there are now new research
areas/capability.
The building is being used by many other
community groups (e.g. Nepean Blue
Mountains Local Health District groups, the
New South Wales ambulance service, rotary
and local foundations)
Project has achieved objectives as set out in
the funding application
Achievements toward objectives:
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Providing new bulk billed services to
the community

Access to enhanced research and
education facilities

Increase in post grad students

Research now conducted in new
areas

Associated with a tripling in grant
research income to the clinical
school. New collaborations to
support community need (e.g.
Charles Perkins Centre)
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4.5.2 Efficiency
Measure evaluation
Summary of findings
Project has increased the number of relevant
services delivered or research capabilities /
topics
New areas of research now being conducted
at the school are obstetrics, telehealth,
gynaecology, surgery and endocrinology.
Also the new bulk billed clinics has seen
about 700 outpatients in the last six months.
4.5.3 Utilisation
Measure evaluation
Summary of findings
Project has increased number of
enrolments/placements to medical and
academic schools
Medical student placements are capped by
government allocated placements and so the
student numbers have remained around 200
(for all four student levels). It is estimated
that the building could accommodate
another 50 students and further medical
clinics for the public however this is limited
by the available hospital staffing/student
resources.
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Workforce domain evaluation
4.5.4 Effectiveness
Measure evaluation
Summary of findings
Project has increased staff development,
availability and access to local training
research infrastructure and shared research
training facilities
Enhanced education, training and research
infrastructure provided in the new building.
There are two new specialist training
positions.
Building capacity has allowed for multiple
new staff development programs, some
examples:

Residents as Student Teachers
program.

Charles Perkins and Boden Institute
videoconference seminars.

Medical doctor degree committee.

GP training evenings.

Computer programs.

A Simulation facility using “Sim
Mom”, “Sim Man”.

Nepean Blue Mountains Local
Health District Nursing Research
Day.

Australian College of Emergency
Nursing workshops.
Project has resulted in increased research
grant income
In 2011 research grant funding was about
$900,000 and that increased to over $3.0
million in 2013. The majority of the new
funding has come from the new research
areas.
Project has increased number of research
projects/publications completed at the
school/facility
Based on a list of publications provided,
there was an increase in publications from 52
in 2011 to 74 in 2013.
The project has increased the number of
researchers and/or the range of research
expertise
PhD and masters student numbers have
increased from 12 in 2011 to the current level
of 35.
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4.6
Clinical Medical Education and Best
Practice in Ambulatory Care, Werribee
The University of Notre Dame Australia (UNDA) received $11.2 million for the construction
of medical clinical school teaching and research facilities in Werribee (first medical student
intake in Sydney in 2008, first intake in Werribee in 2010). Werribee is a low socioeconomic
area of need in Western Melbourne with high proportion of Culturally and Linguistically
Diverse (CALD) residents. Funding was used for the planning, designing, construction,
furnishing, and fit-out of the new school. The facility is 2,145m2 and includes staff and
support areas, teaching and training areas and research facilities.
The objectives of the new medical school were to train doctors that are committed to the local
community, undertake research that is directed towards the health problems and needs of
the community and groups in most need so as to contribute to improved health outcomes
and reduced health inequalities.
Co-contributor Project Funding: none
Practical completion on 30 May 2012 (operating for about two years at the time of this
evaluation)
4.6.1 Appropriateness
Measure evaluation
Summary of findings
Project addresses an overarching strategy of
a state/territory/Commonwealth body
Projects objectives aligns with the
Government’s health reform agenda around
research facilities that are integrated with
improving clinical care and/or health
workforce training.
Focuses on areas of unmet need in terms of
medical and healthcare workforce.
Project has achieved objectives as set out in
the funding application
The new clinical school is functional and
supports the final two years of clinical
training. It has had 83 graduates over the
past three years and 37 have stayed on to do
internships in Victoria. It is not clear how
many stay in the local area after graduating
(there are no dedicated intern places at the
Werribee Mercy Hospital).
The school conducted a pilot trial looking at
care in the community and have applied for
funding to run a more extensive study.
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Workforce domain evaluation
4.6.2 Utilisation
Measure evaluation
Summary of findings
Project has increased number of
enrolments/placements to medical and
academic schools
There are currently 57 students at the new
facility, where there were none before the
development in 2010.
The building capacity is estimated to be
around 8o places for students (40 in each
year) and so the school has room to grow by
about 40%. Placements are however limited
to 32 per year for the clinical training and
guaranteed intern places in Victoria so the
school could only grow by another seven
students (for supported places).
There is considerable excess capacity in the
staff areas of the building. The school is now
preparing some of the space to be leased out.
During the design of the building there was
an agreement with the hospital to use some
of this capacity however that fell through.
4.6.3 Effectiveness
Measure evaluation
Summary of findings
Project has increased staff development,
availability and access to local training
research infrastructure and shared research
training facilities
Research infrastructure and training
facilities available in house for students and
staff including simulation rooms and library.
There is a non-award graduate program in
advanced clinical anatomy running from the
building.
External sessions provided from the building
planned for this year:

three evening sessions run by the
medicare local

three evening sessions by the Mercy
Hospital

eight Saturday sessions run by an
external education provider
Project has improved attraction and
retention of staff
Most of the staff at the school are new (some
were previously employed by UNDA). The
team has grown to 7.1 FTEs at the school, 5.8
FTEs at clinical sites and 24 appointed
adjuncts.
Retained about two thirds of staff since
opening in 2010.
Currently have 1.4 FTEs of vacant roles still
to be filled.
Project has increased number of research
projects/publications completed at the
school/facility
In 2010 there were 11 staff publications and
in 2013 there were 15 staff and four student
publications/projects.
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4.7
Nebo Medical Centre
The Isaac Regional Council received $454,545 to construct a new “walk in/walk out” medical
centre practice facility in Nebo to address the basic medical needs of the community (mining
district). Residents used to have to travel to Glenden (75km) for the basic healthcare services.
The new centre has two consultation rooms, a treatment room, a sterilisation room and a
waiting room.
The objectives of the new medical centre were to address the basic healthcare needs of the
Nebo community, help to attract and retain medical practitioners and health professionals,
reduce the need for residents to travel for healthcare and lessen the overstretched capacity of
the Glenden doctor.
Co-contributor Project Funding: $253,000
Construction completion 08 May 2011, Practical opening on 12 December 2013 (operating
for about six months at the time of this evaluation)
4.7.1 Appropriateness
Measure evaluation
Summary of findings
Project addresses community needs
Previously no healthcare services were
available locally for Nebo residents and they
had to travel at least 75km for basic services.
Nebo is a mining town with a high
proportion of transient males who have high
primary healthcare needs as well as the
employment companies’ requirement health
employment checks.
As a result of HHF funding, now there is now
a functioning primary medical centre that
provides multiple new services to the
community seven days a week. Two teams
(one doctor and one nurse) rotate through
the medical centre every two weeks.
Due to challenges in attracting a service
provider to the town and issues around
functionality and suitability, the completed
facility was vacant for over two years. The
original completed centre was not considered
appropriate by potential tenants and further
funds had to be invested by the Council to
make the facility operational. Additionally
the Council had to reduce the lease
agreement fees to attract a service provider.
The council is not providing any other
financial support to keep the medical service
provider in town.
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Workforce domain evaluation
Measure evaluation
Summary of findings
Project has achieved objectives as set out in
the funding application
Primary healthcare services are now
provided in Nebo with two medical teams
that rotate with each other, to work at the
centre. This has reduced the need for
residents to travel for basic healthcare.
A pharmaceutical dispensary was part of the
application objectives, but limited evidence
was provided from the service provider to
demonstrate is this is being provided to the
community.
Due to issues with the original constructed
centre, there was a two year delay in
providing services.
4.7.2 Efficiency
Measure evaluation
Summary of findings
Project has increased the number of relevant
services delivered or research capabilities /
topics
New services provided include doctor
consultations, health assessment and checks,
some basic emergency care, health
promotions, specialist referrals, various
tests, vaccinations etc.
4.7.3 Utilisation
Measure evaluation
Summary of findings
Project has increased remote/regional
activity (volume)
The local provider would not provide volume
data to the Council however there would be a
clear increase in healthcare services through
the new clinic compared to no services being
provided previously.
The construction/development of the new
facility was done through the use of local
services in the community
Full costs of building the clinic went to
central Queensland businesses. The builder
was based in Mackay.
4.7.4 Effectiveness
Measure evaluation
Summary of findings
Project has reduced travel time and referrals
to a health service
Residents no longer need to travel to
Glenden for basic healthcare.
Project has improved attraction and
retention of staff
No local healthcare professionals hired for
the first two years, however since December
2013 a private medical centre service
provider has been engaged with two teams of
medical staff rotating through every two
weeks. This is a preferred option for
continuity of care compared to hiring various
locums.
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5 Medical research
domain evaluation
Projects funded under the HHF Program in the medical research domain were for facilities
focusing on basic research, applied research and/or translation research conducted to aid
and support the development of knowledge in the field of medicine. The medical research
domain consists of seven such projects, including four case studies which will be explored in
detail.
Medical Research projects received $1.2 billion or 24% of the total HHF funding. There are
14 projects that fall under the medical research category of which only 14% were delivered in
regional areas and the rest are in major cities. Of the total 14 projects, nine have been
completed to date. Seven were selected by the Department for this review, of which six were
in major cities and one in a regional area.
The Department selected four projects as case studies and an in-depth analysis was
conducted on these facilities. These projects were:
1.
Stage 3 John Curtin School of Medical Research (JCSMR), Australian Capital
Territory
2.
Melbourne Neuroscience Project, Victoria
3.
South Australian Health & Medical Research Institute (SAHMRI), South
Australia
4.
The Kinghorn Cancer Centre (Kinghorn), New South Wales
A high level approach was taken in assessing the remaining projects. These projects were
selected and analysed to support the overarching themes of the evaluation. The projects in
this domain sample included:
5.
Ingham Health Research Institute, New South Wales
6.
Hunter Medical Research Institute, New South Wales
7.
Stage 2 Menzies Building, Tasmania
5.1.1
Overall Evaluation
The projects evaluated in the medical research domain have collectively achieved the
objectives of improving the research in the respective areas by creating an environment that
fosters collaboration amongst like-minded researchers in state-of-the-art facilities that would
assist in achieving the research goals. These projects consist of a mix of pre-existing
institutes that were previously located in a number of different locales but are now housed in
one central building and brand new facilities established to bring a strong medical research
focus to the area.
The facilities have been purpose designed, many housing unique pieces of equipment that
are not available anywhere else in the southern hemisphere. Such special features have
assisted these research groups to attract and retain senior researchers from around Australia
and the world. Not only has this built the collaborative efforts within the facilities, but it has
also filled the gaps in specific disciplines. This appealing environment and technical
capability has also attracted a number of students and PhD students to these facilities to
expand the growing workforce in these institutes and universities.
In the short time that these facilities have been open they have managed to attract
considerable grant contributions. This, coupled with the expansion of the research teams,
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has seen an increase in the number of research papers being produced. However, due to the
short period since becoming operational, most of the research conducted has yet to be
translated into clinical trials or directly impact clinical practice and health outcomes. That
being said, these facilities have been strategically placed in the centre of research hubs or
next to major hospitals, providing the ideal testing opportunities for embedding future
research.
Theme evaluation
Summary of findings
Appropriateness
The medical research projects have
established appropriate areas for
collaboration between researchers, with
facilities equipped to assist in future
research.
The location of the projects as part of major
research hubs or next to or connected to
teaching hospitals is key for future research
to be effectively translated to clinical trials,
improved clinical practice and health
outcomes.
Efficiency
The projects in the domain have achieved
some efficiency in drawing on the strengths
of the research groups to create areas of focus
for future work and collaborative
opportunities.
Utilisation
Most of the projects in the medical research
domain have evidenced utilisation of the new
facility through an increase in PhD students
and post doctoral research, contributing
towards achieving targeted capacity goals for
the facility and have been built with
additional capacity for future growth.
Effectiveness
All medical research projects have achieved
improving the accessibility of the facility as
shown in the increase in staff attraction and
retention since the development of the new
facilities.
Attraction of additional senior researchers
and expansion of research expertise has led
to an overall increase in grant funding and
publications produced by these research
groups.
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Theme evaluation
Summary of findings
Overall
Projects in the medical research
domain created state-of-the-art
facilities that will promote research
and collaboration between academics,
researchers and clinicians from
similar focus areas.
New facilities have been quick to
attract growth in staff, researchers as
well as grant funding.
The facilities have been strategically
located to ensure future research can
be more readily translated into clinical
trials or improved practice.
Proximate location and formal
research links are important features
for embedding relevant research into
health services.
Factoring in that all these projects
relatively recently opened, this period
since being operational is too short to
have produced any research which
could have been converted into clinical
practice. That being said, most of these
facilities are well positioned to enable
this to happen in the coming years.
Limited Evidence
(low achievement)
Objectives achieved
(high achievement)
5.1.2 Appropriateness
The selected projects have all accomplished the objectives of addressing both the national
and community needs. The projects in this domain had two common themes. The first was to
create a central site where researchers from varying research backgrounds could gather and
collaborate around the areas of focus. The second was to create purpose specific areas where
the researchers could work together in the areas of expertise.
All the projects have successfully achieved this in the establishment of the facilities. In many
instances, this created an opportunity for researchers in the same state to gather and
collaborate in a fit-for-purpose facility that would provide them with the necessary facilities
to further the research. In the case of SAHMRI, following a review conducted in 2008, a new
state-of-the-art facility was developed to bring together researchers from various partnering
groups (universities, institutes and hospitals) to establish the first research institute of its
type in South Australia.
Most of the projects have been strategically located, be it within a geographic research hub or
near neighbouring hospitals, to ensure the opportunity for relevant clinical research, clinical
trials and improved clinical practice in the future. The Melbourne Neuroscience project for
example, consists of two sites; the Parkville facility at the centre Melbourne’s research hub
surrounded by universities and major research groups, the second site is adjacent to the
Austin Hospital.
Case study evaluation
Summary of findings
JCSMR
The project objectives are well aligned to government
strategies and they are progressing well against the
objectives of collaboration with less progress as yet toward
achieving international significance and generating research
that demonstrates an impact on health outcomes.
Melbourne Neuroscience
Project
Strong evidence the project objectives were appropriate in
addressing both national objectives and community needs.
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Case study evaluation
Summary of findings
SAHMRI
The establishment of SAHMRI and construction of the
facility was the result of the Shine/Young review,
addressing local objectives around health and medical
research. It is a bold, promising development with a
particularly strong collaborative base.
Kinghorn Cancer Centre
Kinghorn is aligned with the New South Wales Cancer
Institute’s objectives and Health’s cancer genomic research
goals as well as further collaboration internationally. The
project created a better environment for staff and patients.
Overall
The medical research projects have established
appropriate areas for collaboration between
researchers, with facilities equipped to assist in
future research.
The location as part of state research hubs or next
to or connected within teaching hospitals is key for
future research to be effectively translated to
clinical trials, improved clinical practice and health
outcomes.
5.1.3 Efficiency
Some of the projects evaluated in this domain have shown achievements in developing a
more efficient approach to conducting the research. The difficulty in evaluating this
particular theme related to the limited amount of evidence that the projects were able to
provide in support. Some were able to convey how they have tried to increase the research
activity by adding to the research focus areas; some have brought in new services with future
endeavours in mind; others have just simply increased the volume of clinical service.
Since being consolidated under the same roof, a number of these research institutes have
grown in terms of the research areas. Some, for example like SAHMRI, have undergone
collaborative planning to select the areas of focus. The intention being for SAHMRI
researchers to complement the work of other’s within the state and Australia, leading to
future opportunities for collaboration.
Other institutes that were already established prior to the new developments, such as the
Florey Institute in Melbourne and the JCSMR, have expanded the portfolio of research areas.
Some have attracted international or domestic researchers to assist in filling gaps in specific
disciplines.
Many of the new facilities have incorporated new equipment that will assist in future
research, such as SAHMRI’s cyclotron and the Florey Institute’s 7T MRI machine. Due to the
recent establishment of these facilities, it has been difficult to evaluate the success of these as
limited evidence is available. In some instances, the facilities are still waiting on licensing
agreements to allow them to use the equipment for commercial use.
The new Kinghorn Cancer Centre building facilitated the Kinghorn Centre for Clinical
Genomics that has the potential to improve efficiency through genomic testing which will
help patients avoid future screening for cancers for which they do not have the genetic traits.
Case study evaluation
Summary of findings
JCSMR
The project has led to an increased in the number of
research areas focused and they have made good progress in
collaboration with clinicians through the use of the clinical
suites.
Melbourne Neuroscience
Project
Project has provided four new core services available to inhouse and external researchers and additional research
areas.
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Case study evaluation
Summary of findings
SAHMRI
Considerable analysis and collaborative planning have been
conducted in selecting the key areas of research focus.
These areas play to the strengths of the SAHMRI’s current
research capabilities.
Kinghorn Cancer Centre
There is a new clinical genome sequencing research
capability and pharmacy facilities provided. No new clinical
services are provided.
Overall
The projects in the medical research domain have
achieved some efficiency in drawing on the
strengths of the research groups to create and/or
areas of focus for future work and collaboration.
5.1.4 Utilisation
Even though some of the facilities have been opened for less than a year, most of the projects
in this domain have evidenced that the facilities have been well utilised by researchers and
students alike.
Since construction of the new facilities, nearly all of the institutes have attracted a number of
new PhD students to the facilities. In the short period that the institute has been operational,
SAHMRI has been able to attract 15 new PhD students. The other institutes that were already
established prior to the new amalgamation have all seen an increase in the PhD student
numbers. The Hunter Medical Research Institute was able to attract an additional 108
students in the period that it has been operational.
All the facilities are tracking well to the expected building capacities. Nearly all of the
projects have achieved at least 50% utilisation of the facilities, with plans in place to achieve
the intended capacity targets. All of the facilities have been built to accommodate current
demands, but have also factored in potential to grow and expand in the future. As such, most
of the facilities in this project have an ideal capacity of 70% FTEs with the remaining 30% to
be used by part time or casual research and for future expansion.
The Florey Institute in Melbourne is one of the stand out facilities, achieving nearly 95% of
the 75% allocation in the Austin building, and has nearly reached capacity in the Parkville
facility. It is important to consider that the Florey institute was established before the
construction of the new facilities. The data provided was limited in defining what portion of
the existing staff came from the previous institute and how many are new.
Case study evaluation
Summary of findings
JCSMR
The building is currently at 70% capacity with plans to
reach 80% in the next two to three years and excess
capacity currently leased out until it is needed.
Melbourne Neuroscience
Project
Both facilities are being well utilised by both the Florey
Institute and University of Melbourne staff.
The number of PhD students has increased 29%.
SAHMRI
The project has created the structure to assist in increase
screening and diagnosis (through cyclotron) and utilisation
of building is on track to meet target despite the short
timeframe.
Kinghorn Cancer Centre
Kinghorn appears to be well utilised – currently at 70% with
plans this year for further growth and further capacity to
grow in the future. Details on capacity and current staff
numbers were not provided.
Overall
Most of the projects in the medical research
domain have evidenced utilisation of the new
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Summary of findings
facility through an increase in PhD students and
post doctoral research, contributing towards
achieving targeted capacity goals for the facility
and have been built with additional capacity in the
building for future growth.
5.1.5
Effectiveness
All of the projects in the medical research domain have demonstrated strong evidence
towards being effective in attracting and retaining staff, expanding the focus areas of
research, obtaining additional grant funding and increasing the number of publications.
However, they have all had less success in demonstrating progress in translating research to
clinical practice (although the short time frames need to be taken into account).
Since becoming operational, all of the projects evaluated have been successful in attracting
new staff and students to the facilities. Some facilities, such as SAHMRI, the Menzies project,
the Hunter Medical Research Institute and the Florey Institute, have all been able to attract a
number of senior international researchers to build around the areas of research and all of
the projects have recorded an increase in the staff numbers since becoming operational.
The increase in collaboration in these institutes has seen a considerable increase in grant
funding. A number of the facilities have nearly doubled the amount they had received in the
prior year to the opening of the facility. The attraction of senior researchers has further
increased the grant stream, as many of these researchers have brought with them the
research teams as well as the existing grants. All projects seem confident that the growth in
funding will continue as they become more established and position themselves more
strongly for future growth and collaboration.
The increase in publications has been another area that has seen strong growth in the short
periods that these facilities have been opened. Factoring that most research papers can take
anywhere between one to two years to get to print, the growth in publications seemed
considerable for the facilities that were able to provide supporting evidence towards this
measure. For already established facilities such as Melbourne’s Florey Institute, additional
information to support this notion was provided in the form of citations recorded for the
papers they published since occupying the new facilities.
Factoring in that all these projects relatively recently opened, with some being opened for
less than a year, this period since being operational is too short to have produced any
research which could have been converted into clinical practice. That being said, most of
these facilities are well positioned to enable this to happen in the coming years. Most of the
projects have been constructed in one of the state’s major research hub. With Melbourne’s
Florey institute being constructed in the Parkville research hub and the second site being
embedded in the Austin Hospital, JCSMR located in Canberra’s equivalent hub and SAHMRI
being the catalyst for medical research with the new Royal Adelaide Hospital currently being
constructed adjacent to the SAHMRI facility. All these locations will accelerate the
translation from clinical research to clinical practice once the various facilities have been well
established in the new surroundings.
Case study evaluation
Summary of findings
JCSMR
The project has increased the number of researchers and
focus areas and made good progress in growing grant
funding, producing publications and conducting clinical
trials. They have begun translating research into clinical
practice, and are expecting a newly developed ophthalmic
instrument to get approval for clinical use in 2015.
Melbourne Neuroscience
Project
Increase in staff numbers, research focus areas, grant
income and publications all demonstrated strong
effectiveness, as well as good progress being made in
translating research into clinical practice.
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Case study evaluation
Summary of findings
SAHMRI
The new facility has helped attract staff and funding,
facilitating a focus in seven dedicated research areas and an
increase in publications.
Kinghorn Cancer Centre
The research and clinical teams are better integrated and
more effective at Kinghorn. The centre has new capabilities,
attracted international talent and led to increased grant
funding. Limited evidence was provided for some of the
measures.
Overall
Medical Research projects have achieved the
objectives to improve the accessibility of the facility
as shown in the increase in staff attraction and
retention since the development of the new
facilities.
Attraction of additional senior researchers and
expansion of research expertise has led to an
overall increase in grant funding and publications
produced by these research groups.
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Medical research domain
Case study evaluation
The seven projects selected for this review relate to the construction or
redevelopment of medical research facilities or the co-location of
existing institutes. Four of the projects were case studies for which
there was a more in depth evaluation of the project outcomes which
included a site visit.
These projects were:
1.
Stage 3 John Curtin School of Medical Research (JCSMR),
Australian Capital Territory
2.
Melbourne Neuroscience Project, Victoria
3.
South Australian Health & Medical Research Institute
(SAHMRI), South Australia
4.
The Kinghorn Cancer Centre (Kinghorn), New South
Wales
5.2
John Curtin School of Medical Research Stage 3
The Australian National University (ANU) received $60.0 million from HHF, and an
additional $1.0 million from other co-contributors, for the construction of the final stage of
the John Curtin School of Medical Research (JCSMR).
Stage 3 included the demolition of the old inadequate research building and the construction
of a new research facility to house all key neuroscience research activity on the ANU campus
to create a centre for mind and vision research (the Eccles Institute). This will also increase
research collaborations with the Canberra Hospital and with the primary care sector in the
ACT and southern NSW. The Eccles Institute brought together multiple groups of
researchers across ANU into one neuroscience research facility.
The objectives of JCSMR are to:
1.
develop a research facility of national and international significance,
2.
generate research outcomes that will have a significant and long-term impact on
health outcomes especially in neurological and sensory diseases,
3.
complement Australia's overall capacity in the field of mind and vision research,
4.
complete the development of a state-of-the-art research facility at the School,
and
5.
develop a facility that meets all the modern standards of laboratory and building
design.
Co - contribution $1.0 million
The facility opened in March 2012 (operating for about two years at the time of this
evaluation).
5.2.1 Overall Evaluation
The project is making good progress against its objectives to develop developing a facility
that will build collaboration between researchers and clinicians and generating research that
will have an impact on health outcomes. The focus areas are well aligned to government
strategies through the focused research on neurological and sensory disorders.
They have increased the number of researchers and focus areas (from six to 14) and made
good progress in growing grant funding, producing publications and conducting clinical
trials. They have begun translating research into clinical practice, and are expecting a newly
developed ophthalmic instrument to get approval for clinical use in 2015. The building is
currently at 70% capacity with plans to reach 80% in the next two to three years and excess
capacity is being occupied by other researchers until it is required.
Theme evaluation
Summary of findings
Appropriateness
The project objectives are well aligned to government
strategies and they are progressing well against the
objectives of collaboration with less progress as yet toward
achieving international significance and generating
research that demonstrates an impact on health outcomes.
Efficiency
The project has led to an increased the number of research
focus areas focused and they have made good progress in
collaboration with clinicians through the use of the clinical
suites.
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Theme evaluation
Summary of findings
Utilisation
The building is currently at 70% capacity with plans to
reach 80% in the next two to three years and excess
capacity currently being utilised by other researchers until
it is needed.
Effectiveness
The project has increased the number of researchers and
focus areas and made good progress in growing grant
funding, producing publications and conducting clinical
trials. They have begun translating research into clinical
practice, and are expecting a newly developed ophthalmic
instrument to get approval for clinical use in 2015.
Overall
The project is making good progress against its
objectives of developing a facility that will build
collaboration between researchers and clinicians
and generating research that will have an impact
on health outcomes.
5.2.2 Appropriateness
The project addressed the objectives set out in the funding application which align to
government strategies.
The project supports the government’s health reform agenda by providing research into
neurological and sensory disorders which are currently the second highest burden of disease
and projected to increase in cost by 356% and 236% respectively by 2033. A coalition
government measure was to increase research into dementia by approximately $200.0
million.
One of the major research activities carried out by the Eccles Institute addresses one of the
National Research Principles - ‘Promoting and Maintaining Good Health’, specifically
focusing on disease of the brain and mind and sensory disorders.
The objectives to develop a research facility at the School that meets all the modern
standards of laboratory and building design (objectives four and five above) has been
achieved, with the construction of one facility to house all researchers. Previously all of the
ANU staff and students working on vision and the spinal cord were located in the Research
School of Biology, about 15 minutes walk from the JCSMR and undergraduate teaching in
neuroscience was split across multiple locations.
The other three objectives (develop a facility of national and international significance;
generate research outcomes that will have a significant impact on health outcomes; and
contribute to Australia’s capacity in the field of mind and vision research) are at an earlier
stage of maturity. The Eccles Institute has made some advances around publications, grant
income, student numbers, etc. with the long term projection to further increase these outputs
in order to satisfy the objectives.
Measure evaluation
Summary of findings
Project addresses an overarching strategy of
a state/territory/Commonwealth body
The project has clearly addressed one of the
National Research Principles by providing
research into neurological and sensory
disorders, which are currently the second
highest burden of disease.
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Measure evaluation
Summary of findings
Project has achieved objectives as set out in
the funding application
The project addressed the objective of
constructing a building to bring together
researchers from multiple locations, however
with the short time frame of about two years,
they are still working on the objectives
around achieving international significance
and generating research that will have an
impact on health outcomes.
Overall
The project objectives are well aligned
to government strategies and they are
progressing well against the objectives
of collaboration with less progress as
yet toward achieving international
significance and generating research
that demonstrates an impact on health
outcomes.
5.2.3 Efficiency
The project has increased the levels of collaboration between researchers and clinicians, due
to the availability of clinical suites in the building, and a number of additional research areas
that have been created.
Prior to the new building, JCSMR comprised of six different research groups working in the
areas of synaptic transmission, sensory processing and the neural control of blood flow with
no collaboration with clinicians. Since the move to the new building, an additional six
research groups working in the above areas have been added and new areas such as visual
neurosciences, obesity, metabolism and spinal injury are being introduced.
In addition, there has also been a change in the nature of the research to involve more
clinical collaborations, with the Eccles Institute undertaking three new collaborative projects
in the areas of ophthalmology and neuro-ophthalmology. The work involves making
ophthalmic measurements on over 750 patients a year, examining them in the clinical suites
constructed as part of this project.
Measure evaluation
Summary of findings
Project has increased the number of relevant
services delivered or research capabilities /
topics
The project has led to an increased the
number of research focus areas focused and
they have made good progress in
collaboration with clinicians through the use
of the clinical suites.
5.2.4 Utilisation
The building is well utilised and has plans to increase the targeted capacity with additional
space for future growth.
The current occupancy of the building is at approximately 70%, with additional space being
used by visiting researchers from the Canberra Hospital or for John Curtin research groups,
until the Eccles Institute requires the additional space. The plan is to increase to 80% fulltime occupancy in the next two to three years by recruiting more research fellows and
students (depending on grant outcomes) with the remaining 20% available for academic
visitors, part-time students working on short projects and future growth. The building was
designed to be fully flexible, with all labs and fit out using removable structures, which can
be altered as needs change.
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Measure evaluation
Summary of findings
Project has reached the targeted capacity of
the facility
The building is currently at 70% capacity
with plans to reach 80% in the next two to
three years. Excess capacity currently being
utilised by other researchers until it is
needed.
5.2.5 Effectiveness
JCSMR have increased the number of researchers and students and are progressing well
around growing grant funding, producing publications, conducting clinical trials and
translating research into clinical practice.
The building was designed to include three new seminar rooms, clinical suites, a stores
facility and a staff tearoom, which are used for development and to drive collaboration. Since
moving in, and due to the increased staffing levels they are conducting larger and more
diversified neuroscience seminars and journal club programs and have established a
neuroscience grant feedback panel. They have also purchased some shared equipment
(Nikon confocal microscope, ThorLabs 2-photon microscopes) which has enabled staff
training in the latest technologies.
With respect to grant income, there has been an increase from $1.0 million to $2.2 million
since the building opened. This is made up of national competitive grants to individual
researchers of approximately $1.4 million, Australian Research Council (ARC) Centre of
Excellence for Visual Sciences grants of $0.4 million and a new ARC Centre of Excellence for
Integrative Brain Function grant awarded $0.4 million.
With respect to research translating into clinical outcomes, JCSMR have started
collaboration with clinicians for clinical trials they are running (refer details above) and
intend to continue increasing the use of clinical trials. One of the scientists has developed a
new ophthalmic instrument (Truefield Analyser) that is designed to map visual function at
44 locations using the responses of the pupils. They are expecting this to be approved for
clinical use in 2015.
In 2011, the six research groups were conducting research on approximately six distinct
projects and 16 journal papers were published (with an average impact factor of 5.1. Post the
build, there are 14 research groups operating who have published 25 papers (cited 139 times)
with an average impact factor5 of 6.6.
Since the new building opened, they have had five new senior academic staff teams move
from the ANU Research School of Biology and one from the University of Sydney. As
mentioned previously, the number of research areas has increased from six to 14 and they
went from 11 PhD students to 29.
Measure evaluation
Summary of findings
Project has increased staff development,
availability and access to local training
research infrastructure and shared research
training facilities
The team have used the facility to conduct
neuroscience seminars and journal clubs,
and established a grant feedback panel as
well as shared equipment.
Project has resulted in increased research
grant income
Grant funding has increased from $1.0
million to $2.2 million for the Eccles
Institute in the two years since they relocated
to the new facility.
5 The impact factor of an academic journal is a measure reflecting the average number of citations to recent articles published in the
journal.
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Measure evaluation
Summary of findings
New facility has increased number of
research outcomes translated into clinical
practice locally
Development of a new ophthalmic
instrument that is expected to be approved
for clinical use in 2015, and a number of
clinical trials being conducted.
Project has increased number of research
projects/publications completed at the
school/facility
Increase in publications from 16 in 2011 to
25 in 2013 with an increase in impact factor
and the 2013 publications being cited 139
times.
The project has increased the number of
researchers and/or the range of research
expertise
Increase in number of research areas from
six to 14, in number of PhD students from 11
to 29 and six new teams moved into the
building.
Overall
The project has increased the number
of researchers and focus areas and
made good progress in growing grant
funding, producing publications and
conducting clinical trials. They have
begun translating research into
clinical practice, and are expecting a
newly developed ophthalmic
instrument to get approval for clinical
use in 2015.
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5.3
Melbourne Neuroscience Project
The Florey Institute of Neuroscience and Mental Health (the Florey Institute) in Melbourne
received $39.8 million for the development of two major neuroscience research facilities the Parkville Neuroscience Research Facility and the Austin Neuroscience Research Facility.
It brings together staff from the Victorian Government, the Florey Neuroscience Institutes,
Mental Health Research Institute, University of Melbourne, Austin Health and the
Australian Government to focus on neuroscience and mental health research.
The Parkville facility is focused on scientific research, housing around 500 neuroscientists,
clinicians and support staff, while the smaller sized Austin facility focuses on clinical
research including an imaging suite and physical linkage between the Austin Hospital
enabling clinical trials to be performed.
The main objective of the project was to create collaboration between researchers, as well as
sharing of the specialised equipment. Research was focused on basic science and
translational research of brain and mind disease, with particular focus on stroke,
neurodegenerative diseases and mental illness.
Co-contributor $186million
The Parkville building was occupied in August 2011 and the Austin facility was occupied in
March 2011 – (operational between almost three years at the time of this evaluation).
5.3.1 Overall Evaluation
The Melbourne Neuroscience project has performed well in addressing the objectives as set
out in the original application to the HHF and in aligning these objectives to the national and
community needs in relation to establishing translational research facilities covering
neurological diseases, as well as improving collaboration between researchers.
Since the construction of the facility, the project has increased the relevant services delivered
to in-house and external researchers as well as the research areas covered with the
amalgamation of the Mental Health Research Institute. This has resulted in the attraction of
a number of new PhD students enrolling in to the medical and academic schools both in the
Parkville building and the Austin Facility. The Florey Institute allocated space at both
buildings is close to capacity.
The Florey Institute has been effective in attracting and retaining new staff, including
recruitments of both domestic and international scientists and groups to fill gaps in specific
disciplines. This has been reflected in the increase in overall grant income from the different
streams, as well as the numerous citations from the publications produced since its
establishment. The Florey Institute are progressing well in translating research into clinical
practice supported by the collaboration with the Austin hospital.
Theme evaluation
Summary of findings
Appropriateness
Strong evidence that the project objectives were
appropriate in addressing both national objectives and
community needs.
Efficiency
Project has provided four new core services available to inhouse and external researchers and additional research
areas.
Utilisation
Both facilities are being well utilised by both the Florey
Institute and University of Melbourne staff.
The number of PhD students has increased 29%.
Effectiveness
Increase in staff numbers, research focus areas, grant
income and publications all demonstrated strong
effectiveness, as well as good progress being made in
translating research into clinical practice.
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Theme evaluation
Summary of findings
Overall
The Melbourne Neuroscience Institute is well
placed in terms of partners, number and type of
researchers, collaboration opportunities and grant
funding to address the objectives.
5.3.2 Appropriateness
The Melbourne Neuroscience project has performed well against the objectives of addressing
national and community needs in relation to establishing translational research facilities
through the aggregation of scientific and clinical research groups.
The project has addressed issues raised in the National health Reform Agenda such as
needing research facilities that are integrated to improve clinical care and healthcare work
force training and focusing on mental health, cardiovascular health and stroke research.
Additionally, the Melbourne neuroscience project addresses the future challenges identified
by the ageing population around neuroscience and degenerative diseases.
The facility has demonstrated integration in a number of ways – through the Austin
Neuroscience Research facility which is physically linked to the Austin Hospital enabling
clinical and research teams to work closely together and clinical trials to be performed. The
co-location of the four Institutes in two buildings in close proximity to a major teaching
hospital and a university has allowed increased collaboration particularly between basic
scientists and clinicians.
In addition, the construction of the two facilities influenced the Mental Health Research
Institute to join the Florey Institute increasing the focus on mental health.
With respect to addressing community needs, the neuroscience research areas that are
undertaken at the Florey Institute cover a number of the degenerative diseases that afflict the
ageing population or mental health patients such as Alzheimer's and Parkinson's diseases,
multiple sclerosis, schizophrenia, drug addiction, stroke, epilepsy, brain and spinal cord
injury.
The Parkville facility has established the DAX centre, which is a gallery dedicated to art
created by people with mental illness. This has been used extensively by schools for certain
Victorian Certificate of Education subjects like psychology, as well as a means to promote
public awareness.
Measure evaluation
Summary of findings
Project addresses an overarching strategy of
a state/ territory/ Commonwealth body
Project clearly addresses overarching
strategy of health reform through the focus
on neuroscience and degenerative diseases.
Project addresses community needs
Project visibly addresses broader community
need for research into neurological
disorders, constructed to encourage
collaboration with clinicians and other
researchers and promotion of art through the
DAX centre.
Overall
Strong evidence the project objectives
were appropriate in addressing both
national objectives and community
needs.
5.3.3 Efficiency
The construction of the Neuroscience facility has performed relatively well towards the
efficiency objective of increasing relevant services delivered and research topics.
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Medical research domain evaluation
The Florey Institute previously offered a number of core services which were available to inhouse researchers and external users. These services included: clinical trials,
electrophysiology, animal MRI, 3T human MRI, animal behavioural testing, statistics and
decision support, Victorian Brain Bank Network, advanced microscopy, bioinformatics,
histology and flow cytometry. Since opening, an additional four services are available,
namely the National Dementia Diagnostics Laboratory, PET-CT facilities, national reference
centre for Creuzfeld Jacob Disease histology and Neuroscience Trials Australia (which is a
clinical research organisation that manages clinical trials).
In addition, with the Mental Health Research Institute joining the Florey Institute since the
facility opened, additional areas of research can be conducted in-house.
The Florey Institute, together with University of Queensland have installed a 7T MRI
machine (due to be operational from July 2014) within the Kenneth Myer building within the
Parkville precinct.
Measure evaluation
Summary of findings
Project has increased the number of relevant
services delivered or research capabilities /
topics
Project has provided four new core services
available to in-house and external
researchers and additional research areas.
5.3.4 Utilisation
The project has done well in utilising the new facility and increasing the number of
placements to the medical and academic schools.
Since its establishment, the number of PhD students has increased by 29%. In 2011, there
were 91 higher degree PhD students across four separate institutes. With the development of
the new Melbourne Neuroscience facility, this has increased to over 126 students who are
completing a course or part of a course at the Florey Institute, including 117 PhD students.
The Parkville facility has a capacity of 515 staff and students. The Florey has approximately
66% ownership of the available space with the University of Melbourne holding the
remainder. Florey is almost at capacity. At the Austin site, the University of Melbourne owns
25% of the space. The 75% owned by Florey is also near capacity, with 95% of its share
currently occupied.
Measure evaluation
Summary of findings
Project has increased number of
enrolments/placements to medical and
academic schools
The project has achieved an increase in PhD
student by 29%.
Project has reached the targeted capacity of
the facility
Parkville facility – almost at capacity
Austin facility - Florey allocated space is at
95% capacity.
Overall
Both facilities are being well utilised
by both the Florey Institute and
University of Melbourne staff.
The number of PhD students has
increased 29%.
5.3.5 Effectiveness
Since 2011, the institute has been effective in attracting and retaining new staff and has
grown by 30% from 416 staff and students to 540. This includes recruiting domestic and
international scientists and groups to fill gaps in specific disciplines, such as neuro-ethics
and neurobiology.
This has led to the institute obtaining additional grant funding and increasing the overall
number of publications across a number of new research areas. Total grant income and
contributions has increased by 99% over the past two years. In 2011 The Florey institute
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grant income from government sources was $18.0 million, other peer review funding was
$2.0 million, commercial income was just under $1.5 million and private donors and
foundations contributed $3.0 million. These increased to $33.0 million, $4.6 million, $6.0
million and $5.3 million respectively as at May 2014.
Since the development, publications have increased from 310 in 2011 to 538 in 2013. Of these
new publications, records have shown that 564 cumulative citations were made in 2013. This
equates to an average of 1.62 citations per item.
Factoring in that the facility has only been opened for almost three years; this is a very short
time frame to produce any clinical research which has been converted into clinical trials.
However, the new facilities are well positioned to enable this to happen in the coming years.
The Melbourne Neuroscience Project has allowed the Institute to embed its clinical research
at Austin Health, a major teaching hospital. Dedicated clinic rooms have facilitated access to
patient populations for clinical trials. Research projects on stroke patients are now
conducted with direct access to the building's MRI facilities via an underground tunnel to the
Hospital, with changes in the way stroke patients are raced through the ED of hospitals to
receive time critical care being one of the implemented changes from this study.
In addition, research conducted prior to 2011 on the Parkinson's kinetigraph to monitor
tremors in Parkinson's disease, has resulted in the product being commercialised and now in
clinical use in 40 major Parkinson's disease centres in Europe.
Co-location across two campuses has fostered greater interdisciplinary collaboration, thus
increasing research output. Strategic recruitment and retention to fill particular gaps has
increased the number of researchers and staff by 30%. The Institute has recruited senior
investigators in the fields of central control of the respiratory pathways, synaptic connections
and dendrite transmission and a new focus on ligand receptor interactions.
Measure evaluation
Summary of findings
Project has improved attraction and
retention of staff
Project has been successful as evident in
increase in employees and affiliated staff of
30%.
Project has resulted in increased research
grant income
Project has increased grant income by 99%.
New facility has increased number of
research outcomes translated into clinical
practice locally
Within the short time frame since they have
been opened, research of stroke patients has
resulted in a change to process within ED’s,
and new diagnostic tool commercialised and
in clinical use.
Project has increased number of research
projects/publications completed at the
school/facility
Increase in number publications by 74% with
564 cumulative citations for 2013.
The project has increased the number of
researchers and/or the range of research
expertise
Recruitment of senior researchers focusing
on specific areas with mental health
institute.
Overall
Increase in staff numbers, research
focus areas, grant income and
publications all demonstrated strong
effectiveness, as well as good progress
being made in translating research
into clinical practice.
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Medical research domain evaluation
5.4
South Australian Health & Medical
Research Institute
The South Australian Health and Medical Research Institute (SAHMRI) received $200.0
million for the establishment of a research facility adjacent to the New Royal Adelaide
Hospital, with the intention of enhancing health and medical research enterprises in South
Australia as well as attracting new researchers to Australia.
The facility caters for approximately 600 staff, with fully flexible lab space and nine research
modules. In addition, it has an animal house facility and a cyclotron (particle accelerator)
bunker.
The facility was opened in December 2013 (operating for less than six months at the time of
this evaluation)
Co-contributor Project Funding: $50.0 million from SAHMRI
5.4.1 Overall Evaluation
Overall, SAHMRI has achieved a lot in the short period of time since establishment towards
reaching the objectives detailed in the funding application, through increasing the staff base,
identifying focus research areas and obtaining grant funding.
The SAHMRI facility has appropriately addressed the recommendations coming out of the
Shine/Young review of 2008. The review recommended the creation and constructions of a
state of the art health and medical research fund to support its research.
Prior to the facility opening, SAHMRI undertook extensive analysis and planning on what
areas of research they will focus on taking into account local capabilities and areas of need
for South Australia. SAHMRI’s location in the centre of Adelaide’s medical precinct has
attracted researchers, both domestically and internationally. The growth in SAHMRI’s
workforce has strengthened the support in the areas of research focus, which has in turn
increased the amount of income grant funding.
Regardless of being opened for such a short time, SAHMRI has made good progress in
occupying the facility at a 59% of total capacity, which is in line with the plan to increase to
70% by the end of 2014. The building houses a cyclotron which will have the capacity to
assist in diagnosis of cancer patients once a licence has been received.
Although SAHMRI has produced 66 papers since the establishment, formal citation of these
publications has not yet been recorded. This has been attributed to the fact that the facility
has only recently opened.
Theme evaluation
Summary of findings
Appropriateness
The establishment of SAHMRI and construction of the
facility was the result of the Shine/Young review,
addressing local objectives around health and medical
research. It is a bold, promising development with a
particularly strong collaborative base.
Efficiency
Considerable analysis and collaborative planning have been
conducted in selecting the key areas of research focus.
These areas play to the strengths of the SAHMRI’s current
research capabilities.
Utilisation
The project has created the structure to assist in increase
screening and diagnosis (through cyclotron) and utilisation
of building is on track to meet target despite the short
timeframe.
Effectiveness
The new facility has helped attract staff and funding,
facilitating a focus in seven dedicated research areas and an
increase in publications.
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Theme evaluation
Summary of findings
Overall
The project has performed well in six months since
opening, through increasing the staff base,
identifying the focus research areas and obtaining
grant funding.
5.4.2 Appropriateness
A review of health and medical research in South Australia was carried out in May 2008 by
Professor John Shine and Mr Alan Young. The Shine/Young review had three major
recommendations that led to the establishment of SAHMRI and the construction of the
facility.
These recommendations and SAHMRI’s achievements against each are as follows:
1.
Establish an independent flagship health and medical research institute – SAHMRI
was incorporated as an independent company under the Commonwealth
Corporations Act 2001 on 21 December 2009
2. Locate the flagship health and medical research institute in a new building –
Corporate and research teams began to occupy the new building in December 2013
3. Build and maintain a health and medical research fund – A deed was signed by the
South Australia’s Minister for Health in 2013 which established the health and
medical research fund to be managed by an independent Board. SAHMRI applies to
the independent Board once a year for funds to support research in the institute
Measure evaluation
Summary of findings
Project addresses an overarching strategy of
a state/ territory/ Commonwealth body
The establishment of SAHMRI and
construction of the facility was the result of
the Shine/Young review, addressing local
objectives around health and medical
research. It is a bold, promising development
with a particularly strong collaborative base.
5.4.3 Efficiency
Despite the short time frame since opening (six months), SAHMRI have achieved efficiency
in conducting background research into the optimal research areas the Institute should focus
on, and establishing these seven areas of focus.
SAHMRI’s annual report for 2013 details the background planning undertaken before the
facility was opened in selecting the seven areas of focus. SAHMRI analysed South Australia’s
existing research capabilities and NHMRC/ARC funding received by research teams in the
area. Based on this analysis, the SAHMRI Research Themes selected were Aboriginal Health,
Cancer, Heart Health, Infection and Immunity, Healthy Mothers, Babies and Children,
Nutrition and Metabolism and Mind and Brain.
These themes allow SAHMRI to draw on noteworthy expertise from within South Australia,
whilst also growing and expanding these research areas. The intention is for SAHMRI
researchers to compliment the work of other’s within the state, leading to future
opportunities for collaboration.
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Medical research domain evaluation
Measure evaluation
Summary of findings
Project has increased the number of relevant
services delivered or research capabilities /
topics
Considerable analysis and collaborative
planning have been conducted in selecting
the key areas of research focus. These areas
play to the strengths of the SAHMRI’s
current research capabilities.
5.4.4 Utilisation
Taking into account that the SAHMRI facility has only been opened for six months, the
facility has been designed to house a cyclotron machine which (once operational) will
support an increase in the number of screenings and diagnosis for the community. SAHMRI
has done well in occupying the new facility in such a short period since opening.
The facility was constructed with a bunker to house a cyclotron machine which has the ability
to produce tracers (radio isotopes) which help detect various cancers. These tracers are
currently flown in from interstate in limited quantities due to the short shelf-life of less than
12 hours and are not available locally. The Adelaide cyclotron and synthesizers will be used
by clinicians to diagnose cancers and decide on treatment plans.
SAHMRI is currently waiting for a license to produce and commercialise the radio isotopes
so they can be sold for clinical use. However, due to the limited time that the facility has been
opened, this is still in the planning stage, and production has yet to commence.
Although the building has only opened six months ago, the facility has done well to attract
researchers. The facility is already at 59% of its capacity of 600 people. The building
currently houses 350 people including both SAHMRI staff/students as well as members from
the three partner universities and CSIRO. Relocation of the partner groups is continuing
until the end of August 2014. SAHMRI expects to reach the target of 70% capacity by the end
of 2014, with the remaining 30% space being kept for future growth.
Measure evaluation
Summary of findings
Project has increased rates/number of
screening, diagnosis and treatment
Cyclotron installed which will be used once a
license is received to enable screening of
various cancers.
Production and use of the cyclotron not yet
in use.
Project has reached the targeted capacity of
the facility
Currently at 59% of building’s capacity.
Target to reach 70% by end of 2014, with
remaining 30% for future growth.
Overall
The project has created the structure
to assist in increase screening and
diagnosis (through cyclotron) and
utilisation of building is on track to
meet target despite the short
timeframe.
5.4.5 Effectiveness
SAHMRI has performed well against the objectives focused on accessibility, equity and
quality of the services they provide. The facility has done well to attract and retain staff, new
grant funding and as a result have produced a number of publications in the short time since
they opened. They have also utilised the facility to reach out to the local community to
educate and promote the areas of research, particularly in relation to the Indigenous
In the last two years, SAHMRI's workforce has grown 425% with the building currently
housing 350 researchers and staff from SAHMRI and partnering organisations. Since
opening, the facility has relocated 17 staff to Adelaide either from interstate or overseas, with
a further nine staff from overseas expected to commence in August 2014. Attention from
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various media sources surrounding the construction of the SAHMRI facility, particularly in
regards to its location in Adelaide’s medical precinct and modern design, has boosted
SAHMRI's image and attracted researchers from within South Australia, nationally and
internationally to join the Institute. They have also attracted 15 new PhD students since
opening.
The facility is located next to the site that the new Royal Adelaide Hospital is being
constructed on and is designed to be integrated with the facility and to foster further
collaborations between researchers and medical practitioners. This location is ideal for
future clinical research to be converted in to clinical trials. However given the short time
frame the facility has yet to progress in this area.
SAHMRI believes that the co-location of the researchers with those from partner
organisations within the new facility has led to a number of funding opportunities. SAHMRI
researchers have attracted $45.8million in Category 1, 2 and 3 funding, with an additional
$6.3 million pending. However, some of this funding would have been generated from work
performed prior to relocation into the new site.
In 2013, SAHMRI has also published 66 research papers. No supporting evidence was
provided in relation to how many citations were made against these publications. SAHMRI
did however state that they are in the process of investing in a research management
database so that this information can be collected in the future.
SAHMRI utilises the auditorium and boardrooms to host seminars to both the public and
research communities to highlight health and medical research occurring across the
Institute. In addition to this, SAHMRI’s Aboriginal Health Research area has established the
first ever South Australian Aboriginal Health Research Network. The network meets on a
regular basis to build capacity in Aboriginal research in South Australia, among both
Indigenous and non-Indigenous researchers; and promotes and supports the translation of
research into policy and practice.
Measure evaluation
Summary of findings
Project has improved attraction and
retention of staff
17 staff members have relocated to Adelaide
(from interstate or overseas) with a further
nine staff from overseas to commence end of
2014.
Project has resulted in increased research
grant income
SAHMRI researchers have attracted $45.8
million in Category 1, 2 and 3 funding (up
until December 2013), with an additional
$6.3 million pending.
Project has improved outreach services to
educate communities to better manage
diseases
Host seminars to both the public and
research communities.
Establishment of SA Aboriginal Health
Research Network to promote and support
translation of research into policy and
practice.
Project has increased number of research
projects/publications completed at the
school/facility
66 research papers published in 2013.
The project has increased the number of
researchers and/or the range of research
expertise
Increase of 15 new PhD students.
Overall
The new facility has helped attract
staff and funding, facilitating a focus
in seven dedicated research areas and
an increase in publications.
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Medical research domain evaluation
5.5
Kinghorn Cancer Centre
The Garvan Institute of medical research received $70.0 million for construction of the
Kinghorn Cancer Centre (Kinghorn), a collaboration between the Garvan Institute of medical
research and St. Vincent’s & Mater Health Sydney that brings together treatment of patients
and medical research for cancer. The cancer treatment teams from St. Vincent’s and the
researchers from the Garvan Institute are now co-located in the new centre. Kinghorn is 13
floors and has space for approximately 250 scientists, clinicians and support staff (650m 2
cancer centre, 2,965 m2 general research space, 820m2 PC2 / wet lab space) with four floors
dedicated for staff and patient parking.
The objectives of Kinghorn were to provide national leadership in translational research,
turn results into innovative prognostic, diagnostic and treatment options for cancer patients,
help realise personalised care for cancer patients and focus on cost effective and suitable
treatment options for integration into larger nationwide cancer treatment services.
Co-contribution of $42.0 million
The project achieved practical completion date on 31 August 2012 (operating for more than
one and half years at the time of this evaluation).
5.5.1 Overall Evaluation
Kinghorn is a large, modern and well-designed building that has improved the environment
for patients and staff. The objectives are in line with both state and national cancer research
and treatment plans, and they are collaborating with state based agencies to collect data and
report against Key Performance Indicators.
Kinghorn are renowned internationally and are working on a number of diagnosis and
treatment committees, and have the largest prostate cancer tissue bank and database in the
southern hemisphere.
New genome sequencing capability and technology has been created, and there is a large
increase in the volume of patients and activity of cancer treatments provided. The research
and clinical teams are better integrated and more effective at Kinghorn with the centre
attracting international talent and increased grant funding.
Theme evaluation
Summary of findings
Appropriateness
Kinghorn is aligned with the New South Wales Cancer
Institute’s objectives and Health’s cancer genomic research
goals as well as further collaboration internationally. The
project created a better environment for staff and patients.
Efficiency
There is a new clinical genome sequencing research
capability and pharmacy facilities provided. No new clinical
services are provided.
Utilisation
Kinghorn appears to be well utilised – currently at 70%
with plans this year for further growth and further capacity
to grow in the future. Details on capacity and current staff
numbers were not provided. There has been an increase of
12% in clinical service volumes and a dramatic increase
genetic counselling services.
Effectiveness
The research and clinical teams are better integrated and
more effective at Kinghorn. The centre has new capabilities,
attracted international talent and led to increased grant
funding. Limited evidence was provided for some of the
measures.
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Theme evaluation
Summary of findings
Overall
Kinghorn is addressing state and national
government medical research objectives, has
created new research capabilities with genome
sequencing and allows for good integration of
researcher and clinicians. The brand and new
capability helped attract new staff and funding.
5.5.2 Appropriateness
The Kinghorn Cancer Centre (Kinghorn) clearly addresses state and national cancer research
objectives through its provision of cancer treatments and research efforts. It is too soon to
know how much of the research will be translated into treatment options for patients
however the genome sequencing is a new research capability at Kinghorn that can potentially
help patients understand which treatment options are best suited for them. Additionally, the
new building provides for better integration of research and clinical teams and a much better
patient treatment experience.
From a state perspective, Kinghorn’s objectives are in line with the New South Wales Cancer
plan 2010-2015 (e.g. translational research, evidence based practice, quality screening
programs, transparency of information etc.) and they participate in the New South Wales
Reporting for Better Cancer Outcomes program through a performance agreement with the
New South Wales Cancer Institute. New South Wales Clinical Cancer Registry staff are based
at Kinghorn to help collect and monitor information around cancer outcomes for the
program.
From a national perspective, they are working with the Department on cancer genomics and
received $5.5 million in federal funding to establish the Australian Prostate Cancer Research
Centre at Kinghorn.
Kinghorn is known on a global scale, has international collaborations with well-known
institutions (e.g. Cornell and St. Mark’s Hospital in London) and has the largest prostate
cancer tissue bank and database in the southern hemisphere. Additionally some of the
Kinghorn staff serve on national and international cancer diagnosis and treatment
committees.
Kinghorn has also deliberately enhanced the experience of patients locally. The new building
was designed around the patient experience and is meant to feel less like a hospital. There
has been strong positive feedback from staff and patients. Since opening, the Kinghorn has
received over 200 patient feedback surveys with a 97% providing positive feedback.
Measure evaluation
Summary of findings
Project addresses an overarching strategy of
a State/ Territory/ Commonwealth body
Kinghorn is aligned with the New South
Wales Cancer Institute’s objectives and
Health’s cancer genomic research goals as
well as further collaboration internationally.
The project created a better environment for
staff and patients.
5.5.3 Efficiency
The opening of the centre has resulted in new research capabilities being developed and
increased treatment volumes being provided.
The construction of the new building allowed for the Kinghorn Centre for Clinical Genomics
(KCCG) be created to conduct clinical genome sequencing research with the goal to support
patient diagnosis and treatment. Genomic sequencing can help patients avoid time and costs
for future screenings for a cancer that they do not have the genetic traits for, and can help
identify which treatments will not be effective, leading to healthcare cost savings and an
improvement on the patient experience and quality of life.
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Medical research domain evaluation
Kinghorn includes an in-house pathology collection service and a cytotoxic pharmacy,
supporting patients fulfilling prescriptions. It also includes a new radio-pharmaceutical lab
which produces isotopes used for clinical care, research and diagnostics.
Kinghorn was designed to be energy efficient and consume an efficient amount of electricity,
water and gas.
Measure evaluation
Summary of findings
Project has increased the number of relevant
services delivered or research capabilities /
topics
There is a new clinical genome sequencing
research capability and pharmacy facilities
provided. No new clinical services are
provided.
5.5.4 Utilisation
Kinghorn is at 70% of its current capacity with the remaining space available to house
additional researchers that are being brought on board or for future growth. The centre was
specifically designed to allow room for future expansion with the ability for further levels to
be built above the top floor. According to the Chief Operating Officer, the remaining 30%
capacity is to allow for future growth.
There has been a clear increase in the number of cancer patients that are being seen as a
result of the centre opening. In the first 12 to 18 months, there was an increase of
approximately 12% in clinical activity in the Nelune Treatment Centre and an increase of
8.5% in the number of patients seen (compared to the prior year at St. Vincent’s). Genetic
counselling services increased by 100% since Kinghorn opened. After the cancer clinical care
services moved from St. Vincent’s, the additional space in the hospital has been used for
renal care services.
There are plans to build a café and wellness centre (for complimentary health services) at
Kinghorn.
Measure evaluation
Summary of findings
Project has reached the targeted capacity of
the facility
Kinghorn appears to be well utilised –
currently at 70% with plans this year for
further growth and further capacity to grow
in the future. Details on current staff
numbers were not provided. There has been
an increase of 12% in clinical service volumes
and a dramatic increase genetic counselling
services.
5.5.5 Effectiveness
The new Kinghorn building has led to a more effective research and clinical treatment
environment where teams are more integrated and have better technology and facilities to
conduct the work. Kinghorn has been able to attract new and international expertise and
additional grant funding. PwC note that detailed information was not provided against all the
measures evaluated.
One of the main goals of building Kinghorn was to bring together patients, clinicians and
researcher into one facility to support enhanced collaboration of multidisciplinary teams
(MDTs) between researchers and clinicians. The MDTs were in place before but are
enhanced now through the new building and co-location and have increased from six to ten
teams. These teams meet weekly or fortnightly to exchange knowledge and discuss patient
cases to determine the most appropriate, evidence based treatment plans for each patient.
The MDT’s are also engaging with GPs, Medicare Locals and allied health professionals (the
dietician) to enhance the collaboration.
A new electronic clinical record system is being implemented (MOSAIQ) which will support
better information management and communication across the various stakeholders. Also
there is a project being implemented with the Cancer Institute where allied health and
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nursing staff are reviewing how patient screening processes can be improved in the new
environment.
The facility was built with meeting rooms and spaces for teams to meet, as well as larger
meeting rooms to support training sessions and community events. Limited evidence was
provided around specific new staff learning and development opportunities.
There has been low turnover in nursing staff and an increase in 18 researchers and bioinformaticians for the Clinical Genomics team, however detailed staff numbers and turnover
rates since opening the centre were not provided. Kinghorn was able to attract established
cancer research specialists. Extracts from the Operations Committee Meetings show that
staff seem to find the work environment better and more effective.
Overall funding (grants, commercial collaborations and donations) for the Garvin Institute of
medical research increased by about 34% from $400 million in 2011 (similar to 2009 and
2010 income levels) to $53.0 million in 2013, however details for specific cancer research
funding was not provided. Philanthropic donations to Kinghorn provided for an additional
$10.0 million to procure the gene sequencers and the centre received $5.5 million in federal
funding to establish the Australian Prostate Cancer Research Centre. A $15.5 million increase
in funding is substantial considering that Garvan’s overall research funding in 2011 was
$40.0 million.
A goal of Kinghorn is to support translational research and provide better treatment options
for patients. Kinghorn was specifically designed to support this by bringing together the
researchers and clinicians however the 1.75 years since the centre has been opened is too
short for any research to have been translated into treatment options. The enhanced
collaboration, new biobank and tissue processing facilities and genome sequencer capability
should support more and higher quality clinical trials. The Kinghorn ‘brand’ has helped to
raise the profile of cancer services and supported an increase in the number (detail not
provided) of industry supported clinical trials conducted through the Clinical Trials Unit.
The new building has improved video and teleconferencing facilities, which staff use to
consult with rural and regional teams in locations like Wagga Wagga, Griffith, Orange and
the Central Coast. The number of additional teleconference consults was not provided.
As a result of Kinghorn there is new expertise around genome sequencing, bioinformatics
and radio-pharma as well as four additional MDT’s focusing on new cancer types. The
research collaborations and capability has helped attract international researchers.
Measure evaluation
Summary of findings
Project resulted in better integration of
locally available medical services
Greater collaboration between researchers
and clinicians through co-location.
Additional four MDTs, further collaboration
with Medicare locals, GP’s and allied health
professionals.
Project has increased staff development,
availability and access to local training
research infrastructure and shared research
training facilities
The centre provides enhanced meeting and
training room facilities. Relatively limited
evidence provided around new staff
development initiatives.
Project has improved attraction and
retention of staff
Unclear how overall staffing numbers have
changed however it appears to be a better
work environment. Able to recruit 18 for the
Clinical Genomic team and established
researchers.
Project has resulted in increased research
grant income
Garvan received a considerable amount
($15.5 million) of additional funding because
of the Kinghorn Centre.
New facility has increased number of
research outcomes translated into clinical
practice locally
Limited evidence provided.
Increased collaboration between clinicians
and researchers, new technology and
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Medical research domain evaluation
Measure evaluation
Summary of findings
enhanced capability should support better
clinical trials.
New facility has improved accessibility
through better telecommunication and eHealth services
No details provided on increased
meeting/call volumes. Better facilities are
being used for teleconferencing consults with
rural areas.
The project has increased the number of
researchers and/or the range of research
expertise
New research focus and capability (new staff)
with genome sequencing. Also additional
MDTs and in-house research support
capabilities like the biobank.
Overall
The research and clinical teams are
better integrated and more effective at
Kinghorn. The centre has new
capabilities, attracted international
talent and led to increased grant
funding. Limited evidence was
provided for some of the measures.
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Medical research domain
Domain sample studies
The remaining three domain sample projects were reviewed at a
higher level and did not include site visits. The domain sample
projects helped to increase the sample size and provide more
information for the overarching themes of the domains and overall
evaluation.
The projects in this domain sample included:
1.
Ingham Health Research Institute, New South Wales
2.
Hunter Medical Research Institute, New South Wales
3.
Stage 2 Menzies Building, Tasmania
5.6
Ingham Health Research Institute
The Ingham Health Research Institute is a partnership between the Ingham Health Research
Institute, South West Sydney Local Health District (SWSLHD), the University of New South
Wales (UNSW) and the University of Western Sydney (UWS). IHRI received $46.9 million
for the development of a multifaceted research facility that is fully integrated with the newly
redeveloped Liverpool Hospital.
The funding covered the building, a research linear accelerator and a skills centre. The
objectives of IHRI were to improve health outcomes in a region of major disadvantage
(South West Sydney) by providing a research facility that would link clinical health services
and universities to clinical practice.
Co-contributor Project Funding: $2.0 million from UNSW, $1.0 million from UWS, $0.5
million from Ingham Institute and $1.5 million from Liverpool Hospital.
The facility opened in October 2012 (operating for approximately one and a half years at the
time of this evaluation).
5.6.1 Appropriateness
Measure evaluation
Summary of findings
Project has achieved objectives as set out in
the funding application
The objective was to improve health
outcomes in the region by creating a
multifaceted research facility that is fully
integrated with Liverpool Hospital.
The Ingham Institute has been built within
the Liverpool Hospital campus and is the
centre of research in the Sydney South
Western region.
5.6.2 Efficiency
Measure evaluation
Summary of findings
Project has increased the number of relevant
services delivered or research capabilities /
topics
Increase in number of research groups,
growing from six in 2010 prior to the
development of the new facility to 18 in 2013.
5.6.3 Utilisation
Measure evaluation
Summary of findings
Project has increased number of student
applications (be it international or domestic)
Increase in UNSW medical student hours
from 130,000 hours in 2010 to 168,800
hours in 2013.
Additional 28,175 hours from new UWS
medical students.
Project has reached the targeted capacity of
the facility
The capacity of the research building is
approximately 250-280 staff.
Currently the facility houses approximately
190 staff which equates to approximately
70% to 75% of the full capacity.
The research facility was designed to be full
in five years.
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5.6.4 Effectiveness
Measure evaluation
Summary of findings
Project has increased staff development,
availability and access to local training
research infrastructure and shared research
training facilities
The institutes runs an Annual Research
Methods Seminar series program to teach
Institute, UNSW, UWS and SWSLHD staff in
methods of modern research.
Project has resulted in increased research
grant income
Increase from $3.3 million in NHMRC grant
income in 2010 to $5.4 million in 2013.
Increase from $1.2 million in other
competitive grant income in 2010 to $3.3
million in 2013.
Project has increased number of research
projects/publications completed at the
school/facility
The new facility houses a MRI Linear
Accelerator for research into cancer therapy
(one of three in the world per the annual
report) and Clinical Skills & Simulation
Centre which is used by the universities for
training clinicians, nurses, students and
allied health professionals and to support the
translation of research and policy into
practice.
The project has increased the number of
researchers and/or the range of research
expertise
Increase from ten active cancer researchers
before the project to 190 researchers as at
2013.
Increase of six new PhD students since new
development.
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Medical research domain evaluation
5.7
Hunter Medical Research Institute
The Hunter Medical Research Institute (HMRI) received $35.0 million for the construction
of the research facility, which was the joint venture between Hunter New England Local
Health District and the University of Newcastle. An additional $57.0 million was funded by
other co-contributors to achieve the total estimated cost of $92.0 million for the relocation.
The strategy of the HMRI Board was to consolidate researchers from seven different
locations into three major neighbouring precincts – the University of Newcastle, Rankin Park
Campus and the Calvary Mater Newcastle Hospital Campus.
The HMRI building was designed for co-location of biomedical, public health and clinical
researchers in close proximity to the region's largest teaching hospital, facilitating effective
translation of research into improved health outcomes.
Co-contributor funding: $57.0 million from co-contributors
The facility was opened in August 2012 (operating for almost two years at the time of this
evaluation).
5.7.1
Appropriateness
Measure evaluation
Summary of findings
Project addresses community needs
HMRI consolidates researchers in a purpose built
facility in close proximity to the Newcastle
Hospital, providing for collaborations between
researchers and with clinicians.
It was estimated by the project team that the
construction of the building will generate 680
new jobs in the Hunter region and add $180.0
million to the local economy.
Through open days and research tours, HMRI is
promoting health and medical research to the
community, aiming to increase the uptake of
tertiary education in the health and medical
research related fields.
Project has achieved objectives as set
out in the funding application
The objectives were to bring together the
researchers into a single facility co-located with
the hospital. This has been achieved with the
building designed in an open plan style with
centralised meeting and lecture facilities, a single
café and staff dining area, to encourage
collaboration.
5.7.2 Utilisation
Measure evaluation
Summary of findings
Project has increased remote/regional
activity
The facility includes the HMRI Clinical Trials
Centre located in the HMRI Building which
contains 14 dedicated clinical trial rooms. This
was compared to the three rooms that were
available in the John Hunter Hospital previously.
These rooms include a specialised cough challenge
clinic, lung function machine, expired nitrous
oxide clinic, nutrition lab and pharmacy.
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Measure evaluation
Summary of findings
The construction/development of the
new facility was done through the use of
local services in the community
Most elements (more than 30% of major
contracts) were sourced locally -including
excavation, concrete and brick supply, form work,
reinforcement placing, bricklaying, structural
steel, ceilings and partitions, waterproofing,
roofing, rendering, doors, door frames, etc.
Some specialist trades were not sourced locally,
but the materials used were purchased locally.
5.7.3 Effectiveness
Measure evaluation
Summary of findings
Project has increased staff
development, availability and access to
local training research infrastructure
and shared research training facilities
The facility is equipped with meeting rooms,
board rooms, seminar rooms and a lecture theatre
that frequently hosts satellite conferences,
research symposia, research meetings and the
HMRI seminar series. The University of
Newcastle, Hunter New England Local Health
District and the Calvary Mater Newcastle often
hire these facilities for the conference, meeting
and symposia activities.
The local community are engaging more often
with the HMRI Building through building tours,
fundraising activities and meetings.
Project has improved attraction and
retention of staff
Affiliated researchers6 increased from 961 in June
2010 to 1,173 in December 2012. This equates to
an increase of 22%.
Project has resulted in increased
research grant income
Increase from $17.0 million in Total Australian
Competitive Grants Register research grants in
2009 to $230 million in 2013 an increase of 35%.
Project has increased number of
academics (international/domestic)
An increase from 366 academics in June 2010 to
447 in December 20127.
Since the redevelopment HMRI has attracted an
additional 108 PhD students.
Project has increased number of
research projects/publications
completed at the school/facility
The number of peer-reviewed journal publications
has increased from 522 in 2011 to 529 in 2012.
Increase in number of non-peer-reviewed journal
publications has remained at 83 between 2011 to
2012.
As of June 2014 there were 3,894 citations against
the 529 Peer reviewed Publications from 2012.
6 Affiliated researchers include researchers, tech support, administration and students; excludes HMRI
management, administration and support staff
7 Increase is based on percentage of academic/total researchers at 30 June 2010
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Medical research domain evaluation
Measure evaluation
Summary of findings
The project has increased the number of
researchers and/or the range of
research expertise
The HMRI building now houses facilities for
health and medical research, including:

the HMRI Clinical Trials Centre,

the HMRI Comprehensive Imaging
Centre; and
 conference and meeting facilities.
The HMRI Building has recruited senior
researchers.
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5.8
Menzies Building- Stage 2
The University of Tasmania (the University) received $44.7 million from HHF and an
addition $45.0 million from other co-contributors, for the construction of Stage 2 of the
Menzies Research Institute to provide dedicated research space and infrastructure for
clinical research. This project was a joint venture between the University of Tasmania’s
Menzies Research Institute (Menzies) and the Tasmanian Department of Health and Human
Services (DHHS).
The construction expanded the Stage 1 development to enable the co-location of the
University’s Schools of Medicine, Nursing and Pharmacy and will contain dedicated research
space for Menzies staff as well as clinical researchers from the DHHS. A key aim of the Stage
1 and 2 developments was to promote greater collaboration between researchers from six
geographically separate locations.
The presence of both Stage one and two buildings in close proximity to the Royal Hobart
Hospital was intended to create a medical precinct that will combine teaching and research
into a single campus.
Co-contributor funding: $45.0 million from co-contributors
The facility was opened in March 2013 (operating for just over one year at the time of this
evaluation).
5.8.1 Appropriateness
Measure evaluation
Summary of findings
Project addresses an overarching strategy of
a state/territory/Commonwealth body
The project addressed local objectives to
expand Tasmania’s medical research base,
and National objectives to conduct research
in the seven National Health Priority Areas,
namely arthritis and musculoskeletal
conditions, asthma, cancer control,
cardiovascular health, diabetes mellitus, and
mental health.
At a broader level, the project supports the
Government's strategy to equip Australia's
health and hospital system to deal with
current and future challenges, resulting in
potential long-term improvements in the
health system for all Australians.
Project has achieved objectives as set out in
the funding application
The objectives were to construct the building
in close proximity to the hospital, to enable
better collaboration between researchers and
clinicians.
These were met through the construction of
the building being completed in March 2013
and shortly thereafter University of
Tasmania staff and students moving into the
designated areas and commencing
operations.
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Medical research domain evaluation
5.8.2 Effectiveness
Measure evaluation
Summary of findings
Project has increased staff development,
availability and access to local training
research infrastructure and shared research
training facilities
A new MRI machine was installed in the
Royal Hobart Hospital for use both in clinical
research and treatment of public patients.
With the new clinic research facility, the
University has established a blood pressure
clinic and a new heart screening program for
patients.
The facility includes a large auditorium
utilised for teaching, conferences (150 of
Tasmania's health professionals came
together to discuss the best way to improve
the health of Tasmanians at the inaugural
TASHealth Conference) and seminars for the
research and local communities. Examples of
the seminars held in the last year were:

public talks on brain ageing and
repair (150 people attended),

statins and cholesterol (300 people
attended) and
 osteoarthritis (180 people attended).
The facility has enabled the expansion of
nursing training, with forecasted enrolment
numbers expected to increase this year by
27% on 2012.
There has been an additional focus on
research and professional practice in the
University, resulting in a new professional
and clinical honours programs created in
Nursing – generating enrolment increase of
52 students from 2012 to 2013.
Project has improved attraction and
retention of staff
Renown senior researchers have joined
Menzies from international and national
sources.
Menzies has 25 researchers employed from
external fellowship funding, through
nationally competitive schemes such as the

NHMRC (13 fellows),

ARC (four fellows)

National Heart Foundation (2.0
fellows).
Project has resulted in increased research
grant income
Research income has increased by 11% from
$9.3 million in 2012 to $10.3 million in 2013.
Project has increased number of research
projects/publications completed at the
school/facility
Increased by 20% in peer-reviewed
publications to 312 in 2013.
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Measure evaluation
Summary of findings
The project has increased the number of
researchers and/or the range of research
expertise
Core research areas have increased to
include:

heart disease research,

glaucoma,

stem cell research; and
 dementia
Increase in number of Menzie’s research
students from 41 in 2012 to 57 in 2013
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6 Recommendations
6.1
Suggestions for similar future projects
In gathering the information for this report, PwC came across some themes, or lessons that
may be helpful for future health infrastructure investments.
6.1.1
Inclusion of targets in application forms
It may be beneficial to have a set number of health outcome measures and a tracking plan
agreed in the funding processes. There were challenges in collecting sufficient and
comparable data sets on community health benefits for this review. In most of the funding
applications that PwC reviewed, there were not articulated measurable health outcome or
community benefit related targets or forecasts. If measures were agreed as part of the
funding plan, the potential health outcomes would be easier to track and could help
applicants more clearly articulate the community need and intended projects outcomes.
Concrete target measures could also potentially be a beneficial reference point when
selecting comparable projects for future funding. These measures should be relatively flexible
to account for changing in demand or local community needs.
Currently medical student capacities are limited at the clinical schools by the number of
Commonwealth Supported Placements or state/territory internship spots. It may be
beneficial to understand the building capacity targets and plans (e.g. for the first five years)
as part of the funding application, so that these can be used to measure how well the project
team is tracking against these targets. These plans should take into consideration relevant
student and funding caps and potential upcoming regulatory changes.
6.1.2 Identification of community need in application form
For the more remote/regional primary care projects, it would be helpful if applicants
provided a fuller picture of the services currently provided in the local community and clearly
articulated the need that is driving the request for funding. If they are planning to expand
services, they should identify and comment on whether those services are already being
provided in the community, by whom and why additional services are necessary. This may
help applicants better articulate the community need, identify potential areas for
collaboration in the community and prevent accidently giving one business an unfair
advantage where capital funding is covered by a government organisation.
6.1.3 Early engagement of clinicians in the design phase
Projects seemed to benefit from engaging clinicians early on in the planning and
development of the facilities. These projects felt that as a result they had more functional
work environments that meet the needs of the teams. Including a clinician in the building
design phase could have been helpful in the development of the medical centre for Nebo,
where additional costs were incurred in amendments to the facility making it better suited to
the needs of the clinicians.
While it is important that facilities are fit for purpose, PwC have heard feedback that rooms
should be flexible or multifunctional where possible to allow for changing plans and needs. It
is also beneficial for facilities to be built in a way that allows for future expansion, such as
some of the research institutes and clinical schools.
6.1.4 Capabilities of project teams in more remote areas
Some of the smaller, more remote projects may not have the resources or experience to
manage infrastructure projects and be able to anticipate some of the potential challenges to
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meeting the timelines and objectives. Further support may be beneficial for these smaller
projects such as the provision of budget tools and guidance on how to deal with changing
project scope, missing milestones or targets.
In addition, some remote projects appeared to believe that the provision of accommodation
would address the local recruitment challenges, and do not provide alternative measures
such as funding incentives. These types of projects may be better supported in future by
considering the holistic elements required to achieve the objectives, such as the support
required for recruiting local staff or appropriate incentive plans to attract GPs to the area.
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Appendices
Appendix A Measures list
138
Appendix B Selected projects
141
Appendix C Sampling matrix
142
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Appendix A Measures list
1
Appropriateness
The table below lists the measures developed to measure the project’s Appropriateness.
Table 1: Measures to be used to address Appropriateness for selected project
samples
ID
Measure
1.01
Project addresses an overarching
strategy of a
state/territory/Commonwealth
body
Project has increased health
professionals in regional areas
(e.g. GPs, nurses, allied health)
Project addresses community
needs
Project has achieved objectives as
set out in the funding application
Project has achieved additional
objectives, that were not planned
in original scope
1.02
1.03
1.04
1.05
2
Primary/
Integrated
Care
Acute care
Workforce
Medical
Research
2
3
1
5
2
2
2
-
7
3
5
2
1
-
5
4
1
1
-
-
Efficiency
The table below lists the measures developed to address the project’s efficiency.
Table 2: Measures to be used to address Efficiency for selected project samples
ID
Measure
2.01
Project has reduced the length of
time between referral and
provision of service
Project has increased the number
of relevant services delivered or
research capabilities / topics
Project has reduced ED waiting
times
Project has reduced the number
of patients that DNW (end status)
2.02
2.03
2.04
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Primary/
Integrated
Care
Acute care
Workforce
Medical
Research
6
-
-
-
6
2
4
5
1
2
-
-
1
2
-
-
138
Utilisation
3
Utilisation
The table below lists the measures developed to address the project’s utilisation.
Table 3: Measures to be used to address Utilisation for selected project samples
ID
Measure
3.01
Project has increased
remote/regional activity
The construction/development of
the new facility was done through
the use of local services in the
community
Project has increased number of
student applications (be it
international or domestic)
Project has increased number of
enrolments/placements to
medical and academic schools
Project has increased
rates/number of screening,
diagnosis and treatment
Project has reached the targeted
capacity of the facility
3.02
3.03
3.04
3.05
3.06
4
Primary/
Integrated
Care
Acute care
Workforce
Medical
Research
4
3
3
1
7
4
4
1
1
-
1
1
-
-
3
1
2
-
-
1
-
-
-
5
Effectiveness
The table below lists the measures developed to address the project’s effectiveness.
Table 4: Measures to be used to address Effectiveness for selected project
samples
ID
4.01
4.02
4.03
4.04
4.05
4.06
4.07
4.08
Primary/
Integrated
Care
Acute care
Workforce
Medical
Research
Project resulted in better
integration of locally available
medical services
Project has reduced travel time
and referrals to a health service
Project has improved access to
specialised health services and
specialist facilities
Project has increased staff
development, availability and
access to local training research
infrastructure and shared
research training facilities
Project has improved attraction
and retention of staff
Project has achieved a NEAT
6
-
2
1
1
3
3
-
2
1
-
-
2
-
3
5
6
2
5
5
-
1
-
-
Services provided by the project
are more culturally accessible
Project has resulted in increased
research grant income
2
4
2
-
-
-
1
7
Measure
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Effectiveness
ID
Measure
4.09
New facility has increased
number of research outcomes
translated into clinical practice
locally
Project has increased number of
academics
(international/domestic)
New facility has improved
accessibility through better
telecommunication and e-Health
services
Services have increased testing,
diagnosis and treatment of
diseases that are prevalent in the
Indigenous population
Project has improved outreach
services to educate communities
to better manage diseases
Services provided by the project
have reduced the number of
avoidable hospitalisations
Project has increased number of
research projects/publications
completed at the school/facility
The project has increased the
number of researchers and/or the
range of research expertise
4.10
4.11
4.12
4.13
4.14
4.15
4.16
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Primary/
Integrated
Care
Acute care
Workforce
Medical
Research
-
-
-
3
-
-
-
1
3
-
-
1
2
-
-
-
3
1
1
1
-
2
-
-
-
-
3
6
-
-
1
7
140
Appendix B Selected
projects
1
Case study samples
 Acute care
–
Hospital ED Alice Springs
–
Replacement Paediatrics Unit Broome & Kimberley
–
Kimberley Renal Services
–
Emergency Department Tennant Creek
 Primary/ integrated care
–
Toowoomba Primary Healthcare Centre
–
Narrabri District Health Service
–
RFDS Mount Isa Base Redevelopment
–
Sheffield Multipurpose Health Precinct
 Workforce
–
WAMS Multidisciplinary Healthcare Centre and accommodation, Walgett
–
Blacktown Clinical School, Research & Education Centre
–
Retention of GPs in the McKinlay & Julia Creek region
 Medical Research
2
–
Stage 3 John Curtin School of Medical Research, Canberra
–
Melbourne Neuroscience Project
–
Health & Medical Research Institute Adelaide
–
Kinghorn Cancer Centre
Domain study samples
 Primary/ integrated care
–
Kincraig Clinical Development
–
Expanded Integrated Primary Healthcare Facility, Shepparton
–
Wallaroo Community Dental Clinic
 Acute care
–
St Stephen's Regional Hospital (was removed as information available was
insufficient for evaluation due to current level of completion)
 Workforce
–
Nepean Clinical School
–
Clinical medical education and best practice in ambulatory care, Werribee
–
Nebo Medical Centre
 Medical Research
–
Ingham Health Research Institute, Liverpool
–
Hunter Medical Research Institute
–
Stage 2 Menzies Building, Hobart
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Appendix C Sampling
matrix
1
Acute care
Table 5
Case study sample
Organisation
Funding recipient
Organisation
type
State/
Territory
Funding
amount
Location
Period in
operation
Hospital ED Alice
Springs
Department of Health
(NT)
Government
NT
$13.6
Million
Remote
less than a
year
Replacement
Paediatrics Unit
Broome & Kimberley
Department of Health
(WA)
Government
WA
$7.9
Million
Remote
Kimberley Renal
Services
Department of Health
(WA)
Government
WA
$8.6
Million
Remote
Emergency
Department Tennant
Creek
Department of Health
(NT)
Government
NT
$3.7
Million
Remote
2
more than
a year, but
less than
two
more than
a year, but
less than
two
less than a
year
Primary Care
Table 6
Case study sample
Organisation
Funding recipient
Organisation
type
State/
Territory
Funding
amount
Location
Period in
operation
Toowoomba Primary
Healthcare Centre
Seven Springs
Building Services Pty
Ltd
NGO
QLD
$7.0
Million
Regional
less than
a year
Narrabri District
Health Service
Department of Health
(NSW)
Government
NSW
$27.0
Million
Regional
more than
two years
RFDS Mount Isa
Base Redevelopment
Royal Flying Doctor
Service of Australia
(Queensland Section)
NGO
QLD
$2.7
Million
Remote
more than
two years
Sheffield
Multipurpose Health
Precinct
Kentish Council
Council
Tas
$1.7
Million
Regional
more than
a year,
but less
than two
Table 7
Domain study samples
Organisation
Funding recipient
Organisation
type
State/
Territory
Funding
amount
Location
Period in
operation
Kincraig Clinical
Development
Limestone Coast
Division of General
Practice.
NGO
SA
$1.3
Million
Regional
less than a
year
Expanded Integrated
Primary Healthcare
Facility, Shepparton
Primary Care
Connect
NGO
Vic
$3.8
Million
Regional
more than
a year, but
less than
two
Wallaroo Community
Dental Clinic
Department of Health
(SA)
Government
SA
$3.3
Million
Regional
less than a
year
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Workforce
3
Workforce
Table 8
Case study sample
Organisation
WAMS
Multidisciplinary
Healthcare Centre
and accommodation,
Walgett
Blacktown Clinical
School, Research &
Education Centre
Retention of GPs in
the McKinlay & Julia
Creek region
Table 9
Funding recipient
Organisation
type
State/
Territory
Funding
amount
Location
Period in
operation
Walgett Aboriginal
Medical Service Cooperative Limited
NGO
NSW
$2.9
Million
Remote
less than a
year
University of Western
Sydney
NGO
NSW
$13.1
Million
Major
City
more than
two years
McKinlay Shire
Council
Council
QLD
$529,217
Remote
more than
a year, but
less than
two
Domain study samples
Organisation
Funding recipient
Organisation
type
State/
Territory
Funding
amount
Location
Period in
operation
Nepean Clinical
School
University of Sydney
NGO
NSW
$17.2
Million
Major
City
more than
two years
Clinical medical
education and best
practice in
ambulatory care,
Werribee
University of Notre
Dame
NGO
Vic
$11.2
Million
Major
City
more than
two years
Nebo Medical Centre
Isaac Regional
Council
Council
QLD
$454,545
Regional
less than a
year*
State/
Territory
Funding
amount
Location
Period in
operation
NGO
ACT
$60.0
Million
Major
City
more than
a year, but
less than
two
NGO
Vic
$39.8
Million
Major
City
more than
two years
NGO
SA
$200.0
Million
Major
City
less than a
year
NGO
NSW
$70.0
Million
Major
City
more than
a year, but
less than
two
4
Medical Research
Table 10 Case study sample
Organisation
Funding recipient
Stage 3 John Curtin
School of Medical
Research, Canberra
Australian National
University
Health & Medical
Research Institute
Adelaide
Florey Institute of
Neuroscience and
Mental Health
South Australian
Health and Medical
Research Institute
Kinghorn Cancer
Centre
Garvan Institute of
Medical Research
Melbourne
Neuroscience Project
Organisation
type
Table 11 Domain study samples
Organisation
Funding recipient
Organisation
type
State/
Territory
Funding
amount
Location
Period in
operation
Ingham Health
Research Institute,
Liverpool
Ingham Health
Research Institute
NGO
NSW
$46.9
Million
Major
City
more than
a year
Hunter Medical
Research Institute
Hunter Medical
Research Institute
NGO
NSW
$35.0
Million
Major
City
more than
a year
Stage 2 Menzies
Building, Hobart
University of
Tasmania
NGO
Tas
$44.7
Million
Regional
more than
a year
Evaluating the Health & Hospitals Fund (HHF)
PwC
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