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Endorsed by Health Infrastructure and Projects Executive Committee

Infrastructure Renewal Planning Project for Rural and Remote Areas

Preliminary Evaluation

April 2011

Version 2.1

Queensland Health

Owner: John Glaister, Deputy Director-General; Health Planning and Infrastructure Division

Contact details: (07) 3247 4814, [email protected]

Program name: Health Service District Planning

Division / Unit: Planning and Coordination Branch; Policy, Planning and Asset Services

Document status: Endorsed by Health Infrastructure and Projects Executive Committee

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Project quality assurance This Preliminary Evaluation has been prepared based on the Department of Infrastructure and Planning’s Project Assurance Framework. The following changes in approach to methodology have been applied for this Project.

This Preliminary Evaluation has been subject to the following assurance reviews:

Date Quality assurance reviewer

Work component subjected to quality assurance review

Result

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Contents Foreword ..................................................................................................................................... 12

1 Executive summary .......................................................................................................... 13

1.1 Service need and outcomes sought (service direction) ............................................. 13

1.2 Options to meet outcome .......................................................................................... 14

1.3 Risks of not delivering the Project ............................................................................. 17

1.4 Procurement strategy ................................................................................................ 17

1.5 Conclusion ................................................................................................................. 17

2 Case for action .................................................................................................................. 19

2.1 Project drivers ........................................................................................................... 21

2.2 Service objectives ..................................................................................................... 22

2.3 Service need ............................................................................................................. 23

2.4 Current service capacity ............................................................................................ 23

2.5 Service direction ........................................................................................................ 25

2.6 Future service requirements ...................................................................................... 26

2.7 Strategic alignment .................................................................................................... 27

2.7.1 Strategic importance ........................................................................................ 27

2.7.2 Alignment with specific strategic initiatives ...................................................... 27

2.8 Priority for government .............................................................................................. 29

3 Project scope .................................................................................................................... 30

3.1 Background ............................................................................................................... 30

3.1.1 Planning to date ............................................................................................... 30

3.1.2 Decisions to date .............................................................................................. 31

3.1.3 Interrelated projects ......................................................................................... 31

3.2 Scope inclusions and exclusions ............................................................................... 31

3.2.1 Included ............................................................................................................ 32

3.2.2 Excluded .......................................................................................................... 32

3.3 Constraints/limitations ............................................................................................... 33

3.4 Prerequisites ............................................................................................................. 33

3.5 Assumptions .............................................................................................................. 33

3.6 Stakeholder consultation ........................................................................................... 34

4 Options for meeting service requirement ...................................................................... 36

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4.1 Option evaluation criteria ........................................................................................... 36

4.2 Identification of the range of options.......................................................................... 36

4.3 Assessment of potential feasibility of options ............................................................ 37

4.4 Description of options for further analysis ................................................................. 38

4.4.1 Option 1: Status quo–minimum upgrade of the facility to enable the safe provision of current services ......................................................................... 38

4.4.2 Option 2: Refurbishment or expansion at existing site ..................................... 38

4.4.3 Option 3: Significant redevelopment ................................................................ 38

4.4.4 Excluded options .............................................................................................. 38

5 Options analysis ............................................................................................................... 39

5.1 Risk analysis ............................................................................................................. 39

5.1.1 Risk analysis approach .................................................................................... 39

5.1.2 Project risk context and potential risk management strategies ........................ 40

5.1.3 Risk analysis of options and potential risk management strategies ................. 42

5.1.4 Site specific risk summary ................................................................................ 45

5.2 Financial analysis ...................................................................................................... 51

5.2.1 Key costing assumptions ................................................................................. 51

5.2.2 Costing Options 1, 2 and 3 ............................................................................... 51

5.2.3 Key infrastructure components ........................................................................ 52

5.2.4 Facility maintenance and management costs .................................................. 53

5.2.5 Clinical and support services costs .................................................................. 56

5.3 Affordability ................................................................................................................ 56

5.3.1 Capital expenditure affordability analysis ......................................................... 57

5.3.2 Recurrent costs affordability analysis ............................................................... 57

5.3.3 Summary .......................................................................................................... 58

5.4 Economic analysis ..................................................................................................... 58

5.4.1 Assessment approach and method .................................................................. 58

5.4.2 Summary of options analysis ........................................................................... 62

5.5 Market sounding ........................................................................................................ 76

5.5.1 Requirement for market sounding .................................................................... 76

5.5.2 Methodology ..................................................................................................... 77

5.5.3 Rural and Remote Project market sounding approach .................................... 77

5.5.4 Desktop analysis findings ................................................................................. 78

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5.5.5 Stakeholder feedback ...................................................................................... 79

5.5.6 Summary of expected market appetite and requirements ............................... 79

5.6 Legislative approval, whole-of-government policy objectives and regulatory issues . 80

5.6.1 Summary of issues and objectives identified ................................................... 80

5.6.2 Legislative approval issues .............................................................................. 87

5.6.3 Whole-of-government policy objectives ........................................................... 87

5.6.4 Regulatory issues ............................................................................................. 89

5.7 Public interest assessment ........................................................................................ 90

5.7.1 Assessment approach and method .................................................................. 90

5.7.2 Outcomes and analysis .................................................................................... 98

5.7.3 Considerations for the Business Case ............................................................. 102

5.8 Procurement Assessment ......................................................................................... 103

5.8.1 Assessment approach ...................................................................................... 103

5.8.2 Procurement analysis ....................................................................................... 107

5.8.3 Findings and recommended procurement strategy .......................................... 110

5.9 Comparison of Options .............................................................................................. 111

5.9.1 Alignment with criteria ...................................................................................... 111

5.9.2 Cost .................................................................................................................. 119

5.9.3 Risk (qualitative) ............................................................................................... 120

5.9.4 Ability of each procurement option to deliver the service direction .................. 120

6 Business Case Development ........................................................................................... 122

6.1 Proposed approach ................................................................................................... 122

6.2 Project governance structure .................................................................................... 123

6.3 Resource requirements ............................................................................................. 124

6.4 Cost estimate for Business Case development ......................................................... 125

7 Acronyms .......................................................................................................................... 128

8 References ........................................................................................................................ 129

List of Tables Table 1: Options analysis against evaluation criteria ...................................................................... 14

Table 2: Core services and capacity and capability issues ............................................................. 24

Table 3: Current service capacity and projected future service requirements to 2021/22 .............. 26

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Table 4: Alignment with specific strategic initiatives ....................................................................... 28

Table 5: List of key planning decisions ........................................................................................... 31

Table 6: List of interrelated projects ................................................................................................ 31

Table 7: Stakeholder consultation ................................................................................................... 34

Table 8: Criteria for evaluating options ........................................................................................... 36

Table 9: Assessment of options ...................................................................................................... 37

Table 10: Queensland Health Integrated Management Analysis Matrix ......................................... 40

Table 11: Whole-of-Project risks ..................................................................................................... 40

Table 12: Option-specific risks ........................................................................................................ 42

Table 13: Relative option risk ranking by site ................................................................................. 46

Table 14: Summary of financial analysis for Options 1, 2 and 3 ..................................................... 52

Table 15: Rural and remote key infrastructure components estimated cost ................................... 52

Table 16: Employee housing accommodation infrastructure estimated cost .................................. 53

Table 17: Annual maintenance costs for Options 1, 2 and 3 .......................................................... 54

Table 18: Building lifecycle costs over 30 years ............................................................................. 54

Table 19: Building lifecycle costs over 30 years for each facility .................................................... 54

Table 20: Clinical and support services annual cost for Options 1, 2 and 3 ................................... 56

Table 21: Total capital costs for Options 1, 2 and 3 ........................................................................ 57

Table 22: Annual recurrent cost for Options 1, 2 and 3 .................................................................. 57

Table 23: Key challenges for service delivery by rural and remote site .......................................... 59

Table 24: Criteria for assessment ................................................................................................... 60

Table 25: Multi-criteria analysis scale ............................................................................................. 61

Table 26: Option ranking per site .................................................................................................... 63

Table 27: Summary of the options analysis—Atherton Hospital ..................................................... 63

Table 28: Summary of the options analysis—Ayr Hospital ............................................................. 65

Table 29: Summary of the options analysis—Biloela Hospital ........................................................ 66

Table 30: Summary of the options analysis—Charleville Hospital .................................................. 67

Table 31: Summary of the options analysis—Charters Towers Hospital ........................................ 68

Table 32: Summary of the options analysis—Emerald Hospital ..................................................... 70

Table 33: Summary of the options analysis—Kingaroy Hospital .................................................... 71

Table 34: Summary of the options analysis—Longreach Hospital ................................................. 72

Table 35: Summary of the options analysis—Mareeba Hospital .................................................... 73

Table 36: Summary of the options analysis—Roma Hospital ......................................................... 74

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Table 37: Summary of the options analysis—Sarina Hospital ........................................................ 75

Table 38: Summary of the options analysis—Thursday Island Hospital ......................................... 76

Table 39: Summary of legislative approval, whole-of-government policy objectives and regulatory issues ............................................................................................................................. 81

Table 40: Summary of public interest criteria .................................................................................. 91

Table 41: Criteria scoring system ................................................................................................... 95

Table 42: Public interest assessment scale .................................................................................... 96

Table 43: Summary of assessment outcomes ................................................................................ 98

Table 44: Evaluation criteria ......................................................................................................... 105

Table 45: Procurement model scoring regime .............................................................................. 106

Table 46: Project option evaluation priority weightings ................................................................. 106

Table 47: Summary of the procurement model analysis results ................................................... 108

Table 48: Options analysis against evaluation criteria .................................................................. 112

Table 49: Total capital costs for Options 1, 2 and 3 ...................................................................... 119

Table 50: Annual recurrent cost for Options 1, 2 and 3 ................................................................ 119

Table 51: Relative option risk ranking ........................................................................................... 120

Table 52: Results of procurement assessment ............................................................................. 120

Table 53: Stages of the Business Case ........................................................................................ 123

Table 54: Total capital costs for preferred option and tier category .............................................. 125

Table 55: Summary of estimated business case development costs ........................................... 125

List of Figures Figure 1: Map of prioritised rural sites ............................................................................................. 20

Figure 2: Alignment with Strategic Objectives ................................................................................ 27

Figure 3: Market sounding methodology ......................................................................................... 77

Figure 4: Project assessment approach ....................................................................................... 104

Figure 5: Project governance framework ...................................................................................... 124

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Appendices Appendix 1: Description of service needs .............................................................................. 132

Appendix 2: Alignment of objectives with strategic initiatives ............................................. 135

Appendix 3: Financial analysis costing assumptions ............................................................ 138

Appendix 4: Clinical Services Capability Framework for Public and Licensed Private Health Facilities v2.0 .................................................................................................................. 145

Appendix 5: National Health Reform Agenda ......................................................................... 146

Appendix 6: Description of options for each site ................................................................... 147

Appendix 7: Risk Register ........................................................................................................ 151

Appendix 8: Options analysis for the public interest assessment ....................................... 155

Appendix 9: Stakeholder feedback Department of Public Works ......................................... 228

Appendix 10: Procurement model analysis inputs ................................................................. 229

Appendix 11: Site options evaluation ...................................................................................... 235

Appendix 12: Business case costing details and project plan ............................................. 267

List of Appendix tables Appendix Table 1: Alignment of objectives with strategic initiatives ............................................. 135

Appendix Table 2: Workforce profile for the rural and remote sites .............................................. 138

Appendix Table 3: Clinical support workforce ............................................................................... 139

Appendix Table 4: Non-clinical support workforce ........................................................................ 139

Appendix Table 5: Adjustment to number of nurses based on actual variation in Hospital profile ............................................................................................................................................ 140

Appendix Table 6 Labour/non-labour costs split for hospital profile. ............................................ 141

Appendix Table 7: Risk Register ................................................................................................... 151

Appendix Table 8: Summary of assessment outcomes for Atherton Hospital .............................. 155

Appendix Table 9: Atherton Hospital: Option 1 effectiveness in meeting service requirement ..... 155

Appendix Table 10: Atherton Hospital: Option 2 effectiveness in meeting service requirement ... 158

Appendix Table 11: Atherton Hospital: Option 3 effectiveness in meeting service requirement ... 160

Appendix Table 12: Summary of assessment outcomes for Ayr Hospital .................................... 162

Appendix Table 13: Ayr Hospital: Option 1 effectiveness in meeting service requirement ........... 162



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Appendix Table 16 Summary of assessment outcomes for Biloela Hospital ................................ 167

Appendix Table 17: Biloela Hospital: Option 1 effectiveness in meeting service requirement ..... 168



Appendix Table 20: Summary of assessment outcomes for Charleville Hospital ......................... 173

Appendix Table 21: Charleville Hospital: Option 1 effectiveness in meeting service requirement ................................................................................................................................... 174

Appendix Table 22: Charleville Hospital: Option 2 effectiveness in meeting service requirement ................................................................................................................................... 176

Appendix Table 23: Charleville Hospital: Option 3 effectiveness in meeting service requirements ................................................................................................................................. 178

Appendix Table 24: Summary of assessment outcomes for Charters Towers Hospital ............... 180

Appendix Table 25: Charters Towers Hospital: Option 1 effectiveness in meeting service requirement ................................................................................................................................... 180



Appendix Table 28: Summary of assessment outcomes for Emerald Hospital ............................ 185

Appendix Table 29: Emerald Hospital: Option 1 effectiveness in meeting service requirement ... 186



Appendix Table 32: Summary of assessment outcomes for Kingaroy Hospital............................ 192

Appendix Table 33: Kingaroy Hospital: Option 1 effectiveness in meeting service requirement .. 193



Appendix Table 36: Summary of assessment outcomes for Longreach Hospital ......................... 199

Appendix Table 37: Longreach Hospital: Option 1 effectiveness in meeting service requirement ................................................................................................................................... 200



Appendix Table 40: Summary of assessment outcomes for Mareeba ......................................... 205

Appendix Table 41: Mareeba Hospital: Option 1 effectiveness in meeting service requirement .. 206


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Appendix Table 44: Summary of assessment outcomes for Roma Hospital ................................ 211

Appendix Table 45: Roma Hospital: Option 1 effectiveness in meeting service requirement ....... 211



Appendix Table 48: Summary of assessment outcomes for the Sarina Hospital ......................... 216

Appendix Table 49: Sarina Hospital: Option 1 effectiveness in meeting service requirement ...... 216



Appendix Table 52: Summary of assessment outcomes for Thursday Island Hospital ................ 222

Appendix Table 53: Thursday Island Hospital: Option 1 effectiveness in meeting service requirement ................................................................................................................................... 222



Appendix Table 56: Procurement model analysis inputs .............................................................. 229

Appendix Table 58: Evaluation of Options against Criteria: Atherton Hospital ............................. 235

Appendix Table 59: Evaluation of Options against Criteria: Ayr Hospital ..................................... 238

Appendix Table 60: Evaluation of Options against Criteria: Biloela Hospital ................................ 240

Appendix Table 61: Evaluation of Options against Criteria: Charleville Hospital .......................... 243

Appendix Table 62: Evaluation of Options against Criteria: Charters Towers Hospital ................ 246

Appendix Table 63: Evaluations of Options against Criteria: Emerald Hospital ........................... 249

Appendix Table 64: Evaluations of Options against Criteria: Kingaroy Hospital ........................... 252

Appendix Table 65: Evaluations of Options against Criteria: Longreach Hospital ........................ 255

Appendix Table 66: Evaluations of Options against Criteria: Mareeba Hospital ........................... 258

Appendix Table 67: Evaluations of Options against Criteria: Roma Hospital ............................... 260

Appendix Table 68: Evaluations of Options against Criteria: Sarina Hospital .............................. 262

Appendix Table 69: Evaluations of Options against Criteria: Thursday Island Hospital ............... 264

Appendix Table 70: Construction and whole-of-project cost for Atherton Hospital, Option 3 ....... 267

Appendix Table 71: Stage 1: Business Case development .......................................................... 267

Appendix Table 72: Stage 2: Final Business Case development ................................................. 268

Appendix Table 73: Construction and whole-of-project cost for Ayr Hospital, Option 2................ 269

Appendix Table 74: Business Case development ........................................................................ 269

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Appendix Table 75: Construction and whole-of-project cost for Biloela Hospital, Option 3 .......... 270



Appendix Table 78: Construction and whole-of-project cost for Charleville Hospital, Option 3 .... 273


Appendix Table 80: Construction and whole-of-project cost for Charters Towers Hospital, Option 3 ........................................................................................................................................ 274



Appendix Table 83: Construction and whole-of-project cost for Emerald Hospital, Option 2 ........ 276


Appendix Table 85: Construction and whole-of-project cost for Kingaroy Hospital, Option 3 ....... 277


Appendix Table 87: Construction and whole-of-project cost for Longreach Hospital, Option 3 .... 279


Appendix Table 89: Construction and whole-of-project cost for Mareeba Hospital, Option 3 ....... 280



Appendix Table 92: Construction and whole-of-project cost for Roma Hospital, Option 3 ........... 283


Appendix Table 94: Construction and whole-of-project cost for Sarina Hospital, Option 3........... 284



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Foreword Queensland Health has undertaken this Preliminary Evaluation, the Infrastructure Renewal Planning Project for Rural and Remote Areas, under the whole-of-government Project Assurance Framework. It takes Queensland Health to a new level of service and infrastructure planning maturity. The Project Assurance Framework—of which this Preliminary Evaluation is part—provides a robust and rigorous process for government to evaluate high priority projects that require significant investment decisions. In addition to the recently developed integrated service planning framework now being used within Queensland Health, the Project Assurance Framework further strengthens the rigour and quality of health service planning for the future of Queensland.

Queensland Health acknowledges the valuable assistance that representatives from the Department of Infrastructure and Planning, Department of Public Works and Queensland Treasury have provided in the development of this Preliminary Evaluation. The Department of Infrastructure and Planning generously provided a part-time resource to review and advise on development of the Preliminary Evaluation. Staff from Queensland Treasury provided valuable support and direction.

Due to the complexity of the health services being evaluated, it has been necessary to depart at a number of points from the Preliminary Evaluation process outlined in the Project Assurance Framework. These points include the quantification of risk, market sounding, and the methodology used for various elements of the economic analysis. If this Preliminary Evaluation is identified by government to progress to the business case development stage, each of these points will be investigated and evaluated thoroughly.

It is recognised there has been no commitment to fund or progress any of these seven proposals, and it has, therefore, been necessary to manage stakeholder expectations accordingly. This has meant that consultation has been limited to a small number of key stakeholders, a strategy requested by, and agreed to, by Queensland Health and Department of Premier and Cabinet.

Queensland Health is committed to providing high quality, safe and sustainable health services to meet the needs of our communities. The development of these Preliminary Evaluations will assist the Queensland Government to develop collaborative and proactive solutions to meet the health needs of Queenslanders now and into the future. The outcomes will assist in further reforming the health care system into one that can meet future challenges.

Deputy-Director-General

Health Planning and Infrastructure Division

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1 Executive summary In 2006, 48 per cent of the Queensland’s population lived outside major cities, many in rural and remote areas. People who live in rural and remote areas have lower life expectancy than those who live in cities (Begg et al. 2003), and the challenge is how best to address this health inequity and provide safe and sustainable health services to rural and remote communities.

There are many challenges in providing health services to these communities including population change, skilled workforce recruitment and retention, ageing hospital infrastructure and technological advances which mean that traditional and in some cases current health service models are becoming obsolete. As a result there is a need to investigate alternative ways to deliver health services in rural and remote communities.

In support of the Government’s commitment to improving access to health services and better meeting people’s health care needs across the continuum, Queensland Health in March 2010 endorsed a policy direction to inform the future delivery of health services for rural and remote areas. This direction—outlined in A definition of a rural model of health service delivery: A hub and spoke (service partner) model— identified 19 hub sites across Queensland.

This service delivery model aims to establish service networks between health providers by developing a hub and spoke model to support the rural health system. These formal links between lower (spoke) and higher (hub) levels of service will enable the development of more integrated and comprehensive health services.

Defining hospital roles based on the draft Clinical Services Capability Framework for Public and Licensed Private Health facilities (draft CSCF v3.0) (Queensland Government 2010) will also support the development of a rural health system that allows small health services to be networked with rural hub hospitals, where the level and mix of core services are similar.

The 19 hub sites identified in the hub and spoke paper were classified as either primary or secondary hub sites. All hub sites have associated spoke sites. Of the 19 hub sites, 11 hub sites (prioritised sites) were identified by Queensland Health as having the most dysfunctional and aged infrastructure impacting on their ability to delivery core health services—surgical and procedural, maternity, emergency and general medical—at Level 3 draft CSCF v 3.0. The 11 prioritised Hospital hub sites— Atherton, Ayr, Biloela, Charleville, Charters Towers, Emerald, Kingaroy, Longreach, Mareeba, Roma and Thursday Island—are the focus of this Preliminary Evaluation.

One additional site was included in the Preliminary Evaluation for a total of 12 prioritised sites. Sarina Hospital is a spoke site and was included in the Preliminary Evaluation because of the dysfunctional and aged infrastructure impacting on the ability to deliver health services to a growing rural population. Sarina Hospital is a spoke of Mackay Hospital and provides a range of health services at Level 2 draft CSCF v3.0.

1.1 Service need and outcomes sought (service direction)

The Preliminary Evaluation has used information from Queensland Health’s Service Profiles and Preliminary Infrastructure Planning Studies (Infrastructure Plans) prepared for the 12 prioritised sites. The outcome sought is to be able to deliver at each of the prioritised sites at a minimum the four core health services—surgical and procedural, maternity, emergency and general medical services— at Level 3 draft CSCF v 3.0.

The Preliminary Evaluation investigates the infrastructure requirements at the prioritised sites necessary to deliver Level 3 services to meet the health care needs of these rural and remote

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communities. The service direction is provided through a hub and spoke model of delivery. The ultimate aim is to improve health outcomes for people who live in rural and remote areas by providing a safe and sustainable health care system.

1. Level 3 draft CSCF services are defined as low to moderate complex inpatient and ambulatory care services.

2. Level 2 draft CSCF services are defined as low complex inpatient and ambulatory care services.

1.2 Options to meet outcome

In order to meet health services needs and to address the service direction required an options analysis was undertaken. From the endorsed service profiles, the following three infrastructure options were developed for each Hospital:

Option 1: Status quo, current health service arrangements and minimal construction work

Option 2: Refurbishment or expansion at the existing site

Option 3: Significant redevelopment

An analysis of these options was then undertaken to assess their ability to meet the pre-determined evaluation criteria. The results are outlined in Table 1 as per evaluation criteria in Table 8.

Table 1: Options analysis against evaluation criteria

Criteria Hospital Option 1 Option 2 Option 3

Capacity

Atherton Does not meet

Meets Meets

Ayr

Biloela Meets

Charleville

Does not meetCharters Towers

Emerald

Kingaroy

Longreach Meets

Mareeba

Does not meetRoma

Sarina

Thursday Island

Capability

Atherton

Does not meet Meets Meets

Ayr

Biloela

Charleville

Charters Towers

Emerald

Kingaroy

Longreach

Mareeba

Roma

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Sarina

Thursday Island

Equity of access

Atherton

Does not meet

Meets

Meets

Ayr

Biloela Partially meets

Charleville

Charters Towers Meets

Emerald

Partially meets

Kingaroy

Meets

Longreach Meets

Mareeba

Roma

Sarina

Thursday Island

Quality

Atherton

Does not meet

Potentially meets

Potentially meets

Ayr

Biloela

Charleville

Charters Towers

Emerald

Kingaroy Partially meets

Longreach Does not meet

Mareeba Partially meets

Roma

Does not meetSarina

Thursday Island

Safety

Atherton Does not meetMeets

Meets

Ayr Meets

Biloela

Does not meetPartially meets Charleville

Charters Towers

Emerald Meets

Kingaroy Partially meetsPartially meets



Potentially meets

Potentially meets

Roma Partially meets Partially meets

Sarina Does not meet Meets Meets

Thursday Island Partially meets Partially meets

Sustainability Atherton Does not meet Meets Meets

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Ayr Partially meets

Biloela Meets

Charleville

Charters Towers Partially meets

Emerald

Meets

Kingaroy

Longreach


Roma Does not meet

Sarina


Efficiency

Atherton

Does not meet

Partially meets

Meets

Ayr

Biloela Meets

Charleville Partially meets

Charters Towers

Emerald Meets


Longreach Meets

Mareeba

Roma Partially meet

Sarina Meets

Thursday Island Partially meets

Affordability Capital expenditure ($,000s)

Atherton 25,696 105,817 107,668

Ayr 1,608 21,776 19,633

Biloela 10,860 64,738 68,188

Charleville 2,654 66,922 73,462

Charters Towers 10,420 58,391 101,233

Emerald 990 66,989 74,724

Kingaroy 3,362 40,376 43,108

Longreach 1,107 77,646 86,261

Mareeba 5,084 21,481 22,203

Roma 5,506 29,176 31,828

Sarina 2,840 12,345 22,045

Thursday Island 11,592 80,702 152,668

Total 81,719 646,359 803,022

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Affordability Recurrent expenditure (incremental) ($,000s)

Atherton 1,464 14,711 14,994

Ayr 91 7,367 7,242

Biloela 543 18,064 18,260

Charleville 139 23,349 23,724

Charters Towers 598 4,152 6,576

Emerald 52 17,173 17,614

Kingaroy 181 7,736 7,883

Longreach 61 23,570 24,177

Mareeba 273 12,280 12,319

Roma 296 18,247 18,389

Sarina 156 5,910 6,473

Thursday Island 659 14,085 18,034

Total 4,512 166,644 175,684

Risk profile All Highest risk

option Medium risk

Option Lower risk

Option

1.3 Risks of not delivering the Project

The risks of not delivering this Project are that the service needs identified in Appendix 1 will not be met. The 12 prioritised sites will not be able to deliver the core services at a Level 3 draft v 3.0 CSCF as outlined in the Queensland Health hub and spoke paper.

This will negatively impact on the ability to deliver contemporary models of service delivery and care and affect health outcomes of rural and remote people. Consequently health service demand will not be met, as dysfunctional and aged infrastructure will not cater for capability and capacity needs, nor meet safety and legislative requirements. Difficulties with recruitment and retention of skilled workforce will increase and not be ameliorated, further exacerbating the ability to provide health services in rural and remote areas.

1.4 Procurement strategy

The results of the procurement assessment indicate that a traditional delivery method should be considered for Options 1 and 2 for all sites. For Option 3, Atherton, Biloela and Charters Towers Hospitals have the potential to be delivered as Public Private Partnerships (PPPs).

As options are further developed through the business case stage, it is recommended that a strong focus be applied to establishing how the specific option characteristics developed impact on the applicability of certain procurement models. This will enable the traditional models to be narrowed down to preferred model(s) for the purpose of comparative analysis.

1.5 Conclusion

Three options for each Hospital have been identified (Section 1.2) that will satisfy all, or part, of the service requirements. Preliminary financial and economic assessments of these options have generally indicated that for rural and remote sites:

Option 1 involves minimal construction work to support current health service arrangements only

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Option 2 involves the partial refurbishment and/or expansion of the facility to support current and projected service requirements. Option 2 will generally upgrade facilities to meet the requirements of draft CSCF v3.0.

Option 3 involves significant redevelopment to support current and projected service requirements. Option 3 will upgrade facilities to meet the requirements of draft CSCF v3.0 and provide safe, sustainable and more environmentally efficient services.

The following conclusions have been reached as part of the Preliminary Evaluation:

there is a clear identified health service need for the Project

the Project is a priority for Queensland Health and the Queensland Government as a whole

preliminary market sounding indicates strong interest across all options

the project is consistent with legislative requirement and cultural considerations

preliminary public interest assessment has been considered in the options analysis

there is a need to investigate, develop and refine the preferred option further through a detailed Business Case

Option 3 for Atherton, Biloela and Charters Towers Hospitals may have the potential to be delivered as PPPs and should this be supported for progression to a Business Case under the Project Assurance Framework (PAF) an assessment of the Value for Money (VfM) Framework will be completed.

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2 Case for action Rural and remote communities face distinct challenges of geography, decentralised populations, distance and equitable access to sustainable quality health services comparable with urban communities. The purpose of this Preliminary Evaluation is to provide an assessment of options for the delivery of health services in rural and remote areas through a hub and spoke model of service delivery.

To meet these challenges, in March 2010, Queensland Health endorsed a policy direction informing the future delivery of health services for rural and remote areas. This established that the provision of safe, high quality and sustainable health services in rural and remote Queensland will be delivered through a tiered hub and spoke (service partner) model. In effect, this model will develop a robust rural health system networked with hospitals and community services that provides the level and mix of core services required—providing equity of access based on patient need.

Queensland Health outlined this model in the policy paper A definition of a rural model of health service delivery: A hub and spoke (service partner) model. In this paper 19 hub sites were identified across Queensland with 14 of these sites classified as primary and five as secondary hub sites.

The hub and spoke model will enable delivery of health services across the healthcare continuum in rural and remote regions through an integrated service network of hospitals, community facilities and primary care arrangements. This will avoid unnecessary duplication of services in each location and will tailor specific service capability to address the needs of the local community. Consequently, this facilitates operational efficiencies and supports the long term sustainability of health care provision in these areas.

Primary hub services will support various spoke services and in some cases, support smaller secondary hub sites with service delivery and workforce assistance. Primary hubs will in turn be part of a larger service network including regional and metropolitan specialist services.

Secondary hubs will have similar services to primary hubs, but lower levels of activity. All hub sites will provide core services at a Level 3 draft CSCFv3.0. Core services to be provided at hub sites include surgical and procedural, maternity, emergency and general medical services. Spoke sites only provide services to their local populations and usually provide lower Level 1 and 2 draft CSCF v3.0 services.

Projected health service requirements at 12 prioritised rural health service sites and their associated catchments by 2021 will be provided within the hub and spoke model. Eleven of the 19 hub sites have been incorporated into this Project with an additional spoke site (Sarina) included as a result of a recent review of the hospital infrastructure. The methodology used to select the 12 sites is discussed in Section 3.1.

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The 12 prioritised rural sites are located across Queensland’s rural and remote areas (Figure 1) and include:

1. Atherton Hospital— Cairns and Hinterland Health Service District

2. Ayr Hospital— Townsville Health Service District

3. Biloela Hospital—Central Queensland Health Service District

4. Charleville Hospital— South West Health Service District

5. Charters Towers Hospital— Townsville Health Service District

6. Emerald Hospital—-Central Queensland Health Service District

7. Kingaroy Hospital— Darling Downs–West Moreton Health Service District

8. Longreach Hospital—Central West Health Service District

9. Mareeba Hospital—Cairns and Hinterland Health Service District

10. Roma Hospital—South West Health Service District

11. Sarina Hospital—Mackay Health Service District (spoke)

12. Thursday Island Hospital—Torres Strait–Northern Peninsula Health Service District.

Figure 1: Map of prioritised rural sites

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To comply with the Queensland Health policy direction endorsed in March 2010 and deliver appropriate care that is responsive to patient needs, there is a need to address the poor condition of rural assets and infrastructure. The poor quality of the infrastructure at these sites is limiting health service delivery and use of contemporary models of care. Contributing to the poor condition of the facilities is the age of the majority of buildings, with many that are 60 years or older resulting in multiple infrastructure issues. The poor condition and age of the buildings is impacting on the delivery of health services in a variety of ways, including:

inefficient and outdated layouts preventing the implementation of efficient contemporary models of service delivery

workplace health and safety risks, due to lack of space and inadequate safety measures, for example infection control and fire precautions

non-compliance with current legislation, for example disability requirements

non-compliance with current building codes, accreditation and safety standards

poor alignment with modern healthcare provision, for example outdated operating theatres, medical imaging and procedural rooms

staff recruitment and retention issues compounded by poor quality employee housing accommodation, resulting in difficulties in staffing current facilities.

The primary case for action is to improve the functional clinical spaces to better enable the provision of the core services of surgical and procedural, maternity, emergency and general medical (refer to Table 2), and employee housing accommodation. While the focus for these rural hubs is to provide improved functional clinical spaces to manage core services, some sites will also require an increase in overnight bed numbers and or an increase in bed alternatives to better provide core services to their communities.

Failure to invest in the provision of a hub and spoke model of service delivery and the infrastructure to support the model will impact the ability of rural and remote populations to access safe and sustainable services close to where they live. It will also impact on Queensland’s ability to address health inequities and access to hospitals in remote areas, as identified in the Commonwealth Government’s National Health and Hospital Network Agreement 2010.

2.1 Project drivers

The need for this Project is driven by the following factors:

Access to services: the dispersed populations in rural and remote areas of Queensland often have difficulties accessing health services especially near to where they live

Current health inequities: in 2003, the health adjusted life expectancy gap between people who live in remote and very remote parts of Queensland and those who live in major cities was 5.6 years (Begg et al. 2003). People who live in regional and remote areas of Queensland also have higher rates of some health risk behaviours than those who live in cities—specifically, smoking, physical inactivity and alcohol-related conditions (Begg et al. 2003)

Provision of core Level 3 draft CSCF v3.0 services: to better meet the needs of their communities rural hubs should be providing core services for surgical and procedural, maternity, emergency and general medical services at a Level 3 draft CSCF v3.0

An ageing population: one of the key emerging health issues is the ageing population —particularly evident in the Atherton and Kingaroy Hospitals catchments—which will increase demand for health services

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Ageing infrastructure: the majority of buildings at hub sites are of a significant age and the poor asset conditions are impacting on the functionality, safety and sustainability of health service provision

Development of a tiered rural hub and spoke model: rural hubs will be supporting spoke services to provide health services within a health service network linked to regional and metropolitan specialist services

Contemporary models of service: local health service needs should be met through contemporary models of service delivery but current infrastructure inhibits the introduction of these models

Shortage of clinical workforce: there is a continual inability in rural and remote areas to recruit and retain appropriately skilled workforce, which impacts on the ability to deliver core health services at Level 3 draft CSCF v3.0. Adequacy of employee housing accommodation and clinical workspaces are major considerations for staff recruitment and retention

Availability of rural general practitioners: the decreased availability of rural general practitioners impacts on the demand for Queensland Health services.

2.2 Service objectives

To achieve the desired outcome the specific objectives for the Project include:

Capacity: Ensure the Hospitals can sustainably deliver the projected service capacity requirements from now to 2021 by providing a hub and spoke model of service delivery, growing clinical and non-clinical support services and improving functionality of clinical treatment spaces.

Capability: Meet the standard set of minimum capability criteria for the following core services at a Level 3 draft CSCF v3.0 by 2021:

surgical and procedural

maternity

emergency

general medical

additional services required to support the four core services including information, communication and technology systems, anaesthetics, neonatal, rehabilitation, medical imaging, pathology and pharmacy services.

Equity of access: Increase equity of access to health care services for residents of the catchment by increasing the capacity and capability of the services and facilities.

Quality: Attract, support and retain sufficient well-trained, committed and motivated staff to appropriately staff the Hospitals.

Safety: Use evidence-based service models and facility designs that comply with applicable legislation and create an environment that enhances patient safety and outcomes, staff wellbeing and clinical excellence.

Sustainability: Ensure continuity of service provision to 2021 in a manner that provides flexibility to address changes in service mix, supports future proofing of facilities and promotes environmentally sustainable outcomes.

Efficiency: Compliment existing and planned services across the health continuum in Queensland to deliver coordinated and cost effective health care services.

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Affordability: Provide a cost effective and efficient service model to achieve value for money in capital and recurrent costs to support service delivery and model of care objectives.

2.3 Service need

To identify service need, a Service Profile for each of the 12 rural sites was developed and endorsed as a component of the Preliminary Evaluation by the Integrated Policy Planning Executive Committee. The key service needs and common statewide issues identified in these Service Profiles relate to the following:

Surgical and procedural services provided at rural hubs are usually provided as same day services to meet a recognised need in the community. Although these visits are arranged to meet patient needs, they are dependent on the availability of visiting specialists, travel options and alignment with specialist schedules of the larger hospitals. The frequency of surgical days and volume of surgical and procedural activity varies at each hub site across the State

Women and their families who live in rural Queensland often need to travel long distances to access maternity services. Ideally antenatal, birthing and postnatal care should be provided as close to home as possible. Each hub will provide core maternity, neonatal and anaesthetic services at a Level 3 draft CSCF v3.0. The hub service will support spoke services to provide antenatal and postnatal care thus antenatal and postnatal care only will be provided at Sarina as it is a spoke service

Emergency Departments at rural hubs currently provide a Level 3 draft CSCF v3.0 service which means they are able to manage emergency care until transfer to a higher-level hospital when required. They have no access to an Intensive Care Unit, although the service has access to monitored beds. At most of the hub sites, Emergency Departments are in varying states of functionality, which impacts on service provision

At most rural hospitals Emergency Departments routinely provide a broad range of general medical and visiting specialist outpatient services including general practice clinics, nurse practitioner clinics, community health clinics and also visiting specialist clinics on designated days. As a consequence, it becomes a challenge to provide adequate consultation space on a regular basis for these primary medical services, particularly when visiting specialists are present.

These service needs and current issues are described in more detail in Appendix 1.

2.4 Current service capacity

Currently, rural hubs provide a range of services and support to spokes for acute and community services. Hub facilities provide services at a Level 3 draft CSCF v3.0, with the ability to support some higher-level services when medical outreach services are required. While larger rural communities are generally able to support local hospitals and specialised services, increasing remoteness and diminishing population size and density impact on the sustainability and capacity of services.

The capacity and ability to sustain health services, as well as the requirement for employee housing accommodation, differs across each of the 12 sites. To identify specific current service capacity at each site, a Service Profile was completed for each of the 12 rural sites and endorsed as a component of the Preliminary Evaluation by the Integrated Policy and Planning Executive Committee.

Within each Profile existing services were mapped against the Level 3 draft CSCF v3.0 requirements. While all 12 rural sites provide varying levels of surgical and procedural,

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maternity, emergency and general medical services, gaps have been identified in the provision of core services and other services provided at each site. Generally infrastructure at rural hospitals is in poor condition with poor layout of clinical spaces or absence of clinical areas required to provide core services. Table 2 provides an outline of the core services provided as well as the common capacity and infrastructure issues experienced across the 12 sites.

Further detail on infrastructure requirements is outlined in the Preliminary Infrastructure Planning Study (the Infrastructure Study) for each site.

Table 2: Core services and capacity and capability issues

Rural Hospital Core services provided

Capacity and capability issues

Atherton Hospital

ED, Maternity, OPD, surgery

the significant age of facilities and associated extremely poor condition impacts on the ability to deliver services

the facilities cannot meet current and future service capacity and or capability due to poor layout of clinical spaces and poor building condition

Ayr Hospital OPD, day surgery facilities are structurally sound and well maintained operational inefficiencies due to dysfunctional layout and

lack of space, as well as risks relating to the overcrowded workspace, lack of isolation rooms and inadequate security systems

Biloela Hospital

ED, Maternity, OPD surgery

the significant age of facilities and associated very poor condition impacts on the ability to deliver services

there is dysfunctional layout of clinical spaces facility cannot meet service capacity and or capability as

there is currently no ED or OPD

Charleville Hospital



the facilities require some structural upgrades and buildings are currently sited in a location prone to flooding

the ward is used as the ED in the evenings, night and weekends and there is insufficient capacity for OPD

Theatres do not have adequate clean and dirty areas

Charters Towers Hospital


the significant age of many of the buildings impacts on functionality creating problems for service delivery

the maternity area (currently located upstairs) has significant safety and infrastructure risks

ED functionality is limited, as it is separate from the main building, therefore the ward has to function as an ED after hours for security reasons, which creates problems

there is inadequate recovery spaces and day theatre areas

there is no compliant access for persons with a disability

Emerald Hospital

ED, OPD, Maternity and surgery

the facility cannot meet capacity requirements. The ED is currently at capacity and there is no OPD

there is inadequate spaces for day surgery and recovery spaces

while the building condition ranges from fair to very good (a new wing was built in 2000), functional inefficiencies exist (theatres are located upstairs, maternity is dysfunctional for workforce and service provision)

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Rural Hospital Core services provided

Capacity and capability issues

Kingaroy Hospital


the condition of infrastructure is poor there are particular issues around functionality and lifts maternity facilities have safety issues as delivery suites

are located away from the ward and staff area and are on another floor with a dysfunctional lift

the ED has an inefficient layout and is at capacity as there are limited outpatient service facilities

facilities cannot meet service capacity and or capability

Longreach Hospital



the facilities require some structural upgrades and improved sufficient surgical areas to provide day surgical services

Mareeba Hospital

ED and OPD ED capacity is insufficient to meet emergency and outpatient services requirements. There is no outpatient services area

there is no central observation area for staff to ensure safe care of acutely unwell patients. The ambulance entry is far from emergency and poses safety issues for staff and patients

Roma Hospital ED, OPD, Maternity and surgery

buildings are in a poor condition and there is only one lift to the third flood where theatres are located

safety concerns in ED as it cannot meet capacity or capability requirements. The layout is dysfunctional and spaces small and difficult to manoeuvre trolleys and equipment

theatres and Maternity also have safety issues as the recovery areas are on a separate floor and building to theatres. The maternity ward is unsafe as corridor and room size make manoeuvrability of equipment difficult

Sarina Hospital

ED, ward beds existing facilities are in extremely poor condition with structural issues

the rehabilitation capacity is limited

Thursday Island Hospital

ED,OPD buildings are in very poor condition, with severe corrosion associated with the marine environment

there are air conditioning and isolation/infection control risks

Cultural affiliations impact on the operational functionality the ED and OPD are at capacity

ED: Emergency Department OPD: Outpatients Department

2.5 Service direction

In March 2010, the Integrated Policy and Planning Executive Committee endorsed that rural hub facilities should provide a set of core services including surgical and procedural, maternity, emergency and general medical services underpinned by the implementation of a hub and spoke model of service delivery. These services would be provided at a Level 3 draft CSCF v3.0. This model of service delivery aims to support safe and sustainable rural health services in Queensland and provide services close to where people live.

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2.6 Future service requirements

In order to provide for future service requirements issues that inhibit the provision of health services in accordance with the hub and spoke model need to be addressed. This includes the ability to deliver the core services of surgical and procedural, maternity, emergency and general medical services at a Level 3 draft CSCF v3.0, and as such the amelioration of capacity issues.

Upgrading existing facilities to address current limitations, deliver the projected service requirements, and ensure there is appropriate infrastructure in place are all vital steps to implement the rural hub and spoke model to meet the service needs of the community. Based on the Service Profiles prepared, the current service capacity and capability and projected service requirements to deliver the hub and spoke model to 2021/22 at each Hospital within the Project are outlined in Table 3.

Table 3: Current service capacity and projected future service requirements to 2021/22

Ath

erto

n

Ayr

Bilo

ela

Ch

arle

ville

Ch

arte

rs

To

wer

s

Em

eral

d

Kin

gar

oy

Lo

ng

reac

h

Mar

eeb

a

Ro

ma

Sar

ina

Th

urs

day

Is

lan

d

Overnight beds current 57 28 25 24 25 36 41 31 44 37 16 36

future 65 30 16 15 21 24 58 11 45 18 21 25

Same day current 0 0 0 0 0 0 0 0 0 0 0 0

future 8 4 2 10 2 7 4 15 4 7 4 1

Bed alternatives

current 20 4 0 6 7 5 6 8 0 13 0 0

future 18 4 0 8 7 10 6 8 0 17 0 12

Emergency Department

current 10 9 6 1 4 9 7 5 8 6 5 0

future 16 6 5 8 10 24 16 6 18 15 7 7

Multipurpose consultation

rooms

current 0 4 0 5 0 1 0 0 0 0 0 2

future 14 11 8 4 7 11 10 5 9 10 2 7

To provide the required services it is also imperative that sustainable workforce recruitment is managed. Workforce recruitment in rural and remote areas is a continual challenge, with the retention and recruitment of rural general practitioners a particular issue. The lack of access to community general practitioners has led to rural hospitals delivering increased levels of primary medical health care. This shift in demand needs to be addressed to ensure the future sustainability of service provision, and allow Queensland Health to meet its commitment to ensuring safe and equitable health care for Queenslanders in rural and remote areas.

To achieve this at each hub site, investment will ensure that every facility:

meets minimum clinical staffing requirements

applies appropriate clinical guidelines and governance reflecting accepted standards of care

has appropriate infrastructure, equipment and clinical support services available

establishes referral protocols.

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Future service requirements for the rural hub sites are explored in more detail in the Health Service Profiles.

2.7 Strategic alignment

2.7.1 Strategic importance

This Project is crucial in meeting the Queensland Government’s commitment to equitable health service provision in rural and remote areas. The 12 sites that comprise the Project have been prioritised by condition assessments and information contained within each individual district’s Five Year Asset Strategy 2010–2015. These facilities have been identified as urgently requiring investment in order to deliver against service need.

Figure 2 shows the various policies and priorities that are currently in place on a Commonwealth, State and Local Government level, that the Project is aligned with.

Figure 2: Alignment with Strategic Objectives

National Policy and Direction

National Healthcare AgreementNational Health and Hospital Reform

Queensland Government Health Priorities

Making Queenslander's Australia's healthiest people: Advancing Health ActionBlueprint for the Bush

Toward Q2: Tomorrows QueenslandQueensland Statewide Health Services Plan 2007-12

Making tracks toward closing the gap in health outcomes for indigenous Queenslanders by 2033

Queensland Health Priorities

Queensland Health Strategic Plan 2007-2012Queensland Health Services Plan 2011-2026

A definition of a rural model of health service delivery: A hub and spoke (service partner) model

2.7.2 Alignment with specific strategic initiatives

This Project’s objectives are aligned with Commonwealth, State, Queensland Health and Local Government policies and strategies as shown in Appendix 2. Further details on how the Project deliverables align with strategic initiatives and plans cited are included in Table 4 below.

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Table 4: Alignment with specific strategic initiatives

Strategic initiatives Strategic alignment

Commonwealth: National Healthcare Agreement increase technical efficiency of public hospital

services improve safety and quality of care improve access to sub acute care National Health and Hospital Reform improve the quality of services and increase

transparency provide integrated and responsive services–delivered

locally ensure sufficient workforce available improve access to elective surgery improve timely treatment in Emergency Departments

This Project will: ensure the Hospitals are better equipped to

sustainably deliver the projected service capacity requirements at the appropriate capability level (Level 3 draft CSCF v3.0)

create a safe environment for the delivery of health services

provide access to sub-acute care health services for rural and remote populations

deliver an integrated solution through a hub and spoke service model to balance equity in health care access with affordability

provide functional surgical areas in rural hospitals where appropriate levels of surgery can be managed

provide functional emergency areas in rural hospitals where safe emergency care can be delivered

Queensland Government: Making Queenslander’s Australia’s healthiest people: Advancing Health Action close the gap in health outcomes for Indigenous and

rural and remote Queenslanders give mothers and babies the best start Blue Print for the Bush Strengthen the planning, coordination and delivery of services to rural and regional Queenslanders: support the provision of the best possible treatment

for rural patients within their own community strengthen rural health services and facilities attract, retain and support skilled health professionals

for rural health services Toward Q2 build and rebuild hospitals throughout the State expand the range of health services available in the

home, workplace or community, so that public hospitals can focus on those in most need

Queensland Statewide Health Services Plan 2007–2012 improve access to safe and sustainable health

services improve the safety of health services increase capacity in services that manage demand in

the acute care sector improve efficiency of service delivery distribute health care resources efficiently and

effectively develop and coordinate support structures to attract

and retain the health workforce ensure infrastructure and assets support service

delivery reforms and contribute to improved health

This Project will:

enable the Hospitals to meet the catchment health service needs

provide improved access to a range of health services close to where people live

provide a working environment that attracts, supports and retains staff

improve functionality of, and access to, maternity services close to where families live through models of service/care relevant to the community

ensure improved functionality of Hospital environments including core service areas of surgical and procedural, maternity, emergency and general medical services

create an environment with improved ability to provide sustainable health services

provide for regional accessibility of health services close to where people live

improve the condition of current Hospitals—most of which are designated as hubs

improve the ability to provide surgical and procedural, maternity, emergency and general medical services

provide infrastructure where health services can be provided through contemporary models of care including models that function across the continuum of health and include the enhancement of cultural appropriateness

improve safety of health services with better functionality of treatment spaces and improved working conditions and accommodation to attract appropriately skilled staff

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Strategic initiatives Strategic alignment outcomes

Making tracks toward closing the gap in health outcomes for Indigenous Queenslanders by 2033 effective health services

improve access to and outcomes from mainstream health services for Aboriginal and Torres Strait Islanders

Queensland Health: Queensland Health Strategic Plan 2007–12 strategic priorities: Improve access to safe and

sustainable health services improve the safety of health services under the

CSCF reduce health service inequities

This Project will: provide core health services at a Level 3 draft

CSCF v3.0 improve access to health services through

improved models of service delivery such as the hub and spoke model of service delivery and including service networks

2.8 Priority for government

The Project will help deliver on government’s stated objectives to strengthen the delivery of health services to rural and remote Queenslanders by:

providing improved access to a range of core health services—surgical and procedural, maternity, emergency and general medical services—close to where people live

improving access to safe and sustainable health services

better meeting people’s health needs across the continuum

closing the gap on health outcomes for Aboriginal and Torres Strait Islander peoples.

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3 Project scope

3.1 Background

3.1.1 Planning to date

In the process of planning for this Preliminary Evaluation the following documents have been prepared:

A definition of a rural model of health service delivery: A hub and spoke (service partner) model, to inform the delivery of health services for rural and remote areas

Service Profiles for 12 rural hospital sites to identify projected service requirements to 2021/22.

Infrastructure Studies for 12 rural Hospital sites to assess the sites and built infrastructure and develop future infrastructure options to meet the projected service requirements.

An initial desktop exercise completed in February 2010 assessed activity at all rural health facilities within Queensland. Using Emergency Department data as an indicator of health service activity, facilities were collated into small, medium and large facilities and then adjusted for the provision of surgical and maternity services. These were categorised into facility groups differentiating hub, type of hub and spoke sites. Hub sites were required to provide surgical and procedural, maternity, emergency and general medical services to a catchment greater than the primary catchment where the hospital was located.

Once these had been identified all hub sites were included in an assessment process to establish which sites were priorities to be included in the Project. There was also a time limitation restricting the number of sites that could be assessed. The methodology used to prioritise the 12 sites was based primarily on the following two criteria:

1. the hospital meets the requirements of a hub (primary and secondary)

2. the current condition of infrastructure based on condition assessments undertaken and each individual district’s Five Year Asset Strategy 2010–2015.

In relation to the second criteria, sites were classified into four groups according to whether the condition rating was:

Poor (Group 1)

Fair (Group 2)

Good (Group 3)

Very good (Group 4).

All hubs classified in Group 1 and 2 were selected, apart from those where:

there had been a recent major refurbishment or a new hospital had been built

there were already a number of sites from the same health service district prioritised

time limitations for infrastructure planning limited the number of sites to be included.

In addition, a number of additional sites were selected on exception.

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3.1.2 Decisions to date

The planning decisions shown in Table 5 impact upon, have a bearing on, or are in some way dependent on this Project.

Table 5: List of key planning decisions

Steering Committee Decision Date

Integrated Policy and Planning Executive Committee

Endorsement of project plan 15 February 2010


Endorsed PPAS paper, A definition of a rural model of health service delivery: A hub and spoke (service partner) model

March 2010


Endorsed Service profiles for all 12 rural and remote projects

June–July 2010

Policy Planning and Asset Services

Endorsed the proposed options for further evaluation in the Preliminary Evaluation. This included generic options for each site

August 2010

Health Planning and Infrastructure Division

The Preliminary Infrastructure Planning Studies (Infrastructure Studies) for the 12 rural and remote projects endorsed for inclusion within the Preliminary Evaluation

August 2010

3.1.3 Interrelated projects

The projects and other initiatives shown in Table 6 have a bearing, or are in some way dependent on this Project.

Table 6: List of interrelated projects

Related Project/Initiative Nature of relationship

Rural model of health service delivery: A hub and spoke (service partner) model

Complementary

Draft CSCF v3.0 (to be released December 2010) Complementary

Queensland Health Plan for Mental Health 2007–2017

Complementary

Queensland Health and Hospitals Reform for Rural and Remote Hospitals

Complementary

Centre for Healthcare Related Infection Surveillance and Prevention (CHRISP) Rural and Remote Clinical Sterilising Department Renewal Project

Complementary

Development of Sustainable Surgical Services for Rural and Remote Health

Complementary

3.2 Scope inclusions and exclusions

A detailed list of inclusions and exclusions relating to health service planning and service enabler requirements is included in Section 5 as well as in the following documents:

Service Profiles

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Infrastructure Studies

ICT Initial Solution Assessment

Financial Analysis Costing Assumptions (Appendix 3).

A high level summary of inclusions and exclusions is detailed below.

3.2.1 Included

The scope of works for the Project includes:

expansion of services to meet projected capability and capacity requirements

upgrade of health services and facilities to comply with draft CSCF v3.0

refurbishment, redevelopment or expansion of facilities as required (varies across options) including maximised use of current infrastructure and planned capital commitments through refurbishment, redevelopment or expansion of facilities as required to meet projected service requirements to 2021/22

consideration of design in compliance with the Building Code of Australia and Disability Discrimination Act 1992

upgrade of ICT capacity

allowance for furniture, fittings and equipment, predominately for Options 2 and 3

projected workforce requirements based on Level 3 draft CSCF v3.0

upgrade of car parking facilities as required

upgrade of employee housing accommodation/housing as required for Options 2 and 3

upgrade of patient accommodation/housing as required for Longreach Hospital (Options 2 and 3)

demolition and site works as required

roads and pedestrian access infrastructure within the site boundary

identification of issues related to the recruitment and retention of staff to deliver the services including provision of housing accommodation, age and functionality of workplace, use of contemporary models of care/service delivery, availability of education and training, supervisory relationships, support and up skilling/maintenance of skills.

3.2.2 Excluded

The scope of works for the Project excludes:

service planning for primary, community and oral health and associated service requirements to 2021/22

alternative models of care for the provision of sub- and non-acute services and interrelationships of the interface between acute, community and ambulatory care

any impacts that the National Health and Hospital Reform (Appendix 5) will have on the Project

the impact of clinical changes at the 11 hubs and one spoke site on their respective spoke or hub partners

infrastructure upgrades to any of the identified hub and spoke facilities outside of these 12 sites

any currently budgeted/planned works at the sites

any headworks or external utility service or road upgrades

traffic and transport studies relating to access and egress to the site

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costs for health technology equipment

consideration of broader community and stakeholder interests

detailed examination of structural elements of all facilities

escalation costs

quantification of risk

staging/transition/decanting timelines

assessment of reducing energy consumption costs associated with operating facilities on site.

3.3 Constraints/limitations

The following constraints and limitations on the Project have been identified:

implications of the roll out of the National Health Reform Agenda (Appendix 5)

current review of the Queensland Health Services Plan 2007–2012

status of the draft CSCF v3.0

activity projections used to calculate the bed requirements including:

– no change to current service models or patient flows except where indicated, i.e. hub and spoke model remains the policy choice of Queensland Health

– no change to public-private service arrangements – no significant change to visiting surgical services

ongoing investigations into alternative models of care

detailed planning for acute and primary health care services at most sites

at the request of Queensland Treasury and Department of Premier and Cabinet, consultation was limited during the preliminary evaluation stage

two of the sites–Atherton and Mareeba–are closely linked from a service planning perspective. Should the Preliminary Evaluation proceed to Business Case for the Tablelands this will consider the requirements of both facilities.

3.4 Prerequisites

The following prerequisites exist for the Project to be delivered:

continuity with strategic policy objectives of Queensland Health, Commonwealth, State and Queensland Health strategic policy directions

capital to undertake current committed infrastructure works

changes resulting from the National Health Reform Agenda are compatible with the objectives of the Project

full implementation of the rural and remote hub and spoke service delivery model

agreement to allocate sufficient funding in health service district budgets to meet additional recurrent/operating costs where required.

3.5 Assumptions

The following assumptions have been made during the planning of this Project:

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the population growth or demand profile upon which the Service Profiles have been developed are accurate

the draft CSCF v3.0 will be endorsed with no changes

adequate workforce will be recruited and retained to support service needs

clinical and non-clinical services will be available to support service needs

a number of assumptions have been applied in undertaking the financial analysis. These are outlined in Appendix 3.

3.6 Stakeholder consultation

In light of the extensive consultation undertaken through previous planning processes, short time frames and risks associated with further raising stakeholder expectations, limited consultation has been undertaken in developing the Preliminary Evaluation.

Table 7 lists stakeholders that have been consulted during the preparation of the Preliminary Evaluation between April and October 2010.

Table 7: Stakeholder consultation

Stakeholder Nature of Consultation

Aboriginal and Torres Strait islander Health Branch

Cultural service provision and implications for Closing the Gap

Clinical and Statewide Services Input into the options analysis undertaken with regard to clinical support services

Clinical Workforce Planning and Development Branch

Input into the options analysis undertaken from a workforce perspective

Department of Infrastructure and Planning

Guidance in relation to the application of the PAF. Input into the methodology used to undertake selected components of the options analysis

Department of Public Works Procurement, risk and project management service for the development of the Infrastructure Studies. Input into the Preliminary Evaluation development including methodology used to undertake the options analysis, procurement assessment and business case costings.

Finance Branch including Models and Costing Team-Corporate Services Division

Input into the options analysis undertaken with regard to the financial analysis including revision of recurrent costings and assumptions

Health Service District representatives

Advice and direction of the scope, implementation and outcomes of the Project

Information Division Input into the options analysis undertaken from an ICT perspective. Provision of ICT cost estimates

Office of the Chief Nursing Officer Input into the options analysis undertaken from a nursing workforce perspective including tools used for nursing workforce numbers and presentation to Director of Nursing Working Group

Office of Rural and Remote Health Advice and direction of the scope, implementation and outcomes of the Project

Queensland Treasury Guidance and input into the methodology used to undertake selected components of the options analysis.

Rural Medical Workforce Group Input into the options analysis undertaken from a rural medical workforce perspective

Steering Committee Advice and direction of the scope, implementation and

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Stakeholder Nature of Consultation outcomes of the Project

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4 Options for meeting service requirement

4.1 Option evaluation criteria

In order to meet the service needs for the Project identified in Appendix 1 a range of options have been considered for each site. To enable these options to be assessed and compared, criteria for evaluating the options have been identified in Table 8. These criteria are aligned with the service objectives (Section 2.2).

Table 8: Criteria for evaluating options

Criteria Options evaluation criteria

Capacity Extent of the delivery of the required service capacity profile to 2021

Capability Extent of the delivery of the required service capability to 2021

Equity of access Contribution towards equity of access to health care services

Quality Ability to attract and retain sufficient skilled staff to the facility

Safety Compliance with mandated legislative requirements e.g. Disability Discrimination Act Compliance with building codes and other non-legislated requirements and contemporary service models

Sustainability Degree of flexibility, future proofing and environmental sustainability

Efficiency Contribution to coordinated cost-effective health services

Affordability Value for money

Risk Degree of risk

4.2 Identification of the range of options

Through internal workshops with Policy Planning and Asset Services, Health Service District representatives and consultant architects, a range of possible options were identified and examined for each site to address the specific service requirements.

In identifying and developing options, consideration was given to the following principles:

maximising reuse of existing infrastructure wherever possible

compliance with the current access code requirements including provisions of the Disability Discrimination Act

addressing fundamental workplace health and safety risks

cost effective delivery of services as detailed in the ‘hub and spoke paper’ and current Health Service Plans

allowance for and inclusion of environmentally sustainable design

consideration of requirements related to clinical functionality

provision for future proofing

value for money in capital and recurrent costs without compromising service provision.

For each site, a range of five possible options were identified as follows:

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Option 1: Status quo—minimum upgrade of the facility to enable the safe provision of current services.

Option 2: Refurbishment or expansion at existing site—some expansion or refurbishment of the existing site and facilities to help meet the Level 3 draft CSCF v3.0 service requirements.

Option 3: Significant redevelopment—significant redevelopment or complete re-build of facilities to completely meet all service requirements, codes and legislation, and evolving demands on the hospital.

Option 4: Do nothing—no action undertaken aside from continuing maintenance.

Option 5: Closure of the facility—cessation of services at the site and services to be provided by alternative facilities.

4.3 Assessment of potential feasibility of options

The range of options was then refined and filtered through discussions with independent advisors and Health Service District representatives to identify those options that:

were not technically feasible for the site

reduced safety or quality of health care services for rural and remote communities

reduced access to health care services for rural and remote communities

did not allow for continuity of existing health services at the site.

The outcomes of this refinement process is set out in Table 9 below, illustrating which options were eliminated and the rationale for their exclusion.

Table 9: Assessment of options

Option Potentially feasible

Comment

Option 1 Status quo Yes This option addresses the fundamental site risks for continuity of existing services

Option 2 Refurbishment Yes This option overcomes fundamental site risks and enables future service capacity and capability

Option 3 Significant redevelopment

Yes This option overcomes fundamental site risks and enables future service capacity and capability

Option 4 Do nothing No The ageing and deteriorating infrastructure reduces workplace safety and quality of care, making it an unfeasible option

Option 5 Closure No The site has been identified as a hub (or spoke for Sarina) site so should provide core services through the hub and spoke model Some sites are a significant distance from other regional facilities making closure unfeasible for service access and equity

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4.4 Description of options for further analysis

The options identified as potentially feasible formed the basis for the preparation of an Infrastructure Study for each site. This included development of a detailed definition of each option at each site and the preparation of concept plans and preliminary costings associated with each option. The basic elements of each option developed through the Infrastructure Studies are outlined below, and in more detail in Appendix 6.

4.4.1 Option 1: Status quo–minimum upgrade of the facility to enable the safe provision of current services

Option 1 involves minimum upgrade of the site and facility to enable the safe provision of current services. This option generally includes addressing major safety risks and non-compliance to relevant codes in order for the facility to continue providing services within a safe workplace environment.

4.4.2 Option 2: Refurbishment or expansion at existing site

Specific actions undertaken in Option 2 vary considerably across the 12 sites depending on individual facility conditions and requirements. However, this option generally provides for some expansion or refurbishment of the existing site and facilities to help meet the Level 3 draft CSCF v3.0 service requirements and other relevant guidelines and legislation. It also includes the provision of suitable employee housing accommodation for the facility.

4.4.3 Option 3: Significant redevelopment

Similar to Option 2, specific actions undertaken in Option 3 vary considerably across the 12 sites. However, this option generally provides for significant redevelopment or complete rebuild of facilities to meet all service requirements, codes and legislation, and evolving demands on the Hospital. As with Option 2, this option includes the provision of suitable employee housing accommodation for the facility.

These options have been assessed in detail in this Preliminary Evaluation against the options evaluation criteria set out in Section 4.1.

4.4.4 Excluded options

As identified in Table 9, the options identified as being unfeasible were:

do nothing

closure.

These options have been excluded from any further analysis.

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5 Options analysis Section 5 has been prepared with input and assistance from Deloitte who were engaged by Queensland Health to assist in the development of the Preliminary Evaluations. The analysis undertaken by Deloitte has relied on data and direction provided by Queensland Health. Data provided has not been audited or verified by Deloitte.

5.1 Risk analysis

5.1.1 Risk analysis approach The risk analysis has been developed in accordance with the requirements of the PAF Preliminary Evaluation Guidelines, and Queensland Health’s Integrated Risk Management Policy and supporting Implementation Standard 2008 Policy. This policy is consistent with the principles outlined in the Queensland Audit Office’s Better Practice Guide Risk Management, 2007 and the Whole-of-Government Risk Management Guidelines on Agency Risk, 2007. It is based on the Australian/New Zealand Standard AS/NZS 4360:2004, now International Standard AS/NZS ISO 31000 for Risk Management.

The purpose of the risk analysis at this stage is to identify and evaluate the key risks for the Project as a whole and for each option. This analysis is intended to inform decision makers and project managers of the risks to the Project throughout the life cycle and will be updated throughout the Project.

The PAF Preliminary Evaluation Guidelines identify four key activities for the risk analysis:

identification and documentation of risks

assessment of risks (qualitative and quantitative)

allocation of risks to parties best able to manage them

development of mitigation strategies.

This risk analysis has been prepared through a series of workshops with representatives from:

Queensland Health (including representatives from all the enabler groups, senior management and the Project team)

Department of Public Works

Department of Infrastructure and Planning

Queensland Treasury.

While the adapted approach represents a departure from the PAF Preliminary Evaluation Guidelines, it was agreed by the representatives of these agencies that given the inherent challenges of valuing health service delivery risks at such an early stage in the Project, quantitative analysis would not result in reliable and desirable information for decision making. A quantitative risk assessment will be undertaken as part of the business case stage, as additional information becomes available to support a sufficiently robust quantification.

During the course of the workshops and in conjunction with review of supporting Project documentation including Infrastructure Studies, a number of risks were identified. These comprised both general risks applicable to the Project as well as those specific to particular Project options. Each risk and its consequence were documented in the Project Risk Register (Appendix Table 7: Risk Register).

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Once identified, each risk was assessed for each Project option in terms of its consequence and likelihood of occurrence to arrive at a risk score and rating, in accordance with the Queensland Health Integrated Management Analysis Matrix, which is set out in Table 10 below.

Table 10: Queensland Health Integrated Management Analysis Matrix

Mitigation strategies appropriate to the severity of the risk were developed and responsibility allocated to appropriate Queensland Health business units.

In a final workshop, the key risks rated as ‘High’, ‘Very High’ or ‘Extreme’ on an unmitigated basis, were discussed and agreed and are set out in Sections 5.1.2 and 5.1.3 below.

5.1.2 Project risk context and potential risk management strategies Table 11 identifies the key Project risks rated as ‘High’, ‘Very High’ or ‘Extreme’ on an unmitigated basis, that are common to all options and most sites. These risks should be considered as whole-of-Project risks, representing risks requiring mitigation.

The Risk Register (Appendix Table 7) provides a full listing of all Project risks, including those that are ranked as ‘Medium’ or ‘Low’.

Table 11: Whole-of-Project risks

Risk No. 1

Category Whole-of-Project risks Option 1 Option 2 Option 3

1 Asset ownership

Whole-of-life costs funding shortfall

Very High Very High Very High

3

Contractor/ sponsor/ financial

Early stage planning underestimates capital and recurrent needs

High High High

5 Only certain sites within the Project receive funding leaving key service risks unaddressed

High High High

11

Design, construction & commission

Noise, dust and disruption from construction


13 Early design risks High High High

14 Limited site access and egress during construction

High High High

15 Force majeure Flooding risk at certain sites High High High

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Risk No. 1

Category Whole-of-Project risks Option 1 Option 2 Option 3

(Charleville, Thursday Island)

17 Industrial Relations/ Workforce

Insufficient ICT and Telehealth staff for design and implementation


28 Operating/ Performance

Models of care change during the service planning period

High High High

37

Site & planning

Capacity/capability changes across the health care continuum impact facility service demand


40 Technology

Insufficient flexibility/future proofing in ICT and infrastructure


42 Timing

State Government and Commonwealth funding priorities change


1 Risk No. refers to the reference in the Project Risk Register, attached as Appendix Table 7.

The works proposed for the 12 Project sites are considerable under each of the options, including Option 1. Consequently, whole-of-Project risks include a range of design, construction and planning risks typical for early stage projects, including risk around the potential underestimation of capital and recurrent funding requirements. These can be largely mitigated through normal detailed design and project management processes.

Charleville and Thursday Island Hospitals are subject to flooding risk. This can be mitigated to some degree through facility design under a redevelopment option but there is limited scope for this under Options 1 and 2.

Technology plays an increasingly important role in health service delivery in rural and remote Queensland. A challenge for all of the sites is the availability of sufficient telehealth and ICT staff to undertake the design and development work. This can be mitigated through early planning and recruitment processes.

Several of the Project risks relate to the risk that service delivery at each site fails to meet demand. This may be due to insufficient primary health care capacity which may place increased demands on Hospital facilities. Risk also exists around future changes to the models of care, which could have a major impact on demand for, and supply of, services at all of these sites, for example as a result of surgical advances reducing the duration of stay for certain orthopaedic procedures. In addition, the increasing and evolving use of technology and automation to deliver services, which impacts on infrastructure layout and design, is a key risk requiring further exploration during the detailed Business Case. For current hospital builds, various technology advances are being considered by Queensland Health for example patient scheduling, automated food services and electronic record keeping. As technology continues to advance, these and other services will need to be considered and their applicability to the Project determined. These future proofing risks can best be assessed through senior executive consultations during the detailed planning phase.

In addition, historically much of Queensland Health’s infrastructure planning has not fully adopted a whole-of-life costs approach, including maintenance, staffing and refurbishment. These risks can be assessed by additional service planning and further detailed whole-of-life

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cost analysis during the business case stage as more information on the National Health and Hospitals Reform and on the site specifications become available. However, a reasonable degree of residual risk is likely to remain.

5.1.3 Risk analysis of options and potential risk management strategies Table 11 identifies the key option risks, rated as ‘High’, ‘Very High’ or ‘Extreme’ on an unmitigated basis. These risks will be considered as option-specific risks and enable comparison between Project options to define the relative risk profile of each option.

In most instances the risks for a particular option are similar across the 12 rural and remote sites and are therefore shown in a single table. Identification of where risks diverge across sites is provided in the full risk register in Appendix Table 7, which also includes risks that are ranked as ‘Medium’ or ‘Low’.

Table 12: Option-specific risks

Risk No. 1

Category Option Specific Risks Option 1 Option 2 Option 3

2 Contractor/ sponsor/ financial

Lack of growth in service demand deters funding support for capability enhancement

N/A Very High Very High

6

Design, construction & commissioning

Fire risks Very High Medium Medium

7 Substantial investment in buildings at or near end of life

Very High Medium Medium

9 Inability to meet disability & other legislative requirements

High Medium Medium

12 Design risks: early design based on square metre assessment

High Very High Very High

43 Operational inefficiencies arising from unsustainable design and development

Very High High Medium

16

Industrial relations/ Workforce

Workforce attraction & retention difficulties

Extreme Very High Very High

19 Industrial relations frameworks limit reform (all staff)

Medium Very High Very High

34 Adequacy of transition funding for workforce upsizing/up skilling

N/A High High

44 Industrial relations risks from maintenance outsourcing under certain procurement models

Medium High Very High

20 Market/ demand

Projected capacity or mix requirements cannot be met by facilities

Extreme High High

22 Community expectations around capacity and capability are not met


23 Facilities and staff cannot meet specified capability

Extreme Very High High

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Risk No. 1

Category Option Specific Risks Option 1 Option 2 Option 3

requirements

24

Operating/ Performance

Poor facility design, interface and adaptation for workforce


25 Excessive running costs (inc. maintenance and workforce)

High Medium Medium

26 Decanting and service continuity risk

Very High Very High High

30

Site and planning

Facilities are in very poor condition

High Medium N/A

35 Community interest/heritage issues

High High Very High

39 Coordination complexities arising from multiple projects

High Very High Very High

41 Technology Poor take up of telehealth Very High High Medium

45 Timing

Extensive period of disruption to patient care and staff from staging

High Very High High

1 Risk No. refers to the reference in the Project risk register, attached as Appendix Table 7.

‘Extreme’ risks exist for Option 1 only. These ‘Extreme’ risks are almost certain to occur and as defined in the Queensland Health Integrated Management Analysis Matrix: Consequence Table, have significant consequences which can include:

loss of life and or injury to patients or staff

sustained adverse publicity

litigation claims greater than $1 million for injury

cessation of some services or programs due to insufficient staffing, capacity or capability.

The ‘Extreme’ risks impacting the Project are described in more detail below.

Workforce attraction and retention difficulties (Risk Reference No. 16)

Option 1 for the 12 rural and remote sites represents a particularly high workforce attraction and retention risk due to the current condition of many of the facilities, lack of appropriate employee housing accommodation and limited career development opportunities available at these sites. This option does not substantially improve staff working conditions or employee housing accommodation. These factors in combination with existing difficulties with recruitment and retention of clinical and non-clinical staff to non-metropolitan regions will have a severe effect on the Hospital’s capacity and capability. In worst case scenarios, failure to recruit and retain appropriately qualified staff may lead to the cessation of critical medical services and/or the potential for loss of life or significant litigation claims arising from deterioration in patient care. This risk is reduced slightly in Options 2 and 3 through the inclusion of employee housing accommodation and in recognition of the improvement in facility condition and staff career opportunities.

Whilst some strategies are already being implemented to address the current workforce challenges that exist across Queensland Health, additional mitigation in the form of further planned recruitment strategies and the use of workforce pools have been identified for the Project.

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Projected capacity or mix requirements cannot be met by facilities (Risk Reference No. 20)

Option 1 does not meet the functionality requirements to deliver Level 3 draft CSCF v3.0 services at most of the sites. Many of the old building layouts are not organised to support safe operation and are lacking in functional relationships between clinical areas and or adequate treatment spaces including in the Emergency and Outpatients Departments and maternity and surgical spaces. Without an improvement in functional layouts, facilities will be unable to address the capacity issues associated with these areas. In addition, Option 1 cannot meet required growth in overall capacity for three of the sites—Kingaroy, Mareeba and Sarina. Failure to meet existing and future growth requirements in particular services will lead to sub-optimal patient care. Furthermore, the rural and remote locations of these Hospitals leave patients with few viable alternatives for secondary care. This risk cannot be mitigated directly without the use of demand management strategies, with associated risks to patient safety.

Facilities and staff cannot meet specified capability requirements (Risk Reference No. 23)

Option 1 for all rural and remote sites fails to upgrade facilities to the required level to meet the draft CSCF v3.0 requirements and to provide suitably qualified and skilled staff to satisfy capability requirements for each of the districts. This is particularly an issue for surgical and procedural, maternity, emergency and general medical services. This risk cannot be effectively mitigated in Option 1, except by directing patients to alternative locations, which may require considerable travel.

Addressing all of these extreme risks in the short term relies heavily on the ability to shift demand for services to other nearby locations, many of which are also experiencing similar staffing and demand challenges.

There are also a considerable number of ‘Very High’ and ‘High’ rated risks for each option across each risk category. The risk profile of each option is described briefly below.

Option 1

Option 1: Status Quo comprises the most extreme risks, which as indicated above can only be mitigated by this option to a limited degree. This option fails to address the fundamental capability and capacity constraints to enable the hub and spoke model and addresses only to a very limited degree current condition and compliance risks at each site. It also involves a considerable investment in facilities without significantly improving patient care, staff outcomes or enhancing the facilities. Other associated risks include ongoing interface risks, stakeholder and community dissatisfaction and service continuity and decanting risks.

Option 2

Option 2: Significant refurbishment of many of the facilities at each site has a design and decanting risk profile consistent with brownfield projects but also includes particular risks around the level of investment in existing facilities to address service capability and mix without significant increase in volume of service delivery. Despite the inclusion of employee housing accommodation which slightly reduces the risk of staff recruitment and retention for both Options 2 and 3, the move to a Level 3 draft CSCF v3.0 capability for the hubs for both of these options also creates industrial relations risks around both reform and potentially maintenance outsourcing. Transition funding and upskilling is also an issue for both Options 2 and 3.

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Risks around service capacity and capability are significantly reduced under Option 2 as service delivery is enhanced. However, the trade off is in the staging and timing risks in continuing to operate the facilities during major construction.

Whilst these risks can all be mitigated to some degree by detailed planning, it is anticipated that a number of residual risks will remain significant.

Option 3

The risk profile under Option 3 improves considerably. Key risks remain around planning, design and construction including heritage and community-interest risks arising from redevelopment or replacement of a number of facilities. As with Option 2, industrial relations risks also remain a key focus area. However, many of these risks can be mitigated through detailed planning, design, project management and workforce management as part of the detailed business case stage.

5.1.4 Site specific risk summary There are also some site-specific risks associated with each option. Analysis suggests that whilst all of the sites have considerable risks, certain sites present particularly high risks in the following areas:

Asset Condition: Atherton, Biloela, Charleville, Longreach, Roma, Sarina, Thursday Island

Flooding: Charleville, Thursday Island

Service delivery: Atherton, Charters Towers, Kingaroy, Roma

Capacity: Atherton, Ayr, Emerald, Kingaroy, Longreach, Mareeba, Roma, Sarina.

Table 13 summarises the relative risk profile for each of the options at each site.

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Table 13: Relative option risk ranking by site

Site Site Specific Risks Option 1 Option 2 * Option 3 *

ATHERTON Relative option risk ranking Highest risk option Medium risk option Lower risk option

Cannot meet capacity, in particular ED Condition is extremely poor (significant age of facilities) Service planning closely linked to Mareeba Functional inefficiencies (theatres, ED, maternity, OPD) No separate functional OPD Insufficient space for Allied Health

Cannot meet service capacity (ED, maternity, OPD) Some components of buildings/facilities are structurally unsound Significant investment does not address fundamental issues

Funding justification Decanting disruption Ongoing maintenance issues with older buildings

Funding justification

AYR Relative option risk ranking Highest risk option Lower risk option Medium risk option

Capacity issues for theatres, Allied Health / Primary Health Condition is good and buildings structurally sound Functional inefficiencies (theatres, primary health/allied health) No separate functional OPD Insufficient space for Allied Health

Cannot meet service capability Cannot meet ED/OPD capacity

Funding justification Reduces functional risks Decanting disruption Does not address whole of life costs

High cost new build Requires helipad relocation Surplus vacant building remain – maintenance cost

BILOELA Relative option risk ranking Highest risk option Medium risk option Lower risk option

No separate functional ED Condition is very poor (significant age of facilities and asbestos) Functional inefficiencies (theatres, maternity, OPD)

Cannot meet service capability Reduced clinical functionality Major disruption from asbestos removal

Funding justification Asbestos removal/decanting risks Ongoing maintenance issues with older buildings

Funding justification

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CHARLEVILLE Relative option risk ranking Highest risk option Medium risk option Lower risk option

Capacity issues for theatre, ED Condition is very poor (significant age of facilities) Functional inefficiencies (theatres, ED, OPD) No separate functional OPD Wards are used for ED after hours Flooding risk which impacts on operation of hospital and evacuation

Cannot meet service capability Flooding risk remains Functional inefficiencies remains Major disruption from asbestos removal

Funding justification Flooding risk remains Functional inefficiencies remains Major disruption from asbestos removal Ongoing maintenance issues with older buildings

Funding justification Flooding issues is ameliorated Ongoing maintenance issues with original Hospital building (used for administration)

CHARTERS TOWERS

Relative option risk ranking Highest risk option Medium risk option Lower risk option

Cannot meet capacity, in particular ED, maternity, OPD Condition is good – well maintained (significant age of facilities) Functional inefficiencies (theatres, ED, maternity, OPD, dental) No separate functional OPD Wards are used for ED after hours Significant functional and patient safety issues with dental

Cannot meet service capability ED capacity issues remain Functional inefficiencies Ongoing deterioration of facilities

Funding justification Various building code compliance issues Functional inefficiencies including links to ED Ongoing maintenance issues with older buildingsDecanting risks

Community interest/heritage issues Funding justification Site availability constraints Construction impacts Transport connections

EMERALD Relative option risk ranking Highest risk option Medium risk option Lower risk option

Cannot meet capacity, in particular ED Extensive distance from any alternative facilities Condition is moderate (new wing built in 2000) Functional inefficiencies (theatres, ED, maternity, OPD) No separate functional OPD

Cannot meet ED capacity Functional inefficiencies remain Surgery and maternity capacity issues and dysfunction layouts remain

Funding justification Substantial disruption

Funding justification – Highest cost Substantial disruption

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Insufficient space for allied health

KINGAROY Relative option risk ranking Highest risk option Medium risk option Lower risk option

Condition is poor for most buildings Cannot meet capacity, in particular ED, maternity and overnight beds Functional inefficiencies (theatre, maternity, ED, OPD) Maternity facilities have safety issues as the facilities are split across two levels within the hospital

Cannot meet service capacity growth requirements or capability Excessive running costs not addressed Structurally unsound (Old Farr) building which is vacated

Funding justification Substantial disruption Ongoing maintenance issues with older buildings

Community interest (Administration building) Funding justification Construction timeframe, disruption and staging risks

LONGREACH Relative option risk ranking Highest risk option Medium risk option Lower risk option

Condition is very poor for most buildings (including asbestos) Functional inefficiencies (theatre, maternity, ED, OPD) Cannot meet surgical capability requirements due to staffing issues and functionality of theatre space

Cannot meet service capability Cannot meet ED capacity Significant investment in poor facilities Functional inefficiencies remain

Funding justification Staging/decanting risks Ongoing maintenance issues with older buildings

Funding justification Ongoing maintenance issues with original Hospital building (used for administration)

MAREEBA Relative option risk ranking Highest risk option Medium risk option Lower risk option

Condition is good – existing plant is over 30 years old Functional inefficiencies (ED, OPD including ambulance entrance) No separate functional OPD Service planning closely linked to Atherton

Cannot meet service capacity growth requirements or capability Functional inefficiencies remain

Funding justification Decanting/service disruption

Funding justification Community interest (with old nurses quarters) Decanting/service disruption

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ROMA Relative option risk ranking Highest risk option Medium risk option Lower risk option

Cannot meet capacity, in particular ED, OPD, maternity, theatres Extensive distance from any alternative facilities Condition is poor Functional inefficiencies (theatres, ED, maternity, OPD) No separate functional OPD Maternity significant inefficiencies and safety issues – routine and emergency access difficult Insufficient space for allied health

Cannot meet service capacity or capability Excessive running costs Functional inefficiencies remain

Funding justification Decanting/services disruption Does not fully address OPD requirements Ongoing maintenance issues with older buildings

Funding justification Decanting/services disruption Ongoing maintenance issues with older buildings

SARINA Relative option risk ranking Highest risk option Medium risk option Lower risk option

Cannot meet future capacity Some functional inefficiencies Condition is extremely poor Rehabilitation capacity limited Poor site access (ambulance)

Cannot meet future service capacity Emergency access delays remains Functional inefficiencies Asbestos and some structural issues Excessive running costs

Funding justification Emergency access delays remains Ongoing maintenance issues with older buildings

Funding justification Staged development/timing

THURSDAY ISLAND

Relative option risk ranking Highest risk option Medium risk option Lower risk option

Extensive distance from any alternative facilities Condition is very poor due to severe corrosion of current facilities associated with marine environment Functional inefficiencies (theatres, ED, OPD) Cultural affiliations impact on operational functionality Air conditioning and isolation/infection control risks

Severe building condition risks remain Flooding during king tides Functional inefficiencies remain

Flooding during king tides Funding justification Ongoing corrosion / building viability risks

Funding justification Decanting/services disruption

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Remote location increases costs and employee housing

ED-Emergency Department OPD-Out Patient Department * on a mitigated basis, the risk profile would be expected to reduce significantly and Option 2 and 3 could have similar risk profiles.

A residual risk assessment following mitigation activities specific to each site should be undertaken within the business case stage to assess remaining critical risks.

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5.2 Financial analysis

The purpose of this preliminary financial analysis is to consider the financial impact of each of the options identified. The analysis is undertaken from the point of view of the State Government as an investor in the Project.

5.2.1 Key costing assumptions Following discussions with Queensland Treasury, the key financial assumptions used in the development of the cost estimates are:

no escalation included

all cost estimates are in real 2010/11 dollars

no discount rate to be applied

all costs are exclusive of GST

recurrent cost estimates are based on the calculation of input costs, labour and non labour of clinical services at a Level 3 draft CSCF v3.0 for 11 hub Hospitals and a Level 2 for one spoke Hospital

incremental recurrent cost only is reported

no cashflow by year has been reported as the cost estimates and staging information has not been developed for this Project. This will need to be considered in the Business Case

whole-of-life cost assumes no growth in cost over time.

The following should be noted for the capital cost estimates developed by the quantity surveyors as part of the Infrastructure Study:

capital cost estimates were reviewed by Department of Public Works and confirmed as Category 2 cost estimates with a confidence level of ‘Low – Moderate’ (Capital Works Management Framework Policy Advice Note)

all capital costs are exclusive of GST and headworks

contingency allowances varied by site and architect. Contingencies ranged from five per cent to 10 per cent for construction and five per cent to 30 per cent for project contingency. All contingency cost estimates have been included in the capital cost infrastructure reported options

for each rural and remote site a locality factor has been used in the cost estimates based on Industry Standards.

Further details including assumptions are documented in Appendix 3.

5.2.2 Costing Options 1, 2 and 3 There are three options for the Project as outlined in Section 4.4. The costs for these options have been summarised in Table 14.

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Table 14: Summary of financial analysis for Options 1, 2 and 3

Rural and remote Option 1 ($’000s)

Option 2 ($’000s)

Option 3 ($’000s)

Capital cost—ICT 962 63,603 65,451

Capital cost—infrastructure 80,757 467,402 622,217

Capital cost – employee housing accommodation infrastructure

0 115,354 115,354

Capital Subtotal 81,719 *646,359 *803,022

Incremental recurrent/operating costs—clinical and support services costs (including ICT)

193 135,621 136,289

Recurrent/operating costs—facility maintenance and management costs

4,319 31,023 39,395

Recurrent Operating Total 4,512 166,644 175,684

*Capital costs sourced from the Infrastructure Studies and ICT Initial Solution Assessment.

* Option 2 and Option3 totals for employee accommodation added to Table 15 totals for Option 2 and Option 3 equal capital totals in Table 14

5.2.3 Key infrastructure components Table 15 outlines the total capital costs by facility excluding employee housing accommodation capital costs which are reported in Table 16. Option 1 addresses infrastructure amendments over and above standard maintenance programs, Option 2 is the refurbishment and expansion on site and Option 3 is a significant redevelopment. Detailed infrastructure information for each option is contained within the Infrastructure Studies.

Table 15: Rural and remote key infrastructure components estimated cost


Option 2 ($’000s)

Option 3 ($’000s)

Option 3 % variation to

Option 2

Atherton 25,696 94,817 96,668 1.95

Ayr 1,608 13,776 11,663 -15.34

Biloela 10,860 60,353 63,803 5.33

Charleville 2,654 61,730 68,270 10.59

Charters Towers 10,420 50,391 93,233 85.02

Emerald 990 60,434 68,169 12.80

Kingaroy 3,362 40,376 43,108 6.77

Longreach 1,107 67,198 75,813 12.82

Mareeba 5,084 16,019 16,741 4.51

Roma 5,506 27,864 30,516 9.52

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Option 2 ($’000s)

Option 3 ($’000s)

Option 3 % variation to

Option 2

Sarina 2,840 12,345 22,045 78.57

Thursday Island 11,592 25,702 97,668 280.00

Total 81,719 *531,005 *687,668 29.50


Table 16: Employee housing accommodation infrastructure estimated cost

Rural and remote Number of units

Option 1 ($’000s)

Option 2 ($’000s)

Option 3 ($’000s)

Atherton 48 0 11,000 11,000

Ayr 21 0 8,000 8,000

Biloela 20 0 4,385 4,385

Charleville 22 0 5,192 5,192

Charters Towers 21 0 8,000 8,000

Emerald 16 0 6,555 6,555

Kingaroy 0 0 0 0

Longreach 13 0 10,448 10,448

Mareeba 30 0 5,462 5,462

Roma 8 0 1,312 1,312

Sarina 0 0 0 0

Thursday Island 56 0 55,000 55,000

Total 255 0 *115,354 *115,354


Accommodation cost estimates are the same for both Option 2 and Option 3. Employee housing accommodation costs include both the provision of additional new housing and replacement of aged and inappropriate housing accommodation.

5.2.4 Facility maintenance and management costs Table 17 reports the incremental annual maintenance and building depreciation costs for the capital injection for each Option. Facility maintenance costs are calculated as 2.15 per cent of the capital cost for each hospital.

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Table 17: Annual maintenance costs for Options 1, 2 and 3


Option 2 ($’000s)

Option 3 ($’000s)

Atherton 1,363 5,191 5,296

Ayr 85 1,078 956

Biloela 543 3,127 3,323

Charleville 139 3,217 3,591


Emerald 52 3,141 3,582

Kingaroy 180 1,834 1,980

Longreach 61 3,748 4,254

Mareeba 273 960 999

Roma 296 1,288 1,431

Sarina 156 500 1,033


Total 4,319 31,023 39,395

As the Project is at preliminary infrastructure planning stage, whole-of-life costs have been calculated using industry benchmarks. The costs reported are calculated on the capital injection for each Option and may not contain the total site whole-of-life-costs. Whole-of-life costs include repairs and maintenance at 2.15 per cent of asset replacement value per annum and asset replacement value at 1 per cent of asset replacement value per annum for a 30 year period. Building lifecycle costs for the Project are shown in Table 18, and for each facility in Table 19.

Table 18: Building lifecycle costs over 30 years

All rural and remote sites Lifecycle costs

Option 1 ($’000s)

Option 2 ($’000s)

Option 3 ($’000s)

Maintenance 116,095 331,512 419,936

Asset Replacement Value 53,998 154,192 195,319

Total 170,093 485,704 615,254

Table 19: Building lifecycle costs over 30 years for each facility

Rural and remote site Lifecycle costs Option 1 ($’000s)

Option 2 ($’000s)

Option 3 ($’000s)

Atherton Maintenance 16,674 52,527 53,647


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Option 2 ($’000s)

Option 3 ($’000s)

Atherton Total 24,429 76,958 78,600

Ayr Maintenance 8,915 11,710 10,952


Ayr Total 13,061 17,156 16,046

Biloela Maintenance 7,776 33,624 35,920


Biloela Total 11,392 49,262 52,626

Charleville Maintenance 5,642 34,590 38,987


Charleville Total 8,266 50,678 57,120

Charters Towers Maintenance 8,673 29,843 52,199


Charters Towers Total 12,707 43,724 76,478

Emerald Maintenance 6,173 32,624 37,797


Emerald Total 9,045 47,798 55,377

Kingaroy Maintenance 8,508 19,568 21,134


Kingaroy Total 12,465 28,670 30,964

Longreach Maintenance 3,539 39,236 45,169


Longreach Total 5,185 57,486 66,178

Mareeba Maintenance 5,433 10,239 10,653


Mareeba Total 7,960 15,002 15,609

Roma Maintenance 26,049 13,745 15,264


Roma Total 38,164 20,138 22,364

Sarina Maintenance 2,501 5,870 12,126


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Option 2 ($’000s)

Option 3 ($’000s)

Sarina Total 3,665 8,600 17,766

Thursday Island Maintenance 16,214 47,936 86,087


Thursday Island Total 23,755 70,232 126,127

5.2.5 Clinical and support services costs Clinical and support service costs have been estimated on an input costing basis. That is a labour profile was developed based on the delivery of a Level 3 service according to the draft CSCF v3.0 in the absence of a more rigorous whole of Department tool. The workforce profile was entered into the Queensland Health Major Projects Costing Template which provided the estimated labour cost. The non labour component of cost was estimated based on the current labour and non-labour cost distribution for each hub and spoke. Only the incremental cost is shown in Table 20.

Table 20: Clinical and support services annual cost for Options 1, 2 and 3

Rural and Remote Hospitals Option 1 ($’000s)

Option 2 ($’000s)

Option 3 ($’000s)

Atherton 101 9,519 9,696

Ayr 6 6,290 6,286

Biloela 0 14,937 14,937

Charleville 0 20,132 20,132


Emerald 0 14,032 14,032

Kingaroy 0 5,901 5,901

Longreach 0 19,822 19,924

Mareeba 0 11,320 11,320

Roma 0 16,958 16,958

Sarina 0 5,410 5,439


Total 193 135,621 136,289

5.3 Affordability

With limited detail available on the implications for the implementation of the National Health and Hospital Reforms, these have not been considered in the financial analysis. While funding

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sources are expected from both the Commonwealth and State Governments on a 60/40 basis respectively, the details on capital and recurrent funding are yet to be made clear (Appendix 6).

5.3.1 Capital expenditure affordability analysis Table 21 shows the total capital expenditure costs for each option.

Table 21: Total capital costs for Options 1, 2 and 3

Rural and remote Hospitals Option 1 ($’000s)

Option 2 ($’000s)

Option 3 ($’000s)

Atherton 25,696 105,817 107,668

Ayr 1,608 21,776 19,633

Biloela 10,860 64,738 68,188

Charleville 2,654 66,922 73,462

Charters Towers 10,420 58,391 101,233

Emerald 990 66,989 74,724

Kingaroy 3,362 40,376 43,108

Longreach 1,107 77,646 86,261

Mareeba 5,084 21,481 22,203

Roma 5,506 29,176 31,828

Sarina 2,840 12,345 22,045

Thursday Island 11,592 80,702 152,668

Total 81,719 646,359 803,022

5.3.2 Recurrent costs affordability analysis The annual recurrent costs are shown in Table 22. These reflect the incremental cost per year as a result of each option.

Table 22: Annual recurrent cost for Options 1, 2 and 3


Option 2 ($’000s)

Option 3 ($’000s)

Atherton 1,464 14,711 14,994

Ayr 91 7,367 7,242

Biloela 543 18,064 18,260

Charleville 139 23,349 23,724


Emerald 52 17,173 17,614

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Option 2 ($’000s)

Option 3 ($’000s)

Kingaroy 181 7,736 7,883

Longreach 61 23,570 24,177

Mareeba 273 12,280 12,319

Roma 296 18,247 18,389

Sarina 156 5,910 6,473


Total 4,512 166,644 175,684

5.3.3 Summary The financial analysis found that Option 1 costs are significant across the facilities but will only address some current infrastructure issues. Option 2 includes issues addressed under Option 1 and provides for additional capacity where required to address draft CSCF v3.0 requirements. Option 3 represents the highest cost option, with the exception of Ayr Hospital, where Option 2 is the most expensive. In all other cases Option 3 ensures all future service requirements are met and in a number of cases completely relifes infrastructure resulting in substantial improvement to maintenance and operating costs.

Detailed analysis of the capital cost of items that were not included as part of the preliminary evaluation stage listed in Section 3.2.2 will need to be completed in the business case stage. Further detailed analysis of the impact to the operational costs for the enhanced clinical service delivery would need to take place for each facility in the business case stage.

5.4 Economic analysis

5.4.1 Assessment approach and method

Objectives of an economic impact assessment

The objective of an economic impact assessment is to examine the effect of a policy, program, project, activity or event on the economy of a given area. This process will inform the response to emerging health care delivery challenges of rural and remote Queensland. Specifically, Queensland Health is evaluating the merits of investing at the 12 prioritised rural sites listed in Section 2.

Service delivery challenges in rural and remote Queensland due to infrastructure limitations

These sites face a number of major challenges for safe, sustainable health care delivery in rural and remote Queensland. In particular, these challenges include:

ageing infrastructure, which may not be compliant with current building codes and disability legislation

inadequate/poor quality employee housing accommodation, which affects the Health Service District’s capacity to attract and retain key staff

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population growth, which may see demand exceed supply in some regions, resulting in either higher rates of patient and carer travel, longer waiting list times, and/or reduced health service utilisation and potentially higher costs of care in the future

demographic shifts towards a more aged population profile, which may see demand exceed supply in some regions even as the population is declining, resulting in either higher rates of patient and carer travel, longer waiting list times, and/or reduced health service utilisation and potentially higher costs of care in the future

higher proportion of vulnerable and disadvantaged groups, including Aboriginal and Torres Strait Islander populations as well as economically disadvantaged groups, measured by the Socio-Economic Index for Areas (the SEIFA Index).

Table 23 details the key challenges for service delivery by Hospital site.

Table 23: Key challenges for service delivery by rural and remote site

Key service delivery challenge

Ath

erto

n

Ayr

Bilo

ela

Ch

arle

ville

Ch

arte

rs T

ow

ers

Em

eral

d

Kin

gar

oy

Lo

ng

reac

h

Mar

eeb

a

Ro

ma

Sar

ina

Th

urs

day

Isla

nd

Ageing/ deteriorating infrastructure

Poor employee housing accommodation

- -

Population growth

- - - - - -

Ageing population challenges

- -

Aboriginal and Torres Strait Islander population considerations

- - - - -

Economically disadvantaged groups (low SEIFA)

- - - - - -

For each of the 12 sites, three infrastructure options have been identified to address the above issues that pertain to the relevant Hospital. Section 5.4 discusses the merits of each option for addressing the above service delivery challenges.

Assessment framework

An economic impact assessment seeks to measure the incremental change of an activity on the economic, social and environmental wellbeing of the community compared to what would have otherwise occurred in the absence of the policy, program, project, activity or event (the

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counterfactual or the base case). In this instance, the economic impact assessment seeks to measure and compare the incremental impact of a proposed range of infrastructure investments at the 12 rural and remote sites.

Multi-criteria analysis has been utilised to assess infrastructure options at each of the 12 sites to contribute to an initial ranking of the alternative options by Project in terms of cost and their ability to meet the identified outcomes and output. Multi-criteria analysis enables options to be compared in a way that utilises quantitative and qualitative evidence fully. This approach to evaluating the costs and benefits is appropriate for the preliminary analysis stage as sufficient detail to quantify all of the costs and benefits is not yet available.

Three categories of assessment criteria were used: economic, social and environmental. These criteria were developed to ensure that all avenues of cost and benefit were considered (Table 24).

Table 24: Criteria for assessment

Category Criteria Description

Economic Whole-of-life costs Assess the costs of construction and operation of buildings, including: any costs associated with the temporary relocation of services any operating efficiencies generated by the provision of new, fit-for-purpose infrastructure or improved service delivery grouping

Impact on community health—economic impacts

Assess the impact of delivery of health care on the wellness of the population and consider how that will impact economic activity within the region— in particular, economic impacts of avoidance of unnecessary care

Patient and carer travel Assess the impact on requirements for patients and carers to travel to access health services and for inter-hospital patient transfers

Impact on workforce sustainability

Assess any impact on the workforce and workforce retraining and recruitment costs associated with relocation of the hospital site or an expansion of services and/or bed numbers

Impact on the local economy

Assess the impact on the local economy generated by Queensland Government investment in health infrastructure

Social Impact on community health—social impacts

Assess the impact of the delivery on the health of the population—in particular, social impacts of reduced disadvantage in the community

Social cohesion Assess the impact of the delivery of health care on the social wellbeing of the community

Disruption during construction

Assess the impact of temporary relocation on health outcomes

Heritage and cultural value

Assess the impact on heritage buildings and building with significant community interest due to the Project

Building safety and accessibility

Assess the impact of the Project on building safety and disability access

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Category Criteria Description

Environmental Impact on resource consumption and waste generation

Assess the impact of infrastructure investment on energy and water consumption and water generation at the hospital site and the impact on emissions and air pollution from patient, carer and staff travel

Noise and traffic impacts Assess the noise and traffic impacts of the Project both during construction and after completion

At this stage of the Project, weightings have not been incorporated into the analysis, therefore each criteria have been weighted equally. Determining relative weightings, to reflect the relative importance of each criterion, is difficult as weights are subjective, and reflect the values of those assigning them. The unweighted scores of the options have been compared and identified. Weightings will be applied if required in the Business Case.

The evaluation criteria will be used to assess each option against a seven point scale (represented by to ) resulting in a quantitative rating that demonstrates the level of variation from the ‘base case’. In an economic impact assessment, the base case is the counterfactual where no investment is undertaken. The scale differs for each assessment category as detailed in Table 25.

Table 25: Multi-criteria analysis scale

Criteria Scale

—

Economic criteria

NO

CH

AN

GE

FR

OM

TH

E B

AS

E C

AS

E

Whole-of-life costs

Generates significant costs Generates significant operating inefficiencies

Generates significant savings. Significantly improves operating efficiencies


Significant deterioration in health outcomes leading to higher absenteeism and lower workplace productivity

Significant improvement in health outcomes leading to lower absenteeism and higher workplace productivity

Patient and carer travel

All patients are required to travel to receive health care services that should be provided in their local area under the draft CSCF v3.0

Ensures no patient is required to travel to receive health care services that should be provided in their local area under the draft CSCF v3.0

Impact on workforce sustainability

Significantly degrades the working environment and staff facilities—including employee housing accommodation

Significantly improves the working environment and staff facilities—including employee housing accommodation


Generates a significant drain on the local economy through sustained lower employment and consumption

Generates a significant boost to the local economy through sustained higher employment and consumption. Leverages private sector investment that would not otherwise have occurred

Social criteria

Impact on Significant deterioration in health Significant improvement in health

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Criteria Scale

—

community health—social impacts

outcomes outcomes

Social cohesion

Has the potential to decrease uptake of health services resulting in a decrease of social and economic participation. Significantly diminishes confidence in public services

Has the potential to increase uptake of health services generating an increase of social and economic participation Significantly enhances confidence in public services


Significant and extended disruption during construction

N/A*

Heritage and cultural value

Reduces the heritage value of the site or buildings within the site

Protects and enhances the heritage value of the site or buildings within the site


Significantly degrades building safety and accessibility

Significantly improves building safety and accessibility

Environmental criteria

Impact on resource consumption and waste generation

Generates an overall increase in resource consumption and waste generation

Generates an overall decrease in resource consumption and waste generation

Noise and traffic impacts

Generates significant additional traffic and/or construction related noise. Generates substantially adverse traffic conditions

N/A*

Note: *A circumstance in which an improvement above the base case is not possible given the problem that has been identified.

5.4.2 Summary of options analysis For almost all Projects, Option 1 represents a limited investment to mitigate against the most serious building safety and disability risks at the site, whereas Options 2 and 3 represent more significant investments to address significant patient service delivery and associated infrastructure issues through investments in employee housing accommodation, and in some cases expansions in the hospital to cater for the projected service demand and provision of core services in line with draft CSCF v3.0.

In most assessments, all options were found to improve economic, social and environmental outcomes compared to a base case where no investment was expected to occur. In most cases, Options 2 and 3 provided a similar, higher level of economic, social and environmental benefit, albeit for a substantially greater cost than Option 1.

It is important to note that in a number of cases Options 2 and 3 were virtually indistinguishable, although a relative ranking was selected for consistency of approach.

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Table 26: Option ranking per site

Option ranking

Ath

erto

n

Ayr

Bilo

ela

Ch

arle

ville

Ch

arte

rs T

ow

ers

Em

eral

d

Kin

gar

oy

Lo

ng

reac

h

Mar

eeb

a

Ro

ma

Sar

ina

Th

urs

day

Isla

nd

Option 1 3 2 3 3 3 3 3 3 3 3 3 3

Option 2 2 1 2 2 2 1 2 2 2 2 2 2

Option 3 1 3 1 1 1 2 1 1 1 1 1 1

Atherton Hospital

All three options to redevelop Atherton Hospital represent an improvement from the base case. Each would address issues associated with the current Hospital infrastructure. They are each expected to have a positive impact on the health of the community (which will have both economic and social impacts), workforce sustainability as well as building safety and access.

The key advantage of refurbishing the existing Hospital (Option 1) compared with rebuilding (Options 2 and 3) is that refurbishment is significantly less expensive—around one third of the cost of rebuilding. The disadvantages of Option 1 compared to a rebuild are that the Hospital would not reach compliance with the Building Code of Australia and other legislative requirements and would not address workforce sustainability issues—particularly relating to existing employee housing accommodation.

Options 2 and 3 are more expensive, but are potentially more sustainable, in economic, workforce and environmental terms. These options may enhance economic and workforce sustainability by lowering maintenance expenditure, addressing inefficient workflows, improving workspaces and upgrading employee housing accommodation. They are also expected to consume less energy and generate less waste than the existing infrastructure. Option 2 increases compliance with building standards and Option 3 achieves full compliance with the Building Code of Australia and other legislative requirements. The addition of new parkland on the current Hospital site under Option 3 may also provide greater cohesion for staff, patients and visitors though the provision of ‘green’ social amenity spaces.

Option 3 was assessed to provide the greatest positive benefit in terms of social, environmental and economic outcomes relative to the base case for the investment that would be incurred.

Table 27summarises the economic, social and environmental impacts of Options 1, 2 and 3.

Table 27: Summary of the options analysis—Atherton Hospital

Criteria Option 1 Option 2 Option 3

Economic criteria

Whole-of-life costs

Cost of capital $25.7 million $105.8 million $107.7 million

Additional operating costs (per annum) $0.49 million $1.75 million $1.79 million

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Patient and carer travel - - -

Impact on workforce sustainability -


Indirect economic stimulus $36.3 million $138.6 million $142.6 million

One year full-time job equivalents created 150 572 588


-

Social criteria

Impact on community health—social impacts -

Social cohesion -


Heritage and cultural value - - -




-

Noise and traffic impacts - - -

Overall ranking 3 2 1

Ayr Hospital

All three options to redevelop Ayr Hospital represent an improvement from the base case. Each would address serious issues associated with the current Hospital infrastructure. They are each expected to have a positive impact on the health of the community (economic and social impacts), workforce sustainability and building safety and access.

The key advantage of the relatively minor works proposed under Option 1 compared with the more substantial refurbishment and rebuilding options (Options 2 and 3 respectively) is that refurbishment is significantly less expensive—around 10 per cent of the cost of the other options. This marginal investment addresses the majority of compliance issues with the Building Code of Australia and the Disability Discrimination Act. However, Option 1 does not address workforce sustainability issues relating to poor functional relationships between departments and issues about existing employee housing accommodation. Furthermore, Option 1 does not address ongoing maintenance issues with the disused nursing home facility.

Options 2 and 3 are much more expensive, but both have benefits beyond those described under Option 1. These options are expected to improve workforce sustainability by addressing inefficient workflows, improving workspaces and upgrading employee housing accommodation. Option 3 only is expected to improve the resource consumption and waste generation impacts of the Hospital by incorporating Green Star advances into the construction of the new primary health/administration building.

Option 3 is marginally less expensive than Option 2; however, Option 3 does not make best use of existing infrastructure with the surplus aged care building remaining vacant and consequently a long term maintenance liability for Queensland Health. The refurbishment of

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the aged care building in Option 2 also provides additional employee housing, therefore under Option 3 a shortage of employee housing accommodation will remain. This issue is not necessarily reflected in the selection criteria, but has been considered in ranking the options.

Option 2 provides the greatest improvement in economic, social and environmental outcomes relative to the expected investment, which is limited.

Table 28 summarises the economic, social and environmental impacts of Options 1, 2 and 3.

Table 28: Summary of the options analysis—Ayr Hospital


Economic criteria

Whole-of-life costs -





Impact on the local economy -

Indirect economic stimulus $2.3 million $32.3 million $28 million



Social criteria

Impact on community health—social impacts

Social cohesion

Disruption during construction -





- -

Noise and traffic impacts -


Biloela Hospital

All three options to redevelop Biloela Hospital represent an improvement from the base case. Each would address serious issues associated with the current Hospital infrastructure. They are each expected to have a positive impact on the health of the community (economic and social impacts), workforce sustainability and building safety and access.

The only advantage of refurbishing the existing Hospital (Option 1) compared with rebuilding (Options 2 and 3) is that refurbishment is significantly less expensive. The disadvantages of Option 1 compared to a rebuild are that the Hospital would not achieve full compliance with the current Building Code of Australia and the Disability Discrimination Act and would not be able to provide services at the draft Level 3 CSCF v3.0 and meet demand into the future.

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Options 2 and 3 are more expensive, but are potentially more sustainable, in economic, workforce and environmental terms. These options may enhance economic and workforce sustainability by lowering maintenance expenditure, addressing inefficient workflows, improving workspaces and substantially upgrading employee housing accommodation. They are also expected to consume less energy and generate less waste than the existing infrastructure. Between Options 2 and 3, the options analysis indicates the net benefits of Option 3 are slightly greater. The construction of a new facility under Option 3 ensures that all elements of the Hospital are fit-for-purpose and the most efficient and functional arrangements are available. Due to the presence of asbestos in Wards A and B, refurbishing will bring significant disruption as a decanting strategy is required. Staff and patients will need to relocate to temporary accommodation and then to move back to Wards A and B once the refurbishment is complete. Overall, Option 3 is therefore considered to be the preferred option.

Table 29summarises the economic, social and environmental impacts of Options 1, 2 and 3.

Table 29: Summary of the options analysis—Biloela Hospital


Economic criteria

Whole-of-life costs






Indirect economic stimulus $12. million $79.9.4 million $84.4 million



-

Social criteria


Social cohesion






-




All three options to redevelop Charleville Hospital represent an improvement from the base case. Each would address serious issues associated with the current Hospital infrastructure.

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They are each expected to have a positive impact on the health of the community (economic and social impacts), workforce sustainability and building safety and access.

The only advantage of refurbishing the existing Hospital (Option 1) compared with rebuilding (Options 2 and 3) is that refurbishment is significantly less expensive. The disadvantages of Option 1 compared to a rebuild are that the Hospital would not achieve full compliance with the current Building Code of Australia and the Disability Discrimination Act and the option does not move any services from the high risk flood zone.

Options 2 and 3 are more expensive, but are potentially more sustainable, in economic, workforce and environmental terms. These options may enhance economic and workforce sustainability by lowering maintenance expenditure, addressing inefficient workflows, improving workspaces and substantially upgrading employee housing accommodation. They are also expected to consume less energy and generate less waste than the existing infrastructure.

Option 3 relocates the Hospital away from the high-risk flood plain, whereas Option 2 moves only key services off the high-risk flood plain. Option 3 also enhances building safety and accessibility because it is a single storey building, whereas Option 2 retains services within the multi-storey configuration with risks to service delivery due to reliance on a single lift. Due to the presence of asbestos in the building Option 2 has decanting issues that will cause significant disruption to patients and staff during the construction phase. This is avoided in Option 3. Both options retain and refurbish the original hospital building with Option 3 utilising the building for the delivery of community health and administration services.


Table 30: Summary of the options analysis—Charleville Hospital


Economic criteria




Savings from ability to remain operational during flooding

$3.6 million $3.6 million $3.6 million

Patient and carer travel






-

Social criteria


Social cohesion




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-




All three options to redevelop Charters Towers Hospital represent an improvement from the base case. Each would address serious issues associated with the current Hospital infrastructure.

The key advantage of Option 1 is that it is significantly less expensive than either Option 2 or 3. The disadvantages of Option 1 are that it does not address ongoing maintenance issues, operational flow issues or inefficiencies in the functional arrangements of the departments. It therefore does not alleviate staff dissatisfaction with overcrowded work areas.

Options 2 and 3 are more expensive, but are potentially more sustainable, in economic, workforce and environmental terms.

Option 2 addresses the issues in departments that are most at risk and compromised by the existing infrastructure, and consequently reduces risks to staff and patients, and potentially improves their safety and satisfaction levels. However, this option will not resolve a number of building code issues and identified infrastructure risks.

Option 3 provides for the construction of an entirely new facility, enables compliance with all relevant codes and legislative requirements, and improves overall efficiency and safety of health service delivery. This option also enables the greatest enhancement of economic and workforce sustainability, and addresses inefficient workflows and consumes less energy. It should be noted that with this Option buildings of significant community interest (Tent Ward, original Morgue and original theatre) will become vacant and surplus to Queensland Health requirements. There may be strategies to mitigate this impact that could be explored in the Business Case.


Table 31: Summary of the options analysis—Charters Towers Hospital


Economic criteria







Indirect economic stimulus $14 million $75.5 million $128.6 million


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-

Social criteria


Social cohesion


Heritage and cultural value -




-



Emerald Hospital

Emerald Hospital is located in a mining centre and is experiencing rapid growth over and above other ‘non-resource’ rural and remote sites. While the Hospital was recently redeveloped (circa 2000), there are some infrastructure limitations including the capacity and functionality of the Emergency Department, Operating Theatres and maternity. There has also been significant increase in demand for services, predominantly emergency, due to the significant growth in nearby mining operations.

All three options to redevelop Emerald Hospital represent an improvement from the base case. Each would address serious issues associated with the current Hospital infrastructure. They are each expected to have a positive impact on the health of the community (economic and social impacts), workforce sustainability and building safety and access.

Option 1 is significantly less expensive than either Option 2 or 3. This option represents a slight improvement on the base case, but is disadvantaged in that it is not expected to achieve full compliance with the current Building Code of Australia and the Disability Discrimination Act. Moreover, in Option 1, the Hospital will continue to face risks to security of service supply due to the absence of a second lift. The existing lift experiences frequent service issues, which represent a risk to patients and staff as the Operating Theatres are on the first floor.

Option 2 and Option 3 are significantly more expensive than Option 1 (Option 3 is an extension of Option 2). These options involve the redevelopment of a substantial proportion of the existing Hospital and are expected to have a greater impact on health outcomes (economic and social) as well as building safety and access. Both options are expected to achieve full compliance with the Building Code of Australia and the Disability Discrimination Act. Option 2 is less expensive than Option 3 because it makes greater use of existing infrastructure.

Option 2 was assessed to provide the greatest net benefit in economic, social and environmental terms relative to the proposed investment.


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Table 32: Summary of the options analysis—Emerald Hospital


Economic criteria


Cost of capital $1 million $67 million $74.7 million

Additional operating costs (per annum) $1.1 million $1.3 million






Impact on community health—economic impacts -

Social criteria


Social cohesion -






-



Kingaroy Hospital

All three options to redevelop Kingaroy Hospital represent an improvement from the base case. Each would address serious issues associated with the current Hospital infrastructure. However, only Option 2 and 3 are expected to have a positive impact on the health of the community, workforce sustainability and building safety and accessibility.

While Options 2 and 3 are significantly more expensive than Option 1, these options will have a greater positive impact on the health of the community, workforce sustainability, social cohesion, building safety and accessibility and patient and carer travel. In particular, Options 2 and 3 provide for the growth in demand in services generated by population growth and an ageing population in Kingaroy. Between Option 2 and 3, the options analysis indicates the net benefits of Option 3 are slightly greater. On most measures, Option 3 has similar or greater benefits than Option 2 and involves less disruption and relatively similar whole-of-life costs.

In the base case, it was found that Kingaroy Hospital was experiencing a growing workforce turnover rate, which in 2008/09 reached 30 per cent. It is anticipated that under Option 1 and the base case the workforce turnover rate would continue to grow as a result of staff dissatisfaction and stress associated with being unable to meet the health care needs of the community. Option 2 and 3 is expected to have a more positive impact on workforce sustainability due to the more substantial redevelopment.

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Overall, Option 3 is considered to be the preferred option.


Table 33: Summary of the options analysis—Kingaroy Hospital


Economic criteria




Patient and carer travel -






-

Social criteria


Social cohesion -



Building safety and accessibility -



-



Longreach Hospital

All three options to redevelop Longreach Hospital represent an improvement from the base case. Each would address serious issues associated with the current Hospital infrastructure. However, only Option 2 and 3 are expected to have a positive impact on the health of the community, workforce sustainability and building safety and accessibility.

While Options 2 and 3 are significantly more expensive than Option 1, both have a greater impact on community health, workforce sustainability, social cohesion, building safety and accessibility and patient and carer travel. Between Option 2 and 3, the options analysis indicates the net benefits of Option 3 are significantly greater. On most measures, Option 3 has similar or greater benefits than Option 2 and also involves less disruption and relatively similar whole-of-life costs. In the base case, it was found that Longreach Hospital has experienced extremely high staff turnover of around 40 to 50 per cent per annum, with medical and nursing staff turning over by 60 per cent in 2008/09. Option 3 is expected to have a more significant improvement on workforce sustainability due to the more substantial

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redevelopment. Option 3 also provides for a central energy plant with the potential to use renewable energy. Overall, Option 3 is therefore considered to be the preferred option.


Table 34: Summary of the options analysis—Longreach Hospital


Economic criteria

Whole-of-life costs


Additional operating costs (per annum) - $1.3 million 1.5 million







-

Social criteria


Social cohesion -






-



Mareeba Hospital

All three options to redevelop Mareeba Hospital represent an improvement from the base case. Each would address serious issues associated with the current Hospital infrastructure. They are each expected to have a positive impact on building safety and accessibility and social cohesion.

The key advantage of Option 1 compared with Options 2 and 3 is that it is significantly less expensive. The disadvantages of Option 1 compared to a rebuild are that the Hospital would only partially comply with the current Building Code of Australia. Option 1 will not provide sufficient space to meet the service demand and will not meet minimum patient safety requirements. It will not address most of the issues identified with the existing infrastructure.

Options 2 and 3 are more expensive, but are potentially more sustainable, in economic, workforce and environmental terms. These options may enhance economic and workforce sustainability by lowering maintenance expenditure, addressing inefficient workflows,

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undertaking upgrades of building services and upgrading employee housing accommodation. Both options present very similar measures, with the key difference between them being the construction of an extended Dental Department under Option 3. Under both Options 2 and 3 there is a substantial refurbishment of the Emergency Department which improves workflow. This measure is anticipated to improve patient and carer satisfaction with the service. Overall, Option 3 is therefore considered to be the preferred option.


Table 35: Summary of the options analysis—Mareeba Hospital


Economic criteria



Additional operating costs (per annum) -$0.1 million $0.34 million $0.36 million







-

Social criteria


Social cohesion -








Roma Hospital

All three options to redevelop Roma Hospital represent an improvement from the base case. Each would address serious issues associated with the current Hospital infrastructure. Each also has a positive impact on workforce sustainability, building safety and accessibility, social cohesion and the health of the community. However, on each of these measures the impacts tend to be larger for Options 2 and 3. Furthermore, only Options 2 and 3 can ensure the future demand for services is met.

Table 36 summarises the economic, social and environmental impacts of Options 1, 2 and 3. As shown, Options 2 and 3 have similar impacts for most measures. The key difference between these options is the provision of a GP Super Clinic in Option 3 which will provide

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increased general medical services to the catchment. On this basis, Option 3 is the preferred of the three options.

Table 36: Summary of the options analysis—Roma Hospital


Economic criteria




Patient and carer travel - -






-

Social criteria


Social cohesion -






-

Noise and traffic impacts - -


Sarina Hospital

All three options to redevelop Sarina Hospital represent an improvement from the base case. Each would address serious issues associated with the current Hospital infrastructure. They are each expected to have a positive impact on the health of the community, workforce sustainability and building safety and accessibility.

Options 2 and 3 are significantly more expensive than Option 1 however these options provide a greater positive impact on community health, workforce sustainability, social cohesion, building safety and accessibility and patient and carer travel. In particular, both Options 2 and 3 provide for the growth in demand for services generated by an ageing and growing population in Sarina. Between Options 2 and 3, the options analysis indicates the net benefits of Option 3 are slightly greater. On most measures, Option 3 has similar or greater benefits than Option 2 while also involving lower disruption and relative similar whole-of-life costs. Option 2 and 3 are both expected to result in a significant improvement in workforce sustainability due to the more substantial redevelopment and the improvement of the employee housing accommodation. Option 3 also changes the ambulance approach to the

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Hospital which is likely to reduce delays in emergency access through having to pass over railway level crossings. This has caused delays to ambulances in the past, especially in the cane-cutting season.

Overall, Option 3 is therefore considered to be the preferred option.


Table 37: Summary of the options analysis—Sarina Hospital


Economic criteria










-

Social criteria


Social cohesion -






-

Noise and traffic impacts - - -



All three options to redevelop Thursday Island Hospital will address serious issues associated with the current Thursday Island Hospital infrastructure. They are each expected to have a positive impact on the health of the community (economic and social impacts), social cohesion, workforce sustainability and building safety and access.

The key advantage of Option 1 compared with Options 2 and 3 is that Option 1 is significantly less expensive. However Option 1 cannot fully address the failing infrastructure, overcrowding and non-compliance with building codes and regulations. It also does not include any new employee housing accommodation.

Options 2 and 3 are more expensive, but are potentially more sustainable, in economic, workforce and environmental terms. These options may enhance economic and workforce

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sustainability by addressing inefficient workflows, improving workspaces and upgrading employee housing accommodation. Overall, Option 3 is expected to have the greatest net benefit because it is the only option capable of fully addressing issues related to overcrowding, compliance with regulations and guidelines and deteriorating infrastructure.

If either Option 1 or 2 were chosen over Option 3, the structural issues associated with the current building would not be addressed and it is anticipated that significant on-going maintenance would be required to mitigate the impact of the harsh coastal conditions on building exteriors.


Table 38: Summary of the options analysis—Thursday Island Hospital


Economic criteria

Whole-of-life costs









-

Social criteria


Social cohesion -






- -

Noise and traffic impacts - -


5.5 Market sounding

5.5.1 Requirement for market sounding The PAF Preliminary Evaluation Guidelines specify where the private sector may have involvement in a project, market sounding should be undertaken to validate any assumptions made.

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The purpose of the market sounding is to assess the expected appetite of the private sector for involvement in the Infrastructure Renewal Planning Project for Rural and Remote Areas and to explore the potential range of solutions, including any feedback which might impact on the way in which the Project is packaged and presented to market.

5.5.2 Methodology The market sounding methodology applied has been illustrated in the diagram (Figure 3) below.

Figure 3: Market sounding methodology

Where projects are believed to be particularly sensitive, an assessment of market appetite is undertaken by using desktop analysis only, supported by discussions with internal Government stakeholders and advisors, in place of approaching the private sector.

5.5.3 Rural and Remote Project market sounding approach

Rural and Remote Project characteristics

This Project represents a considerable potential investment in the 12 prioritised Hospitals. As described in Section 4.4, options range from status quo; addressing the most significant safety infrastructure risks (Option 1) to a significant refurbishment solution including employee housing accommodation (Option 2) and a major redevelopment solution including employee housing accommodation (Option 3)—each with different timing and decanting profiles. Only one utilises a separate greenfield site, although several require access to vacant hospital land currently owned by Queensland Health.

In addition, each of the 12 sites are geographically dispersed, with some located within reasonable proximity of major towns or cities, and others in remote locations.

Private sector involvement in each of the rural and remote sites may take the form of:

construction and delivery of the Project under a traditional procurement model such as construction only, construction management, design and construction, an alliance or a managed contractor arrangement. This is discussed in more detail in the procurement assessment in Section 5.8

construction, delivery and ongoing service provision under a PPP delivery model. This is discussed further in Section 5.8.

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Potential to bundle with other sites or projects

The ability for some or all of the rural and remote sites to be bundled together to increase market interest for this Project has been assessed. The scale of the refurbishment and redevelopment options (Options 2 and 3) at any of the sites should be sufficient to attract interest in their own right, although the range of delivery models available to some of the sites is likely to be impacted by their smaller scale.

The bundling of two sites, Atherton and Mareeba, may prove to be appropriate for procurement purposes. These Hospitals service the growing Tablelands region and as such, service delivery would need to be coordinated during any refurbishment or redevelopment of either facility.

It is anticipated that the bundling of the remaining sites with other facilities within the Project would provide limited benefit given their geographical separation and would instead be more likely to constrain market appetite. This is a consequence of expected differences in the timing of when these sites might come to market, given their differing design and development needs.

Depending on the timing of when each site comes to market, there may be potential to bundle some procurements with other social or economic infrastructure developments in the same location at that time e.g. Emerald or Longreach. Once there is greater clarity around possible timing of the Project, the potential impact of other regional development-related projects on private sector market capacity would need to be assessed.

These matters will be considered further during the detailed business case market sounding.

Project sensitivities

There are a number of sensitivities around the Project. At this early stage of planning, and in the absence of any Queensland Government commitment or announcement in regard to the Project it would not be appropriate for external market sounding to be undertaken.

Approach applied

To assess the potential for private sector involvement, desktop analysis of potential market appetite for development and construction of the Project has been undertaken. This assessed contractor capability against criteria relevant to the delivery of this Project including:

organisational capacity

delivering projects of similar scale and complexity

successful delivery of health projects

using alternative delivery models, including construct only, design and construct, managing contractor, PPP and alliancing

contractor analysis supported by discussions with representatives from the Department of Public Works.

5.5.4 Desktop analysis findings Preliminary desktop analysis revealed that market appetite for each of the 12 sites within this Project would be strong. A review of some of the major contracting companies identified:

many of the contractors had recently delivered contracts in rural and regional Queensland

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the size of the projects the contractors engaged in ranged from approximately $10 million to more than $1 billion, adequately addressing the scale of the Rural and Remote Project options

most of the contactors identified had experience in the health industry

the contractors were experienced and willing to undertake projects using various delivery methods including construct only, construction management, design and construct, managing contractor and PPP.

5.5.5 Stakeholder feedback As part of the market sounding process Queensland Health and the Department of Public Works provided expertise and opinion on the market appetite for this Project. All contractors for Queensland Health projects are currently drawn from the Department of Public Works’ Prequalification System.

Queensland Health has been involved in the delivery of a number of similar projects, and has direct experience in previous health and hospitals projects. To date, Queensland Health has not experienced a market failure for the provision of infrastructure construction works. This includes both greenfield and brownfield projects in rural and remote regions, including the recent delivery of projects in rural areas such as Innisfail, Weipa and Ingham. However, certain delivery models, in particular design and construct, have proven challenging in the past in the Queensland Health environment, given the design input requirements in the health environment.

The Department of Public Works concurred with Queensland Health that there would be sufficient market appetite for the Project in the current economic environment, including smaller contractors capable of addressing options for the smaller scale sites. All of the sites were likely, in their opinion to attract sufficient interest for a competitive market process. However, since the timing of the Project was uncertain and may not proceed for several years (given Business Case, funding, detailed planning and design requirements), it is difficult to forecast market appetite if economic conditions were to change. This might impact on market capacity and willingness to bid at the time the Project comes to market.

The Department of Public Works identified that bidders for this Project would be drawn from the Pre-qualified Contractors System. However, from January 2011, the introduction of the National Prequalification Register will allow mutual access to all other Commonwealth and State Government prequalification Systems. This is expected to enable the Queensland Government to identify additional developers and managing contractors who are not on the Pre-qualified Contractors System but who may be interested in this Project, further expanding the potential pool of market interest.

In consideration of these factors, the Department of Public Works was of the opinion that the market has sufficient capacity and capability to undertake any of the options for this Project but that precise timing will impact on the extent of the appetite and the particular parties that will be attracted at that time.

An extract of the Department of Public Works opinion can be found in Appendix 9.

5.5.6 Summary of expected market appetite and requirements In summary, based on the preliminary desktop analysis and stakeholder feedback as at the date of this Preliminary Evaluation, there is expected to be sufficient market appetite for the development and construction of any of the Project options for any of the rural and remote

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sites. At this point, there does not appear to be any market capability or capacity limitations that would restrict the traditional delivery options that could be applied, although the scale of works proposed will limit the viability of PPP at some of the sites.

Further detailed market sounding should be undertaken in the business case stage to confirm potential private sector appetite based on location-specific conditions at that time. This would include the potential appetite of the private sector to divest of land required for some of the hospitals and likely pricing, which would need to be assessed and costed once information is available on precise land requirements and expected timing.

5.6 Legislative approval, whole-of-government policy objectives and regulatory issues

5.6.1 Summary of issues and objectives identified

As required by the PAF Preliminary Evaluation Guidelines, this section provides the preliminary consideration of the legislative approval issues, whole-of-government policy objectives and regulatory issues relevant to the Project. The issues are categorised as follows:

environmental, planning, cultural heritage and native title issues

employee, employment and skills development issues

market competition issues.

Based on the preliminary assessment, there are no insurmountable legislative approval issues related to the Project that would render any of the options unworkable. However, for many of the sites, Option 1 will not achieve compliance with building standards, the Disability Discrimination Act, occupational health and safety and energy efficiency requirements. Issues of particular concern for some sites include the risk of flooding, fire safety and the ability to control infectious diseases.

The Project options appear to be consistent with existing whole-of-government policies. However, any Business Case will need to demonstrate the Project’s consistency with each of these polices and specific stakeholder consultation will be required throughout each phase of the Project to ensure risks are effectively managed.

At the request of Queensland Treasury and the Department of the Premier and Cabinet, consultation was limited during the preliminary evaluation stage given the early phase of the Project. All assessments at the preliminary evaluation stage have been drawn from the Infrastructure Study and Preliminary Evaluation risk workshops. Future consultations with stakeholders will need to occur at the business case stage.

In Table 39, each issue is identified, the potential impact on the Project is considered and an initial plan to address the issue is outlined. The table is followed by a discussion of the key legislative approval issues, whole-of-government policy objectives and regulatory issues.

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Table 39: Summary of legislative approval, whole-of-government policy objectives and regulatory issues

Description of issue Category Sub-category

Potential impact Plan to address

Planning approvals and demonstrating compliance with the Sustainable Planning Act 2009, local planning scheme requirements and standards for buildings and accessibility, including: Vegetation Management Act 1999 Building Code of Australia Australian Standards

Legislative Planning Under Option 1 there are some areas that may not achieve compliance with the Building Code of Australia If there is remnant (native) vegetation located on the hospitals’ sites, a Property Vegetation Management Plan may be required to gain approval for a works application Delays in approval decisions may delay construction of new buildings and result in higher capital costs Approvals and compliance costs may be payable in addition to the capital cost of refurbishment/expansion

Allow appropriate time for planning approvals, including development of a Building Code of Australia Section J Assessment and Compliance Report An assessment will be undertaken to identify whether regulated remnant vegetation is located within the sites Incorporate a budget allowance for approvals and compliance costs

Compliance with the Disability Discrimination Act and the Disability Services Act 1992

Legislative Planning/ social inclusion

Under Option 1 there would continue to be some areas with access difficulties for persons with a disability and therefore non-compliance with the Disability Discrimination Act Costs resulting from specific design requirements Delays in approval decisions may result in delays to the Project and result in higher capital costs Potential for exposure to legal action should a breach in compliance occur

Assess non-compliance issues and develop approaches to mitigate risks during the design phase and to ensure compliance during the implementation stage

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Compliance with the Environmental Protection Act 1994 and environmental efficiency/climate change policies including the Ecologically Sustainable Queensland Health Facilities Policy

Legislative Planning/ environment

Costs resulting from mitigation efforts Delays in approval decisions may result in delays to the Project, which may in turn, have adverse impacts on financial costs

The Department of Public Works will be engaged in the development of the preferred option to ensure alignment with current policies on environmentally sustainable government buildings

Compliance with the Workplace Health and Safety Act 1995 and Queensland Health specific policies and requirements (e.g. Queensland Health Prevention and Control of Healthcare Associated Infection Policy) Appropriate measures are taken to ensure duty of care requirements are met

Legislative Planning/ safety

Under Option 1 there would continue to be some areas of non-compliance with occupational health and safety requirements, in particular fire safety and control of infectious diseases Costs resulting from specific design requirements Potential for exposure to legal action and associated costs, should an accident occur resulting from breaches in compliance with Australian Standards and Building Code of Australia

Appropriate measures are taken to ensure duty of care requirements are met

Cultural heritage and native title concerns at particular sites

Legislative Cultural Heritage/ Native Title

A number of sites have cultural heritage issues and or are of community interest Where relevant, stakeholder consultation requirements, negotiation and approval decisions may result in delays to the ProjectOutcomes of such processes may result in construction/design changes that could increase costs Potential for community concerns to impact Queensland Health and Queensland Government’s reputation

Heritage issues at specific sites will need to be considered in further detail during the business case stage. For buildings on the Queensland Heritage List, the Queensland Heritage Council will need to be involved in the decision making process No native title issues have been identified during the preliminary evaluation stage. However, given some sites’ proximity to Aboriginal and Torres Strait Islander communities, any potential risks should be

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considered in the Business Case

Compliance with Indigenous Employment Policy

Whole-of-Government Policy

Employment Costs and possible delays to construction projects if requirements cannot be met locally

Requires research into availability of appropriate local resources to meet 10 % training policy (and 20% in specified Aboriginal and Torres Strait Island communities, where Thursday Island is located) Skills development strategies already in place should be leveraged to the extent possible

Compliance with employment conditions and entitlements, including: Legislation Industrial instruments (e.g. Certified Agreements and Awards) Directives Queensland Health policies Integrated (Human Resource/Industrial Relations) Resource Manual (IRMs) Human Resource Circulars


Employment Stakeholder consultation requirements and negotiations may result in delays to the Project Outcomes of such processes may result in changes that could reduce the feasibility of some options and/or increase costs

A comprehensive transition strategy for staff potentially impacted by the Project should be a key activity during the next stages of the Project

Alignment with health workforce employment policies, including the Queensland Health Strategic Plan


Employment If the Business Case does not demonstrate the Project’s alignment with policy objectives, the Project may not receive support from government(s)

Ensure that the Business Case assessment criteria incorporates consideration of policy objectives Project transition strategy should include focus on skills development and key issues that impact on attraction and retention of staff Skills development strategies already in place should be leveraged to the extent possible

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Risk of labour shortages and not being able to attract and retain resources


Employment May not be able to adequately staff new facilities and new services

Collaboration with the Work for Us and Human resources teams at Queensland Health to develop an early strategy to attract workers from within Queensland as well as interstate and overseas

Alignment with the rural and remote policy objectives within the Blueprint for the Bush


Social Inclusion

If the Business Case does not demonstrate the Project’s alignment with policy objectives, the Project may not receive support from government(s)

Ensure that the Business Case assessment criteria incorporates consideration of policy objectives The Rural and Regional Queensland Unit within the Department of Employment and Economic Development is responsible for the Blueprint and should be engaged

Alignment with the policy objectives within the Australian Government's Closing the Gap in Indigenous Health


Social Inclusion

If the Business Case does not demonstrate the Project’s alignment with policy objectives, the Project may not receive support from government

Ensure that the Business Case assessment criteria incorporates consideration of policy objectives

Alignment with state, regional and local planning policies


Planning If the Business Case does not demonstrate the Project’s alignment with policy objectives, the Project may not receive support from government(s)

Ensure that the Business Case addresses planning policies in more detail

Alignment with the Workplace Health and Safety Queensland Industry Action Plan for the health and community services industry and the National Occupational Health and Safety Strategy


Safety Under Option 1 there are some areas of risk that need to be attended to in order to reduce occupational health and safety concerns

Engagement with stakeholders, such as the Health and Community Services Industry Sector Standing Committee on workplace health and safety Relevant policies need to be taken into account during the design, construction and implementation stage

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Implication of the new National Health and Hospital Reforms


Funding Uncertainty created by these reforms (and potential for further reforms) may impact on structure (case-mix) and funding for Hospitals Uncertainty could result in deferred decision making and may delay the Project, increasing costs (particularly Options 2 and 3)

Progress in Commonwealth discussions and assessment of outcomes will be monitored on an ongoing basis. Executive representation at the national level reform discussions will be maintained

Alignment with the eHealth policy objectives


Health Investing in built infrastructure may not appear to be aligned with eHealth initiatives and may impact on availability of funding

Ensure that the Business Case addresses IT future proofing considerations and links improvements in built infrastructure to enable implementation of eHealth policy

Compliance with State Procurement Policy – including the Capital Works Management Framework, Maintenance Management Framework and Quality Assurance Policy


Procurement Regulates the method by which contractors can be engaged and may cause delays through time spent demonstrating compliance

Assistance from the Queensland Government Chief Procurement Office and Department of Public Works should be sought during the implementation phase to ensure compliance with the State Procurement Policy

Compliance with Queensland Government Enterprise Architecture – ICT legislative provisions, policy, strategy and standards and enterprise architecture – including: Public Records Act 2002 Information and Communication

Technology (ICT) Purchasing Framework, including the Government Information


ICT Regulates the process by which ICT decisions and investment can be undertaken and the management of ICT in the longer term Potential for poor integration with existing Queensland Health network

The Queensland Government Enterprise Architecture Guidelines should be used to ensure ICT investment is consistent with the policy and an Implementation Advice and Implementation Toolbox is available to guide agencies in implementing Information Standards. The Queensland Government Chief Information Office should be engaged in the development of ICT-related infrastructure

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Technology Contracting Framework ICT SME Participation Scheme Financial and Performance

Management Standard 2009 Information Risk Management Best

Practice Guidelines

Compliance with the Local Industry Policy A fair go for local industry. The Project will be required to have a Local Industry Participation Plan and the tender will be required to have local content as one of the evaluation criteria


Procurement Costs and possible delays to construction projects if requirements cannot be met locally. Requirement to submit a report on the outcome of Local Industry Participation Plans to the chair of the Local Industry Committee on a six-monthly basis

The Local Industry Policy Guidelines, published by the Department of Employment, Economic Development and Innovation, should be followed to ensure consistency with the policy. The Industry Capability Network can provide advice to government department staff and their agents, find suitable local suppliers, including providing advice and assistance with the development of Local Industry Participation Plans for all eligible projects. The Industry Capability Network can prepare these Plans at no cost to the Project proponent if requested

Impact on the market for hospital services in the region

Regulatory Market competition

The continued increase in demand will provide sufficient growth opportunities for the private sector, such that an increase in the supply of public hospital beds will not adversely influence market competition

Impact on the private sector should be considered as part of the public benefit test at the business case stage

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5.6.2 Legislative approval issues

The PAF Preliminary Evaluation Guidelines require identification of the material legislative approval issues that are likely to arise to ensure that:

there are no insurmountable issues that would render any of the options unworkable

appropriate modifications can be made to the options to accommodate specific issues.

As outlined in Table 40, there are environmental, native title, disability access and workplace health and safety legislative requirements that must be taken into account in a health facility planning process. Based on the preliminary assessment, there are no insurmountable issues related to the Projects that would render any of the options unworkable however Option 1 for most sites does not fully rectify legislative compliance issues.

The Sustainable Planning Act is the principal legislative instrument for planning and development in Queensland. The Business Case will consider how the preferred option is consistent with the planning parameters and engage with relevant stakeholders to identify the preferred options’ alignment with strategic objectives for the area.

The Sustainable Planning Act, intends to provide accelerated and clearer State planning instruments and enhances Ministerial powers to intervene in the planning and development processes. Engagement with the Department of Infrastructure and Planning and the Minister for Infrastructure and Planning will be essential to managing the process by which development takes place.

As the Projects involve redevelopment of the Hospital facilities at existing brownfield sites (under all options), it is unlikely that an environmental impact statement will be required. The Department of Public Works will be engaged in the development of the preferred option to ensure that the proposed redevelopment is aligned with current Queensland Government and Queensland Health policy on environmentally sustainable government buildings. Under the Ecologically Sustainable Queensland Health Facilities Policy (endorsed 12 July 2010), it is a requirement that infrastructure improvements are consistent with the policy and the related implementation standards. In addition, a Section J Assessment and Compliance Report will be required as part of the Development Application process to demonstrate compliance with the Building Code of Australia.

The Charleville, Charters Towers, Kingaroy, Longreach and Roma sites have potential cultural heritage or community interest issues. Where relevant stakeholder consultation requirements, negotiation and approval decisions may result in delays to the Project. For buildings on the Queensland Heritage List, the Queensland Heritage Council will need to be involved in the decision making process where options have the potential to impact the heritage building.

5.6.3 Whole-of-government policy objectives

The PAF Preliminary Evaluation Guidelines require the Project options to be assessed to ensure consistency with existing whole-of-government policies, in particular to identify any employee, employment or skills development issues that may need to be addressed.

The purpose of the Preliminary Evaluation is to identify where stakeholder consultation will be required to ensure effective change management mechanisms can be developed and implemented during the Project’s developments. As outlined in Table 39, there are a number of whole-of-government policies that are relevant to the Project including:

industrial and employee relations

employment and skills development policies

health funding policies

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planning policies

Workplace Health and Safety Strategy

State Procurement Policy.

The Business Case will need to demonstrate the Project’s consistency with each of these polices and specific stakeholder consultation will be required throughout each phase of the Project.

Queensland Health employees’ conditions of employment are determined by a combination of legislative requirements, industrial instruments and Queensland Health policies. These conditions of employment will need to be complied with throughout:

the preliminary phases

the capital/construction phase

the workforce transition phase

the long term operational phase.

In the preliminary phases, the consultation requirements and organisational change provisions under the enterprise bargaining agreements will need to be adhered to. Specifically, for any significant organisational change that will impact on the workforce, the employer must establish the benefits in a Business Case that is tabled for the purposes of consultation with union representatives and employees at the District Consultative Forum or equivalent (Queensland Health 2008). During the consultation phase, broader industrial relations-related issues may arise (such as the change in service direction and potential outsourcing of functions) that could potentially delay the Project.

There is a skills shortage in the health industry. A number of health professional positions are listed on the State and Territory Skill Shortage List and the expected increase in demand for health services will exacerbate these shortages (Department of Education, Employment and Workplace Relations 2010). Workforce distribution is also an issue, with labour shortages being most significant in outer metropolitan and rural and remote areas especially in Aboriginal and Torres Strait Islander communities (Productivity Commission 2005). Policies to improve the health workforce capability and capacity are a priority of both the Commonwealth and Queensland Governments. Improving the health workforce capability and supply is a core component of the Council of Australian Governments National Partnership agreement on hospital and health workforce reform (Council of Australian Governments 2010a). “Developing our staff and enhancing organisational performance” is a strategic priority in the Queensland Health Strategic Plan (Queensland Health 2007). Where an option that proposes the expansion of a Hospital is adopted, a strategy to attract and retain new health workers from within Queensland as well as interstate and overseas will be important.

Under the State Government Building and Construction Contracts Structured Training Policy, 10 per cent of the total labour hours must be undertaken by Aboriginal and Torres Strait Islander workers. This applies to all Queensland Government building or civil construction projects. Under the Indigenous Employment Policy for Queensland Government, building construction projects in specified Aboriginal and Torres Strait Island communities exceeding $250,000 require a 20 per cent minimum benchmark of total labour hours (Department of Employment, Economic Development and Innovation 2008). This additional Aboriginal and Torres Strait Islander training requirement will be applicable to Thursday Island Hospital and could also be an issue for Mareeba Hospital. The Department of Employment and Industrial Relations can provide assistance in meeting the requirements, and compliance must be demonstrated.

In April 2010, Council of Australian Governments agreed to the establishment of a National Health and Hospitals Network, which is intended to reform the service delivery of hospitals

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across Australia and provides for new funding arrangements (Council of Australian Governments 2010b). There is a risk that the uncertainty created by these reforms (and the potential for further reforms) may impact on the structure (case-mix) and funding for hospitals. This uncertainty could result in deferred decision making and may delay the Project. Ongoing monitoring of Council of Australian Governments discussions and strategic assessment of potential outcomes will ensure that Queensland Health is well equipped to manage this risk.

Workplace Health and Safety Queensland has developed an Industry Action Plan for the health and community services industry, which is aligned with the National Occupational Health and Safety Strategy (Department of Employment and Industrial Relations 2008). Key priorities relevant to the Project are to reduce high incidence/severity risks and to eliminate hazards at the design stage. In addition to ensuring compliance with the minimum safety standards, engagement with resources, such as the Health and Community Services Industry Sector Standing Committee on workplace health and safety, will help ensure any refurbishment or redevelopment of the hospital is aligned with best practice workplace safety principles.

In addition to the legislated planning approval requirements under the Sustainable Planning Act (discussed above), the policy objectives under the Queensland Government’s Planning for a Prosperous Queensland and Queensland Regional Plan needs to be complied with (Department of Local Government, Planning, Sport and Recreation 2007; Department of Infrastructure and Planning 2009). The planning policies sit within Queensland’s land use planning framework and also inform local government plans and policies. The Regional Plan takes precedence over all other planning instruments and must be taken into account in all planning and development decision-making processes.

The Queensland Government has an overarching State Procurement Policy and a number of related policies and frameworks for government procurement such as building construction and maintenance (Department of Public Works 2010). The State Procurement Policy seeks to maximise the benefits that can be delivered through effective and efficient government procurement. Assistance from the Queensland Government Chief Procurement Office and Department of Public Works should be sought during the implementation phase to ensure compliance with the State Procurement Policy.

5.6.4 Regulatory issues

The PAF Preliminary Evaluation Guidelines require preliminary consideration of the regulatory issues, including the potential to influence market competition and/or to change the regulatory framework.

Based on the preliminary assessment, the Projects would not require regulatory change or impose regulatory burden. As such, it is unlikely that the Business Case would require a regulatory impact statement.

While the Projects will not restrict competition, it is expected to increase the supply of public hospital beds which may influence market competition. Preliminary assessment indicates that the continued increase in demand will provide sufficient growth opportunities for the private sector, such that an increase in the supply of public hospital beds will not adversely influence market competition. In some locations, particularly the more remote, the potential market for private provision of acute health care services is small and hence, the public provision of such services more pertinent. However, the expected impact on the private sector should be considered as part of the public benefit test at the business case stage.

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5.7 Public interest assessment

5.7.1 Assessment approach and method

Objectives of a Public interest assessment

A public interest assessment is a key component of a comprehensive evaluation of the costs, risks and benefits associated with each of the identified Project options. It queries whether there are any other matters not yet considered which may indicate that a proposed Project option is contrary to the public interest.

At the preliminary evaluation stage, many costs, risks and benefits are uncertain because Project details are yet to be determined. Furthermore, many potential risks and costs can be eliminated or offset through the use of appropriate mechanisms as they arise. At the preliminary stage the public interest assessment has two objectives:

1. to determine, where possible, the potential impact of the identified Project option on the community as a whole

2. to identify issues relating to the public interest that will need to be addressed with appropriate mechanisms at a later Project stage when more information is available (Section 5.7.3). This objective is necessary because many of the criteria relate less to the impacts of the Project options themselves than to how the Project options are managed, how services for the options are procured and how the public interest can be protected during these processes.

The second objective is necessary because many of the criteria relate less to the impacts of the Project options themselves than to how the Project options are managed, how services for the options are procured and how the public interest can be protected during these processes.

Criteria for assessment

Public interest assessments, historically, have focused on PPPs. Requirements for developing public interest assessment for PPPs for Queensland, other Australian states and national projects are all relatively consistent. The criteria used to assess the Project options reflect those provided in the PAF Preliminary Evaluation Guidelines and draw on guidance for assessment contained in Partnership Victoria’s public interest assessment guidelines.1

In order to ensure that the public interest criteria contained in the PAF are fit-for-purpose they have been adapted for use in this Preliminary Evaluation. In total, seven criteria have been used that are generally considered in a public interest assessment. These seven criteria are outlined in Table 40. The descriptions in this table reflect how these criteria have generally been interpreted elsewhere in Queensland and Australia. Clearly, however, at a preliminary evaluation stage not all aspects of the assessment identified here are able to be fully considered.

Only four of the seven criteria have been used for scoring purposes, as insufficient information is available at the preliminary evaluation stage to score the other three criteria. Table 42 provides the scoring methodology against the four criteria including—effectiveness in meeting service requirements, distributional equity and impact on stakeholders, public access and security. The remaining three criteria—accountability and transparency, consumer rights and privacy will be assessed at the business case phase.

1 Where appropriate, some of the criteria identified in the PAF have been combined into a single criterion in the section below. Department of Planning and Infrastructure, Project Assurance Framework Guidelines, 2010.

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Table 40: Summary of public interest criteria

Public interest element

General considerations by most jurisdictions regarding each element

Considered in the preliminary evaluation stage

Effectiveness in meeting the service requirement

Identify minimum government standards and service delivery requirements applicable to the prioritised rural and remote sites Consider output/service delivery requirements in similar projects that have already been delivered

Yes but should be further investigated at the business case stage as more detailed planning becomes available

Distributional equity and impact on stakeholders

Identify: the individuals and sectors of the

community that will be affected by the Project and how they will be affected (including service provision and during construction)

relevant rights of affected individuals and communities, including: - any legal requirements - current government policy

requirements - minimum requirements from

previous similar projects–mitigation of adverse impacts on key groups related to project process

Yes but further investigation will be required at the business case stage, based on more detailed planning for the site and consultations with stakeholder groups Although this is assessed as part of the Preliminary Evaluation, Section 5.7.3 provides a discussion of how this can be further considered at the business case stage.

Accountability and transparency

Identify: the mechanisms that are in place to

ensure that the community can be well informed about the obligations of the government and any private providers involved in the process

the avenues of independent oversight

Not able to be considered at the Preliminary Evaluation stage; see Section 5.7.3 for a discussion of how this can be considered at the business case stage.

Public access Identify the mechanisms to ensure ongoing public access to essential infrastructure and a continuous supply of services Consider: if there are adequate arrangements

to ensure that disadvantaged groups can effectively use the infrastructure

the implications for rural and remote areas


Consumer rights Identify: those recipients to whom government

owes a high level of duty of care those who are most vulnerable Do any rights or needs of these recipients need to be provided for, or protected by government: at law under government policy

Not able to be considered at the Preliminary Evaluation stage; see Section 5.7.3 for a discussion of how this can be considered at the business case stage

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Public interest element

General considerations by most jurisdictions regarding each element

Considered in the preliminary evaluation stage

Security Identify the mechanisms by which the Project provides assurance that community health and safety will be secured


Privacy Identify: the users’ rights to privacy governments’ obligations to the

public under law governments’ obligations under

government policy any other undertaking by government

to the public, to preserve the rights to privacy identified above

Not able to be considered at the Preliminary Evaluation stage; see Section 5.7.3 for a discussion of how this can be considered at the business case stage.

The public interest criteria are discussed in more detail below.

Effectiveness in meeting service requirement

This first criterion relates to the effectiveness of the Project in meeting the government’s key service requirements. Through discussions with Queensland Health, three closely aligned key service requirements have been identified:

accessibility

sustainability

safety.

Accessibility refers to the capacity for the public to access a network of well-integrated, safe public health services in a timely manner. This includes capacity for the local hospital to meet projected demand from the relevant catchment, at the appropriate level of service as outlined in the draft CSCF v3.0 (Appendix 4) This criterion does not suggest that all health care services should be available locally for all Queensland residents, but rather that rural hubs should provide health services in line with Queensland Health policy.

Sustainability refers to the provision of health services in a manner which ensures workforce, environmental and economic sustainability. The level of sustainability associated with a health facility is closely related to accessibility. For example, if skilled staff are not able to be recruited or retained then service provision will not be sustained. A Project option that did not enhance the attraction and retention of staff would be assessed as not in the public interest.

Another issue that may affect environmental and economic sustainability of the health service is the operational efficiency of the facility. If a Project option involves an improvement to the water, energy or waste efficiency of a building, this is assessed to be in the public interest.

Safety refers to fostering a safe environment for all stakeholders and maintaining clinically appropriate care for patients. Compliance with the Building Code of Australia represents a good proxy for measuring the safety of the environment for delivering health services. If a Project option substantially addresses major safety risks this is assessed to be in the public interest; conversely, if the Project option is found to be non-compliant with the Building Code of Australia it is assessed to be significantly adverse to the public interest.

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This criterion concerns the impact of the identified Project option on all individuals and sectors of the community; including patients, carers, hospital staff, members of the local community as well as the wider Queensland population. It particularly relates to instances where an identified Project option may infringe on the rights of groups or individuals (especially vulnerable groups or individuals) and their equitable access to resources. For example, a Project option could be assessed as being significantly adverse to the public interest if services were not available to meet the needs of vulnerable groups.

An option could also be assessed as not in the public interest if it involved significant disruption to local residents during construction.

Where possible, the identification of the relevant rights of affected individuals and communities should align with legal requirements, current government policy requirements and relevant standards and guidelines.

At the preliminary evaluation stage, it is not possible to assess all the aspects of distributional equity and impact on stakeholders for each of the identified Project options, as sufficient detail has not been developed. Rather, a discussion of potential distributional equity and impacts on stakeholders of the Project options, should all or any of them progress to Business Case, is provided in Section 5.7.3.

Accountability and transparency

This criterion concerns the ability of the identified Project option to meet disclosure and transparency requirements of a legal or policy nature. This includes the identification of mechanisms to ensure that the community can be well informed about the obligations of the government and any private providers involved in the process and to identify avenues of independent oversight. This criterion relates less to the outcomes of the Project itself than to the process of Project procurement and delivery. For example, if Queensland Health contracted providers for initial construction and on-going maintenance, it would be important to correctly balance transparency and confidentiality during the bidding process.

At the preliminary stage, the procurement process for the identified Project options is yet to be determined so it has not been possible to develop an assessment of the impact of the options on accountability and transparency. A discussion of general accountability and transparency considerations, should all or any of the Project options progress to Business Case, is provided in Section 5.7.3.

Public access

Public access refers to the provision of access to the community in a way that is sensitive to cultural differences and enabling for persons with disabilities. This relates not merely to whether services are available but whether all persons can access them. While accessibility refers to the provision of appropriate health services, public access considers the specific barriers that may be experienced by particular groups within the community. Potential barriers to public access include financial, cultural, linguistic, distance and lack of mobility. Particular attention is paid to barriers affecting disadvantaged individuals and communities and those living in rural and remote areas.

A Project option could be assessed as significantly adverse to the public interest if the option was assessed to be non-compliant with the Disability Discrimination Act. Conversely, if a Project option is assessed to bring the facility into compliance with the Disability Discrimination Act, it is assessed to be in the public interest.

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Consumer rights

This criterion considers whether the Project has sufficient safeguards for users of health services especially vulnerable users and those for whom the government has a high duty of care. In identifying potential issues relating to consumer rights the Australian Charter of Healthcare Rights could be used as a key reference. For example, some Project options may require the temporary or permanent transfer of patients to an alternative facility. Under the Australian Charter of Healthcare Rights, patients have a right to participation in choices. Careful consideration would need to be given to whether this means patients need to be given the right to participate in the choice of an alternative facility.

At the preliminary evaluation stage it has not been possible to develop an assessment of the impact of the options on consumer rights. A discussion of general consumer rights considerations relevant to the Project options, should all or any of them progress to Business Case, is provided in Section 5.7.3.

Security

This criterion considers the ability of the infrastructure to withstand events that may impact the security of health service supply. Major risks to the security of supply of health services include infrastructure-related hazards such as flooding, fire, high wind events, and/or mechanical failure. An option that failed to address one or more of these hazards would be assessed as adverse to the public interest. Conversely a Project option would be assessed as being in the public interest if it resulted in the facility being relocated above the flood line where flooding was an issue.

Privacy

This criterion concerns whether a Project option considered the rights to privacy of patients and staff. Under the Australian Charter of Healthcare Rights, patients have a right to privacy and confidentiality with regard to personal information. Commonwealth and Queensland government information privacy legislation also imposes important obligations. For example a Project option may face privacy issues if the option involves changing the location of record keeping facilities. Safeguards would need to be in place to ensure patient records are kept secure during the process of relocation and that the relocation adheres to privacy legislation.

At the preliminary evaluation stage it has not been possible to develop an assessment of the impact of the options on privacy aspects. A discussion of general privacy considerations relevant to the Project options, should all or any of them progress to Business Case, is provided in Section 5.7.3.

Criteria scoring system

Options are scored according to their ability to meet the above criteria. Table 41 shows the criteria scoring system. Scores range from for a Project option that generates an outcome that is significantly adverse to the public interest to for a Project outcome that is significantly in the public interest.

In general, Project options are assessed to be either in the public interest () or not in the public interest (). An option will only be scored significantly not in the public interest ( ) if the option creates considerable risks with a limited capacity to mitigate the risks. Similarly, an option will only be scored significantly in the public interest () if the option represents an exceptional and timely improvement that mitigates all risks.

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Table 41: Criteria scoring system

Ability to meet the criteria Score

Significantly in the public interest

In the public interest

Not in the public interest

Significantly adverse to the public interest

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Table 42 demonstrates how the scale is applied to each of the assessment criteria.

Table 42: Public interest assessment scale

Significantly adverse to the public

interest





Acc

essi

bili

ty

This is not scored as it was judged that the Project option would either meet or not meet the relevant standard.

Does not meet the requirements to provide some of the core and related support services at a Level 3 draft CSCF v3.0 and/or there are significant shortfalls in the hospital’s capacity to meet projected demand

Meets the major requirements to provide the core and related support services at a Level 3 draft CSCF v3.0 and/or there are shortfalls in the hospital’s capacity to meet projected demand

Meets all requirements to provide core and related support services at a Level 3 draft CSCF v3.0 and the hospital is able to meet projected demand

Su

stai

nab

ility

Exacerbates existing issues relating to economic, workforce and environmental sustainability

Does not support or promote economic, workforce and environmental sustainability

Supports and promotes economic, workforce and environmental sustainability

Provides optimal conditions for economic, workforce and environmental sustainability

Saf

ety

Generates immediate life-threatening risks and is significantly non-compliant with the Building Code of Australia

Significant risks to the safety of staff, patients and the community, and not fully compliant with the Building Code of Australia

Provides a safe environment for staff, patients and the community, and is compliant with the Building Code of Australia

Provides a safe environment for staff, patients and the community, is fully compliant with the Building Code of Australia and addresses key access issues that relate to patient safety

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Significantly adverse to the public

interest





Adversely impacts vulnerable individuals and groups and unable to provide any core and related services as determined by Queensland Health policy for rural and remote communities Significant disruption to and/or temporary suspension of services during construction Significant adverse impacts on buildings or land of cultural significance

Some adverse impact on vulnerable individuals and groups and able to provide only some of the core and related services as determined by Queensland Health policy for rural and remote communities Some disruption to and/or temporary suspension of services during construction Some adverse impact on buildings or land of cultural significance

No adverse impact on vulnerable individuals and groups and able to provide all core and related services as determined by Queensland Health policy for rural and remote communities Minimal disruption of services during construction No adverse impact on buildings or land of cultural significance

Positive impact on vulnerable individuals and groups and able to exceed core and related service provision as determined by Queensland Health policy for rural and remote communities No disruption of services during construction Preserves and/or enhances buildings or land of cultural significance

Public access

Does not address barriers to accessing services experienced by vulnerable groups and does not comply with the Disability Discrimination Act

Does not address all barriers to accessing services experienced by vulnerable groups and complies with some requirements of the Disability Discrimination Act

Removes major barriers to accessing services experienced by vulnerable groups and complies with most requirements of the Disability Discrimination Act

Provides optimal access to all members of the community and fully complies with the Disability Discrimination Act

Security

Significant risks to security of supply of health services due to likely infrastructure-related hazards such as flooding, fire, high wind events, and/or mechanical failure

Some risks to security of supply of health services due to potential infrastructure-related hazards such as flooding, fire, high wind events, and/or mechanical failure

Most risks to security of supply of health services due to potential infrastructure-related hazards such as flooding, fire, high wind events, and/or mechanical failure are substantially mitigated

All risks to security of supply of health services due to potential infrastructure-related hazards such as flooding, fire, high wind events, and/or mechanical failure are fully addressed

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Relevant sources

This assessment has drawn on a variety of sources to support the assessment against the criteria. These include:

the draft CSCF v3.0 (Appendix 4)

the Disability Discrimination Act

the Building Code of Australia.

5.7.2 Outcomes and analysis

Summary of outcomes

The primary reference documents used to assess the options were the Infrastructure Study and the Service Profiles.

Table 42 provides a summary of the assessment outcomes for the public interest assessment by Hospital and criteria as outlined in Table 43. The detailed options analysis for each Hospital for the public interest is outlined in Appendix 8.

Option 1 is not in the public interest for most Hospitals as generally it does not effectively meet service requirements, distributional equity, public access and security. The exceptions to this are the following:

Atherton Hospital meets public access

Ayr Hospital meets public access and security

Charleville, Charters Towers, Kingaroy, Longreach, Roma, Sarina and Thursday Island Hospitals all meet security requirements.

Option 2 is generally assessed as effective in meeting service requirements and so is assessed as being in the public interest.

In all instances Option 3 is considered to be in the public interest with Option 3 generally scoring a higher result due to extensive refurbishment or new builds with the following exceptions:

Ayr Hospital—Option 2 provides a preferred option as in this option the unused aged care building is refurbished to address capacity issues in the acute block and increases employee housing accommodation. Whereas Option 3 would leave the aged care building unused and a long term maintenance issue.

Emerald Hospital—Option 2 addresses the major capacity and capability issues for surgical/procedural, maternity, emergency and general medical services. Option 3 provides additional capacity to meet future demand.

Table 43: Summary of assessment outcomes


Atherton Hospital

Effectiveness in meeting service requirements


Public access

Security

Ayr Hospital


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Public access

Security

Biloela Hospital



Public access

Security




Public access

Security




Public access

Security

Emerald Hospital



Public access

Security

Kingaroy Hospital



Public access

Security

Longreach Hospital



Public access

Security

Mareeba Hospital



Public access

Security

Roma Hospital



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Public access

Security

Sarina Hospital



Public access

Security




Public access

Security


Sustainability, safety and accessibility has been assessed for each Hospital to determine the effectiveness in meeting service requirements. For detailed information on each assessment criteria refer to individual Hospital details provided in Appendix 8.

When assessing the options against accessibility, sustainability and safety, Option 1 is assessed to be not in the public interest for all Hospital facilities, whereas Option 2 and 3 are assessed as in the public interest. There are some variations as detailed in Appendix 8 where Option 3 is significantly in the public interest.

It should be noted for Ayr Hospital that while Option 2 and 3 were both assessed as being in the public interest, Option 2 would refurbish the unused aged care building to better address capacity issues in the acute block, whereas Option 3 would leave the building unused and present ongoing maintenance and capacity issues.

Accessibility

Currently, there are a number of safety issues at all the Hospitals, including fire safety, occupational health and safety, security, infection control and disability access. These issues impact on the ability of the Hospitals to meet the requirements for Level 3 draft CSCF v3.0 services and to provide sufficient capacity to meet current and projected demand.

Although Option 1 generally involves substantial measures to address these issues, these are not sufficient to upgrade the facility to comply with requirements to deliver services at Level 3 draft CSCF v3.0, or to fully comply with the current standards, with the exception of Ayr Hospital. All Hospitals are assessed under Option 1 as not in the public interest noting that Charleville, Emerald and Thursday Island are assessed as significantly adverse to the public interest.

Generally Option 2 involves refurbishment that will improve compliance with safety standards, improve conditions to address workforce recruitment and retention issues and generally enable the provision of Level 3 draft CSCF v3.0 services and meet demand requirements.

Due to extensive refurbishment and/or new builds involved, Option 3 is an improvement on Option 2 as it provides compliance with requirements to deliver services at Level 3 draft CSCF v3.0 and fully meets service demand.

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Sustainability

Option 1 proposes few changes that will lead to improved sustainability of services. However this option generally makes substantial improvements to access and safety, but does not meet the requirements to ensure workforce, environmental and economic sustainability.

Biloela Hospital is the exception where Option 1 includes construction of a new Emergency and Outpatients Department—despite this, it does not resolve all issues for Biloela Hospital.

In terms of workforce sustainability, Option 1 makes some improvement to access and safety issues but does not address functional inefficiencies, capacity and capability requirements impacting on workforce sustainability. Improvements to workplace condition, security, staff amenities and provision of appropriate employee housing accommodation is addressed through Options 2 and 3.

The improvements for environmental sustainability under Option 1 are unlikely to be significant. Options 2 and 3 will have a positive impact on sustainability by reducing energy costs and ongoing capital expenditure addressing public concerns about energy consumption.

In most instances Option 3 provides a much larger proportion of new build. Consequently Hospitals are expected to be more energy efficient, achieving part or full compliance with the Queensland Health Energy Efficiency Guidelines. In particular Option 3 for Atherton and Roma Hospitals were assessed as significantly in the public interest for sustainability as compared with Option 2 (Appendix 8).

Safety

All options seek to address the serious safety risks identified. Option 1, however, will not ensure that Hospitals will be fully compliant with current standards, despite upgrades. The exceptions are Ayr, Charters Towers, Mareeba and Roma Hospitals. Conversely for Option 1 Biloela Hospital has been assessed as significantly adverse to the public interest. This will impact on the ability to deliver some services at a Level 3 draft CSCF v3.0 service capability.

Options 2 and 3 include all improvements proposed in Option 1. In addition any new construction and/or major refurbishments will comply with current Building Code of Australia and Disability Discrimination Act standards. The options are also expected to address all of the major safety issues at each Hospital. In particular Option 3 for Charleville and Sarina Hospitals were assessed as significantly in the public interest for safety as compared with Option 2 (Appendix 8).

In a number of cases both Option 2 and 3 seek to retain and refurbish existing buildings. In these instances refurbishment works will address current standards.


Under Option 1 Hospitals will generally have difficulty meeting both capacity and capability requirements. This has a negative impact on all groups, including international/Culturally and Linguistically Diverse (CALD), Aboriginal and Torres Strait Islanders, lower socio-economic groups and persons with a disability.

Option 1 fails to ensure that core and related support services are provided at a level determined by Queensland Health as necessary for rural and remote communities and is assessed to be significantly adverse to the public interest for Atherton and Longreach Hospitals. For the remaining Hospitals Option 1 is considered to be not in the public interest.

Option 2 and 3 ensures that the service capacity and capability is sufficient to meet the current and projected demand for services in the relevant Hospital catchments to 2021. These options go some way to ensuring that distributional equity is achieved. However, for Option 2 most

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Hospitals would experience decanting and disruption issues during construction. This would be considered to not be in the public interest unless mitigated during this time.

Unlike Option 1, Option 2 and 3 make significant improvements to the condition of employee housing accommodation.

Generally Option 3 has an advantage over Option 2 in that a greater proportion of building is proposed for refurbishment or a new build is provided and therefore decanting and disruption issues would be reduced. Option 3 is assessed to be in the public interest for most Hospitals and it is significantly in the public interest for Atherton Hospital.

Public access

Option 1 has a positive impact on public access by making improvements to ensure access for persons with a disability. In most cases, however, it is significantly adverse to the public interest except for Atherton, Ayr and Charleville Hospitals where it has been assessed as in the public interest.

Option 2 further enhances compliance with the Disability Discrimination Act, and is assessed to be in the public interest with respect to providing public access to essential health services. The exception to this is Biloela Hospital where Option 2 is assessed to be significantly adverse to the public interest.

Like Option 2, Option 3 includes significant upgrades of the Hospital to current standards including the Building Code of Australia and the Disability Discrimination Act and meets the requirements for providing services at a capability for Level 3 draft CSCF v3.0 services. Option 3 provides a positive impact on public access by providing increased proportion of new build, refurbishments and site improvement.

Security

Infrastructure at all Hospitals presents a number of security issues for ensuring the delivery of health services. Option 1 provides an improvement on the current security of supply; however, as many of the Hospital’s structural deficiencies are not addressed, the option is assessed as not being in the public interest with respect to security of supply requirements.

Option 2, like Option 1, would rectify serious risks to supply of health services for all Hospitals. This option is an improvement on Option 1 as it addresses a greater number of structural limitations of the site and functional inefficiencies at all sites. This option has been assessed as being in the public interest with respect to security of supply for essential health services.

Option 3 is an improvement on Option 2 in that it would address a greater number of functional inefficiencies at the site, with the exception of Ayr Hospital. This option is assessed as being in the public interest with respect to security of supply for essential health services. Option 3 is assessed as being significantly in the public interest for Charleville Hospital as it is the only option that ensures the Hospital is above the flood line,

5.7.3 Considerations for the Business Case

This public interest assessment is necessarily preliminary, given the Project’s current state of development. All dimensions of public interest should be considered at greater depth at a business case stage, should any of the Project options progress to a more detailed phase of analysis. In particular, the following key points should be taken into consideration:

Accountability and transparency—encourages the efficient, effective and ethical procurement of goods and services to support the operation of any future facility. Queensland Health officials have the responsibility of ensuring that any procurement process is open and transparent and that decisions are justified, and that it is accountable

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for outcomes. Queensland Health will need to ensure it has procedures in place to ensure that procurement processes are conducted soundly and decisions are documented, defensible and substantiated facilitate. The appropriate mix and level of documentation depends on the nature and risk profile of the procurement that is ultimately undertaken following the findings of the Business Case. In all cases, Queensland Health officials need to ensure documented procedures, including all relevant decisions, including approvals, authorisations, and the basis of those decisions

Distributional equity—the business case stage should incorporate stakeholder consultations around more detailed design builds to ensure no patient cohorts or community groups are substantially disadvantaged. Where a Project option is identified to be significantly adverse to a particular group’s interests, strategies to mitigate this outcome should be undertaken and built into the proposed project plan. Mechanisms to ensure distributional equity should be appropriately documented

Consumer rights—the business case stage should incorporate stakeholder consultations around more detailed design builds to consumer rights are not infringed. In particular, the Business Case should identify a plan to ensure sufficient safeguards for the users of the health services during any construction and transition periods. Mechanisms to ensure consumer rights are respected should be appropriately documented

Privacy—at the business case stage, a more detailed design will be available which will allow analysis of whether any of the proposed options will infringe on patient and/or staff privacy rights. Any option that is pursued will need to be compliance with relevant Commonwealth and Queensland privacy legislation. The Business Case will need to set out a plan to ensure that actions are put in place to manage any potential risks to privacy.

5.8 Procurement Assessment

5.8.1 Assessment approach The PAF Preliminary Evaluation Guidelines require a qualitative assessment of the potential for greater value for money to be achieved under a PPP delivery option, as compared to traditional delivery models.

The purpose of the procurement assessment is to provide a preliminary assessment of the characteristics of potential procurement models in terms of their effectiveness at satisfying specific Project criteria in order to:

establish two or three preferred procurement models to be evaluated during the business case stage

determine whether the Project has the potential for PPP procurement and hence should be considered under the VfM Framework during the business case stage.

The potential procurement models considered for the Project are set out below:

traditional delivery models:

– Construct-Only – Construction Management – Project Alliancing – Design and Construct (and a variation including maintenance) – Managing Contractor (and a variation including maintenance)

PPP model.

Throughout the process, a number of workshops and discussions were held with representatives from Queensland Health, Department of Infrastructure and Planning,

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Queensland Treasury and the Department of Public Works to agree the procurement evaluation assessment approach, evaluation criteria and inputs and final outcomes.

Typically, as part of a Business Case, a comparative analysis of two preferred traditional procurement models (for example Managing Contractor and Design and Construct) would be undertaken. In a VfM Framework Business Case, the preferred traditional delivery model would form the Public Sector Comparator for comparison against the PPP model.

As a departure from the PAF Preliminary Evaluation Guidelines, it was agreed by the representatives of Queensland Health, Department of Infrastructure and Planning, Queensland Treasury and the Department of Public Works that no traditional delivery models should be ruled out at this stage. Instead, the focus of the procurement strategy work within the Preliminary Evaluation would be to determine whether the Project had the potential to achieve greater value for money under a PPP delivery model and hence whether the VfM Framework should be applied for the Business Case.

This departure was agreed to given the early development nature of the Project and the consequent lack of detailed information on factors such as design input requirements, staging and decanting arrangements and ability to transfer risk, which are important determinants for the suitability of different procurement models. It would be premature to exclude any traditional models at this point, as they may subsequently prove suitable, once this information is available.

The assessment approach adopted for the Project is outlined in Figure 4.

Figure 4: Project assessment approach

Establish procurement evaluation criteria

This step involved establishing primary and secondary evaluation criteria against which each of the Project options were assessed.

The primary evaluation criteria comprised the PPP threshold test to establish whether the whole-of-life costs for each Project option would exceed $100 million.

The secondary evaluation criteria looked at more specific characteristics of each of the delivery models, as shown in Table 44. The criteria were based on the original 14 criteria outlined in the PAF Preliminary Evaluation Guidelines; however, some of the original criteria were refined to make them more specific to the Project. The final criteria were normalised against each category to ensure that the final weightings were in accordance with the original criteria.

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Table 44: Evaluation criteria

No. Category Key elements analysed

1 Requirements The ability of the model to deliver the required outcomes in terms of: quality of the design and constructed facility robustness and functionality of the design accommodating Queensland Health’s detailed design inputs,

such as specific operating theatre layouts, into the design process

2 Requirements The ability of the model to deliver the required outcomes in terms of allowing for future proofing and flexibility development due to changed operational needs (including during the asset life)

3 Requirements The ability of the model to provide the opportunity for bundling of ancillary services

4 Timeline The ability of the model to deliver the Project in the required timeframes and enable effective management of risk around delays focussing on: certainty regarding achievement of Project completion dates providing progressive delivery and completion throughout

the construction timeframe (supporting decant requirements)

5 Timeline The ability of the model to deliver the Project in the required timeframes and enable effective management of risk around delays focussing on commencement of construction as early as possible

6 Budget for capital costs

The ability of the model to provide budget certainty in respect of the construction of the facility and remove unexpected funding requirements

7 Budget for operating costs

The ability of the model to provide budget certainty in respect of the maintenance and refurbishment costs of the facility and remove unexpected funding requirements

8 Whole-of-life design and maintenance

The extent to which the model promotes a whole-of-asset life management solution, including incentive to optimise life-cycle, general maintenance and inter-related service provision

9 Market appetite and capability

The ability of the model to attract small primary local contractors


The ability of the model to attract large private sector players

11 Stakeholder and scope management

The ability of the model to ensure that delivery of the Project is consistent with stakeholder interest and stakeholder expectations are effectively managed The ability of the model to effectively manage scope change requests by stakeholders and to minimise impact on cost, time and quality

12 Risk management The extent that the procurement model allows for: appropriate allocation of risks to the party best placed to

manage the risk at the lowest cost efficient risk management and/or mitigation

13 Cost minimisation The ability of the model to reduce capital costs

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No. Category Key elements analysed

14 Cost minimisation The ability of the model to reduce operation costs

15 Cost minimisation The ability of the model to minimise tender costs

16 Innovation The ability of the model to achieve innovation in design, construction methods, construction program, life-cycle and ecologically sustainable development considerations, achievement of requirements, etc

17 New versus refurbishment

The ability of the model to address the Project's requirements in respect of new build (greenfield) as well as refurbishments (brownfield)

18 Industrial relations The ability of the model to effectively manage and deal with industrial relations issues

19 Asset utilisation/Commercial Opportunities

The ability of the model to draw on the innovation and risk capital from the private sector in the delivery of additional commercial opportunities

20 Complexity of staging and decanting

The ability of the approach to deal with complexity of construction program in respect of staging and decanting

Assess delivery models

The next step in the assessment approach involved an evaluation of each of the procurement delivery models against the evaluation criteria in accordance with the scoring regime set out in Table 45.

Table 45: Procurement model scoring regime

Analysis rating

Rating scale

Definition

√√√ 4 Procurement model fully, or almost fully, satisfies the evaluation criteria by meeting all, or substantially all, criteria requirements

√√ 3 Procurement model is effective in satisfying the criteria requirements

√ 2 Procurement model just satisfies the evaluation criteria by meeting minimum criteria requirements

X 1 Procurement model is ineffective in meeting the criteria requirements

XX 0 Procurement model is extremely ineffective in satisfying the criteria requirements

Project option priorities

This step involved allocating a priority weighting against each of the evaluation criteria for each of the Project options. This represents the relative importance of each criterion to the Project option. The scoring applied to these priorities is set out in Table 46.

Table 46: Project option evaluation priority weightings

Priority Score

High 3

Medium 2

Low 1

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Nil 0

The prioritisation of evaluation criteria for each Project option is set out in Appendix 11.

Model evaluation

The PPP threshold test, the prioritisation of secondary criteria, and the delivery model scoring were then applied to a procurement matrix. This calculated a total score for each procurement model, by applying a normalised weighted priority score for each criterion to each delivery model’s performance score for that criteria and summing the outputs. This established the relative performance of each delivery model under each of the Project’s options and identified whether PPP could potentially provide value for money as a delivery model. An example output of the procurement matrix and the scores of each delivery model for each option for one of the sites is set out in Appendix 10.

Under the PAF Preliminary Evaluation Guidelines, the lower scoring delivery models would typically be excluded from further consideration. However, as described above, for the purposes of this Preliminary Evaluation, only PPP has been excluded where it is not feasible and all traditional delivery models have been retained.

Qualitative assessment

The procurement matrix cannot fully reflect specific challenges associated with certain Project options (such as timing, economic climate, design development, interface with existing hospital operations, capital budget, staged construction, location, expected maintenance arrangements and stakeholder issues) and therefore may still include a PPP delivery model for some Project options, where it may not be optimal.

This step therefore involved a qualitative assessment workshop with representatives of Queensland Health, Department of Infrastructure and Planning, Queensland Treasury and the Department of Public Works that reviewed the results from the evaluation against the Project option-specific drivers to remove any obvious anomalies.

5.8.2 Procurement analysis Table 47 provides a summary of the results from the procurement model evaluation.

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.

Table 47: Summary of the procurement model analysis results

Delivery Model

Atherton Option 1:

Status quo

Atherton Option 2: Refurbish

plus housing

Atherton Option 3:

Redevelop plus housing

Ayr Option 1:

Status quo

Ayr Option 2: Refurbish

plus housing

-Ayr Option 3:


Biloela Option 1:

Status quo

Biloela Option 2: Refurbish

plus housing

Biloela Option 3:


Charleville Option 1:

Status quo

Charleville Option 2: Refurbish

plus housing

Charleville Option 3:


Indicative capital cost1 $26 million $106 million $108 million $2 million $22 million $20 million $15 million $69 million $73 million $8 million $72 million $79 million

Construct-only 7 8 8 4 4 4 4 7 8 3 7 7

Construction management

4 6 6 2 2 2 2 4 7 2 4 6

Project alliancing 4 5 5 6 6 6 6 3 5 6 3 4

Design & construct excluding maintenance

6 7 7 5 5 5 5 6 6 5 6 5

Design & construct including maintenance

3 4 4 7 7 7 7 5 4 7 5 3

PPP Unsuitable Anomaly Suitable1 Unsuitable Unsuitable Unsuitable Unsuitable Unsuitable Suitable Unsuitable Unsuitable Unsuitable

Managing contractor excluding maintenance

1 1 3 1 1 1 1 1 3 1 1 1

Managing contractor including maintenance

2 2 2 3 3 3 3 2 1 4 2 2

Delivery Model

Charters Towers

Option 1: Status quo

Charters Towers

Option 2: Refurbish

plus housing

Charters Towers

Option 3: Redevelop

plus housing

Emerald Option 1:

Status quo

Emerald Option 2: Refurbish

plus housing

Emerald Option 3:


Kingaroy Option 1:

Status quo

Kingaroy Option 2: Refurbish

plus housing

Kingaroy Option 3:


Longreach Option 1:

Status quo

Longreach Option 2: Refurbish

plus housing

Longreach Option 3:



Construct-only 4 7 8 3 7 7 3 7 7 6 7 7


2 4 7 4 4 5 2 4 4 4 4 6



5 6 5 5 6 6 5 6 6 3 6 5


7 5 4 7 5 3 7 5 5 5 5 3

PPP Unsuitable Unsuitable Suitable 1 Unsuitable Unsuitable Unsuitable Unsuitable Unsuitable Unsuitable Unsuitable Unsuitable Unsuitable


1 1 3 1 1 2 1 1 1 1 1 2

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.


3 2 2 2 2 1 4 2 2 2 2 1

Delivery Model

Mareeba Option 1:

Status quo

Mareeba Option 2: Refurbish

plus housing

Mareeba Option 3:


Roma Option 1:

Status quo

Roma Option 2: Refurbish

plus housing

Roma Option 3:


Sarina Option 1:

Status quo

Sarina Option 2: Refurbish

plus housing

Sarina Option 3:


Thursday Island

Option 1: Status quo

Thursday Island

Option 2: Refurbish

plus housing

Thursday Island

Option 3: Redevelop

plus housing


Construct-only 4 6 7 3 7 7 3 7 7 7 7 8


2 4 3 2 5 5 2 4 5 6 5 6



5 3 4 5 6 6 5 6 6 3 6 7


7 5 6 7 4 4 7 5 3 5 4 4

PPP Unsuitable Unsuitable Unsuitable Unsuitable Unsuitable Unsuitable Unsuitable Unsuitable Unsuitable Unsuitable Unsuitable Anomaly


1 1 1 1 1 2 1 1 2 1 1 2


3 2 2 4 2 1 4 2 1 2 2 1

1 Indicative capital cost comprises forecast capital expenditure costs as identified in the Infrastructure studies plus ICT capital expenditure identified in the ICT Plans.

█ Procurement delivery model may be suitable

█ Procurement delivery model is not suitable

█ Possible anomaly—PPP procurement delivery model may not be appropriate.

Atherton Option 2 and Thursday Island Option 3, which the procurement matrix proposed as a potential PPP, were identified during the workshop as possible anomalies.

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5.8.3 Findings and recommended procurement strategy During the procurement evaluation the possibility for bundling sites within the Project in order to generate procurement-scale efficiencies was considered but deemed problematic due to likely differences in the timing of when sites might come to market.

On a site by site procurement basis, the results of the assessment indicate that the following procurement methods should be considered during the business case stage:

Option 1: For all of the Hospitals within the Project, this option is not suited to a PPP due to the whole-of-life costs not exceeding the PPP threshold test. A traditional delivery method should be considered for Option 1 for all sites.

Option 2: With the exception of Atherton, this option is not suited to a PPP for any of the sites. In most cases, the whole-of-life costs are not expected to meet the PPP threshold test and in addition, the nature of the option as a refurbishment of the existing facilities (as compared to new build) and likely ongoing internal maintenance arrangements, create particular barriers to achieving value for money through PPP for projects of this scale.

Atherton Option 2 presents an anomaly as the whole-of-life costs would exceed the PPP threshold. However, the location and the increased complexity and cost associated with transferring risks associated with the reuse of existing infrastructure is unlikely to deliver value for money through delivery via PPP.

A traditional delivery method should therefore be considered for Option 2 at all sites.

Option 3: Both traditional and PPP delivery methods should be considered for Option 3 for Atherton, Biloela and Charters Towers. While Biloela and Charters Towers at an indicative capital cost are slightly below the PPP threshold, the nature of all three of these options, which are fundamentally new builds rather than redevelopment of existing facilities, lends itself well to PPP delivery. A PPP delivery model may provide opportunities for value for money in regard to both ‘hard’ (e.g. maintenance services) and ‘soft’ (e.g. cleaning, catering and security services) facilities management. However, any outsourcing of maintenance and other services may give rise to industrial relations issues, as identified in the risk analysis in Section 5.1.

Thursday Island Option 3 presents an anomaly as the whole-of-life costs are expected to exceed the PPP threshold. However, due to the remote location, nature of redevelopment in a very restricted site and likely internal maintenance arrangements, this option is unlikely to deliver value for money through a PPP delivery model.

A traditional delivery method should be considered for Option 3 for all of the following sites:

Ayr

Charleville

Emerald

Kingaroy

Longreach

Mareeba

Roma

Sarina

Thursday Island.

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As noted above, in view of the early stage of the Project, it is not appropriate to limit the range of traditional procurement options at this point. Accordingly, as options are further developed through the business case stage, specific option characteristics should be considered relative to the applicability of certain procurement models. This will enable the traditional models to be refined to a preferred model(s) for the purpose of comparative analysis.

5.9 Comparison of Options

5.9.1 Alignment with criteria The options analysis undertaken for each of the options allows us to eliminate any unfeasible options, and also to rank them with regard to:

cost

risk

ability to meet the outcome sought.

In assessing each option, the evaluation criteria outlined in Section 4.1 has been utilised and a summary of the findings is shown in Table 48 below. The assessment has also been completed on an individual basis for each Hospital and is included in Appendix 12.

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Table 48: Options analysis against evaluation criteria

Criteria Hospital Option 1 Option 2 Option 3 Rationale Reference in options analysis

Capacity

Atherton Does not meet

Meets Meets

Option 1 does not increase the capacity of the Hospitals, and therefore does not meet the required service capacity. The exception to this is Biloela and Longreach, where no growth is planned Options 2 and 3 meet the required service capacity in 2021/22

Economic Impact Assessment and Risk analysis

Ayr

Biloela Meets

Charleville

Does not meet

Charters Towers

Emerald

Kingaroy

Longreach Meets

Mareeba

Does not meet Roma

Sarina

Thursday Island

Capability

Atherton

Does not meet Meets Meets

Option 1 does not increase the capability of the hospitals as no additional workforce is planned under this option Options 2 and 3 meet the required service capability in 2021/22 with the addition of the minimum resource requirements for a Level 3 CSCF v3.0 service at the Hub hospitals and a Level 2 CSCF v3.0 at Sarina Hospital. Information is not available in relation to the ability to meet service capability need in interim years

Public Interest Assessment and Risk analysis

Ayr

Biloela

Charleville

Charters Towers

Emerald

Kingaroy

Longreach

Mareeba

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Roma

Sarina

Thursday Island

Equity of access

Atherton

Does not meet

Meets

Meets

Option 1 does not improve equity of access to healthcare services as it does not meet projected demand for services in the region Options 2 and 3 ensure that future demand for services is satisfied in the medium term, and therefore contributes to improving equity of access. The exception to this is Option 2 for Biloela, which partially meets as it does not fully comply with Disability Discrimination Act requirements Option 3 for Emerald partially meets as the demolition of the original hospital building is not considered favourable to stakeholders

Economic Impact Assessment and Public Interest Assessment

Ayr

Biloela Partially Meets

Charleville

Meets

Charters Towers

Emerald Partially Meets

Kingaroy

Meets

Longreach

Mareeba

Roma

Sarina

Thursday Island

Quality

Atherton

Does not meet Potentially Meets

Potentially Meets

Option 1 does not provide for the retention and recruitment of sufficiently skilled staff due to the current lack of capacity and ageing infrastructure for service provision. The exception to this is Kingaroy and Mareeba which include minor improvements to workforce conditions Options 2 and 3 may provide the ability to attract and retain sufficient skilled staff. It should be noted that workforce attraction and

Economic Impact Assessment, Public Interest Assessment and Risk analysis

Ayr

Biloela

Charleville

Charters Towers

Emerald

Kingaroy Partially Meets

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Longreach Does not meet retention is already and will continue to be a significant challenge


Roma

Does not meet Sarina

Thursday Island

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Safety

Atherton Does not meet Meets

Meets

Option 1 includes several minor measures to improve safety for staff, patients and visitors at the Hospitals; however it does not address all issues, which varies across sites. The exception to this is Ayr which addresses a number of safety concerns. Option 2 addresses safety issues to varying degrees across sites Option 3 ensures that there are no major safety issues unaddressed at the Hospitals. The exception to this is Mareeba and Roma. Insufficient information exists for Mareeba to make an assessment. Roma includes a number of improvements, but does not fully comply


Ayr Meets

Biloela

Does not meet Partially meets

Charleville

Charters Towers

Emerald Meets

Kingaroy Partially meets Partially Meets



Potentially Meets

Potentially Meets

Roma Partially meets Partially meets

Sarina Does not meet Meets Meets


Sustainability

Atherton

Does not meet

Meets

Meets

Option 1 does not include any measures which are likely to have a meaningful impact on the sustainability of service provision at the Hospitals. The exception to this is Mareeba and Thursday Island which include minor improvements to sustainability Options 2 and 3 are likely to lead to improvements in the sustainability of Rural and Remote Hospitals due to the new buildings being developed utilising environmentally sustainable design. The exception for Option 2 is Ayr, Charters Towers and Thursday Island which will have some impact on sustainability


Ayr Partially meets

Biloela Meets

Charleville

Charters Towers Partially meets

Emerald

Meets Kingaroy

Longreach


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Roma Does not meet

Sarina


Efficiency

Atherton

Does not meet

Partially meets

Meets

Option 1 allows for minimal improvement in functional efficiency and improvement in the contribution to the health care continuum across the sites Option 2 varies across the sites from partially addressing functional and departmental inefficiencies to providing significant improvement in these areas Option 3 in most cases involving significant redevelopment, considerably enhances the efficiency of the hospital

Public Interest Assessment Ayr

Biloela Meets

Charleville

Partially meets Charters Towers

Emerald Meets


Longreach Meets

Mareeba

Roma Partially meet

Sarina Meets

Thursday Island Partially meets

Affordability Program Capital expenditure

$111,835 million

$676,490 million

$830,806 million

Option 1 costs are significant across the facilities but will only address some current infrastructure issues

Financial Analysis

Option 2 includes issues addressed under Option 1 and provides for some additional capacity

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Option 3 represent the highest costs due to the significant redevelopment cost estimates except in the case of Ayr Hospital where a Greenfield redevelopment has been estimated less than the refurbishment of existing infrastructure

Program Recurrent expenditure (incremental)

$6,077 million

$168,164 million

$177,356 million

Option 1 has minimal recurrent cost implications as no increase in the clinical resources is planned under this option

Options 2 and 3 costs are estimated on the establishment of a workforce profile for a Level 3 draft CSCF v3.0 at each Hub hospital and for a Level 2 draft CSCF v3.0 at Sarina Hospital. There is no difference in the planned workforce profile between Option 2 and 3 with the variation in cost estimate being caused by the increased maintenance and depreciation schedule for costlier infrastructure in Option 3

Risk profile All Highest risk option

Medium risk option

Lower risk option

Option 1 comprises a number of extreme risks which can only be mitigated to a limited degree. This option fails to address the fundamental capability and capacity constraints to enable the hub and spoke model

Risk Analysis

Option 2 contains a number of high risks, some can be mitigated through detailed planning, but a number of residual risks such as industrial relations issues will remain

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Option 3 risk profile improves considerably; as with Option 2, industrial relations risks also remain a key focus area, many of the risks can be mitigated through detailed design and project management and workforce planning.

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5.9.2 Cost In accordance with Section 5.2 and 5.3, Table 49 and Table 50 show the findings of the affordability analysis for each Hospital.

Table 49: Total capital costs for Options 1, 2 and 3

Rural and remote Hospitals Option 1($’000s)

Option 2 ($’000s)

Option 3($’000s)

Atherton 25,696 105,817 107,668

Ayr 1,608 21,776 19,633

Biloela 15,245 69,123 72,573

Charleville 7,846 72,114 78,654

Charters Towers 10,420 58,391 101,233

Emerald 7,545 73,544 81,279

Kingaroy 3,362 40,376 43,108

Longreach 11,555 88,094 94,362

Mareeba 7,908 24,320 25,043

Roma 6,218 29,888 32,540

Sarina 2,840 12,345 22,045

Thursday Island 11,592 80,702 152,668

Total 111,835 676,490 830,806

Table 50: Annual recurrent cost for Options 1, 2 and 3

Rural and remote Hospitals Option 1($’000s)

Option 2 ($’000s)

Option 3($’000s)

Atherton 1,464 14,711 14,994

Ayr 91 7,367 7,254

Biloela 784 18,306 18,501

Charleville 410 23,635 24,010


Emerald 393 17,535 17,975

Kingaroy 181 7,736 7,883

Longreach 589 24,146 24,753

Mareeba 420 12,437 12,476

Roma 333 18,286 18,429

Sarina 156 5,910 6,473


Total 6,077 168,305 177,356

This shows that the cost of Option 1 is insignificant in comparison to Options 2 and 3. On a program basis however, these costs are quite large across the facilities given the fact that they will only address some current infrastructure issues.

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The capital costs for Option 3 represent the highest costs due to the significant redevelopment except in the case of Ayr Hospital where a greenfield redevelopment has been estimated to be less costly than the refurbishment of existing infrastructure.

In terms of recurrent costs, Option 1 has minor recurrent cost implications as minimal increase in the clinical resources is planned. Options 2 and 3 are higher given the increase in workforce profile to a Level 3 draft CSCF v3.0 at each Hub hospital and Level 2 draft CSCF v3.0 at Sarina Hospital. There is no difference in the planned workforce profile between Options 2 and 3, the variation in cost estimate is due to the increased maintenance and depreciation schedule for Option 3.

Further detailed analysis of capital and operational costs associated with staging will need to be completed at the business case stage.

5.9.3 Risk (qualitative) As detailed in Section 5.1, Table 51 details the relative option risk ranking for each of the options.

Table 51: Relative option risk ranking

Option Ranking Comments

Option 1 Highest Risk Contains a number of extreme risks which can only be mitigated to a limited degree. This option fails to address the fundamental capability and capacity constraints to enable the hub and spoke model

Option 2 Medium Risk Still contains a number of high risks, reflecting major refurbishment at many of the sites. Some can be mitigated through detailed planning, but a number of residual risks such as industrial relations issues will remain *

Option 3 Lower Risk Risk profile is generally consistent with early stage planning of a major redevelopment of each site. Most risks can be mitigated through detailed design, planning and stakeholder consultation *

* On a mitigated basis, the risk profile would be expected to reduce significantly and Option 2 and 3 could have similar risk profiles for each site

This shows that on an unmitigated basis, Option 1 has the highest risk profile, and Option 3 has the lowest risk profile.

5.9.4 Ability of each procurement option to deliver the service direction In view of the early stage of the Project, it is not appropriate to narrow down the range of traditional procurement options at this point. Therefore, the procurement analysis focussed primarily on determining whether a traditional delivery method or a PPP model would be appropriate for each option at each site.

Table 52 details the results of the procurement assessment.

Table 52: Results of procurement assessment

Option Traditional PPP Reasoning

Option 1 Suitable for all sites Unsuitable for all sites

Whole-of-life costs do not exceed the PPP threshold test

Option 2 Suitable for all sites Unsuitable for all sites

In most cases, the whole-of-life costs are not expected to meet the PPP threshold test and in addition, the nature of the option as a

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Option Traditional PPP Reasoning refurbishment of the existing facilities (as compared to new build) and likely ongoing internal maintenance arrangements, create particular barriers to achieving value for money through PPP for projects of this scale Atherton Option 2 presents an anomaly as the whole-of-life costs would exceed the PPP threshold. However, the location and the increased complexity and cost associated with transferring risks associated with the reuse of existing infrastructure is unlikely to deliver value for money through delivery via PPP

Option 3 Suitable for all sites Suitable only for: Atherton Biloela Charters Towers

In most cases, the whole-of-life costs are not expected to meet the PPP threshold test. For Atherton, Biloela and Charters Towers, the nature of these options, which are fundamentally new builds rather than redevelopment of existing facilities, lends itself well to PPP delivery. While the whole-of-life costs of Thursday Island are expected to exceed the PPP threshold, due to the remote location, nature of redevelopment in a very restricted site and likely internal maintenance arrangements, this option is unlikely to deliver value for money through a PPP delivery model.

As options are further developed through the business case stage, it is recommended that a strong focus be applied to establishing how the specific option characteristics developed impact on the applicability of certain procurement models. This will enable the traditional models to be narrowed down to a preferred model(s) for the purpose of comparative analysis.

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6 Business Case Development

6.1 Proposed approach

The business case development phase follows the Preliminary Evaluation phase and is proposed to be undertaken in line with the PAF Guidelines. Under the PAF Guidelines a very high confidence cost estimate is required to be achieved within the development of the Business Case including a Category 3 capital cost estimate (Capital Works Management Framework Policy Advice Note).

While the Preliminary Evaluation has been prepared for the combined 12 rural sites, due to the individual Hospital project complexities, timing and planning requirements, business case development costs have been prepared at an individual facility level.

Due to the timeframes and complexity of this Preliminary Evaluation phase, it was not possible to narrow down or prioritise the range of potential procurement models to proceed to the business case stage for further evaluation. It is therefore proposed that a two-staged approach to the Business Case is undertaken for those sites where PPP was identified as a potential procurement option, namely Atherton, Biloela and Charters Towers. In addition, due to the potential for grouping with Atherton, it is proposed that business case development for Mareeba Hospital is also undertaken through a two stage approach.

For these projects, Stage 1 will be aimed at finalising the procurement assessment. This assessment will:

establish two or three preferred procurement models to be evaluated during Stage 2 of the Business Case

determine whether the project has the potential for PPP procurement and hence should proceed to a VfM framework or Project Assurance Framework business case stage.

On completion of Stage 1, Queensland Health will seek approval from Queensland Government to proceed to Stage 2 of the Business Case. It is noted that this is a variance to the traditional Project Assurance Framework, as this procurement assessment would usually be undertaken during the Preliminary Evaluation phase.

For all other Hospitals it is proposed to undertake the business case development in a single stage due to the size of the proposed projects and noting that the Preliminary Evaluation identified that only traditional procurement was considered viable for these sites.

The option pursued during the business case phase will depend upon the affordability of the option within the context of overall government priorities. The complexity and cost of preparing a Business Case will also necessarily depend upon the option and or facilities selected.

The resourcing and requirements for development of the Business Case have been based on the preferred option as identified in Section 5.4.2 for each facility. Should alternative options be pursued to those identified, cost estimates will need to be revised, thereby potentially incurring additional expenditure.

Development of the Business Case will provide a Category 3 cost estimate. For those projects proposed to have the Business Case developed over two stages, the combination of

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the two stages will provide a Category 3 cost estimate. To reach this level of confidence all work as listed in Table 53 will need to be undertaken.

Stages of the Business Case

Table 53: Stages of the Business Case

Single Stage Business Case Development (traditional business case)

Two Stage Business Case Development (potential for PPP procurement)

health service planning, including investigation of alternative models of care and delivery of service, e.g. community or hospital

detailed master planning risk analysis (qualitative and quantitative) financial analysis (updated figures) economic analysis confirmation of procurement potential, in

particular potential for private sector involvement.

confirm project organisation and governance arrangements

conduct a detailed comparative evaluation of the options

undertake detailed risk, financial and economic analyses

conduct market sounding and public interest assessment

consider legislative requirements consider whole-of-government regulatory and

policy issues consider procurement/delivery strategies recommend a preferred option and delivery

model develop a project implementation plan for the

preferred option seek approval to proceed.

Stage 1 health service planning, including investigation

of alternative models of care and delivery of service, e.g. community or hospital

detailed master planning risk analysis (qualitative and quantitative) financial analysis (updated figures) economic analysis confirmation of procurement potential, in

particular potential for private sector involvement.

Stage 1 of the Business Case is planned to be completed within a six month period. Stage 1 will need to be completed before Stage 2 can commence. Stage 2 will either progress down the VfM PPP procurement path or traditional procurement depending on the outcomes of Stage 1. It is estimated that this process could take 12-18 months dependant on the procurement model and individual project complexities.

A preliminary project plan outlining key activities in the Business Case preparation (based on traditional delivery) is attached at Appendix 12.

6.2 Project governance structure

The governance arrangements will follow the Health Planning Infrastructure Division Capital Infrastructure Planning and Project Governance Policy and Implementation Standard. The project governance framework to be adopted is illustrated in Figure 5. Project Steering Committee, Strategic Advisors Group and Stakeholder Working Groups will be formed. A modified version of the Terms of Reference used for the Preliminary Evaluation Committee will be used as a starting point.

Probity arrangements will need to be considered based on the complexity of the Project and whether a PPP will be evaluated.

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Figure 5: Project governance framework

Source: Capital Infrastructure Planning and Project Governance Policy Implementation Standard, Queensland Health

6.3 Resource requirements

The complexity of investigations required for Business Case development will require the engagement of specialist external consulting and stakeholder skills including (not limited to):

architecture

project management and programming

engineering (civil, structural and services)

quantity surveying

town planning

financial and economic analysis

environmental and social impact assessment

legal advisors

technical advisors

probity advisors

project management

stakeholder engagement.

Individual Hospital Projects have been assessed as ranging from Tier 2 to Tier 3 Projects based on a preliminary classification. The level of complexity may require Queensland Health to outsource professional project management expertise to facilitate the delivery of the

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Business Case. In the event of outsourcing, Queensland Health will provide technical input. Table 54 provides details on individual Hospital project complexity tiers.

Table 54: Total capital costs for preferred option and tier category

Rural and remote Hospitals Preferred Option

Option1 ($’000s)

Tier2

Atherton Option 3 107,668 Tier 2

Ayr Option 2 21,776 Tier 3

Biloela Option 3 68,188 Tier 3

Charleville Option 3 73,462 Tier 3

Charters Towers Option 3 101,233 Tier 2

Emerald Option 2 66,989 Tier 3

Kingaroy Option 3 43,108 Tier 3

Longreach Option 3 86,261 Tier 3

Mareeba Option 3 22,203 Tier 3

Roma Option 3 31,828 Tier 3

Sarina Option 3 22,045 Tier 3

Thursday Island Option 3 152,668 Tier 2

Total 797,429

1. Based on Capital Cost – Infrastructure and Capital Cost – ICT for the preferred option 2. Capital Infrastructure Planning and Project Governance Policy Implementation Standard (Queensland Health)

6.4 Cost estimate for Business Case development

The whole-of-project cost to construct the preferred options is estimated to be $797.429 million and the base construction cost is estimated at $598.072 million—based on Category 2 confidence level costing.

The total business case cost estimate to achieve a Category 3 confidence level for capital costs and P90 for whole of project costs is $62.767 million (based on traditional business case development). This investment will have advanced the project to schematic design stage.

Table 55 below provides a summary of the estimated business case development costs for each site based on traditional procurement. Appendix 12 provides a detailed breakdown of the cost workup to undertake business case development for each site.

Table 55: Summary of estimated business case development costs

Rural and remote Hospitals Stage 1 Cost ($’000s)

Stage 2 Cost ($’000s)

Total Cost ($’000s)

Atherton 2.042 5.558 7.600

Ayr 3.159 NA 3.159

Biloela 1.833 4.312 6.145

Charleville 5.064 NA 5.064

Charters Towers 2.008 5.355 7.363

Emerald 4.825 NA 4.825

Kingaroy 3.945 NA 3.945

Longreach 5.535 NA 5.535

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Mareeba 1.589 2.862 4.451

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Roma 3.530 NA 3.530

Sarina 3.169 NA 3.169

Thursday Island 7.982 NA 7.982

Total 44.680 18.087 62.767

It should be noted that while business case development costs have been developed for each individual Hospital, efficiencies in resourcing are likely to be achieved where projects are combined within the one business case.

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7 Acronyms Acronym Description

ABS Australian Bureau of Statistics

CSCF Clinical Services Capability Framework

draft CSCF v3.0 draft Clinical Services Capability Framework for Public and Licensed Private Health Facilities v3.0

DEEDI Department of Employment Economic Development and Innovation

FTE Full-time equivalent

ICT Information and Communication Technology

PAF Project Assurance Framework

PPP Public Private Partnerships

SEQIPP South East Queensland Infrastructure Plan and Programme

VfM Framework Value for Money Framework

PAF Preliminary Evaluation Guidelines

Queensland Governments Project Assurance Framework Preliminary Evaluation Guidelines

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8 References Australian Human Rights Commission. 2010. D.D.A Guide: What’s it all about. http://www.hreoc.gov.au/disability_rights/dda_guide/about/about.html (accessed September 24, 2010).

Begg,S., S. Khor, M. Bright, L. Stanley and C. Harper, 2003, Burden of Disease and Health Adjusted Life Expectancy in Health Service District of Queensland, Queensland Health, Queensland Health.

Council of Australian Governments, 2010, National Partnership Agreement on Hospital and Health Workforce Reform, Council of Australian Governments, Canberra. http://www.coag.gov.au/intergov_agreements/federal_financial_relations/docs/national_partnership/national_partnership_on_hospital_and_health_workforce_reform.pdf

Council of Australian Governments, 2010, National Health and Hospitals Network Agreement, Council of Australian Governments, Canberra. http://www.coag.gov.au/coag_meeting_outcomes/2010-04-19/index.cfm?CFID=450719&CFTOKEN=15842056#nathealth

Department of Education, Employment and Workplace Relations, 2010, State and Territory Skill Shortage List—Queensland, Department of Education, Employment and Workplace Relations, Brisbane. http://www.deewr.gov.au/Employment/LMI/SkillShortages/Documents/SkillShortageListQLD.pdf

Department of Employment and Industrial Relations, 2008, Queensland Workplace Health and Safety Strategy, Industry Action Plan—Health and Community Services Industry, Department of Employment and Industrial Relations, Brisbane. http://www.deir.qld.gov.au/workplace/resources/pdfs/iap-health-2008.pdf

Department of Employment, Economic Development and Innovation, 2008, Indigenous Employment Policy for Queensland Government Building and civil construction projects (IEP 20%), Department of Employment, Economic Development and Innovation, Brisbane. http://www.employment.qld.gov.au/pdf/eii/iep-policy-building-&-civil-construction-projects.pdf

Department of Infrastructure and Planning, 2009, Queensland South East Queensland Regional Plan 2009–2031, Department of Infrastructure and Planning, Brisbane. http://www.dip.qld.gov.au/resources/plan/SEQ/regional-plan-2009/seq-regional-plan-2009.pdf

Department of Local Government, Planning, Sport and Recreation, 2007, Planning for a Prosperous Queensland—A reform agenda for planning and development in the Smart State, Department of Local Government, Planning, Sport and Recreation, Brisbane. http://www.dip.qld.gov.au/resources/plan/planning-reform/part-1-reform-agenda-full.pdf

Department of Public Works, 2010, State Procurement Policy, Department of Public Works, Brisbane. http://www.qgm.qld.gov.au/02_policy/pdfs/state_procurement_policy_0910.pdf

Australasian Legal Information Institute, 2010, Disability Discrimination Act 1992, Australasian Legal Information Institute, Sydney. http://www.austlii.edu.au/au/legis/cth/consol_act/dda1992264/s3.html (accessed September 27, 2010).

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Productivity Commission, 2005, Australia’s Health Workforce, Productivity Commission, Brisbane. http://www.pc.gov.au/__data/assets/pdf_file/0003/9480/healthworkforce.pdf

Queensland Health, 2007, Queensland Health Strategic Plan 2007–2012, Queensland Government, Brisbane. http://www.health.qld.gov.au/about_qhealth/strategic.asp

Queensland Health Policy, Planning and Asset Services, 2010, Service Profile for Emerald Hospital Infrastructure Renewal Planning Project for Rural and Remote Areas, Queensland Government, Brisbane.

Queensland Health, 2008, Queensland Public Health Sector Certified Agreement (No. 7) 2008 (EB7), Queensland Government, Brisbane. http://www.health.qld.gov.au/eb/agreements/eb7/eb7_cert_agree_final.pdf

Queensland Health, 2008, The Health of Queenslanders 2008: Prevention of Chronic Disease, Second Report of the Chief Health Officer Queensland, Queensland Health, Brisbane.

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Appendices

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Appendix 1: Description of service needs A description of the key service needs under the hub and spoke model is set out below.

Surgical and procedural Surgical and procedural services provided at rural hubs are usually provided as same day services to meet a recognised need in the community. Although these visits are arranged to meet patient needs they are dependent on the availability of visiting specialists, travel options and alignment with specialist schedules of the larger hospitals. The frequency of surgical days and volume of surgical and procedural activity varies at each hub site across the state. The volume of activity is dependent on how many specialists visit, how often they visit and the type of activity that occurs as a result of their visit.

This service model often means that visiting specialists may not be available to provide patient after care, or to respond to emergency situations postoperatively. Intensive care is not available at these hospitals and if higher-level care is required postoperatively the patient will need transfer to a hospital providing the needed level of care. All services will have local risk mitigation strategies—including the establishment of transfer protocols to higher-level services—however these may not be formalised.

The layout or placement of surgical treatment areas in rural hub sites is often outdated, with dysfunctional Operating Theatre Suites unable to accommodate current surgical functions and processes. Stage 2 recovery areas are often in other clinical areas and may not be located in close proximity to theatres and medical staff. Recovery spaces and waiting areas are generally insufficient for the number to patients scheduled on visiting specialist lists, regardless of the frequency of those visits.

Due to scheduling requirements there are often difficulties in providing adequate numbers of treatment spaces. Treatment spaces in the Emergency Department or other areas—including hallways or transit areas, are often used to meet this need. As a result routine care is often disrupted, delayed, or managed in inappropriate places.

There are also workforce challenges—in the last few years many specialists who were willing to travel have retired or reduced the number of clinics for which they will travel. Replacement specialists have become increasingly difficult to identify.

Maternity Women and their families who live in rural Queensland often need to travel long distances from their homes in order to access maternity services. Many are required to stay in town near the hospital from 36–38 weeks gestation. Their length of stay in hospital is often longer than for women delivering in metropolitan hospitals, as services are not available close to their homes should a post-natal problem arise. Hospital stays may be further increased if there is no accommodation available close to the hospital.

Ideally, antenatal and postnatal care should be provided as close to home as possible with both hub and spoke services providing this service. Each hub should provide Level 3 draft CSCF v3.0 maternity services as a core service.

Many of the rural hubs in Queensland suffer from outdated Maternity Departments with dysfunctional layouts—with treatment spaces often too small to meet the requirements for service provision. Additionally many delivery suites are totally separate from maternity beds and other maternity treatment spaces causing patient and staff safety concerns and work inefficiencies.

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Recruitment and retention of midwives to rural hub sites is often difficult, compounded by the fact that some nurses do not want to work with outdated models of care and poor infrastructure conditions. Some rural hubs have developed, or are in the process of developing, models of care to accommodate best practice and local needs. There is funding currently available from the Office of the Chief Nurse to assist with this. However, such improvements are often limited by the current configuration of maternity treatment spaces.

General medical Primary medical care in rural towns is generally delivered by resident general practitioners, and inpatient and outpatient care is delivered by Queensland Health employees. Specialist care is usually delivered by visiting specialists on an intermittent basis when there is patient need.

Increasingly resident rural general practitioners are not seeing new patients and do not bulk bill for their services. Many general practitioners are ageing and looking to retire. Retention and recruitment of rural practitioners is becoming increasingly difficult resulting in Queensland Health rural hospitals becoming the default alternative for primary medical care. This is demonstrated by the rising number of triage category four and five presentations to Emergency Departments in most rural hospitals, despite a lack of corresponding population growth.

Queensland Health supports the Rural Generalist Pathway which is delivering an increasing supply of junior and senior medical officers for rural and regional areas. Rural generalists have advanced specialist skills mainly in obstetrics, anaesthetics and surgery, however, the numbers in training will not meet demand in all rural towns and hospitals.

Emergency Department All rural hub services currently provide emergency services at Level 3 draft CSCF v3.0. Although Emergency Care Centre is the terminology used to describe emergency services at Level 3, draft CSCF v3.0, for the purposes of this document, and in line with the Review of the more beds for hospitals strategy, emergency services will be referred to as an Emergency Department.

Most rural Emergency Departments have inadequate treatment spaces and dysfunctional layouts for managing the increasing volume of presentations that hub sites are experiencing. The physical layout of the infrastructure at most hub hospitals does not support best practice models of triage and emergency treatment. Triage spaces in rural hub sites are inappropriate for operational purposes—many lacking any view of waiting rooms with staff unable to observe waiting patients and act with immediacy when required. Often there is no triage desk or triage is not immediately evident to patients. Due to lack of security many Emergency Departments become thoroughfares, resulting in a lack of treatment spaces that afford privacy to patients.

At most rural Emergency Departments there are staffing issues because rural hub hospitals do not always staff their Emergency Departments 24 hours a day. Ward staff are often used for Emergency Department activity after hours (specific to hospital) as well as deployed to assist Emergency Department staff when busy. This can lead to patient and staff safety concerns both in the ward and in the Emergency Department. In contrast, because of staffing constraints, Emergency Departments that operate limited hours often use the ward as the Emergency Department after hours—a situation which is detrimental to patients and staff safety and the ward becomes a thoroughfare at all hours of the night disturbing patients. To maintain safety and functionality of these acute clinical areas it is evident that a closer

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connection between ward areas and emergency areas is required even if this model of staffing is improved.

In addition, most rural Emergency Department space is also used as an Outpatient Department. This becomes a problem when visiting specialists make use of all available consultation rooms. This is particularly apparent when the numbers of triage category four and five presentations make up the majority of presentations to rural Emergency Departments and the consultation rooms are required for routine activity.

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Appendix 2: Alignment of objectives with strategic initiatives Appendix Table 1: Alignment of objectives with strategic initiatives

Strategic alignment Overall objectives

Deputy Premier and Minister for Heath Priority Project Queensland Statewide Health Services Plan 2007–2012 increase capacity in services that manage demand in the acute care sector (Aim

2.4) Improve efficiency of service delivery (Aim 2.5) Queensland Health Strategic Plan 2007–12 Strategic challenge: Manage the growing demand for services within the economic and financial environment Strategic priorities: Meet Queenslanders healthcare needs safely and sustainably expand hospital and related services to meet the needs of a growing population so

Queensland has: - the shortest median waiting time for elective surgery in Australia - the lowest percentage of elective surgery patients waiting longer than clinically

recommended in Australia - an equal or shorter median waiting time for Emergency Department treatment

than the national average - an equal or lower percentage of Emergency Department patients waiting longer

than the clinically recommended time than the national average. National Healthcare Agreement Agreed policy directions include: reduce elective surgery and emergency department waiting times increase technical efficiency of public hospital services improve safety and quality of care, and patient access to performance information South East Queensland Regional Plan 2009–2031 identify and plan for social infrastructure provision in sequence with residential

development (10.8.1) South East Queensland Infrastructure Plan and Program

Capacity: Ensure the hospitals can sustainably deliver the projected service capacity requirements from now to 2021/22 by providing a hub and spoke model of service delivery and a growth in clinical and non-clinical support services. To meet capacity requirements for the hub and spoke model, infrastructure will change to support the necessary bed and treatment space requirements. Capability: Meet the catchment health service needs by delivering the following core services at a Level 3 draft CSCF v3.0 medical surgical/procedural maternity emergency services; and additional services required to support the four core services

including information, communication and technology systems, anaesthetics, neonatal, rehabilitation, medical imaging, pathology and pharmacy services

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Strategic alignment Overall objectives creating a more sustainable future accommodating future residential and employment growth providing infrastructure and services regional accessibility supporting strong and healthy communities. plan, coordinate and deliver regional infrastructure and services in a timely manner

to support the regional settlement pattern and desired community outcomes

Toward Q2 Healthy: want to make Queenslanders Australia’s healthiest people shortest public hospital waiting times in Australia (2020 Target) Blue Print for the Bush Goal 4: Strengthen the planning coordination and delivery of services to rural and regional Queenslanders support the provision of the best possible treatment for rural patients within their

own community strengthen rural health services and facilities attract, retain and support skilled health professionals for rural health services National Health and Hospital Reform ensuring the health and hospital system can work effectively improving the quality of services and increasing transparency integrated and responsive services–delivered locally Advancing Health Action Target 1–reduce public hospital waiting times Target 5–close the gap in health outcomes for Indigenous and rural and remote Queenslanders Making tracks toward closing the gap in health outcomes for Indigenous Queenslanders by 2033 Priority areas A healthy start to life Addressing risk factors

Equity of access: Increase equity of access to healthcare services for residents of the catchment by increasing the capacity and capability of the facilities, including information, communication and technology.

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Strategic alignment Overall objectives Managing illness better Effective health services

Queensland Statewide Health Services Plan 2007–2012 To improve access to safe and sustainable health services Improve the safety of health services (Aim 1.4) Expand acute care to meet population growth (Aim 2.3) Draft Clinical Services Capability Framework for Public and Licensed Health Facilities v3.0 (Draft CSCF v3.0)

Quality: Attract, support and retain sufficient well-trained, committed and motivated staff to appropriately staff the hospital

Queensland Statewide Health Services Plan 2007–2012 Manage infrastructure and assets to: Deliver major infrastructure developments on time and within budget Maintain infrastructure and assets through developing maintenance and life cycle

replacement funding models Define hospital roles to improve planning and service delivery (Aim 1.2) Distribute healthcare resources efficiently and effectively (Aim 3.1) Develop and coordinate support structures to attract and retain the health

workforce (Aim 5.3) Ensure infrastructure and assets support service delivery reforms and contribute to

improved health outcomes (Aim 6.1) Enhance the use of technology to improve links to local service providers

Safety: Use evidence-based service and facility design that complies with applicable legislation and creates an environment that enhances patient safety, patient outcomes, staff wellbeing and clinical excellence.

Sustainability and affordability: Ensure continuity of service provision to 2021/22 in a manner that provides flexibility to address changes in service mix, supports future proofing of facilities and promotes environmentally sustainable outcomes.

Efficiency: Compliment existing and planned facilities across the healthcare continuum in Queensland to deliver coordinated and cost efficient healthcare services.

Affordability: Provide a cost effective and efficient service model and building design, and information, communication and technology system to achieve value for money in capital and recurrent costs to support service delivery and model of care objectives.

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Appendix 3: Financial analysis costing assumptions Balance Sheet assumptions

Option 1 Status quo (minimum requirements): no employee housing accommodation or ICT costs (unless specified in the capital works program in the Infrastructure Plans)

Option 2 Redevelopment includes employee housing accommodation and ICT costs

Option 3 Significant redevelopment and refurbishment: includes employee housing accommodation and ICT costs

ICT costs, where applicable, are added to ‘computer hardware’.

Full Time Equivalent (FTE) assumptions Using the draft CSCFv3.0 the qualitative information for workforce requirements at a clinical services level was translated into a quantitative FTE requirement. Each draft CSCFv3.0 Level 1 through 3 was interpreted into FTE values.

Key terminology assumptions and interpretation:

“Immediate” means that workforce is in place 24 hours seven days a week for that particular service

“Access to” means that Medical works is available one shift per day, except for Level 1 or Level 2 where access may be to a General Practitioner

“Remote access” means that no FTE added in profile (noted only)

Health Practitioner workforce is available in clinical support for each core discipline, Physiotherapy, Occupational Therapy, Social Work, Dietetics, Speech Pathology, Other Health Practitioner.

Nursing workforce is available one shift per day

FTE calculation was based on an eight hour day, evening and night shift for Medical staff; 7.6 hour day, evening and night shift for all other staff categories.

The quantitative FTE data is input to the ‘FTE Data’ worksheet of Options 2 and 3 of the costing template.

The workforce profile for the rural and remote sites as detailed in Appendix Table 2 is based on providing Level 3 draft CSCF v3.0 services.

Appendix Table 2: Workforce profile for the rural and remote sites

Clinical Services Nursing Medical HP1* TO2* OO3* AO4* Total

Medical 13.75 5.89 0 0 4.42 1.0 25.07

Maternity Neonatal

11.53 12.60 1.0 0 4.42 1.0 30.55

Clinical Support 9.48 2.0 19.88 0 3.0 1.0 35.35

Non Clinical Support

1.0 0.0 1.0 2.0 24.55 8.0 36.55

Total 35.76 20.49 21.88 2.0 36.39 11.0 127.52 1* Health Practitioner 2* Technical officer

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3* Operational officer 4* Administration officer

The nursing skills mix is based on the following Business Planning Framework. 25 per cent clinical nurses (grade 6)

55 per cent registered nurses (grade 5)

20 per cent enrolled nurses (grade 3).

The workforce mix for clinical and non-clinical support staff is detailed in Appendix Tables 3 and 4 respectively.

Appendix Table 3: Clinical support workforce

Type Grade/ Level

Nursing Medical HP1* OO2* AO3*

CSSD/ Infection Control

Nurse gr 6 1.0

Nurse gr 3 2.0

OO2 2.0

Medication services

HP5 1.40

HP3 1.0

Nurse gr 5 1.0

OO3 1.0

Allied health HP5 12.0

Medical imaging HP5 1.0

L19 2.0

AO3 1.0

Pathology/ Morgue

Nurse gr 5 4.48

PO4 4.48

Total 9.48 2.0 19.88 3.0 1.0 1* Health Practitioner 2* Operational officer 3* Administration officer

Appendix Table 4: Non-clinical support workforce

Type Grade/ Level

Nursing Medical HP1* TO2* OO3* AO4*

Kitchen OO5 1.0

OO3 0.95

OO2 4.8

Engineer/BEMS TO4 2.0

Laundry OO4 1.0

OO2 2.0

Grounds/ Cleaning

OO2 4.0

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Type Grade/ Level

Nursing Medical HP1* TO2* OO3* AO4*

Executive DES1 1.0

AO3 1.0

Admin/ Medical records

AO2 1.0

AO3 3.0

AO5 1.0

Security, fire safety, OHS

OO2 8.80

ICT AO6 1.0

Educators Nurse gr

6 1.0

HP5 1.0

Stores OO4 1.0

OO2 1.0

Total 1.0 0.0 1.0 2.0 24.55 8.0 1* Health Practitioner 2* Technical officer 3* Operational officer 4* Administration office

A further adjustment is made to the number of nurses based on the actual variation in hospital profile and indicated in Appendix Table 5.

Appendix Table 5: Adjustment to number of nurses based on actual variation in Hospital profile

Location

Total workforce profile for

Level 3

Calculated workforce

profile Difference

Clinical gr 6

Registered nurse gr 5

Enrolled nurse gr 3

Atherton 127.52 172.56 45.04 11.26 24.77 9.01

Ayr 127.52 140.11 12.59 3.15 6.92 2.52

Biloela 127.52 128.3 0.78 0.19 0.43 0.16

Charleville 127.52 140.85 13.33 3.33 7.33 2.67

Charters Towers 127.52 146.42 18.90 4.72 10.39 3.78

Emerald 127.52 146.05 18.53 4.63 10.19 3.71

Kingaroy 127.52 136.1 8.58 2.14 4.72 1.72

Longreach 127.52 145.47 17.95 4.49 9.87 3.59

Mareeba 127.52 161.95 34.43 8.61 18.94 6.89

Roma 127.52 155.55 28.03 7.01 15.42 5.61

Sarina 127.52 120.77 -6.75 -1.69 -3.71 -1.35

Thursday Island 127.52 154.77 27.25 6.81 14.99 5.45

The following adjustments of -49.91 FTE are made to Sarina to account for its spoke nature:

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no maternity service included (-30.55)

no pharmacist is included (-1.4)

no assistant pharmacist is included (-1)

only the six core allied health disciplines are included (-6)

no nurse for pathology/morgue (-4.48)

no scientist for pathology/morgue (-4.48)

no executive and support officer are included (-2)

Other FTE assumptions REC leave backfill is six weeks for nurses and four weeks for all other staff

Facility maintenance and management costs

The annual facility maintenance cost is calculated in the QH costing template as 2.15 per cent of the capital cost of buildings from the balance sheet

Facility and Management recurrent costs is “Depexp-Right To Use Buildings” (in Depn and Amort costing sheet) + “Building Maintenance” (in Supplies and Services costing sheet).

Lifecycle costing (In the absence of a more rigorous tool) The lifecycle costing methodology is based on industry benchmarks. The lifecycle costing assumes no growth in actual cost over time.

Building repairs and maintenance at 2.15 per cent of the Asset Replacement Value (ARV) Per Annum (PA)

Asset Replacement at 1 per cent of ARV PA

Option 1

– Asset value = asset value sourced from ‘ARV report request.xls’ + additional building asset from balance sheet

– Maintenance = 2.15 per cent X asset value X 30 years – Asset replacement value = 1 per cent of ARV per annum X 30 years

Options 2 and 3

– Asset value = “Asset Buildings” infrastructure cost in Balance sheet – Maintenance = 2.15 per cent X asset value X 30 years – Asset replacement value = 1 per cent of ARV per annum X 30 years.

Recurrent costs Financial year budget for each hub and spoke has been used to calculate the non-labour component of the costs to get a total cost for the hospital profile labour costs (shown in ‘Employee Expenses’).

This is based on the labour/non-labour split as indicated in Appendix Table 6.

Appendix Table 6 Labour/non-labour costs split for hospital profile.

Hub/Spoke Labour % Non-labour % Divider to generate non-labour supplies

and services

Atherton 83.15% 16.85% 4.93

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Hub/Spoke Labour % Non-labour % Divider to generate non-labour supplies

and services

Ayr 80.22% 19.78% 4.05

Biloela 79.62% 20.38% 3.91

Charleville 74.40% 25.60% 2.91

Charters Towers 85.31% 14.69% 5.81

Emerald 71.46% 28.54% 2.50

Kingaroy 80.89% 19.11% 4.23

Longreach 81.57% 18.43% 4.43

Mareeba 82.89% 17.11% 4.85

Roma 77.51% 22.49% 3.45

Sarina 85.60% 14.40% 5.94

Thursday Island 54.00% 46.00% 1.17

Recurrent non-labour costs are inputted into ‘supplies and services’ under ‘Clnsup-Other-General’ (Clinical Supplies, Other General).

Data for the population of the costing tools sourced from:

FTE input file: WFbuidup_CSCFv3 R&R_201000923.xlsx

ICT ISA Atherton.doc

ICT ISA Ayr.doc

ICT ISA Biloela.doc

ICT ISA Charleville.doc

ICT ISA Charters Towers.doc

ICT ISA Emerald.doc

ICT ISA Kingaroy.doc

ICT ISA Longreach.doc

ICT ISA Mareeba.doc

ICT ISA Roma.doc

ICT ISA Sarina.doc

ICT ISA Thursday Island.doc

2 Service Profile_Atherton-Mareeba DRAFT (2).pdf

3 Current+Future Requirements_Atherton-Mareeba (2).pdf

Ayr Service Profile_2010-06-18 JP Exec Summary.doc

Ayr_End Table_2010-06-06-10 Data.doc

2 Service Profile_Biolela (2).pdf

3 Current+Future Reqs A3 size_Biloela CORRECTED.pdf

2 Service Profile_Charleville_DRAFT.pdf

3 Current+Future Reqs A3 size_Charleville CORRECTED.pdf

Charters Profile_2010-06-18PM Atts updated.doc

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Charters_End Table_2010-06-06-10 Data.doc

2 Service Profile_Emerald (2).pdf

3 Current+Future Reqs A3 size_Emerald CORRECTED.pdf

20100618AM_Kingaroy Profile v21-Exec Sum added.doc

Kingaroy_End Table_2010-06-06-10 Data.doc

Longreach Profile v0-5_2010-06-18 HC Atts updated.doc

Longreach_End Table_2010-0606-10 Data HC new front.doc.

2 Service Profile_Atherton_Mareeba DRAFT (2).pdf

3 Current+Future A3 size_Ath-Mareeba CORRECTED.pdf

3 Current+Future Requirements_Atherton-Mareeba (2).pdf

2 Service Profile_Roma_DRAFT (2).pdf

3 Current+Future Reqs A3 size_Roma CORRECTED.pdf

20100629_Sarina profile v1-4_ JW Check.pdf

Att1 K Sarina SP_20100726_IPPEC rev HC.doc

Sarina Hospital Planning Study.pdf

Sarina report_April 2010.pdf

ICT ISA Thursday Island v1.0b.doc

Thurs Island Profile_20100618_Exec Summary added.doc

Thurs Island_End Table_2010-06-06-10 Data.doc

Atherton Volume 2[1].pdf

Attachment 2 Atherton Volume 1_Rev1[1] 20100722.pdf

Attachment 3 Ayr Volume 1_Rev1_JK[1] 20100722.pdf

Ayr Volume 2[1].pdf

001 Biloela Prelim Infrastructure Plan.pdf

002 Biloela Prelim Infrastructure Plan.pdf

002 Charleville Prelim Infrastructure Plan.pdf

Attachment 4-20100723_Comments volume 1.pdf

Attachment 5 Charters Towers Volume 1_Rev1[1] 20100722.pdf

Charters Towers Volume 2[1].pdf

001 Emerald Prelim Infrastructure Plan.pdf

002 Emerald Prelim Infrastructure Plan.pdf

20100802_Kingaroy Final document-Volume 1.pdf

20100802 Kingaroy Final document-Volume 2.pdf

B21710_Kingaroy Final report-VOLUME 1.pdf

001 Longreach Prelim Infrastructure Plan.pdf

002 Longreach Prelim Infrastructure Plan.pdf

Attachment 6 20100802_Mareeba Final report-VOLUME 1.pdf

20100722_Mareeba Final July Volume 1.pdf

20100802_Mareeba Final report-VOLUME 2.pdf

20100723_Roma Final report-July-VOLUME 1.pdf

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20100723_Roma Final report-July-VOLUME 2.pdf

20100308_Sarina study vol 1 August 2010.pdf

Attachment 7 Thursday Island Volume 1_Rev1[1] 20100722.pdf

Thursday Island Volume 2[1].pdf

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Appendix 4: Clinical Services Capability Framework for Public and Licensed Private Health Facilities v2.0 The Clinical Services Capability Framework for Public and Licensed Private Health Facilities v2.0 (CSCF) outlines the minimum support services, staffing, safety standards and other requirements in both public and private health facilities to ensure safe and appropriately supported clinical services.

The CSCF serves two major purposes:

to provide a standard set of capability requirements for most acute and sub-acute health facility services provided in Queensland by public and private health facilities

to provide a consistent language for health care providers and planners to use when describing health services and planning service developments.

The CSCF is part of a suite of tools that address patient safety. In Queensland Health, it identifies services provided in facilities by clinical service area and the capability of these services (referred to as the capability level).

The CSCF v2.0 is currently being reviewed and the draft CSCF v3.0 is expected to be released in early 2011, followed by a 12 month transition period.

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Appendix 5: National Health Reform Agenda In April 2010, The Council of Australian Governments (with the exception of Western Australia) agreed on major reforms to the way hospitals are funded and run, including the establishment of Local Hospital Networks and introduction of activity based funding (ABF).

Under the National Health and Hospitals Network Agreement (NHHN), the Commonwealth will invest $675.7 million in Queensland over four years to address key pressure points in the public hospital system and deliver improved services for patients, including a four-hour National Access Target for emergency departments, access targets for elective surgery including a National Access Guarantee and $327 million for an additional 265 sub-acute care beds.

The introduction of ABF will see the Commonwealth fund 60 per cent of the ‘efficient price’ for public hospital services, research and capital and 100 per cent of general practitioner and primary health care services. The Commonwealth will also have full funding and policy responsibility for aged care services. The State Government will retain a primary management role, meet the residual cost of public hospital services and negotiate service agreements with Local Hospital Networks.

These reforms will be financed through funding from the current National Specific Purpose Payment for Healthcare (National Healthcare Agreement), approximately 30 per cent of the state’s GST revenue and Commonwealth top-up funds for growth in health costs above GST growth from 2014–15 (a minimum of $15.6 billion nationally). The Commonwealth have stated that no state will be worse off under the NHHN, with the national ‘efficient price’ to be set by an Independent Hospital Pricing Authority, which will also determine the funding arrangements for smaller hospitals.

A key component of the NHHN is the acceleration of the national activity based funding (ABF) model from 1 July 2012, compared to the original target date of 1 July 2015 under the National Partnership Agreement for Hospital and Health Workforce Reform. Queensland has committed to commence ABF from 1 July 2011 and is currently developing a state-wide strategy to implement ABF.

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Appendix 6: Description of options for each site A brief summary of the key features of the final three options for each site is outlined below.

Atherton

Option 1: includes addressing the serious risks around security, fire and infection control. This option only addresses serious risks and non-compliance with various building codes, Acts and Legislation. It does not address the overall operational functionality of the Hospital or general problems with the condition of the Hospital

Option 2: is the partial redevelopment if the main Hospital departments on the available greenfield land adjacent to the existing Hospital. The development would include the construction of Emergency and Outpatient Departments, Operating Theatres, x-ray, maternity, 78 bed general wards, medical records, pathology, pharmacy, kitchen and relocation of the helipad and services

Option 3: is a fully staged rebuild of the entire Hospital campus on the Greenfield land adjacent to the existing infrastructure. Option 3 is similar to Option 2, although provides new administration space adding a further 650 m2.

Ayr

Option 1: involves the rectification of the existing non compliance to Building Codes, Standards, Acts or Legislation. This will involve reviewing services, e.g. air conditioning, and undertaking structural reconfiguration to ensure disability access and access to egress for fire safety

Option 2: is an extension of Option 1. As well as addressing the major risks identified in the preliminary infrastructure assessment, this option would address a number of the operational deficiencies throughout the Hospital and includes the refurbishment of the existing aged care building for employee housing accommodation, administration and primary health services

Option 3: is also an extension of Option 1. As well as addressing the major risks identified in the preliminary infrastructure assessment, this option includes the construction of a new building adjacent to the existing hospital on the greenfield site, to provide for primary health, administration services and secondary storage of medical records.

Biloela

Option 1: improves the infrastructure of Biloela Hospital to order to continue providing services

Option 2: provides for the refurbishment of the existing hospital site involving new builds for all buildings except Wards A and B. This option includes the redevelopment of Wards A and B, a new fully compliant theatre facility including a CSSD facility, and the development of new employee housing accommodation

Option 3: involves a fully compliant new facility to be developed on site. The features include independent access for services with clear identification of the main entrance and ambulance/Emergency Department entrance, provision of drop off area and parking for staff and visitors and concentration of common services for easy staff and patient access.

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Charleville

Option 1: improves the infrastructure of the site in order to allow current services to be provided, however, it does not allow for full compliance to standards or resolve the level 3 service requirements

Option 2: further addresses the risks and delivery of Level 3 services, including a significant proportion of new build

Option 3: involves a new facility and is the only option which will enable full compliance with current regulations.

Charters Towers

Option 1: improves Charters Towers Hospital by addressing actual or potential serious risk issues to improve health service delivery

Option 2: provides for the extensive refurbishment of the Charters Towers Hospital that addresses the risks identified and includes the extension of the existing Emergency, Outpatient, Pharmacy, and X-ray, departments. It will include the building of a new endoscopy theatre, two maternity delivery suites, and will refurbish existing ward area to include an isolation room and a secure room for ‘at risk’ or aggressive patients

Option 3: involves the construction of a brand new Hospital on the greenfield land adjacent to the Eventide Nursing Home. A helipad is also included in this option.

Emerald

Option 1: will address most of the issues related to access for persons with disabilities within the existing buildings, but will not satisfy all requirements. The main issue to be addressed with this option is the condition of the nurse’s quarters and the Community Health building

Option 2: incorporates the modifications associate with Option 1 (above). The main difference between the two options is that Option 2 improves the adjacencies between Hospital departments by shifting the Operating Theatres from level one to the ground level

Option 3: is an extension of Option 2. The largest difference between this option and Option 2 is the demolition of the existing original Hospital, the Community Health building as well as the stores and laundry.

Kingaroy

Option 1: includes the minimal work to protect patient and staff safety, meet partial Building Code of Australia requirements, meet minimum access codes, ensure Health Services are provided albeit in not an optimal manner, however, it does not provide the additional space and infrastructure to service the forecast growth in demand

Option 2: provides for the extensive refurbishment of the main Hospital buildings, including full compliance with current regulations. This option includes the construction of a new oral health and renal building, a new ward and maternity building, a new theatre building and the expansion of the Emergency Department to include new ambulance bays

Option 3: includes all of the new builds proposed in Option 2, as well as the construction of new allied health facilities, medical records store, laundry, goods receiving store and Bems office.

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Longreach

Option 1: provides an upgrade to the Longreach Hospital to maintain Hospital operation

Option 2: provides for the extensive refurbishment of the Hospital. It will bring the facility closer to compliance with standards but not ensure full compliance

Option 3: includes the complete rebuild of Hospital facilities. The main Hospital building is retained for reuse due to its value to the community in terms of history and character.

Mareeba

Option 1: includes the minimal work to protect patient and staff safety, meet partial Building Code of Australia requirements, meet minimum access codes, ensure Health Services are provided albeit in not an optimal manner

Option 2: includes the majority of the infrastructure improvements outlined in Option 1. It also provides for the refurbishment of the main Hospital buildings, including the extensive refurbishment and expansion of the emergency department, the refurbishment of the nurses’ quarters building and critical electrical and electronic upgrades

Option 3: is the same as Option 2 but would include a new build of the Emergency and Theatre.

Roma

Option 1: provides an upgrade to the Roma Hospital to maintain Hospital operation. This option does not upgrade the facility to AHFG standards or provide the additional space and infrastructure to meet the services profile

Option 2: provides for the extensive refurbishment of both of the main Hospital buildings, the relocation of allied health services into a refurbished Old Westhaven building and the construction of a new kitchen

Option 3: includes all of the new builds proposed in Option 2, as well as the construction of specialist clinic and a GP super clinic on a vacant area to the east of the existing Emergency Department.

Sarina

Option 1: aims to address the major current risks of the facility in the short-term, but does not solve the fundamental problems of the site and can, at best, be considered a short term fix

Option 2: aims to address current risks as far as possible while maintaining existing structures and current services at the facility, aiming to extend its life from 10–15 years. This option includes most measure from Option 1, with some actions replaced with more permanent solutions.

Option 3: includes the demolition of the current main Hospital building and staff quarters, with a complete re-build on the site. This re-build would be staged to provide for an uninterrupted service, and would leave the community health building intact.

Thursday Island

Option 1: provides an upgrade to the Thursday Island Hospital to maintain Hospital operation. It does not address issues relating operational flow and inefficiencies due to functional arrangement of the departments, or issues associated with ongoing deterioration of existing structures

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Option 2: provides for minor refurbishments and extensions to the general Hospital building and primary healthcare centre in addition to upgrades described in Option 1. internal building defects and structural corrosion are also not addressed

Option 3: includes a complete rebuild of the Hospital campus with a single building to be purpose-built. Additionally, this option includes a full refurbishment of the existing primary healthcare centre to address issues of overcrowding, fire safety and lack of storage.

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Appendix 7: Risk Register Appendix Table 7: Risk Register

Item Risk Category Risk Description Atherton Ayr Biloela Charleville Charters Towers

Emerald Kingaroy Longreach Mareeba Roma Sarina Thursday Island

Consequences Consequence Likelihood Ranking Comments Likelihood Ranking Comments Likelihood Ranking Comments Management Measures Responsibility

1 Asset ownership Whole-of-life costs assumption used understates maintenance and workforce costs (since already funding shortfall under EB arrangements)

All options All options All options All options All options All options All options All options All options All options All options All options May be insufficient recurrent budget to adequately staff and maintain and operate facilities

Minor Almost Certain

Very High Almost Certain


Very High

Full business case to document projected recurrent and maintenance funding requirements and full recurrent funding to be sought as part of full business case (potential to quarantine)

QH (PPAS)

2 Contractor / sponsor / financial

Ability to achieve funding support for significant changes given lack of growth in service demand (Deal breaker) Ability to deliver on universal obligation (where no service growth identified)

Option 2 and 3

Option 2 and 3

Option 2 and 3

Option 2 and 3

Option 2 and 3

Option 2 and 3

Option 2 and 3

Option 2 and 3

Option 2 and 3

Could not proceed with option 2 or 3. Impact on quality of patient care and ability to attract staff

Major N/A N/A Possible Very High Possible Very High

Articulate decline in environment, safety concerns and eventual negative health outcomes in PE. Continue to review requirements during detailed business case based on updated district planning.

QH (PPAS)


Early stage planning may result in a significant underestimation of final costs for all enablers (including infrastructure).

All options All options All options All options All options All options All options All options All options All options All options All options Insufficient funding for full business case development. Sets unrealistic expectations around eventual program costs which may be significantly underestimated.

Moderate Possible High Possible High Possible High Sufficient attention to project plan budget (for the detailed business case) during PE stage. Benchmark against other projects.

QH (PPAS)


Inability to attract quality contractors given other developments around the State e.g. ULDA investments. Requirement to comply with Gov local employment and indigenous EIA / SIA metrics constrains bidder poolRequirement to comply with Gov 10% local employment and indigenous EIA / SIA metrics constrains bidder pool

All options All options All options All options All options All options All options All options All options All options All options All options Impacts on quality and value for money. Moderate Unlikely Medium Unlikely Medium Unlikely Medium Structure effective procurement process including market sounding in line with usual departmental processes R equired EIA / SIA metrics to be pro vided by T reasury/ D IP

HPID


Site does not have sufficient priority, compared to other competing Rural & Remote projects

All options All options All options All options All options All options All options All options All options All options All options All options In constrained funding environment, may not attract funding for business case or eventual project

Moderate Possible High Possible High Possible High Demonstrate the compelling case for change in PE and emphasise further during business case phase

QH (PPAS)

6 Design, construction & commissioning

Fire risks - existing fire safety risks and compliance with requirements

Option 1 Option 1 Option 1 Option 1 Option 1 Option 1 Option 1 Option 1 Option 1 Option 1 Option 1 Option 1 Existing facilities contain a number of fire hazards that could result in fires, patient and staff safety risks and property damage.


Very High Possible Medium Possible Medium Standard project design and management procedures will be adhered to. Urgent concerns to be addressed through ongoing maintenance procedures

HPID


Buildings at or near end of life. Lack of historic maintenance escalates future funding requirement and impacts remaining life

Option 1 and 2

Option 1 and 2

Option 1 and 2

Option 1 and 2

Option 1 and 2

Option 1 and 2

Option 1 and 2

Option 1 and 2

Option 1 and 2

Option 1 and 2

Option 1 and 2

Option 1 and 2

Heavy investment without 're-lifing' facilities

Moderate Almost Certain

Very High Unlikely Medium Unlikely Medium Replacement of buildings beyond useful life to be included in all option designs

HPID


Asbestos in facilities is disturbed by works

All options All options All options All options All options All options There is significant cost and potential health risks to staff and patients in removing the asbestos contained in the building material

Minor Possible Medium Possible Medium Possible Medium Follow strict protocol to mitigate health risk to patients and/or community

Contractor


Inability to meet disability and other legislation requirements

Option 1 Option 1 Option 1 Option 1 Option 1 Option 1 Option 1 Option 1 Option 1 Option 1 Option 1 Option 1 Potential litigation and reputational impacts

Moderate Possible High Unlikely Medium Unlikely Medium Address through design in each option HPID


Design, construction and commissioning may result in adverse cost and / or service delivery consequences (for example disruption to essential services, noise, dust, potential) injury during construction.

All options All options All options All options All options All options All options All options All options All options All options All options Patient impacts, staff morale impacts (may lose key staff), community disturbance, negative PR, potential litigation




Very High

As part of each project's overall management. Procedures will be adhered to.

HPID


Design risks: early design based on square metre assessment. No account taken of requirements for new models of care, workflow impacts etc. that are critical to rural and remote projects

Option 2 and 3

Option 2 and 3

Option 2 and 3

Option 2 and 3

Option 2 and 3

Option 2 and 3

No acceptance of the option by the District

Moderate Possible High Likely Very High Likely Very High

In the detail business case ensure that greater consultation and clinical and CSCF inputs are accounted for. Include models of care in the design stage.

QH (PPAS)


Early design risks (including delays in completion and approval of PE, insufficient resources for detailed business case development, delays in achieving project approvals, changes in legislation impacting on building requirements)

All options All options All options All options All options All options All options All options All options All options All options All options Push back timeframe for approval of PE and eventual funding of all options, potentially increased costs, reputational consequences. May not deliver on options within committed timeframes.

Moderate Possible High Possible High Possible High Actively manage and escalate as appropriate. Develop sufficient flexibility within project scheduling to address planning requirements and stakeholder communication plan.

QH (PPAS)


Limited site access and egress during construction

All options All options All options All options All options All options All options All options All options All options All options All options Extensive construction period with ongoing use of facilities expected to result in negative impacts for patients, staff, visitors and neighbouring areas

Minor Likely High Likely High Likely High Develop access / egress plan as part of detailed project planning in business case stage. Undertake community and stakeholder (e.g. fire department) consultations and incorporate into plans. Consult with town planning.

HPID

Option 1 - Status Quo Option 2 - Refurbushment and staff housing accommodation

Option 3 - Redevelop and staff housing accommodation

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15 Force majeure Flooding risk at certain sites All options Option 1 and 2

Facilities can be cut off or damaged with risks to patient care. Significant amount of maintenance is required following the onset of local flooding

Moderate Possible High CharlevilleKingaroyThursday Island

Possible High CharlevilleKingaroyThursday Island

Possible High CharlevilleKingaroy

Only patients with reasonable mobility in areas most prone to flooding, no emergency services on lower levels, sound backup generator system, emergency IT systems, evacuation site i.e. helipad on roof in case of emergency, capacity for critical/emergency patients. Consider alternative sites if redeveloping

District / HPID

16 Industrial relations / Workforce

Inability to attract / retain sufficient / skilled clinical and non-clinical staff:- general availability and skill sets of available resources (including training/ support for capability maintenance e.g. nursing students) - attraction of speciality staff to rural areas (dependency on supporting social infrastructure e.g. schools, housing) - require sufficient activity levels to maintain skills- extensive lead times for recruitment of speciality staff including ICT staff (up to 18 months) - competition from other new facilities (e.g. Gold coast / Sunshine coast)- buy in / support from district for recruitment- lack of specialist clinicians for telehealth services outreach

All options All options All options All options All options All options All options All options All options All options All options All options Cannot adequately staff facilities, cannot attract new staff due to conditions and lack of accommodation, possible exhaustion, potential IR and enterprise bargaining issues, closure of some beds, PR issues

Major Almost Certain

Extreme Possible Very High Possible Very High

Provide programs for both highly skilled and supporting staff to locate to rural and remote areas. Arrange for temporary staff transfers from R&R relief pool until FTE positions are filled. Support training initiatives e.g. student nurses, early consultation to achieve district buy in and support for particular locations. Link/feed into other existing local and statewide recruitment programs/structures such as Work for Us and tap into relief pools. Implement recruitment plans well in advance of workforce requirement. Form partnerships with education institutions / colleges to bring through qualified staffConsider models of care within business case stage to optimise workforce requirement. Align recruitment with social infrastructure benefits e.g. availability of schools. Ensure availability of accommodation / temporary housing for nursing staff. Upgrade existing accommodation where possible under

Workforce


Insufficient ICT and telehealth staff to support design, delivery and ongoing maintenance of ICT requirements for new facilities

Option 3 Option 3 Option 3 Option 3 Option 3 Option 3 Option 3 Option 3 Option 3 Option 3 Option 3 Option 3 The implementation and maintenance of ICT systems may be insufficient, leading to implementation delays, additional Capex and Opex costs and the potential for a system that is not fit for purpose.

Moderate Likely Very High Likely Very High Likely Very High

Improving current processes for design and procurement to reduce lead times.

ICT


Impact of transferred labour on local labour markets.

Option 2 and 3

Option 2 and 3

Option 2 and 3

Option 2 and 3

Option 2 and 3

Option 2 and 3

Option 2 and 3

Option 2 and 3

Option 2 and 3

Option 2 and 3

Option 2 and 3

Option 2 and 3

Adverse local community impacts and distorted effects on local economy. Can create vacancies.

Minor N/A N/A Possible Medium Possible Medium Identify possible impacts during public interest assessment. Develop detailed workforce planning and local impact assessment further during business case.

Workforce


Industrial Relations frameworks limit reform (all staff)

Option 2 and 3

Option 2 and 3

Option 2 and 3

Option 2 and 3

Option 2 and 3

Option 2 and 3

Option 2 and 3

Option 2 and 3

Option 2 and 3

Option 2 and 3

Option 2 and 3

Option 2 and 3

Opex costs may rise.QH may face union backed industrial conflict

Moderate Unlikely Medium Likely Very High Likely Very High

During detailed business case, evaluate staffing impacts once capability framework approved, assess limitations to delivery of services, arrange early consultation with staff and unions.

Workforce

20 Market / demand

Projected capacity or mix requirements cannot be met by facilities (where growth required)

Option 1 Option 1 Option 1 Insufficient capacity or lack of particular services negatively impacts on patient care


Extreme KingaroyMareebaSarina only

Unlikely High Unlikely High Continue to review requirements during detailed business case based on updated district planning. Conduct scenario analysis to identify if capacity is sufficient in the event of unexpected changes

QH (PPAS)

21 Market / demand

Itinerant workforce in mining and gas regions will create additional demand on the hospitals.

All options All options All options All options All options All options All options All options All options All options All options All options The demand for health services may be under estimated, leading to solutions that are not appropriate or sufficient to meet community demand.

Minor Possible Medium Possible Medium Possible Medium Include consideration of this cohort within detailed service planning as part of business case

QH (PPAS)

22 Market / demand

Community expectations regarding specialist offerings and quality and conditions may not be met.

All options All options All options All options All options All options All options All options All options All options All options All options community resistance, negative PR, delays


Very High Likely High Possible Medium Undertake extensive stakeholder consultation during detailed business case phase

District

23 Market / demand

Facilities and staff cannot meet specified Level 3 capability requirements for Hub and spoke Model

Option 1 Option 1 Option 1 Option 1 Option 1 Option 1 Option 1 Option 1 Option 1 Option 1 Option 1 Option 1 Inability to deliver certain services negatively impacts on patient care and safety. Creates significant stress (capacity and capability requirements) at district and other facilities with corresponding safety impacts.


Extreme Possible Very High Unlikely High Address capability requirements wherever possible through other district facilities but monitor for staff and patient impacts. Consider implications in detail on surrounding facilities during detailed business case

QH (PPAS)

24 Operating / Performance

Adhoc development and reuse has resulted in poor facility design, interface and adaptation for workforce including:- Poor separation of wards (Biloela)- Poor working conditions- Inappropriate facilities for mental health (lack of safe rooms prior to patient transfer)- Poor lighting and infection control

Option 1 and 2

Option 1 and 2

Option 1 and 2

Option 1 and 2

Option 1 and 2

Option 1 and 2

Option 1 and 2

Option 1 and 2

Option 1 and 2

Option 1 and 2

Option 1 and 2

Option 1 and 2

Does not support efficient models of care. Negative impact on patient care and staff inefficiencies

Moderate Likely Very High Possible High Unlikely Medium Redevelopment plans to include consideration of appropriate patient flows.

QH (PPAS)


Excessive running costs including maintenance

Option 1 and 2

Option 1 and 2

Option 1 and 2

Option 1 and 2

Issues associated with the deterioration of the buildings that may contribute to costs being higher than budgeted (i.e. inefficient electricity usage and air conditioning systems)

Minor Likely High Possible Medium Unlikely Medium Identify the drivers of excessive running costs and address accordingly (i.e. more efficient usage of electricity)Consider sustainability of built beds vs. available beds

QH (PPAS)


Decanting risk and service continuity (physical & care arrangements). May have adverse impact on patients.

Option 2 and 3

Option 2 and 3

Option 2 and 3

Option 2 and 3

Option 2 and 3

Option 2 and 3

Option 2 and 3

Option 2 and 3

Option 2 and 3

Option 2 and 3

Option 2 and 3

Option 2 and 3

Disruption to clinical care, inadequate staffing levels and mix, reputational risk, staff morale.

Moderate Likely Very High Likely Very High Possible High As part of each project's overall management. Procedures will be adhered to.

HPID


Key stakeholders (particularly clinicians) do not support service planning and infrastructure options

All options All options All options All options All options All options All options All options All options All options All options All options Delays to project development Minor Possible Medium Possible Medium Possible Medium Involve stakeholders early but only once PE is approved. Allow for extensive consultation with management, clinical staff and local community and include an educational element to discussions drawing out the benefits/outcomes of new facilities.

District

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Models of Care are assumed to be constant. Any change to the models of care (for example greater integration with community health / continuum models of care, pathology approaches) may significantly change staffing requirements (number and capability)

All options All options All options All options All options All options All options All options All options All options All options All options Changes to models of care would impact:- Service requirements at the facility- Infrastructure design- Staffing requirements - Cost

Moderate Possible High Possible High Possible High Review appropriateness of models of care during detailed business case phase. Assess impacts of any proposed changes and reflect in facility design, requirements and costings and requirements

QH (PPAS)

29 Site & planning Facilities are structurally unsound Option 1 and 2

Option 1 and 2

Option 1 and 2

Facilities cannot be used for service delivery

Major Possible Very High Possible Very High N/A N/A Replacement of unsafe facilities to be included in all option designs

HPID

30 Site & planning Facilities are in very poor condition. Option 1 and 2

Option 1 and 2

Option 1 and 2

Option 1 and 2

Option 1 and 2

Option 1 and 2

Option 1 and 2

Option 1 and 2

Option 1 and 2

Option 1 and 2

Option 1 and 2

Option 1 and 2

Risks to staff and patient safety Moderate Possible High Unlikely Medium N/A N/A Replacement / refurbishment of very poor condition facilities to be included in all option designs

HPID

31 Site & planning Site constraints - i.e. inability to identify suitable relocation sites and delay with activation (including political and community resistance). Also site access issues for construction (Charleville)

Option 3 Option 3 Option 3 Limits optimal development options and may prevent further expansion

Minor N/A N/A N/A N/A Possible Medium Address through design process to maximise flexibility

HPID

32 Site & planning Inadequate parking and transport arrangements

Option 1 Option 1 and 2

Option 1 Option 1 and 2

Option 1 and 2

Option 1 Option 1 Option 1 Access for community and facility visitors. Impacts on staff attraction, retention and morale.

Minor Possible Medium Possible Medium N/A N/A Plan for transport linkage and sufficient parking based on detailed design of business case. Consideration of provision of additional parking during full business case (early planning and costing incorporate full infrastructure needs).

QH (PPAS) / DPI

33 Site & planning Security risks All options All options All options All options All options All options All options All options All options All options All options All options Security and safety for patients, staff and community. Adverse impact on dignity and privacy for patients. Reputational concerns.

Minor Possible Medium Possible Medium Unlikely Medium Improve perimeter integrity (safety/security) and issues of co-location within design processes

HPID


Transitioning risk - insufficient funding / timing for workforce upskilling to professional capability requirements,

Option 2 and 3

Option 2 and 3

Option 2 and 3

Option 2 and 3

Option 2 and 3

Option 2 and 3

Option 2 and 3

Option 2 and 3

Option 2 and 3

Option 2 and 3

Option 2 and 3

Option 2 and 3

Inadequate staffing levels and mix, detrimental impacts on clinical care, reputational risk, staff morale.

Minor N/A N/A Likely High Likely High Detailed consideration of transitioning requirements within business case phase and early planning for workforce reskilling.

HPID

35 Site & planning Community interest / heritage issues Option 3 Option 3 Option 3 Option 3 Option 3 Delays, extensive stakeholder consultations, potential for reputational issues and increased cost to State. Limitations on scope of redevelopment option

Minor Likely High Likely High Almost Certain

Very High

CharlevilleLongreachChaters TowersKingaroyMareeba

Review sites (in line with usual whole of government processes) and develop management plan including potential for alternative sites within detailed business case

HPID

36 Site & planning Town planning / designation issues Option 3 Option 3 Option 3 Option 3 Option 3 Option 3 Option 3 Option 3 Option 3 Option 3 Option 3 Option 3 Development or redevelopment needs to consider if a ‘Material Change of Use’ is occurring. Potential for delay and withholding of approvals.

Minor N/A N/A N/A N/A Possible Medium Early consideration of planning requirements and consultation during detailed business case stage

HPID

37 Site & planning Capacity / capability changes across whole health care continuum (including existing internal and external programs, general practitioners) impact facility service demand

All options All options All options All options All options All options All options All options All options All options All options All options A broader consideration of the health care continuum may change the requirements of the building (capacity and capability)

major Possible Very High Possible Very High Possible Very High

In the business case stage, develop robust planning processes, consultation and integration with the wider community, including broader District implications

QH (PPAS)

38 Site & planning Adequacy / capacity of service provision to site boundaries (e.g. power, water, sewerage).

Option 2 and 3

Option 2 and 3

Option 2 and 3

Option 2 and 3

Option 2 and 3

Option 2 and 3

Option 2 and 3

Option 2 and 3

Option 2 and 3

Option 2 and 3

Option 2 and 3

Option 2 and 3

Significant cost increases (e.g. substation expansion) and delays

Minor N/A N/A Possible Medium Possible Medium Undertake detailed site services and planning consultations to assess expected requirements at an early stage during business case development

HPID

39 Site & planning Coordination challenges arising from multiple major projects being run in parallel.

All options All options All options All options All options All options All options All options All options All options All options All options Requirements may not be adequately delivered, value for money is not achieved, project is delayed.

Moderate Possible High Likely Very High Likely Very High

Ensure sufficient capacity and experience within project teams. Implement strong governance processes and monitor closely for signs of project strain. Seek external review at key milestones.

QH (PPAS)

40 Technology Insufficient flexibility / future proofing in ICT and infrastructure, including: - assumed retention of current models of care- existing funding arrangement applied (which does not match current requirement)- insufficient physical space to locate new ICT- inconsistent standards applied by outsourced providers- WAN constraints- poorly maintained ICT registers

All options All options All options All options All options All options All options All options All options All options All options All options Functionality cannot be readily upgraded to reflect technology advances or required changes without significant expense. Dependent on retaining current models of care - no provision for future changes in models of care for example increased eHealth requirements

Major Likely Very High Possible Very High Possible Very High

Flexibility in options to allow for changes in requirements and technology to be more easily and quickly adopted. In detailed business case, future proof for expected changes in models of care for R&R, especially increased use of eHealth / TeleHealth

ICT

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41 Technology Poor take up of telehealth: - settings within R&R may be unsuitable for telehealth. Including lack of sound proofing and inappropriate rooms for screens.- Uptake of telehealth systems by workforce may be low due to training and time constraints - public privacy concerns

Option 1 Option 1 Option 1 Option 1 Option 1 Option 1 Option 1 Option 1 Option 1 Option 1 Option 1 Option 1 The take up of the telehealth service model may be jeopardised by availability / capacity.Patient confidentiality / privacy issues.Service delivery and cost savings associated with telehealth may not be realised.

Moderate Likely Very High Possible High Unlikely Medium Address with detailed business stage as part of detailed specifications and design

TeleHealth

42 Timing State Government priorities change due to community pressure / change of Government (including implication of the new National Health and Hospital Reforms). Partial funding for staged projects, sequencing.

All options All options All options All options All options All options All options All options All options All options All options All options Insufficient funding or lack of support for critical priorities. May impact on structure (case-mix) and funding. Uncertainty may delay project. Delivery of services and hence patient outcomes may be compromised. Can't deliver the full range of services, impacts on the supporting system.

Major Likely Very High Likely Very High Likely Very High

Queensland is the lead agency for community service obligation hospitals and is involved in the development of the reform. Monitor and review.

QH (PPAS)


Inefficiencies arising from unsustainable design and development

Option 1 and 2

Option 1 and 2

Option 1 and 2

Option 1 and 2

Option 1 and 2

Option 1 and 2

Option 1 and 2

Option 1 and 2

Option 1 and 2

Option 1 and 2

Option 1 and 2

Option 1 and 2

Whole of life costs, reputational impacts Minor Almost Certain

Very High Likely High Unlikely Medium Include as part of design principles for all options, especially 2& 3. Identify strategies for improving sustainability under Option 1.

QH (PPAS)


IR risks from maintenance outsourcing under certain procurement models

All options All options All options All options All options All options All options All options All options All options All options All options Potential IR consequences Major Rare Medium Unlikely High Possible Very High

Address within procurement strategy and models

HPID

45 Timing Staging risk - extensive disruption All options All options All options All options All options All options All options All options All options All options All options All options Extensive negative impact for patients and staff

Moderate Possible High Likely Very High Possible High Seek to limit staging and decanting through design

HPID

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Appendix 8: Options analysis for the public interest assessment Atherton Hospital infrastructure options

Summary of outcomes

The results of the public interest assessment for the Atherton Hospital infrastructure options are presented in Appendix Table 8. The primary reference documents used to assess the options were the Infrastructure Study and the Service Profile for Atherton Hospital.

Option 1 is assessed as not in the public interest, while Option 2 and 3 are both assessed as in the public interest. In particular, Option 1 does not satisfy the public interest when assessed against the effectiveness in meeting service requirements, providing distributional equity and security. Option 3 potentially involves less disruption to local services. Option 3 will result in the construction of a new park for the community, including patients and staff at the Hospital.

Appendix Table 8: Summary of assessment outcomes for Atherton Hospital




Public access

Security

A detailed discussion of the public interest assessment is provided in the following sections.

Option 1


As demonstrated in Appendix Table 9, Option 1 is found to be significantly adverse to the public interest when assessed against the sustainability criteria, and not in the public interest when assessed against the accessibility and safety criteria. Option 1 is found to be not in the public interest when assessed against effectiveness in meeting service requirements.

Appendix Table 9: Atherton Hospital: Option 1 effectiveness in meeting service requirement

Criterion Component Option 1

Accessibility

Sustainability

Safety

Overall rating

Accessibility

The population of the catchment is projected to grow by 19 per cent over the period to 2021/22 and the average age of the population is expected to increase. A larger and older regional population will place greater demands on local health infrastructure and the current infrastructure is not sufficient to meet expected levels of demand.

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Currently, there are a number of safety issues at Atherton Hospital, including issues around fire safety, security, infection control, disability access and health and safety. Option 1 involves substantial measures to address these issues, but these measures are not sufficient to upgrade the facility to comply with draft CSCF v3.0, building codes and disability access requirements.

Sustainability

The focus of Option 1 is on improving compliance with current Building Code of Australia and Disability Discrimination Act. Few changes are proposed in this option that will lead to improved sustainability of the service. Option 1 addresses serious risks identified in the Infrastructure Study. The option makes substantial improvements to the Hospital, but does not address the operational flow issues or the inefficiencies in the functional arrangements of the departments. Functional relationships between different areas of the Hospital are identified in the Infrastructure Study as being extremely poor. Buildings have been added to the Hospital site progressively over the past 100 years—many of these buildings are not used for their original purpose creating inefficiencies.

Many of the buildings are considered beyond their usable life. Despite the extensive works proposed under Option 1 there are ongoing issues about the level of maintenance that would be required for these buildings. The Infrastructure Study notes that there is a high risk of cost escalation associated with Option 1 due to the poor condition of the current buildings.

In terms of workforce sustainability, Option 1 should result in some improvement, but does not address major issues at the current site. The option would provide improved security for staff, by providing locking mechanisms for nurses’ stations, improved security surveillance systems, double barrier entry to the main Hospital building and secure storage for staff personal belongings. Despite this, the option will not alleviate staff dissatisfaction with overcrowded working areas. It also does not include an upgrade to the five employee housing accommodation units at the site which are in poor condition. The provision of appropriate, safe and secure employee housing accommodation in rural hospitals is acknowledged as a vital element in the ongoing attraction and retention of staff.

The impacts on environmental sustainability under this option are unlikely to be significant. The option does not include the replacement of a number of inefficient systems at the site (current air conditioning systems are up to 33 years old). As such, this option does not address public concern about the impacts of climate change and increasing demand on limited energy resources.

Safety

Option 1 is focused on addressing the serious safety risks identified at Atherton Hospital. The list of safety issues addressed by this option is extensive. A non-exhaustive list of specific improvements is outlined below. Option 1 includes:

improvements to fire safety at the Hospital, such as, upgrades to the fire panels, the installation of more fire detectors and evacuation speakers, installation of more smoke detectors, replacement of fire hoses that are beyond their usable life and relocation of hydrants to comply with current requirements

improvements to security for staff and patients, such as, increased surveillance, the fitting of a double barrier entry to the front of the main Hospital and increased security for the storage of medical equipment

the refurbishment of Hospital bathrooms to meet safety standards outlined in the Building Code of Australia for disabled persons, and replacement of bolts on safety rails

the replacement of rotting timber flooring in the Primary Health Care Centre.

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The option also addresses a number of serious risks relating to infection control. It includes an isolation room fitted with a negative pressure air ventilation system for patients presenting with contagious or infectious diseases in the Outpatients and Emergency Departments. It would replace the air conditioning units in the chemotherapy room, Endoscopy Theatre and Operating Theatre. The air conditioning unit in the Operating Theatre currently allows particles to travel through the system and be deposited throughout the Central Sterilising Department. Consequently staff cannot use the benches below the air conditioning units.

Despite upgrades undertaken as part of Option 1, the Hospital would not be able to operate at a Level 3 draft CSCF v3.0 service capability. This option is not fully compliant with all standards against which it is assessed.


Option 1 includes upgrades to Atherton Hospital infrastructure that would be expected to improve the level of care provided to the area. The Hospital, however, would not be able to operate at Level 3 draft CSCF v3.0 capability to deliver services. Failure to meet this capability will have a negative impact on all groups, including International/Culturally and Linguistically Diverse (CALD), Aboriginal and Torres Strait Islanders, lower socio-economic groups and persons with a disability.

Option 1 fails to address serious issues with the usable life of the Atherton Hospital and similar issues about staff recruitment and retention. It does not ensure that services, of a level commensurate with similar communities within rural and regional Queensland, will be provided at the Atherton Hospital.

The Infrastructure Study identifies that Option 1 would cause considerable disruption to service delivery at the site. The impact of this disruption is not clear; however, it may be significant, especially given the presence of asbestos in many of the Hospital’s buildings.

The option is assessed to be significantly adverse to the public interest for equity of access to essential health services and impact on stakeholders.

Public access

Option 1 has a positive impact on public access by making improvements to ensure disabled access. This includes:

the refurbishment of disabled toilet amenities in order to comply with current Building Code of Australia standards

providing disabled parking and parking signage to current standards

connecting car parking areas to the Hospital buildings by accessible pathways

adding tactile indicators around the Hospital to assist persons with a visual impairment

installing appropriate handrails and balustrades

installing tactile ground surface indicators at changes of slope, stairs or ramps.

These improvements will rectify non-compliance with the Disability Discrimination Act.

This option improves access for disabled persons and is considered in the public interest.

Security

The infrastructure at Atherton Hospital presents a number of serious security issues for the delivery of health services. The rectification works proposed under Option 1 address many of these issues. Specific issues of security of supply that are addressed under Option 1 include:

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risk of fire threatening the supply of health services—Option 1 includes extensive rectification works to limit the risk of fire impacting on the Hospital. As well as expanding and upgrading fire systems Option 1 includes substantial reconstruction works to provide fire separation between different areas of the Hospital

water ingress in the primary health building—currently the primary health building at Atherton Hospital suffers from water ingress at times of heavy rainfall. Option 1 would rectify this issue

faulty fire alarms—currently fire alarms at Atherton Hospital activate, for no apparent reason, at least once per month. This restricts the supply of services during these incidents because of the need to evacuate. This issue is expected to be rectified under Option 1.

The measures outlined for Option 1 are an improvement on the current security of supply; however, as many of the Hospital’s structural deficiencies are not addressed the option is assessed not to be in the public interest with respect to security of supply requirements.

Option 2


As demonstrated in Appendix Table 10, Option 2 is found to be in the public interest when assessed against the accessibility, sustainability and safety criteria. Option 2 is found to be in the public interest when assessed against effectiveness in meeting service requirements.



Accessibility

Sustainability

Safety

Overall rating

Accessibility

In terms of accessibility, Option 2 provides for ongoing access to Hospital services for Atherton.

The new development would be compliant with minimum support services, staffing, and safety standards as well as operating at a Level 3 draft CSCF v3.0. The option would address the serious compliance issues at Atherton Hospital, including issues around fire safety, security, infection control, disability access and health and safety.

Sustainability

Option 2 will maintain the current range of health care services and ensure that current and future demands are met. The impacts on sustainability resulting from this option are positive.

The proposed improvements from Option 2 will lead to higher quality and more efficient provision of services. The option includes addressing the serious risks around fire, security and infection control identified under Option 1. It also extends upon Option 1 by addressing some of the operational inefficiencies that are present at the Hospital. This is expected to allow for more efficient staffing models to be deployed. Option 2 is also expected to reduce energy costs and the ongoing capital expenditure required at the Hospital.

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Option 2 has the potential to improve workforce sustainability by increasing staff satisfaction at the Hospital. The Infrastructure Study reports that currently, the inefficient functional layout of the Hospital, the poor condition of Hospital infrastructure and lack of staff amenities are contributing to staff dissatisfaction. The ability to recruit and retain staff at regional and rural hospitals is crucial to the ongoing provision of health services. This option improves workforce sustainability by:

improving the functional layout of the Hospital and addressing overcrowding

improving security for staff

providing appropriate staff amenities

addressing staff privacy issues.

Unlike Option 1, Option 2 includes the construction of 48 new employee housing accommodation units (including the replacement of five existing accommodation units). The Infrastructure Study reports that the existing employee housing accommodation is unsuitable and complaints have been received from staff.

In many cases, the buildings at Atherton Hospital are more than 50 years old and have reached the end of their usable life. The systems in these buildings, including air conditioners more than 30 years old, are inefficient and do not conform to current Building Code of Australia standards. Option 2 involves the reconstruction of most of the Hospital’s facilities. It would be designed with green star developments at the time of construction and it is anticipated that the new facility would produce significant energy efficiencies. This option reflects public concerns about energy consumption while improving services.

Safety

Option 2 includes all the changes to buildings and facilities that improve compliance with standards proposed for Option 1. The newly constructed areas of the Hospital will be built to comply with current Disability Discrimination Act and Building Code of Australia standards. The option is also expected to address all of the major safety issues with Atherton Hospital, as it would not be impeded by the structural limitations of a refurbishment.


Option 2 ensures that the service capacity is commensurate with the projected demand for services in the catchment over the period to 2021/22. This ensures that catchment residents will receive a level of care that is consistent with the required standard across rural and remote communities.

Option 2 addresses some of the risks to the usable life of the Atherton Hospital and similar issues about staff recruitment and retention. This option goes some way to ensuring that distributional equity is achieved by providing services at a level commensurate with similar communities within rural and regional Queensland.

Unlike Option 1, Option 2 would make significant improvements to the state of employee housing accommodation at Atherton Hospital. Appropriate, safe and secure employee housing accommodation is critical to attracting and retaining staff at rural and regional hospitals and therefore ensuring the ongoing provision of services of a quality that is similar to comparable regions.

Improvements proposed under Option 2 are considered to be in the public interest with respect to equity of access to essential health services.

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Public access

Option 2 enhances compliance with the Disability Discrimination Act. This will improve access to facilities, particularly for persons with disabilities. Measures include:

providing onsite disability car parking

connecting car parks to Hospital buildings by accessible walk ways

refurbishing toilet amenities to comply with current Building Code of Australia standards

installing Braille and tactile signage in toilets, lifts and other accessible areas.

The option is assessed to be in the public interest with respect to providing public access to essential health services.

Security

As noted for Option 1, the infrastructure at Atherton Hospital presents a number of serious issues for the security of supply of health services. Option 2, like Option 1 would rectify serious risks to supply from fire and water ingress. Option 2 is an improvement on Option 1 as it would address a greater number of structural limitations of the site and functional inefficiencies.

This option has been assessed as in the public interest with respect to security of supply for essential health services.

Option 3


As demonstrated in Appendix Table 11, Option 3 is found to be in the public interest when assessed against the criteria of accessibility and safety in terms of meeting the services requirement, and significantly in the public interest when assessed against the sustainability criterion. Option 3 is found to be in the public interest when assessed against effectiveness in meeting service requirements.



Accessibility

Sustainability

Safety

Overall rating

Accessibility

Option 3 is a fully staged rebuild of the entire Hospital campus on the greenfield land adjacent to the existing Hospital.

This option improves on Option 2 by being able to operate at a Level 3 draft CSCF v3.0 capability and meets Building Code of Australia and Disability Discrimination Act standards.

Sustainability

As with Option 2, the focus of Option 3 is maintaining a minimum level of health care services so that current and future demands are met. An assessment of the impacts of Option 3 on the economic, workforce and environmental sustainability of Atherton Hospital is provided below.

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The proposed improvements from Option 3 will lead to higher quality and more efficient provision of services. Option 3 allows for the most effective provision of services based on the service profile. This option makes significant improvements to the links between different components of the Hospital and enables better management of the Hospital’s ongoing operating expenditure through reducing energy consumption, staffing and maintenance requirements. Option 3 will improve the efficiency of service delivery at the Hospital.

Option 3 is expected to provide considerable benefits to workforce sustainability at Atherton Hospital. The option includes the improvements to employee housing accommodation outlined for Option 2 and provides a more functional and efficient working environment. The Infrastructure Study for Atherton Hospital predicts that Option 3 would have a positive influence on attracting medical staff to the Hospital beyond what is proposed under Option 2.

The impact on environment sustainability is also likely to be more significant than under Option 2. A much larger proportion of Option 3 is a new build. As a result, the Hospital is expected to be more energy efficient, including achieving compliance with the Queensland Health Energy Efficiency Guidelines.

Safety

Option 3 addresses all the safety risks addressed in Option 2.


Option 3 ensures that the service capacity is commensurate with the projected demand for services in the catchment over the period to 2021/22.

Like Option 2, the use of the greenfield land adjacent to the current Hospital under Option 3 will allow for new buildings to be constructed before the old ones are demolished. This means that services will only require minimal levels of decanting during the construction period. It is expected that phase one of the redevelopment could be completed without disruption to existing services (except minor disruption from noise). Phase two of the construction (the refurbishment of the Pioneer Building) would require the temporary decant of some administration functions and primary health services.

Option 3 has an advantage over Option 2 in that the brownfield site of the current Hospital would be converted into parkland. This is expected to provide additional benefits to patients, carers, staff and the Atherton community.

Option 3 will protect and extend the worklife of the oldest building—the Pioneer Ward, which has local significance.

This option is assessed to be significantly in the public interest with respect to providing public access to essential health services.

Public access

Like Option 2, Option 3 includes significant upgrades of the Hospital to current standards including the Building Code of Australia and the Disability Discrimination Act and meets capability for Level 3 draft CSCF v3.0 services.

The level of disruption to service as a result of Option 3 would be expected to be less than under Option 2, as there is a greater emphasis on new builds.

This option has been assessed as in the public interest with respect to security of supply and access to essential health services.

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Security

As noted for Options 1 and 2, the infrastructure investments at Atherton Hospital would address a number of serious security issues for delivery of health services. Option 3 is a slight improvement on Option 2 in that it would address a greater number of functional inefficiencies at the site.

This option is assessed as being in the public interest with respect to security of supply for essential health services.

Ayr Hospital infrastructure options

Summary of outcomes

The results of the public interest assessment for the Ayr Hospital infrastructure options are presented in Appendix Table 12. The primary reference documents used to assess the options were the Infrastructure Study and the Service Profile for Ayr Hospital.

Option 1 addresses major risks at the Hospital. Its effectiveness in meeting service requirements is not assessed to be in the public interest, because it does little to address major issues impacting on the Hospital’s ability to recruit and retain staff. Options 2 and 3 are similarly assessed. The main difference between these options is that Option 2 involves the refurbishment of an existing building at the site, whereas Option 3 would involve a new building. In terms of public interest it is difficult to distinguish between the two options at this point.

Appendix Table 12: Summary of assessment outcomes for Ayr Hospital




Public access

Security


Option 1


As demonstrated in Appendix Table 13, Option 1 is found to be not in the public interest when assessed against the accessibility and sustainability criteria, but in the public interest, when assessed against the safety criteria. Option 1 is found to be not in the public interest when assessed against effectiveness in meeting service requirements.

Appendix Table 13: Ayr Hospital: Option 1 effectiveness in meeting service requirement


Accessibility

Sustainability

Safety

Overall rating

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Accessibility

The population of Ayr is expected to decline by around one per cent, over the period 2006 to 2026. Despite the decline, an ageing population is expected to result in an increase in the demand for health services at Ayr Hospital. There are no indications that demand for health services in the catchment will exceed supply, however, there are a number of serious issues about the impact that the current infrastructure and facilities are having on the current provision of services.

Currently, there are a number of serious compliance issues at Ayr Hospital, including risks around fire safety, security, infection control, disability access and workplace health and safety. Option 1 involves substantial measures to address these risks; however, it does little to improve employee housing accommodation and working conditions. The inability of Ayr Hospital to attract and retain staff limits the capacity of the Hospital to provide services.

Sustainability

The focus of Option 1 is on improving compliance with current Building Code of Australia and Disability Discrimination Act standards. Few changes are proposed in this option that will lead to improved sustainability of service. Option 1 addresses serious risks identified during the Infrastructure Study for the Hospital. An assessment of the economic, workforce and environmental sustainability of Option 1 is provided below.

Option 1 does not address the operational work flow issues or the inefficiencies in the functional arrangements of the departments identified in the Infrastructure Study. Ayr Hospital was reconstructed in 2004 and buildings are generally fit for purpose, however, due to design variations during the construction phase, there are a number of issues impacting on overcrowding of work areas that will not be addressed under Option 1.

In terms of workforce sustainability, Option 1 should result in some improvement, but does not address major issues at the current site. The option addresses a number of serious security risks for the staff (and patients) including the provision of additional security surveillance, a double-barrier entry to the Hospital and upgrades to alarm systems. Option 1 however, does not provide for any upgrade to employee housing accommodation, which is reportedly unsuitable. The option also does not address functional efficiency issues which impact on staff morale. The option has been assessed as inadequate.

The impacts on environmental sustainability of this option are unlikely to be significant. The option does not include plans to upgrade major Hospital systems, but will take some measures to prolong the buildings’ usable life. As such, this option does not address public concern about the impacts of climate change and increasing demand on limited energy resources.

Safety

Option 1 includes a number of changes to buildings that address a number of safety issues at Ayr Hospital including:

infection issues—addressed through the installation of backflow devices and isolation rooms to treat patients with infectious conditions

fire issues—addressed through shifting some Hospital activities, repairing breaches to fire walls, retrofitting fire collars and upgrading emergency lighting

security issues—addressed through improvements to surveillance systems, a double barrier entry to the Hospital and upgrades to alarm systems.

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This option mitigates and/or reduces to a safe level all of the risks identified by the Infrastructure Study.


Option 1 provides for some improvement to the infrastructure at Ayr Hospital, thus improving the level of care provided to people in the area. The option does not address major staff issues with overcrowded work areas or inadequate maintenance of facilities. It also fails to include any upgrade of staff facilities, which were assessed as not fit-for-purpose. The failure to address these issues impedes Queensland Health’s ability to recruit and retain staff at Ayr Hospital, which is critical to the ongoing provision of services. All stakeholders are likely to be adversely affected by this option. Vulnerable groups such as CALD, Aboriginal and Torres Strait Islanders, low socio-economic and persons with a disability are likely to be impacted the most.

This option is assessed as not being in the public interest with respect to equity of access to essential health services.

Public access

Option 1 has a positive impact on public access by ensuring that minimum standards for access for persons with disabilities under the Disability Discrimination Act are met. This includes:

the refurbishment of toilet facilities to comply with standards

installation of Braille/tactile signage for toilets, lifts and other accessible areas (currently aides for visually impaired persons in the Hospital are non-existent)

upgrade disabled bathrooms to meet current standards

labelling the existing disabled car parks to comply with standards.

The option will address areas of non-compliance with the Disability Discrimination Act. This is assessed to be in the public interest with respect to providing public access to essential health services.

Security

Ayr Hospital is relatively new, having been constructed in 2004 and most of the issues with the Hospital are addressed in Option 1, such as those concerning fire risks. This option is assessed as being in the public interest with respect to security of supply requirements.

Option 2





Accessibility

Sustainability

Safety

Overall rating

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Accessibility

Option 2 includes addressing all of the safety and compliance issues discussed under Option 1. The option also includes a major refurbishment of the disused nursing home building on the site to be used for employee housing accommodation, administrative services and some primary health services. Areas made available from the relocation of selected services and administration will relieve overcrowding issues for the remainder of the primary health and dental services. Option 2, unlike Option 1 includes a substantial upgrade to employee housing accommodation at Ayr Hospital.

Improvements under Option 2, in particular reductions in overcrowding and the provision of new accommodation, are considered essential to the ongoing attraction and retention of staff and the capacity of the Hospital to operate at Level 3 draft CSCF v3.0 capability.

Sustainability

An assessment of the economic, workforce and environmental sustainability of Option 2 is provided below.

In terms of economic sustainability, the option will lead to marginal improvement in the efficient provision of services. By shifting some of the administrative and primary care functions of the Hospital to the refurbished nursing home building, the Hospital can make functional improvements to the layout of the primary health and dental areas as well as relieve the overcrowding issues that are prevalent because of insufficient clinical spaces.

This option also includes refurbishing the nursing home. The 50 year old building is structurally sound; however, its usable life (after refurbishment) may not be the same as for a new build.

In terms of workforce sustainability, Option 2 has the potential to generate a positive impact by increasing staff satisfaction through improved employee housing accommodation and working environment. Option 2 includes the construction of 21 new units of accommodation and alleviates the overcrowding in work areas at the Hospital. The Infrastructure Study, however, notes that this option does not address the inefficiencies in the functional arrangements across all primary health and administration departments.

Impacts on environmental sustainability under Option 2 are minimal. There may be some marginal improvements to redeveloped components of the Hospital as these would be required to be built to current Building Code of Australia standards, which are not currently being achieved. More detailed planning would need to be undertaken to determine whether other environmental improvements could be made under this option.

Safety

Option 2 addresses the same safety issues outlined under Option 1, and is therefore in the public interest.


Option 2 does not increase the range or level of service provision at Ayr Hospital. The option will have a positive impact on stakeholders to the extent that improvements to overcrowding and employee housing accommodation will aid recruitment and retention of staff and ensure the ongoing viability of the Hospital. As such, Ayr Hospital is more likely to be able to provide catchment residents with services at Level 3 draft CSCF v3.0.

Unlike Option 1, Option 2 would make significant improvements to employee housing accommodation at Ayr Hospital.

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The construction activities outlined under Option 2 are mostly focused on the disused nursing home building. There may be a need for some minor decanting of services during construction; however, it is not expected that this would cause significant disruption.


Public access

Option 2 includes all of the improvements identified under Option 1. It is assessed as being in the public interest with respect to public access to essential health services.

Security

Option 2 addresses all the impacts on security of supply addressed in Option 1. The improvements in security are assessed to be in the public interest with respect to security of supply requirements.

Option 3





Accessibility

Sustainability

Safety

Overall rating

Accessibility

Option 3, like Option 2 addresses all of the safety and compliance issues discussed under Option 1. Option 3 also includes the construction of a new building adjacent to the existing Hospital for primary health, administration services and secondary storage of medical records. It is proposed that the building be placed on greenfield land adjacent to the existing infrastructure and that the helipad be relocated to accommodate the new build. Areas made available from the relocation of selected services and administration will relieve overcrowding issues for primary health and dental services. Option 3, like Option 2, includes a substantial upgrade to employee housing accommodation at Ayr Hospital.

Improvements under Option 3, similar to Option 2, are considered essential to the ongoing attraction and retention of staff and the capability of the Hospital to provide services at Level 3 draft CSCF v3.0.

Sustainability

As with Option 2, the focus of Option 3 is to maintain the delivery of services at Level 3 draft CSCF v3.0 to meet current and projected demand. The impacts on sustainability resulting from this option are positive.

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Option 3 allows for the most effective provision of services based on the service profile. This option makes significant improvements to the links between different components of the Hospital, addresses overcrowding issues and enables better management of the Hospital’s ongoing operating expenditure through reducing energy consumption and maintenance requirements.

Option 3 will provide considerable benefits to workforce sustainability at Ayr Hospital. The option includes the improvements to employee housing accommodation outlined for Option 2 and provides a more functional and efficient working environment.

Impacts on environmental sustainability under Option 3 are also likely to be more significant than under Option 2. The new facility would be built to the Queensland Government’s Health Energy Efficiency Guidelines and would produce significant energy efficiencies. The new construction is aligned with the principles of ecological sustainable design in that it would be orientated with an east-west axis, providing for long elevations facing north and south.

Safety

The option addresses the safety issues outlined under Option 1 and so is in the public interest.


Option 3 ensures that service capacity is commensurate with the projected demand for services in the catchment to 2021/22.

Option 3 would provide appropriate, safe and secure employee housing accommodation at Ayr Hospital.


Public access

Option 3 includes all of the improvements to facilities identified under Option 2. It is assessed as being in the public interest with respect to public access of essential health services.

Security

Option 3 addresses all the impacts on security of supply addressed in Option 2. The improvements are assessed to be in the public interest with respect to security of supply requirements.

Biloela Hospital infrastructure options

Summary of outcomes

The results of the public interest assessment for the Biloela Hospital infrastructure options are presented in Appendix Table 16. The primary reference documents used to assess the options were the Infrastructure Study and the Service Profile for Biloela Hospital.

Option 1 is assessed as not in the public interest, while Options 2 and 3 are assessed as in the public interest.

Appendix Table 16 Summary of assessment outcomes for Biloela Hospital




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Public access

Security


Option 1


As demonstrated in Appendix Table 17, Option 1 is found to be not in the public interest when assessed against the accessibility and sustainability criteria and is significantly adverse to the public interest when assessed against the safety criterion. Option 1 is found to be not in the public interest when assessed against effectiveness in providing service requirements.

Appendix Table 17: Biloela Hospital: Option 1 effectiveness in meeting service requirement


Accessibility

Sustainability

Safety

Overall rating

Accessibility

The population of Biloela Hospital catchment is projected to grow by four per cent over the period to 2021 and the average age of the population is expected to increase. Although a larger and older regional population is likely to place greater demands on local health infrastructure, the current infrastructure should be sufficient to meet expected levels of demand.

Currently, there are a number of serious compliance issues at Biloela Hospital, including issues around fire safety, security, infection control, disability access and health and safety. Option 1 involves substantial measures to address these issues, but these measures are not sufficient to upgrade the facility to provide services at Level 3 draft CSCF v3.0 capability.

Sustainability

The proposed improvements in Option 1 suggest a very minor positive impact for economic sustainability. These improvements are largely generated through the provision of new facilities for services such as the Emergency Department, laundry/physiotherapy and oral health buildings and the relocation of community health services on the Hospital site and collocated with oral health and allied health services.

The Infrastructure Study noted that the upgrades under Option 1 may negatively impact on workforce sustainability. Although this option includes the replacement of the old nurses’ quarters with new accommodation facilities, the poor condition of the Hospital buildings and the maintenance issues experienced due to the presence of asbestos provides for less than desirable working conditions. As a result, in the short term construction may increase staff dissatisfaction and create morale issues.

The impacts on environmental sustainability under Option 1 are likely to be minor. The Infrastructure Study makes no mention of system energy usage improvements or other environmental improvements. As such, this option is assumed to not address public concern about the impacts of climate change and increasing demand on limited energy resources.

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Safety

Option 1 includes very minor changes to buildings and facilities that improve compliance with Building Code of Australia and Disability Discrimination Act standards. Option 1 addresses some, but not all, of the identified fire safety and infection control risks. The new Emergency Department will be able to operate at Level 3 draft CSCF v3.0 standards, however, the remainder of the Hospital will not.

This option is not fully compliant with all standards against which it is assessed.


Option 1 provides for some improvement to Biloela Hospital infrastructure, supporting improvements in the level of care provided to residents. However the service capacity will not be improved sufficiently to operate at Level 3 draft CSCF v3.0.

All stakeholder groups are likely to be adversely affected under this option. The impact of not supplying adequate capacity for health care is likely to be greatest on vulnerable groups such as CALD, Aboriginal and Torres Strait Islanders, lower socio-economic and persons with a disability.

This Option is assessed to be not in the public interest with respect to equity of access to essential health services.

Public access

Under Option 1 minor upgrades are undertaken to improve access for persons with disabilities. These minor improvements are, however, insufficient to meet the requirements under the Building Code of Australia and the Disability Discrimination Act.

This is assessed to be significantly adverse to the public interest.

Security

The Infrastructure Study for Biloela Hospital identified a limited number of risks in relation to security of supply, primarily around the risk of fire threatening supply. Option 1 includes some improvements to fire safety, however, there are additional outstanding risks associated with fire or smoke compartments within the main buildings.

This option has been assessed as not in the public interest with respect to security of supply for essential health services.

Option 2


As demonstrated in Appendix Table 18, Option 2 is found to be in the public interest when assessed against the accessibility and safety criteria and significantly in the public interest when assessed against the sustainability criterion. Option 2 is found to be in the public interest when assessed against effectiveness in meeting service requirements.



Accessibility

Sustainability

Safety

Overall rating

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Accessibility

In terms of accessibility, Option 2 provides for improved access to services at Biloela Hospital. The option includes the construction of a new integrated Emergency, Outpatient and Medical Imaging Department, new Operating Theatres and Central Sterilising Department and relocates the community health services to the Hospital site.

The option will address the serious compliance issues at Biloela Hospital, including issues around fire safety, security, infection control, disability access and health and safety.

Sustainability

The upgrades under Option 2 will support more efficient provision of services. The construction of new buildings and expansion of existing areas should improve functionality and the relationship between services. The clustering of the new Emergency and Outpatient Departments and medical imaging and the community and allied health and dental services will improve interdepartmental functioning.

Additionally, the removal of asbestos— which may have potential adverse health consequences for staff, patients and carers—will improve the Hospital environment. Option 2 has the potential to improve workforce sustainability as it includes substantially larger and better facilities for staff. In particular, the location and design of the new employee housing accommodation will allow for separation between services and residential areas, providing privacy and space for staff. The redevelopment and refurbishment of the majority of Hospital buildings coupled with the grouping of selected departments will improve the working environment. Overall these changes suggest likely improvements to staff satisfaction.

The redevelopment of all buildings, apart from Wards A and B, is anticipated to result in more energy efficient buildings, further contributing to the reduction of greenhouse gas emissions. This option reflects the public’s concerns about energy consumption while improving services.

Safety

Option 2 includes changes to buildings and facilities that improves compliance with Building Code of Australia and Disability Discrimination Act standards proposed for Option 1. Key improvements identified in the Infrastructure Study include:

provision of new fully Disability Discrimination Act compliant and user friendly entrance

removal of asbestos from Wards A and B

provision of covered walkway connecting the kitchen to Ward A.

Refurbishment and redevelopment activities will result in the removal of asbestos currently present in the buildings. This provides for a safer environment as it reduces the exposure of staff and patients to hazardous building materials. However, the Infrastructure Study reports that the upgrades will be insufficient to reach compliance with the Building Code of Australia. For example, while Ward B will be upgraded to suit current regulations, the external fabric will not comply with Part J of the Building Code of Australia. This option is not fully compliant with all standards against which it is assessed but it is a significant improvement on the current arrangements.



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Unlike Option 1, Option 2 would make significant improvements to the state of employee housing accommodation at Biloela Hospital. These further improvements should boost staff morale.

Option 2 involves substantially more construction work than Option 1 including the redevelopment of all buildings with the exception of Wards A and B where refurbishment will be undertaken. The Project is designed to be done in stages to ensure continued service provision but there will inevitably be some disruption for patients and staff. In particular, the removal of asbestos from Wards A and B will bring significant disruption to these buildings as a double decanting strategy is required to relocate staff and patients to temporary accommodation and back to the refurbished wards.


Public access

Option 2 includes significant improvements to compliance with current regulation as a result of the amount of new builds proposed. Improvements around public access include:

development of car parking areas for staff and visitors alongside the central road spine

integration of the new Emergency Department, Outpatient Department and imaging areas to provide easy of access to common/related services

provision of new entrance fully compliant and user friendly.

Despite these improvements the Biloela Hospital will not be compliant with the Disability Discrimination Act as a result of the changes under Option 2.

This criterion has been assessed to be significantly adverse to the public interest with respect to public access to essential health services.

Security

Option 2 addresses all of the outstanding issues associated with the security of supply not addressed in Option 1.

This criterion is assessed to be in the public interest with respect to security of supply requirements.

Option 3


As demonstrated in Appendix Table 19, Option 3 is found to be in the public interest against the accessibility and safety criteria and significantly in the public interest against the sustainability criterion. Option 3 is found to be in the public interest when assessed against effectiveness in meeting service requirements.



Accessibility

Sustainability

Safety

Overall rating

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Accessibility

This option involves the construction of a completely new facility on the site. As for Option 2, Option 3 continues to provide all of the current health care services. Option 3, therefore, also provides services at a Level 3 draft CSCF v3.0 capability. The development of a completely new facility will also mean full compliance with the Building Code of Australia and the Disability Discrimination Act and as well as the Queensland Health Energy Efficiency Guidelines.

Sustainability

The proposed improvements in Option 3 will lead to more efficient provision of services. Option 3 allows for the most effective provision of services based on the service profile. It allows for a more efficient and compact site and better relationship between services. For example, the consolidation of laundry and kitchen services will allow easy access for staff and patients. It is also expected to result in efficient and improved performance of systems that will enable a more efficient use of energy.

In terms of workforce sustainability, the key improvements to staff areas under Option 3 are the same as those under Option 2. However, Option 3 also includes improvements around the location of the support facilities (laundry, kitchen, stores, etc) to provide a more concentrated service able to be accessed independently without disturbing the flow of patients and staff. These improvements should further boost staff satisfaction by providing for a more spacious, comfortable and better integrated work environment.

Based on the Infrastructure Study the impact on environment sustainability is likely to be more significant than under Option 2. Under Option 3 the Hospital will be fully compliant with the Queensland Health Energy Efficiency Guidelines. This option reflects the public concern about energy consumption and global warming while improving services.

Safety

Based on the Infrastructure Study, Option 3 addresses all the safety risks identified. In addition, under Option 3 all Hospital facilities are compliant with the Building Code of Australia and the Disability Discrimination Act, and the Queensland Health Energy Efficiency Guidelines.



Option 3 involves the construction of new buildings at the Biloela Hospital site. The focus of this option on new buildings, rather than refurbishment of existing buildings, means that service disruptions should be reduced as compared with Option 2. New builds can be constructed while the original building is still in use with relocation into the new facility taking place after construction has finished.

This criterion is assessed as in the public interest with respect to equity of access to essential health services.

Public access

Public access is significantly improved in Option 3 compared to Option 2. The main improvements to public access are separate access for services, clear identification of the main entrance and ambulance and Emergency Department entrance and improvements to access for persons with disabilities. Other improvements include:

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provision of a drop off area by the main entrance

concentration of services, such as kitchen and laundry, improving access for both patients and staff

provision of independent access to services without disturbing the flow of patients and staff

provision of a single storey facility that provides all services on ground floor.

Option 3 includes all the improvements to ensure compliance with the Disability Discrimination Act.

This criterion has been assessed as in the public interest with respect to public access to essential health services.

Security

As with Option 2, Option 3 addresses all the security of supply risk identified in the Infrastructure Study.

This criterion is assessed to be in the public interest with respect to security of supply requirements.

Charleville Hospital infrastructure options

Summary of outcomes

The results of the public interest assessment for the Charleville Hospital infrastructure options are presented in Appendix Table 20. The primary reference documents used to assess the options were the Infrastructure Study and the Service Profile for Charleville Hospital.

Option 2 and, to a greater extent, Option 3 are both assessed as in the public interest. Option 1 has been found to be in the public interest when assessed against security criteria; however, it is found to not satisfy the public interest when assessed against the effectiveness in meeting service requirement, public access, and distributional equity and impact on stakeholders.

Appendix Table 20: Summary of assessment outcomes for Charleville Hospital




Public access

Security


Option 1


As demonstrated in Appendix Table 21, Option 1 is found to be adverse to the public interest when assessed against the sustainability and safety criteria, and significantly adverse to the public interest when assessed against the accessibility criteria. Option 1’s overall rating against the effectiveness in meeting service requirements is found to be adverse to the public interest.

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Appendix Table 21: Charleville Hospital: Option 1 effectiveness in meeting service requirement

Criterion component Option 1

Accessibility

Sustainability

Safety

Overall rating

Accessibility

The population of the Charleville Hospital catchment is projected to decline by around one per cent, over the period to 2021; however, the average age of the population is expected to increase. An older population is likely to place greater demands on local health infrastructure.

Currently, there are a number of serious compliance issues at Charleville Hospital, including issues around fire safety, security, infection control, disability access and health and safety. Option 1 involves substantial measures to address these issues, but these measures are not sufficient to upgrade the facility to provide Level 3 draft CSCF v3.0 services.

Sustainability

The focus of Option 1 is on sufficiently improving existing infrastructure to allow for the provision of current services. Few changes are proposed in this option that will lead to improved sustainability of service.

The proposed improvements in Option 1 will lead to a very minor positive impact for economic sustainability resulting from measures that may improve the quality and/or efficiency of service provision. Improvements include the provision of a common services building which will enable facilities to remain operational during flooding, the relocation of the Community Health building to the site and the upgrading of access to points to provide appropriate disabled access.

Impacts on workforce sustainability under Option 1 are minor. While this option provides for relocation of employee housing accommodation and the provision of some new housing, few measures will improve the working conditions of staff, due to the continued use of existing infrastructure. Inadequate interdepartmental functional relationships, as well as significant issues during flooding, may result in job dissatisfaction.

Impacts on environmental sustainability under Option 1 are minor. Works under Option 1 will not achieve energy efficiencies due to the age and condition of the existing infrastructure.

Safety

Option 1 includes a number of changes to buildings and facilities that address some safety issues currently experienced at the site. These include:

provision of a new road on the eastern side of the site in order to diminish the risk of isolation during flooding in conjunction with crossing over the railway

upgrade of access points to provide appropriate disabled access

some improvement to fire protection

improvement of internal stairs to address issue of access and egress and meet standards for a safe egress route.

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Upgrades undertaken as part of Option 1 are not sufficient to meet the standards against which it is assessed, including the Building Code of Australia and the Disability Discrimination Act.


Option 1 includes some measures which will improve Charleville Hospital infrastructure, thus improving the level of care provided to the area. The Infrastructure Study notes, however, that the service capacity will not be improved sufficiently to meet Level 3 service requirements as identified in the draft CSCF v3.0. It is not in the public interest to provide inconsistent levels of care across rural and regional areas. All stakeholder groups are likely to be adversely affected under insufficient service capacity. Of all stakeholders, those most adversely affected will include vulnerable groups including lower socio-economic groups, CALD, Aboriginal and Torres Strait Islanders and persons with a disability.

This option is assessed to be not in the public interest with respect to equity of access to essential health services.

Public access

Option 1 has a positive impact on public access by addressing some issues of access for persons with disabilities, including the upgrade of access points to provide appropriate disabled access and provision of accessible car park spaces. This option also includes addressing issues of access and egress around the internal staircase. While these upgrades address some public access issues, it is important to note that the upgrades under Option 1 are not sufficient to reach compliance with the Disability Discrimination Act.

A new road on the eastern side of the site will be built under Option 1 in order to diminish the risk of isolation during flooding in conjunction with crossing over the railway, which may help to improve public access to the facility.

This option is assessed to be not in the public interest with respect to public access to essential health services.

Security

There are a number of risks in relation to security of supply identified for Charleville Hospital. Not all of the risks identified are addressed in this option; however, the Project option does address a number of key areas. The two key measures undertaken to ensure security of supply are:

provision of a new road on the eastern side of the site in order to diminish the risk of isolation during flooding in conjunction with crossing over the railway

creation of a common services building which will ensure ability of facilities to remain operational during flooding.

These improvements are vital to the security of supply of services at Charleville Hospital, due to its location on a flood plain and the frequency of local flooding.

This option is assessed to be in the public interest with respect to security of supply requirements.

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Option 2



Appendix Table 22: Charleville Hospital: Option 2 effectiveness in meeting service requirement


Accessibility

Sustainability

Safety

Overall rating

Accessibility

Option 2 provides for ongoing access to Charleville Hospital services. The option includes the replacement of all buildings except the main building by new construction, in order to allow for a greater concentration of services, the construction of new employee housing accommodation and the construction of a new access road to avoid isolation from the town during times of flooding.

The new development would be compliant with minimum support services, staffing, safety standards and other requirements to provide Level 3 services of the draft CSCF v3.0. The option would address the serious compliance issues at Charleville Hospital, including issues around fire safety, security, infection control, disability access and health and safety. Furthermore, under this option key services are relocated to avoid high-risk flood zones. These factors contribute to an increase in accessibility of services to the catchment.

Sustainability

The focus of Option 2 is on achieving a minimum level of health care services and further addressing issues identified in the current facility. The impacts on sustainability resulting from this option are moderate.

The proposed measures in Option 2 will lead to higher quality and more efficient provision of services. Measures undertaken to achieve this improvement include:

the removal of all asbestos from the current building to enable use for a wider range of functions, such as accommodation

a significant portion of rebuild including the replacement of all building except the main building, allowing for a logical concentration of services accounting for segregation of flows

clustering of the Outpatient, Emergency and Medical Imaging Department to enhance synergy

the addition of two lifts plus stairs to ease movement from the ground floor to level 1.

These measures will lead to an increase in sustainability and reduce maintenance costs, which were expected to increase under Option 1.

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Option 2 has the potential to improve workforce sustainability by increasing staff satisfaction. The measures listed above will contribute to an easier and more efficient delivery of services, enhancing staff ability to effectively meet healthcare demands of the community. In addition, this option includes new employee housing accommodation.

Impacts on environmental sustainability under Option 2 are likely to be minimal. No indication is given in the Infrastructure Study that significant environmental benefits will be achieved under this option. It is assumed that the significant proportion of new buildings constructed will comply with the Queensland Health Energy Efficiency Guidelines and will therefore present some benefit to environmental sustainability.

Safety

Option 2 includes all of the changes to buildings and facilities that improve compliance with Building Code of Australia and Disability Discrimination Act standards proposed for Option 1. The additional key measures include:

removal of asbestos from the current main building

a new fully Disability Discrimination Act compliant entrance

relocation of key services to avoid high risk flood zones

improved emergency access during flooding.


Option 2 ensures that the Hospital is able to provide services at a Level 3 draft CSCF v3.0 capability.

Option 2 involves substantially more construction work than Option 1, with all buildings except the main building being reconstructed. In addition, key services are relocated to avoid high-risk flood zones under this option. The staging and decanting process required in this option is achievable without major disruption to the existing services, but will likely have some temporary impact on disruption of patients and staff. However, this impact will be short term and should be minimal.

Unlike Option 1, Option 2 would make significant improvements to the state of employee housing accommodation at Charleville Hospital.

This option is assessed to be in the public interest with respect to equity of access to essential health services.

Public access

Option 2 includes all measures to improve compliance with current regulations under Option 1, plus additional measures including the addition of two lifts to ease movement from the ground floor to level one and the grouping of services in one block with vehicular access and in close proximity to the main services buildings. This option achieves increased compliance with the Disability Discrimination Act; however, there are still some areas where additional accessibility could be facilitated. Option 2 also removes all key services from the high-risk flood plain; however, there is still some risk of flooding to the parts of the Hospital that remain on the high-risk flood plain.

This option is assessed to be in the public interest with respect to public access to essential heath services.

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Security

Option 2 addresses all the impacts on security of supply addressed in Option 1. In addition to this, it ensures that key services are relocated to avoid high risk flood zones, expands Hospital services to meet future demand, and removes all asbestos from current buildings.


Option 3



Appendix Table 23: Charleville Hospital: Option 3 effectiveness in meeting service requirements


Accessibility

Sustainability

Safety

Overall rating

Accessibility

As in Option 2, Option 3 offers a level of accessibility to services at Level 3 draft CSCF v3.0. Furthermore, under this option, all Hospital services are removed from the high-risk flood plain.

Sustainability

As with Option 2, the focus of Option 3 is to maintain a minimum level of health care services, such that, current and future service requirements are met.

The proposed measures under Option 3 allow for a more efficient site through optimal interdepartmental relationships due to the construction of an entirely new facility maximising potential for in-built flexibility of design. In addition, the removal of Hospital services from the high-risk flood plain significantly increases sustainability and improves maintenance costs which were expected to increase under Option 1.

In terms of workforce sustainability, the key improvements to staff areas under Option 3 are the same as those under Option 2. However, further improvements generated from the construction of an entirely new facility including full compliance with Building Code of Australia and Disability Discrimination Act standards and optimal interdepartmental relationships should further boost staff morale/recruitment and provide a better integrated work environment.

Environmental sustainability is likely to improve under Option 3. The Infrastructure Study indicates that all new build stock will be designed and built to maximise opportunities of performance in energy, water, waste and guarantee the lasting qualities of the fabric and systems. Given that an entirely new facility is constructed under this option, it is assumed that the greatest opportunity would exist for environmentally sustainable benefits to be achieved. Compliance with Part J of the Building Code of Australia and Queensland Health Energy Efficiency Guidelines is achieved under this option.

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Safety

Option 3 addresses all the safety risks addressed in Option 2. In addition under Option 3, full compliance with the Building Code of Australia and Disability Discrimination Act are achieved and Hospital services are removed from the high-risk flood plain.


The measures undertaken in Option 3 achieve all of the outcomes of Option 2 and ensure that the residents of the catchment will receive a level of care that is consistent with the required standard across rural and remote communities. Option 3 is compliant with the requirements for Level 3 draft CSCF v3.0 services and with all relevant standards. It also removes clinical services from flood zone impacts and reduces isolation during flooding. All of these measures should further improve distributional equity for stakeholders and provide access to required levels of care.


Public access

As with previous options, the main improvements to public access under Option 3 come in the form of improvements to access for persons with disabilities. Option 3 includes all the improvements undertaken in Option 2, achieves full compliance with the Disability Discrimination Act and includes an entirely new facility which will be a single storey and provide all services on the ground floor, therefore improving ease of access.

This option is assessed to be in the public interest with respect to public access to essential health services.

Security

Option 3 addresses all the impacts on security of supply addressed in Option 2 and additionally removes all clinical services from flood zone impact, achieving the most effective security of supply under any option.

This option is assessed to be significantly in the public interest with respect to security of supply requirements.

Charters Towers Hospital infrastructure options

Summary of outcomes

The results of the public interest assessment for the Charters Towers Hospital infrastructure options are presented in Appendix Table 24. The primary reference documents used to assess the options were the Infrastructure Study and the Service Profile for Charters Towers Hospital.

Option 1 has elements that have been assessed as not in the public interest, while Option 2 and, to a greater extent, Option 3, are both assessed as in the public interest. In particular, Option 1 has been found to not satisfy the public interest when assessed against the effectiveness in meeting service requirement and the distributional equity and impact on stakeholders.

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Appendix Table 24: Summary of assessment outcomes for Charters Towers Hospital




Public access

Security


Option 1


As demonstrated in Appendix Table 25, Option 1 is found to be adverse to the public interest when assessed against the sustainability and safety criteria, and significantly adverse to the public interest when assessed against the accessibility criteria. Option 3 is found to be not in the public interest when assessed against effectiveness in meeting service requirements.

Appendix Table 25: Charters Towers Hospital: Option 1 effectiveness in meeting service requirement


Accessibility

Sustainability

Safety

Overall rating

Accessibility

The population of the Charters Towers Hospital catchment is projected to grow by around 3 per cent over the period to 2021 and the average age of the population is expected to increase. A larger and older regional population is likely to place greater demands on local health infrastructure.

Currently, there are a number of serious compliance issues at Charters Towers Hospital, including issues around fire safety, security, infection control, disability access and health and safety. Option 1 involves substantial measures to address these issues, but these measures are not sufficient to meet requirements for Level 3 draft CSCF v3.0 services.

Sustainability

The proposed improvements for Option 1 will lead to a very minor positive impact for economic sustainability. These improvements are largely related to improving staff and patient safety, for example through the installation of CCTV cameras into the resuscitation room and the Emergency Department and providing adequate access to facilities for persons with a disability.

The impacts on workforce sustainability under Option 1 are likely to be minor. The current Hospital has an inefficient layout of service departments and overcrowded work areas. These issues are not addressed in Option 1—as a result, staff dissatisfaction resulting from these issues will remain.

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Works undertaken in Option 1 are likely to have very minimal impact on system energy usage and no other environmental improvements are noted. As such, this option does not address public concern about the impacts of climate change and increasing demand on limited energy resources.

Safety

Option 1 includes a number of changes to buildings and facilities that improve compliance with the Building Code of Australia. Some of these include improvements to mitigate and/or reduce health and safety risk to a safe level through:

installing more fire hydrants and upgrading fire panels and fire detection system

replacing the main switchboard

providing security surveillance and monitoring to external entries and exits and car parks

installing CCTV in waiting areas, entry doors and corridors from waiting areas

upgrading the nurse call bell system.

Option 1 mitigates or reduces to a safe level all the serious risks identified in the Infrastructure Study.


Option 1 includes upgrades to Charters Towers Hospital infrastructure that would be expected to improve the level of care provided to the area. The Hospital, however, would not operate at a Level 3 draft CSCF v3.0 capability. Failure to meet these standards will have a negative impact on all groups, including CALD, Aboriginal and Torres Strait Islanders, lower socio-economic groups and persons with a disability.

However, Option 1 will cause considerable disruption to service delivery at the site. The impact of this disruption is not clear; however, it may be significant, especially given the presence of asbestos in many of the Hospital’s buildings.

The option is assessed to be not in the public interest for equity of access to essential health services.

Public access

Option 1 is likely to have a positive impact on public access, in particular improvements around access for persons with disabilities, including:

provision of car parking areas/access for persons with a disability

refurbishment to provide for appropriate disabled toilet amenities

installation of inward opening doors to disabled facilities with lift-off hinges

installation of Braille/tactile signage to toilets, lifts and other accessible areas to assist persons with vision impairments.

This option achieves increased accessibility; however, under this option Charters Towers Hospital would still not achieve compliance with the Disability Discrimination Act.

This option is assessed to be significantly adverse to the public interest with respect to public access to essential heath services.

Security

There are a number of risks in relation to security of supply. Key improvements in Option 1 around ensuring security of supply include:

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replacing the main switchboard

installing additional fuel storage to supply emergency power for operations greater than 12 hours

upgrading of the medical air and vacuum systems

upgrading systems to provide sufficient oxygen and suction outlets.


Option 2





Accessibility

Sustainability

Safety

Overall rating

Accessibility

The refurbishment would be compliant with minimum support services, staffing, safety standards and other requirements to operate at a Level 3 draft CSCF v3.0 capability. The option would address the serious compliance issues at Charters Towers Hospital, including issues around fire safety, security, infection control, disability access and health and safety.

Sustainability

The proposed improvements in Option 2 will lead to higher quality and more efficient provision of services. The expanded Emergency Department will create a functional layout between the triage room, resuscitation room and patient waiting area improving the functionality and relationship between services. However, a number of building code non-compliances and ongoing maintenance issues will not be addressed, for example cracking in rendered brick walls.

Option 2 has the potential to improve workforce sustainability by increasing staff satisfaction at Charters Towers Hospital. The Infrastructure Study reports that currently, the inefficient functional layout of the Hospital, the poor condition of infrastructure and lack of staff amenities are contributing to staff dissatisfaction. The ability to recruit and retain staff at regional and rural hospitals is crucial to the ongoing provision of health services. This option improves workforce sustainability by:

improving the functional layout of the Hospital and addressing overcrowding


providing appropriate staff amenities.

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Unlike Option 1, Option 2 includes the construction of an additional 21 employee housing accommodation units. The provision of appropriate, safe and security employee housing in rural areas is broadly acknowledged as a vital element in the ongoing attraction and retention of staff and the provision of safe and sustainable health services.

Impacts on environmental sustainability under Option 2 are minimal. There may be some marginal improvements to the redeveloped components of the Hospital as these would be built to current Building Code of Australia standards.

Safety

Option 2 includes refurbishment of the administration and ward blocks, both identified as the most ‘at risk’ infrastructure, and also addresses safety risks identified in Option 1. Additional improvements include:

refurbish the general ward to provide a secure nurse station and room for managing patients with challenging behaviours

extend the pharmacy to improve security of department

expand the Outpatient’s Department to provide a plaster room with appropriate exhaust/ventilation services.

Furthermore, the increase in general efficiency throughout departments is noted to have a positive impact on staff and also on patients’ safety. Option 2, however, will not be compliant with the Building Code of Australia. This option is not fully compliant with all standards against which it is assessed but it is a significant improvement on the current arrangements.


The extensive refurbishment and new builds of Option 2 will better provide a level of care for Charters Towers Hospital that is consistent with the required standard across rural and remote communities.

Option 2 involves substantially more construction work than Option 1, including refurbishment of the most ‘at risk’ infrastructures and new builds. The Project is designed to be done in stages to ensure continued service provision, but there will inevitably be some disruption for patients and staff. In particular, as all of the buildings contain asbestos, refurbishment and development activities will bring significant disruption to these buildings as a double decanting strategy is required to relocate staff and patients to temporary accommodation and back to the refurbished facility.

This option is assessed as in the public interest with respect to equity of access to essential health services.

Public access

Option 2 significantly enhances compliance with the Disability Discrimination Act. This will significantly improve access to facilities, particularly for persons with disabilities. Measures include compliant bathroom amenities for patient and visitor use.

This option is assessed to be in the public interest with respect to public access to essential health services.

Security

Option 2 addresses all the risks in relation to security of supply addressed in Option 1.


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Option 3





Accessibility

Sustainability

Safety

Overall rating

Accessibility

The new development would be compliant with minimum support services, staffing and safety standards to provide a Level 3 draft CSCF v3.0 capability. The option addresses the serious compliance issues at Charters Towers Hospital, including issues around fire safety, security, infection control, disability access and health and safety.

Sustainability

The proposed improvements for Option 3 will lead to higher quality and more efficient provision of services. The new facility will provide a more efficient and better functional relationship between services. It is also expected to result in reduced operating expenditure in the areas of energy, staffing and maintenance requirements.

In terms of workforce sustainability, the key improvements to staff areas under Option 3 are the same as those under Option 2, in that it includes new employee housing accommodation. However, the new facility developed under Option 3 will provide a better and more attractive working environment compared to Option 2. This is likely to improve staff satisfaction and also enhance staff retention.

The impact on environment sustainability is likely to be more significant than under Option 2. The replacement of old building stock with new buildings is likely to lead to improvements in energy efficiency due to better insulation and better heating and cooling systems. This option reflects the public concern about energy consumption and global warming while improving services.

Safety

Option 3 addresses all the safety risks identified and provides compliance with the Building Code of Australia and the Disability Discrimination Act.


Option 3 ensures that the Charters Towers Hospital provides health services in an environment that supports the needs of the catchment. The new facilities ensure that residents of the Charters Towers catchment will receive a level of care that is consistent with the required standard across rural and remote communities.

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Option 3 involves the construction of a new facility at the greenfield land site adjacent to the Eventide Nursing Home. The development of the new buildings at a different site mean service disruptions should be reduced as compared with Option 2, however, the increasing noise and vehicular movement during the construction phase will have a negative impact on the Eventide Nursing Home residents and staff.


Public access

The development of a fully compliant new facility means public access is significantly improved compared to Option 2. In particular, the improvements will address key risks identified relating to access for persons with a disability and those with vision impairments. This option ensures compliance with the Disability Discrimination Act. It should be noted, however, that relocating the new facility further away from the town centre may have a negative impact on its accessibility for some individuals.

This option is assessed as in the public interest with respect to providing public access to essential health services.

Security

Option 3 addresses all the security of supply risks identified in the Infrastructure Study.

This option is assessed as in the public interest with respect to security of supply requirements.

Emerald Hospital infrastructure options

Summary of outcomes

The results of the public interest assessment for the Emerald Hospital infrastructure options are presented in Appendix Table 28. The primary reference documents used to assess the options were the Infrastructure Study and the Service Profile for Emerald Hospital.

Option 1 is assessed as not in the public interest, while Option 2 and Option 3 are both assessed as in the public interest. In particular, Option 1 has been found to not satisfy the public interest when assessed against the effectiveness in meeting service requirements—in particular projected Emergency Department demand. The advantage of Option 3 is that it will potentially involve less disruption to local services; however, it is not the preferred option of the District as it would involve the demolition of the original Emerald Hospital building, which has been identified as having local community significance.

Appendix Table 28: Summary of assessment outcomes for Emerald Hospital




Public access

Security


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Option 1


As demonstrated in Appendix Table 29 Option 1 is found to be adverse to the public interest when assessed against the sustainability and safety criteria, and significantly adverse to the public interest when assessed against the accessibility criteria. Option 1 is found to be significantly adverse to the public interest when assessed against effectiveness in meeting service requirements.

Appendix Table 29: Emerald Hospital: Option 1 effectiveness in meeting service requirement


Accessibility

Sustainability

Safety

Overall rating

Accessibility

The population of Emerald and the surrounding catchment is projected to experience significant growth of around 39 per cent by 2021, and the average age of the population is expected to increase.

Emergency presentations have increased by 25 per cent in the past five years (Queensland Health Policy, Planning and Asset Services 2010). This has been attributed to an increasing population as well as increasing activity in the mining sector in the region. The existing Emergency Department at Emerald Hospital is relatively new (built 2000) and well situated within the Hospital, however, it does not have enough treatment spaces to manage the level of activity that is projected to occur to 2021/22. This is a significant issue for access to health services in the region.

Option 1 would not provide a Level 3 draft CSCF v3.0 service capability.

Sustainability

Option 1 is primarily intended to meet minimum standards, including Building Code of Australia and the Disability Discrimination Act. In terms of economic sustainability, Option 1 may lead to a very minor positive impact. The option does not address inefficiencies in the Hospital layout or weaknesses in interdepartmental relationships (i.e. proximity of mental health to paediatric services). Option 1 does address a number of issues around service provision including infection control issues and inadequate disabled access. A decision needs to be taken whether to remove asbestos from the site, and if so a temporary decanting of services will be required.

Limited information is available to assess the impact on the Emerald Hospital workforce of Option 1. Improvements are made to the nurse’s quarters under this option; however, risks to staff retention, recruitment and morale were raised in the options analysis undertaken as part of the Infrastructure Study.

The impacts on environmental sustainability under Option 1 are minimal. Energy efficiency is not achieved in existing buildings. A full assessment of the Hospital’s energy usage would need to be undertaken to determine what improvements can be made, beyond addressing key mechanical components, which could not be completed under Option 1. As such, this option

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does not address public concern about the impacts of climate change and increasing demand on limited energy resources.

Safety

Although Option 1 includes a number of changes to buildings and facilities, no department is modified in order to provide services at a Level 3 draft CSCF v3.0 capability and full compliance with the Building Code of Australia is not achieved. This option proposes to replace existing buildings that are the most inadequate for current service provision, namely the nurse’s quarters and the Community Health Building. Other improvements to the safety of the Hospital include:

upgrading the fire alarm and detection systems and changes to the spacing and positioning of hydrants and hoses

upgrading surfaces to wet areas both for staff and patients to non-slip materials

addressing infection control issues where possible, including the addition of hand wash basins, gel wash stations and other minor improvements.

Option 1 is not fully compliant with all standards against which it is has been assessed.


Option 1 provides for some improvement to Hospital infrastructure thereby potentially improving the level of care provided to the catchment residents. The main issues addressed by this option are the condition of the nurse’s quarters and the Community Health Building. No department is modified to operate at a Level 3 draft CSCF v3.0 capability. It is not in the public interest to provide inconsistent levels of care across rural and regional areas. All stakeholder groups are likely to be adversely affected under this option, including vulnerable groups.

The other effect of Option 1 which may impact public access relates to temporary closures due to upgrades and the resulting lack of access to services. A number of decisions still need to be made to determine the extent of disruptions while rectification works are taking place, including whether asbestos will be removed from the site.

This option is assessed as not in the public interest with respect to equity of access to essential health services.

Public access

Option 1 has a positive impact on public access by making some improvements in disabled access. This includes:

replacing a large glass door in the main building with a door that requires less force to open

providing disabled parking and parking signage to meet current Disability Discrimination Act standards

adding tactile indicators around the Hospital to assist persons with a visual impairment

installing appropriate handrails and balustrades.

While the above upgrades allow for improvements, it is important to note that this option does not address a number of important access issues (particularly for persons with a disability) and is not compliant with the Disability Discrimination Act.

This option is assessed as being significantly adverse to the public interest with respect to providing public access to essential health services.

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Security

Treatment areas at Emerald Hospital are currently split across two levels. Most services are provided on the ground level, but Operating Theatres are currently located on level one. There is a serious risk to security of supply of services as a result of the Hospital having only one lift. The lift is not reliable and the motor room is not compliant with current regulations. Consideration of the addition of a second lift is recommended, however, it is not currently included in Option 1.

The improvements in security of supply under the current description of Option 1 are not assessed to be in the public interest.

Option 2


As demonstrated in Appendix Table 30, Option 2 is found to be in the public interest when assessed against each of the accessibility, sustainability and safety criteria for meeting the service requirement.



Accessibility

Sustainability

Safety

Overall rating

Accessibility

A key feature of Option 2 is that the Emergency Department is expanded to accommodate projected increases in demand. As mentioned above, the existing Emergency Department at Emerald Hospital is relatively new and well situated within the Hospital, however, it does not have enough treatment spaces to manage the level of activity that is projected to occur until 2021/22. Option 2 would address this significant access issue and would also include a new Emergency Department entrance to more effectively distinguish it from the main Hospital entrance.

Improvements under Option 2 address most of the requirements to operate at a Level 3 draft CSCF v3.0 capability and increases compliance with the Building Code of Australia and the Disability Discrimination Act.

Sustainability

Option 2 includes the redevelopment of the Operating Theatres, moving them to the ground floor. This will improve efficiencies between departments and remove the reliance on the Hospital’s only lift to transfer patients between the wards and Operating Theatres. Redevelopment of the Hospital’s emergency and main entrances will reduce the risk of confusion between the two. These improvements may lead to higher quality and more efficient provision of services.

Option 2 makes use of existing infrastructure at the site and, if properly planned and staged, will have a usable life of 20 or more years. The construction of new buildings and expansion of existing areas should improve functionality and the relationship between services.

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Option 2 has the potential to improve workforce sustainability by increasing staff satisfaction. Option 2 extends on the improvements for Option 1 by increasing compliance with the Disability Discrimination Act. Unlike Option 1, Option 2 includes the construction of 11 new employee housing accommodation units (including the replacement of three existing employee housing accommodation units). Existing employee housing accommodation had been deemed unsuitable.

Furthermore, most Hospital departments are refurbished or relocated into permanent new facilities improving functionality, privacy and space for staff. Overall these changes should improve staff satisfaction.

Impacts on environmental sustainability under Option 2 are minimal. The redeveloped components of the Hospital would be required to be built to current standards, including the Queensland Health Energy Efficiency Guidelines, which are not currently being achieved. More detailed planning would need to be undertaken to determine whether other environmental improvements could be made under this option.

Safety

Option 2 includes all of the changes to buildings and facilities that improve compliance with standards proposed for Option 1. The redeveloped areas of the Hospital will be built to comply with current Building Code of Australia and the Disability Discrimination Act and the option will attempt to meet compliance for other areas of the Hospital. Option 2 will improve on Option 1 by allowing for other serious safety issues to be addressed, including:

fire resistance and stability issues in the kitchen area

infection control issues.



The original Hospital building on the site has been identified as having some local significance. Option 2, unlike Option 3, retains this building.

Option 2 involves substantially more construction work than Option 1. The refurbishment of a large proportion of the Hospital, including the Emergency Department, Operating Theatres, medical imaging and pharmacy is expected to cause considerable disruption to the continuous provision of Hospital services. The services that would be disrupted under this option are not currently known, nor the extent or length of the disruption. The impact of the disruption on stakeholders has not yet been detailed.


Public access

Option 2 increases compliance with the Disability Discrimination Act. This will significantly improve access to facilities, particularly for persons with disabilities. Measures include:

widening of doorways to improve access

providing adequate disabled parking

installing a lift in the administration building to allow for wheelchair access

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providing full facilities for persons with disabilities in a new ward.


Security

Option 2 addresses the majority of issues associated with the security of supply. Unlike Option 1, this option is able to meet the projected demand for Emergency Department presentations over the next 10 years. All clinical services are also moved to the ground floor, reducing the dependence on an ageing lift to transfer patients and medical staff between floors. As well as providing almost all of Emerald Hospital with a 20 plus useable life, this option includes the provision of adequate space for a CT scanner, should one be required at the Hospital in the future.

The improvements in security of supply under Option 2 are assessed to be in the public interest.

Option 3


As demonstrated in Appendix Table 31, Option 3 is found to be in the public interest when assessed against the accessibility, sustainability and safety criteria for meeting the service requirement. Option 3’s overall rating against the effectiveness in meeting service requirements is found to be in the public interest.



Accessibility

Sustainability

Safety

Overall rating

Accessibility

Option 3 is an extension of Option 2, however, incorporates the demolition of the existing Hospital, the community health building and the stores and laundry—all to be replaced with new builds. Like Option 2 it will shift all clinical activities to the ground floor and expand the Hospital’s Emergency Department to meet expected increases in demand to 2021/22.

The option improves on Option 2 by guaranteeing that current Building Code of Australia and Disability Discrimination Act standards are met throughout the Hospital.

Sustainability

As with Option 2, the focus of Option 3 is on maintaining a minimum level of health care services in order to meet current and future demand for services.

The proposed improvements from Option 3 will lead to higher quality and more efficient provision of services. Option 3 allows for the most effective provision of services based on the service profile. This option makes significant improvements to the links between different components of the Hospital. The existing level one of the Hospital (where the existing Operating Theatres are located) would be remodelled into Hospital administration, easing the pressure on vertical circulation.

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In terms of workforce sustainability, the key improvements to staff areas under Option 3 are the same as those under Option 2, including upgrades to employee housing accommodation. A higher proportion of fit-for-purpose, new build may make some marginal improvements to staff satisfaction with facilities.

The impact on environment sustainability is likely to be more significant than under Option 2. A much larger proportion of Option 3 is a new build. As a result the Hospital is expected to be more energy efficient, including achieving compliance with the Queensland Health Energy Efficiency Guidelines.

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Safety




Option 3 allows for better staging of construction. Existing buildings can be retained while new ones are constructed. If carefully planned, this is expected to result in less disruption to Hospital services than for Option 2.

Option 3 will however, involve the demolition of the original Hospital building, which has been identified as having some local significance. There is no real mitigating actions that can address this detrimental impact and stakeholder consultation would need to be considered.

This option has been assessed as in the public interest with respect to equity of access to essential health services.

Public access

Like Option 2, Option 3 includes significant upgrades of the Hospital to current standards.

This option has been assessed as in the public interest with respect to providing public access to essential health services.

Security

Option 3 provides no significant additions to the security of supply from those discussed under Option 2.

The improvements in security of supply under the current description of Option 2 are assessed to be in the public interest.

Kingaroy Hospital infrastructure options

Summary of outcomes

The results of the public interest assessment for the Kingaroy Hospital infrastructure options are presented in Appendix Table 32. The primary reference documents used to assess the options were the Infrastructure Study and the Service Profile for Kingaroy Hospital.

As demonstrated in Appendix Table 32, Option 1 is assessed as not in the public interest, while Option 2 and Option 3 are both assessed as in the public interest. In particular, Option 1 has been found to not satisfy the public interest when assessed against the effectiveness in meeting service requirement and the distributional equity and impact on stakeholders and significantly not in relation to public access.

Appendix Table 32: Summary of assessment outcomes for Kingaroy Hospital




Public access

Security

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Option 1


As demonstrated in Appendix Table 33, Option 1 is found to not be in the public interest when assessed against the accessibility, sustainability and safety criteria. Option 1’s overall rating against the effectiveness in meeting services requirements is found to be not in the public interest.

Appendix Table 33: Kingaroy Hospital: Option 1 effectiveness in meeting service requirement


Accessibility

Sustainability

Safety

Overall rating

Accessibility

The population in the catchment is projected to grow over the period to 2021. The current infrastructure at Kingaroy Hospital does not provide sufficient capacity for the estimated growth in demand. The improvements proposed as part of Option 1 do not include any change in the provision of services, or cater for the projected growth in demand for services in the catchment. If health care services provided at Kingaroy Hospital are to be maintained at least at the current level Option 1 will not serve the public interest in the long term. Current services provided at the Kingaroy Hospital meet all requirements of the draft CSCF v3.0. The services offered at Kingaroy Hospital are therefore assessed as being appropriate.

Demand for health care services in the Kingaroy region, however, is projected to grow such that demand will exceed current capacity. Under Option 1, accessibility to minimum services of a Level 3 draft CSCF v3.0 capability is set to decline over the period to 2026.

Sustainability

Few changes are proposed in this option that will lead to improved sustainability of service. The proposed improvements from Option 1 will lead to a minor positive impact for economic sustainability resulting from improvements in the quality and/or efficiency of service provision. These improvements are largely generated by the provision of more appropriate sanitary infrastructure.

There is likely to be a negative impact on workforce sustainability under Option 1. As demand for Hospital services exceeds capacity, staff will experience increasing pressure and job dissatisfaction generated from an inability to meet the demands of their community.

Impacts on environmental sustainability under Option 1 and will have minimal impact on system energy usage.

As such, this option does not address public concern about the impacts of climate change and increasing demand on limited energy resources.

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Safety

Option 1 includes a number of changes to buildings and facilities that improve compliance with standards. This option includes upgrades to buildings and facilities, particularly relating to hot water temperature control and fire and electrical safety to improve compliance with the Building Code of Australia. Key improvements to the safety of the Hospital include:

upgrading the air-conditioning in Operations Theatre providing high efficiency air filtration system to reduce the risk of airborne infection

upgrading car park, evacuation, exit and stairwell lighting to reduce safety and security risks associated with poor lighting

rectifying spalling concrete on the external portions of the main Hospital building and the administration and communications building to prevent the risk of concrete falling off the buildings and injuring people below

upgrading the fire alarm and detection systems and changes to the spacing and positioning of hydrants and hoses.


Option 1 provides for some improvement to Kingaroy Hospital infrastructure, potentially improving the level of care provided to residents of the catchment. The service capacity, however, is not commensurate with the projected demand for services in the Kingaroy catchment. It is not in the public interest to provide inconsistent levels of care across rural and regional areas. All stakeholder groups are likely to be adversely affected under this option. The impact of not supplying adequate capacity for health care is likely to be greatest on vulnerable groups such as CALD, Aboriginal and Torres Strait Islanders, lower socio-economic and persons with a disability. These groups are likely to be more adversely affected due to a lack of resources to respond to the challenge of accessing necessary health care services.

This option is assessed to be not in the public interest with respect to equity of access to health care services.

Public access

Option 1 has a positive impact on public access by ensuring minimum standards for access for persons with disabilities under the Building Code of Australia are met. These include:

refurbishment of a bathroom in the ward block to provide a disability compliant toilet and shower

installation of a new lift in the main Hospital building that will allow for independent access and use by persons with disabilities

installation of new ramps and rectification of existing ramps/steps.

While the above upgrades allow for improvements, it is important to note that this option does not address a number of important access issues for persons with a disability and is not compliant with the Disability Discrimination Act. As such, this option is not in the public interest.

The other effect of Option 1 which may impact public access relates to temporary closures due to upgrades and the resulting lack of access to services, resulting in minor disruptions while rectification works are taking place. It is not clear at this early stage the extent to which this will impact the availability of services but because the steps undertaken in Option 1 are so minor the overall impact of public access to services is likely to be limited.

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This option is assessed to be significantly adverse to the public interest with respect to public access of essential health services.

Security

The Infrastructure Study for Kingaroy Hospital identified a number of risks in relation to security of supply. Not all of the risks identified are addressed in this option; however, the Project option does include improvements in a number of key areas. Key improvements to ensure security of supply include:

replacing the old cable-operated lift in the main Hospital building with a new lift to allow for secure and reliable access

rerouting pipes so they do not run above the communications room, removing the security of supply risks relating to a communications system outage stemming from leaking pipes leading to equipment malfunction.

Upgrades as part of Option 1 do not address on-going security of supply issues around the issues with the collection, storage and reticulation of potable water. At present, the town reticulated water is unsuitable for potable use at the Hospital. Potable water is sourced from rainwater storage on site. Should rainfall prove insufficient it would be necessary to truck water in from Gympie.

The improvements in security of supply are assessed to be in the public interest.

Option 2


As demonstrated in Appendix Table 34, Option 2 is found to not be in the public interest when assessed against the accessibility, sustainability and safety criteria. Option 2 is found to be in the public interest when assessed against effectiveness in meeting service requirements.



Accessibility

Sustainability

Safety

Overall rating

Accessibility

As with Option 1, Option 2 continues to provide all of the current health care services. Option 2 will also allow the Hospital to operate at a Level 3 draft CSCF v3.0 capability. Furthermore, this option also caters for the projected increase in demand for services to 2021/22. As such, accessibility to an appropriate level of health care services, as dictated by the draft CSCF v3.0 will be maintained over the period to 2021/22.

Sustainability

The focus of Option 2 is on maintaining a minimum level of health care services, to meet current and future demands. The proposed improvements from Option 2 will lead to higher quality and more efficient provision of services. The construction of new buildings and expansion of existing areas should improve functionality and the relationship between services. For example, under Option 2 most rooms including staff rooms, consulting rooms,

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nurses’ stations and utility rooms are positioned to provide optimal functional relationships. There will, however, still be areas in the Kingaroy Hospital with less than optimal configuration. For instance, the allied health and consulting rooms will continue to be located on the second floor of the general Hospital building creating high traffic through the ground floor. Additionally, community services are spread out across the Hospital campus with no main entrance point.

Option 2 has the potential to improve workforce sustainability by increasing staff satisfaction. The option includes substantially larger and better facilities for staff. Specifically, a new staff dining room, activity room and canteen (these facilities are currently located in a building that has been condemned) as well as additional office space. Furthermore most Hospital departments are refurbished or relocated into permanent new facilities improving functionality, privacy and space for staff. Overall these changes should improve staff satisfaction.

Impacts on environmental sustainability under Option 2 are moderate. This option includes upgrading Hospital lighting to ensure compliance with the Building Code of Australia’s artificial lighting and power energy efficiency provisions. A number of windows in the old Hospital building are also unable to close and most of the original windows are unable to provide an adequate seal. The refurbishment of the old Hospital building will provide an opportunity to reduce energy usage on air conditioning and heating by improving these window seals. Furthermore, the movement of the Renal Department from a demountable to a new building should provide further energy savings as prefabricated demountable buildings tend not to be as well-insulated or air tight as permanent structures. This option reflects the public concern about energy consumption while improving services.

Safety

Option 2 includes all of the changes to buildings and facilities that improve compliance with standards proposed for Option 1 plus providing significant additional measures including:

relaying pavers along external walkways to remove trip hazards

replacing the sunken floor in the Emergency Department

sealing windows and doors to prevent the infection risk associated with the intrusion of dust

upgrading the duress alarm and CCTV so that coverage is extended to all Hospital buildings.


Option 2 ensures that the service capacity is commensurate with the projected demand for services in the Kingaroy catchment over the period to 2021/22. This ensures that catchment residents will receive a level of care that is consistent with the required standard across rural and remote communities.

Option 2 involves substantially more construction work than Option 1 and includes the refurbishment of the main Hospital building, extension of the Emergency Department and the construction of three new buildings to house expanded renal, oral health, ward and maternity departments, and Operating Theatres. The Project is designed to be completed in stages to ensure continued service provision but there will inevitably be some disruption for patients and staff. This is particularly likely to be the case on the ground floor of the main Hospital building. To prevent the interruption of services, the ground floor will need to continue to operate while the first floor is refurbished to accommodate allied health and consulting suites.


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Public access

Option 2 includes all the improvements to ensure compliance with minimum standards for access under the Building Code of Australia undertaken in Option 1, plus additional measures to provide equal access. Additional measures include:

installing permanent hearing augmentation listening systems to the main reception counter. This improves the ability of staff, patients and visitors with hearing impairment to receive messages broadcast over the Hospital’s public address system.

widening of doorways to improve access

providing adequate parking adjacent to the main entrance of all buildings

installing a lift in the administration building to allow for wheelchair access

providing full facilities for persons with disabilities in the new ward.

Option 2 goes much further towards ensuring compliance with Disability Discrimination Act requirements but there are still some areas where additional accessibility upgrades are possible. For example, this option includes no provision for visual alarms in the event of an emergency.

Option 2 also includes the installation of pictograms and way-finding signage, which will assist patients and visitors to follow Hospital rules and locate services. This enhances public access for all members of the community. The addition of pictograms to English language signs is likely to be especially helpful to members of the community who do not speak English as a first language.

This option has been assessed as in the public interest with respect to public access to essential health infrastructure.

Security

Option 2 addresses all the impacts on security of supply addressed in Option 1 and ensures that there is a more secure source of potable water for the Hospital.


Option 3





Accessibility

Sustainability

Safety

Overall rating

Accessibility

As for Option 1, Option 3 continues to provide all of the current health care services. Option 3 also supports the Hospital to operate at a Level 3 draft CSCF v3.0 capability. Furthermore this

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option also caters for the increasing projected demand for services to 2021/22. As such, accessibility to an appropriate level of health care services, as indicated by the draft CSCF v3.0, will be maintained over the period to 2021/22.

Sustainability

As with Option 2, the focus of Option 3 is on maintaining a minimum level of health care services so that current and future demands are met. An assessment of the impacts of Option 3 on the economic, workforce and environmental sustainability of Kingaroy Hospital is provided below.

The improvements from Option 3 will provide a more efficient and compact site and better relationship between services to support the most effective provision of services. In terms of workforce sustainability, the key improvements to staff areas under Option 3 are the same as those under Option 2. However, Option 3 also includes development of new clinical and acute facilities. All support facilities (medical records store, laundry, goods receiving store, building and equipment maintenance) are also rehoused in new permanent premises and located to provide a more compact site with all facilities accessed via a central ring road. These improvements should further boost staff satisfaction by providing a more spacious, comfortable and better integrated work environment.

The impact on environment sustainability is likely to represent a slight improvement on Option 2. The relocation of administration to the main Hospital building and the decommissioning of the existing administration building can be expected to have positive impacts for energy efficiency. This is because the administration building was originally built in the 1940s and is likely to be poorly insulated and contains several windows and doors that are not properly sealed. The building and equipment maintenance office which is currently housed in a demountable will also be replaced by a permanent building under this option. As discussed in Option 2, prefabricated demountable buildings tend not to be as well-insulated or air tight as permanent structures so the replacement of the demountable is likely to have further benefits in terms of energy efficiency. It is also likely that the replacement of old building stock with new buildings is likely lead to improvements in energy efficiency due to better insulation and better heating and cooling systems that are not specifically mentioned in the Infrastructure Study. This option reflects the public concern about energy consumption while improving services.

Safety



Option 3 ensures that the service capacity is commensurate with the projected demand for services in the Kingaroy catchment over the period to 2021/22. This ensures that catchment residents will receive a level of care that is consistent with the required standard across rural and remote communities.

Option 3 involves almost all the construction work in Option 2; however, some of the departments that were to be refurbished under Option 2 will be replaced with new buildings. The focus of this option on new buildings—rather than refurbishment of existing buildings—means service disruptions should be reduced as compared with Option 2.

This option is assessed in the public interest with respect to equity of access to essential health services.

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Public access

As with previous options, the main improvements to public access under Option 3 come in the form of improvements to access for persons with a disability. Option 3, like Option 2, includes improvements to ensure compliance with minimum Disability Discrimination Act standards for access for persons with a disability. In addition, it includes:

installation of permanent hearing augmentation listening systems to all counters as opposed to just the main reception counter under Option 2

provision of visual emergency alarms for persons with impaired hearing

upgrades to external travel paths to ensure wheelchair accessibility.

With these additional measures, risk of complaints from not meeting requirements under the Disability Discrimination Act is all but eliminated.

This option has been assessed as in the public interest with respect to public access to essential health services.

Security

Option 3 addresses all the impacts on security of supply addressed in Option 2.


Longreach Hospital infrastructure options

Summary of outcomes

The results of the public interest assessment for the Longreach Hospital infrastructure options are presented in Appendix Table 36. The primary reference documents used to assess the options were the Infrastructure Study and the Service Profile for Longreach Hospital.

Option 1 has elements that have been assessed as not in the public interest, while Option 2 and Option 3 are both assessed as in the public interest. In particular, Option 1 has been found to not satisfy the public interest when assessed against the effectiveness in meeting service requirement and the distributional equity and impact on stakeholders’ criteria.

Appendix Table 36: Summary of assessment outcomes for Longreach Hospital




Public access

Security


Option 1


As demonstrated in Appendix Table 37, Option 1 is found to be not in the public interest when assessed against the accessibility, sustainability and safety criteria. Option 1’s overall rating against the effectiveness in meeting services requirements is found to be not in the public interest.

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Appendix Table 37: Longreach Hospital: Option 1 effectiveness in meeting service requirement


Accessibility

Sustainability

Safety

Overall rating

Accessibility

The population of Longreach Hospital catchment is projected to grow by around one per cent over the period to 2021. While the population growth is minor, the average age of the population is expected to increase. Projections prepared by Queensland Health show that the current infrastructure is sufficient to meet expected levels of demand.

Currently, there are a number of serious compliance issues at Longreach Hospital, including issues around fire safety, security, infection control, disability access and health and safety. Option 1 involves substantial measures to address these issues, but these measures do not support the Hospital to operate at a Level 3 draft CSCF v3.0 capability.

Sustainability

Option 1 is primarily intended to meet minimum standards. The proposed improvements for Option 1 will lead to a very minor positive impact for economic sustainability resulting from improvements in the quality and/or efficiency of service provision. These improvements include upgrades to clinical hand washing facilities to reduce infection risk, installation of handrails on at least one side of every passageway and the relocation of the Community Health Building on site. However, sanitary service provision which is non-compliant with the Disability Discrimination Act is not addressed under Option 1.

The Infrastructure Study suggests the impacts on workforce sustainability under Option 1 are likely to be negative. The poor condition of current facilities, inefficient layout of clinical services, inadequate medical ward spaces coupled with maintenance issues experienced due to the presence of asbestos provide less than desirable working conditions. None of these issues are addressed in Option 1. As such, staff dissatisfaction generated by these issues will remain.

Impacts on environmental sustainability under Option 1 are minor. Works under Option 1 are likely to have very minimal impact on system energy usage and no other environmental improvements are noted. As such, this option does not address public concern about the impacts of climate change and increasing demand on limited energy resources.

Safety

Option 1 includes a number of changes to buildings and facilities that improve compliance with the Building Code of Australia. Key improvements to the safety of the Hospital include:

installing handrails at least on one side of every passage way and replacing all non-compliant door hardware

upgrading wet area surfaces with non-slip materials

upgrading fire hydrants and installing fire hose reels

upgrading portable fire fighting equipment signage and illuminated general exit lighting.

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Upgrades undertaken as part of Option 1 are insufficient to fully comply with the Building Code of Australia and the Disability Discrimination Act. This option is not fully compliant with all standards against which it is assessed.


The Infrastructure Study indicates Option 1 provides some improvements to Longreach Hospital infrastructure, improving the level of care provided to the catchment. However, as noted in the Infrastructure Study, it is not compliant with the Building Code of Australia and the Disability Discrimination Act. In addition, this option will not provide services at a Level 3 draft CSCF v3.0 capability.

It is not in the public interest to provide inconsistent levels of care across rural and regional areas. All stakeholder groups are likely to be adversely affected under this option. Vulnerable groups such as CALD, Aboriginal and Torres Strait Islanders, lower socio-economic and persons with a disability are likely to be impacted most by non-supply of adequate capacity for health care.

The other effect of Option 1 which may impact public access relates to temporary disruption and potential lack of access to services while upgrades are undertaken. It is not clear at this early stage the extent to which this will impact the availability of services, however, as the Infrastructure Study has indicated that a decanting strategy will be required, the overall impact of public access to services is likely to be considerable.

This option is assessed to be not in the public interest with respect of equity to essential health services.

Public access

Option 1 has a positive impact on public access through a number of key improvements, in particular improvements around access for persons with disabilities. Improvements identified in the Infrastructure Study include:

providing car park spaces and associated signage for persons with a disability

upgrading signage to public toilets, location and heights

refurbishing access to all existing buildings to ensure suitability for persons with a disability

providing tactile indicators within and around the facility for persons with vision impairments.

While the above upgrades consist of improvements to public access, it is important to note that this option is not compliant with the Disability Discrimination Act.

This option is assessed as significantly adverse to the public interest with respect to providing public access to essential health services.

Security

There are a number of risks at Longreach Hospital in relation to security of supply. Not all of the risks identified are addressed in Option 1; however, the option does include improvements in a number of areas. Key improvements to ensure security of supply include:

upgrading the switch room to comply with the fire safety requirements of the Building Code of Australia

providing compliant ladders/stairs to access plant rooms.

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Option 2





Accessibility

Sustainability

Safety

Overall rating

Accessibility

As for Option 1, Option 2 continues to provide all of the current health care services. Option 2, also provides services at Level 3 draft CSCF v3.0 capability. Furthermore this option caters for the increase in demand for those services that has been projected to 2021/22. As such, accessibility to an appropriate level of health care services, as dictated by the draft CSCF v3.0 will be maintained to 2021/22.

Sustainability

Option 2 is likely to lead to higher-quality and more efficient service provision than Option 1. The provision of a new, defined ambulance entrance with external space for ambulances and pedestrians and the relocation of the community health facilities on site are expected to improve functionality and the relationship between services. Additionally, the removal of asbestos is expected to improve the Hospital environment. There will, however, still be areas in the Longreach Hospital with less than optimal configuration. For instance, the first floor will still house the Operating Theatres which increases risks during patient transfer.

Option 2 has the potential to improve workforce sustainability. The option includes substantially larger and better facilities for staff. This includes new employee housing accommodation as well as additional space to house the expanded services, such as the Emergency and Outpatient Departments and pharmacy. Furthermore, most Hospital departments are refurbished or relocated into permanent new facilities improving functionality and space for staff. Overall these changes should improve staff satisfaction.

Impacts on environmental sustainability under Option 2 are minimal. The redeveloped components of the Hospital will be built to current standards, including the Queensland Health Energy Efficiency Guidelines. More detailed planning will need to be undertaken to determine whether other environmental improvements could be made under this option.

Safety

Option 2 includes changes to buildings and facilities that improve compliance with standards proposed for Option 1. Key improvements include:

upgrading the staff entrance area

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upgrading the Emergency Department ambulance entrance to be compliant and easily identified

creating shelter areas in the ground level for Outpatients Department and allied health.

Refurbishment and redevelopment activities will result in the removal of asbestos currently present in the buildings. This provides for a safer environment as it reduces the exposure to staff, patients and carers to hazardous building materials. However, the upgrades are insufficient to be compliant with Building Code of Australia and Disability Discrimination Act standards. Though this option is not fully compliant with all standards against which it is assessed, it is a significant improvement on the current arrangements.


Option 2 ensures that the Longreach Hospital provides health services in an environment that supports the needs of the community. The extensive refurbishment and expansion at the existing Hospital site ensures that residents of the Longreach catchment will receive a level of care that is consistent with the required standard across rural and remote communities.

Option 2 involves substantially more construction work than Option 1, including the refurbishment of the main Hospital building, the expansion of the Emergency and Outpatients Department and the construction of new buildings as part of the level 1 ward extension. The Project is designed to be completed in stages to ensure continued service provision, however, there will inevitably be some disruption for patients and staff. In particular, the removal of asbestos in refurbished buildings will bring significant disruptions to services as a double decanting strategy is required to relocate staff and patients to temporary accommodation and back following completion of the refurbishment.


Public access

Option 2 includes the significant improvements to ensure compliance with minimum standards undertaken in Option 1, plus additional measures to provide equal access. Additional measures include:

providing an additional lift which is compliant with needs of persons with a disability

incorporating the Pathology Department within the Allied Health Department

refurbishing the main building to house expanded services.

This option goes much further towards ensuring compliance with requirements under the Disability Discrimination Act but there are still some areas where additional accessibility could be achieved.


Security

Option 2 addresses all the impacts on security of supply addressed in Option 1. The improvements in security of supply are assessed to be in the public interest.

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Option 3


As demonstrated in Appendix Table 39, Option 3 is found to be in the public interest when assessed against the accessibility, sustainability and safety criteria. Option 3 is also found to be in the public interest when assessed against effectiveness in meeting service requirements.



Accessibility

Sustainability

Safety

Overall rating

Accessibility

As for Option 1, Option 3 continues to provide all of the current health care services. Option 3 will also provide services at Level 3 draft CSCF v3.0. Furthermore this option caters for the projected demand in services to 2021/22.

Sustainability

As with Option 2, the focus of Option 3 is on maintaining a minimum level of health care services, such that, current and future demand are met.

The proposed improvements for Option 3 will lead to more efficient provision of services. The relocation of the Outpatient Department and wards adjacent to each other and the relocation of the Operating Theatres adjacent to medical imaging (for easy access from the Emergency Department) will provide a more efficient and compact site and a better relationship between services. It is also expected to enhance synergies and increase efficiencies in staffing levels. Reduced operating expenditure in the areas of energy, water, waste and maintenance costs is expected at the same time—extending the operational life of the facility.

In terms of workforce sustainability, the key improvements to staff areas under Option 3 are the same as those under Option 2. However, Option 3 provides optimised interdepartmental functional relationships resulting in a better and more attractive working environment compared to Option 2. These improvements should further boost staff satisfaction by providing for a more spacious, comfortable and better integrated work environment.

The impact on environment sustainability is likely to be more significant than under Option 2. Option 3 includes the provision of a central energy plant which could potentially be operated using renewable energy. If this were to occur it would greatly reduce the environmental impact of the Hospital. However, it is also noted that the existing main building is retained for reuse due to its value to the community in terms of history and character. While the building will be refurbished to house community health services and administration offices, the age of the building will continue to pose increasing maintenance costs due to its age. The replacement of old buildings with new buildings is likely to lead to improvements in energy efficiency due to better insulation and better heating and cooling systems that are not specifically mentioned in the Infrastructure Study. This option reflects the public concern about energy consumption and global warming while improving services.

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Safety

Option 3 addresses all the safety risks addressed in Option 2. In addition under Option 3, all Hospital facilities will be compliant with the Building Code of Australia and the Disability Discrimination Act.


Option 3 ensures that Longreach Hospital provides health services in an environment that supports the needs of the community. The development of a brand new facility ensures that residents in the Longreach catchment will receive a level of care that is consistent with the required standard across rural and remote communities. In addition, achieving compliance with the Building Code of Australia and the Disability Discrimination Act means Longreach Hospital will be able to provide health services in a safe and secure environment at the same time be equipped to cater for the needs of persons with a disability.

The focus of this option is on new buildings rather than the refurbishment of existing buildings. Service disruptions under Option 3 should be reduced compared to Option 2 as new builds can be constructed while the original building is still in use and relocation into the new facility can take place after construction is finished.

This option has been assessed as in the public interest with respect to equity of access to essential health resources.

Public access

As with previous options, the main improvements to public access under Option 3 are for persons with disabilities. Option 3 includes all the improvements to ensure compliance with minimum standards of access for persons with disabilities incorporated in Option 2. Additionally having the entire facility developed on one level eliminates the inconvenience of vertical travel for patients, the public and staff.

This option has been assessed as in the public interest with respect to providing public access to essential health resources.

Security

Based on the Infrastructure Study, Option 3 addresses all the security of supply risks identified in the Infrastructure Study. The improvements in security are assessed as in the public interest.

Mareeba Hospital infrastructure options

Summary of outcomes

The results of the public interest assessment for the Mareeba Hospital infrastructure options are presented in Appendix Table 40. The primary reference documents used to assess the options were the Infrastructure Study and the Service Profile for Mareeba Hospital.

Option 2 and Option 3 are both assessed as in the public interest. Option 1 has been found to not satisfy the public interest when assessed against each criterion.

Appendix Table 40: Summary of assessment outcomes for Mareeba




Public access

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Security


Option 1


As demonstrated in Appendix Table 41, Option 1 is found to be in the public interest when assessed against the safety criteria; however, it is found to be not in the public interest when assessed against accessibility and sustainability. Option 1’s overall rating against the effectiveness in meeting service requirements is found to be not in the public interest.

Appendix Table 41: Mareeba Hospital: Option 1 effectiveness in meeting service requirement


Accessibility

Sustainability

Safety

Overall rating

Accessibility

Option 1 offers a level of accessibility to services that is consistent with the infrastructure, improving existing infrastructure sufficiently to protect patient and staff safety. Level 3 service capabilities, as defined by the draft CSCF v3.0 are not met as the Infrastructure Study states that this option includes the risk of not providing sufficient required facilities to the community. Therefore, the Hospital does not achieve the accessibility requirement of meeting capacity for the public to access an appropriate network of well-integrated public health services in a timely manner.

Sustainability

The focus of Option 1 is on sufficiently improving existing infrastructure to protect patient and staff safety. Few changes are proposed in this option that will lead to improved sustainability of service.

The proposed improvements in Option 1 may lead to a very minor positive impact on economic sustainability resulting from improvements in the quality and/or efficiency of service provision. Minor works to be undertaken include upgrading work spaces adjacent to the Operating Theatre, addressing critical workplace health and safety issues, and upgrading some facilities to improve disability access.

Impacts on workforce sustainability under Option 1 are minor, and the employee housing accommodation is not appropriate, safe or secure. In addition, areas of non-compliance to relevant guidelines and the risk of not providing sufficient required facilities to the community may place stress of staff and result in job dissatisfaction.

Impacts on environmental sustainability under Option 1 are minor. An increase in energy efficiency of the chilled water system will be achieved under this option; however, environmental sustainability improvements remain limited under Option 1.

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Safety

Option 1 includes a number of changes to buildings and facilities that address some safety issues currently experienced at the site. These include:

upgrades to fire services

an upgrade of external lighting and helipad lighting

an upgrade of existing Operating Theatre air conditioning filtration to comply with current codes and reduce the risk of patient infections.

Upgrades undertaken as part of Option 1 are not sufficient to ensure compliance with the Building Code of Australia.


Option 1 provides some improvement to Mareeba Hospital infrastructure, potentially improving the level of care provided to the area. The service capacity does not meet Level 3 capabilities as identified in the draft CSCF v3.0. The Infrastructure Study states that this option includes the risk of not providing sufficient facilities for the community. It is not in the public interest to provide inconsistent levels of care across rural and regional areas.

All stakeholder groups may be adversely affected under this option. Of all stakeholders, those most adversely affected will include vulnerable groups including lower socio-economic groups, CALD, Aboriginal and Torres Strait Islanders and persons with a disability. Mareeba’s population has high representations of vulnerable groups, including lower socio-economic groups and Aboriginal and Torres Strait Islanders, this impact will potentially have an impact on the population.

This option is assessed as not in the public interest with respect to equity of access to essential health services.

Public access

Option 1 has a positive impact on public access by addressing some issues of access for persons with disabilities, including:

developing a Disability Discrimination Act Action Plan of action to address areas of non-compliance and develop inclusive services and facilities, decrease the likelihood of complaints under the Disability Discrimination Act and increase the likelihood of successfully defending complaints

upgrading disabled toilet in Hospital building to comply with Australian Standards

upgrading signage to identify access to the Emergency Department.

These upgrades would not be sufficient to ensure compliance with the Disability Discrimination Act at the Mareeba Hospital and as such this option is assessed to be significantly adverse to the public interest with respect to provision of public access to essential health services.

Security

Option 1 includes some improvements which will enhance security of supply of clinical services. These include necessary safety upgrades, maintenance of existing infrastructure and reduction of infection risks.


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Option 2


As demonstrated in Appendix Table 42, Option 2 is found to be in the public interest when assessed against the safety, sustainability and accessibility criteria. Option 2 is found to be in the public interest when assessed against effectiveness in meeting service requirements.



Accessibility

Sustainability

Safety

Overall rating

Accessibility

Option 2 improves the existing infrastructure to protect patient and staff safety. Option 2 also meets the Level 3 service capability, defined in the draft CSCF v3.0. Furthermore, this option includes the refurbishment and extension of existing infrastructure, enabling the facility to meet the capacity for the public to access an appropriate network of well-integrated public health services in a timely manner.

Sustainability

The impacts on sustainability resulting from Option 2 are moderate. The proposed improvements from Option 2 will lead to a higher quality and more efficient provision of services. Measures undertaken to achieve this improvement include:

an extension and refurbishment of the Emergency Department, allowing it to meet current and future needs and undergo re-planning

the movement of offices to free up space for consultant rooms.

Option 2 has the potential to improve workforce sustainability by increasing staff satisfaction. The measures listed above will all contribute to an easier and more efficient delivery of services, enhancing staff ability to effectively meet healthcare demands of the community. In addition, this option includes new employee housing accommodation.

Like Option 1 the impacts on environmental sustainability under Option 2 are minimal. However, the construction and extension of infrastructure would be expected to have a positive impact on environmental sustainability as new build will meet required standards.

Safety

Option 2 includes all of the changes to buildings and facilities that improve compliance with standards proposed for Option 1 plus minor additional measures designed to address deficiencies such as removing trip hazards and adding CCTV cameras to external and internal areas.


Option 2 ensures that the Hospital will meet Level 3 draft CSCF v3.0 capability.

Option 2 involves refurbishment and expansion of some infrastructure, including the extension of the Emergency Department to meet its current and future needs and further measures to

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address disability issues. The Infrastructure Study notes that there will be disruptions to the functioning of areas of the existing building as repairs and strengthening works are carried out.


Public access

Option 2 includes all measures to improve compliance with current regulations under Option 1, plus additional measures including:

providing signage to the entire facility

providing permanent hearing augmentation listening systems to main reception counter

upgrading existing sanitary facilities for persons with a disability

providing adequate public and patient sanitary facilities for persons with a disability

widening of doorways and lower door hardware.

This option increases Mareeba Hospital’s compliance with the Disability Discrimination Act. This option is assessed to be in the public interest with respect to providing public access to essential health services.

Security

Option 2 addresses all the impacts on security of supply addressed in Option 1. In addition to this, the refurbishment and extension of existing infrastructure will improve the efficiency and effectiveness of service provision and enhance security of supply.


Option 3


As demonstrated in Appendix Table 43, Option 3 is found to be in the public interest when assessed against the safety, sustainability and accessibility criteria. Option 3’s overall rating against the effectiveness in meeting service requirements is found to be in the public interest.



Accessibility

Sustainability

Safety

Overall rating

Accessibility

Option 3 provides the same level of accessibility as Option 2. In addition to this, Option 3 includes the construction of an extended Dental Department, a more effective facility layout and further compliance with the Building Code of Australia and the Disability Discrimination Act, thus increasing the quality of services available to the community.

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Sustainability

As with Option 2, the focus of Option 3 is maintaining a minimum level of health care services, such that, current and future service requirements are met.

The proposed improvements from Option 3 will lead to higher-quality and more efficient provision of services. Option 3 allows for the most effective provision of services and provides the greatest level of compliance with relevant standards. Having the largest amount of re-build, it provides maximum economic sustainability due to the greatest amount of flexibility and most efficient delivery of services.

In terms of workforce sustainability, the key improvements to staff areas under Option 3 are the same as those under Option 2; however, the additional measures listed above may further boost staff satisfaction and provide a more efficient and less stressful work environment.

The impact on environmental sustainability is likely to be similar to Option 2. However, given that this option includes the greatest amount of rebuild, there is the most significant opportunity for environmentally sustainable benefits to be achieved in complying with current guidelines.

Safety



The measures undertaken in Option 3 achieve all of the outcomes of Option 2, and ensure that the residents of the catchment will receive a level of care that is consistent with the required standard across rural and remote communities. A Level 3 capability under the draft CSCF v3.0 and increased compliance with relevant standards is achieved, as well as additional construction of an extended Dental Department and the most efficient use of space in the new building. These factors will enhance quality and efficiency of service provision and will ensure distributional equity for stakeholders and ensure access to required levels of care.


Public access

As with previous options, the main improvements to public access under Option 3 are for persons with a disability. Option 3 includes all the improvements undertaken in Option 2, and in addition the Infrastructure Study notes that Option 3 “provides compliant, equal, dignified, independent services and facilitates for staff and patients”.

This option is assessed to be in the public interest with respect to providing public access to essential heath services.

Security

Option 3 addresses all the impacts on security of supply addressed in Option 2 as well as providing an extended Dental Department and the most efficient use of space in the new building, achieving the most effective security of supply under any option.


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Roma Hospital infrastructure options

Summary of outcomes

The results of the public interest assessment for the Roma Hospital infrastructure options are presented in Appendix Table 44. The primary reference documents used to assess the options were the Infrastructure Study and the Service Profile for Roma Hospital.

Option 1 has elements that have been assessed as not being in the public interest while Option 2 and 3 are both assessed as in the public interest. In particular, Option 1 does not satisfy the public interest when assessed against service requirements, distributional equity and public access criteria.

Appendix Table 44: Summary of assessment outcomes for Roma Hospital




Public access

Security


Option 1


As demonstrated in Appendix Table 45, Option 1 is found to be in the public interest when assessed against the safety criteria but not in the public interest when assessed against accessibility and sustainability. Option 1 is found to not be in the public interest when assessed against effectiveness in meeting service requirements.

Appendix Table 45: Roma Hospital: Option 1 effectiveness in meeting service requirement


Accessibility

Sustainability

Safety

Overall rating

Accessibility

The improvements under Option 1 do not include any change to the provision of services, or cater for the projected growth in demand for services in the catchment. If health care services provided at Roma Hospital are to be maintained at the current level or meet projected demand Option 1 will not serve the public interest in the long term. Assessed against this Level 3 draft CSCF v3.0, current services provided at the Roma Hospital do not meet all requirements. The services offered at Roma Hospital are therefore assessed as being compromised because of dysfunctional infrastructure.

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Sustainability

Option 1 provides a minor positive impact for economic sustainability by addressing dysfunctional treatment spaces in the Emergency Department and some facility upgrades to comply with the Disability Discrimination Act.

Option 1 does not address the inefficient and dysfunctional building layouts and maintenance issues which impact on workforce sustainability—creating poor working conditions.

Impacts on environmental sustainability under Option 1 are minor and as such, this option does not address public concern about the impacts of climate change and the increasing demand on limited energy resources.

Safety


improving external lighting and upgrading body and cardiac protection electrical systems

installing a Building Code of Australia compliant exit and evacuation lighting and access-compliant ramps

replacing cracked precast concrete stair treads and address areas of spalling concrete

rectifying issues with the duress system

1. installing emergency lighting where deficient.

While the upgrades are possible to meet requirements of the Building Code of Australia, the Infrastructure Study notes that they are insufficient to meet the full compliance with the Disability Discrimination Act. This option is not fully compliant with all standards against which it is assessed.


Option 1 provides for some improvement to Roma Hospital infrastructure, but not sufficient to provide services at Level 3 draft CSCF v3.0 capability.

All stakeholder groups are likely to be adversely affected under this option. The impact of not supplying adequate capacity for health care is likely to be greatest on vulnerable groups such as CALD, Aboriginal and Torres Strait Islanders, lower socio-economic and persons with a disability.

This option is assessed as not being in the public interest with respect to equity of access to essential health services.

Public access

Option 1 has a positive impact on public access through a number of key improvements as identified in the Infrastructure Study, in particular improvements around access for persons with disabilities. These include:

upgrading sanitary facilities to be disability compliant

upgrading ramps to be compliant.

While the above upgrades allow for improvements to public access, the facility will not be compliant with the Disability Discrimination Act.

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The other effect of Option 1 which may impact public access relates to temporary disruption and the potential of lack of access to services while upgrades are undertaken. Option 1 has the least interruption to existing services.

This option is assessed as not in the public interest with respect to providing public access to essential health services.

Security

Option 1 identifies a number of issues in relation to security. Not all of the issues are addressed in this option; however, Option 1 does include improvements including:

upgrading the main electrical switchboard

fixing Ergon main connection at Hospital substation

upgrading body and cardiac protection electrical system.

The improvements in security are assessed to be in the public interest.

Option 2


As demonstrated in Appendix Table 46, Option 2 is found to be in the public interest when assessed against the safety, sustainability and accessibility criteria. Option 2’s overall rating against the effectiveness in meeting service requirements is found to be in the public interest.



Accessibility

Sustainability

Safety

Overall rating

Accessibility

Under Option 2 the Hospital will provide services at Level 3 draft CSCF v3.0 capability to 2021/22.

Sustainability

Under Option 2 the expanded Emergency Department will assist Roma Hospital to meet its current and future needs while the refurbishment of the maternity ward will enable the safe and sustainable provision of maternity services. However, there will still be areas in Roma Hospital with less than optimal configuration.

Option 2 has the potential to improve workforce sustainability by providing substantially larger and better work facilities and new employee housing accommodation. Overall these changes should improve staff satisfaction.

Impacts on environmental sustainability under Option 2 are minimal. In addition to Option 1 refurbishment and extension of infrastructure will have a positive impact on environmental sustainability.

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Safety

Option 2 includes changes to buildings and facilities that improve compliance with Building Code of Australia proposed for Option 1. Key improvements noted include:

installing an emergency lift with fire service controls and an Emergency Warden Intercom System (EWIS)

upgrading trip hazards and smoke detection equipment

installing compliant hardware to all exit doors.

While the refurbishment and redevelopment activities address several Building Code of Australia and Disability Discrimination Act non-compliance issues, they are not sufficient to fully comply with all standards.


Option 2 involves substantially more construction work than Option 1, including the refurbishment of the Emergency Department, maternity ward and delivery rooms and development of a new theatre, kitchen and consultation rooms for general practitioners. The Project is designed to be done in stages to ensure continued service provision but there will inevitably be some disruption for patients and staff.


Public access

Option 2 includes significant improvements to ensure compliance with minimum standards undertaken in Option 1 plus additional measures towards compliance including:

providing public and patient sanitary facilities for persons with disabilities

widening doorways and improving signage

providing hearing augmentation listening systems to counters

relocating allied health to a refurbished Westhaven building

providing car parking located adjacent to main entrances.

This option goes much further towards ensuring compliance with requirements under the Disability Discrimination Act but there are still some areas that are non-compliant.

This option has been assessed as in the public interest with respect to providing public access to essential Hospital services.

Security

Option 2 addresses all the impacts on security of supply addressed in Option 1. In addition, the following improvements are also made:

addressing potable water supply and backup issues

addressing hot water temperature control issues.

The improvements in security are assessed to be in the public interest.

Option 3


As demonstrated in Appendix Table 47, Option 3 is found to be in the public interest when assessed against the safety and accessibility criteria and significantly in the public interest

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when assessed against the sustainability criterion. Option 3 is found to be in the public interest when assessed against effectiveness in meeting service requirements.



Accessibility

Sustainability

Safety

Overall rating

Accessibility

Similar to Option 2, Option 3 will ensure Roma Hospital provides services at Level 3 draft CSCF v3.0 capability. Option 3 also includes the construction of a new GP Super Clinic which improves accessibility to general medical health care services.

Sustainability

The addition of a new GP Super Clinic under Option 3 will provide efficiencies by providing additional general medical services adjacent to the Emergency Department. The new building will provide a more efficient layout.

In terms of workforce sustainability, the key improvements to staff areas under Option 3 are the same as those under Option 2. However, Option 3 provides for improved interdepartmental functional relationships resulting in a better and more attractive working environment compared to Option 2. These improvements should further boost staff satisfaction by providing an integrated, more spacious and comfortable work environment.

Environmental sustainability is likely to improve under Option 3 as the new builds will be designed to provide energy efficiencies. This option reflects the public concern about energy consumption and global warming while improving services.

Safety



Option 3 ensures that Roma Hospital provides health services in an environment that supports the needs of the community. While full compliance with the Disability Discrimination Act and Building Code of Australia is not achieved, the level of health services to be provided at Roma Hospital is significantly improved, particularly in relation to catering for the needs of persons with disabilities.

Option 3 is a combination of extensive refurbishment of existing buildings and new builds. The development of new buildings under Option 3 means that service disruptions should be slightly reduced when compared with Option 2. However, disruptions to functioning areas of existing building are to be expected while works are carried out.


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Public access

As with previous options, the main improvements to public access under Option 3 are for persons with disabilities. While this option further addresses public access issues including access to the Dental building, there are still some areas where additional access could be facilitated.

This option has been assessed as in the public interest with respect to providing public access to essential health services.

Security

Option 3 addresses all the impacts on security of supply addressed in Option 2.

The improvements in security are assessed as in the public interest.

Sarina Hospital infrastructure options

Summary of outcomes

The results of the public interest assessment for the Sarina Hospital infrastructure options are presented in Appendix Table 48. The primary reference documents used to assess the options were the Infrastructure Study and the Service Profile for Sarina Hospital.

As demonstrated in Appendix Table 48, Option 1 is assessed as not in the public interest, while Option 2 and, to a greater extent, Option 3 are both assessed as in the public interest. In particular, Option 1 has been found to not satisfy the public interest when assessed against the effectiveness in meeting service requirement, the distributional equity and impact on stakeholders and public access criteria.

Appendix Table 48: Summary of assessment outcomes for the Sarina Hospital




Public access

Security


Option 1


As demonstrated in Appendix Table 49, Option 1 is found to not be in the public interest when assessed against the accessibility, sustainability and safety criteria. Option 3 is found to be not in the public interest when assessed against effectiveness in meeting service requirements.

Appendix Table 49: Sarina Hospital: Option 1 effectiveness in meeting service requirement


Accessibility

Sustainability

Safety

Overall rating

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Accessibility

The population in the Sarina catchment is projected to grow by around 38 per cent over the period to 2021. The current infrastructure at Sarina Hospital does not provide sufficient capacity for this projected growth in demand. The improvements proposed as part of Option 1 do not include any change in the provision of services, or cater for the projected growth in demand for services in the Sarina region. This option does not serve the public interest in the long term, as it will not meet future capacity requirements.

Current services at Sarina Hospital meet Level 2 draft CSCF v3.0 capability. The services offered at Sarina Hospital are therefore assessed as being appropriate.

Demand for health care services in the Sarina region, however, is projected to grow such that demand will exceed current capacity.

Sustainability

The proposed improvements in the quality and/or efficiency of service provision will lead to a minor positive impact for economic sustainability.

There is a negative impact on workforce sustainability under Option 1. As demand for Hospital services exceeds capacity, staff will experience increasing pressure and job dissatisfaction.

Impacts on environmental sustainability under Option 1 are minor. No improvements in energy use will result from this option.

Safety

Option 1 includes a number of changes to buildings and facilities that improve compliance with the Building Code of Australia. This option includes upgrades to buildings and facilities, particularly relating to hot water temperature control and fire and electrical safety. Key improvements to the safety of the Hospital include:

improving the fire detection and response systems, such as, installing a fire sprinkler system throughout the main building and in the employee housing accommodation building, upgrading the hydrant system, installing an additional fire hose and installing additional heat and smoke detectors

upgrading external lighting to the main driveway, car park and the area between the main Hospital and the staff quarters to improve safety and security

resurfacing the sealed road and walkway to eliminate trip and slip hazards and incorporate markings to better segregate pedestrians from vehicles

upgrading the electrical switchboards and lighting in the wards and providing safety switches and body protection to bring the system up to current standards.

Despite these improvements there remains continued exposure for staff, patients, carers and the general public to safety risks including fire and evacuation risks, personal safety and security risks especially in the emergency treatment room at night and cramped and badly laid out waiting and outpatient areas. Also, under Option 1 there is no capacity to address the delays to ambulances because all access roads to the Hospital pass over railway level crossings. This causes delays to ambulances, especially during the cane-cutting season.


Option 1 provides for some improvement to Sarina Hospital infrastructure, increasing the capacity to provide health care services, but will not meet the projected demand. The impact

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of not meeting the demand for health services is likely to impact greatest on vulnerable groups such as CALD, Aboriginal and Torres Strait Islanders, lower socio-economic and persons with a disability.

The Infrastructure Study does not indicate that there will be any disruption to services as a result of the steps undertaken in Option 1.

This option is assessed to be not in the public interest with respect to equity of access to health care services.

Public access

Option 1 has a minor positive impact on public access by ensuring minimum standards for access for persons with disabilities under the Disability Discrimination Act are met. This option includes:

a wheelchair accessible pathway from the street to the Hospital entrance

car parking for persons with disabilities, including access from the car park to the building entrance.

While the above upgrades allow for improvements, it is important to note that this option does not address a number of important access issues for persons with a disability and will not comply with Disability Discrimination Act standards.

This option is assessed to be significantly adverse to the public interest with respect to public access of essential health services.

Security

Sarina Hospital has a number of risks in relation to security of supply. Not all of the risks identified are addressed in this option; however, it does include improvements in a number of key areas. Key improvements to ensure security of supply include:

upgrading the back veranda to the employee housing accommodation building to meet current codes and obtain approval under the Building Act, currently this construction presents the possibility of structural failure during a high wind event

repairing and replacing damaged stumps under buildings

removing the rusted tank in the plant room to avoid local flooding and damage to adjacent equipment.

Upgrades as part of Option 1 do not address ongoing security of supply issues in a significant cyclonic event with the potential failure of roof and wall structures due to tie-down and bracing being less than the current standard.


Option 2



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Accessibility

Sustainability

Safety

Overall rating

Accessibility

As for Option 1, Option 2 continues to provide health care services at a Level 2 draft CSCF v3.0 capability. Furthermore this option also caters for the increase in demand for those services that has been projected over the period to 2021/22.

Sustainability

The proposed improvements from Option 2 will lead to higher-quality and more efficient provision of services. The expansion of existing areas should improve functionality and the relationship between services.

Option 2 has the potential to improve workforce sustainability by increasing staff satisfaction at Sarina Hospital. This option improves workforce sustainability by:

improving the functional layout of the Hospital, increasing the size of the wards and providing additional office space


providing appropriate staff amenities, including accommodation; unlike Option 1, Option 2 includes the construction of five self-contained one-bedroom units.

The impacts of Option 2 on environmental sustainability are moderate. This option addresses some of the public concern about energy consumption.

Safety

Option 2 includes all of the changes to buildings and facilities that improve compliance with standards proposed for Option 1 plus providing significant additional measures including:

providing a dedicated truck unloading area

providing ramped access from the street to the main building suitable for evacuation of patients

replacing all floor finishes (currently torn and worn vinyl floors present trip hazards).

Under Option 2, however, there is no capacity to address the delays to ambulances due to all access roads to the Hospital passing over railway level crossings.


Option 2 ensures that the service capacity is commensurate with the projected demand for services in the Sarina catchment over the period to 2021/22.

Option 2 involves substantially more construction work than Option 1 including the refurbishment of the majority of the main Hospital building. This option is likely to cause major disruptions to services; however, these disruptions would be relatively short lived.

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Public access

Option 2 includes all the improvements undertaken in Option 1 to ensure compliance with the Disability Discrimination Act plus additional measures to provide equal access. Additional measures include:

wheelchair accessibility to the main entrance and outpatient area

disability accessible bathrooms in the wards.

full facilities for persons with disabilities in the new ward.

This option goes much further towards ensuring compliance with requirements under the Disability Discrimination Act but there are still some areas where additional accessibility is possible.

This option has been assessed as in the public interest with respect to public access to essential health infrastructure.

Security

Option 2 addresses all the impacts on security of supply addressed in Option 1. In addition Option 2 incorporates improved cyclone protection.


Option 3


As demonstrated in Appendix Table 51, Option 3 is found to be in the public interest when assessed against the accessibility and sustainability criteria, and significantly in the public interest when assessed against the safety criterion. Option 3 is found to be in the public interest when assessed against effectiveness in meeting service requirements.



Accessibility

Sustainability

Safety

Overall rating

Accessibility

As for Option 1, Option 3 continues to provide current and projected demand for health care services to 2021/22 at a Level 2 draft CSCF v3.0 capability.

Sustainability

Option 3 allows for a more efficient and compact site and a better relationship between services.

In terms of workforce sustainability, the key improvements to staff areas under Option 3 are the same as those under Option 2. However, Option 3 also includes development of a

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completely new facility which should further improve staff satisfaction by providing an integrated, more spacious and comfortable work environment.

The impact on environment sustainability is likely to be more significant than under Option 2. It is likely that the new building will improve energy efficiency.

This option reflects the public concern about energy consumption while improving services.

Safety

Option 3 addresses all the safety risks addressed in Option 2. In addition, Option 3 includes a new access road, which should enable ambulances to avoid railway crossings, thus reducing delays to emergency treatment.


Option 3 ensures that the service capacity is commensurate with the projected demand for services in the Sarina catchment over the period to 2021/22.

Option 3 involves the construction of a new facility. The focus of this option on new buildings rather than refurbishment of existing buildings mean service disruptions should be reduced as compared with Option 2.

This option is assessed in the public interest with respect to equity of access to essential health services.

Public access

As with previous options, the main improvements to public access under Option 3 come in the form of improvements to access for persons with disabilities. Option 3 involves a completely new facility; which would be compliant with the Disability Discrimination Act. With these additional measures included, risks of complaint under the Disability Discrimination Act are all but eliminated.

This option has been assessed as in the public interest with respect to public access to essential health services.

Security

Option 3 addresses all the impacts on security of supply addressed in Option 2. In addition roof and wall structure tie-downs and bracing would meet the current standards reducing the likelihood of structural failure from a cyclonic event.


Thursday Island Hospital infrastructure options

Summary of outcomes

The results of the public interest assessment for Thursday Island Hospital infrastructure options are presented in Appendix Table 52. The primary reference documents used to assess the options were the Infrastructure Study and the Service Profile for Thursday Island Hospital provided by Queensland Health.

Option 1 is assessed as not in the public interest, while Option 2 and Option 3 are both assessed as in the public interest. In particular, Option 1 has been found to not satisfy the public interest when assessed against the effectiveness in meeting service requirement, distributional equity and impact on stakeholders, and public access criteria.

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Appendix Table 52: Summary of assessment outcomes for Thursday Island Hospital




Public access

Security


Option 1


As demonstrated in Appendix Table 53, Option 1 is found to not be in the public interest when assessed against the accessibility, sustainability and safety criteria. Option 1 is found to be not in the public interest when assessed against effectiveness in meeting service requirements.

Appendix Table 53: Thursday Island Hospital: Option 1 effectiveness in meeting service requirement


Accessibility

Sustainability

Safety

Overall rating

Accessibility

The population of Thursday Island, and the wider Torres Shire, is expected to experience moderate growth of around 18 per cent to 2021. The current infrastructure at Thursday Island Hospital does not provide sufficient capacity for current or projected demand, including the delivery of services at Level 3 draft CSCF v3.0.

Sustainability

While there are some minor positive impacts in terms of economic and environmental sustainability, the failure of this option to provide the infrastructure required to meet expected projected demand is likely to have a negative impact on workforce sustainability which outweighs these minor positive impacts. In terms of sustainability, this option is not in the public interest.

Safety


improvements to existing isolation wards to allow them to meet the Building Code of Australia and reduce the risk of airborne infection for patients and staff

improvements to air conditioning and ventilation, particularly in the Operating Theatre to ensure negative air pressure and thereby reduce infection risks

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repairs to the Hospital (such as replacing rotting timber floors and corroded steel roofs) due to water damage and salt sprays from the sea

improvements to reduce fire risks such as the installation of a fire evacuation system, installation of appropriate fire doors and seals and changes to the spacing and positioning of hydrants and hoses.

It should be noted that while this option provides for rectification of critical safety issues relating to the structure of the building, corrosion and deterioration of building materials is so severe that further repairs are likely within a few years.


Option 1 provides for some improvement to Thursday Island Hospital infrastructure, improving the level of care provided to the catchment. The service capacity, however, is not commensurate with the projected demand for services in the Torres Shire. All stakeholder groups are likely to be adversely affected under this option. The impact of not supplying adequate capacity for health care is likely to be greatest on vulnerable groups such as CALD, Aboriginal and Torres Strait Islanders, lower socio-economic groups and persons with a disability.

This option is assessed to be not in the public interest with respect to equity of access to essential health services.

Public access

The major impact of Option 1 with regard to public access is to undertake upgrades to improve access for persons with disabilities. Currently, disability access to the Hospital is poor. Examples of improvements in public access include:

replacing all rotted timber ramps at the maternity hostel

providing disability car parking

providing Braille and tactile signs for toilets throughout buildings.

While the above upgrades allow for some improvements, it is important to note that Option 1 does not address some disability access issues identified in the Infrastructure Study. Particularly, poor disability access to a number of key Hospital departments such as emergency, outpatient and primary health.

Overall, this option is assessed to be significantly adverse to the public interest with respect to the provision public access to essential health services.

Security

There are a number of infrastructure-related risks that could compromise the ability to continue to provide services. The following security of supply risks are addressed in Option 1:

the upgrades to ventilation, air filtration, air conditioning and isolation rooms to reduce risks associated with cross contamination and the spread of contagious diseases

2. repairs to components of the Hospital buildings compromised due to corrosion and moisture intrusion. Without these repairs, there is the risk that structural components of the building may fail resulting in temporary closures.

Given the severity of the supply risks which Option 1 seeks to overcome, this option is assessed to be in the public interest with regard to security of supply requirements.

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Option 2


As demonstrated in Appendix Table 54, Option 2 is found to be in the public interest when assessed against the accessibility and sustainability criteria and not in the public interest when assessed against the safety criterion. Option 2 is found to be in the public interest when assessed against effectiveness in meeting service requirements.



Accessibility

Sustainability

Safety

Overall rating

Accessibility

Unlike Option 1, Option 2 ensures Thursday Island Hospital is able to operate at a Level 3 draft CSCF v3.0 capability. Furthermore this option also caters for the projected increase in demand for services over the period to 2021/22.

Sustainability

The proposed improvements from Option 2 will lead to improvements in the efficiency of service provision over and above those in Option 1. Option 2 improves the efficiency of service provision mainly by providing additional space to alleviate staff and patient congestion and increase storage room. Specific improvements include:

construction of a purpose built medical records archive room with compactus

construction of additional storage and relocation of staff work areas in the primary health care building

extension to the Pathology Department to reduce overcrowding.

By improving the efficiency of service provision these measures will increase the economic sustainability of Thursday Island Hospital. However, this option is limited to minor building extensions, and does not allow buildings to be reconstructed to ensure optimal functional relationships between departments.

Option 2 has the potential to improve workforce sustainability by increasing staff satisfaction because it includes refurbishments of all areas of the Hospital to bring them up to modern standards. Option 2 includes specific benefits for staff—a new staff car park and new employee housing accommodation. At present, the site includes 71 employee housing accommodation units and under Option 2 an additional 56 housing units would be built.

Option 2 does not include any changes that are likely to directly or indirectly have a significant impact on environmental sustainability.

Safety

Option 2 includes the changes to buildings and facilities that improve compliance with standards proposed for Option 1. The only additional changes under Option 2 which may lead to increased safety relate to the building extensions. By reducing overcrowding and

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congestion, these measures not only improve workplace efficiency, they also reduce the risk of accidents.

It is also noted that while this option includes refurbishment of existing buildings, it does not take measures to prevent further corrosion and deterioration in the structure of the Hospital buildings. New safety issues relating to the building structure may emerge after a number of years. As such, this option does not address the safety issues for any meaningful period of time.


Option 2 ensures that the service capacity is commensurate with the projected demand for services in the Torres Shire over the period to 2021/22.

Option 2 involves somewhat more construction that Option 1. It also has a strong focus on refitting existing buildings. This will result in some minor disruption to staff and patients and their families. The main area of disruption will be in the Operating Theatre while the floor is replaced. Temporary decanting of the operating theatre will need to take place while this occurs.

This option may also provide some scope for improving the cultural appropriateness of infrastructure. Given that this option ensures current and future demand for services is satisfied the equity of access facilitated by this option is assessed as in the public interest.

Public access

Option 2 does not specify any improvements to public access additional to those proposed under Option 1, however, as this option includes a complete refurbishment of the Hospital it is expected that all buildings would then be compliant with the Building Code of Australia and the Disability Discrimination Act.

This option is assessed to be in the public interest with respect to public access of essential Hospital services.

Security

Option 2 addresses all the impacts on security of supply addressed in Option 1. However, as noted above, it does not address corrosion and deterioration of building materials. Given that immediate issues are addressed, this does not impose security of supply risks at present but these could become apparent in the medium term.

The improvements in security supply generated by this option are assessed to be in the public interest.

Option 3



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Accessibility

Sustainability

Safety

Overall rating

Accessibility

As for Option 1, Option 3 continues to provide all of the current health care services. Option 3, therefore, also meets a draft CSCF v3.0 Level 3 service capability. Furthermore this option also caters for the increase in demand for those services that has been projected over the period to 2021/22.

Sustainability

Given that this option includes a full rebuild of the entire Hospital campus the sustainability impacts of this option are likely to be significant.

In terms of economic sustainability, this is the only option which allows the Hospital to meet optimum functional relationship requirements.

In terms of workforce sustainability, the key improvements to staff areas under Option 3 are the same as those under Option 2. The complete rebuild of the Hospital site may have negative impacts on workforce sustainability in the short term due to the level of disruption a complete rebuild would involve, however, this can be expected to be more than offset by the long-term benefits of a better integrated, more spacious and comfortable work environment that would be provided by an all-new facility.

In terms of environmental sustainability, this option is also likely to have more significant impacts than Option 2. All new buildings will comply with the Queensland Health Energy Efficiency Guidelines which means environmental sustainability should be substantially increased. This option reflects the public concerns about energy consumption while improving services.

Safety

Option 3 addresses all the safety risks addressed in Option 2. It is also the only option that addresses medium issues relating to building corrosion—all new buildings are to be built with materials which can withstand the harsh coastal conditions to which the Hospital is exposed. This should remove the possibility of new safety issues relating to a deteriorating building structure emerging in the near future.


As with Option 2, Option 3 ensures that the service capacity is commensurate with the projected demand for services in the Torres Shire to 2021/22.

The complete rebuild of the Hospital proposed under Option 3 will require the temporary decanting of the administration, kitchen, laundry, pharmacy, kiosk and building services so that the new Hospital building can be constructed on the site. Once the new building is complete the essential Hospital services will also need to be moved from the existing to the new building. It is also proposed that the primary health care building be completely

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refurbished. While the construction is staged so as to minimise disruption, some disruption will be unavoidable and the scale of the construction under this option suggests disruption will be greater than under the other options proposed.

This option is assessed as in the public interest with respect to equity of access to essential health services and the impact on stakeholders.

Public access

Option 3 includes all the improvements to ensure compliance with minimum standards for access for persons with disabilities incorporated in Option 2. The complete rebuild of the Hospital site should mean any remaining impediments to access for persons with disabilities are removed.

Option 3 provides the best opportunity (of the three options) to ensure that buildings are designed in a culturally appropriate way to meet the needs of the community. However, at this early stage, no such plans are detailed.

This option has been assessed as in the public interest with respect to the provision of public access to essential health services.

Security

Option 3 addresses all the impacts on security of supply addressed in the previous options. As noted under the safety criterion, because this option involves a complete Hospital rebuild it also means that future security of supply risks relating to the degradation of Hospital infrastructure are likely to be mitigated. However, this option may introduce new security of supply risks due to the level of disruption involved in a complete rebuild.

This option is assessed as in the public interest with respect to security of supply requirements.

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Appendix 9: Stakeholder feedback Department of Public Works [Extract of email dated 6/9/2010, Director, Building Policy Unit, Works Division, Queensland Department of Public Works]

Department of Public Works can advise as follows:

The Capital Works Management Framework and its associated Prequalification (PQC) System applies to non PPP government building projects. The PQC System constitutes a risk based process of prequalification of contractors that operate in Queensland in accordance with set criteria, including financial capacity and previous performance. DPW can say, in terms of its understanding of the state of the market in the planning horizon for this program, that the industry has more than sufficient capacity to undertake these projects. Market sounding is not necessary by virtue of the existence of the PQC System. And in any event, the commencement of the National Prequalification System on 1 January will, potentially, open up PQC to the Australian market, subject to local legislation and local requirements (including licensing). Nonetheless it has never been a requirement of the PQC System that contractors been Queensland-base exclusively. The PQC System contains all contractors that would, by any independent assessment, be candidates for these projects.

We are not able to, nor is it safe to do so, identify contractors for the proposed projects (see above general statement). At the appropriate time DPW in conjunction with QH will prepare a select list of contractors from whom tenders will be sought.

Queensland Government policy is such that all appropriately prequalified contractors are to be considered for these works when preparing any select list. The existence of a local office may be a factor for some of these projects but local origin is not. The Qld Govt's Local Industry Policy applies to all such projects and head contractors are required, under the policy, to afford full and fair opportunity to local sub contactors and suppliers.

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Appendix 10: Procurement model analysis inputs Appendix Table 56: Procurement model analysis inputs

Project Options

Rural and Remote-Atherton:Option 1) Status quo

Rural and Remote-Atherton:Option 2) Refurb plus accom

Rural and Remote-Atherton:Option 3) Redevelop plus accom

Rural and Remote-Ayr:Option 1) Status quo

Rural and Remote-Ayr:Option 2) Refurb plus accom

Rural and Remote-Ayr:Option 3) Redevelop plus accom

Rural and Remote-Biloela:Option 1) Status quo

Rural and Remote-Biloela:Option 2) Refurb plus accom

Rural and Remote-Biloela:Option 3) Redevelop plus accom

Rural and Remote-Charleville:Option 1) Status quo

Rural and Remote-Charleville:Option 2) Refurb plus accom

Rural and Remote-Charleville:Option 3) Redevelop plus accom

Indicative capital cost $26.00M $106.00M $108.00M $2.00M $22.00M $20.00M $15.00M $69.00M $73.00M $8.00M $72.00M $79.00M

Primary Procurement Model Test

1 ThresholdDoes the net present value/whole of life cost exceed $100m?

No Yes Yes No No No No No Yes No No No

1 Requirements

The ability of the model to deliver the required outcomes in terms of:- quality of the design and quality of the constructed facility- robustness and functionality of the design- accommodating Queensland Health input's into the design process

Medium High High Low Medium Medium Medium High High Nil High High

2 Requirements

The ability of the model to deliver the required outcomes in terms ofallowing for future proofing and flexibility development due to changed operational needs (including during the asset life)

Medium High High Low Low Low Low High High Medium Medium High

3 RequirementsThe ability of the model to provide the opportunity for bundling of ancillary services Nil Low Low Low Low Low Low Low Low Low Low Low

4 Timeline

The ability of the model to deliver the project in the required timeframes and enable effective management of risk around delays focussing on:- certainty regarding achievement of project completion dates - providing progressive delivery and completion throughout the construction timeframe (supporting decant requirements)

High Medium Medium Low Medium Medium Low Medium Medium Medium Medium Medium

5 Timeline

The ability of the model to deliver the project in the required timeframes and enable effective management of risk around delays focussing oncommencement of construction as early as possible

High Medium Medium High Medium Medium High Medium Medium High Medium Medium

6Budget for capital

costs

Ability of model to provide budget certainty in respect of the construction of the facility and remove unexpected funding requirements. High High High High High High High High High Low High High

7Budget for

operating costs

Ability of model to provide budget certainty in respect of the maintenance and refurbishment costs of the facility and remove unexpected funding requirements.

High High High Low Low Low Low Medium High Low Medium Medium

8Whole-of-life design and maintenance


Low Medium Medium Nil Low Low Low Medium High Nil Medium High

9Market appetite and capability

Ability of model to attract small primary local contractorsMedium Medium Medium High High High High Low Low High Low Low


Ability of model to attract large private sector playersMedium High High Low Low Low Low Medium Medium Low High High

11Stakeholder and

scope management

Ability of model to ensure that delivery of the project is consistent with stakeholder interest and stakeholder expectations are effectively managedAbility of model to effectively manage scope change requests by stakeholders and to minimise impact on cost, time and quality

Medium High High Medium Medium Medium Medium High High High High High

12 Risk management

The extent that the procurement model allows for:- appropriate allocation of risks to the party best placed to manage the risk at the lowest cost- efficient risk management and/or mitigation

High High Medium Medium Medium Medium High Medium Medium Medium Medium Medium

13 Cost minimisationThe ability of the model to reduce capital costs

High High High High High High High High High High High High

14 Cost minimisationThe ability of the model to reduce operation costs

Low Medium Medium Low Low Low Low Medium High Low Medium High

15 Cost minimisationThe ability of the model to minimise tender costs

High Low Low High High High High Low Low High Low Low

16 Innovation

The ability of the model to achieve innovation in design, construction methods, construction program, life-cycle and ESD considerations, achievement of requirements, etc

Low Medium High Low Low Low Low Medium High Low Medium High

17New vs

refurbishment

The extent to which the model addresses the project's requirements in respect of new build (green field) as well as refurbishments (brown field) Low High High Medium Medium Medium Medium High Low Low High Medium

18 Industrial relationsThe ability of the model to effectively manage and deal with industrial relations issues High High High High High High High High High High High High

19Asset Utilisation /

Commercial The ability to draw on the innovation and risk capital from the private sector in the delivery of additional commercial opportunities. Nil Nil Low Nil Nil Nil Nil Nil Nil Nil Nil Nil

20Complexity of staging and decanting

The ability of approach to deal with complexity of construction program in respect of staging and decanting High High Medium Medium Medium Medium Medium High Medium Low High Medium

Secondary Procurement evaluation criteria

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Project Options

Rural and Remote-Charters Towers:Option 1) Status quo

Rural and Remote-Charters Towers:Option 2) Refurb plus accom

Rural and Remote-Charters Towers:Option 3) Redevelop plus accom

Rural and Remote-Emerald:Option 1) Status quo

Rural and Remote-Emerald:Option 2) Refurb plus accom

Rural and Remote-Emerald:Option 3)Redevelop plus accom

Rural and Remote-Kingaroy:Option 1) Status quo

Rural and Remote-Kingaroy:Option 2) Refurb plus accom

Rural and Remote- Kingaroy:Option 3) Redevelop plus accom

Rural and Remote- Longreach: Option 1) Status quo

Rural and Remote-Longreach:Option 2) Refurb plus accom

Rural and Remote-Longreach:Option 3) Redevelop plus carom




No No Yes No No No No No No No No No

1 Requirements

The ability of the model to deliver the required outcomes in terms of:- quality of the design and quality of the constructed facility - robustness and functionality of the design- accommodating Queensland Health input's into the design process

Low High High Low High High Low High High Low High High

2 Requirements

The ability of the model to deliver the required outcomes in terms ofallowing for future proofing and flexibility development due to changedoperational needs (including during the asset life)

Low Medium High Medium High High Low Medium High Low Medium High

3 RequirementsThe ability of the model to provide the opportunity for bundling of ancillary services

Low Low Low Low Low Low Low Low Low Low Low Low

4 Timeline

The ability of the model to deliver the project in the required timeframes and enable effective management of risk around delays focusing on:- certainty regarding achievement of project completion dates- providing progressive delivery and completion throughout the construction timeframe (supporting decant requirements)

Low Medium Medium Low Medium Medium Low Medium Medium Low Medium Medium

5 Timeline

The ability of the model to deliver the project in the required timeframes and enable effective management of risk around delays focusing oncommencement of construction as early as possible

High Medium Medium Medium Medium Medium High Medium Medium High Medium Medium

6 Budget for capital costs

Ability of model to provide budget certainty in respect of the construction of the facility and remove unexpected funding requirements. Medium High High High High High Low High High High High High

7 Budget for operating costs


Low Medium High Low Medium High Low Medium Medium Low Medium High



Nil Medium High Nil Medium High Nil Medium Medium Nil Medium High


Ability of model to attract small primary local contractors High Medium Medium High Medium Medium High Medium Medium Low Low Nil


Ability of model to attract large private sector playersLow Medium High Low Medium Medium Low Medium Medium Low High High

11Stakeholder and

scope management


Medium High High Low High High High High High High High High

12 Risk management

The extent that the procurement model allows for:- appropriate allocation of risks to the party best placed to manage the riskat the lowest cost- efficient risk management and/or mitigation

High Medium Medium High Medium Medium Low Medium Medium High Medium Medium

13 Cost minimisation The ability of the model to reduce capital costs


14 Cost minimisation The ability of the model to reduce operation costsLow Medium High Low Medium High Low Medium Medium Low Medium High

15 Cost minimisation The ability of the model to minimise tender costs

High Low Low High Low Low High Low Low High Low Low

16 Innovation


Low Medium High Low Medium Medium Low Medium Medium Low Medium High

17New vs

refurbishment

The extent to which the model addresses the project's requirements in respect of new build (greenfield) as well as refurbishments (brownfield) Medium High Low Low High High Low High High Low High Medium



Commercial Opportunities

The ability to draw on the innovation and risk capital from the private sector in the delivery of additional commercial opportunities. Nil Nil Nil Nil Nil Low Nil Nil Nil Nil Nil Nil


The ability of approach to deal with complexity of construction program in respect of staging and decanting Medium High Low Medium High High Low High High Low High High


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Project Options

Rural and Remote-Mareeba:Option 1) Status quo

Rural and Remote-Mareeba:Option 2) Refurb plus accom

Rural and Remote-Mareeba:Option 3) Redevelop plus accom

Rural and Remote-Roma:Option 1) Status quo

Rural and Remote-Roma:Option 2) Refurb plus accom

Rural and Remote-Roma:Option 3) Redevelop plus accom

Rural and Remote-Sarina:Option 1) Status quo

Rural and Remote-Sarina:Option 2) Refurb plus accom

Rural and Remote-Sarina:Option 3) Redevelop plus accom

Rural and Remote-Thursday Island:Option 1) Status quo

Rural and Remote-Thursday Island:Option 2) Refurb plus accom

Rural and Remote-Thursday Island:Option 3) Redevelop plus accom




No No No No No No No No No No No Yes

1 Requirements

The ability of the model to deliver the required outcomes in terms of:- quality of the design and quality of the constructed facility- robustness and functionality of the design- accommodating Queensland Health input's into the design process

Low Medium Medium Low High High Low Medium High Low High High

2 Requirements

The ability of the model to deliver the required outcomes in terms ofallowing for future proofing and flexibility development due to changed operational needs (including during the asset life)

Low Low Medium Low Medium Medium Low Low High Low Low High

3 RequirementsThe ability of the model to provide the opportunity for bundling of ancillary services Nil Nil Nil Low Low Low Low Low Low Low Low Low

4 Timeline

The ability of the model to deliver the project in the required timeframes and enable effective management of risk around delays focussing on:- certainty regarding achievement of project completion dates - providing progressive delivery and completion throughout the construction timeframe (supporting decant requirements)

Low Medium Medium Low Medium Medium Low Medium Medium Medium Medium Medium

5 Timeline

The ability of the model to deliver the project in the required timeframes and enable effective management of risk around delays focussing oncommencement of construction as early as possible

High Medium Medium High Medium Medium High Medium Medium High Medium Medium

6Budget for capital

costs

Ability of model to provide budget certainty in respect of the construction of the facility and remove unexpected funding requirements. High High High Low High High Low Medium High High High High

7Budget for

operating costs


Low Medium Medium Low Medium Medium Low Medium High Low Medium High

8Whole-of-life design and maintenance


Nil Low Low Nil Medium Medium Nil Medium High Nil Medium High


Ability of model to attract small primary local contractorsHigh Medium Medium High Low Low High Medium Medium Nil Nil High


Ability of model to attract large private sector playersLow Medium Medium Low Medium Medium Low Medium Medium Medium Medium Low

11Stakeholder and

scope management



12 Risk management

The extent that the procurement model allows for:- appropriate allocation of risks to the party best placed to manage the risk at the lowest cost- efficient risk management and/or mitigation

High Medium Medium High Medium Medium High Medium Medium High High High

13 Cost minimisationThe ability of the model to reduce capital costs


14 Cost minimisationThe ability of the model to reduce operation costs

Low Medium Medium Low Medium Medium Low Medium High Low Medium High

15 Cost minimisationThe ability of the model to minimise tender costs

High Low Low High Low Low High Low Low Medium Low Low

16 Innovation


Low Low Low Low Medium Medium Low Medium High Low Medium High

17New vs

refurbishment

The extent to which the model addresses the project's requirements in respect of new build (green field) as well as refurbishments (brown field) Low Low Low Low Medium Medium Low Medium Medium Low High High



Commercial The ability to draw on the innovation and risk capital from the private sector in the delivery of additional commercial opportunities. Nil Nil Nil Nil Nil Medium Nil Nil Nil Nil Nil Nil


The ability of approach to deal with complexity of construction program in respect of staging and decanting Low Low Medium Low High High Low Medium Medium Low High High


of 287



Procurement model analysis sample output Appendix Table 57: Procurement model analysis sample output

Project Name:

No Evaluation Criteria

Yes/NoConstruct-

OnlyConstruction Management

Project Alliancing

D&C exc Maint D&C inc Maint PPP MC exc Maint MC inc Maint

1 PPP Threshold

No

may be suitable

may be suitable

may be suitable

may be suitable

may be suitable

not suitable may be suitable

may be suitable

No Criteria Key elements analysed Priority Rating ScalePrimary

Weighting out of 100

Normalised Weighting out of

100

Construct-Only

Construction Management

Project Alliancing

D&C exc Maint D&C inc Maint PPP MC exc Maint MC inc Maint Construct-OnlyConstruction Management

Project Alliancing D&C exc Maint D&C inc Maint PPP MC exc Maint MC inc Maint

1 Requirements The ability of the model to deliver the required outcomes in terms of:- quality of the design and quality of the constructed facility- robustness and functionality of the design- accommodating Queensland Health input's into the design process

Medium

2 4.88% 2.17% √√√ √√√ √√ √√ √√ √√ √√ √√

0.0870 0.0870 0.0652 0.0652 0.0652 0.0652 0.0652 0.06522 Requirements The ability of the model to deliver the required outcomes in terms of allowing for future

proofing and flexibility development due to changed operational needs (including during the asset life)

Medium

2 4.88% 2.17% √ √ √√ √ √ √ √√ √√

0.0435 0.0435 0.0652 0.0435 0.0435 0.0435 0.0652 0.06523 Requirements The ability of the model to provide the opportunity for bundling of ancillary services Nil

0 0.00% 0.00% XX XX XX XX √√ √√√ XX √√0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

4 Timeline The ability of the model to deliver the project in the required timeframes and enable effective management of risk around delays focussing on:- certainty regarding achievement of project completion dates - providing progressive delivery and completion throughout the construction timeframe (supporting decant requirements)

High

3 7.32% 4.89% √ √ √ √√ √√ √√√ √√ √√

0.0978 0.0978 0.0978 0.1467 0.1467 0.1957 0.1467 0.14675 Timeline The ability of the model to deliver the project in the required timeframes and enable

effective management of risk around delays focussing oncommencement of construction as early as possible

High

3 7.32% 4.89% √ √ √ √√ √√ X √√√ √√√

0.0978 0.0978 0.0978 0.1467 0.1467 0.0489 0.1957 0.19576 Budget for capital

costsAbility of model to provide budget certainty in respect of the construction of the facility and remove unexpected funding requirements.

High3 7.32% 9.78% √ X X √√ √√ √√√ √√ √√

0.1957 0.0978 0.0978 0.2935 0.2935 0.3913 0.2935 0.29357 Budget for operating

costsAbility of model to provide budget certainty in respect of the maintenance and refurbishment costs of the facility and remove unexpected funding requirements.

High

3 7.32% 9.78% XX XX XX XX √√√ √√√ XX √√√0.0000 0.0000 0.0000 0.0000 0.3913 0.3913 0.0000 0.3913



Low

1 2.44% 3.26% √ √ √ √ √√ √√√ √ √√0.0652 0.0652 0.0652 0.0652 0.0978 0.1304 0.0652 0.0978


Ability of model to attract small primary local contractors Medium 2 4.88% 6.52% √√√ √√ X √ X XX √√ X

0.2609 0.1957 0.0652 0.1304 0.0652 0.0000 0.1957 0.065210 Market appetite and

capabilityAbility of model to attract large private sector players Medium

2 4.88% 6.52% √ √√ √√√ √√ √√ √√√ √√√ √√0.1304 0.1957 0.2609 0.1957 0.1957 0.2609 0.2609 0.1957



Medium

2 4.88% 6.52% √ √√ √√ √ √ √ √√ √√

0.1304 0.1957 0.1957 0.1304 0.1304 0.1304 0.1957 0.195712 Risk management The extent that the procurement model allows for:

- appropriate allocation of risks to the party best placed to manage the risk at the lowest cost- efficient risk management and/or mitigation

High

3 7.32% 9.78% √ √ √ √√ √√ √√√ √√ √√

0.1957 0.1957 0.1957 0.2935 0.2935 0.3913 0.2935 0.293513 Cost minimisation The ability of the model to reduce capital costs High

3 7.32% 3.26% √√ √ √ √√ √√ √√ √√ √√0.0978 0.0652 0.0652 0.0978 0.0978 0.0978 0.0978 0.0978

14 Cost minimisation The ability of the model to reduce operation costs Low1 2.44% 1.09% X X X √ √√ √√√ √ √√

0.0109 0.0109 0.0109 0.0217 0.0326 0.0435 0.0217 0.032615 Cost minimisation The ability of the model to minimise tender costs High

3 7.32% 3.26% √√ √√√ √ √ √ X √√ √0.0978 0.1304 0.0652 0.0652 0.0652 0.0326 0.0978 0.0652

16 Innovation The ability of the model to achieve innovation in design, construction methods, construction program, life-cycle and ESD considerations, achievement of requirements, etc

Low

1 2.44% 3.26% √ √ √√√ √√ √√√ √√√ √√ √√√0.0652 0.0652 0.1304 0.0978 0.1304 0.1304 0.0978 0.1304

17 New vs refurbishment

The extent to which the model addresses the project's requirements in respect of new build (green field) as well as refurbishments (brown field)

Low

1 2.44% 3.26% √ √√√ √√ √ √ √ √√ √0.0652 0.1304 0.0978 0.0652 0.0652 0.0652 0.0978 0.0652

18 Industrial relations The ability of the model to effectively manage and deal with industrial relations issues High3 7.32% 9.78% √√√ √√√ √√ √√ XX XX √√ XX

0.3913 0.3913 0.2935 0.2935 0.0000 0.0000 0.2935 0.000019 Asset Utilisation /


The ability to draw on the innovation and risk capital from the private sector in the delivery of additional commercial opportunities.

Nil

0 0.00% 0.00% XX XX XX XX XX √√√ XX X0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000


The ability of approach to deal with complexity of construction program in respect of staging and decanting

High

3 7.32% 9.78% X √ √√√ X X X √√ √√0.0978 0.1957 0.3913 0.0978 0.0978 0.0978 0.2935 0.2935

Total 41 100.00% 100.00% 2.1304 2.2609 2.2609 2.2500 2.3587 2.5163 2.7772 2.6902

7 4 4 6 3 10 1 2may be suitable may be suitable may be suitable may be suitable may be suitable not suitable may be suitable may be suitable

RatingSecondary Procurement evaluation criteria

Key elements analysed

Does the net present value/whole of life cost exceed $100m?

Calculated Score and Overall Ranking

Rural and Remote-Atherton:Option 1) Status quo

Results

Primary Procurement Model Test Rating

of 287



Project Name:


Yes/NoConstruct-


Project Alliancing


1 PPP Threshold

Yes

may be suitable

may be suitable

may be suitable

may be suitable

may be suitable

may be suitable

may be suitable

may be suitable




100

Construct-Only


Project Alliancing




High

3 6.38% 2.75% √√√ √√√ √√ √√ √√ √√ √√ √√



High

3 6.38% 2.75% √ √ √√ √ √ √ √√ √√

0.0550 0.0550 0.0826 0.0550 0.0550 0.0550 0.0826 0.08263 Requirements The ability of the model to provide the opportunity for bundling of ancillary services Low

1 2.13% 0.92% XX XX XX XX √√ √√√ XX √√0.0000 0.0000 0.0000 0.0000 0.0275 0.0367 0.0000 0.0275


Medium

2 4.26% 2.75% √ √ √ √√ √√ √√√ √√ √√



Medium

2 4.26% 2.75% √ √ √ √√ √√ X √√√ √√√



High3 6.38% 8.26% √ X X √√ √√ √√√ √√ √√



High

3 6.38% 8.26% XX XX XX XX √√√ √√√ XX √√√0.0000 0.0000 0.0000 0.0000 0.3303 0.3303 0.0000 0.3303



Medium

2 4.26% 5.50% √ √ √ √ √√ √√√ √ √√0.1101 0.1101 0.1101 0.1101 0.1651 0.2202 0.1101 0.1651




capabilityAbility of model to attract large private sector players High

3 6.38% 8.26% √ √√ √√√ √√ √√ √√√ √√√ √√0.1651 0.2477 0.3303 0.2477 0.2477 0.3303 0.3303 0.2477



High

3 6.38% 8.26% √ √√ √√ √ √ √ √√ √√



High

3 6.38% 8.26% √ √ √ √√ √√ √√√ √√ √√


3 6.38% 2.75% √√ √ √ √√ √√ √√ √√ √√0.0826 0.0550 0.0550 0.0826 0.0826 0.0826 0.0826 0.0826

14 Cost minimisation The ability of the model to reduce operation costs Medium 2 4.26% 1.83% X X X √ √√ √√√ √ √√

0.0183 0.0183 0.0183 0.0367 0.0550 0.0734 0.0367 0.055015 Cost minimisation The ability of the model to minimise tender costs Low

1 2.13% 0.92% √√ √√√ √ √ √ X √√ √0.0275 0.0367 0.0183 0.0183 0.0183 0.0092 0.0275 0.0183


Medium

2 4.26% 5.50% √ √ √√√ √√ √√√ √√√ √√ √√√0.1101 0.1101 0.2202 0.1651 0.2202 0.2202 0.1651 0.2202



High

3 6.38% 8.26% √ √√√ √√ √ √ √ √√ √0.1651 0.3303 0.2477 0.1651 0.1651 0.1651 0.2477 0.1651





Nil

0 0.00% 0.00% XX XX XX XX XX √√√ XX X0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000



High

3 6.38% 8.26% X √ √√√ X X X √√ √√0.0826 0.1651 0.3303 0.0826 0.0826 0.0826 0.2477 0.2477

Total 47 100.00% 100.00% 2.0826 2.3394 2.4037 2.2294 2.4128 2.6514 2.7615 2.7156

8 6 5 7 4 3 1 2may be suitable may be suitable may be suitable may be suitable may be suitable may be suitable may be suitable may be suitable





Rural and Remote-Atherton:Option 2) Refurb plus accom

Results


of 287



Project Name:


Yes/NoConstruct-


Project Alliancing


1 PPP Threshold

Yes

may be suitable

may be suitable

may be suitable

may be suitable

may be suitable

may be suitable

may be suitable

may be suitable




100

Construct-Only


Project Alliancing




High

3 6.38% 2.75% √√√ √√√ √√ √√ √√ √√ √√ √√



High

3 6.38% 2.75% √ √ √√ √ √ √ √√ √√

0.0550 0.0550 0.0826 0.0550 0.0550 0.0550 0.0826 0.08263 Requirements The ability of the model to provide the opportunity for bundling of ancillary services Low

1 2.13% 0.92% XX XX XX XX √√ √√√ XX √√0.0000 0.0000 0.0000 0.0000 0.0275 0.0367 0.0000 0.0275


Medium

2 4.26% 2.75% √ √ √ √√ √√ √√√ √√ √√



Medium

2 4.26% 2.75% √ √ √ √√ √√ X √√√ √√√



High3 6.38% 8.26% √ X X √√ √√ √√√ √√ √√



High

3 6.38% 8.26% XX XX XX XX √√√ √√√ XX √√√0.0000 0.0000 0.0000 0.0000 0.3303 0.3303 0.0000 0.3303



Medium

2 4.26% 5.50% √ √ √ √ √√ √√√ √ √√0.1101 0.1101 0.1101 0.1101 0.1651 0.2202 0.1101 0.1651




capabilityAbility of model to attract large private sector players High

3 6.38% 8.26% √ √√ √√√ √√ √√ √√√ √√√ √√0.1651 0.2477 0.3303 0.2477 0.2477 0.3303 0.3303 0.2477



High

3 6.38% 8.26% √ √√ √√ √ √ √ √√ √√



Medium

2 4.26% 5.50% √ √ √ √√ √√ √√√ √√ √√


3 6.38% 2.75% √√ √ √ √√ √√ √√ √√ √√0.0826 0.0550 0.0550 0.0826 0.0826 0.0826 0.0826 0.0826

14 Cost minimisation The ability of the model to reduce operation costs Medium 2 4.26% 1.83% X X X √ √√ √√√ √ √√

0.0183 0.0183 0.0183 0.0367 0.0550 0.0734 0.0367 0.055015 Cost minimisation The ability of the model to minimise tender costs Low

1 2.13% 0.92% √√ √√√ √ √ √ X √√ √0.0275 0.0367 0.0183 0.0183 0.0183 0.0092 0.0275 0.0183


High

3 6.38% 8.26% √ √ √√√ √√ √√√ √√√ √√ √√√0.1651 0.1651 0.3303 0.2477 0.3303 0.3303 0.2477 0.3303



High

3 6.38% 8.26% √ √√√ √√ √ √ √ √√ √0.1651 0.3303 0.2477 0.1651 0.1651 0.1651 0.2477 0.1651





Low

1 2.13% 2.75% XX XX XX XX XX √√√ XX X0.0000 0.0000 0.0000 0.0000 0.0000 0.1101 0.0000 0.0275



Medium

2 4.26% 5.50% X √ √√√ X X X √√ √√0.0550 0.1101 0.2202 0.0550 0.0550 0.0550 0.1651 0.1651

Total 47 100.00% 100.00% 2.0550 2.2844 2.3486 2.2018 2.4128 2.7339 2.6789 2.6881

8 6 5 7 4 1 3 2may be suitable may be suitable may be suitable may be suitable may be suitable may be suitable may be suitable may be suitable





Rural and Remote-Atherton:Option 3) Redevelop plus accom

Results


of 287



Appendix 11: Site options evaluation Appendix Table 58: Evaluation of Options against Criteria: Atherton Hospital

Criteria Option 1 Option 2 Option 3 Rationale Reference in options

Analysis

Capacity Does not

meet Meets Meets

Option 1 does not increase the capacity of the Hospital, and therefore does not meet the required service capacity Options 2 and 3 ensure that service capacity is commensurate with projected demand for services


Capability Does not

meet Meets Meets

Option 1 will result in minimal improvements to the level of care but will not suffice requirements of a Level 3 draft CSCFv3.0 service Option 2 will suffice requirements of a Level 3 draft CSCFv3.0 service Option 3 will guarantee compliance with draft CSCFv3.0


Equity of access Does not

meet Meets Meets

Option 1 is expected to cause significant disruption to service delivery, therefore not improving equity of access Option 2 provides for ongoing access to hospital services and meets capability and capacity requirements Option 3 provides for ongoing access to hospital services, meets capability and capacity requirements whilst having minimal disruption to services


Quality Does not

meet Potentially

meets Potentially

meets

Option 1 does not address issues regarding staff recruitment and retention Option 2 and 3 has the potential to reduce issues regarding staff recruitment and retainment, primarily through improvements in employee housing accommodation


Safety Does not

meet Meets Meets

Option 1 will make some improvements in safety however compliance with Disability Discrimination Act, Building Code of Australia will mean that buildings will still be structurally unsound Option 2 and 3 will address all of the major safety concerns.


Sustainability Does not

meet Meets Meets

Option 1 will make few changes that will improve sustainability of service and workforce sustainability. Minimal impact on environmental

Economic Impact Assessment and Public

of 287




Analysis sustainability is expected Option 2 will improve workforce and environmental sustainability Option 3 will result in significant improvements in workforce and environmental sustainability, whilst enhancing service delivery

Interest Assessment

Efficiency Does not

meet Partially meets

Meets

Option 1 does not address the operational flow issues or the inefficiencies in the functional arrangements of the departments. It also fails to address all capacity and capability requirements, limiting the role of the Hospital within the health care continuum Option 2 addresses some but not all of the functional inefficiencies and operational flow issues Option 3 addresses the functional inefficiencies, operational flow issues and alignment with the health care continuum for more efficient service delivery

Public Interest Assessment

Affordability

Capital expenditure

$25.696 million

$105.817 million

$107.668 million

Option 1 undertakes building refurbishments to mitigate risks Option 2 is a total refurbishment and construction of new buildings Option 3 is the build of the entire hospital on Greenfield land

Financial Analysis

Annual recurrent expenditure (incremental)

$1.464 million

$14.711 million

$14.994 million

Option 1 cost estimates only relate to the incremental costs associated with maintenance and depreciation of the building refurbishments Option 2 and 3 incremental recurrent cost estimate is the same workforce profile, with the cost variance being driven by the increased capital depreciation and maintenance

Risk Profile Highest

risk option Medium

risk option Lower risk

option

Option 1 comprises the most extreme risks around service capacity and structural integrity which can only be mitigated to a limited degree Option 2 still contains a number of high risks including functional inefficiencies, maintenance costs and decanting disruption. Some can be mitigated through detailed planning but a number of residual risks will remain Option 3’s risk profile improves considerably; many of the risks can be mitigated through detailed planning and design

Risk Analysis

of 287



of 287



Appendix Table 59: Evaluation of Options against Criteria: Ayr Hospital


Analysis

Capacity Does not

meet Meets Meets

Option 1 improvements in service capacity are hindered significantly by staff retention and recruitment issues Options 2 and 3 ensure service capacity meets forecasted demand


Capability Does not

meet Meets Meets

Option 1 does not comply with Level 3 draft CSCFv3.0 requirements Options 2 and 3 comply with the Level 3 draft CSCFv3.0 requirements



meet Meets Meets

Option 1 will result in some improvements in the level of care provided, however staffing concerns will prevent equity of access to be achieved Option 2 will ensure ongoing provision of services, therefore improving equity of access Option 3 will enhance service provision and capacity therefore improving equity of access


Quality Does not

meet Potentially

meets Potentially

meets

Option 1 does not address staff retention and recruitment concerns Option 2 and Option 3 have the potential to address the staffing recruitment and retention issues


Safety Meets Meets Meets Option 1 will address a number of safety concerns, including infection risks, fire risks and security risks Options 2 and 3 address all safety concerns outlined in option 1




Meets

Option 1 will lead to minor improvements in workforce, service delivery and environmental sustainability Option 2 will improve workforce sustainability, however the impact on environmental sustainability is considered minimal Option 3 will have significant improvements for both workforce and environmental sustainability


Efficiency Does not


Meets Option 1 does not address the operational flow issues or the inefficiencies in functional arrangements of the departments, including overcrowded workspaces


of 287




Analysis Option 2 will result in some improvements in efficiency however it will not address the inefficiencies in the functional arrangements across all primary health and administrative departments Option 3 provides for significant improvements to functional arrangements and efficiencies across the health care continuum

Affordability

Capital expenditure

$1.608 million

$21.776 million

$19.633 million

Option 1 undertakes building refurbishments to mitigate risks Option 2 includes the refurbishments of Option 1 and includes the refurbishment of the disused nursing home and is estimated to be the most costly Option 3 is the construction of a new building on Greenfield site

Financial Analysis


$0.091 million

$7.367 million

$7.254 million

Option 1 cost estimates only relate to the incremental costs associated with maintenance and depreciation of the building refurbishments Option 2 and 3 recurrent cost estimate is calculated based on the same workforce profile, with the cost variance being driven by the increased capital depreciation and maintenance for Option 2


risk option Medium

risk option Lower risk

option

Option 1 comprises extreme risks around service capacity, capability and workforce which can only be mitigated to a limited degree Option 2 still contains a number of high risks including functional inefficiencies. Some can be mitigated through detailed planning, but a number of residual risks will remain Option 3’s risk profile improves considerably; many of the risks can be mitigated through detailed design and project planning

Risk Analysis

of 287



Appendix Table 60: Evaluation of Options against Criteria: Biloela Hospital


Analysis

Capacity Meets Meets Meets

Options 1, 2 and 3 meet capacity requirements. The population of Biloela and the surrounding region is forecast to grow over the period to 2021 and the average age of the population is expected to increase. Although a larger and older regional population is likely to place greater demands on local health infrastructure, population demand forecasts show that the current infrastructure is sufficient to meet expected levels of demand


Capability Does not

meet Meets Meets

Option 1 does not suffice requirements of a Level 3 draft CSCF v3.0 service. Options 2 and 3 comply with a Level 3 draft CSCF v3.0 service.




Meets

Option 1 will result in inadequate service provision to numerous population groups; therefore no improvement in equity of access is expected Option 2 does provide for ongoing access to hospital services in the future, however disruption during the refurbishment will compromise access during that time and this option does not fully comply with Disability Discrimination Act Option 3 does improve service provision and disruptions to services are likely to be reduced


Quality Does not

meet Potentially

meets Potentially

meets

Option 1 does not address workforce retention and recruitment issues Options 2 and 3 has the potential to address staff and recruitment issues through improved employee housing accommodation


Safety Does not


Meets

Option 1 addresses a minimal number of safety concerns Option 2 will address most safety concerns however compliance with Building Code of Australia will not be achieved Option 3 addresses all safety risks and is compliant with Disability Discrimination Act and Building Code of Australia


Sustainability Does not Meets Meets Option 1 will negatively impact on workforce sustainability and Economic Impact Assessment and Public

of 287




Analysis meet improvements in environmental sustainability will be minor

Option 2 will improve workforce sustainability and moderate improvements in environmental sustainability are expected Option 3 will improve workforce sustainability and have a more significant impact on environmental sustainability

Interest Assessment

Efficiency Does not

meet Meets Meets

Option 1 does not address the operational flow issues or the inefficiencies in the functional arrangements of the departments. It also fails to address all capability requirements, limiting the role of the Hospital within the health care continuum Option 2 and 3 address the functional inefficiencies, operational flow issues and alignment with the health care continuum for more efficient service delivery


Affordability

Capital expenditure

$15.245 million

$69.123 million

$72.573 million

Option 1 undertakes building refurbishments to mitigate risks. Option 2 includes new build of many clinical areas, with a refurbishment of the inpatient medical services, and kitchen Option 3 is the new build of all clinical and support areas of the hospital and is estimated as the most costly

Financial Analysis


$0.784 million

$18.306 million

$18.501 million

Option 1 cost estimates only relate to the incremental costs associated with maintenance and depreciation of the building refurbishments Option 2 and 3 recurrent cost estimate is calculated based on the same workforce profile, with the cost variance being driven by the increased capital depreciation and maintenance


risk option Medium

risk option Lowest risk

option

Option 1 comprises extreme risks around service capability and workforce which can only be mitigated to a limited degree. It also includes significant building condition limitations and functional inefficiencies Option 2 still contains a number of high risks including heavy investment in existing facilities and decanting risks. Some can be mitigated through detailed planning, but a number of residual risks will remain

Risk Analysis

of 287




Analysis Option 3’s risk profile improves considerably; many of the risks can be mitigated through detailed design and project planning

of 287



Appendix Table 61: Evaluation of Options against Criteria: Charleville Hospital


Analysis

Capacity Does not

meet Meets Meets

Option 1 will not improve service capacity and may result in inconsistent levels of care Options 2 and 3 will ensure service capacity will meet forecasted demand projections


Capability Does not

meet Meets Meets

Option 1 will not result in compliance with a Level 3 draft CSCFv3.0 service Options 2 and 3 will result in compliance with a Level 3 draft CSCFv3.0 service



meet Meets Meets

Option 1 service capacity will not be improved resulting in vulnerable groups being adversely affected Option 2 will improve service provision and access, it must be noted that minimal disruption to services may occur Option 3 will improve access to services; in particular clinical services will be removed from flood zones


Quality Does not

meet Potentially

meets Potentially

meets

Option 1 does not address workforce retention and recruitment issues due to lack of improvement in working conditions Options 2 and 3 has the potential to improve workforce retention and recruitment issues through improved employee housing accommodation


Safety Does not


Meets

Option 1 does address some of the safety concerns, however compliance with Disability Discrimination Act and Building Code of Australia are not achieved Option 2 will address most safety concerns Option 3 addresses all safety concerns and achieves compliance with Building Code of Australia and Disability Discrimination Act



meet Meets Meets

Option 1 does not result in improvements for workforce or environmental sustainability Option 2 could potentially improve operational efficiency by lowering maintenance costs associated with flooding. It would also likely improve workforce sustainability


of 287




Analysis Option 3 will result in significant improvements in workforce and environmental sustainability, and in particular will wholly relocate the hospital off the high-risk flood plain, whereas Option 2 only removes key services off the high-risk flood plain

Efficiency Does not


Meets

Option 1 does not address many of the operational flow issues or the inefficiencies in the functional arrangements of the departments. It also fails to address all capability requirements, limiting the role of the Hospital within the health care continuum Option 2 will result in some improvements in efficiency however it will not address the inefficiencies in the functional arrangements across the theatres and wards on the first floor Option 3 addresses the functional inefficiencies, operational flow issues and alignment with the health care continuum for more efficient service delivery


Affordability

Capital expenditure

$7.846 million

$72.114 million

$78.654 million

Option 1 undertakes building refurbishments to mitigate risks. Option 2 includes new build of many clinical areas, with a refurbishment of the inpatient medical, maternity and rehabilitation services Option 3 is the new build of all clinical and support areas of the hospital, except rehabilitation and community health and is estimated as the most costly Financial Analysis


$0.410 million

$23.635 million

$24.010 million



risk option Medium


option

Option 1 comprises extreme risks around service capability and workforce which can only be mitigated to a limited degree. It also includes significant flooding risks and functional inefficiencies Option 2 still contains a number of high risks including heavy investment in existing facilities. Some can be mitigated through detailed planning, but a number of residual risks will remain, including flooding

Risk Analysis

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Analysis Option 3’s risk profile improves considerably; many of the risks can be mitigated through detailed design and project planning although flooding remains a risk

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Appendix Table 62: Evaluation of Options against Criteria: Charters Towers Hospital


Analysis

Capacity Does not

meet Meets Meets

Option 1 is unlikely to meet sufficient service capacity requirements Options 2 and 3 will meet sufficient service capacity requirements


Capability Does not

meet Meets Meets

Option 1 does not comply with a Level 3 draft CSCF v3.0 service Options 2 and 3 will achieve compliance with a Level 3 draft CSCF v3.0 service



meet Meets Meets

Option 1 does not comply with draft CSCF v3.0 which adversely affects vulnerable groups and disruptions to service provision are expected to be significant Option 2 will ensure health services support the needs of the community, however there will be disruptions during construction phaseOption 3 will improve service delivery and access to the community and disruptions due to construction minimised


Quality Does not

meet Potentially

meets Potentially

meets

Option 1 impact on workforce sustainability likely to be minor Options 2 and 3 has the potential to address staff recruitment and retention issues through improved employee housing accommodation


Safety Does not


Meets

Option 1 improves compliance with the Disability Discrimination Act but does not bring the site into compliance with the Building Code of Australia Option 2 will address a greater number of the building standards; however, will not be compliant with Building Code of Australia Option 3 addresses all safety concerns and achieves compliance with Building Code of Australia and Disability Discrimination Act




Meets

Option 1 will result in minor improvements in workforce and environmental sustainability Option 2 can potentially improve workforce sustainability; however, there will be minimal improvements in environmental sustainability Option 3 involves the construction of a new facility and will improve


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Analysis workforce sustainability beyond that of Option 2, environmental sustainability is expected to be improved significantly

Efficiency Does not


Meets

Option 1 does not address many of the operational flow issues, inefficiencies in the functional arrangements of the departments and overcrowding issues. It also fails to address all capability requirements, limiting the role of the Hospital within the health care continuum Option 2 will result in some improvements in departmental efficiency however it will not address all the functional inefficiencies. Option 3 addresses the functional inefficiencies, operational flow issues and alignment with the health care continuum for more efficient service delivery


Affordability

Capital expenditure

$10.420 million

$58.391 million

$101.233 million

Option 1 undertakes building refurbishments to mitigate risks Option 2 is refurbishment of existing site to mitigate risks and to improve functionality of departments Option 3 is a new build on greenfield land and is estimated as the most costly

Financial Analysis


$0.598 million

$4.152 million

$6.576 million



risk option Medium


option

Option 1 comprises extreme risks around service capability and workforce which can only be mitigated to a limited degree. It also includes building condition limitations and considerable functional inefficiencies Option 2 still contains a number of high risks including heavy investment in existing facilities and decanting risks. Some can be mitigated through detailed planning, but a number of residual risks will remain Option 3’s risk profile for the facility improves considerably. However as a greenfield development at a different location, it confers risks

Risk Analysis

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Analysis around community interest, transportation and site availability. Many of these risks can be mitigated through detailed design, consultation and project planning

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Appendix Table 63: Evaluations of Options against Criteria: Emerald Hospital


Analysis

Capacity Does not

meet Meets Meets

Option 1 will not meet service capacity requirements needed for forecasted demand projections Options 2 and 3 meet required service capacity for forecasted demand


Capability Does not

meet Meets Meets

Option 1 does not comply with Level 3 draft CSCF v3.0 service Options 2 and 3 comply with Level 3 draft CSCF v3.0 service



meet Meets

Partially meets

Option 1 does not comply with draft CSCFv3.0 which will adversely affect vulnerable groups. Temporary closures will also result in lack of access to services Option 2 addresses most of the requirements for the draft CSCF v3.0 and increases compliance with the Disability Discrimination Act and Building Code of Australia Option 3 addresses the requirements of the draft CSCF v3.0. The demolition of the original hospital building has been assessed as a significant impact on stakeholders and is considered not in the public interest


Quality Does not

meet Potentially

meets Potentially

meets

Option 1 provides limited information is available to assess the impact on the Emerald Hospital workforce Options 2 and 3 have the potential to improve workforce sustainability by increasing staff satisfaction


Safety Does not

meet Meets Meets

Option 1 will address some safety concerns; however compliance with Building Code of Australia and Disability Discrimination Act will not be achieved Option 2 builds on Option 1 by addressing additional safety concerns and achieve compliance with Building Code of Australia and Disability Discrimination Act Option 3 addresses all the safety risks addressed in Option 2


Sustainability Does not Meets Meets Option 1 there is limited information available regarding workforce Economic Impact

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Analysis meet sustainability however there will be a minimal impact on environmental

sustainability Option 2 will improve workforce sustainability and environmental sustainability Option 3 is more likely to lead to significant environmental sustainability improvements than Option 2 achieving compliance with the Queensland Health Energy Efficiency Guidelines

Assessment and Public Interest Assessment

Efficiency Does not

meet Meets Meets

Option 1 does not address many of the operational flow issues and inefficiencies in the functional arrangements of the departments. It also fails to address all capability requirements, limiting the role of the Hospital within the health care continuum Option 2 and 3 address the functional inefficiencies, operational flow issues and alignment with the health care continuum for more efficient service delivery


Affordability

Capital expenditure

$7.545 million

$73.544 million

$81.279 million

Option 1 undertakes building refurbishments to mitigate risks Option 2 is mix of refurbishment and new build of existing site to mitigate risks and to improve functionality of departments Option 3 has significant new build of infrastructure

Financial Analysis


$0.393 million

$17.535 million

$17.975 million



risk option Medium


option

Option 1 comprises extreme risks around service capability and workforce which can only be mitigated to a limited degree. It also includes considerable functional inefficiencies Option 2 still contains a number of high risks including heavy investment in existing facilities, asbestos removal and decanting risks. Some can be mitigated through detailed planning, but a number of residual risks will remain

Risk Analysis

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Analysis Option 3’s risk profile improves considerably; many of the risks can be mitigated through detailed design and project planning

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Appendix Table 64: Evaluations of Options against Criteria: Kingaroy Hospital


Analysis

Capacity Does not

meet Meets Meets

Option 1 does not increase the capacity of the Hospital, and therefore does not meet the required service capacity Options 2 and 3 meet the required service capacity in 2021/22 Information is not available in relation to the ability to meet service capacity need in interim years


Capability Does not

meet Meets Meets

Option 1 shows accessibility to minimum services determined under the Level 3 draft CSCF v3.0 service is set to decline over the period to 2021/22 Option 2 and 3 ensure accessibility for a Level 3 draft CSCF v3.0 service in 2021/22. Information is not available in relation to the ability to meet service capability need in interim years



meet Meets Meets

Option 1 does not improve equity of access to healthcare services as it does not meet projected demand for services in the region Options 2 and 3 ensure that future demand for services is satisfied, and therefore significantly contribute to improving equity of access


Quality Partially Meets

Potentially meets

Potentially meets

Kingaroy does not have major issues with employee housing accommodation, however, Option 1 will provide only minor improvements to the quality of the working environment Options 2 and 3 have the potential to improve workforce sustainability by increasing staff satisfaction. Option 3 also includes development of new clinical and acute facilities further boosting staff satisfaction by providing for a better integrated work environment


Safety Partially Meets

Partially Meets

Meets

Option 1 includes a number of changes to buildings and facilities that improve compliance with standards Option 2 includes all of the changes proposed for Option 1 plus providing significant additional measures Option 3 addresses all the safety risks addressed in Option 2


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Analysis


meet Meets Meets

Option 1 will lead to a minor positive impact for economic sustainability, very minimal impact on system energy usage and no other environmental improvements Options 2 and 3 will lead to higher quality and more efficient provision of services, moderate impacts on environmental sustainability In addition, option 3 represents a slight improvement on Option 2 in terms of environmental sustainability


Efficiency Does not


Meets

Option 1 does not address many of the operational flow issues and inefficiencies in the functional arrangements of the departments. It also fails to address all capacity requirements, limiting the role of the Hospital within the health care continuum Option 2 will result in some improvements in departmental efficiency however it will not address all the functional inefficiencies, for example in allied health Option 3 addresses the functional inefficiencies, operational flow issues and alignment with the health care continuum for more efficient service delivery


Affordability

Capital expenditure

$3.362 million

$40.376 million

$43.108 million

Option 1 undertakes building refurbishments to mitigate risks Option 2 is refurbishment of existing site to mitigate risks and to improve functionality of departments Option 3 similar to option 2 is a redevelopment with increased space and is estimated as the most costly

Financial Analysis


$0.181 million

$7.736 million

$7.883 million



risk option Medium


option

Option 1 comprises extreme risks around service capacity and workforce which can only be mitigated to a limited degree. It also includes considerable functional inefficiencies Option 2 still contains a number of high risks including heavy

Risk Analysis

of 287




Analysis investment in existing facilities, maintenance costs and decanting risks. Some can be mitigated through detailed planning, but a number of residual risks will remain Option 3’s risk profile improves considerably; many of the risks can be mitigated through detailed design and project planning although the proposed accommodation arrangements may require extensive community consultation

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Appendix Table 65: Evaluations of Options against Criteria: Longreach Hospital


Analysis

Capacity Meets Meets Meets

Options 1, 2 and 3 meet capacity requirements. Although a larger and older regional population is likely to place greater demands on local health infrastructure, population demand forecasts show that the current infrastructure is sufficient to meet expected levels of demand


Capability Does not

meet Meets Meets

Option 1 is not sufficient to upgrade the facility to comply with Level 3 draft CSCF v3.0 service Options 2 and 3 meet the requirements of Level 3 CSCF v3.0 service



meet Meets Meets

Option 1 will have considerable impact on public access to essential services Options 2 and 3 are assessed to be in the public interest with respect to equity of access to essential health services


Quality Does not

meet Potentially

meets Potentially

meets

Option 1 is not likely to have a significant impact on workforce sustainability Option 2 has the potential to improve workforce sustainability Option 3 improves workforce sustainability by providing for optimised interdepartmental functional relationships as well as improved employee housing accommodation


Safety Does not

meet Partially Meets

Meets

Options 1 and 2 are insufficient to meet full compliance with the Disability Discrimination Act and Building Code of Australia Option 3 ensures all hospital facilities are compliant with the Disability Discrimination Act and Building Code of Australia



meet Meets Meets

Option 1 will lead to a very minor positive impact for economic, workforce and environmental sustainability Option 2 has minimal impacts on environmental sustainability and positive effects on workforce sustainability Option 3 in addition to positive workforce improvements, significant improvements in sustainability will be achieved through the development of new buildings which are likely to lead to improvements in energy efficiency due to better insulation and better heating and


of 287




Analysis cooling systems

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Analysis

Efficiency Does not

meet Meets Meets

Option 1 does not address many of the operational flow issues and inefficiencies in the functional arrangements of the departments. It also fails to address many capability requirements, limiting the role of the Hospital within the health care continuum Options 2 and 3 address the functional inefficiencies, operational flow issues and alignment with the health care continuum for more efficient service delivery


Affordability

Capital expenditure

$11.555 million

$88.094 million

$94.362 million

Option 1 undertakes building refurbishments to mitigate risks Option 2 is refurbishment of existing site to mitigate risks and to improve functionality of departments Option 3 similar to option 2 is a redevelopment with a new site layout and is estimated as the most costly

Financial Analysis


$0.589 million

$24.146 million

$24.753 million



risk option Medium


option

Option 1 comprises extreme risks around service capability and workforce which can only be mitigated to a limited degree. It also includes considerable building condition risks and functional inefficiencies Option 2 still contains a number of high risks including heavy investment in existing facilities, asbestos and decanting risks. Some can be mitigated through detailed planning, but a number of residual risks will remain Option 3’s risk profile improves considerably; many of the risks can be mitigated through detailed design and project planning

Risk Analysis

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Appendix Table 66: Evaluations of Options against Criteria: Mareeba Hospital


Analysis

Capacity Does not

meet Meets Meets

Option 1 does not achieve the accessibility requirements in regard to meeting capacity Options 2 and 3 ensure that the service capacity meets the future demand


Capability Does not

meet Meets Meets

Option 1 does not meet Level 3 CSCF v3.0 service as the risk exists of not providing sufficient required facilities to the community Options 2 and 3 meet the service requirements of the Level 3 draft CSCF v3.0



meet Meets Meets

Option 1 is assessed as not being in the public interest with respect to equity of access to essential health services. Options 2 and 3 are assessed to be in the public interest with respect to providing public access to essential health services


Quality Partially meets

Potentially meets

Potentially meets

Option 1 has minor impacts on workforce sustainability Options 2 and 3 have the potential to improve workforce sustainability by increasing staff satisfaction


Safety Partially meets

Potentially Meets

Potentially Meets

Option 1 is not sufficient to ensure compliance with the Building Code of Australia but does involve upgrades to minimum access and Building Code of Australia requirements While the Preliminary Infrastructure Planning Study was not fully explicit, it was expected that Option 2 investments would increase Mareeba Hospital’s compliance with the Disability Discrimination Act and that Option 3 would allows for further increases on Option 2’s compliance with Disability Discrimination Act and Building Code of Australia standards


Sustainability Partially meets

Meets Meets

Option 1 may lead to a very minor positive impact for economic and environmental sustainability Options 2 and 3 result in moderate improvements to sustainability and minimal impacts on environmental sustainability


of 287




Analysis

Efficiency Does not

meet Meets Meets

Option 1 does not address many of the operational flow issues and inefficiencies in the functional arrangements of the departments. It also fails to address many capacity requirements, limiting the role of the Hospital within the health care continuum Option 2 addresses most of the functional inefficiencies and operational flow issues but involves refurbishment so is slightly constrained by the existing building structure Option 3 addresses the functional inefficiencies, operational flow issues and alignment with the health care continuum for more efficient service delivery and provides for expanded dental facilities


Affordability

Capital expenditure

$7.908 million

$24.320 million

$25.043 million

Option 1 undertakes building refurbishments to mitigate risks. Option 2 is refurbishment of existing site to mitigate risks and to improve functionality of departments Option 3 similar to option 2 is a redevelopment with a new build for ED, outreach and administration

Financial Analysis


$0.420 million

$12.437 million

$12.476 million



risk option Medium


option

Option 1 comprises extreme risks around service capacity and workforce which can only be mitigated to a limited degree. It also includes functional inefficiencies Option 2 still contains a number of high risks including heavy investment in existing facilities and decanting risks. Some can be mitigated through detailed planning, but a number of residual risks will remain Option 3’s risk profile improves considerably; many of the risks can be mitigated through detailed design and project planning

Risk Analysis

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Appendix Table 67: Evaluations of Options against Criteria: Roma Hospital


Analysis

Capacity Does not

meet Meets Meets

Option 1 does not change the departmental service infrastructure, and therefore does not meet the required service capacity Option 2 and 3 caters for the increase in demand for those services that has been forecast over the period to 2021/22 Information is not available in relation to the ability to meet service capacity need in interim years


Capability Does not

meet Meets Meets

Option 1 is not compliant with a Level 3 draft CSCF v3.0 service Options 2 and 3 meet the requirements of Level 3 draft CSCF v3.0



meet Meets Meets

Option 1 is not in the public interest with respect to equity of access to essential health services Options 2 and 3 are assessed as in the public interest with respect to equity of access to essential health services


Quality Does not

meet Potentially

meets Potentially

meets

Option 1 suggests negative impacts on workforce sustainability as low grade facilities and inefficient layout of services coupled with maintenance issues experienced noted in the Preliminary Infrastructure Planning Study provides for less than desirable working conditions Options 2 and 3 have the potential to improve workforce sustainability due to investment in improved employee housing accommodation and the working environment



Partially meets

Partially meets

Options 1, 2 and 3 are not sufficient to fully comply with all Building Code of Australia and Disability Discrimination Act standards but do address major concerns for access and safety



meet Meets Meets

Options 1 will have very minor positive impacts for economic, environmental and workforce sustainability Option 2 will lead to positive impacts for economic and environmental sustainability and addresses workforce sustainability Option 3 addresses workforce sustainability and environmental


of 287




Analysis sustainability is likely to improve as is economic sustainability with the construction of a GP Super Clinic on site.

Efficiency Does not


Meets

Option 1 does not address many of the operational flow issues and inefficiencies in the functional arrangements of the departments. It also fails to address all capacity and capability requirements, limiting the role of the Hospital within the health care continuum Option 2 will result in some improvements in departmental efficiency however it will not address all the functional inefficiencies Option 3 addresses the functional inefficiencies and operational flow issues and in conjunction with the GP super clinic improves alignment with the health care continuum for more efficient service delivery


Affordability

Capital expenditure

$6.218 million

$29.888 million

$32.540 million

Option 1 undertakes building refurbishments to mitigate risks. Option 2 is refurbishment of existing site to mitigate risks and to improve functionality of departments Option 3 is similar to Option 2 and includes a new build for a GP super clinic

Financial Analysis


$0.333 million

$18.286 million

$18.429 million

Option 1 cost estimates only relate to the incremental costs associated with maintenance and depreciation of the building refurbishments Option 2 and 3 recurrent cost estimate is calculated based on the sameworkforce profile, with the cost variance being driven by the increased capital depreciation and maintenance


risk option Medium


option

Option 1 comprises extreme risks around service capacity and workforce which can only be mitigated to a limited degree. It also includes functional inefficiencies Option 2 still contains a number of high risks including heavy investment in existing facilities, functional inefficiencies and decanting risks. Some can be mitigated through detailed planning, but a number of residual risks will remain Option 3’s risk profile improves considerably; many of the risks can be mitigated through detailed design and project planning

Risk Analysis

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Appendix Table 68: Evaluations of Options against Criteria: Sarina Hospital


Analysis

Capacity Does not

meet Meets Meets

Option 1 does not include any change in the provision of services, or cater for the projected growth in demand for services in the Sarina region. Therefore, this option does not meet the future demand Options 2 and 3 cater for the increase in demand for those services that has been forecast over the period to 2021/22


Capability Does not

meet Meets Meets

Option 1 does not meet Level 2 draft CSCF v3.0 Options 2 and 3 meet Level 2 draft CSCF v3.0 service requirements



meet Meets Meets

Option 1 is not in the public interest with respect to equity of access to health care services Options 2 and 3 are assessed as in the public interest with respect to equity of access to essential health services


Quality Does not

meet Potentially

meets Potentially

meets

Option 1 Impacts on workforce sustainability are likely to be negative Options 2 and 3 have the potential to improve workforce sustainability by increasing staff satisfaction


Safety Does not

meet Meets Meets

Options 1 not sufficient to fully comply with all standards Options 2 and 3 ensure full compliance with the Building Code of Australia and majority compliance with the Disability Discrimination Act. Option 3 includes a new access road, which should enable ambulances to avoid railway crossings, thus reducing delays to emergency treatment



meet Meets Meets

Option 1 will lead to minor positive impacts on economic and environmental sustainability Option 2 impacts moderately on environmental sustainability. Option 3 provides more significant positive improvements in environmental sustainability than option 2


Efficiency Does not

meet Meets Meets

Option 1 does not address many of the operational flow issues and inefficiencies in the functional arrangements of the departments. It also


of 287




Analysis fails to address many capability or capacity requirements, limiting the role of the Hospital within the health care continuum Option 2 and 3 address the functional inefficiencies, operational flow issues and alignment with the health care continuum for more efficient service delivery

Affordability

Capital expenditure

$2.840 million

$12.345 million

$22.045 million

Option 1 undertakes building refurbishments to mitigate risks. Option 2 is refurbishment of existing site and includes the addition of a new wing Option 3 is demolish and re-build the hospital with additional capacity and represents the most costly option

Financial Analysis


$0.156 million

$5.910 million

$6.473 million

Option 1 cost estimates only relate to the incremental costs associated with maintenance and depreciation of the building refurbishments Option 2 and 3 recurrent cost estimate is calculated based on the same workforce profile for a Level 2 draft CSCF v3.0 service, with the cost variance being driven by the increased capital depreciation and maintenance


risk option Medium


option

Option 1 comprises extreme risks around service capacity, capability and workforce which can only be mitigated to a limited degree. It also includes functional inefficiencies and condition risks Option 2 still contains a number of high risks including ongoing structural risks and functional inefficiencies. Some can be mitigated through detailed planning, but a number of residual risks will remain Option 3’s risk profile improves considerably with a staged development approach; many of the risks can be mitigated through detailed design and project planning

Risk Analysis

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Appendix Table 69: Evaluations of Options against Criteria: Thursday Island Hospital


Analysis

Capacity Does not

meet Meets Meets

Option 1 does meet the forecast demand for services Options 2 and 3 ensure that the service capacity is commensurate with the projected demand for services in the Torres Shire over the period to 2021/22


Capability Does not

meet Meets Meets

Option 1 does not meet requirements of the Level 3 draft CSCF v3.0 service Options 2 and 3 ensure Thursday Island Hospital meets the requirements of the Level 3 draft CSCF v3.0 service



meet Meets Meets

Option 1 is assessed to be significantly adverse to the public interest with respect to the provision public access to essential health services Option 2 and 3 assessed as in the public interest with respect to equity of access to essential health services


Quality Does not

meet Potentially

meets Potentially

meets

Option 1 is likely to have a minor impact on workforce sustainability Options 2 and 3 have the potential to improve workforce sustainability by increasing staff satisfaction through improvements to employee housing accommodation and working conditions at the hospital



Partially meets

Meets

Options 1 and 2 do not address the safety issues for any meaningful period of time but do address minimum access code and Building Code of Australia requirements Option 3 addresses medium concerns relating to building corrosion and all building code requirements


Sustainability Partially meets

Partially meets

Meets

Option 1 is likely to have minor positive impacts for economic sustainability Option 2 significant impacts on economic and workforce sustainability no impact on environmental sustainability Option 3 positive impact on environmental sustainability, in terms of economic sustainability, this is the only option which allows the hospital to meet optimum functional relationship requirements


Efficiency Does not Partially Meets Option 1 does not address the operational flow issues and Public Interest

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Analysis meet meets inefficiencies in the functional arrangements of the departments. It also

fails to address all capacity requirements, limiting the role of the Hospital within the health care continuum Option 2 will result in some improvements in departmental efficiency however it will not address all the functional inefficiencies and overcrowding issues Option 3 addresses the functional inefficiencies, operational flow issues and alignment with the health care continuum for more efficient service delivery

Assessment

Affordability

Capital expenditure

$11.592 million

$80.702 million

$152.668 million

Option 1 undertakes building refurbishments to mitigate risks. Option 2 is refurbishment of existing site to mitigate risks and to improve functionality of departments Option 3 is the rebuild of the hospital on an adjacent greenfield site and is the most costly option

Financial Analysis


$0.659 million

$14.085 million

$18.034 million



risk option Medium


option

Option 1 comprises extreme risks around service capacity and workforce which can only be mitigated to a limited degree. It also includes severe condition risks, significant flooding risks and functional inefficiencies Option 2 still contains a number of high risks including ongoing condition risks, flooding risks, functional inefficiencies and decanting risks. Some can be mitigated through detailed planning, but a number of residual risks will remain, including flooding Option 3’s risk profile improves considerably; many of the risks can be mitigated through detailed design and project planning

Risk Analysis

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Appendix 12: Business case costing details and project plan Detailed below is a cost breakdown for each individual Hospital site to undertake business case development. As noted within Section 6, Atherton, Biloela, Charters Towers and Mareeba are proposed to have the business case developed across two stages due to the potential for PPP procurement and, in the case of Atherton and Mareeba, potential for project grouping.

For the purpose of consistency the construction cost has been established as 75 per cent of the whole of project cost. Whole of project cost is based on the combined Capital Cost – Infrastructure and Capital Cost – ICT as detailed in Section 5.3.1, Table 21 Total capital costs for Options 1, 2 and 3.

While business case development costs have been developed at an individual Hospital project level, efficiencies in resourcing are likely to be achieved where projects are combined.

Atherton Business Case development cost breakdown Appendix Table 70 provides the summarised construction and whole-of-project cost Atherton Hospital, Option 3 on which Business Case cost estimates have been based.

Appendix Table 70: Construction and whole-of-project cost for Atherton Hospital, Option 3

EXPECTED COST ESTIMATE: BUSINESS CASE DEVELOPMENT

$M

Based on construction cost 80.751

Based on whole-of-project cost 107.668

Appendix Table 71: Stage 1: Business Case development

ADVISOR/CONSULTANCY COST ESTIMATE

Advisors: FTE/annum

Cost $M

Architect 0.154

Services 0.155

Civil Structural 0.024

Project Manager 0.047

Quantity Surveyor 0.044

Programmer 0.015

Subtotal 0.439

ADDITIONAL ITEMS

Geotechnical Investigation (DPW estimate)

Subtotal

0.050

Surveying (DPW estimate) 0.050

Environmental Impact Study (DPW estimate) 0.100

Consultation 0.200

Business Case development 0.250

0.650

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GOVERNMENT RESOURCES ESTIMATE

Project Director (SO1) 0.151

Subtotal

0.076

Project Officers (AO8; AO6; AO5) 0.315 0.157

Workforce Planning; Change Management (2xAO7.5) 0.057 0.028

Service planners (AO8) 0.125 0.063

District Project Staff (AO8; AO6; AO5) 0.315 0.158

0.482

All costs Subtotal 1.571

Contingency 0.471

TOTAL 2.042

Notes: Assumptions for government resources estimate: 1. Stage 1 Business Case assumes the requirement to undertake detailed master planning for the preferred

option. 2. Construction cost and whole-of-project cost based on Option 3 as detailed within the Preliminary

Evaluation. 3. Advisors have been based on costs for development of Gold Coast University Hospital Master Plan and

Business Case and adjusted to the Option 3 base construction cost. 4. Staffing has been based on advice from Queensland Health Capital Delivery Program on the basis of

projects of similar size. 5. Staffing has been based on stage 1 being completed within six months. 6. Staff costs per annum as follows— AO8 @ $125k; AO7 @ $114k; AO6 @ $101k; AO5 @ $89k; SO1

@$151k—These figures have been taken from Queensland Health Finance Template. 7. Contingency calculated at 30 per cent of total project Business Case development estimate.

It should be noted that in order to continue to final Business Case the following costs are estimated to be required (Appendix Table 72) based on the project proceeding through traditional procurement.

Appendix Table 72: Stage 2: Final Business Case development


Advisors: FTE /annum

Cost $M

Architect 1.083

Services 0.431




Programmer 0.039

Subtotal 2.612

ADDITIONAL ITEMS

Consultation

Subtotal

0.200


0.700

of 287





Subtotal

0.151





0.963

All Costs Subtotal 4.275

Contingency 1.283

TOTAL 5.558

Notes: Assumptions for government resources estimate: 1. Stage 2 Business Case assumes the requirement to achieve Category 3 Cost Estimate as per Capital

Works Management Framework or capital costs. It is understood that Category 3 Cost Estimate requires development of Schematic Design. Should these elements not be required, costs can be refined.

2. Construction cost and whole-of-project cost based on option 3 detailed within the Preliminary Evaluation. 3. Advisors have been based on costs for development of Gold Coast University Hospital Project Definition

Plan and Schematic Design and business case and adjusted to the base construction cost. 4. Staffing has been based on advice from Queensland Health Capital Delivery Program on the basis of

projects of similar size. 5. Staffing has been based on completing the stage 2 Business Case within 12 months. 6. Staff costs per annum as follows— AO8 @ $125k; AO7 @ $114k; AO6 @ $101k; AO5 @ $89k; SO1

@$151k. These figures have been taken from Queensland Health Finance Template. 7. Contingency calculated at 30 per cent of total project business case development estimate.

Ayr Business Case development cost breakdown Appendix Table 73 provides the summarised construction and whole-of-project cost Ayr Hospital, Option 2 on which business case cost estimates have been based. Business case development for Ayr Hospital is proposed to be undertaken under traditional procurement within a single stage.

Appendix Table 73: Construction and whole-of-project cost for Ayr Hospital, Option 2


$M



Appendix Table 74: Business Case development


Advisors: FTE/annum

Cost $M

Architect 0.250

Services 0.118




Programmer 0.011

of 287



Subtotal 0.617

ADDITIONAL ITEMS


Subtotal

0.050



Consultation 0.300


0.850



Subtotal

0.151





0.963


Contingency 0.729

TOTAL 3.159

Notes: Assumptions for government resources estimate: 1. Business Case assumes the requirement to achieve Category 3 Cost Estimate as per Capital Works

Management Framework or capital costs. It is understood that Category 3 Cost Estimate requires development of Detailed Master Planning, Project Definition Plan and Schematic Design. Should these elements not be required, costs can be refined.

2. Construction cost and whole-of-project cost based on Option 2 as detailed within the Preliminary Evaluation.

3. Advisors have been based on costs for development of Gold Coast University Hospital Master Plan and Business Case and adjusted to the Option 2 base construction cost.

4. Staffing has been based on advice from Queensland Health Capital Delivery Program on the basis of projects of similar size.

5. Staffing has been based on business case being completed within 12 months. 6. Staff costs per annum as follows— AO8 @ $125k; AO7 @ $114k; AO6 @ $101k; AO5 @ $89k; SO1

@$151k. These figures have been taken from Queensland Health Finance Template. 7. Contingency calculated at 30 per cent of total project Business Case development estimate.

Biloela Business Case development cost breakdown Appendix Table 75 provides the summarised construction and whole-of-project cost Biloela Hospital, Option 3 on which Business Case cost estimates have been based.

Appendix Table 75: Construction and whole-of-project cost for Biloela Hospital, Option 3


$M



of 287





Advisors: FTE/annum

Cost $M

Architect 0.098

Services 0.098




Programmer 0.009

Subtotal 0.278

ADDITIONAL ITEMS


Subtotal

0.050



Consultation 0.200


0.650



Subtotal

0.076





0.482


Contingency 0.423

TOTAL 1.833





projects of similar size. 5. Staffing has been based on stage 1 being completed within six months. 6. Staff costs per annum as follows—AO8 @ $125k; AO7 @ $114k; AO6 @ $101k; AO5 @ $89k; SO1


of 287







Cost $M

Architect 0.686

Services 0.273




Programmer 0.025

Subtotal 1.654

ADDITIONAL ITEMS

Consultation

Subtotal

0.200


0.700



Subtotal

0.151





0.963


Contingency 0.995

TOTAL 4.312







of 287



Charleville Business Case Development Cost Breakdown Appendix Table 78 provides the summarised construction and whole-of-project cost Charleville Hospital, Option 3 on which Business Case cost estimates have been based. Business case development for Charleville Hospital is proposed to be undertaken under traditional procurement within a single stage.

Appendix Table 78: Construction and whole-of-project cost for Charleville Hospital, Option 3


$M





Advisors: FTE/annum

Cost $M

Architect 0.844

Services 0.399




Programmer 0.037

Subtotal 2.082

ADDITIONAL ITEMS


Subtotal

0.050



Consultation 0.300


0.850



Subtotal

0.151





0.963


Contingency 1.169

of 287



TOTAL 5.064








Charters Towers Business Case Development Cost Breakdown Appendix Table 80 provides the summarised construction and whole-of-project cost Charters Towers Hospital, Option 3 on which Business Case cost estimates have been based.

Appendix Table 80: Construction and whole-of-project cost for Charters Towers Hospital, Option 3


$M





Advisors: FTE/annum

Cost $M

Architect 0.145

Services 0.146




Programmer 0.014

Subtotal 0.413

ADDITIONAL ITEMS


Subtotal

0.050



Consultation 0.200


0.650

of 287





Subtotal

0.076





0.482


Contingency 0.463

TOTAL 2.008





projects of similar size. 5. Staffing has been based on Stage 1 being completed within six months. 6. Staff costs per annum as follows— AO8 @ $125k; AO7 @ $114k; AO6 @ $101k; AO5 @ $89k; SO1






Cost $M

Architect 1.018

Services 0.405




Programmer 0.037

Subtotal 2.456

ADDITIONAL ITEMS

Consultation

Subtotal

0.200


0.700

of 287





Subtotal

0.151





0.963


Contingency 0.963

TOTAL 5.355





projects of similar size. 5. Staffing has been based on completing the Stage 2 Business Case within 12 months. 6. Staff costs per annum as follows— AO8 @ $125k; AO7 @ $114k; AO6 @ $101k; AO5 @ $89k; SO1


Emerald Business Case Development Cost Breakdown Appendix Table 83 provides the summarised construction and whole-of-project cost Emerald Hospital, Option 2 on which Business Case cost estimates have been based. Business case development for Emerald Hospital is proposed to be undertaken under traditional procurement within a single stage.

Appendix Table 83: Construction and whole-of-project cost for Emerald Hospital, Option 2


$M





Advisors: FTE/annum

Cost $M

Architect 0.770

Services 0.364




Programmer 0.033

of 287



Subtotal 1.899

ADDITIONAL ITEMS


Subtotal

0.050



Consultation 0.300


0.850



Subtotal

0.151





0.963


Contingency 1.113

TOTAL 4.825








Kingaroy Business Case Development Cost Breakdown Appendix Table 85 provides the summarised construction and whole-of-project cost Kingaroy Hospital, Option 3 on which Business Case cost estimates have been based. Business case development for Kingaroy Hospital is proposed to be undertaken under traditional procurement within a single stage.

Appendix Table 85: Construction and whole-of-project cost for Kingaroy Hospital, Option 3


$M


of 287






Advisors: FTE/annum

Cost $M

Architect 0.496

Services 0.234




Programmer 0.022

Subtotal 1.222

ADDITIONAL ITEMS


Subtotal

0.050



Consultation 0.300


0.850



Subtotal

0.151





0.963


Contingency 0.910

TOTAL 3.945






5. Staffing has been based on business case being completed within 12 months.

of 287



6. Staff costs per annum as follows— AO8 @ $125k; AO7 @ $114k; AO6 @ $101k; AO5 @ $89k; SO1 @$151k. These figures have been taken from Queensland Health Finance Template.

7. Contingency calculated at 30 per cent of total project Business Case development estimate.

Longreach Business Case Development Cost Breakdown Appendix Table 87 provides the summarised construction and whole-of-project cost Longreach Hospital, Option 3 on which Business Case cost estimates have been based. Business case development for Longreach Hospital is proposed to be undertaken under traditional procurement within a single stage.

Appendix Table 87: Construction and whole-of-project cost for Longreach Hospital, Option 3


$M





Advisors: FTE/annum

Cost $M

Architect 0.991

Services 0.469




Programmer 0.043

Subtotal 2.445

ADDITIONAL ITEMS


Subtotal

0.050



Consultation 0.300


0.850



Subtotal

0.151





0.963

of 287




Contingency 1.277

TOTAL 5.535








Mareeba Business Case Development Cost Breakdown Appendix Table 89 provides the summarised construction and whole-of-project cost Mareeba Hospital, Option 3 on which Business Case cost estimates have been based.

Appendix Table 89: Construction and whole-of-project cost for Mareeba Hospital, Option 3


$M





Advisors: FTE/annum

Cost $M

Architect 0.032

Services 0.032




Programmer 0.003

Subtotal 0.091

ADDITIONAL ITEMS


Subtotal

0.050



Consultation 0.200


of 287



0.650

of 287





Subtotal

0.076





0.482


Contingency 0.367

TOTAL 1.589





projects of similar size. 5. Staffing has been based on Stage 1 being completed within six months. 6. Staff costs per annum as follows— AO8 @ $125k; AO7 @ $114k; AO6 @ $101k; AO5 @ $89k; SO1






Cost $M

Architect 0.223

Services 0.089




Programmer 0.008

Subtotal 0.539

ADDITIONAL ITEMS

Consultation

Subtotal

0.200


0.700

of 287





Subtotal

0.151





0.963


Contingency 0.660

TOTAL 2.862



2. Construction cost and whole-of-project cost based on Option 3 detailed within the Preliminary Evaluation. 3. Advisors have been based on costs for development of Gold Coast University Hospital Project Definition




Roma Business Case Development Cost Breakdown Appendix Table 92 provides the summarised construction and whole-of-project cost Roma Hospital, Option 3 on which Business Case cost estimates have been based. Business case development for Roma Hospital is proposed to be undertaken under traditional procurement within a single stage.

Appendix Table 92: Construction and whole-of-project cost for Roma Hospital, Option 3


$M





Advisors: FTE/annum

Cost $M

Architect 0.366

Services 0.173




Programmer 0.016

of 287



Subtotal 0.902

ADDITIONAL ITEMS


Subtotal

0.050



Consultation 0.300


0.850



Subtotal

0.151





0.963


Contingency 0.815

TOTAL 3.530








Sarina Business Case Development Cost Breakdown Appendix Table 94 provides the summarised construction and whole-of-project cost Sarina Hospital, Option 3 on which Business Case cost estimates have been based. Business case development for Sarina Hospital is proposed to be undertaken under traditional procurement within a single stage.

Appendix Table 94: Construction and whole-of-project cost for Sarina Hospital, Option 3


$M


of 287






Advisors: FTE/annum

Cost $M

Architect 0.253

Services 0.120




Programmer 0.011

Subtotal 0.625

ADDITIONAL ITEMS


Subtotal

0.050



Consultation 0.300


0.850



Subtotal

0.151





0.963


Contingency 0.731

TOTAL 3.169






5. Staffing has been based on business case being completed within 12 months.

of 287



6. Staff costs per annum as follows— AO8 @ $125k; AO7 @ $114k; AO6 @ $101k; AO5 @ $89k; SO1 @$151k. These figures have been taken from Queensland Health Finance Template.

7. Contingency calculated at 30 per cent of total project Business Case development estimate.

Thursday Island Business Case Development Cost Breakdown Appendix Table 96 provides the summarised construction and whole-of-project cost Thursday Island Hospital, Option 3 on which Business Case cost estimates have been based. Business case development for Thursday Island Hospital is proposed to be undertaken under traditional procurement within a single stage.

Appendix Table 96: Construction and whole-of-project cost for Thursday Island Hospital, Option 3 EXPECTED COST ESTIMATE: BUSINESS CASE DEVELOPMENT

$M





Advisors: FTE/annum

Cost $M

Architect 1.754

Services 0.830




Programmer 0.076

Subtotal 4.327

ADDITIONAL ITEMS


Subtotal

0.050



Consultation 0.300


0.850



Subtotal

0.151





0.963

of 287




Contingency 1.842

TOTAL 7.982






