Regional Health Planning

Briefing Note Summary

Cairns Hospital is under constant pressure as the only tertiary-level hospital in Far North Queensland.

Additional primary health and community care initiatives can help to alleviate pressure on the hospital.

There are five identified strategies to ease pressure on hospital services:

    1. FNQ Palliative Care Hospice
    2. Community-based mental health initiatives
    3. A chronic condition care facility
    4. Health research and education investment
    5. Regional health plan development.

These strategies will ease capacity restraints on the hospital, improve community health services, and divert patients to more appropriate care settings.

The Issue

Regional health strategies

Far North Queensland (FNQ) continues to experience a high burden of disease and poorer health outcomes compared with the Queensland average. Cairns Hospital is the only tertiary-level hospital in FNQ, but it is under constant bed pressure, which negatively impacts the community’s access to acute care services. Unlike large metropolitan areas, there is only one emergency department in Cairns, with no option to divert to any other facilities when the hospital reaches capacity, both in terms of inpatient beds and emergency care.

Strategic initiatives are being progressed to maximise capacity at Cairns Hospital – including transitioning Cairns Hospital to university status – to allow the delivery of more and better health services, but additional primary health and community care initiatives can also assist in alleviating the pressure. Community-based initiatives could divert patients to more appropriate care services, which would help ease pressure on the hospital.

To successfully achieve genuine improvements in health and wellbeing in FNQ, investment is required to enable development of a comprehensive regional health care plan, along with expansion of community health services. The five identified strategies are:

  1. A Far North Queensland Palliative Care Hospice: The demand for palliative care services within FNQ continues to increase year on year, with more than 650 people being admitted to hospital for palliative care in 2020 and many more receiving palliative care support in their homes. Currently, there are no palliative care hospice or respite centres for people with palliative care needs in FNQ. Cairns Hospital and the Gordonvale Palliative Care Unit (an off-site ward of Cairns Hospital) provide acute care for patients needing interventions and life-extending treatment. A community-run hospice would provide a comfortable residential environment away from a hospital environment to improve the wellbeing of adults and children needing end-of-life care and who cannot manage at home.
  2. Community-based mental health initiatives: Mental health and wellbeing can dominate a person’s health status across their lifespan, and the demand for services in FNQ is at a critical point. Self-harm is one of the top five leading causes of death for people under the age of 65 in Queensland, and suicide and self-inflicted injuries in FNQ are higher than the state-wide rate. Services are needed now to address the doubling of mental health and behavioural conditions since 2001.
  3. Establishment of a Chronic Condition Care Facility (healthy living centre) in Cairns’ southern region is required to meet the needs of people with selected chronic illnesses, to empower self-management and reduce repeated presentations to Cairns Hospital. The proposed facility would provide a collaborative approach to managing chronic conditions, thereby freeing up space at hospitals. Potential conditions to be managed include chronic obstructive pulmonary disease (COPD) and respiratory diseases, diabetes, cardiac conditions, mental health, and renal disease.
  4. Investment in health research and education: Co-contributions to Cairns and Hinterland Hospital and Health Service and universities are sought to partner and provide conjoint appointments and research support positions to fully realise integration across clinical, research, and education functions, to enable the university hospital to become a reality. Professorial chairs of medicine, allied health, and nursing are sought, as well as the development of interprofessional teams across relevant research areas for the region (e.g. Aboriginal and Torres Strait Islander health, tropical medicine, and chronic disease). Coupled with James Cook University’s intent to offer a full medical degree in Cairns, with the allocation of further Commonwealth Supported Places (CSPs), considerable benefits will be realised.
  5. Development of a regional health plan: An integrated regional health plan draws together relevant government, council, non-government, and community service providers to collectively prioritise and partner to meet the health needs of the community.

These initiatives need to be prioritised to meet existing healthcare gaps and improve community services that will alleviate pressure on Cairns Hospital. These initiatives have been selected as they represent service gaps where there are no alternatives to acute hospital care, and where a hospital is often not the right setting for the type of care required.


Easing regional health challenges

The Cairns Hospital supports an estimated resident population of 259,000 and regularly provides acute medical services for residents of the Cape York and Torres Strait Islands regions (population of 27,928). Combined with estimated population growth of 1.1% (compound annual growth rate) per annum and an ageing population, it is estimated that by 2026 an additional 27,643 people will reside in the catchment area with close to one in five residents aged over 65.

The Cairns Hospital continues to see increased demand on its Emergency Department. In 2019-2020 there were 71,690 presentations to the Cairns Hospital Emergency Department, averaging 211 patients per day (a 4% increase on the previous year). From November 2020 to April 2021, there was further increased pressure on the ED with an average of 232 patients presenting each day. Historically, 30% of emergency patients are tourists or people who live in rural and remote areas outside Cairns.

Cairns and Hinterland Hospital and Health Service (CHHHS) provides health services across the continuum of care to some of the most remote communities in Queensland and strives to meet the unique health needs of the largest and most diverse Aboriginal and Torres Strait Islander population in the state. A funding injection into the five identified health priorities will see benefits for the region, whilst also resulting in reduced pressure on Cairns Hospital, enabling the community to receive health care where they need it.

Next Steps

Far North Queensland Palliative Care Hospice: Cairns Organisation United for Cancer Health (COUCH), a community-focused charity, has a strategy to create the Cairns COUCH Community Health Precinct, inclusive of a 12-bed palliative care hospice with respite facilities. Commonwealth capital funding of $6M and three-year recurrent operating costs of $3.5M per year are sought to build the hospice within the COUCH precinct.

A suite of community-based mental health initiatives will address current and emerging mental health needs for the community, exacerbated due to the pressures of the COVID-19 pandemic. There are four high-impact strategies prioritised for community-based mental health intervention:

  • A GP/mental health model targeting physical health outcomes
  • A mental health youth psychosocial model
  • A community crisis support space, and
  • A transition to parenthood (perinatal mental health & wellness) program.

A Commonwealth funding injection of $1.5M to the North Queensland Primary Health Network (NQPHN) to commission these services under the Joint Regional Wellbeing Plan for Northern Queensland is sought.

Cairns chronic condition care facility (healthy living centre): The facility would be a ‘one-stop shop’ for co-located services to meet the needs of people living with chronic conditions. Partnerships with universities and training organisations are envisaged, enabling student-led clinics and clinical research trials. An estimated $15M capital funding is required to build this facility, inclusive of development of a concept brief detailing the model and proposed partnerships between the health service, universities, training organisations, and community organisations.

Ongoing investments into health research and education are critical to enable development of alternative models of care and to ensure optimum health outcomes can be achieved. Cairns Hospital has a vision to become Cairns University Hospital, with a range of benefits identified, including expanded clinical services enabling patients to receive care closer to home, attraction of high-calibre health specialists and researchers, and development of the local workforce. A recurrent funding injection of $2M is required to enable conjoint appointments to be established across Cairns Hospital and university partners. Additionally, support for the training and recruitment of Cairns-based clinicians is also sought. Additional Commonwealth Supported Places (CSPs) will allow JCU to offer a full medical degree in Cairns.

The development of a regional health plan will enable an integrated, collaborative approach to address prioritised health needs for Far North Queensland. The regional health plan is envisaged as a holistic plan, with a particular focus on health equity, and would be developed via a co-design collaborative approach across the region. A commitment of $1M is required for the CHHHS to develop the regional health plan in partnership with the NQPHN.

Our Recommendation

  • That Federal infrastructure funding of $6M be provided to build a palliative care hospice, along with $10.5M state funding for 3 years of recurrent operational funding.
  • That Federal funding of $1.5M be provided to enable comprehensive investment in community mental health initiatives.
  • That the State and Federal Governments commit joint funding of $15M for a chronic condition care facility.
  • That Federal funding of $2M be provided to enable conjoint appointments to be established between universities and the Cairns Hospital.
  • That to support the training of a regional medical workforce, the Federal Government allocates an additional 80 Commonwealth Supported Places recurrent, plus an allocation of Destination Australia scholarships to JCU’s School of Medicine and Dentistry.