safe applicable healthcare for rural and remote queensland ...€¦ · safe applicable healthcare...
TRANSCRIPT
Department of Health
Great state. Great opportunity.
Safe applicable healthcare for
rural and remote Queensland
—an implementation plan
3
I have much pleasure in presenting the implementation plan for Safe applicable healthcare for rural and remote Queensland. This plan builds on the report I delivered to the Minister for Health in May 2013. The report and accompanying documents were subject to extensive consultation and feedback.
The draft implementation plan was developed in light of this and subjected to a daylong consultation. Many useful comments from that consultation have been incorporated into this final document.
The implementation plan incorporates, acknowledges and builds on existing Department of Health and Hospital and Health Service (HHS) initiatives. It continues the work between the Statewide Rural and Remote Clinical Network (SRRCN), the HHSs and other areas of the Department of Health, and the partnership with them and organisations in the non-government sector. I look forward to these teams bringing these initiatives to reality over the next six months.
The SRRCN will report on progress in June 2014. Already other issues such as Aboriginal and Torres Strait Islander health and mental health have been raised and we look forward to developing consensus initiatives on these during that time.
I am proud that the hard working frontline service providers of the SRRCN have been able to deliver this plan as promised.
Associate Professor Alan Bruce Chater
Chair Statewide rural and remote clinical network
i f l
Foreword
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Specialist
services
Regional hospital
District hospital
24 hours emergency service; advanced life support and stabilisation
until transfer, medical, surgical maternity and neonatal services in line with a range of
primary, ambulatory, aged care and community services in line with community needs; visiting
specialist services; enhanced services in line with patient need; care is integrated with the GP.
Rural hospital
24 hours emergency service; life support and stabilisation until transfer, medical, surgical services with a range of primary, ambulatory, aged care and community services in line with community needs; visiting specialist
services; enhanced services in line with patient need; care is integrated with the GP.
Multi-purpose health service
Provides a mix of acute, aged care and community services; enhanced services in line with the patient need; acute services may be similar in mix and services capability to a rural or community hospital.
Community hospital
24 hours emergency services; life support and stablisation until transfer; medical services with a range of primary, ambulatory, aged care and community services in-line with community needs; visiting specialist services;
care is integrated with the GP.
Community clinic with after hours emergency care
Monday to Friday and emergency on-call 24/7
Community clinic
Monday to Friday business hours
Business hours health/medical clinic; basic life support and stabilisation until transfer; triage for lower level medical conditions and minor procedures with a range of primary, ambulatory, aged care and community services in line with community needs;
visiting specialist services in line with patient need.
Queensland rural and remote health service framework, 2013
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Priority area Actions achieved to date Actions proposed next six months (January to June 2014)
Organising
services for
safety
Policy and Planning Branch Chief Health Officer Branch HHSs
Review and revision of the draft Queensland rural and remote health service framework to
— develop a classification of rural health facilities — incorporate three types of services to be provided by rural and remote services � core services � enhanced services in line with patient need � services provided in line with community needs
Classification of hospitals clarified with input from HHSs and other key stakeholdersDraft data table developed outlining characteristics and performance of rural health facilities Review of level one services completed.Functional assessment of Clinical Services Capability Framework (CSCF v3.1 ) and amendment to ensure applicability to rural and remote health services commenced
Develop a user-friendly description of each service level that consumers can easily understand and relate toThe updated data table and map of health services be published with 2012–13 data and including Level 1 servicesThe classification of each health service, based on the current level of service, to be validatedThe data to be provided in a web friendly form that allows comparison between servicesFunctional assessment of CSCF v3.1 specific to rural and remote health services to be completed
Community clinics (CSCF Level 1) — Two-tier model of service provision in remote and very remote areas to be adopted � community clinic with after-hours emergency service—open Monday to Friday during business hours with 24-hour emergency on-call—more than 80 km (or one hour where poor or no road access) from higher health service
� community clinic open Monday to Friday during business hours—clinic within 80 km of higher health service
— Accreditation of Level 1 services to be investigated.
— ensure that revised CSCF reflects these arrangements
Tier 2 community clinics (providing 24-hour cover) — development of a guideline that supports Tier 1 clinics to � provide a minimum safe standard of service provision
� maintain adequate and sustainable staffing standard
� provide a safe and quality emergency, including ambulance, service
Tier 1 community clinic — community health centres to host provision of health services by a range of health service providers � HHSs to review clinics in locations less than 80 km away from a Level 2 (or higher) service to ensure that they are providing optimal services
Achieving
efficiency
Healthcare Purchasing, Funding and Performance Management Branch HHSs
Feedback provided to Independent Hospital Pricing Authority (IHPA) to improve dataQueensland Small Hospital Working Group formedFunding framework for Telehealth established
Work with IHPA representatives to ensure that data on rural hospitals is more reliableData analysis and clinician consultationEstablish funding method for outreachEnsure appropriate support and incentives for telechemotherapy, renal dialysis, birthing services and service integration
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Priority area Actions achieved to date Actions proposed next six months (January to June 2014)
Redevelopment and reinvigoration
Multi-purpose
health service
(MPHS)
Health Purchasing, Funding and Performance Branch Policy and Planning Branch HHS
Review of MPHS model of service delivery—existing, under development and eligible—complete MPHS guideline produced
Assist HHSs to implement MPHS in eligible hospitalsReview cost-effectiveness of MPHS
Outreach and
private/public
partnerships
HHS
Review of Flying Obstetric and Surgery Services Draft Service Plan (South West HHS)Review of service integrationMedical Outreach Indigenous Chronic Disease Program (MOICDP) and Rural Health Outreach Fund (RHOF) review and planning (CheckUP and Queensland Aboriginal and Islander Health Council)Regional planning begun
Consultative group to be established to oversee service mapping and coordination strategies — coordinate Telehealth support services — service mapping to ensure ongoing complementary skills base to rural generalist skills on-site — service mapping between visiting services:
� MOICDP/RHOF � HHSs specialist outreach service � private outreach service � flying specialist clinics and emergency services
Flying Obstetric and Surgery Services plan implementation and governance group to be established
Providing services closer to home
Telehealth
Clinical Access and Redesign Unit (CARU) HHS
Report and recommendations paper prepared and presented to Minister for HealthGovernance group on Telehealth establishedDeveloped funding/purchasing incentives to promote the uptake of Telehealth
Implement Telehealth strategy Scheduled care
— establish Telehealth coordinator positions across 17 HHSs — provision/reconfigure fit-for-purpose technologies to meet clinical business requirements
Unscheduled care — establish the Telehealth emergency management support unit
Telehealth support — establish a Telehealth Support Unit within the Department of Health
Enable a whole-of-health-sector network — progress a consultancy to carry out business analysis to define whole-of-health-sector service delivery models and identify fit-for-purpose solutions to address existing operational and system barriers
Incentives implemented to assist Telehealth adoption
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Priority area Actions achieved to date Actions proposed next six months (January to June 2014)
Birthing
Nursing and Midwifery Office of Queensland (NMOQ) Statewide Maternity and Neonatal Care Network (SMNCN) Queensland centre for Mothers and Babies (QCMB) Queensland Maternity Services Development Committee (QMSDC)
CSCF changes identified to facilitate birthing serviceFlying Obstetric and Surgery Services reviewedConsultation and collaboration SMNCNMaternity forum organised by QCMB Midwifery education program for 50 newly registered nurses initiative
Data — register of birthing sites and relevant parameters
— rural services data map to include specific data wrt maternity services
Models of care — ensure sustainable models for level three birthing services
— develop options for birthing in level two hospitals
— ensure that all models respect the role of all providers including midwives, general practitioners, nurse midwives and hospital doctors
— recommend models of staffing including private and contracted services for Level 2 and 3 services
— CSCF review to be completed, feedback sought and revised CSCF published to ensure Level 3 services have the ability to provide birthing services and existing Level 2 services are supported to provide birthing within the hub and spoke model
— maximise and support the involvement of private practising eligible midwives to support HHS services
— recommend effective employment models for direct entry N(mid) midwives
— review obstetrics and gynaecology/GP, anaesthetic/GP workforce to sustain and increase rural maternity services
— ensure that services at all rural service levels are able to deal with the unexpected birth and neonatal resuscitation
— ensure adequate antenatal and post-natal care at all service levels
Support services — that birthing services without proximate emergency blood supply be supported by an emergency donor panel where a senior clinician provides oversight and HHS boards are aware of their governance responsibility
— develop support models for more remote birthing services that build on the experience of the renewed Flying Obstetrician/Gynaecologist (FOG) model
Education — provide safe effective antenatal care in isolated areas by staff support and upskilling especially with ultrasound, Telehealth support and visiting services when required
— develop a register of standardized education programs for use in rural areas to maintain clinical competency—these should preferably provide onsite team education (e.g. PROMPT course)
Systems — review birthing documentation and simplify to develop a single entry system that allows emphasis on clinical care rather than on documentation
— Queensland Maternity and Perinatal Quality Council (QMPQC) explore options to measure the outcomes of rural services and provide data to allow individual services to benchmark their performance
Chemotherapy
Statewide Cancer Clinical Network (SCCN) HHS
Pilot sites in Townsville HHS reviewedQueensland Remote Chemotherapy Supervision (QReCS) guide developed and submitted to the networks for endorsement
Finalise statewide Queensland Remote Chemotherapy Supervision (QReCS) guideAssist HHSs to implement QReCS SRRCN and SCCN to work together to engage with cancer community To work with Clinical Oncological Society of Australia (COSA) and Cancer Nurses Society of Australia (CNSA) to implement this model Explore funding mechanisms to ensure adequate support at tertiary and rural sites
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Priority area Actions achieved to date Actions proposed next six months (January to June 2014)
Renal Dialysis
Torres Strait and Northern Peninsular HHS Cairns Renal Unit Statewide Renal Clinical Network
Plan developed for home dialysis in rural areasSelf care unit at Bamaga Hospital had been expanded from one to four self-care haemodialysis machines
Commencement of nurse assisted dialysis unit as part of the recently completed $39 million Community Wellness Centre at Thursday Island Hospital.Pro forma for introduction of renal dialysis supported by or in rural facilitiesDevelop plan for staff credentialingDevelop plan for Telehealth support
New
technology
Pathology Queensland–Statewide Point of Care Testing (PoCT) Health Services Information Agency (HSIA) Rural and Remote Clinical Support Unit (RRCSU) CARU Clinical Guidelines Group
Rural Emergency Services Standardisation project PoCT differential blood count testing trial in four sitesIntegrated electronic medical record (IeMR) plan
Establish a register of new rurally appropriate technologyReview results of trial of POC differential blood count testing and advise regarding implementation, including provision for integration into Queensland Health information technology systems Trial of IeMR in rural facilities within Cairns and Hinterland HHSReview of IeMR trial by SRRCN and expand to other rural areas Review and update the rural and remote emergency services standardisation guidelinesEstablish new rural clinical guidelines
Workforce
The rural
generalist team
(collaboration as below)
Co-operation between professions facilitated with respect to development of the generalist team
Ensure that the HHS education unit provides each facility with an interdisciplinary advanced life support course onsite each year Develop a rural health professional education model that additionally
— provides backup staff in smaller facilities during education activities — provides advice on facility improvement
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Priority area Actions achieved to date Actions proposed next six months (January to June 2014)
Medical
Rural and Remote Clinical Support Unit GP Credentialing Committee (RRCSU Credentialing)Rural and Remote Medical Support (for Queensland) hosted by Darling Downs HHS
Rural generalist pathway established and now expanded to 80 places Workforce reform in consultation Credentialing and Scope of Clinical Practice Unit
Formation of a steering group on rural medical workforceReview of rural medical workforce planning with reference to the rural and remote map as outlined in the Rural and Remote Health Service FrameworkAdd staff establishment to the rural services data sheet to ensure that services can benchmark their staff establishment and HHSs can identify services at riskCreation of an interpretive Queensland traffic-light map to enable identification at a state level those services considered to be at-risk according to the framework advisedAlignment and standardisation of rural health service credentialing processes, recognising the clinical scope of practice for rural medical practitioners as applied to the current review of CSCF of rural hospitals
Nursing and
Midwifery
Partner NMOQ
Rural Registered Nurse Graduate pathway—105 new rural graduate registered nursing positionsCredentialing and Scope of Clinical Practice policy inclusive of nurse practitioners, eligible midwives and mental health nursesNurse practitioners specialising in rural and remote pathway Strengthening health services through optimising nursing strategy and action plan releasedRegistered nurse professional practice in Queensland guide developed
Support the Rural and Remote Executive Director of Nursing subgroup and the Queensland Nursing and Midwifery Executive Council (QNMExC)Continue to implement rural nurse and midwife graduate scheme through NMOQImplement 2014 round of rural registered nurse graduate employment modelAlignment and standardisation of credentialing and scope of practice for nurse practitioners, mental health nurses and eligible midwivesAlignment and standardisation of scope of practice of rural and remote registered nurses and registered midwivesWork with professional nursing organisations to establish standards and certification pathways for registered nurses and registered midwives practising within rural and remote practice contextsPolicy alignment with Strengthening health services through optimising nursing strategy and action planGuidance to practitioners, employers and consumers regarding registered nurse’s full scope of practice (as in registered nurse professional practice in Queensland)
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Priority area Actions achieved to date Actions proposed next six months (January to June 2014)
Allied health
professional
services
Allied Health Professions’ Office of Queensland (AHPOQ)
Ministerial Taskforce on health practitioner expanded scope of practiceSpecific implementation plan for rural and remote developed Endorsement of actions by directors of allied health Expressions of interest for new graduate rural and remote allied health generalists trial sites completed—11 positions allocatedExpressions of interest for research grants targeting rural and remote openedRural and remote workforce mapping concept brief approved
Trial 11 new graduate rural and remote generalist positionsSupport HHS to redesign, implement and evaluate service delivery models of care that include use of
— allied health assistants/co-workers — Telehealth outreach — student-led clinics — partnerships with other services — 19(2) Medicare exemption — rights to private practice — full scope of practice — broadened skill-sets
Conduct Queensland Health rural and remote allied health workforce mappingProvide research funding opportunities for rural and remote service delivery models of care
Other providers
– physicians assistants
Physician assistants trials completed Implementation planProfessional governance and regulation arrangements
