Funding boost to improve health services in the Torres and Cape

• Queensland Health will provide a $1.4 million funding boost to Torres and Cape Hospital and Health Service to enhance the delivery of health services and ensure First Nations peoples receive the best possible care.
• The boost is on top of a $36 million increase to the HHS budget for 2024-25.
• It comes after an independent report made eight recommendations about improvements that should be undertaken in the region’s health system.

An independent investigation was commissioned by Queensland Health last year, into the Torres and Cape HHS in response to community concerns raised about health outcomes in the region.

The first part of the investigation is now complete and has made eight recommendations.

The report highlights state and nationwide disparities in health outcomes for First Nations peoples.

It acknowledges the importance of culturally appropriate, placed-based care and the need for more early intervention preventative initiatives.

An additional $1.4 million has been committed by Queensland Health to further enhance the delivery of services in the region, on top of the $351.75 million committed by the Miles Government to the HHS’s 2024-25 budget.

As part of investigators work, more than 400 separate documents and records were reviewed, and more than 70 people interviewed.

Key findings in the independent report included:

• The ongoing higher rate of potentially avoidable deaths in the TCHHS is consistent with outcomes for First Nations people across Australia.
• While it was not possible to make conclusive findings in relation to changes in life expectancy, there is evidence of improvements in the median age of death of First Nations peoples over the past 25 years, with variations in outcomes across the region.
• There has been a slight decrease in potentially preventable hospitalisations in recent years across the region.
• Within the Torres Strait region there has been improvements in the rates of babies born with a healthy birth weight (babies born with a low birthweight in the Torres Strait reduced from 12% down to 6%).
• There are fundamental differences in approaches to primary health care service delivery across the northern and southern parts of the HHS. 
• There is evidence of fragmentation of services between different health providers in the Cape.
• There is scope to improve access to primary health care.
• The HHS met its performance and financial requirements in FY22-23.
• The HHS has robust measures in place for clinical governance, including incident reporting and follow up, use of the Primary Clinical Care Manual, escalation of care framework and procedures and patient safety.

Recommendations cover a broad range of issues including improving orientation and induction for new staff, mapping service provision in every community in the southern part of the HHS, and formally documenting an approach to comprehensive health service delivery that captures the key strengths of the Torres Model of Care, while allowing for community and cultural variations within the region.

Queensland Health has accepted the recommendations and will work with the local community and staff to determine the best way to implement them.

The HHS has already undertaken a range of work with First Nations peoples to improve the delivery of healthcare. Key initiatives already delivered include hiring new frontline staff, filling key medical positions, improving infrastructure and boosting services, with the report showing an increase in annual health checks of 20 per cent.

The second part of the investigation is expected to be complete late 2024 or early 2025 and is assessing the cultural safety of health services provided by TCHHS for Aboriginal and Torres Strait Islander employees and those receiving care.

The Minister for Health, Director-General and HHS Chief Executive have met staff, key stakeholders and community representatives to discuss the report and its recommendations.

All recommendations highlight the importance of work currently underway to establish a community-controlled commissioning entity in the region which will allow greater self-determination in the planning and funding of health services.

The Miles Government remains committed to strengthening outcomes in the Torres and Cape and investments so far include funding for 15 new traineeships for First Nations health students, $800,000 to assist up to ten First Nations students with travel and living costs and six scholarships up to the value of $10,000 to assist in retaining and enhancing skills of First Nations health workers.

The report can be accessed at: https://www.health.qld.gov.au/research-reports/reports/review-investigation

Quotes attributable to the Minister for Health, Mental Health and Ambulance Service and Minister for Women Shannon Fentiman:

“When the local Government Leaders in the Torres Strait first shared their concerns with me, I visited Thursday Island to hear from Traditional Owners, elders, community members who had lost loved ones, health practitioners and Indigenous Health Workers.

"What I heard was concerning and warranted an investigation.

“There’s a strong sense in the report that the HHS provides quality clinical care to its communities but that we can, and must, do better.

“I want to acknowledge the work the new Chief Executive and Board Chair have done, including hiring more staff, re-establishing vital leadership positions and implementing a First Nations Leadership program to support the workforce and build a pipeline for the future.

“I have been pleased to see the prompt action taken by the HHS in the past 12 months to address the concerns raised, ahead of the report’s completion, and progress to date should provide confidence the HHS will continue to strengthen their health care delivery.

“And I am so happy to be hearing from staff within the HHS that they are already seeing a commitment to change.

“I’ve asked the Director-General and the Chief Executive to work through these recommendations in a thorough, meaningful and collaborative way.”

Quotes attributable to Queensland Health Director-General Michael Walsh:

“Delivering care in a region as vast and as geographically and culturally diverse as the Torres Strait and Cape York is complex.

“But we are committed to providing equitable access to safe and high-quality health care for all Queenslanders, no matter where they live.

“The investigation has been running since last year and investigators reviewed more than 400 separate documents and records and interviewed more than 70 people.

“I want the community to know that we have heard you; the investigators have heard you, and we will work with you to improve the care you receive.

“And I want to thank our staff who continue to deliver the best possible care for the people of the region.”

Quotes attributable to Torres and Cape Hospital and Health Service Chief Executive Rex O’Rourke:

“I welcome the report and I welcome taking the strengths it has identified and building on them over time.

“The HHS has been doing a lot of work in the past year to boost staffing, including hiring 7 new doctors, 50 new nurses, 11 extra allied health staff and four new

Aboriginal and Torres Strait Islander Health Workers.

“We’ve made key new clinical appointments across our communities and undertaken key upgrades to the Thursday Island Emergency department, maternity unit and introduction of CT scanner.

“But I acknowledge the report indicates there is much more to do.

“I’m committed to building on the strengths the report identifies and working with the community, staff and stakeholders to develop a HHS wide approach to delivering care that is appropriate and acknowledges differences across communities.”

ENDS

Report recommendations:

Recommendation 1: The Investigators recommend that OHO's recent momentum in engaging with First Nations communities to provide awareness about the role of OHO and the rights of community members in relation to their healthcare is encouraging and should be continued.

Recommendation 2: The Investigators recommend that consideration should be given to increasing the frequency of the Morbidity and Mortality Review Committee meetings in the East and West to align with those of the Northern region.

Recommendation 3: The Investigators recommend that the current informal model for morbidity and mortality review in midwifery units in Thursday Island and Cooktown should be adopted across the TCHHS to standardise the clinical governance for the Maternity Services Midwifery Group Practice Model of Care.

Recommendation 4: The Investigators recommend that orientation and induction processes are strengthened to ensure all new staff are adequately prepared for the cultural, community and health service context in which they will be operating. This training needs to be tailored to the specific needs of each community and cannot be a one-size-fits-all approach.

Recommendation 5: The Investigators recommend that a comprehensive analysis of service provision across every community in the Southern TCHHS Region be undertaken.

Recommendation 6: The Investigators recommend, whilst not interfering with the work of TORCH, the progress to date, and the steps moving forward, that TORCH-related decision-making processes, where both appropriate and practical, have regard to best practice PHC principles in undertaking coordination activities.

Recommendation 7: The Investigators have reached an overarching recommendation that an approach to comprehensive health service delivery across the TCHHS region should be formally documented. Any formal documentation should be inclusive of the requirement to consider community and cultural variations within the TCHHS region.

Recommendation 8: When formally documenting an approach, the investigators recommend that consideration be given to the incorporation of the following:

(i). The key strengths of the Torres Model of Care which are set out in the summary of the investigators’ observations, noting that when doing so, consideration should be given to incorporating a degree of flexibility to ensure these strengths of the Torres Model of Care are compatible in the current financial, operational and regulatory settings applicable to TCHHS;

(ii). The additional elements relating to robust clinical governance and administrative processes as set out in the summary of the investigators’ observations