Terms of reference for ambulance service audit

The terms of reference for an audit of the Queensland Ambulance Service (QAS) have been released.

Emergency Services Minister Neil Roberts said the audit, announced by the Government last month, was an important initiative to ensure the efficient and effective operation of the QAS.

“Ambulance services in Queensland are responding to increasing demands. The Queensland Ambulance Service has a record budget of $404.4 million this year with funding for an extra 250 ambulance officers,” Mr Roberts said.

“The terms of reference of the audit are comprehensive. The audit will help us to ensure the QAS operates efficiently and effectively.”

“It will benchmark QAS with other ambulance services in Australia.”

Specifically, the audit will look at:
- how increasing demands for ambulance services are managed;
- how resources are allocated to get the best value for money for taxpayers;
- how the workforce are managed to best meet the workload; and
- how the ambulance service works with the health system.

Mr Roberts told State Parliament that significant progress was already being made in the rostering of our hard-working ambulance officers.

“The Government has announced it has accepted a recommendation for a new 12-hour roster system at the State’s busiest ambulance stations and communication centres,” Mr Roberts said.

“Currently officers at Queensland’s 24-hour, seven-days-a-week stations are working 10-hour shifts.”

“Under the new system, there will be a core roster comprised of two 12-hour day shifts and two 12-hour night shifts effectively giving paramedics four days on and four days off.”

“This will result in paramedics having more consecutive days off more regularly.”

“Another feature of the proposed roster is the mechanism to reduce the impact of shift overruns, where paramedics are called out on jobs towards the end of their shift.”

“These new roster arrangements have been negotiated between the Queensland Ambulance Service and Liquor, Hospitality and Miscellaneous Union. “

“I look forward to the roll-out of the new roster system in the New Year.”

“It will provide for a better work-life balance for ambulance officers.”

“In combination with the implementation of the 38-hour week this month, it will mean our ambulance officers will effectively receive nine weeks’ leave – made up of annual leave and accrued time off - each year.”

“These initiatives demonstrate that the Government is responding to the needs of our ambulance officers.”

Terms of reference are attached.

9 October 2007
Media contacts:
Kirby Anderson (Minister’s office) 3247 8194 or 0418 197 350
Brendan Connell (Minister’s office) 3247 8992 or 0437 837 976

Purpose

1. The purpose is to outline the scope of the audit to be undertaken of the Queensland Ambulance Service (QAS) that has recently been announced by the Government.

Background

2. The Queensland Ambulance Service is operating in an environment where the demand for ambulance services continues to escalate at rates well in excess of population growth and the demand for health services generally.

3. The number of urgent ambulance responses (Code 1 and 2) has increased by more than 65,000 responses or 12% over the period 2005-06 to 2006-07 compared to 10% growth the previous year. Early indications are that the level of growth in 2007-08 may be even higher.

4. The Government introduced the Community Ambulance Care levy in July 2003 to provide greater certainty for the QAS in terms of funding. The CAC levy raises approximately one third of the total revenue provided to the QAS with the majority of revenue sourced from general government funds. The QAS budget has grown significantly from $253M in 2002-03 to $404M in 2007-08, an increase of $151M or almost 60%.

Terms of Reference

5. Given the increasing demand pressures on the service and the significant increase in funding that has been provided, it is important to ensure the QAS is operating efficiently and effectively and that as many resources as possible are being deployed to front line service delivery.

6. A proper understanding of the factors driving the demand for ambulance services is also required to inform the development of options for managing the steadily increasing demand being experienced. These options should include consideration of funding models for the QAS to provide a sustainable funding base for the service.

7. The key tasks/activities to be undertaken as part of the review are summarised below.

Demand Analysis and Strategies for Managing Demand

• Examine trends in the demand for ambulance services in Queensland and identify all the factors driving demand;
• Undertake modelling of the relative impact of various demand factors and develop projections of the future demand for ambulance services;
• Undertake detailed benchmarking to compare Queensland’s performance with other jurisdictions; and
• Develop a broad range of options to address and manage demand for Government’s consideration.

Budgetary and Resource Allocation Assessment

• Undertake a detailed examination of the QAS budget and the various funding sources which make up the budget;
• Identify the specific services and activities undertaken by the QAS and the resources allocated to those services/activities;
• Assess trends in expenditure at the global level and across the various service delivery areas including salary and non-salary related expenditure;
• Undertake detailed benchmarking to compare Queensland’s performance with other jurisdictions; and
• Develop strategies for improving the efficiency of service delivery and resource allocation.

Workforce Management Systems

• Analyse current workforce management systems including rostering and leave arrangements and identify opportunities for improvements;
• Assess industrial relations risks and develop strategies for addressing those risks;
• Examine methods for matching workload and staffing across the various service delivery areas and identify areas for improvement; and
• Undertake benchmarking with other jurisdictions including levels of staffing and labour productivity indicators.

Organisational and Service Delivery Model

• Across the State, assess the suitability of the current service delivery model and overall organisational effectiveness in responding to the increasing demand for services;
• Review administrative and overhead costs (including growth in non-front line costs) to ensure that as many resources as possible are being directed to operational service delivery;
• Analyse performance with respect to service quality and responsiveness; and
• Identify areas for improvement where necessary.

Intersection with the Health System

• Examine opportunities to refer inappropriate calls to 13Health;
• Explore alternative service delivery mechanisms for those patients who require attention, but who do not necessarily require an urgent ambulance response;
• Develop options to enhance the resources and coordination of patient transport services to provide more efficient and timely responses to health related transport including transfer of patients between hospitals; and
• Explore with Queensland Health a range of initiatives to better manage the flow of patients through hospital emergency departments.

Roles and Responsibilities

8. The audit will be undertaken by Queensland Treasury and the Department of the Premier and Cabinet with the assistance of the Acting Director-General of the Department of Emergency Services.

9. A dedicated project team will be established to conduct the audit within Queensland Treasury. The team will be led by a Senior Treasury officer. The project team will engage external consultants to provide technical advice and expertise especially with regard to financial/budgetary analysis, modelling expertise on the demand issues, benchmarking with other jurisdictions, and the development of alternative revenue/funding models.
10. The Acting Director-General will provide specific input to workforce management and industrial relations matters. A Senior Queensland Health Officer will assist the acting Director-General on the issues regarding the interface between the QAS and Queensland Health.

Timing

11. The audit is to commence immediately and to be completed by the end of November. Any funding implications arising from the review will be considered at Mid Year Review.

Governance

12. The audit will be overseen by a Steering Committee comprising the Director-General, the Department of the Premier and Cabinet, the Under-Treasurer, Queensland Treasury, the Acting Director-General, the Department of Emergency Services and the Director-General of Queensland Health.