Qld health system defies post-pandemic pressures to deliver quality care

• The Queensland Audit Office’s Health 2023 Report highlights the ongoing impact of COVID-19 on the public health system.
• The QAO recommends that Queensland Health improve its internal controls related to rostering, overtime and asset management.
• The department is actively implementing several initiatives, including a comprehensive review of payroll policies and processes, the introduction of an electronic rostering system and a substantial capital program to renew or replace assets. 

Queensland boasts one of the best performing health systems in the country, despite a costly COVID-19 legacy that continues to place pressure on its hospitals.

The Queensland Audit Office’s (QAO) Health 2023 Report reveals the pandemic’s ongoing impact on healthcare delivery across Queensland.

It identifies major challenges facing the public health system, including budgetary pressures, surging demand for services, workforce shortages and rising employee expenses.

Despite these significant pressures, Queensland Health continues to demonstrate progress, evident in positive data from the September quarter. This includes a record number of elective surgeries performed, shorter surgery wait times, increased outpatient appointments and reduced lost ambulance time.

The report found that Queensland Health’s internal controls were effective but identified opportunities for improvement, particularly in rostering and overtime management.

They acknowledged the complexity of managing the department’s massive workforce of over 125,000 employees across more than 893,000 shifts every fortnight.

In response, Queensland Health has begun reviewing its payroll policies and processes in partnership with Hospital and Health Services (HHS) and relevant unions.

To further enhance its rostering and overtime management, Queensland Health is rolling out an electronic rostering system for its nursing and midwifery workforce by late 2024. This system will be progressively expanded to other occupational groups within the department.

The report also recommended that Queensland Health address inconsistencies in how it calculates its anticipated asset maintenance needs.

The anticipated maintenance required for HHS buildings and equipment has risen by $351 million to $1.448 billion.

A key initiative already addressing this is the Sustaining Capital Program, which will invest $346 million in 2023-24 to improve, renew or replace aging assets.

Enhancing its commitment to efficient asset management, Queensland Health will initiate the Asset Management Uplift project in 2024. This project seeks to centralise governance for all assets across their lifecycles and standardise processes for assessing and predicting maintenance needs.

The QAO report highlighted that the combined operating deficit of the 16 HHSs in 2022-23 was $68.9 million, representing only 0.34 per cent of their $20 billion budget. Importantly, eight HHSs achieved surplus.

Queensland Health’s overall spending exceeded its 2022-23 budget by $1.8 billion (9.9 per cent). This was primarily due to two factors: the need to expand services by 11 per cent due to COVID-19, resulting in additional funding, and construction cost pressures, leading to project overruns.

Health workforce shortages resulted in a $47 million (16 per cent) increase in the cost of frontline contractors to meet service demands.

Staff overtime and sick leave also increased, with a 20 per cent rise in overtime and a 10 per cent increase in sick leave compared to 2021.

While public hospitals saw a 9 per cent increase in specialist outpatient appointments, fewer are being seen within the clinically recommended timeframe.

The report also highlights that Queensland’s public health system is facing a growing demand for services that significantly outstrips population growth.

This imbalance is evident in the dramatic 12.7 per cent increase in emergency department (ED) presentations since 2018-19, compared to the state’s 6.5 per cent population growth during the same period.

Despite this surge, Queensland boasts the third-best performance in Australia for ED wait times, with 62 per cent of patients admitted or discharged from ED within four hours.

The Queensland Ambulance Service (QAS) has also experienced a significant surge in demand over the past five years.

Code 1 (emergency) incidents have increased by 33 per cent.

Despite having the highest demand for ambulance services in Australia, QAS maintains faster code 1 response times than most other jurisdictions.

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

“I welcome the Queensland Auditor-General’s report. It helps us identify areas where we can improve and ensure we’re delivering the best possible health care to Queenslanders.

“The report also speaks to the challenges the system is under, and working to overcome – including demand, supply chain pressures in the infrastructure space, and workforce availability.

“Queensland Health has already begun addressing some of the issues raised and is committed to making continuous progress.

“The Queensland Government’s top priority remains ensuring accessible, high-quality healthcare for all Queenslanders.

“This requires strong infrastructure, accurately and timely staff payments and financial sustainability.

“Despite emerging from a global pandemic that heavily impacted our system, Queensland Health has performed exceptionally well.

“We’ve witnessed an 11 per cent increase in services this year compared to an 8 per cent budget increase, demonstrating improved efficiency.

“I acknowledge the ongoing challenges, but I’m confident we’re headed in the right direction.”

ENDS