The implementation of National Health Reform has finally arrived in Queensland with the introduction of the Health and Hospitals Network Bill 2011 (the Bill).
The Bill was presented to State Parliament on 16 June 2011 and has progressed through the first and second readings. A six week consultative process is now underway before a final vote is taken.
The primary objectives of the Bill are the establishment of a public sector health system that delivers high quality hospital and other health services, in alignment with the principles and objectives of the National Health Agreement.* They are to be achieved through the following measures:
- Strengthening local decision making and accountability;
- Local consumer and community engagement;
- Providing for State-wide health system management, including health system planning, co-ordination and standard setting; and
- Balancing the benefits of local and system-wide approaches.
Health Services Act 1991 (HSA)
The Bill repeals the HSA. However, some of the provisions of the HSA have been preserved and enhanced in the Bill, for example:
- the establishment of quality assurance committees;
- the undertaking of root cause analysis;
- confidentiality provisions; and
- health service investigations.
Local Health and Hospital Networks (Networks)
- The Bill provides for the establishment of Networks as separate statutory authorities in order to devolve operational management for public hospitals to the local level.
- Each Network is a separate legal entity to be the principal providers of public health sector services in Queensland. The Networks are body corporates representing the State, and as such, enjoy the privileges and immunities of the State.
- Regulations will specify those public sector hospitals, facilities and services for which the Network is responsible. These are expected to be divided into 17 local health and hospital networks.
- Various functions of the Networks are specified in the Bill and include:
- the carrying out of operations efficiently, effectively and economically;
- the implementation of State-wide plans and undertaking of further planning in the Network area;
- the monitoring and improvement of the quality of health service delivered by the Network;
- the development of local clinical governance arrangements;
- undertaking minor capital works and maintaining assets; and
- co-operation and consultation with other service providers, local primary health care organisations (Medicare locals), Network health professionals and health consumers and community members.
- Each Network is to be independently and locally controlled by an expertise-based Governing Council and overseen by a Network chief executive. Governing Councils will consist of five or more members appointed by the Governor in Council on recommendation by the Minister, including persons with expertise in:
- health management;
- business management;
- financial management;
- human resource management;
- clinical expertise;
- legal expertise;
- primary health care;
- health consumer and community issues; and
- universities, clinical school or research centres.
- Networks will have the power to employ Network chief executives and other health executives, but not other staff until the Network has demonstrated to the departmental chief executive that it has the appropriate capacity and capability to administer human resource matters.
- Land and buildings, and other prescribed assets, will continue to be owned by the State.
- Networks will be held directly accountable for hospital performance, with clear lines of responsibility and new reporting on clinical and financial performance at the Network and facility level. Community members will have access to information including how their Network’s or hospital’s performance compares with like Networks or facilities.
- Through the execution of service agreements with the State, new funding models create an explicit relationship between the funds allocated and the services provided, thereby focusing the Network on outputs, outcomes and quality.
- Networks are to co-operate with other service providers and local primary health care organisations. Networks are also required to develop a protocol with Medicare locals to facilitate co-operation in the planning and delivery of health services.
- Networks are required to develop and publish a clinician engagement strategy and a consumer and community engagement strategy, each of which must meet the minimum requirements prescribed under Regulation.
The State, through the departmental chief executive, will play a support role of “system manager”, to the Networks in order to ensure consistency of service, access and quality across the State.
The State’s responsibilities include:
- entering into service agreements with Networks to provide public sector health services;
- system-wide health service planning and policy;
- system-wide public hospital capital planning and management;
- State-wide public hospital industrial relations;
- setting employment conditions and remuneration for staff working in Networks;
- monitoring Network performance, including taking action to address poor performance;
- issuing binding health service directives to Networks; and
- providing performance data to the Commonwealth.
Performance Reporting and Auditing
- Performance data provided by a Network to the departmental chief executive pursuant to a service agreement may be validated by the departmental chief executive and provided to the Commonwealth.
- The Bill provides for a health service auditor to be appointed to:
- examine the accuracy of performance data and other data;
- investigate the circumstances leading to the inability of a Network or a specialised health service to meet relevant performance measures; and
- investigate any other matter for the effective and efficient use of available resources.
- The Bill outlines wide powers of health service auditors, including the entering of a public sector health facility at any time the facility is open for business or otherwise open for entry. An auditor may also require an employee to give the auditor a document, including a document that contains confidential information.
The Bill’s introduction into State Parliament demonstrates the Queensland Government’s legislative commitments that arise from COAG agreements on National Health Reform.
These changes highlight the way in which public health services are to be delivered to the people of Queensland, with increased local autonomy and accountability which is directly linked to performance. It is hoped that these initiatives will better position the health system to meet the challenges associated with the ongoing funding of a population afflicted with a growing incidence of chronic disease and longevity.
*The Council of Australian Government’s (COAG) Inter-Governmental Agreement, as agreed on 20 April 2010, and the COAG Heads of Agreement on National Health Reform, as agreed on 13 February 2011