5     Department of Health

Agency Outline

The Department of Health is responsible for purchasing and delivering integrated services that maintain and improve the health and wellbeing of Tasmanians. The Department reports to the Minister for Health, Hon Michael Ferguson MP.

The Department coordinates the delivery of public health services across Tasmania through a network of facilities, community services and home‑based care.

The principal responsibilities of the Department include:

·       planning and purchasing high quality, safe and efficient health services through the public hospital system; primary and community health services, including mental health, oral health and correctional health services; and ambulance services;

·       delivering health protection through emergency management, environmental health, chronic diseases prevention and other public health and health improvement services;

·       funding care for Tasmanians over 65 years of age, as well as support and assistance to enable them to remain living independently in their own homes; and

·       funding a network of alcohol and drug abuse prevention and treatment services.

The Department also coordinates the delivery of public hospital services and a broad range of community health services through a statutory relationship between the Minister for Health, the Secretary of the Department and the Tasmanian Health Service in accordance with the Tasmanian Health Service Act 2018.

The functions of the THS include:

·       improving, promoting, protecting and maintaining the health of Tasmanians as required by its Service Plan;

·       managing public hospitals, health institutions, health services and health support services;

·       achieving and maintaining standards of patient care and delivery of services;

·       providing training and education relevant to the provision of health services;

·       undertaking research and development relevant to the provision of health services; and

·       collecting and providing health data for reporting and research purposes.

Funding for the THS is provided by both the State and Australian Governments. Australian Government Activity Based Funding and Block Funding, and State ABF, flows through the National Health Funding Pool, which is overseen by an independent statutory office holder known as the Administrator. Block funding for some activities is paid to the THS via a State‑managed Fund. In addition to State and Australian Government funding, the THS also generates its own revenue to fund some of its activities.

This chapter provides the Department’s financial information for 2019‑20 and over the Forward Estimates period (2020‑21 to 2022‑23). Further information about the Department is provided at www.dhhs.tas.gov.au.

National Health Reform Agreement

The National Health Reform Agreement sets out arrangements for the Tasmanian and Australian Government contributions to the provision of health services in Tasmania as primarily delivered by the THS. Under the NHRA, State and Australian Government funding is provided on the basis of activity through ABF wherever practicable. Where it is not practical, funding is provided on a Block basis.

Block funded services include smaller regional or rural hospitals and teaching, training and research, and non‑admitted mental health services. Pricing under the NHRA is determined by the Independent Hospital Pricing Authority.

From 1 July 2014, the Australian Government has provided growth funding equivalent to 45 per cent of the efficient growth in activity under the NHRA. The IHPA determines the efficient price of ABF and the efficient cost of Block grants. From 1 July 2016, growth in Australian Government funding to the states and territories was capped at 6.5 per cent per year.

The NHRA is due to expire on 30 June 2020. The Tasmanian Government signed the Heads of Agreement for a new National Health Agreement on 16 May 2018. The Heads of Agreement represents an agreement between State and Australian governments on the high level parameters for public hospital funding from 1 July 2020 to 30 June 2025 and identified reform areas for further development. The Heads of Agreement preserves the current arrangement of the Australian Government contributing 45 per cent of the efficient growth in ABF services, Block grants and growth in Australian Government funding capped at 6.5 per cent per annum nationally and provides a level of certainty of the Australian Government’s contribution to public hospital funding over the 2019‑20 Budget and Forward Estimates period.

Whilst the Heads of Agreement also includes a minimum funding guarantee to Tasmania, negotiations continue around whether, following the expiration of the current NHRA on 30 June 2020, the new National Health Agreement will also contain a guarantee. Without the guarantee, Tasmania is at risk of receiving less ABF Based Funding from one year to the next if ABF activity decreases. This risk is reflected in the current Forward Estimates.

There also remains an underlying risk to the Budget and Forward Estimates period that demand for health services in the State may grow at a faster rate than the Australian Government’s funding contribution.

The signatories to the Heads of Agreement are now working to draft the new National Health Agreement, which will replace the current NHRA from 1 July 2020.


 

Key Deliverables

Table 5.1 provides a summary of the Budget and Forward Estimates allocations for key deliverables being undertaken by the Department.

Table 5.1:         Key Deliverables Statement

 

2019-20

 

Budget

2020-21

Forward

Estimate

2021-22

Forward

Estimate

2022-23

Forward

Estimate

 

$'000

$'000

$'000

$'000

New Initiatives

 

 

 

 

 

 

 

 

 

Tasmanian Health Service

 

 

 

 

Health Demand

45 000

45 000

45 000

45 000

Royal Hobart Hospital Stage 2 Redevelopment1,2

1 600

30 000

31 400

....

Women’s Health Package

2 000

....

....

....

 

 

 

 

 

Ambulance Tasmania

 

 

 

 

Health Demand

5 000

5 000

5 000

5 000

 

 

 

 

 

Health Services System Management

 

 

 

 

Salvation Army Street Teams

90

....

....

....

 

 

 

 

 

Public Health

 

 

 

 

Additional Funding for NGO Health Organisations

160

160

....

....

 

 

 

 

 

Existing Election Commitments and Other Major Initiatives

 

 

 

 

 

 

 

 

 

Tasmanian Health Service

 

 

 

 

Acute Hospital Services3

 

 

 

 

180 more Nursing Graduates across Tasmania

2 836

2 892

2 951

3 010

250 beds for the Royal Hobart Hospital

....

16 184

36 796

79 131

Air Conditioning Upgrades - Statewide1

2 500

1 535

....

....

Eight Bed Acute Medical Unit at the North West Regional Hospital

4 933

5 057

5 183

5 313

Eight Beds on Ward 4K at Launceston General Hospital

3 627

3 718

3 811

3 906

Launceston General Hospital Redevelopment 2018-191,4

12 872

15 802

12 000

20 508

Maternity Services at the North West Regional Hospital1

1 950

....

....

....

Mersey Community Hospital Capital Upgrades1

10 000

17 500

4 081

....

New Services and New Staff for the Mersey Community Hospital

....

....

1 000

3 000

Royal Hobart Hospital Stage 2 Redevelopment (RHH Ward Upgrades)1,2

2 640

2 640

22 300

....

Ward 3D - A 32 Bed Inpatient Ward5

....

....

....

....


 

Table 5.1:         Key Deliverables Statement (continued)

 

2019-20

 

Budget

2020-21

Forward

Estimate

2021-22

Forward

Estimate

2022-23

Forward

Estimate

 

$'000

$'000

$'000

$'000

 

 

 

 

 

Community and Aged Care Services

 

 

 

 

Better Accommodation for Health Professionals on Flinders Island1

390

....

....

....

Better Patient Transport on Flinders Island

30

....

....

....

Community Defibrillator Fund

270

....

....

....

Community Rapid Response

5 530

5 670

 1 162

1 191

Midlands Multipurpose Centre (Oatlands Hospital) Upgrade1

1 872

....

....

....

Palliative Care Clinical Nurse Educators

400

....

....

....

Palliative Care Tasmania

66

....

....

....

Stage 2 of the King Island Hospital Redevelopment1

3 790

3 250

2 720

....

 

 

 

 

 

Statewide and Mental Health Services

 

 

 

 

27 Mental Health Beds in Southern Tasmania ‑ Infrastructure1,6

6 468

13 770

....

....

27 Mental Health Beds in Southern Tasmania6

3 317

7 130

6 480

6 642

Drug and Alcohol Rehabilitation Beds in Ulverstone

800

800

800

....

Eating Disorders Peer Workers Partnership

200

....

....

....

Good Sports Program

435

....

....

....

Holyoake Gottawanna

50

....

....

....

Housing and Accommodation Support Initiative7

500

....

....

....

Mental Health Peer‑Workforce Strategy

60

....

....

....

More Drug and Alcohol Rehabilitation Beds

1 998

1 998

....

....

Pathways Tasmania

100

....

....

....

Rural Alive and Well

920

....

....

....

 

 

 

 

 

Ambulance Tasmania8

 

 

 

 

Aeromedical Helicopter Service ‑ Infrastructure1

350

....

....

....

Aeromedical Helicopter Service

8 453

10 100

10 352

10 611

Burnie and Glenorchy Ambulance Stations1

5 860

5 900

....

....

More Paramedics in Regional Areas

2 828

4 807

6 374

7 001

Secondary Triage

1 900

2 500

2 900

2 900

Smithton Ambulance Training Station1

1 030

....

....

....

State Operations Centre Boost

734

749

764

779

Statewide Rural Hospital and Ambulance Station Upgrade Fund1

8 148

5 850

....

....

Volunteer Support Package

800

800

800

800

 

 

 

 

 

Public Health

 

 

 

 

A Healthy Tasmania (continued funding)

....

1 100

1 100

1 100

Epilepsy Tasmania

440

....

....

....

Stroke Foundation

220

....

....

....

Tasmanian Community Health Fund

6 550

....

....

....

 

 

 

 

 

Notes:

1.    These initiatives are also included in the Capital Investment Program at Table 5.6, with descriptions for each project included below.

2.    The 2018‑19 Budget provided $28.1 million for Royal Hobart Hospital Ward Upgrades. This project now forms part of the Royal Hobart Hospital Stage 2 Redevelopment.

3.    These initiatives are included in the Government’s Better Care in Northern Tasmania, Better Care in North West Tasmania and Record Boost to Health in Southern Tasmania policies.

4.    Includes the Launceston General Hospital Redevelopment and the Launceston General Hospital - More Car Parking 2018 election commitments.

5.    Funding for this project has been allocated beyond the Forward Estimates period.

6.    The 2018‑19 Budget allocated capital and recurrent funding for 25 Mental Health Beds in Southern Tasmania. This project is now titled 27 Mental Health Beds in Southern Tasmania, as a result of changes to the scope of the project and additional funding allocated during 2018‑19.

7.    This 2018 election commitment initiative was allocated to the Department of Communities Tasmanian in the 2018‑19 Budget and was transferred to the Department of Health during 2018‑19 due to the initiatives focus on mental health.

8.    These initiatives are included in the Government’s Investment in Ambulance Services policy.

Tasmanian Health Service - new initiatives

Health Demand

Additional funding of $180 million has been allocated in the 2019‑20 Budget and over the Forward Estimates period to meet health demand pressures across the Tasmanian Health Service, including $5 million per annum for the Royal Hobart Hospital Emergency Department.

Further funding of $30 million in 2019‑20 and $10 million in 2020‑21, is included in Finance‑General for health demand.

This funding will largely support emergency care and bed access throughout the health system, including support for any immediate measures adopted following the planned Access Solutions Meeting for mid‑June 2019, to address access block, and will assist in supporting the commissioning of additional hospital capacity enabled by the Royal Hobart Hospital Redevelopment.

Royal Hobart Hospital Stage 2 Redevelopment

The 2019‑20 Budget provides additional funding of $63 million to commence Stage 2 of the Royal Hobart Hospital Redevelopment. This is in addition to $28.1 million allocated in the 2018‑19 Budget for Royal Hobart Hospital Ward Upgrades, of which $500 000 was allocated to 2018‑19.

In total, funding of $90.6 million is provided over the next three years for the redevelopment, which comprises:

·       an immediate improvement to lift infrastructure with a new second dedicated patient lift to connect the Emergency Department, medical imaging and J‑Block;

·       expansion of the Emergency Department, to meet growing patient demand;

·       a comprehensive refurbishment of A‑Block, which will provide contemporary space for additional beds;

·       an expansion of the Intensive Care Unit in its current location, providing space for an additional 10 beds on the same floor by 2024, whilst retaining close physical linkage to medical imaging; and

·       a refit of the soon to be vacated J‑Block to meet additional demand and provide for new clinical uses.

Women’s Health Package

Funding of $2 million per annum has been allocated to 2018‑19 and 2019‑20 to boost access to women’s health services, specifically targeting those women who have waited the longest on the elective surgery waiting list for procedures. This package will also boost support for women not requiring surgery.

Ambulance Tasmania ‑ new initiatives

Health Demand

Additional funding of $20 million has been allocated in the 2019‑20 Budget and over the Forward Estimates period to meet health demand pressures within Ambulance Tasmania.

Health Services System Management ‑ new initiatives

Salvation Army Street Teams

The 2019‑20 Budget provides additional funding of $90 000 to the Salvation Army for Street Teams. The program provides late‑night support to those at risk of harm from alcohol or drug misuse in the waterfront areas. Funding of $70 000 was also provided in 2018‑19 to support this program.

Public Health - new initiatives

Additional Funding for NGO Health Organisations

The 2019‑20 Budget provides additional funding of $320 000 over two years for non‑government organisations for educational services. Funding will be utilised by Family Planning Tasmania, Hobart Women’s Health Centre, The Link Youth Health Service and Pregnancy Counselling and Support Tasmania.

Tasmanian Health Service - existing election commitments

Acute Hospital Services

180 more Nursing Graduates across Tasmania

Building on the success of the 2014 election commitment, where transition to practice placements have increased each year, this initiative will fund an additional 30 nursing positions each year, which will see an additional 180 nursing positions offered over six years (2018‑19 to 2023‑24).

250 beds for the Royal Hobart Hospital

Commencing in 2020‑21, funding of $299 million is provided over four years to boost acute care in Tasmania by fully staffing 250 new beds at the newly refurbished Royal Hobart Hospital. These new beds will be progressively rolled out from 2020‑21, and include 10 new Intensive Care Unit beds and a dedicated 16 bed adolescent unit. Clinicians will determine the final mix of services and beds.

Air Conditioning Upgrades - Statewide

Commencing in 2018‑19, funding of $4.9 million was provided to undertake comprehensive air conditioning upgrades at the Royal Hobart Hospital ($3 million), the Launceston General Hospital ($1.4 million) and the North West Regional Hospital ($500 000). Engineering consultants have now been engaged for all sites to review options to improve air conditioning at these facilities.

Eight Bed Acute Medical Unit at the North West Regional Hospital

Commencing in 2018‑19, funding of $28.3 million was provided over six years to open eight new acute medical beds at the North West Regional Hospital, including four Emergency Department short stay beds and four surgical beds for elective surgery patients who need to stay overnight.

Eight Beds on Ward 4K at the Launceston General Hospital

The 2019‑20 Budget continues the provision of funding announced in the 2018‑19 Budget of $19.1 million over five years to fully staff and open eight new beds on Ward 4K at the Launceston General Hospital, on completion of the redevelopment.

Launceston General Hospital Redevelopment 2018‑19

Commencing in 2018‑19, funding of $87.3 million was provided over six years for a major redevelopment and expansion of the LGH building, including improvements across medical, surgical, maternity, obstetric, paediatric and mental health units, with an additional $5 million of funding allocated to provide more car parking.

The program of works is expected to include:

·       refurbishment of existing wards, and the development of new single rooms;

·       expansion of existing blocks to accommodate additional beds;

·       a new Women’s and Children’s outpatient building on top of the proposed Ward 4K project; and

·       contemporary mental health facilities.

The redevelopment commenced in 2018 and will be completed in 2024. Consultation and planning for the Women and Children’s precinct is now complete.

Maternity Services at the North West Regional Hospital

Funding of $2.1 million was provided in the 2018‑19 Budget to construct a purpose built antenatal clinic at the North West Regional Hospital as part of the Integrated North West Birthing Service. This will provide a state‑of‑the‑art facility to better support mums, babies and the staff that operate the service. Funding allocated to the project in the 2019‑20 Budget is $2 million.

Mersey Community Hospital Capital Upgrades

The 2017‑18 Budget provided additional funding of $35 million to deliver a significant capital upgrade of the Mersey Community Hospital. The 2019‑20 Budget continues the provision of this funding with $10 million allocated in 2019‑20; $17.5 million allocated in 2020‑21; and $4.1 million allocated in 2021‑22. The upgrade will support the new service profile being implemented as part of the One Health System reforms. It is expected that the redevelopment will be completed in 2021.

New Services and New Staff for the Mersey Community Hospital

The Tasmanian Government is continuing to implement new services at the Mersey Community Hospital, Tasmania’s Dedicated Elective Surgery Centre, to deliver better health outcomes on the North West Coast and across the State as part of the One Health System reforms. Additional funding will be provided in 2021‑22 and 2022‑23 to support additional services and staff on completion of the capital works in 2021.

Ward 3D - A 32 Bed Inpatient Ward

Funding of $21.9 million for 2023‑24 was announced as a 2018 election commitment to recruit, fully staff and open 32 new beds on a new ward 3D at the Launceston General Hospital.

Community and Aged Care Services - existing election commitments

Better Accommodation for Health Professionals on Flinders Island

The 2018‑19 Budget provided funding of $500 000 for the purchase of a new property, as well as refurbishments to provide better accommodation for nursing, medical and allied health professionals working on Flinders Island. Funding of $390 000 is allocated in 2019‑20 to finalise this project.

Better Patient Transport on Flinders Island

The 2018‑19 Budget provided $60 000 over two years to fund a pilot partnership program with Community Transport Services Tasmania to extend transport operations on Flinders Island. The 2019‑20 Budget continues this funding with $30 000 allocated in 2019‑20.

Community Defibrillator Fund

The 2018‑19 Budget provided $540 000 over two years commencing in 2018‑19 for the purchase of 90 community defibrillators in each year.

Community Rapid Response

Commencing in 2018‑19, funding of $6.9 million was provided over six years to extend the Community Rapid Response Service pilot program in the North into a permanent part of the health system. This program supports people who need short‑term intermediate care that can be safely delivered in the community or in the home.

Funding was also provided to roll out a three‑year pilot program to the Greater Hobart Area ($5.6 million) and the North West Coast ($5.6 million). Evaluation of the new pilot programs will occur after two years.

Midlands Multipurpose Centre (Oatlands Hospital) Upgrade

The 2018‑19 Budget provided funding of $2.5 million for a major upgrade of the Midlands Multipurpose Centre at Oatlands. This project commenced in 2018‑19, with $1.9 million provided in the 2019‑20 Budget for completion of the project.

Palliative Care

The Palliative Care initiatives provide funding of $132 000 to Palliative Care Tasmania and $800 000 for Palliative Care Clinical Nurse Educators over two years from 2018‑19. This will enable the important work of Palliative Care Tasmania in continuing to assist families to provide a caring and supportive environment, deliver End of Life Care projects focused on staff training and development of care support models.

Stage 2 of the King Island Hospital Redevelopment

The 2018‑19 Budget provided funding of $10.5 million over four years from 2018‑19 to build the next stage of the King Island Hospital Redevelopment. Works will include: palliative care and associated family rooms; acute care and observation areas; improved emergency and after‑hours access; and a kitchen upgrade. The redevelopment will also include construction of dedicated housing for nurses working and living on King Island. The development of a concept design is currently in progress.

Statewide and Mental Health Services ‑ existing election commitments

27 Mental Health Beds in Southern Tasmania (including infrastructure)

The 2018‑19 Budget provided funding of $11.8 million to build 25 mental health beds in the South for: safe, supportive ‘step down’ care post hospitalisation; ‘step up’ care to avoid hospitalisation for those whose condition has escalated; and community mental health services. These beds will help take pressure off the Royal Hobart Hospital.

Funding of $29.9 million was also provided over six years from 2018‑19 for the operation of the new beds ($15.7 million for the Peacock Centre and $14.2 million for Mistral Place).

In October 2018, the Government announced an additional $8.9 million in new funding to build a brand‑new mental health facility on a greenfield site at St John’s Park, delivering more capacity for the mental health system and extra mental health beds. The existing capital funding of $2.6 million for Mistral Place was redirected to this project, bringing the total funding allocation to $11.5 million. This increased the commitment from delivery of 25 extra mental health beds to 27 extra beds.

While the St John’s Park facility is under construction, an equivalent mental health Hospital in the Home Service will be established (with the $14.2 million operational allocation for Mistral Place redirected to this project). This will allow patients to receive hospital level care whilst being accommodated in their own home, thereby reducing pressure on Emergency Departments. The 2019‑20 Budget provides an additional $1.7 million over two years towards this service.

Drug and Alcohol Rehabilitation Beds in Ulverstone

Commencing in 2019‑20, $2.4 million is provided over three years for additional community‑based drug and alcohol rehabilitation beds in Ulverstone, which forms part of the boost to health in the North West.

Eating Disorders Peer Workers Partnership

The 2018‑19 Budget provided funding of $400 000 over two years for a trial partnership between the Government and the Butterfly Foundation.

This project continues in 2019‑20 and enables the recruitment of peer workers to support Tasmanians living with eating disorders who provide support to both adolescents and adults, as well as their families and loved ones.

Good Sports Program

The 2019‑20 Budget continues the funding of $870 000 over two years announced in the 2018‑19 Budget to the Alcohol and Drug Foundation to expand the Good Sports Program. The Program provides community sporting club volunteers with the resources, training and guidance they need to build a healthy club environment. The Program was designed as an alcohol management program ‑ a way to change the drinking culture in clubs, and has recently expanding to include components focusing on mental health and nutrition, as well as information on other legal and illegal drugs.

Holyoake Gottawanna

The 2018‑19 Budget provided Holyoake with $100 000 over two years, to continue the Gottawanna program. This program continues in 2019‑20 providing support to clients with drug and alcohol addiction issues, including helping them to develop strategies that improve their family relationships.

Housing and Accommodation Support Initiative

Commencing in 2018-19, funding of $1 million was provided over two years to trial the Housing and Accommodation Support Initiative, which has been highly successful in New South Wales.

HASI is a partnership between the Tasmanian Health Service, Housing Tasmania and Colony 47 to provide better clinical and psychosocial rehabilitation supports to Tasmanians with mental illness. This will be linked in with stable housing and supported accommodation.

Mental Health Peer‑Workforce Strategy

Commencing in 2018‑19, funding of $120 000 was provided over two years to the Mental Health Council of Tasmania to facilitate a partnership with the Government to develop a Tasmanian Mental Health Peer‑Workforce Strategy. This Strategy provides an overarching framework to ensure Tasmania’s mental health and suicide prevention peer workforce is supported into the future.

More Drug and Alcohol Rehabilitation Beds

The 2019‑20 Budget continues the funding of $6 million over three years announced in the 2018‑19 Budget to enable the provision of 30 additional community based drug and alcohol rehabilitation beds.

Pathways Tasmania

The 2018‑19 Budget provided $200 000 over two years for Pathways Tasmania to expand its Transformations residential program to include a new program specifically for women, as part of the statewide initiative related to drug and alcohol rehabilitation. This program continues in 2019‑20 with $100 000 allocated.

Rural Alive and Well

The 2018‑19 Budget provided $380 000 over two years to assist RAW to provide better outreach support, particularly focusing on older Tasmanians who are experiencing mental health concerns in regional areas. This funding is in addition to $730 000 provided in each of 2018‑19 and 2019‑20 and detailed in the Government’s Taking Agriculture to the Next Level policy, with a total commitment of $1.8 million.

Ambulance Tasmania - existing election commitments

Aeromedical Helicopter Service (including infrastructure)

The 2018‑19 Budget provided funding of $51.8 million over five years, commencing 2019‑20, to establish a dedicated aeromedical and medical retrieval service. The funding will be used to provide additional staffing consisting of flight paramedics and specialist retrieval doctors. During 2018‑19, $1.4 million was reallocated from 2019‑20 to 2018‑19 to commence this initiative.

In addition, the 2018‑19 Budget also included funding of $1.6 million for capital costs associated with establishing a dedicated aeromedical and medical retrieval service including expanded base facilities to accommodate crew on‑site and additional road vehicles so that the helicopter crew can respond by road if required. Upgrades to the base facilities (including accommodation and IT services) are currently underway, with $350 000 to be spent in 2019-20 on equipment for flight paramedics.

Burnie and Glenorchy Ambulance Stations

The 2018‑19 Budget provided funding of $12 million over three years to build a state‑of‑the‑art ambulance station on a greenfield site in Burnie ($6 million) and an ambulance super‑station on a greenfield site in Glenorchy ($6 million).

The new Burnie station will provide greatly improved facilities including dedicated staff meeting facilities, a bigger garage to ensure that service vehicles do not have to park outside, and better parking and disability access. The Glenorchy super‑station will have a specific focus on state‑of‑the‑art training facilities, including contemporary administration, operations and staff amenities, better garaging of vehicles and parking spaces. It is anticipated that the new stations will be completed in 2021.

More Paramedics in Regional Areas

Commencing in 2018‑19, additional funding of $29 million is provided over six years to recruit an additional 42 paramedics, to reduce overtime costs, increase ambulance responsiveness, and reduce fatigue in regional areas around Tasmania. These paramedics will provide 24 hour on duty coverage in those communities to better support Ambulance Tasmania volunteers. The allocation of the additional staff has been determined with the first of these positions to commence during 2019‑20.

Secondary Triage

Commencing in 2018‑19, funding of $13.8 million is provided over six years to fully roll‑out secondary triage of Ambulance Tasmania calls. Secondary triage will ensure that patients not requiring emergency intervention or transport to an emergency department will be referred to an appropriate health service, keeping paramedic resources available for emergency calls. Once fully operational, the secondary triage service will assess almost 2 200 calls per annum and has the potential to divert up to 16 000 patients to alternate service providers.

Smithton Ambulance Training Station

The 2018‑19 Budget provided funding of $1.1 million to construct a dedicated training room at the Smithton Ambulance Station and a new two bedroom unit for relief staff. An architect has been appointed, design meetings have progressed and the site has been identified.

State Operations Centre Boost

Commencing in 2018‑19, additional funding of $4.5 million was provided over six years for the Ambulance Tasmania State Operations Centre, which will boost staffing in the Centre by employing an additional six full‑time staff. These staff will help meet the growing demand for services and are in addition to a staffing increase of five full‑time staff in 2017‑18.

Statewide Rural Hospital and Ambulance Station Upgrade Fund

Commencing in 2018‑19, funding of $15 million was provided over three years for capital improvements at Tasmania’s rural and regional hospitals. It is anticipated that $10 million will be spent on rural hospitals to provide better facilities for staff and patients; and $5 million will be spent on ambulance stations to provide better facilities for paramedics and volunteers at rural stations. Funding is being allocated based on areas with the greatest need.

Volunteer Support Package

Commencing in 2018‑19, additional funding of $800 000 per annum is provided to enhance support for ambulance volunteers including:

·       reimbursement of out‑of‑pocket expenses;

·       enhanced training and coordination;

·       enhanced equipment for training volunteers;

·       formal recognition of skills developed, including Advanced First Aid certificates;

·       reviewing operational responsibility to ensure volunteer stations have support from a Branch Station Officer; and

·       increased volunteer recruitment and retention to improve the efficiency of Ambulance Tasmania and the response to patients, particularly in rural communities.

Public Health - existing election commitments

A Healthy Tasmania

In 2016‑17, additional funding of $1.6 million was provided over four years to fund initiatives under the Healthy Tasmania policy. In addition, the Department reallocated existing funding of $1 million over the same period.

This funding was re‑profiled over that period to align with the implementation of initiatives identified in the Government’s Healthy Tasmania Five Year Strategic Plan targeted at key areas of smoking and obesity.

Consistent with the 2018‑19 Budget, the 2019‑20 Budget continues funding of $1.1 million per annum to support the Healthy Tasmania Five Year Strategic Plan from 2020‑21, after existing funding allocations cease.

Epilepsy Tasmania

The 2018‑19 Budget provided $880 000 over two years from 2018‑19 to Epilepsy Tasmania to support improved services for Tasmanians living with epilepsy. Epilepsy Tasmania is increasing the availability of support services, improve GP liaison and hospital avoidance, increase education and awareness of epilepsy (including through the Smart Schools program), and boost peer and family/carer support.

Stroke Foundation

The 2018‑19 Budget provided $440 000 over two years from 2018‑19 to the Stroke Foundation to enable health support on a regional basis. This program continues in 2019‑20 with $220 000 allocated.

Tasmanian Community Health Fund

Commencing in 2018‑19, the 2018‑19 Budget provided $6.6 million over two years to establish the Tasmanian Community Health Fund which will provide grant funding to individuals and groups with ideas to improve the health of their community. During 2018‑19, funding for 2018‑19 was reallocated to 2019‑20 to better reflecting the profile of the expected spend.


 

Output Information

Outputs of the Department of Health are provided under the following Output Groups:

·       Output Group 1 ‑ Health Services System Management;

·       Output Group 2 ‑ Tasmanian Health Service; and

·       Output Group 3 ‑ Statewide Services.

Table 5.2 provides an Output Group Expense Summary for the Department.

Table 5.2:         Output Group Expense Summary

 

2018-19 

2019-20 

2020-21 

2021-22 

2022-23 

 

 

 

Forward 

Forward 

Forward 

 

 Budget 

Budget1 

Estimate 

Estimate 

Estimate 

 

$'000 

$'000 

$'000 

$'000 

$'000 

Minister for Health

 

 

 

 

 

 

 

 

 

 

 

Output Group 1 - Health Services System Management

 

 

 

 

 

1.1 Health Services System Management2

183 237 

189 297

176 036

184 373

188 139

 

183 237 

189 297

176 036

184 373

188 139

Output Group 2 - Tasmanian Health Service

 

 

 

 

 

2.1 Admitted Services3

879 435 

932 379

947 094

1 000 329

1 058 863

2.2 Non-admitted Services4

189 880 

202 260

208 329

217 522

213 832

2.3 Emergency Department Services5

120 214 

146 083

153 197

159 199

165 212

2.4 Community and Aged Care Services6

204 870 

209 935

207 718

209 336

213 204

2.5 Statewide and Mental Health Services7

113 708 

119 621

122 590

122 437

125 813

2.6 Forensic Medicine Service

2 340 

2 399

2 441

2 458

2 479

 

1 510 446 

1 612 677

1 641 369

1 711 281

1 779 403

Output Group 3 - Statewide Services

 

 

 

 

 

3.1 Ambulance Services8

81 865 

101 021

107 846

113 136

116 058

3.2 Public Health Services9

25 505 

25 849

25 663

24 415

24 339

 

107 370 

126 870

133 509

137 551

140 397

 

 

 

 

 

 

Special Capital Investment Funds10

6 500 

51

....

....

....

 

 

 

 

 

 

TOTAL

1 807 553 

1 928 895

1 950 914

2 033 205

2 107 939

 

 

 

 

 

 

Notes:

1.    The 2019‑20 Budget estimate includes expenditure associated with the 27th Pay Period that is due to occur in that year.

2.    The decrease in Health Services System Management in 2020‑21 reflects the cessation of Australian Government funding provided under the National Partnership Agreement for Improving Health Services in Tasmania. From 2020‑21 funding increases with the commencement of the 2018 election commitment for A Healthy Tasmania.


 

3.    The increase in Admitted Services reflects the provision of additional funding for Health Demand in 2019‑20 and additional funding for 2018 election commitments including: the Eight Bed Acute Medical Unit at the North West Regional Hospital; 250 beds for the Royal Hobart Hospital; and an additional Eight Beds on Ward 4K at the Launceston General Hospital. This increase in funding is partially offset by reductions in Australian Government funding relating to the cessation of the funding guarantee for Tasmania from 2020‑21 which forms part of the current National Health Reform Agreement. Whilst the new Heads of Agreement includes a provision for a guarantee, the actual guarantee amount from 2021‑22 is unknown until the new agreement is finalised.

4.    The increase in Non‑admitted Services reflects the provision of additional funding for Health Demand. The reduction in 2022‑23 reflects the cessation of the National Partnership Agreement for Improving Health Services in Tasmania, and the expiry of the Australian Government funded Commonwealth Initiative on Organ Donation, and the National Partnership Agreements for Expansion of BreastScreen Australia Program and the National Bowel Cancer Screening Program for 50 year olds. These numbers reflect current agreements and will be updated when new agreements are signed.

5.    The increase in Emergency Department Services reflects the realignment of budgets across the THS Outputs to more accurately reflect activity and additional funding for Health Demand (including $5 million allocated to Emergency Department Services).

6.    The increase in Community and Aged Care Services in 2019‑20 reflects the provision of additional funding for Health Demand; and the Community Rapid Response initiatives. The reduction in 2020-21 is due to the cessation of Australian Government funding for Oral Health. In March 2019, the Child Dental Benefits Scheme was extended until December 2022 (this was due to expire in December 2019), however this is not currently reflected in the Budget.

7.    The increase in Statewide and Mental Health Services reflects additional funding to meet increased service demands through the 27 Mental Health Beds in Southern Tasmania election commitment, which are due to be fully operable from 2020‑21.

8.    The increase in Ambulance Services primarily reflects additional Health Demand funding in 2019‑20 and 2018 election commitment funding for: an Aeromedical Helicopter Service; More Paramedics in Regional Areas; Secondary Triage; Volunteer Support Package; and State Operations Centre Boost.

9.    The reduction in Public Health Services after 2019‑20 reflects the cessation of Australian Government funding including funding provided under the Essential Vaccines National Partnership Agreement.

10.  This amount reflects the final payment from the Fund that is being expensed. Other expenditure is reflected as Purchases of Non-Financial Assets. As at 30 June 2019, remaining funding in the Hospital Capital Fund and the Infrastructure Tasmania Fund has been transferred to the Department’s Agency Financial Management Account. There has been no change to projects or available funding as a result of this administrative change. Projects to be finalised with these funds are detailed in chapter 6 of The Budget Budget Paper No 1.


11.   

Output Group 1:    Health Services System Management

1.1 Health Services System Management

This Output provides a number of functions including the provision of support for corporate services, policy, planning, regulation, funding, monitoring and service improvement across health services. This Output also provides support to the Secretary in establishing output priorities, including service improvement and supporting the THS to develop consistent, collaborative models of care particularly for chronic and complex conditions.

This Output includes:

·       grants provided to non‑government organisations in relation to mental health services, home and community health services, population health and alcohol and drugs;

·       funding held centrally for health related expenses including payments to nationally funded centres, the National Blood Authority and the Post Graduate Medical Council;

·       the Department’s contribution to the Australian Government for older people receiving basic community care to reflect the additional cost to the Australian Government to offset the net additional financial responsibilities taken on as part of the National Health Reform Agreement; and

·       centralised functions in relation to the delivery of Statewide Mental Health Services.

Table 5.3:         Performance Information ‑ Output Group 1

Performance Measure

Unit of

Measure

2016-17 Actual

2017-18 Actual

2018-19 Target

2019-20 Target

 

 

 

 

 

 

Implementation of Government reform agenda goals achieved within published timeframe1,2

%

96

92

100

100

Service Plan developed and administered in accordance with the THS Act, and policy settings endorsed by the Minister for Health3

Number

na

1

1

1

 

 

 

 

 

 

Notes:

1.    Figures for dates prior to 1 July 2018 relate to activities administered by the then Department of Health and Human Services (DHHS). Figures from 1 July 2018 relate to activities administered by the Department of Health.

2.    The health reform goals are those specified in the Government’s Deliverables 2017 and the First 100 Days plans. The 2017‑18 target of 100 per cent was not achieved due to the upgrade of housing infrastructure on Cape Barren Island and Flinders Island being delayed. The evaluation of the Joined‑up Human Services Place‑Based Initiative; the Mental Health Best Practice Framework for Workplaces in Tasmania; the Strong Families, Safe Kids new statewide advice and referral service; and the 10‑year Community Sector Industry Development Plan to be developed with TASCOSS, were also delayed until 2018.

3.    The Tasmanian Health Service Act 2018 requires a Service Plan to be prepared by the Secretary. The Service Plan replaces the previous requirement for a Service Agreement.


 

Output Group 2:    Tasmanian Health Service

2.1 Admitted Services

This Output provides admitted acute and sub‑acute inpatient services (elective and non‑elective) provided by Tasmania’s major public hospitals to patients either admitted to a ward or in an out‑of‑hospital setting.

It excludes designated mental health wards in major public hospitals, which are included in Output 2.5 Statewide and Mental Health Services.

2.2 Non‑admitted Services

This Output provides non‑admitted services, including ambulatory acute and sub‑acute services provided by Tasmania’s major public hospitals either on‑site or in an out‑of‑hospital setting. This includes the provision of Cancer Screening Services.

2.3 Emergency Department Services

This Output provides services relating to emergency presentations at Tasmania’s major public hospital emergency departments.

2.4 Community and Aged Care Services

This Output comprises rural hospitals, residential aged care and community health based services including:

·       rehabilitation, allied health assessments and case management;

·       community nursing, continence, orthotics and prosthetics services, and equipment schemes; and

·       the Child Health and Parenting Service.

In addition, community palliative care services provide interdisciplinary care, support and counselling to people living with life limiting illnesses, and their families. These services are provided in a community health centre or home‑based environment.

This Output also provides emergency and general oral care and dentures to eligible adults (holders of Health Care or Pensioner Concession cards) and all children under the age of 18 years, as well as a range of health promotion and prevention activities.

2.5 Statewide and Mental Health Services

This Output provides services to clients and their families to treat, support and manage mental health disorders. The service also provides:

·       crisis assessment and treatment, intensive support, community care and rehabilitation services;

·       primary health care services in correctional facilities;

·       forensic mental health services to people with mental illness who have come into contact with the criminal justice system; and

·       alcohol and drug services at the individual and population level.

2.6 Forensic Medicine Services

This Output provides forensic and medical services, forensic pathology and clinical forensic medicine.

Table 5.4:         Performance Information ‑ Output Group 21

Performance Measure

Unit of

Measure

2016-17 Actual

2017-18 Actual

2018-19 Target

2019-20 Target

 

 

 

 

 

 

Admitted Services

 

 

 

 

 

Admitted patients - National Weighted Activity Unit2

Number

109 641

114 796

117 600

117 600

Elective surgery patients seen on time3

 

 

 

 

 

Category 1

%

78.0

75.6

75.6

na

Category 2

%

59.0

61.4

61.4

na

Category 3

%

81.0

86.8

86.8

na

Elective surgery patients ‑ average overdue wait time for those waiting beyond the recommended time4

 

 

 

 

 

Category 1

Days

23.6

49.7

49.7

na

Category 2

Days

87.9

100.1

100.1

na

Category 3

Days

66.4

55.0

55.0

na

Elective surgery admissions5

Number

19 205

17 564

17 978

14 930

Hand hygiene compliance

%

80.4

79.3

80.0

80.0

Healthcare associated staphylococcus aureus (including MRSA) bacteraemia (rate per 10 000 patient days)6

Rate

1.0

1.0

≤2.0

≤2.0

Cost per weighted separation7

$

5 085

5 048

5 000

5 000

 

 

 

 

 

 

Non‑admitted Services

 

 

 

 

 

Outpatient attendances8

Number

548 034

561 286

581 409

581 000

 

 

 

 

 

 

Emergency Department Services

 

 

 

 

 

Department of Emergency Medicine presentations9

 

Number

 

156 587

 

162 441

 

166 000

 

169 600

Emergency Department patients who are admitted, referred for treatment or discharged within four hours10

%

64.7

64.4

64.4

na

Percentage of all ED patients seen within the recommended triage time9

%

64.8

65.5

65.5

na

 

 

 

 

 

 

 


 

Table 5.4:         Performance Information ‑ Output Group 21 (continued)

Performance Measure

Unit of

Measure

2016-17 Actual

2017-18 Actual

2018-19 Target

2019-20 Target

 

 

 

 

 

 

Community and Aged Care Services

 

 

 

 

 

Rural hospitals ‑ separations

Number

4 024

4 002

4 153

4 150

Rural hospitals ‑ occupancy rate11

%

62.0

59.2

60.0

60.0

Community nursing ‑ occasions of service12

Number

174 010

169 232

171 000

171 500

Residential aged care ‑ occupancy rate

%

91.0

89.3

90.0

90.0

Aged Care Assessment Program ‑ completed assessments13

Number

3 999

4 443

4 400

4 400

Mothers attending the eight week Child Health Assessment

%

89.9

91.0

91.0

91.0

 

 

 

 

 

 

Oral Health Services14

 

 

 

 

 

Adults ‑ occasions of service ‑ general15

Number

12 933

11 152

12 000

10 300

Adults ‑ occasions of service ‑ episodic15

Number

31 487

33 576

33 000

29 200

Adults ‑ occasions of service ‑ dentures

Number

19 929

17 901

17 500

17 900

Children ‑ occasions of service

Number

62 122

63 686

62 908

63 100

General (adults) waiting list15

Number

8 901

10 462

10 500

11 600

Dentures waiting list

Number

222

170

187

270

 

 

 

 

 

 

Mental Health and Alcohol and Drug Services

 

 

 

 

 

Inpatient Separations

Number

2 044

1 795

2 100

2 100

Community and Residential ‑ active clients

Number

7 828

7 865

7 800

7 800

28 day readmission rate

%

14.3

15.3

≤14.0

≤14.0

Proportion of persons with a mental illness whose needs are met by the Tasmanian Mental Health Service16

%

62.1

61.3

63.0

63.0

Average length of acute inpatient stay

Days

11.3

13.3

12.0

12.0

Alcohol and Drug Services ‑ closed episodes of treatment

Number

3 389

3 574

4 000

4 000

Pharmacotherapy Program - total active participants17

Number

946

na

na

na

Withdrawal Unit - bed occupancy

%

48.4

54.8

75.0

75.0

Withdrawal Unit - average length of stay

Days

6.7

6.3

7.0

7.0

 

 

 

 

 

 

Cancer Screening

 

 

 

 

 

Eligible women screened for breast cancer18

Number

31 491

34 103

33 380

36 149

BreastScreen - percentage of clients assessed within 28 days of screening19

%

85.5

97.9

90.0

90.0

 

 

 

 

 

 

Notes:

1.    The 2019‑20 Service Plan was not finalised at the time of this Table’s preparation. The draft targets for 2018‑19 and 2019‑20 do not consider all additional funding provided in this Budget (unless otherwise specified), and targets in the final 2019‑20 Service Plan may differ from those reported in this Table.

2.    National Weighted Activity Units are measured differently each year, which means this measure is not directly comparable between years. The discontinued admitted patients performance measure, which had used weighted inlier units, has been removed from this Table and the replacement national weighted activity unit measure is reported for 2016‑17. In accordance with the 2017‑18 Service Agreement amendment, national weighted activity units are now reported as the total for the four major public hospitals for all acute, subacute and non‑acute admissions. The 2018‑19 target has been revised in accordance with the estimate provided to the National Health Funding Body to encompass expenditure commitments detailed in the Revised Estimates Report 2018‑19.

3.    2018‑19 targets have been revised to reflect 2017‑18 actual performance. As indicated at note 1, at the time of the 2019‑20 Budget Paper preparation, the 2019‑20 Service Plan has not been finalised.

4.    The 2016‑17 actuals for elective surgery patients ‑ average overdue wait time have been revised to correct a calculation error. 2018‑19 targets have been revised to reflect 2017‑18 actual performance. As indicated at note 1, at the time of the 2019‑20 Budget Paper preparation, the 2019‑20 Service Plan has not been finalised.

5.    The 2018‑19 target for elective surgery admissions has been revised in accordance with the 2018‑19 Service Plan. The 2019‑20 target comprises a baseline of 14 500 and an additional 430 estimated surgeries under the Women’s Health Initiative announced in the Revised Estimates Report 2018‑19. This target will be revised as part of Service Plan development, and does not include additional funding provided in the 2019‑20 Australian Government Budget.

6.    The 2016‑17 actual for healthcare associated staphylococcus aureus bacteraemia has been revised to correct a calculation error.

7.    The 2017‑18 actual for Cost per weighted separation for acute admitted patients reflects the preliminary result (not yet published) from the Round 22, 2017‑18 National Hospital Cost Data Collection. The revised 2018‑19 target and the 2019‑20 target are based on the Round 22 preliminary result.

8.    The 2019‑20 target for Outpatient attendances is set at a similar level to the 2018‑19 target.

9.    Emergency department presentations for 2017‑18 were over 6 000 higher than the target in the 2018‑19 Budget. Annual growth of approximately 3 500 is expected in 2018‑19 and 2019‑20. The 2018‑19 target has been revised accordingly.

10.  2018‑19 targets have been revised to reflect 2017‑18 actual performance. As indicated at note 1, at the time of the 2019‑20 Budget Paper preparation, the 2019‑20 Service Plan has not been finalised.

11.  Occupancy is an average for all 18 rural facilities and is calculated from the ‘beds occupied daily average’.

12.  The method used to define and count community nursing ‑ occasions of service has been revised for 2017‑18 onwards to more accurately reflect the delivery of community nursing services. Counts using the revised method are approximately two per cent lower than using the previous method and the 2018‑19 target has been revised accordingly.

13.  Major Australian Government reforms have permanently impacted the THS aged care assessment teams’ work processes under the Aged Care Assessment Program. Some assessments for clients with entry level service needs are now being undertaken by the Regional Assessment Service, rather than the THS. The THS role now includes care co‑ordination work and reviews, which are in addition to assessments. Trends in completed assessments have stabilised at around 4 400 per year and the 2018‑19 target has been revised accordingly.

14.  The 2019‑20 targets assumes the continuation of Australian Government funding for both the NPA on Public Dental Services for Adults and the Child Dental Benefits Scheme.

15.  The 2019‑20 targets for Oral Health Services general and episodic care are lower than the 2018‑19 targets because the THS has funded additional activity in recent financial years by carrying forward Australian Government funds across those periods.

16.  This indicator is based on the estimated three per cent of the Tasmanian population with severe mental illness. The Australian Bureau of Statistics estimation of the Tasmanian population as at 31 December 2017 was 525 061, giving an estimated 15 752 people with a severe and persistent mental illness in 2017‑18.

17.  The reporting of pharmacotherapy program ‑ total active participants ceased in 2016‑17.

18.  The 2019‑20 target for eligible women screened for breast cancer is based on 6 per cent growth on the 2017‑18 attendance figure. This reflects growth in the demographic and an increase in participation.

19.  The target for the percentage of clients assessed within 28 days of screening is in accordance with the BreastScreen Australia National Accreditation Standards.

Performance Information Comments

The Tasmanian Health Service Act 2018 details the provisions for the Service Plan, the key mechanism of accountability between the Minister for Health and the THS. The Service Plan includes:

·       a schedule of services to be provided by or on behalf of the THS and the funding to be provided in relation to the provision of those services;

·       performance standards, targets and measures;

·       standards of patient care and service delivery;

·       reporting requirements; and

·       a performance management process.

The 2019‑20 Service Plan will be finalised following the delivery of the 2019‑20 Budget.

THS performance in relation to the Service Plan targets will be monitored by the Department of Health throughout 2019‑20.

Performance monitoring through the Service Plan process focuses on improving the efficiency and effectiveness of service delivery, and the safety and quality of care.

Output Group 3:    Statewide Services

3.1 Ambulance Services

This Output provides integrated pre‑hospital emergency and medical services, health transport, aero‑medical and medical retrieval services to the Tasmanian community. It provides these services through a system of paramedics, doctors, patient transport officers, volunteer officers and the support and partnership of independent non‑government services around the State.

3.2 Public Health Services

This Output protects and improves the health of Tasmanians by enabling Tasmanians to make positive health choices and live in safe environments. Public Health Services provides two service streams:

·       Health Protection, which monitors and enforces legislation to manage and help prevent disease, illness and injury; and

·       Health Improvement, which develops and implements evidence based policies and programs to improve health outcomes and prevent or reduce risk factors that lead to chronic conditions.

The statutory scope of Health Protection is defined by legislation including the Public Health Act 1997, Poisons Act 1971, Fluoridation Act 1968, Food Act 2003 and the Radiation Protection Act 2005. The aim of Health Improvement practice is to guide and support the health service and community service sectors in the State, particularly to work closely with key partners to implement programs and target interventions within populations that are at higher risk of poorer health outcomes. This work is closely aligned with the Government’s strategy for preventive health, the Healthy Tasmania Five Year Strategic Plan.

Table 5.5:         Performance Information ‑ Output Group 3

Performance Measure

Unit of

Measure

2016-17 Actual

2017-18 Actual

2018-19 Target

2019-20 Target

 

 

 

 

 

 

Ambulance Services

 

 

 

 

 

Total Ambulance Responses1

Number

83 764

89 220

92 789

96 500

Emergency Ambulance Responses2

Number

43 064

44 895

46 690

48 558

Satisfaction with Ambulance Services

%

97

98

98

98

Median Emergency Response Times (Statewide)3

Mins

13.8

12.8

12.8

12.8

Median Emergency Response Times (Hobart)3

Mins

12.6

11.5

11.5

11.5

Median Emergency Response Times (Launceston)3

Mins

12.2

11.1

11.1

11.1

Median Emergency Response Times (Devonport)3

Mins

10.6

9.8

9.8

9.8

Median Emergency Response Times (Burnie)3

Mins

11.0

10.2

10.2

10.2

Ambulance Services expenditure per person4

$

140.5

157.6

na

na

 

 

 

 

 

 

Public Health Services

 

 

 

 

 

Radiation Protection

 

 

 

 

 

Radiation Management Plan ‑ Notifying of a review5

%

84.0

94.0

98.0

98.0

Radiation Source Certification ‑ Recertified prior to expiry

%

96.0

96.0

100.0

100.0

Immunisation

 

 

 

 

 

Vaccine coverage in children aged 12‑15 months

%

93.8

94.6

95.0

95.0

Vaccine coverage in children aged 24‑27 months

%

92.0

90.9

95.0

95.0

Move Well Eat Well

 

 

 

 

 

Primary School Program Membership

%

81.0

82.4

83.0

83.0

Primary School Program Awarded

%

26.7

27.2

34.0

34.0

Early Childhood Program Membership

%

78.0

79.7

86.0

86.0

Early Childhood Program Awarded

%

24.0

25.2

28.0

28.0

 

 

 

 

 

 

Notes:

1.    The number of vehicles dispatched (responses) is one measure of the Ambulance Service’s workload and an indicator of the demand for ambulance services in Tasmania. This measure includes emergency, urgent and non‑urgent responses. This indicator is a measure of demand rather than performance. The figures presented here for 2016‑17 and 2017‑18 are actual caseload. The target figures presented here for 2018‑19 and 2019‑20 are estimated caseloads based on an expected increase in caseload of four per cent per annum.

2.    An emergency incident is one requiring at least one immediate ambulance response under lights and sirens. This measure is a subset of the figure reported as Total Ambulance Responses, but for emergency incidents only.

3.    The ambulance emergency response time is the difference in time between an emergency 000 call being received at the Ambulance Tasmania Communications Centre and the first vehicle arriving at the location to treat the sick or injured patient. The Median Emergency Response Time is the middle time value when all the response times are ordered from the shortest to the longest. The MERT can be broadly interpreted as the time within which approximately 50 per cent of the first responding ambulance resources arrive at the scene of an emergency. The target for these measures is based on the previous year’s reported figures.


 

4.    Ambulance Services expenditure per person are as published in the Productivity Commission’s annual Report on Government Services. Each year the Productivity Commission adjusts the time series financial data to current year dollars using the General Government Final Consumption Expenditure chain price deflator (2017‑18 = 100). Consequently, the figures reported this year may differ from those reported in previous reports. Targets are no longer set for this indicator as historical actual expenditure does not provide a good indicator for future expenditure. 

5.    Radiation Management Plans are required for providers who hold licences which have the dealing of ‘possession’- that is, being in control of a radiation source. The plan is approved when the licence is issued. Plans do not have an expiry date and only need re‑approving if there are changes to the licensees’ radiation safety practices. Practices are reminded to review their plans and to notify that the review has been conducted.

Performance Information Comments

Ambulance Services

There are a variety of factors which affect ambulance response times in Tasmania including:

·       demand for service against the available resource base;

·       the ageing population as a primary driver of demand;

·       a relatively high proportion of the population living in rural and remote areas;

·       hilly terrain and ribbon urban development along the Derwent and Tamar rivers; and

·       a high reliance on Volunteer Ambulance Officers.

The demand for Ambulance Services in 2017‑18 was 89 220 responses, an increase of 5 456 ambulance responses or approximately 6.5 per cent on the previous year.

The 2017‑18 median emergency response time for Tasmania is 12.8 minutes, meaning that approximately 50 per cent of all Tasmanian emergency calls were responded to within that timeframe.

Ambulance response times in Tasmania are affected by the wide dispersal of the population. Tasmania has the greatest proportion of people living in rural areas of all states. According to the Australian Bureau of Statistics Estimated Resident Population by Remoteness publication, the proportion of Tasmania’s population living in rural and remote areas is twice the national figure.

Strategies to reduce the impact of demand are a high priority for Ambulance Tasmania. Initiatives being progressed include public education campaigns and community announcements, improvements in technology, and roll out of the Secondary Triage initiative.

Public Health Services

Radiation Protection

Practices holding licences under the Radiation Protection Act 2005 are required to have a current and approved radiation management plan. Radiation sources (x‑ray, laser and radioactive materials) require a certificate of compliance. Maintaining continuity of currency of management plans and retesting and certification of radiation sources prior to expiry is a key to radiation protection. Licence holders make returns to the Radiation Protection Unit demonstrating compliance with both these requirements. This is recorded for each licence holder in the licensing and information management system.

Immunisation

Children are considered fully immunised if they have received vaccines for diphtheria, tetanus and pertussis, polio, Haemophilus influenzae type B, hepatitis B and pneumococcal by 12 to 15 months; with the addition of meningococcal C and measles, mumps, rubella and varicella by 24 to 27 months.

In the period between 2016‑17 and 2017‑18, the:

·       reported vaccination coverage in the 12 to 15 month age cohort increased by 0.8 per cent to 94.6 per cent. This is just above the Australian national average of 94.1 per cent; and

·       reported vaccination coverage in the 24 to 27 month age cohort decreased by 1.1 per cent to 90.9 per cent. The vaccination coverage in this age range in Tasmania remains above the national average of 90.5 per cent.

The decrease reflects a national trend resulting from changes in the definition of ‘fully immunised’ to include several new vaccines. In Tasmania, rates are also impacted by the relatively small cohort of children within these age groups.

Move Well Eat Well

The Move Well Eat Well Award Program is offered to all Tasmanian schools with a primary enrolment and eligible early childhood education and care services.

This program works actively with schools and early childhood services to take a sustainable and strategic approach to promoting healthy eating and physical activity as a regular part of every child’s day.

Membership of the Program includes a professional learning session for the whole school and early childhood staff. This enables staff to orientate the Program, receive available resources and arrange Program support. Schools and services then strengthen and embed health promotion requirements and messages in policies, curriculum and procedures for staff, children and families with the aim of achieving consistent and sustained healthy behaviours within the setting. Once the school or service meets the requirements of the Program criteria they receive the Move Well Eat Well Award, which is reviewed every two years.

The data in Table 5.5 show the total at end of each period and are cumulative from one reporting period to the next. Data is calculated as a percentage of the current number of Tasmanian schools with a primary enrolment as at the time of reporting (with 221 schools enrolled as of 30 June 2018) and the current number of Tasmanian long day care services (with 124 long day care services enrolled as of 30 June 2018). Schools and services that have been ‘closed’ at the time of reporting have been excluded from this data, regardless of their previous Move Well Eat Well membership status. During the reporting period there has been an increase in the number of Early Childhood Education Centres eligible for membership which has affected the percentages reported. Hence, although there has been new members and award services during the reporting period the percentages reported do not reflect this growth. Future predictions have been altered to allow for this discrepancy.

 


 

Capital Investment Program

Table 5.6 provides financial information for the Department’s Capital Investment Program. More information on the Capital Investment Program is provided in chapter 6 of The Budget Budget Paper No 1.

Table 5.6:         Capital Investment Program

 

Estimated

2019-20 

2020-21 

2021-22 

2022-23 

 

Total

 

Forward 

Forward 

Forward 

 

Cost 

Budget 

Estimate 

Estimate 

Estimate 

 

$'000

$'000

$'000

$'000

$'000

 

 

 

 

 

 

New Infrastructure Commitments

 

 

 

 

 

 

 

 

 

 

 

Minister for Health

 

 

 

 

 

Royal Hobart Hospital Stage 2 Redevelopment1

63 000 

1 600 

30 000 

31 400 

....

 

 

 

 

 

 

Existing Infrastructure Commitments

 

 

 

 

 

 

 

 

 

 

 

Minister for Health

 

 

 

 

 

27 New Mental Health Beds in Southern Tasmania1

20 740 

6 468 

13 770 

....

....

Aeromedical Helicopter Service1

1 615 

350 

....

....

....

Air Conditioning Upgrades - Statewide1

4 900 

2 500 

1 535 

....

....

Better Accommodation for Health Professionals on Flinders Island1

500 

390 

....

....

....

Burnie and Glenorchy Ambulance Stations1

12 000 

5 860 

5 900 

....

....

Campbell Town Ambulance Station

2 960

2 180 

640

....

....

Health Transport and Coordination Infrastructure

10 000

884 

880

....

....

Launceston General Hospital - More Car Parking1

5 000

1 375 

3 269

....

....

Launceston General Hospital - Redevelopment1

87 331

11 497 

12 533

12 000

20 508

Maternity Services at the North West Regional Hospital1

2 100

1 950 

....

....

....

Mersey Community Hospital Capital Upgrades1

35 000

10 000 

17 500

4 081

....

Midlands Multipurpose Centre (Oatlands Hospital) Upgrade1

2 500

1 872 

....

....

....

Royal Hobart Hospital Pharmacy Redevelopment

3 761

1 000 

2 761

....

....

Royal Hobart Hospital Redevelopment2

469 200

82 269 

....

....

....

Royal Hobart Hospital Stage 2 Redevelopment (RHH Ward Upgrades)1,3

28 080

 2 640 

2 640

22 300

....

Smithton Ambulance Training Station1

1 130

1 030 

....

....

....

Stage 2 of the King Island Hospital Redevelopment1

10 500

3 790 

3 250

2 720

....

Statewide – Rural Hospital and Ambulance Station Upgrade Fund1

15 000

8 148 

5 850

....

....

Statewide Hospital Critical Facility Upgrades

10 500

3 000 

3 600

....

....

Statewide Rural Health Facility Infrastructure Upgrades

4 700

1 500 

1 200

....

....

THS Infrastructure Upgrades

1 880

720 

1 160

....

....

 

 

 

 

 

 

Total CIP Allocations

 

151 023 

106 488 

72 501 

20 508 

Notes:

1.    These projects are included at Table 5.1 in the Key Deliverables section at the commencement of this chapter, along with a description for each project.

2.    Funds allocated in 2019‑20 include: final payments to contractors; client operational commissioning; and works on other existing buildings scheduled post K‑Block completion. The Managing Contractor, John Holland Fairbrother, has advised that practical completion of K‑Block is expected in August 2019.

3.    The 2018‑19 Budget provided $28.1 million for Royal Hobart Hospital Ward Upgrades. This project now forms part of the Royal Hobart Hospital Stage 2 Redevelopment.

Campbell Town Ambulance Station

Additional funding of $3 million was allocated in 2017‑18 to construct a new Campbell Town Ambulance Station. The new Station will deliver a contemporary ambulance station on a green field site at the southern end of Campbell Town. The project will include accommodation for relieving paramedics. In 2019‑20, $2.2 million has been allocated to the project.

Health Transport and Coordination Infrastructure

Funding of $10 million was provided in the 2015‑16 Budget for health transport infrastructure projects. These funds will be used for investment in improved infrastructure associated with changes to patient coordination, transport and accommodation arising from the One Health System reforms. These funds target capital upgrades to support patients that need to travel for services, staff that may need to travel to provide outreach services to patients, or strategies that limit the need for patients or staff to travel in order to provide or receive services under a single statewide Tasmanian health system.

Royal Hobart Hospital Pharmacy Redevelopment

The 2016‑17 Budget provided additional funding of $3.8 million for the Royal Hobart Hospital Pharmacy Redevelopment project. This project will deliver a new, purpose built sterile pharmaceutical production facility at the Royal Hobart Hospital. This facility will be a contemporary, safe, high‑capacity sterile production suite that is able to meet patient throughput needs for chemotherapy and elective surgery, and other services as required. This project will run concurrently with the Royal Hobart Hospital Stage 2 Redevelopment works, with planning commencing in 2019.

Royal Hobart Hospital Redevelopment

The $689 million Royal Hobart Hospital Redevelopment is Tasmania’s largest ever health infrastructure project and will deliver a modern health facility for future generations. This project is jointly funded by the Australian and Tasmanian Governments.

Construction of K‑Block, a 10 storey inpatient facility, continues to progress well, with practical completion, as advised by the Managing Contractor, expected in August 2019.

The total $689 million cost of this project includes $469 million from the Capital Investment Program project identified in Table 5.6, funds from the completed Special Capital Investment Fund, and funds relating to the Women’s and Children’s Precinct and Cancer Centre phases of the project.

Statewide Hospital Critical Facility Upgrades

The 2017‑18 Budget provided additional funding of $10.5 million over three years for critical upgrades at hospital facilities across the State. This included $2.2 million for the new dedicated Nurse Training facilities at the North West Regional Hospital, which will replace a substandard demountable facility. The new on site facility will support better education and skills building that is paramount to achieving excellent patient care.

Statewide Rural Health Facility Infrastructure Upgrades

The 2017‑18 Budget provided funding of $4.7 million over three years for high priority infrastructure upgrades in rural health facilities across the State. Investment is primarily dedicated to roof upgrades and heating, ventilation and air‑conditioning units across the State that are in urgent need of upgrade and replacement.

THS Infrastructure Upgrades

Funding of $1.9 million is provided over two years, commencing in 2019‑20, for significant infrastructure upgrades and replacements in the THS in addition to the Essential Maintenance program already undertaken.

Special Capital Investment Funds Projects

Work will be undertaken over the 2019-20 Budget and Forward Estimates period to complete the Kingston Health Centre and the Mersey Hospital Upgrades infrastructure projects. As at 30 June 2019, funding to finalise these projects has been transferred from Finance-General to the Department’s new Agency Financial Management Account. There has been no change to funding available to these projects as a result of this administrative change. Funding is not reflected in the Capital Investment Program, but is included as part of broader infrastructure investment detailed in chapter 6 of The Budget Budget Paper No 1.


 

Detailed Budget Statements

Table 5.7:         Statement of Comprehensive Income

 

2018-19 

2019-20 

2020-21 

2021-22 

2022-23 

 

 

 

Forward 

Forward 

Forward 

 

Budget 

Budget 

Estimate 

Estimate 

Estimate 

 

$'000 

$'000 

$'000 

$'000 

$'000 

 

 

 

 

 

 

Revenue and other income from transactions

 

 

 

 

 

Appropriation revenue - operating1

1 072 057 

1 180 798 

1 189 380 

1 234 666 

1 290 780 

Appropriation revenue - capital2

93 322 

95 993 

106 488 

72 501 

20 508 

Revenue from Special Capital Investment Funds3

6 260 

.... 

.... 

.... 

.... 

Grants4

599 311 

565 618 

481 345 

496 940 

516 257 

Sales of goods and services5

208 118 

203 363 

204 403 

205 275 

205 761 

Interest

325 

334 

343 

343 

343 

Other revenue6

18 698 

22 671 

22 553 

23 494 

23 992 

Total revenue and other income from transactions

1 998 091 

2 068 777 

2 004 512 

2 033 219 

2 057 641 

 

 

 

 

 

 

Expenses from transactions

 

 

 

 

 

Employee benefits7

1 171 948 

1 216 692 

1 240 760 

1 280 626 

1 322 830 

Depreciation and amortisation8

39 306 

67 777 

73 661 

74 902 

74 181 

Supplies and consumables9

458 188 

488 241 

487 989 

524 268 

549 273 

Grants and subsidies10

110 299 

115 915 

107 901 

112 392 

118 958 

Borrowing costs11

.... 

1 471 

1 500 

1 530 

1 559 

Other expenses

27 812 

38 799 

39 103 

39 487 

41 138 

Total expenses from transactions

1 807 553 

1 928 895 

1 950 914 

2 033 205 

2 107 939 

 

 

 

 

 

 

Net result from transactions (net operating balance)

190 538 

139 882 

53 598 

14 

(50 298)

 

 

 

 

 

 

Other economic flows included in net result

 

 

 

 

 

Net gain/(loss) on non-financial assets

14 

13 

13 

13 

13 

Total other economic flows included in net result

14 

13 

13 

13 

13 

 

 

 

 

 

 

Net result

190 552 

139 895 

53 611 

27 

(50 285)

 

 

 

 

 

 

Other economic flows - other non-owner changes in equity

 

 

 

 

 

Changes in physical asset revaluation reserve

23 619 

30 908 

41 422 

42 344 

43 286 

Other movements taken directly to equity12

3 173 

.... 

.... 

.... 

.... 

Total other economic flows - other non-owner changes in equity

26 792 

30 908 

41 422 

42 344 

43 286 

 

 

 

 

 

 

Comprehensive result

217 344 

170 803 

95 033 

42 371 

(6 999)

 

 

 

 

 

 

 


 

Notes:

1.    The increase in Appropriation revenue ‑ operating primarily reflects additional funding provided in the 2019‑20 Budget for initiatives detailed in Table 5.1 Key Deliverables Statement, and scaling up of 2018 election commitments.

2.    The variation in Appropriation revenue ‑ capital reflects the profile of capital project funding from the Capital Investment Program detailed in Table 5.6.

3.    As at 30 June 2019, remaining funding in the Hospital Capital Fund and the Infrastructure Tasmania Fund has been transferred to the Department’s Agency Financial Management Account. There has been no change to projects or available funding as a result of this administrative change. Projects to be finalised with these funds are detailed in chapter 6 of The Budget Budget Paper No 1.

4.    The decrease in Grants in 2019‑20 primarily reflects the cessation of Australian Government National Partnership Agreement funding for the RHH Redevelopment and Improving Health Services in Tasmanian Sub‑acute Care NPA. The further decrease in 2020‑21 reflects the cessation of the Australian Government funding guarantee for Tasmania which forms part of the current National Health Reform Agreement. Whilst the new Heads of Agreement includes a provision for a guarantee the actual guarantee amount from 2021‑22 is unknown until the new agreement is finalised.

5.    The variation in Sales of goods and services primarily reflects the expected reduction in activity of Department of Veterans’ Affairs related inpatient treatment, and a reduction in Dental Services related to the Child Dental Benefits Scheme. The Child Dental Benefits Scheme was due to expire in December 2019. In March 2019 the agreement was extended until December 2022, however, the new agreement is currently not reflected in the Budget.

6.    The increase in Other revenue from 2019‑20 primarily reflects funding from third party entities for training positions within the THS and expected recoveries to be received through the National Disability Insurance Scheme, including Orthotics and Prosthetics, TasEquip Scheme, Physiotherapy and Occupational Therapies, Home and Community Care, Statewide Equipment Library and Statewide Continence Scheme.

7.    The variation in Employee benefits over the Budget and Forward Estimates period reflects the addition of Health Demand funding; and an increase in staffing as a result of 2018 election commitments including 250 beds for the Royal Hobart Hospital; 180 More Nursing Graduates across Tasmania; initiatives under the Record Boost for Mental Health Care policy and the Investment in Ambulance Services. These initiatives scale‑up over the Forward Estimates period, which is reflected in the increasing profile of Employee benefits.

8.    The variation in Depreciation and amortisation primarily reflects the Department’s anticipated depreciation schedules based on current asset balances and anticipated purchases of non‑financial assets over the Budget and Forward Estimates period.

9.    The variation in Supplies and consumables reflects the cessation of the Australian Government funding guarantee for Tasmania in 2019‑20 which forms part of the current National Health Reform Agreement. Whilst the new Heads of Agreement includes a provision for a guarantee, the actual guarantee amount from 2021‑22 is unknown until the new agreement is finalised. This is partially offset by increases in funding associated with the 2018 election commitments for 250 beds for the Royal Hobart Hospital; 180 More Nursing Graduates across Tasmania; and initiatives under the Record Boost for Mental Health Care policy as recurrent funding for these initiatives peaks.

10.  The variation in Grants and subsidies primarily reflects the allocation of funds for 2018 election commitments including time limited funding for Rural Alive and Well initiatives; Epilepsy Tasmania and the Stroke Foundation; and the Tasmanian Community Health Fund.

11.  The increase in Borrowing costs in 2019‑20 is due to the introduction of the new Australian Accounting Standard AASB 16 Leases from 1 July 2019

12.  The 2018-19 estimate has been updated to reflect changes resulting from the agency restructure implemented on 1 July 2018. There is no net impact across the three agencies involved (Department of Communities Tasmania, Department of Health and Department of Premier and Cabinet).


1.     

Table 5.8:         Revenue from Appropriation by Output

 

2018-19 

2019-20 

2020-21 

2021-22 

2022-23 

 

 

 

Forward 

Forward 

Forward 

 

Budget 

Budget1 

Estimate 

Estimate 

Estimate 

 

$'000 

$'000 

$'000 

$'000 

$'000 

Minister for Health

 

 

 

 

 

 

 

 

 

 

 

Output Group 1 - Health Services System Management

 

 

 

 

 

1.1 Health Services System Management2

142 756 

147 992

144 385

152 961

157 625

 

142 756 

147 992

144 385

152 961

157 625

Output Group 2 - Tasmanian Health Service

 

 

 

 

 

2.1 Admitted Services3

488 910 

529 920

533 381

553 404

590 732

2.2 Non-admitted Services4

108 299 

119 115

118 606

121 763

122 824

2.3 Emergency Department Services5

68 351 

77 323

80 212

87 098

91 327

2.4 Community and Aged Care Services6

116 733 

129 301

128 578

128 422

132 328

2.5 Statewide and Mental Health Services7

63 727 

72 674

75 994

77 205

79 031

2.6 Forensic Medicine Service

802 

917

915

936

957

 

846 822 

929 250

937 686

968 828

1 017 199

Output Group 3 - Statewide Services

 

 

 

 

 

3.1 Ambulance Services8

70 307 

90 153

94 041

99 434

102 356

3.2 Public Health Services

12 172 

13 403

13 268

13 443

13 600

 

82 479 

103 556

107 309

112 877

115 956

 

 

 

 

 

 

Capital Investment Program

93 322 

95 993

106 488

72 501

20 508

 

 

 

 

 

 

Department of Health

 

 

 

 

 

Total Operating Services Expenditure

1 072 057 

1 180 798

1 189 380

1 234 666

1 290 780

Total Capital Services Expenditure

93 322 

95 993

106 488

72 501

20 508

 

1 165 379 

1 276 791

1 295 868

1 307 167

1 311 288

 

 

 

 

 

 

Total Revenue from Appropriation

1 165 379 

1 276 791

1 295 868

1 307 167

1 311 288

 

 

 

 

 

 

Controlled Revenue from Appropriation

1 165 379 

1 276 791

1 295 868

1 307 167

1 311 288

 

1 165 379 

1 276 791

1 295 868

1 307 167

1 311 288

 

 

 

 

 

 

Notes:

1.    The 2019‑20 Budget estimate includes revenue associated with the 27th Pay Period that is due to occur in that year.

2.    The decrease in Health Services System Management from 2019‑20 to 2020‑21 primarily reflects the completion of 2018 election commitment funding for Rural Alive and Well and the Tasmanian Community Health Fund. From 2020‑21 funding increases in line with the impacts of 2018 election commitments scaling‑up.

3.    The increase in Admitted Services in 2019‑20 primarily reflects additional funding for Health Demand and for initiatives detailed in Table 5.1 Key Deliverables Statement including 250 beds for the Royal Hobart Hospital; Eight Bed Acute Medical Unit at the North West Regional Hospital; and Eight Beds on Ward 4K at the Launceston General Hospital.

4.    The decrease in Non‑admitted services in 2020‑21 relates to the restructure of the Department of Health and the elimination of internal transfers between the Department of Health and the THS resulting in minor variations of appropriation between the THS Outputs. The subsequent increases from 2020‑21 reflects the 2019‑20 Budget initiative to address increased demand within the THS.

5.    The increase in Emergency Department Services primarily reflects increased funding through the Health Demand initiative, to address the increased demand being experienced in the Emergency Departments within the THS.

6.    The increase in Community and Aged Care Services reflects the provision of additional funding for the Health Demand and Community Rapid Response initiatives. The minor decrease in 2020‑21 relates to the 1 July 2018 restructure of the Department of Health with the elimination of internal transfers between the Department of Health and THS resulting in minor reallocations of appropriation between the THS Outputs.

7.    The increase in Statewide and Mental Health Services in 2019‑20 primarily reflects funding allocated for initiatives under the Record Boost for Mental Health Care policy, including 27 Mental Health Beds in Southern Tasmania.

8.    The increase in Ambulance Services in 2019‑20 primarily reflects additional Health Demand funding and 2018 election commitments for the Investment in Ambulance Services policy, including additional funding for an Aeromedical Helicopter Service; More Paramedics in Regional Areas; Secondary Triage; Volunteer Support Package; and State Operations Centre Boost.


9.     

Table 5.9:         Statement of Financial Position as at 30 June

 

2019 

2020 

2021 

2022 

2023 

 

 

 

Forward 

Forward 

Forward 

 

Budget 

Budget 

Estimate 

Estimate 

Estimate 

 

$'000 

$'000 

$'000 

$'000 

$'000 

 

 

 

 

 

 

Assets

 

 

 

 

 

Financial assets

 

 

 

 

 

Cash and deposits1,2

97 487 

137 369

136 586

140 481

144 818

Investments3

929 

....

....

....

....

Receivables2

27 505 

27 810

27 794

27 757

27 720

Other financial assets

22 964 

22 345

22 318

22 318

22 318

 

148 885 

187 524

186 698

190 556

194 856

Non-financial assets

 

 

 

 

 

Inventories4

14 186 

13 687

10 915

11 654

12 393

Property, plant and equipment5

1 526 248 

1 839 606

1 946 959

2 013 815

2 031 082

Infrastructure6

3 603 

....

....

....

....

Heritage and cultural assets

1 241 

1 983

1 983

2 061

2 139

Intangibles

10 996 

7 776

6 569

5 362

4 155

Other assets7

7 769 

90 257

91 954

93 506

95 092

 

1 564 043 

1 953 309

2 058 380

2 126 398

2 144 861

 

 

 

 

 

 

Total assets

1 712 928 

2 140 833

2 245 078

2 316 954

2 339 717

 

 

 

 

 

 

Liabilities

 

 

 

 

 

Payables2

66 524 

96 976

99 068

99 781

100 494

Interest bearing liabilities7

15 070 

76 164

77 686

79 238

80 824

Employee benefits8

279 124 

275 321

279 943

288 066

296 189

Superannuation9

(2 916)

(4 804)

(4 799)

(4 709)

(4 619)

Other liabilities2

14 722 

20 629

21 600

40 627

59 877

Total liabilities

372 524 

464 286

473 498

503 003

532 765

 

 

 

 

 

 

Net assets (liabilities)

1 340 404 

1 676 547

1 771 580

1 813 951

1 806 952

 

 

 

 

 

 

Equity

 

 

 

 

 

Reserves

556 880 

412 081

453 503

495 847

539 133

Accumulated funds1,10

201 630 

1 264 466

1 318 077

1 318 104

1 267 819

Other Equity11

581 894 

....

....

....

....

Total equity

1 340 404 

1 676 547 

1 771 580 

1 813 951 

1 806 952 

 

 

 

 

 

 

Notes:

1.    The 2018-19 Budget has been updated to reflect changes resulting from the agency restructure implemented on 1 July 2018. There is no net impact across the three agencies involved (Department of Communities Tasmania, Department of Health and Department of Premier and Cabinet).

2.    The variations in the 2020 Budget of Cash and deposits, Receivables, Payables and Other liabilities reflect more accurate estimates based on the 30 June 2018 outcome.

3.    The 2019 Budget for Investments relates to the budget for Housing Investments that was transferred to the Department of Communities Tasmanian at 30 June 2018, as a result of the restructure of the Department of Health and Human Services.

4.    The decrease in Inventories reflects the expiry of the former Essential Vaccines National Partnership Agreement and associated inventories funded by the program.

5.    The variations in Property, plant and equipment over the Budget and Forward Estimates period reflect the timing of anticipated expenditure on key capital projects, including the Royal Hobart Hospital Redevelopment Project.

6.    The variation in Infrastructure reflects the correct treatment of the work-in-progress component of the capital investment program for Health Transport and Coordination Infrastructure, Statewide Rural Health Facility Infrastructure Upgrades and Priority Infrastructure Works - Health. These projects now form part of the Department’s Property, plant and equipment assets.

7.    The increase in Other Assets and Interest bearing liabilities is due to the introduction of the new Australian Accounting Standard AASB 16 Leases from 1 July 2019.

8.    The decrease in Employee benefits in 2020 reflects the impact of the 27th Pay Period pay in 2019‑20.

9.    The balance for Superannuation liability reflects the Ambulance Tasmania Superannuation Fund actuarial determination as at 30 June 2018, which has taken into account the significant gain on investments during 2017‑18 within this fund. The Actuary determined that assets exceed the discounted liability owing to members.

10.  The variation in Accumulated funds reflects the completion of CIP projects predominantly associated with the Royal Hobart Hospital and Launceston General Hospital redevelopments and Mersey Community Hospital Capital Upgrades, as well as the reclassification of Other Equity.

11.  The 2019 Budget for Other Equity represents contributed capital of the THS as at 30 June 2018, as a result of the restructure of the Department of Health and Human Services and the THS. Balances of Other Equity have been transferred to Accumulated funds to reflect the appropriate accounting treatment. There has been no overall impact on the Department’s financial position.


12.   

Table 5.10:       Statement of Cash Flows

 

2018-19 

2019-20 

2020-21 

2021-22 

2022-23 

 

 

 

Forward 

Forward 

Forward 

 

Budget 

Budget1 

Estimate 

Estimate 

Estimate 

 

$'000 

$'000 

$'000 

$'000 

$'000 

 

 

 

 

 

 

Cash flows from operating activities

 

 

 

 

 

Cash inflows

 

 

 

 

 

Appropriation receipts - operating2

1 072 057 

1 180 798 

1 189 380 

1 234 666 

1 290 780 

Appropriation receipts - capital3

93 322 

95 993 

106 488 

72 501 

20 508 

Receipts from Special Capital Investment Funds3

6 260 

.... 

.... 

.... 

.... 

Grants3

599 393 

565 699 

481 345 

496 940 

516 257 

Sales of goods and services4

207 286 

202 597 

204 496 

203 827 

204 313 

GST receipts5

48 867 

44 856 

44 691 

44 691 

44 691 

Interest received

325 

334 

343 

343 

343 

Other cash receipts

18 698 

22 671 

22 553 

23 494 

23 992 

Total cash inflows

2 046 208 

2 112 948 

2 049 296 

2 076 462 

2 100 884 

 

 

 

 

 

 

Cash outflows

 

 

 

 

 

Employee benefits6,7

(1 048 105)

(1 120 603)

(1 114 434)

(1 146 142)

(1 185 425)

Superannuation6,8

(120 151)

(123 759)

(121 682)

(124 761)

(127 682)

Borrowing costs9

.... 

(1 471)

(1 500)

(1 530)

(1 559)

GST payments5

(48 864)

(44 486)

(44 709)

(44 709)

(44 709)

Grants and subsidies10

(110 381)

(115 996)

(107 901)

(112 392)

(118 958)

Supplies and consumables

(459 103)

(485 212)

(482 334)

(505 191)

(529 973)

Other cash payments

(27 812)

(38 797)

(39 103)

(39 473)

(41 124)

Total cash outflows

(1 814 416)

(1 930 324)

(1 911 663)

(1 974 198)

(2 049 430)

 

 

 

 

 

 

Net cash from (used by) operating activities

231 792 

182 624 

137 633 

102 264 

51 454 

 

 

 

 

 

 

Cash flows from investing activities

 

 

 

 

 

Payments for acquisition of non-financial assets11,12

(229 425)

(169 348)

(129 669)

(89 448)

(38 015)

Proceeds from the disposal of non-financial assets

14 

13 

13 

13 

13 

Net cash from (used by) investing activities

(229 411)

(169 335)

(129 656)

(89 435)

(38 002)

 

 

 

 

 

 

Cash flows from financing activities

 

 

 

 

 

Net borrowings13

.... 

(8 587)

(8 760)

(8 934)

(9 115)

Net cash from (used by) financing activities

.... 

(8 587)

(8 760)

(8 934)

(9 115)

 

 

 

 

 

 

Net increase (decrease) in cash and cash equivalents

held

2 381 

4 702 

(783)

3 895 

4 337 

 

 

 

 

 

 

Cash and deposits at the beginning of the reporting

period

95 106 

132 667 

137 369 

136 586 

140 481 

Cash and deposits at the end of the reporting period

97 487 

137 369 

136 586 

140 481 

144 818 

 

 

 

 

 

 

Notes:

1.    The 2019‑20 Budget estimate includes receipts and expenditure associated with the 27th Pay Period that is due to occur in that year.

2.    The increase in Appropriation receipts ‑ operating primarily reflects additional funding provided in relation to initiatives detailed in Table 5.1 Key Deliverables Statement, the 27th Pay Period  and scaling up of 2018 election commitments.

3.    The variation in Appropriation receipts ‑ capital, Receipts from Special Capital Investment Funds and Grants reflect movements in capital project funding from CIP and SCIF, including those components of CIP that are funded by the Australian Government.

4.    The variation in Sales of goods and services primarily reflects the reduction in Department of Veterans’ Affairs related inpatient treatment and a reduction in Dental Services related to the Child Dental Benefits Scheme. The Child Dental Benefits Scheme was due to expire in December 2019. In March 2019 the agreement was extended until December 2022, however, the new agreement is currently not reflected in the Budget.

5.    The reduction in GST receipts and payments relates to the expected reduction in the volume of payments by the Department of Health mainly as a result of the expected practical completion of the Royal Hobart Hospital Redevelopment in August 2019.

6.    The decrease in 2020‑21 in Employee benefits and Superannuation is a result of ABF budget realignments undertaken in 2018‑19, which moved funding to Supplies and consumables across the THS in 2019‑20 and over the Forward Estimates period.

7.    The variation in Employee benefits over the Budget and Forward Estimates period reflects the impact of the 27th Pay in 2019‑20; the addition of Health Demand funding; and an increase in staffing as a result of 2018 election commitments including 250 beds for the Royal Hobart Hospital; 180 More Nursing Graduates across Tasmania; initiatives under the Record Boost for Mental Health Care policy and the Investment in Ambulance Services. These initiatives scale‑up over the Forward Estimates period, which is reflected in the increasing profile of Employee benefits.

8.    The variations in Superannuation reflect the staffing levels resulting from the profile of funding for 2018 election commitments and the time based arrangements for National Partnership Agreement and Commonwealth Own Purpose Expenditure payments.

9.    The increase in Borrowing costs in 2019‑20 is due to the introduction of the new Australian Accounting Standard AASB 16 Leases from 1 July 2019.

10.  The variation in Grants and subsidies primarily reflects the allocation of funds for 2018 election commitments including time limited funding for the Rural Alive and Well initiatives, Epilepsy Tasmania and the Stroke Foundation; and the Tasmanian Community Health Fund.

11.  The 2018-19 estimate has been updated to reflect minor changes resulting from the agency restructure implemented on 1 July 2018. There is no net impact across the three agencies involved (Department of Communities Tasmania, Department of Health and Department of Premier and Cabinet).

12.  The variation in Payments for acquisition of non‑financial assets primarily reflects the anticipated timing of expenditure on major capital projects, including the Royal Hobart Hospital Redevelopment.

13.  The increase in Net borrowings in 2019‑20 is due to the introduction of the new Australian Accounting Standard AASB 16 Leases from 1 July 2019.