Question on Notice
Health and Environment Committee
Oral Briefing – 29 November 2021
QUESTION asked by the Member for Southport (Mr Rob Molhoek MP) and Member for Pumicestone (Ms Ali King) –
(a) Data on the number of beds occupied by disability / aged care patients - broken down by year, by HHS / facility, from 2011-12.
(b) Trend analysis of the above data.
(c) Commentary on Queensland Health interventions – such as the Rapid Response Initiative.
ANSWER
(a) Data on beds occupied by disability and aged care patients. Queensland Health’s response focuses on long-stay patients, who remain in hospital despite being medically ready for discharge. The following response does not consider the many other older people and people with disability occupying hospital beds while receiving medical treatment. Long-stay patients are inpatients that are medically ready for discharge but are awaiting appropriate supports to transition to the community. Long-stay younger patients (LSYPs) are under the age of 65 years and typically awaiting supports under the National Disability Insurance Scheme (NDIS) to be discharged. Long-stay older patients (LSOPs) are over the age of 65 years and are eligible for aged care services. Over time, an increasing number of people aged over 65 years will have had gained access to NDIS supports (prior to turning 65 years old). Aboriginal and Torres Strait Islander people aged 50-64 can access either scheme.
Table 1. Long-stay totals by year/month
Date LSYPs LSOPs Total
2012 283 228 511
2013 230 207 437
2014 242 226 468
20151 516 184 700
2016 499 391 890
2017 537 254 791
2018 470 178 648
2019 412 262 674
2 0
2 0
25-Mar2 254 233 487
29-Apr 212 279 491
27-May 199 277 476
24-Jun 214 281 495
29-Jul3 197 280 477
26-Aug 201 252 453
30-Sep 208 259 467
28-Oct 190 231 421
25-Nov4 208 234 442
2 0
2 1
24-Feb 286 289 575
26-May 237 312 549
25-Aug 238 325 563
24-Nov 235 272 507
Footnotes (further explained in the trend analysis section):
1 Greater awareness of NDIS eligibility requirements and activities undertaken through the Queensland Government’s
multi-agency Joint Action plan saw an increase in LSYPs.
2 From March 2020, there was increased monitoring of hospital capacity in response to the COVID-19 pandemic which required
a change in reporting. Australian Government measures were also introduced to facilitate expedited long-stay patient
discharge.
3 From July 2020, the Australian Government began withdrawing its COVID-19 measures for facilitating expedited long-stay
patient discharge.
4 From November 2020, long-stay data collections were reduced in frequency to occur quarterly.
Table 2. LSYPs by HHS, 2016–19
HHS LSYPs 2016 LSYPs 2017 LSYPs 2018 LSYPs 2019
Cairns and Hinterland
9 10 - 24
Central Queensland
38 27 21 21
Central West - - - -
Children's Health Queensland
- - 1 2
Darling Downs 70 60 54 29
Gold Coast 41 39 9 20
Mackay - 5 5 6
Metro North 213 248 185 132
Metro South 18 20 45 57
North West 1 - 1 1
South West 4 6 6 8
Sunshine Coast 5 3 3 2
Torres and Cape 1 1 - -
Townsville 88 108 89 42
West Moreton 9 10 48 61
Wide Bay 2 - 3 7
Grand Total 499 537 470 412
Table 3. LSYPs by HHS, 2020
HHS 25/03 29/04 27/05 24/06 29/07 26/08 30/09 28/10 25/11
Cairns and Hinterland
27 20 22 22 22 20 15 14 14
Central Queensland
3 12 12 9 15 19 20 13 12
Central West 0 0 0 0 0 0 0 0 0
Children's Health Queensland
0 2 4 4 2 4 6 4 3
Darling Downs 12 4 8 11 7 8 13 12 9
Gold Coast 55 21 17 16 15 19 16 17 23
Mackay 2 2 1 4 5 5 4 5 5
Mater Public - - - - 0 0 2 0 0
Metro North 49 39 49 52 44 35 42 35 35
Metro South 64 48 29 37 31 30 30 30 41
North West 0 6 5 4 4 4 7 6 3
South West 1 0 0 0 0 0 0 0 0
Sunshine Coast 9 8 7 7 4 5 11 11 22
Torres and Cape 0 0 0 0 0 0 0 0 0
Townsville 13 35 30 34 34 28 28 30 26
West Moreton 17 10 9 9 9 18 8 7 10
Wide Bay 2 5 6 5 5 6 6 6 5
Grand Total 254 212 199 214 197 201 208 190 208
Table 4. LSYPs by HHS, 2021
HHS 24/02 26/05 25/08 24/11
Cairns and Hinterland 18 14 16 14
Central Queensland 22 15 11 5
Central West 0 0 0 -
Children's Health Queensland 6 2 0 3
Darling Downs 12 19 18 23
Gold Coast 24 41 32 34
Mackay 3 4 3 5
Mater Public 0 0 0 -
Metro North 59 47 61 52
Metro South 42 21 14 9
North West 4 1 0 -
South West 0 0 0 -
Sunshine Coast 32 23 19 20
Torres and Cape 0 0 0 -
Townsville 38 27 27 25
West Moreton 16 18 20 22
Wide Bay 10 5 17 23
Grand Total 286 237 238 235
Table 5. LSYPs by facility (top ten), as at 24 November 2021
Facility Name HHS LSYPs %
1 Toowoomba Hospital Darling Downs 20 8.51%
2 Robina Hospital Gold Coast 17 7.23%
3 Gold Coast University Hospital Gold Coast 17 7.23%
4 Townsville University Hospital Townsville 17 7.23%
5 Ipswich Hospital West Moreton 16 6.81%
6 Surgical Treatment and Rehabilitation Service
Metro North 15 6.38%
7 Maryborough Hospital Wide Bay 13 5.53%
8 The Prince Charles Hospital Metro North 12 5.11%
9 Brighton Health Campus Metro North 12 5.11%
10 Cairns Hospital Cairns and Hinterland 11 4.68%
Table 6. LSOPs by HHS, 2016–19
HHS LSOPs 2016 LSOPs 2017 LSOPs 2018 LSOPs 2019
Cairns and Hinterland
19 28 <5 9
Central Queensland
22 23 7 23
Central West 31 25 16 -
Darling Downs 25 27 8 -
Gold Coast 5 8 6 18
Mackay 7 - <5 16
Metro North 101 46 33 54
Metro South 48 24 28 31
North West <5 <5 <5 7
South West <5 5 - 13
Sunshine Coast 19 10 5 1
Torres and Cape <5 - - 2
Townsville 81 44 58 55
West Moreton 18 11 <5 27
Wide Bay 9 <5 6 6
Grand Total 391 254 178 262
Table 7. LSOPs by HHS, 2020
HHS 25/03 29/04 27/05 24/06 29/07 26/08 30/09 28/10 25/11
Cairns and Hinterland
14 12 11 12 11 7 6 5 5
Central Queensland
11 12 20 9 23 19 24 12 18
Central West - - - - - - - - -
Darling Downs 16 16 20 17 27 21 34 25 19
Gold Coast 0 30 27 13 26 14 22 23 24
Mackay 16 27 25 32 18 15 10 13 13
Metro North 42 45 44 67 47 52 54 48 44
Metro South 56 46 51 50 46 32 32 25 28
North West 7 5 4 7 7 7 10 13 8
South West 4 5 4 6 9 9 9 9 9
Sunshine Coast - - - - - - - - -
Torres and Cape - 1 1 1 1 1 1 1 1
Townsville 19 53 42 46 45 40 35 29 45
West Moreton 18 3 5 5 4 9 4 13 13
Wide Bay 30 24 20 16 16 26 13 14 6
Mater - 0 3 0 0 0 5 1 1
Grand Total 233 279 277 281 280 252 259 231 234
Table 8. LSOPs by HHS, 2021
HHS 24/02 26/05 25/08 24/11
Cairns and Hinterland 4 5 3 6
Central Queensland 22 22 40 38
Central West - - - -
Darling Downs 15 30 44 24
Gold Coast 34 9 18 19
Mackay 10 18 19 15
Metro North 61 76 55 62
Metro South 18 21 35 17
North West 9 10 0 7
South West 7 10 1 0
Sunshine Coast - 38 29 16
Torres and Cape 1 0 1 0
Townsville 81 40 44 36
West Moreton 9 20 9 11
Wide Bay 17 13 27 21
Mater 1 0 0 0
Grand Total 289 312 325 272
Table 9. LSOPs by facility (top ten), as at 24 November 2021
Facility Name HHS LSOPs %
1 Townsville University Hospital Townsville 36 13.24%
2 Brighton Health Campus Metro North 35 12.87%
3 Rockhampton Hospital Central Queensland 28 10.29%
4 The Prince Charles Hospital Metro North 14 5.15%
5 Princess Alexandra Hospital Metro South 13 4.78%
6 Robina Hospital Gold Coast 11 4.04%
7 Maryborough Hospital Wide Bay 11 4.04%
8 Toowoomba Hospital Darling Downs 10 3.68%
9 Bundaberg Hospital Wide Bay 10 3.68%
10 Gold Coast University Hospital Gold Coast 8 2.94%
(b) Trend analysis of the data. Long-stay data collections are point-in-time snapshots. The number of long-stay patients is subject to change daily as long-stay patients transition to the community and other patients become long-stay. Long-stay data collections are manually conducted and have resourcing implications for frontline health workers. Prior to the COVID-19 pandemic, data was collected annually. In 2015, there was a significant increase in LSYPs (from 242 in 2014 to 516 in 2015). This was attributed to greater awareness, understanding and clarity around the eligibility criteria for the NDIS and increased awareness of the activities undertaken as part of the Queensland Government’s multi-agency Joint Action Plan: Transitioning long-stay younger people with disability from Queensland public health facilities. From 2020, the COVID-19 pandemic presented a greater need to monitor hospital capacity, and as such, data collections increased in frequency. To facilitate this increase, changes to data collection were implemented:
• The data sought from HHSs was streamlined and focused on patients who were ready for immediate discharge.
• It is understood that given the competing priorities in March – June 2020, the data collections during this time underestimate the total number of long-stay patients.
• Between March and October 2020, a significant number of long-stay patients were able to transition to the community in response to the risks of COVID-19. This was achieved through flexibility in policy from Australian Government agencies (National Disability Insurance Agency (NDIA) and Department of Health) and substantial efforts from hospital and Australian Government agency staff. Many of the Australian Government’s measures were retracted by the end of 2020.
• Due to the unlikelihood of these patients transitioning to community in the pandemic, people in Queensland Health residential disability settings are not included (Halwyn, Birribi, Gaibal Unit – Baillie Henderson Hospital, Brighton Brain Injury Service). In 2019, these settings accounted for approximately 90 long-stay younger patients (contributing to the decrease in LSYPs in 2020).
In 2021, data collections were reduced in frequency to occur quarterly and long-stay patient numbers have remained stable. The data suggests that although the interventions implemented by Queensland Health in 2021 have not decreased long-stay patient numbers, they have resulted in reduced long-stay patient length of stay. As at 24 November 2021, the reported LSYPs had been in hospital for a median of 125 days (an average of 282 days) and the reported LSOPs had been in hospital for a median of 43 days (an average of 111 days).
Table 10. LSYPs’ length of stay (LoS)
Date LSYPs Median LoS (days) Average LoS (days)
28 October 2020 190 176 375
25 November 2020 208 172 348
24 February 2021 286 175 330
26 May 2021 237 155 312
25 August 2021 238 99 266
24 November 2021 235 125 282
Table 11. LSOPs’ length of stay (LoS)
Date LSOPs Median LoS (days) Average LoS (days)
28 October 2020 231 48 112
25 November 2020 234 48 88
24 February 2021 289 62 103
26 May 2021 312 42 81
25 August 2021 325 47 111
24 November 2021 272 43 111
In 2021, approximately 43 per cent of long-stay patients in each quarter remained in hospital for the next quarter, and 57 per cent were new. Anecdotal evidence, consistent with other States and Territories, is that the number of patients becoming long-stay has increased during this period. In particular, the number of ‘social admissions’ or relinquishments due to inadequate NDIS supports has increased. A social admission occurs when a parent or support provider believes they can no longer safely care for a person with disability with the current level of NDIS funding. Without an NDIS safety net, these people are regularly dropped at hospital emergency departments. As they do not require medical care but cannot live safely in the community, they often remain in hospital as long-stay patients. Data on the number of social admissions of people with disability is not captured. Unnecessarily prolonged hospitalisations are associated with adverse patient outcomes including deconditioning, institutionalisation, hospital acquired infection and psychological distress. It also diverts resources away from other patients who need acute care and leads to unnecessary financial costs for the health system. As at 24 November 2021, there were 235 LSYPs and 272 LSOPs occupying Queensland Health beds at a cost of approximately $1.02 million per day, based on a $2,011 bed day cost. In reality, the costs are even higher, given the complex needs of some patients who may require nurse specialists, multiple beds, or increased security in the hospital. This cost is substantially more than hospitals receive in revenue for the patients’ care and a patient with extremely high care needs can cost the health system up to $20,000 per day. As at 24 November 2021, the highest reported barriers to discharge for LSYPs were NDIS-related administrative delays in access and planning (31.5 per cent), supported independent living availability (13.2 per cent) and complex medical requirements (7.7 per cent) but medically ready for discharge.
Table 12. LSYPs by primary barrier to discharge, 24 November 2021
Primary barrier to discharge LSYPs %
Administrative 115 48.90%
NDIS plan is inadequate/awaiting a plan review 49 20.90%
Delays with NDIS access and plan approval 25 10.60%
Delays with NDIS support coordination 14 6.00%
Pending QCAT decision 12 5.10%
Pending Public Guardian decision 7 3.00%
Forensic orders (disability and mental health) 6 2.50%
Pending other substitute decision maker 2 0.80%
Availability/Supply 67 28.50%
Waiting for Supported Independent Living (SIL) 31 13.20%
Community/public housing wait 14 6.00%
Waiting for SDA 13 5.50%
Waiting for appropriate support provider 5 2.10%
Other Availability/Supply (e.g. home mods, assistive tech)
4 1.70%
Complex Care Needs e.g. Palliative Care 28 11.90%
Other/Not stated 25 10.60%
Grand Total 235 100.00%
As at 24 November 2021, the highest reported barrier to discharge for LSOPs was waiting for a residential aged care facility bed (63.6 per cent). Table 13. LSOPs by primary barrier to discharge, 24 November 2021
Primary barrier to discharge LSOPs %
Availability/Supply 180 66.20%
Waiting for residential aged care facility bed 173 63.60%
Waiting for Transition Care Program package 3 1.10%
Other Availability/Supply (e.g. home mods, assistive tech)
4 1.60%
Administrative 49 18.00%
Pending QCAT decision 34 12.50%
Pending Public Guardian decision 6 2.20%
Pending other substitute decision maker 4 1.50%
Awaiting ACAT assessment/approval 3 1.10%
Other administrative delays 2 0.80%
Complex Care Needs 16 5.90%
Other 27 9.90%
Grand Total 272 100.0%
(c) Commentary on Queensland Health interventions – such as the Rapid Response Initiative.
Queensland Health has committed significant workforce effort and investment to support long stay patients who no longer require medical care in a hospital to be discharged into a out-of-hospital setting more appropriate to their needs and wellbeing. The following summaries key initiatives noting that frontline Hospital and Health Service staff, including doctors, nurses and allied health staff, work daily to support discharge of long stay patients through interactions with the National Disability Insurance Agency, Aged Care providers and other stakeholders. This effort cannot be quantified.
Long-Stay Rapid Response As part of the $100 million Care4Qld Strategy to address unprecedented demand in Queensland’s public hospitals, $4 million was invested into the Long-Stay Rapid Response (LSRR) to support appropriate hospital discharge for patients awaiting access to disability and aged care supports. LSRR is an internal escalation pathway for HHSs and operates by funding solutions that should be the responsibility of the Australian Government. Possible solutions include interim accommodation, home modifications or increased nursing supports. LSRR has also established six new clinical staff dedicated to facilitating hospital discharge for long-stay patients and those at risk of becoming long-stay. As at 22 November 2021, 154 patients involved in the program have been able to leave hospital and a further 61 patients are in the process of being supported to discharge. Mr Boots Williams from Atherton was one of the patients involved in LSRR. Admitted to hospital in March 2021 following a stroke which left him with the inability to swallow and speak, he was treated in Cairns and Atherton hospitals with a total length of stay of 217 days. Eighty of these days were clinically unnecessary. The reason for his extended stay was the failure of the NDIS to provide a suitable supported, independent living option. Mr Williams experienced low moods and high levels of frustration awaiting his forever home. Through LSRR, Mr Williams transitioned to interim accommodation on 9 October 2021 following a rapid approval of required disability supports. Mr Williams expressed his happiness to be out of hospital and excitement to get on with his life. Queensland Civil and Administrative Tribunal (QCAT) program In March 2020, Queensland Health collaborated with QCAT to fund a trial expansion of a program which accelerates the QCAT process for long-stay patients awaiting QCAT decisions to ensure they are discharged to appropriate accommodation in a timely manner. The program is based in Metro North and the expansion trial has successfully reduced average waiting times for QCAT hearings by approximately 61 days, from 98 days to 37 days as at November 2021. As a COVID-19 response, the Department of Health provided funding for the Metro North model to be expanded to all HHSs in Queensland. Metro North coordinated the COVID-funded expansion concurrently with its own program.
The COVID funding concluded on 30 June 2021 and the initiative is now funded under the Care4Qld Strategy. Summer Foundation Hospital Discharge and Housing Project In November 2019, Queensland Health partnered with the then Department of Housing and Public Works to fund the Summer Foundation to deliver its Hospital Discharge and Housing project aimed at reducing extended stays in hospital for patients with disability across Metro South, Gold Coast and West Moreton HHSs. The project improved staff capability, supported discharge for complex long-stay patients, assisted to prevent unnecessary admissions and improved clinical governance structures. The project also contributed to the reduction of LSYPs seen in 2020. Funding for the project ended at the beginning of 2021. Ongoing national advocacy work On 30 April 2021, the Queensland Minister for Health and Ambulance Services led a discussion at a Health Ministers’ Meeting about NDIS-related barriers to discharge. All States and Territories reported to be experiencing similar challenges. Health Ministers agreed to establish a senior officers working group (SOWG), led by Queensland, comprising representatives from health, disability and social services agencies, to develop solutions that would facilitate timely patient discharge and prevent patients from becoming long-stay. On 28 October 2021, State and Territory Health Ministers invited their disability reform counterparts and national disability peak organisation representatives to meet and discuss long-stay patient issues. Broad support was received for the SOWG developed actions paper. On 4 November 2021, Health Ministers met with Senator the Hon Linda Reynolds CSC, Minister for the NDIS, to discuss issues at the health and disability interface. All Ministers participated in a robust discussion about the issues and there was broad commitment to work together on implementing solutions to improve the interface. The Australian Government committed to reviewing and responding to the actions paper. As at 30 November 2021, Health Ministers are still awaiting the Australian Government’s response.