3.1 Create one national framework with clear accountability

The Commonwealth should hold primary responsibility for financing rules, national service standards, workforce frameworks, data standards and strategic capacity planning. States and territories should deliver services under five-year agreements with measurable outputs and transparent reporting.

3.2 Reduce congestion and waiting times

Capacity must be planned across emergency care, diagnostics, theatres, intensive care, wards, rehabilitation, outpatient care and community follow-up. The aim is faster movement through the complete episode of care, not simply more beds in one part of the hospital.

3.3 Strengthen regional access

Australians should have access to a reasonable standard of care regardless of postcode. Regional hospitals should be classified by the services they are required to deliver, supported by population health data, referral times and clear escalation pathways.

3.4 Build a national workforce pipeline

Recruitment, education, credentialing, mobility and retention should be managed as one problem. Nationally portable classifications, regional training partnerships and public staffing pools should reduce persistent shortages and dependence on high-cost agencies.

3.5 Protect the public system while using private capacity

Private participation may add investment and choice, but it must be clinically accountable and financially separate. Public patients retain priority for publicly funded services and must not subsidise private activity.

3.6 Provide sustainable long-term funding

Funding should be visible, predictable and tied to capacity and outcomes. Capital decisions should be staged, independently assessed and accompanied by published operating-cost assumptions.

4.1 Definition of a Hospital (Hospital-Level Facility)

For the purposes of the national system, a hospital—whether publicly or privately operated—must provide comprehensive, continuous and clinically accountable care across the full episode of treatment.

At a minimum, a hospital-level facility must provide 24-hour clinical care, maintain capacity for overnight and extended patient stays, and include access to an Intensive Care Unit or equivalent critical care capability, either on-site or through formally integrated and immediate access arrangements. It must be equipped to manage post-operative complications within its declared clinical scope without routine reliance on transfer to external facilities, and must maintain access to essential support services including diagnostics, pharmacy and allied health.

Facilities must also operate within a comprehensive clinical governance framework, including participation in national reporting systems and the national patient record.

Facilities that do not meet these requirements should not be classified, funded or represented as hospitals within the national system.

Established not-for-profit and private providers, including major institutions such as Mater and St Vincent’s, demonstrate that private operators can meet full hospital-level capability. The distinction is therefore not between public and private ownership, but between facilities that meet hospital-level standards and those that do not.

4.2 Procedural Facilities (Surgical Clinics and Day Procedure Centres)

Facilities that do not meet hospital-level capability requirements should be classified as procedural facilities, including surgical clinics and day procedure centres.

These facilities perform an important role in delivering efficient, lower-complexity care. However, they are not designed to provide extended post-operative care or manage complex complications. Their role should therefore be clearly defined and limited to procedures that align with their clinical capability.

Procedural facilities must not be represented, regulated or funded as hospitals.

4.3 Post-Operative Care and Clinical Responsibility

All facilities undertaking surgical procedures must operate within their clinical capability and retain responsibility for patient outcomes within that scope.

Facilities must not undertake procedures that exceed their capacity to safely manage post-operative care. Where complications arise within the expected scope of the procedure, the originating facility must retain responsibility for management rather than relying on transfer as a routine practice.

Transfer to public hospitals should be limited to cases that genuinely exceed the declared clinical scope of the facility. Public hospitals should not be relied upon as a default provider of post-operative or complication care for privately initiated procedures.

4.4 Classification, Funding and System Integrity

Facility classification must be directly linked to funding eligibility and system participation.

Hospital-level funding and private patient subsidy arrangements should apply only to facilities that meet the hospital definition. Procedural facilities may participate in appropriate service delivery but should not receive hospital-level funding.

Private health insurer partnerships must align with this classification framework. Public subsidy should not support models that rely on the public system to complete the patient journey.

This approach ensures that patients receive care in appropriately resourced settings, that public hospital capacity is protected, and that funding reflects actual service capability.

6.1 Central Clinical Services Building

The central building concentrates the services that are clinically interdependent, expensive to duplicate and required around the clock. It is connected directly to both inpatient buildings, with controlled patient, staff and supply routes. The helipad should sit behind or above the central building with a protected direct route to emergency, theatres and intensive care.

A GP and urgent-care service forms the non-life-threatening front door. Patients are assessed and treated there when appropriate, then referred directly to the adjoining emergency department if escalation is required. Ambulance arrivals and obvious emergencies bypass the GP stream. Triage and treatment must never be delayed while insurance status is checked.

6.2 Public Hospital Building

The public building contains the majority of inpatient and public-facing services. Its scale should be determined by population need, disease burden, travel times, projected demand and the hospital's regional referral role. Public capacity and staffing are commissioned first and cannot be reduced to create private capacity.

6.3 Private Hospital Building

The private building is a separate inpatient facility rather than a subsidised ward inside the public hospital. The preferred model is an investor-financed or long-term leased shell developed only after an open expression-of-interest process demonstrates demand. The private operator funds all internal fit-out, ward equipment and operating costs.

Private patients may use central theatres, diagnostics, critical care and other shared services under transparent agreements. Usage must be metered and charged at full cost, including capital recovery, staffing, consumables, maintenance and an appropriate share of overhead. The arrangement must not create an implicit public subsidy.

6.4 Public priority and scheduling

• Emergency and clinically urgent care is prioritised by need, not insurance status.

• Publicly funded theatre, imaging, ICU and workforce capacity is protected by minimum public allocations and escalation rules.

• Private bookings may use genuinely available capacity but cannot displace public activity or extend public waiting times.

• Shared-service performance, cancellations and cross-subsidies are independently audited and reported.

6.5 Clinical responsibility and transfers

The private operator remains responsible for its patients within its declared clinical scope and must maintain the staffing, ward capability and on-call arrangements required to manage expected complications. Physical proximity to the public building must not become a routine transfer pathway. A transfer occurs only when clinically necessary and is documented, reviewed and charged to the responsible private funder for the continuing episode.

6.6 Identification of private cover

Where appropriate, patients may be asked at or shortly after emergency registration whether they hold private cover. This supports informed choice and correct billing, but emergency assessment and treatment must not be delayed or made conditional on insurance. Patients must receive neutral information and retain the right to elect public treatment.

6.7 Shared workforce and specialist practice

Specialists may practise across the public and private buildings under credentialing, conflict-of-interest and roster rules. Public obligations must be met first. Employment, on-call and fee arrangements should be disclosed, and access to shared theatres or diagnostics should follow published scheduling rules.

6.8 Education and research

A university and clinical-training hub may be linked to the campus, preferably near the private building and central services. It should proceed only with confirmed Commonwealth, university or other partner funding and must not divert the core hospital capital budget. Agreements should secure placements and research benefits for the public system.

6.9 Staged construction

1. Build and commission the Central Clinical Services Building and Public Hospital Building first, including utilities, transport access, parking, helipad connections and expansion capacity.

2. Test private-sector demand through an open expression-of-interest process. Proceed with the Private Hospital Building only where financing, tenancy and full-cost service agreements are credible.

3. Add the university and training hub only after external funding and operating commitments are secured.

4. Protect the master plan from land sales or later development that would block clinical expansion.

7.1 Purpose of a national framework

The framework would establish nationally portable classifications, core pay bands, recognition of experience, minimum conditions and a common structure for nurses, hospital support workers and relevant support staff. States and employers could still add site-specific incentives, but the base framework would be portable across the country.

7.2 Why portability matters

A nurse moving from one state system to another, or between hospital, rehabilitation and community-health settings, should not effectively restart their employment position. The system needs portable service recognition, consistent credentialing, and a clear transfer mechanism for leave and entitlements.

Without that, national reform will still operate like a patchwork.

7.3 National deployment pool

The Commonwealth should establish a voluntary national workforce pool for temporary placements in high-demand locations. This pool would be relevant for regional shortages, new precinct commissioning, seasonal surges and emergency situations. The pool would not replace permanent staffing; it would stabilise system gaps while local recruitment catches up.

Participants should retain their core classification and entitlements. Government should fund travel, temporary accommodation and relocation support where required. Additional loadings should apply for remote or difficult-to-fill placements. Placement lengths should be long enough to be useful operationally, such as eight to twenty-six weeks.

7.4 Workforce portability and system integration

The national framework should align with credentialing systems, digital rostering, workforce data systems, and national training standards so that staff movement across jurisdictions is administratively simple rather than procedurally burdensome.

8.1 Overview

A nationally integrated health services system requires a workforce model that is equally integrated. Training, education and workforce development must be aligned with system design, rather than operating as a separate pipeline disconnected from real service demand.

Australia’s current training system produces qualified professionals, but it does not consistently produce a workforce that is:

• distributed according to need;

• prepared to work across care settings;

• supported to remain in the system long term;

• able to move easily between regions and service types. The purpose of this framework is to create a continuous, nationally coordinated workforce pipeline, linking education, training, employment and career progression across the entire system.

8.2 Core principles

The national training and development model should be built on the following principles:

• training must be aligned to actual system demand, not just enrolment capacity;

• education pathways must be clear, portable and progressive;

• clinical training must occur within real service environments, not separate systems;

• workforce entry should be accessible to school leavers and mature-age workers;

• career progression should be visible and supported across the system;

• regional and rural workforce development must be embedded, not treated as an afterthought.

8.3 Integrated training campuses

Each major integrated precinct should include a co-located training campus delivered in partnership with:

• universities;

• TAFEs;

• registered training organisations;

• health services and local clinical providers. These campuses should operate as live training environments, not purely classroom-based institutions.

Key features include:

• student rotation through emergency, acute hospital care, rehabilitation, mental health, primary care and community health;

• shared supervision between clinical staff and educators;

• exposure to the full patient journey rather than isolated care settings;

• embedded use of national digital systems and patient records. This model produces a workforce that is immediately familiar with integrated care delivery.

8.4 Structured entry pathways

The system should provide multiple entry points into the workforce.

School Leaver Pathways Direct entry into nursing, allied health or hospital support roles, supported placements within integrated precincts, and structured transition from education into employment.

Vocational Entry Hospital-support and allied-health-assistant qualifications, pathways into enrolled nursing, and credit transfer into higher qualifications.

Mature-Age Entry Fast-track training programs for career changers, recognition of prior learning, and flexible study options linked to employment.

Internal Progression Pathways Hospital support worker to enrolled nurse to registered nurse, supported study with employer partnerships, and paid training models where possible.

The objective is to create a ladder, not a series of disconnected steps.

8.5 National skills framework and standardisation

Training must align with the national system structure.

This requires:

• a national skills and competency framework across hospitals, primary care, rehabilitation, mental health and community health;

• standardised qualifications and role definitions;

• consistent clinical training requirements;

• alignment with the National Health Workforce Framework. This ensures that qualifications are recognised across all states, staff can move without retraining, and employers understand skill levels consistently.

8.6 Clinical placement reform

Clinical placements are currently a bottleneck in workforce development.

The integrated model addresses this by:

• embedding placements within precincts;

• increasing placement capacity through hospitals, primary care, rehabilitation, mental health and community health;

• aligning placement supply with workforce demand;

• reducing competition between institutions for limited placements. Students should graduate having worked across multiple care environments, not just one.

8.7 Workforce retention and career development

Training is only effective if staff remain in the system.

Retention should be supported through:

• clear career progression pathways;

• portable entitlements under the national framework;

• access to ongoing professional development;

• opportunities to move between regions, care settings and roles. Career pathways should include clinical specialisation, leadership and management, education and training roles, and regional and remote practice incentives.

The system should be structured so that remaining in the workforce is the easiest and most attractive option.

8.8 Regional and rural workforce strategy

Regional workforce shortages are a persistent challenge.

This framework addresses them by:

• locating training campuses within regional precincts;

• prioritising local recruitment and training;

• providing bonded or supported training pathways;

• offering relocation incentives and housing support;

• using the national deployment pool to stabilise shortages. People trained in regional areas are more likely to remain in regional practice. The system should therefore train where it needs staff.

8.9 Workforce data and planning

A national system requires national workforce planning.

This should include:

• real-time workforce data across hospitals, primary care, rehabilitation, mental health and community health;

• forecasting based on population ageing, regional demand and service expansion;

• alignment between training intake and system needs. The National Health Funding Authority should work alongside education providers to ensure that workforce supply matches system demand.

8.10 National Flexible Workforce Pool

In addition to permanent staffing and the national deployment pool, the system should establish a National Flexible Workforce Pool consisting of casual and part-time nurses, hospital support workers and allied health staff available to support short-term staffing gaps.

This pool would operate as a public alternative to private nursing agencies, providing a centrally coordinated, cost-controlled and clinically consistent staffing solution across the national system.

The purpose of the flexible workforce pool is to:

• provide rapid coverage for unplanned absences and short-term shortages;

• reduce reliance on high-cost private agency staffing;

• improve workforce flexibility for clinicians seeking part-time or casual roles;

• ensure consistent standards, credentialing and system familiarity across all placements;

• support regional and high-demand areas without requiring permanent relocation. The pool should function as a nationally coordinated staffing service with:

• a central digital platform linked to national workforce systems;

• real-time visibility of staffing shortages across facilities;

• a roster of pre-credentialed staff available for same-day shifts, short-term placements and recurring part-time roles;

• standardised pay rates aligned with the National Health Workforce Framework;

• transparent booking and allocation processes. The pool would be open to part-time nurses and hospital support workers seeking additional shifts, semi-retired or returning clinicians, staff preferring flexible work arrangements, clinicians balancing family or study commitments, and regional staff seeking occasional metropolitan shifts or vice versa.

The current reliance on agency staffing introduces higher hourly costs, inconsistent clinical familiarity, fragmented credentialing processes and limited integration with local systems. A national public pool would reduce staffing costs through standardised rates, ensure all staff are trained in national systems and protocols, improve continuity and quality of care, and retain workforce capacity within the public system rather than external agencies.

8.11 Emergency workforce integration

The training system should also support emergency preparedness.

This includes:

• maintaining a register of trained personnel available for surge deployment;

• incorporating emergency response training into standard education;

• enabling rapid upskilling where required;

• linking training institutions into emergency workforce planning. This ensures the workforce can scale during crises without relying solely on ad hoc arrangements.

8.12 Funding and support mechanisms

Workforce development requires sustained investment.

Funding should support:

• training campuses within precincts;

• clinical supervision and placement capacity;

• scholarships and incentives for priority areas;

• paid training pathways where feasible;

• digital training systems aligned with national platforms. This investment should be treated as core system infrastructure, not discretionary spending.

8.13 Strategic impact

A national training and development framework delivers long-term system stability. It strengthens workforce supply, improves staff mobility, reduces recruitment pressure, supports regional services, improves quality and consistency of care, and aligns workforce capability with system design.

Without workforce reform, infrastructure reform will fail. With it, the system becomes sustainable.

9.1 Base Medicare levy

The proposal uses an indicative increase in the base Medicare levy from 2.0 percent to a range of approximately 3.0 to 3.5 percent of taxable income. The purpose of the increase is to fund a strengthened national universal system covering public hospitals, primary care, essential specialist care, mental health and core system administration.

This range is presented as a planning assumption rather than a final recommended rate. Treasury and the Department of Health would need to model the exact rate against projected expenditure, demographic demand and interaction with existing Commonwealth health spending.

9.2 Medicare Plus optional tiers

To reduce pressure on the base levy while still allowing an expanded public offer, optional tiers would sit alongside the universal system. These tiers are intended to operate like a public framework for additional cover rather than a compulsory second tax.

1. Dental option: indicative additional contribution of 1.5 to 2.0 percent. Intended to cover preventive dental care, routine restorative work and a defined share of major dental costs.

2. Private patient option: indicative additional contribution of 1.5 to 2.5 percent. Intended to allow a person to elect to be treated as a private patient within the new national system, helping avoid waiting times while remaining inside a publicly regulated framework.

These percentages are not presented as final tax recommendations. They are policy design ranges intended to show how the system could separate the universal base from optional enhanced cover. A full actuarial model would be needed before implementation.

9.3 Capital funding

The Central Clinical Services Building and Public Hospital Building are core public infrastructure and should remain publicly owned. Capital business cases must disclose construction, equipment, workforce, maintenance and whole-of-life operating costs rather than presenting only the initial build price.

The Private Hospital Building should proceed only after an open expression-of-interest process demonstrates credible demand. The preferred structure is an investor-financed or long-term leased shell under which the private operator funds its internal fit-out, ward equipment and operating costs. Private access to central clinical services must be metered and charged at full cost, including staffing, consumables, maintenance, digital services, overhead and capital recovery.

9.4 Transition funding

Major reform fails when governments fund the destination but not the transition. A dedicated transition envelope should therefore be established for at least the first five years. It should fund project offices, pilot-site staffing, digital integration, industrial transition work, training expansion and temporary parallel-running costs while old and new systems overlap.

9.5 Public reporting

The public will accept reform more readily if the system shows where money goes. Annual statements should therefore report, at minimum, revenue raised from the base levy and optional tiers, expenditure by stream, additional rehabilitation, step-down and clinical capacity created, number of hospital beds freed through reduced delayed discharge, and regional workforce growth.

9.6 Private Health Insurer Partnerships and Facility Alignment

The current private health insurance system includes contractual arrangements between insurers and healthcare providers that do not consistently reflect clinical capability.

In practice, some insurer networks include facilities that do not meet hospital-level standards but are presented to consumers as equivalent pathways of care. This creates a disconnect between expectation and reality, particularly where those facilities rely on the public system to complete the episode of care.

Under a nationally integrated system, insurer participation should align with facility classification.

Hospital-level insurance pathways should be limited to facilities that meet the hospital definition, including critical care capability and post-operative management capacity.

Public subsidy should support models that contribute genuine system capacity rather than those that rely on the public system to absorb risk.

9.7 Continuity of Funding Responsibility for Transferred Patients

A nationally integrated system requires that funding responsibility follows the patient across the full episode of care.

Where a patient undergoes a procedure in a private hospital or procedural facility and is subsequently transferred to a public hospital for complications or ongoing treatment, the patient should remain classified as a private patient for that episode.

The relevant private health insurer should be responsible for the full cost of treatment, including inpatient care and post-operative management.

This approach ensures that the system initiating care retains responsibility for its outcomes, reduces cost shifting to the public system, and protects access for public patients.

10.1 Overview

The proposed national integrated health services system is not solely a cost expansion model. It is a structural reform designed to reduce systemic inefficiencies, eliminate duplication and redirect existing expenditure toward more effective care delivery.

Australia’s current system carries significant hidden costs arising from fragmentation. These costs are not always visible in budget papers, but they manifest through:

• duplicated administrative structures across jurisdictions;

• inconsistent procurement and purchasing arrangements;

• incompatible digital systems requiring parallel investment;

• delayed patient flow through hospitals;

• avoidable hospital admissions and extended lengths of stay;

• workforce inefficiencies caused by lack of mobility and standardisation. The reform addresses these inefficiencies directly and converts them into measurable system savings.

10.2 Administrative consolidation savings

Australia currently maintains multiple layers of administrative and policy infrastructure across the Commonwealth, states and territories. While some local administration is necessary, a substantial portion of system design, procurement, digital management and policy development is duplicated.

Under a national framework:

• policy design, funding architecture and system standards are centralised;

• procurement and digital systems are coordinated nationally;

• reporting, compliance and planning frameworks are standardised. This allows for a gradual reduction in duplicated administrative functions. Savings are expected to arise from consolidation of policy and planning units, reduced duplication in procurement teams, unified reporting and compliance systems, and shared digital infrastructure and support services.

These savings should be realised progressively through natural attrition, redeployment and system integration, rather than abrupt workforce reduction. Even modest efficiency gains across multiple jurisdictions represent a substantial redirection of funding capacity into frontline services.

10.3 Procurement and supply chain savings

The shift to national procurement is one of the most immediate and quantifiable efficiency gains.

Current fragmentation results in:

• variable pricing for identical goods;

• reduced bargaining power;

• duplicated contract negotiation processes;

• inconsistent supply resilience. Through aggregated national purchasing:

• unit costs for consumables, equipment and services are reduced;

• supplier contracts are streamlined;

• administrative overhead decreases;

• supply chain stability improves. A practical example of inefficiency is that even basic consumables and fittings used in clinical environments, such as clips, connectors and tubing components, can vary between hospitals and jurisdictions due to separate procurement decisions and supplier arrangements. This creates higher unit costs, incompatibility between equipment and consumables, increased training requirements for staff moving between facilities, and reduced ability to share stock across sites during shortages.

Standardising common consumables and equipment interfaces at a national level would reduce cost, improve safety and support workforce mobility.

10.4 Digital system rationalisation

Australia’s current health system operates multiple overlapping digital platforms across jurisdictions, including electronic medical records, clinical and community-health management systems, workforce systems, procurement platforms and reporting tools.

This results in duplicated licensing costs, expensive system integration requirements, repeated staff training, and limited interoperability.

A national digital platform would reduce licensing and maintenance costs, eliminate redundant systems over time, simplify training and onboarding, and improve operational efficiency. Digital consolidation represents both direct cost savings and indirect productivity gains, particularly in clinical and administrative workflows.

10.5 Hospital flow and bed utilisation savings

One of the largest hidden costs in the current system is inefficient use of hospital beds.

Acute hospital care is the most expensive form of care. When patients remain in hospital due to lack of rehabilitation, step-down or an appropriate external placement, the system incurs avoidable costs.

The integrated model improves flow by enabling earlier transfer to step-down care, expanding rehabilitation, step-down and community-health capacity, reducing delayed discharges, and preventing avoidable admissions through early intervention.

The financial impact includes reduced cost per patient episode, improved throughput of existing hospital infrastructure, reduced need for new acute hospital expansion driven purely by congestion, and improved elective surgery capacity.

10.6 Workforce efficiency gains

The current workforce model produces inefficiencies through limited interstate mobility, inconsistent pay and conditions, duplication of credentialing processes, uneven distribution of staff across regions, and heavy use of agency staffing to fill routine gaps.

The National Health Workforce Framework, combined with national deployment mechanisms and the National Flexible Workforce Pool, enables more efficient allocation of staff across the system, reduced reliance on short-term agency staffing, improved retention through clearer career pathways, and faster response to regional shortages.

10.7 Avoided future costs

A critical but often overlooked benefit of structural reform is the avoidance of future cost escalation.

Without reform, Australia is likely to face increasing hospital demand driven by ageing, rising community-care costs without integrated planning, continued duplication in digital and procurement systems, and growing pressure for ad hoc infrastructure expansion.

By integrating the system now, the Commonwealth can reduce the need for reactive infrastructure spending, better align capital investment with actual system demand, and avoid compounding inefficiencies over time.

10.8 Reinvestment of savings

Savings generated through efficiency and consolidation should not be treated as general budget reductions. They should be reinvested into system improvement, including expansion of rehabilitation, step-down and regional clinical capacity, reduction of hospital congestion, workforce development and training, regional service strengthening, and digital system implementation and maintenance.

10.9 Strategic position

The reform is not based on the assumption that Australia must simply spend more on health care. It is based on the understanding that Australia is already spending significant resources, but not in a way that delivers a coordinated system.

By removing duplication, standardising systems, improving patient flow, and aligning workforce and infrastructure, the Commonwealth can build a system that is both more effective and more financially sustainable.

14.1 National procurement and purchasing contracts

The current approach to procurement is unnecessarily fragmented. States and territories often negotiate separately for clinical consumables, medical devices, non-PBS pharmaceuticals, information systems and facility services. This weakens national bargaining power, produces inconsistent pricing and duplicates procurement effort across multiple bureaucracies.

A federalised system should establish a National Health Procurement Authority responsible for aggregating demand and negotiating national purchasing contracts where standardisation makes operational and financial sense.

The Authority should:

• consolidate demand data from hospitals, rehabilitation services and related public providers;

• negotiate national contracts for common equipment, consumables and relevant digital systems;

• develop preferred supplier panels;

• standardise product categories where clinically appropriate;

• manage strategic procurement planning for shortages, surge events and supply resilience. This would not require every site in Australia to use identical products in every clinical context.

Specialist exceptions would still be necessary. The principle is that routine and large-scale procurement should take place with the bargaining power of a national system rather than in eight separate negotiations.

14.2 National clinical policies and procedures

Variation in clinical and operational procedures across states, hospital networks and contracted health providers creates inefficiency and inconsistency. Policy teams in different jurisdictions often duplicate similar work, while staff moving between systems must relearn local procedures that should not materially differ.

The Commonwealth should therefore establish a National Clinical Standards Framework covering hospitals, rehabilitation, step-down care and participating community providers.

This framework should include:

• standardised clinical protocols for common transitions and patient groups;

• best-practice guidelines for discharge planning, medication management, discharge and follow-up assessment, infection control and escalation pathways;

• national operational procedures for core services where consistency improves quality and mobility;

• regular review mechanisms so standards are updated in line with evidence and practice. The objective is not to impose unnecessary uniformity where local flexibility is justified. It is to eliminate needless procedural fragmentation in areas where best practice should be shared.

14.3 National digital and software systems

Perhaps the largest hidden inefficiency in the current system lies in digital fragmentation. Health services use a patchwork of electronic medical record systems, community-health software products, rostering tools, procurement systems and reporting platforms. The result is duplicated licensing, expensive interfaces, repeated training burdens and poor interoperability.

A national system should therefore move toward a National Health Digital Platform. This does not necessarily mean one monolithic software product for every service in the country. It does mean one nationally governed digital environment with common standards, shared licensing logic and interoperable platforms.

The digital program should include:

• a standardised EMR environment or nationally approved interoperable EMR suite;

• integrated rehabilitation, discharge and community-health software capability;

• full compatibility with the National Patient Record System;

• standard workforce, procurement and reporting modules where practical;

• nationally negotiated licensing and support arrangements. Implementation should begin by selecting the preferred architecture, defining interoperability requirements and identifying which existing systems can be retained, adapted or retired. Legacy systems should be phased out according to risk and value, not left indefinitely in place because they already exist.

The Commonwealth should also fund standardised training and national support arrangements so digital capability does not vary wildly by location.

Taken together, national procurement, national standards and national digital systems represent one of the clearest efficiency dividends in the whole reform package. They are central to turning federalisation into a practical operating system rather than a change in funding labels alone.

15.1 Why a national framework is necessary

Australia’s current arrangements rely heavily on coordination between jurisdictions at the point of crisis. In ordinary times, this can appear workable. In emergencies, it creates delay, duplication and inconsistent decision-making.

The main structural weaknesses are already familiar:

• separate state-based operating systems and command structures;

• variable hospital surge capacity;

• inconsistent access to staff across borders;

• fragmented procurement and stockholding;

• different patient-record and reporting systems;

• inconsistent public health messaging and escalation triggers;

• uneven integration between hospitals, disability support, primary care and community health. A national framework would reduce those risks by ensuring there is one core structure for command, information, workforce and logistics.

15.2 Core objectives

The framework should be designed to:

• preserve continuity of essential care;

• protect acute hospital capacity;

• enable rapid workforce deployment;

• protect high-risk care environments;

• standardise command, data and communication;

• maintain sovereign capability in essential supply.

15.3 National emergency health command structure

A national system requires a clear emergency command model. This should not replace local operational leadership, but it should provide a legally and administratively defined framework for national coordination.

The proposed structure would include:

• a National Health Emergency Coordination Authority operating within or alongside the National Health Funding Authority;

• pre-defined emergency powers for national coordination of beds, staffing, procurement and inter-jurisdictional support;

• a national command protocol for public health emergencies, pandemics, mass casualty events and major system disruptions;

• mandatory participation by state and territory health authorities through standing intergovernmental agreements.

15.4 Integrated surge capacity model

Under the integrated model proposed in this paper, emergency surge capacity would be drawn from five linked layers:

• acute hospital surge;

• step-down and transitional surge;

• rehabilitation and step-down surge;

• community-health and regional transfer capacity;

• regional transfer networks. This model is stronger than simply adding more acute beds because it keeps patients moving through the system instead of allowing hospitals to become blocked at every downstream point.

15.5 Workforce emergency mobility and reserve capacity

Emergency response fails quickly if staffing cannot be moved at speed. The National Health Workforce Framework should therefore include an emergency mobility function.

This should be supported by:

• a national emergency workforce register;

• pre-cleared credentialing across all jurisdictions;

• portable entitlements and standard deployment terms;

• accommodation, travel and hardship support for emergency placements;

• emergency loadings for high-risk or remote deployments;

• a reserve pool of recently retired clinicians, educators and qualified professionals willing to undertake temporary supervised roles.

15.6 National patient record and emergency data use

The National Patient Record System becomes even more critical in an emergency. During a pandemic or disaster, the system should support immediate access to medication, allergy and comorbidity data, rapid sharing of discharge summaries and transfer decisions, visibility of high-risk residents and high-risk patients moving between settings, and outbreak and capacity reporting using common national data standards.

15.7 National procurement, stockpiles and supply chain coordination

The emergency framework should establish a national health emergency supply model including:

• strategic national stockpiles of essential items;

• national purchasing triggers for rapid emergency procurement;

• domestic supply resilience for a limited but critical basket of goods.

15.8 Public communication and national triggers

A federalised system should establish common emergency stages and public communication rules, including nationally defined trigger levels, standard language for public-health advice, coordinated communication between Commonwealth and state authorities, and common reporting formats.

15.9 Implementation approach

This framework should not be treated as a separate reform stream. It should be built into the main implementation roadmap from the outset and tested through pilot regions and simulation exercises.

Embedding emergency and pandemic management into the national system would improve ordinary bed management, strengthen workforce portability, improve digital interoperability, support better procurement planning, reduce vulnerability in community and regional health services, and create a more disciplined, nationally coherent public system.

16.1 Proposed Burnie campus

• A new Central Clinical Services Building containing emergency care, the GP and urgent-care front door, theatres, intensive and high-dependency care, cardiac and stroke capability, imaging, pathology, sterilisation, pharmacy, ambulance access and a direct helipad link.

• A Public Hospital Building sized for regional demand, including wards, maternity and paediatrics, cancer services, renal and dialysis, mental health, rehabilitation, palliative care, outpatient services and allied health.

• A smaller Private Hospital Building of approximately 6,000-8,000 square metres, proceeding only after market testing and on terms requiring private fit-out, equipment, rent and full-cost payment for shared services.

• Parking beneath the public and private buildings where geotechnical, access and cost analysis supports it.

• A protected expansion zone and an optional education hub funded through confirmed Commonwealth, UTAS or other partner contributions.

16.2 Services and population need

The Burnie business case should test cardiac catheterisation and other specialist capability against regional cardiovascular burden, transfer times, clinical volumes, workforce sustainability and network arrangements. The decision should be evidence-led and should consider both planned procedures and time-critical access.

16.3 Pilot questions

• Does the GP and urgent-care front door reduce avoidable emergency demand without creating delay or confusion?

• Do shared theatres, diagnostics and critical care improve utilisation while preserving public priority?

• Are private charges sufficient to prevent public subsidy and recover whole-of-life costs?

• Can shared specialist practice improve recruitment and retention without weakening public rosters?

• Do the classification and transfer rules reduce routine cost shifting into public beds?

• Does the design improve emergency access, patient flow, clinical outcomes and regional confidence?

17.1 Phase One - Design and enabling action (Years 1-2)

• Establish an empowered national taskforce supported by Health, Treasury, Finance and infrastructure expertise.

• Complete service planning, site assessment and reference design for Burnie and two comparison pilots.

• Draft classification, shared-service charging, public-priority and transfer-accountability rules.

• Negotiate heads of agreement with participating jurisdictions and education partners.

• Begin workforce, digital interoperability and procurement design.

17.2 Phase Two - Public core and pilot delivery (Years 2-5)

Construct or redevelop the central and public buildings first. Commission services in stages, test the urgent-care front door, introduce national reporting and evaluate patient flow, access, workforce and operating costs.

17.3 Phase Three - Private and education components (Years 3-6)

Following open market testing, proceed with the private building only when financing and full-cost service agreements are demonstrably sustainable. Proceed with the education hub only when partner funding and placement commitments are secured.

17.4 Phase Four - Expansion and standardisation (Years 5-10)

Use independently evaluated pilot evidence to issue national design, contracting and service standards. Scale first where regional access and health outcomes show the greatest need.