Author: Dr Rhonda Kerr - Committee Member

This article reviews the recent Australian Climate Service report on risks associated with climate change and considers the implications for planning health services and health infrastructure.

Background

On 15 September, Australia’s first National Climate Risk Assessment was released, reporting on expected changes in climate and their impacts on people, services, and infrastructure.

Read the full report HERE

From an economy and society wide perspective, health risks are at the forefront of government concern. Key risks include:

• Risks to human health, medical, and emergency services from damage and disruption to critical health facilities and supporting infrastructure (energy, water, transport), particularly in regional and remote communities.
• Risks to health and wellbeing of individuals and communities in exposed and vulnerable situations that increase inequity as a result of impacts on the wider determinants of health and reduce access to health and social support services.
• Risks to health and wellbeing from slow onset and extreme climate impacts including increasing temperatures, heat extremes, storms, floods, and bushfires.
• Risks to mental health and wellbeing including post-disaster trauma, climate anxiety, and a lost sense of belonging and connection to Country.
• Risks to delivery of health and social support services and the health workforce that are caused by increased demand, cost and disruptions.
• Risks to health and wellbeing from aeroallergens and worsening indoor and outdoor air quality.
• Risks to health and wellbeing from the emergence and increased transmission of communicable diseases.
• Risks to health and wellbeing from compromised ecosystem services that support food and water security.
• Specific risks to Aboriginal and Torres Strait Islander peoples, including food, water, energy and housing insecurity, and impacts on connection to Country.
• Risks to physical health and care infrastructure that affect the accessibility of healthcare and social support resources
• Risks to buildings and building liveability that reduce building life expectancy and increase maintenance and running costs.
• Risks to energy production and distribution infrastructure that increase outages and reduce energy supply reliability.

The report also highlights that extreme heat will significantly strain hospital access (page 21) and increase admissions (page 42). It stresses the need for health systems infrastructure including hospitals, clinics, and other facilities to be equipped with resilient technology and resources.

Managing Risks in Service Delivery

To deliver required healthcare during times of climate change and a cascading series of climate events the Report advises that the health “system’s infrastructure includes hospitals, clinics and other healthcare facilities equipped with the necessary technology and resources.’’ (page 128).  How do we manage these risks into planning for effective service delivery?

Hazardous conditions with high risks of injury and death are increasing across Australia. With high certainty, the report projects:

• Heatwaves will cause more deaths and hospital admissions nationwide, especially in northern Australia.
• Tropical cyclones in the north will increase in frequency and severity, leading to more injuries and fatalities.
• Droughts will become more frequent and prolonged in many regions.
• Bushfires in southern regions will become more common, compounding air quality issues and respiratory illness.
• Flooding (riverine and flash) will increase in prevalence.
• Mental health burdens will rise across affected populations.

Table 11 (page 132) quantifies these effects in terms of increased mortality, while page 137 identifies heightened risks of communicable diseases, including waterborne and vector-borne pathogens such as cryptosporidium and cyanobacteria.

Integrity of Planning

Health service and facility planning must incorporate the increased demand for acute care associated with climate change. Unexpected risks from outside Australia may also arise (e.g. COVID). Risks from climate change are described as ‘’cascading and compounding’’ rather than one-off events.  They represent a new and evolving normal.

Prudent planning requires:

• Provision for additional beds, ED bays, ambulances, pathology (including mortuary), procedural areas, and equipment to meet surges in demand.
• Testing hub-and-spoke acute care models for access during heatwaves, fires, and floods.
• Mental health service provision should be calibrated against projected demand under climate stress to ensure services and facilities are evidence-based and robust.
• Ensuring workforce reliability, including clinician travel arrangements.
• Expanding stores and supplies in case of disrupted supply lines.
• Strengthening ICT systems and ensuring medical record access during climate events.
• Assessing the integrity of facilities (fabric, energy, air and water supply) to ensure continuity of care.

Conclusion

The Australian National Climate Risk Assessment makes it clear that demand for hospital services will rise as climate-related events increase.  Provision must be made when planning hospitals to respond to the risks outlined, to ensure that health infrastructure is robust, adaptable, and fit for purpose.

It is widely held that improved prevention of illness, personal responsibility for health and affordable primary care can reduce the demand for hospital care. While this may one day be proven, the current demand for acute healthcare, coupled with the certainty of increasing climate-related demand, requires professional health planners to prepare expanded services that can meet the risks outlined in the National Climate Risk Assessment.  Hospitals and health facilities must be designed and resourced to withstand climate impacts and deliver care reliably under stress.

Author: Dr Rhonda Kerr - Co-Chair AAHP

In a report released on 15 August 2025 the Australian Productivity Commission recommended major changes to the way healthcare is planned, delivered and evaluated. Importantly the Report also recommends the Australian government should fund planning and collaborative commissioning. Funding will be dependent on achieving agreed outcomes.

The Productivity commission Interim Report on Delivering quality care more efficiently recommendation says “Governments should embed collaborative commissioning, with an initial focus on reducing fragmentation in health care to foster innovation, improve care outcomes and generate savings.

In the next addendum to the National Health Reform Agreement, governments should agree to governance and funding arrangements that support better collaboration between Local Hospital Networks (LHNs), Primary Health Networks (PHNs) and Aboriginal Community Controlled Health Organisations (ACCHOs). New joint governance arrangements to support collaboration are needed.

• LHNs and PHNs should be required to plan together to identify areas for collaboration, including joint needs assessments, agreed plans of work and joint monitoring and reporting of outcomes.
• LHNs and PHNs must work in partnership with ACCHOs and other organisations to inform planning and shared decision making. Partnering with ACCHOs should be consistent with the principles set out in the National Agreement on Closing the Gap to ensure relevant needs are appropriately and respectfully assessed and key decisions are shared.
• There needs to be stronger requirements for formal joint collaborative commissioning committees and the development of data-sharing arrangements to underpin joint needs assessments and evaluation of outcomes. Changes to funding arrangements are also needed to embed collaborative commissioning.
• Barriers to pooling funding or other forms of joint commissioning should be removed. The Australian Government should make funding for PHNs more flexible. State and territory governments need to ensure that service agreements provide flexibility in the services and programs that LHNs can fund.
• LHNs, PHNs and ACCHOs should be sufficiently resourced to undertake comprehensive joint governance.

The Australian Government should provide LHNs and PHNs with sufficient dedicated funding to embed collaborative commissioning programs once they submit a joint plan. The joint plan should clearly link agreed shared outcomes to enhanced productivity in the form of quality improvements or more services that lower potential future costs. Initially, the focus should be on reducing potentially preventable hospitalisations. Future funding should be adjusted based on whether agreed shared outcomes have been achieved at the local level.’’

Identifying that Australia’s care system is fragmented, ‘’care services is siloed, and complex governance and disconnected funding arrangements produce inefficiencies, cost shifting and discontinuity of care ‘’ the commissioners hold that Collaborative commissioning can support more integrated care by helping to align the planning and provision of services between different organisations and types of care, contributing to a more seamless experience for care users, particularly people with chronic or complex conditions. ‘’

There are systemic barriers they found including the difficulty in moving beyond trials, rigid and short-term funding, capability constraints, a lack of formal joint governance architecture, misaligned incentives and data an evaluation constraint. These are the challenges.

Health planners have a role to play in navigating the collaborative environment.

If you would like read more about the findings or to comment on the Productivity Commission draft recommendations go to https://www.pc.gov.au/inquiries/current/quality-care/interim/quality-care-interim.pdf

Alternatively, you can forward your advice to the admin@aahp.online for inclusion in our AAHP Submission to the Productivity Commission.

Author: Dr Rhonda Kerr - Co-Chair AAHP

Australia’s largest health system, New South Wales, has just undergone one of the most comprehensive reviews in its history. Over 18 months, a team led by highly qualified legal professionals undertook a rigorous examination of healthcare funding in NSW. This involved extensive submissions, hours of testimony, and careful interrogation of the issues facing health service delivery.

Many challenges were well described. Clinicians, managers, researchers and non-government organisations gave compelling accounts of the obstacles to delivering equitable, timely and quality healthcare across the state. Insightful evidence was gathered and made publicly available. https://healthcarefunding.specialcommission.nsw.gov.au/documents/

At a cost of between $15.7(1) million and $25.5 million, the Special Commission’s report (2) identified major funding gaps in areas largely under Commonwealth responsibility: general practice, Medicare, aged care, primary health care, mental health, dental services and First Nations health. It also highlighted weaknesses in shared funding arrangements between the state and the Commonwealth.

Many of the report’s recommendations such as a sugar tax and a whole-of- government approach to prevention have been heard before. The importance of preventing chronic disease, particularly among socioeconomically disadvantaged populations, was once again reinforced.

The report acknowledges funding constraints across Local Health Districts (LHDs) and proposes a familiar solution: better planning. It calls for improved systems, workforce, and service planning grounded in a robust understanding of local and specialty needs.

(1) NSW Parliamentary Budget Office Report 20 March 2023
/NSW%20Parliamentary%20Budget%20Office%20Report%2020%20March2023https://www.parliament.nsw.gov.au/pbo/Documents/2023OppositionCostingsandRequests/C1411%20-%20Costing%20-%20Special%20Commission%20of%20Inquiry%20into%20the%20funding%20of%20healthcare%20in%20NSW.PDF

(2) NSW Special Commission Inquiry into Healthcare Funding - 16 May 2025 
special-commission-inquiry-funding.pdf

And yet, strikingly, nowhere in the 1,000+ page report is there any substantive recommendation to invest in health systems or health service planning. The foundational work of Health Needs Assessment, strategic planning, and service model design at the local level, often delivered through partnerships with health planners, remains unfunded and unrecognised.

If “form follows finance,” as the adage goes, how can this level of planning occur without dedicated investment?

The report also critiques current infrastructure-led planning approaches, stating: “Because LHDs and SHNs have traditionally delivered facility- based services, planning processes have had a tendency to be driven by capital needs... The ‘real planning need’ or the needs of [a] community [have] nothing to do with a facility.”

It recommends shifting focus from "bricks and mortar" to service models delivered through general practice, nurse-led care, or allied health. While this shift is well-intentioned, the idea that diverting capital funding from acute care infrastructure to preventative and primary services will resolve current and future demand is, frankly, naïve.

Anyone working in healthcare understands the long lead times required for prevention initiatives to take effect. Even the most successful anti-smoking campaigns (arguably the gold standard in preventive health) have not eliminated the burden of lung cancer. In 2024, 66 per 100,000 men are still diagnosed annually. The need for acute treatment services remains and will for the foreseeable future.

Obesity prevention was identified in the report as a priority, yet no funding was recommended for targeted campaigns. This disconnect between analysis and investment is concerning.

The report’s Finding 2.107 rightly notes that decisions about acute services are driven by funding, workforce constraints, political realities, and legacy commitments. It calls for system wide service planning responsive to local community needs and local decision-making. But again, the resourcing remains centralised, and the LHDs remain constrained.

How, then, can localised, strategic, community-informed planning occur without funding, support or recognition for the health planning profession?

It is deeply disappointing to see the work of NSW Health Infrastructure Planners and Health Service Planners so lightly dismissed. AAHP members engaged in this work are committed professionals dedicated to improving community health outcomes through evidence-informed planning.

Equally concerning is the report’s lack of attention to future demand. There is little meaningful exploration of service projections or demographic trends. The very elements the report calls for - population health analysis, demand forecasting, socio-economic profiling - are core competencies of professional health planners.

Too often, those without a health planning background overemphasise population size and overlook the importance of epidemiology, age and gender profiles, socio-economic determinants, fertility trends, and local patterns of morbidity and mortality.

Despite the high quality of the submissions and testimonies, the report fails to grapple with the true complexity of the health landscape, and the growing demands on acute services.

The solution lies in health systems planning. But planning to the standard required (the standard AAHP members deliver) needs appropriate recognition and resourcing.

Author: Dr Rhonda Kerr - Co-Chair

During election cycles, public and political opinions on healthcare—especially emergency and hospital services—are strongly expressed. While access to health services is a recurring theme, are popular solutions always the right ones for long-term hospital and health service planning?

Recent state and federal elections in Australia, and the national election in New Zealand, have seen commitments to fund hospitals, expand emergency departments, and build new facilities. In Queensland and New Zealand, new governments have reviewed existing health plans, identifying new priorities while removing previous ones.

Planning Beyond Bricks and Mortar

Health planners understand the complexity of delivering appropriate, timely, and effective care. Health planning principles go far beyond infrastructure alone. They are grounded in a thorough understanding of population health trends and current and future service needs - ensuring that services are designed with both present demands and future shifts in mind.

Effective planning considers interdependent factors such as:

• Workforce availability and sustainability
• Clinical relationships and service adjacencies
  
• Patient flow and continuity of care across the system
  
• Technological and digital infrastructure to support care within and beyond hospital walls.

Beyond the Headlines: What Political Promises Miss

Despite their good intentions, many political commitments don’t address the deeper, structural challenges that determine the success of healthcare transformation:

• Adapting service configurations to meet changing population needs - not just scaling up, but right-sizing services to ensure the right care is provided in the right place
  
• Building integrated networks that optimise workforce capacity and clinical collaboration
  
• Incorporating new technologies to enhance care delivery, patient experience, and system efficiency
  
• Navigating the ever-present challenge of finite budgets, which require thoughtful prioritisation.

The Cost of Planning Disruption

One overlooked consequence of politically driven health planning is the stop-start cycle of project revisions. These changes can:

• Disrupt and disperse committed workforces
  
• Undermine trust among clinicians and project stakeholders
  
• Delay the implementation of critical technologies and service improvements
  
• Ultimately, reduce timely patient access to appropriate care.
  

Every delay or cancellation represents lost momentum and missed opportunities for innovation.

Planning Beyond Politics

AAHP members play a vital role in navigating these complexities - without partisanship. They work to ensure sustainable improvements in healthcare access and effectiveness, at local, regional, and national levels.

But lasting progress requires more than planning expertise. It requires stability. Can we create a planning environment where healthcare transformation continues—even through political change?

As we reflect during this election period, it’s worth considering the value of consistent, evidence-based planning that transcends electoral cycles. The Australasian Association of Health Planners exists to support this long-term vision, enabling better healthcare for both patients and policymakers.

Author: Isabelle Mansour - AAHP Secretary and Committee Member

The Healthcare system nationally and globally is challenged by multiple issues from rising costs, workforce shortages, health disparities pandemics and natural disasters to name a few. A study published in the ‘Medical Journal of Australia’; in July 2024 shows that containing hospital costs by limiting bed availability and reducing the length of stay using new models of care may no longer be a viable strategy.

The research found that the burden of Australia’s ageing population and the prevalence of comorbidities will continue to push increased demand on healthcare systems. For the first time in history, there are more people aged 65 years and over than there are aged under 5 years.

Add to it, Australia’s vast geography makes healthcare access a persistent challenge, particularly for rural and remote communities. Yet, our current funding models still disproportionately favour the delivery of bricks and mortars, leaving many regions underserved.

Building more physical beds doesn’t seem to alleviate solely the increased pressure on the healthcare system. As with more physical hospital beds comes further pressure on the

workforce, more impact on the environment without necessarily solving the issue of healthcare equity and access block. Digital health has the potential to play a pivotal role in emerging models of care, but its impact depends on effective implementation, monitoring, and evaluation.  There is a need to start identifying other strategies that will help ease pressure on the acute care sector.

While digital health has the potential to bridge this gap, it remains inefficiently implemented - not because of a lack of technology, but because we lack the right models of care to integrate it effectively.

The Misconception: Digital Health is Just About Convenience

Many assume that digital healthcare is simply about making access more convenient. But in reality, it’s about improving efficiency, equity, and patient outcomes.

The Challenge: Silos & Slow Collaboration

Despite the potential, Australia’s fragmented healthcare system is slowing progress. Health services remain siloed, and state and commonwealth systems struggle to collaborate on sustainable, scalable models of care. Meanwhile, international examples show that integrated digital healthcare models can work when designed with the right incentives and structures.

What’s Holding Us Back?

We have the technology. We have global case studies proving success. Yet, digital transformation in Australian healthcare is lagging. Is it funding? Policy inertia? Resistance to change? A lack of coordination?

Author: Eleni Naude - AAHP Treasurer and Committee Member

As healthcare needs evolve, so must the way we plan, design, and deliver services. Health service planners play a pivotal role in ensuring that our healthcare systems are not only equipped to meet today’s demands but are also prepared for the challenges of the future.

By leveraging health data, population demographics, and service demand projections, planners provide critical insights that shape strategic decision-making. Their expertise bridges the gap between clinical needs and system-wide infrastructure planning, ensuring that resources, technology, and workforce strategies are aligned with patient and community needs.

A core part of health service planning involves large-scale infrastructure projects. These developments require deep analysis, scenario modelling, and extensive stakeholder engagement—from frontline clinicians to government bodies—to create healthcare environments that enhance service delivery and improve patient outcomes. 

And, the role of a health service planner extends beyond hospital walls. Increasingly, planners are involved in health precinct development, integrating healthcare with research, education, and community services. This holistic approach fosters innovation, supports workforce sustainability, and builds resilient healthcare ecosystems that improve the overall health and wellbeing of communities.

Over time, we have seen health service planners transition into infrastructure project management roles, supporting and leading the planning and delivery of health development projects. Their understanding of the service- and system-level outcomes and benefits enables the project to be delivered as intended, as well as influence key processes such as model of care development, operational commissioning and post occupancy evaluations. 

With a commitment to evidence-based planning, innovation, and collaboration, health service planners are shaping the future of healthcare—creating adaptable, efficient, and patient-centred systems that will serve generations to come.

Author: Lesley Alway - AAHP Co-chair

“The average healthcare organization is 2000% more complex than the average business and has five times as much regulatory oversight.”
— Brent James, CEO of Intermountain HealthCare, 2012

This powerful statement highlights the immense challenges that Health Planners and professionals involved in Health Precinct Design face. Healthcare systems are uniquely complex, and the knowledge required to navigate these challenges is spread across various specialised domains. To succeed in such a multifaceted environment, the key lies in effective integration and collaboration across these knowledge silos.

The Challenge
One challenge is ensuring that all expertise - such as staff skilled in Infection, Prevention and Control - are involved early in the planning process to prevent silos in information sharing and ensure seamless communication throughout the project.

Who do Health Planners collaborate with?
As an example, a critical partnership exists between Health Facility Planners and Health Architects. While these roles work closely together, they are distinctly different.  The Health Facility Planner acts on the client’s behalf to interpret clinical standards, spatial relationships, work practices, patient/staff flows, as well as the movement of goods and equipment. This holistic understanding helps optimise the design of healthcare spaces for maximum efficiency and safety.

The Outcomes of Successful Collaboration
By working together, these teams can achieve several outcomes that directly impact healthcare delivery:

• Ergonomic Work Environments: Promoting safety, comfort, and efficiency for staff
• Efficient Staff and Patient Flows: Ensuring optimal use of resources and minimising delays
• Increased Safety: Both for patients and staff through improved design and processes
• Impact on Facility Design: Reducing patient length of stay and streamlining healthcare operations, which ultimately influences the physical space requirements.

The Importance of Innovation and Future-Proofing
Through effective collaboration, Health Facility Planners contribute to innovation and future-proofing of healthcare architecture.  The design of flexible, adaptable spaces ensures that healthcare facilities can meet future clinical and technological advancements, ultimately supporting better care delivery in the long term.  

Author: Rhonda Kerr - AAHP Co-chair

2024 was a year of discovery, delight and achievement. From an initial meeting of health planners from every mainland state, New Zealand and the ACT we have discovered an impressive healthcare knowledge base, brilliant systems thinkers and a passion for working through challenges to achieve remarkable outcomes.

Discovery. The first question in 2024 was ‘’Who are Health Planners and what can they do?’’ was answered with a world first Capability Framework describing the scope of practice, capabilities and capacities of health planners, standard deliverables, qualifications and attributes. These were affirmed by literature reviews, consultations and survey of 80 Australasian health planners.

Delight. All that happened by June!   The name and constitution were ratified in August and the Australasian Association of Health Planners Inc. was registered in September. Moving to the operating mode, financial systems were installed by November and the Association was launched on 27 November 2024.  One year since the initial concept meeting. Membership applications have exceeded our expectations.

Achievement. A group of competitors came together to form the first professional association for health planners in Australia and New Zealand and one of the first in the world, in 12 months. They proved to be dynamic, insightful, hard-working, brilliant, cooperative, generous, thoughtful professionals with a wealth of experiences. The AAHP has created a platform for sharing knowledge, expanding scope, learning, and above all, generous collegiate fellowship. These are people of great worth. I note the powerful contributions of Isabelle Mansour and Annabel Frazer in particular.

Advocacy for the profession status of health planners amongst decision makers in healthcare and with other professional colleagues will be a key focus in 2025. Happy New Year!!