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Report 1/2018
3. 3. Joint Health Command Garrison Health Facilities Upgrade Project
3.1
The Department of Defence (Defence) seeks approval from the Committee to proceed with the Joint Health Command (JHC) Garrison Health Facilities Upgrade. The project proposes to construct eight new health centres and refurbish five existing health centres across 13 sites around Australia.
3.2
The estimated cost of the project is $212.5 million (excluding GST).
3.3
The project was referred to the Committee on 7 December 2017.

Conduct of the inquiry

3.4
Following referral, the inquiry was publicised on the Committee’s website and via media release.
3.5
The Committee received two submissions and one confidential submission. A list of submissions can be found at Appendix A.
3.6
On 31 January 2018 Defence conducted a site inspection by presentation. The Committee also conducted a public and in-camera hearing on this date. A transcript of the public hearing is available on the Committee’s website.

Need for the works

3.7
The project seeks to create a hub model and will consolidate an existing 22 facilities into 13 centres that offer comprehensive health services.[1] Speaking at a public hearing, Defence explained:
The model of care is based on flexible, modern, best-practice health service delivery specific to defence. Defence health is different to civilian health. Defence health requires a high level of proactive care at a consolidated primary care hub delivering GP, rehabilitation and mental health services, with a pharmacy and dental and physiotherapy departments also. Services need to be delivered in time frames to suit the ADF’s training and operational needs.[2]
3.8
Defence stated that a key objective of this project is to deliver consistent and efficient health care facilities across Defence.[3]
3.9
Defence identified that there are a number of issues with existing facilities that are affecting the JHC’s ability to deliver effective health care services, including:
Non-compliance with legislative codes including the Building Code of Australia, the Disability Discrimination Act, and policies including Defence’s Manual of Fire Protection Engineering, and the Defence Security Manual;
Non-compliance with design standards including the Australasian Health Facilities Guidelines;
Dysfunctional layouts that limit JHC’s ability to provide efficient services;
Infection control risks associated with outdated fittings and fixtures;
Multiple extensions and repurposing of ad hoc spaces to accommodate new or modified capability requirements; and
Engineering systems that are at the end of their serviceable life.[4]
3.10
In its submission, Defence identified that the rationalisation of health facilities will improve effectiveness and efficiency within garrison health care service delivery, including better utilisation of Australian Defence Force (ADF), Australian Public Service, contracted personnel and material resources.[5]
3.11
Defence identified that existing mainstream health services did not offer the same benefits that an internal health system could. At the public hearing, Commodore Sharkey said:
… an important and critical part of our ability to deliver high-quality healthcare services that optimise the health of ADF members is a really detailed and nuanced understanding of the ADF environment both in the training garrison environment and the environment that they will be exposed to on operations and on operational taskings. That is not a knowledge base that is common in the civilian community. A familiarity with our standards of healthcare and our policy framework from which we deliver health services is really critical to us providing those health services to ADF members. Providing services on base that can be in close communication with a dedicated team with some continuity of membership of that team that supports command and individual ADF members is critical in underpinning our entire ADF health system.[6]

Scope of the works

3.12
The proposed project will deliver fit-for-purpose health buildings at 13 sites around Australia. The project proposes to construct eight new health centres and refurbish five existing health centres including:
1
Simpson Health Centre, Watsonia, Victoria. Defence proposes the construction of a new facility at this site. This new facility will include entry, administration, primary care (including mental health and rehabilitation), pharmacy, physiotherapy, dental, general support, external works, and Joint Health Unit Headquarters.
2
Puckapunyal Health Centre, Victoria. Defence proposes the construction of a new facility at this site. This facility will include entry, administration, primary care (including mental health and rehabilitation), inpatient unit, pharmacy, physiotherapy, dental, general support, external works and range response.
3
Albury Wodonga Health Centre, Victoria. Defence proposes the construction of a new facility at this site. This new facility will include entry, administration, primary care (including mental health and rehabilitation), inpatient unit, pharmacy, physiotherapy, dental, general support, and external works.
4
ACT Health Centre, Australian Capital Territory. Defence proposes the construction of a new facility at this site. This new facility will include entry, administration, primary care (including mental health and rehabilitation), inpatient unit, pharmacy, physiotherapy, dental, general support, external works and Joint Health Unit Headquarters.
5
Larrakeyah Health Centre, Northern Territory. Defence proposes the construction of a new facility at this site. This new facility will include entry, administration, primary care (including mental health and rehabilitation), inpatient unit, pharmacy, physiotherapy, dental, general support, and external works.
6
Oakey Health Centre, Queensland. Defence proposes the construction of a new facility at this site. This new facility will include entry, administration, primary care (including mental health and rehabilitation), inpatient unit, pharmacy, physiotherapy, dental, general support, external works and airfield response.
7
Campbell Health Centre, Western Australia. Defence proposes the construction of a new facility at this site. This new facility will include entry, administration, primary care (including mental health and rehabilitation), inpatient unit, pharmacy, physiotherapy, dental, general support, external works and deployable health accommodation for the Special Air Service Regiment.
8
Townsville Health Centre, Queensland. Defence proposes the construction of a new facility at this site. This new facility will include entry, administration, primary care (including mental health and rehabilitation), inpatient unit, pharmacy, physiotherapy, dental, general support, external works, airfield response and deployable health accommodation for No. 1 Expeditionary Health Squadron.
9
Russell Clinic, Australian Capital Territory. Defence proposes a minor refurbishment to an existing facility at this site. The refurbished facility will include entry, administration and primary care only.
10
Holsworthy Health Centre, New South Wales. Defence proposes a major refurbishment to an existing facility at this site. The refurbishment will include entry, administration, primary care (including mental health, pharmacy and dental).
11
Robertson Health Centre, Northern Territory. Defence proposes a minor refurbishment to an existing facility at this site. Minor upgrades are proposed for the mental health area, physiotherapy, inpatient and administration areas, while a higher level refurbishment will be undertaken in the dental clinic.
12
Enoggera Health Centre, Queensland. Defence proposes a major refurbishment to an existing facility at this site. The currently vacant operating theatres will be refurbished to accommodate the dental clinic. Other refurbishments will include entry, administration, primary care, mental health, pharmacy, and dental.
13
Pearce Health Centre, Western Australia. Defence proposes a major refurbishment to an existing facility at this site. The existing dental building will be demolished, and the dental department will be relocated from a separate building to the main health centre. The refurbished facility will include entry, administration, primary care (including mental health and rehabilitation), pharmacy, physiotherapy, dental, airfield response and deployable health accommodation for No 2 Expeditionary Health Squadron.[7]

Cost of the works

3.13
The total estimated capital delivery cost of this project is $212.5 million (excluding GST). The cost estimate includes construction costs, professional management of design fees and all fittings, equipment and infrastructure. It also includes appropriate allowances for contingencies and escalation.
3.14
The Committee received a confidential supplementary submission detailing the project costs and held a hearing with Defence on the project.
3.15
The Committee is satisfied that the costings for the project provided to it have been adequately assessed by the proponent agency.

Local impacts

3.16
The Committee received evidence from one local residents group regarding the impact of proposed works at one site; Gallipoli Barracks, Enoggera, Queensland.
3.17
The submission from the Gallipoli Precinct Action Group (GPAG) stated concerns relating to traffic management at the site:
…non-compliance to Traffic Management Plan and Traffic Directives by Gallipoli Barracks [means] traffic remains problematic and continues to affect the safety and amenity of the local residents.[8]
3.18
The GPAG highlighted that traffic management at the site had been an ongoing issue impacting local residents:
A long, documented history regarding non-compliance to Traffic Management Plans and traffic directives exists and these issues are exacerbated when projects are undertaken at Gallipoli Barracks. These issues of non-compliance have formed the foundation of a number of submissions to the Public Works Committee by the GPAG and others over the past several years and remain problematic and unresolved.[9]
3.19
Defence provided a Community Consultation Report[10] to the Committee that outlined a response addressing the traffic management issue, stating that GPAG representatives had attended community information session about the project and that:
The project team confirmed that the contractor would be required to adhere to a Defence approved traffic management plan during construction, and that a single point of contact would be provided to raise issues with.[11]
3.20
The Community Consultation Report from Defence outlined all other consultation activities relating to all other sites the project encompasses, stating:
Whilst there was limited public participation across the provided communication channels and engagement activities, there were no objections raised to the proposed works. There were some minor concerns raised about traffic, dust and noise during construction, but there are no major issues or concerns that require further action. Defence will continue to manage these issues until construction is completed.[12]

Environmental

3.21
In its submission, Defence stated that environmental and heritage impacts had been considered for each proposed new site.
3.22
Only one site was identified as having a high-risk heritage impact: the ACT Health Centre at the Royal Military College. This site is proximate to the Changi Chapel and Robert Campbell Road, which are regarded as having heritage value of exceptional significance.[13]
3.23
Defence explained that the heritage risk at this site would be mitigated:
Defence has undertaken a heritage impact assessment of the proposed new ACT Health Centre, and extensive consultation with National Capital Authority (NCA) and designed into the plans protection and extension of the heritage vista requirements.[14]
3.24
There are no significant heritage concerns for the other 12 sites.
3.25
Environmental assessments have occurred at each of the new sites, including reviewing the Asbestos Register and geotechnical testing for poly-fluoroalkyl Substances (PFAS).
3.26
Defence stated:
Defence’s Asbestos Register for each of the sites has been reviewed during the design phase. This will guide the identification and removal of asbestos during the construction phase of the project. Asbestos accommodation will be removed in seven existing facilities proposed for demolition (Simpson Health Centre, Albury Wodonga Health Centre, ACT Health Centre, Holsworthy dental building, Oakey Health Centre, Townsville Health Centre and Pearce dental building). The asbestos will be disposed of in accordance with local statutory requirements.[15]
3.27
Defence told the Committee that PFAS testing had occurred at each site.[16]
3.28
Defence submitted:
Geotechnical testing for [PFAS] has been undertaken at every new build site. Minor concentrations of PFAS compounds were detected in shallow soil samples at Oakey Army Aviation Centre and RAAF Base Townsville. The concentrations were found to be below the adopted Defence Human Health (Residential) screening criteria. The risk to human health and the environment is considered low. Testing will continue at these sites prior to, and during construction.[17]
3.29
Defence also acknowledged it is possible that other types of contamination will be discovered during the construction phase - but Defence would mitigate this risk:
The site-specific Construction Environment Management Plans (CEMP) will incorporate appropriate environmental control measures to ensure that any contaminated material is handled in accordance with the relevant legislation, codes or standards. Development of the site-specific CEMP is the contractual responsibility of the construction contractor. Compliance with the approved management plans will be audited throughout the course of the project.[18]

Committee Comment

3.30
The Committee recognises the importance of suitable health facilities in enabling Defence capability.
3.31
The Committee understands that it is important that ADF staff utilise internal health services over mainstream health services. The ADF needs to know the health status of personnel, especially to determine suitability for operations. This helps Defence manage risk, in particular for deployment. Being able to offer more comprehensive health services will encourage personnel to stay within the internal health system.
3.32
Furthermore, the Committee notes that Defence is a nuanced operating environment that has different health standards to civilian norms. Unlike civilian primary healthcare providers, internal ADF practitioners have a unique insight into the operational requirements and overarching policies and services that impact personnel. The Committee notes that offering a comprehensive, internal health service will therefore better meet the needs of personnel and the ADF more broadly.
3.33
The Committee understands that mental health is a key issue for the ADF and that this project will help remove barriers for personnel accessing these services. For example, existing mental health services are often in obvious stand-alone buildings. The new facilities will be large, multi-purpose spaces that will offer a variety of services. This new model will help reduce the stigma around accessing mental health services.
3.34
The Committee is aware that PFAS has had a significant impact in local communities where Defence facilities are located. The Committee appreciates the steps Defence is taking to address PFAS management in this project.
3.35
The Committee notes the on-going traffic issues experienced by local residents at Gallipoli Barracks, Enoggera, Queensland. The Committee encourages Defence to keep communicating with local residents in order to find solutions that work for both parties.
3.36
Having regard to its role and the responsibilities contained in the Public Works Committee Act 1969, the Committee is of the view that this project signifies value for money for the Commonwealth and constitutes a project which is fit for purpose, having regard to the established need.

Recommendation 2

3.37
The Committee recommends that the House of Representatives resolve, pursuant to Section 18(7) of the Public Works Committee Act 1969, that it is expedient to carry out the following proposed work: Joint Health Command Garrison Health Facilities Upgrade Project.
3.38
Proponent agencies must notify the Committee of any changes to the project scope, time, cost, function or design. The Committee also requires that a post-implementation report be provided within three months of project completion. A report template can be found on the Committee’s website.

[1]     

Department of Defence, Submission 1, p. 5.

[2]     

Brigadier Matt Galton, Department of Defence, Transcript of evidence, 31 January 2018, p. 1.

[3]     

Department of Defence, Submission 1, p.p. 5-6.

[4]     

Department of Defence, Submission 1, p. 6.

[5]     

Department of Defence, Submission 1, p.p. 5-6.

[6]     

Commodore Sarah Sharkey, Department of Defence, Transcript of evidence, 31 January 2018, p. 6.

[7]     

Department of Defence, Submission 1, p.p. 23-26.

[8]     

Gallipoli Precinct Action Group, Submission 2, p. 3.

[9]     

Gallipoli Precinct Action Group, Submission 2, p. 2.

[10]     

Department of Defence, Submission 1.2

[11]     

Department of Defence, Submission 1.2, p. 9.

[12]     

Department of Defence, Submission 1.2, p. 2.

[13]     

Department of Defence, Submission 1, p. 9.

[14]     

Department of Defence, Submission 1, p. 9.

[15]     

Department of Defence, Submission 1, p. 10.

[16]     

Brigadier Matt Galton, Department of Defence, Transcript of evidence, 31 January 2018, p. 5.

[17]     

Department of Defence, Submission 1, p. 10.

[18]     

Department of Defence, Submission 1, p.p. 10 -11.