Choosing where to open, when need and workforce sit in different places

Most location questions get answered with a map of need. That is only half the answer. For services that depend on a scarce, specialised workforce, the places with the deepest need are often the places that are hardest to staff, so a plan built on need alone will stall on recruitment. The organising principle that came out of this work is simple enough to hold in a board meeting: need should guide where you look, and workforce feasibility should guide how and how fast you move.

Our client provides free, specialist mental health support to parents and infants, a model where the relationship between parent and baby is the focus of care. They had grown out from an inner-suburban base into the outer growth fronts, and demand was running well ahead of capacity, with families waiting nine to 12 months across the network.

Then a lease on one of their sites was confirmed as ending and would not be renewed. The two remaining clinics in that part of the city were both at 100 per cent of practical capacity, so the families served by the closing site could not simply be absorbed. A property date had become a service decision, on a deadline.

They wanted to understand:

• Where should the affected clinics be consolidated, so a single replacement site is both well located for families and realistically staffable?
• Does the rest of the current footprint still sit where demand is heading, or does it need to move?
• Which two areas are the strongest candidates for future clinics, and what would have to be true before opening one?

Behind all three sat a fourth need. As a not-for-profit making a case to a board, to funders and to government, they wanted evidence that was independent of their own advocacy and comparable across every part of the city.

We built one consistent measure of need for every residential small area in the metro, so a score in one suburb means the same thing as a score in another. The unit of analysis was the ABS Statistical Area Level 2 (SA2), roughly suburb scale.

The Service Need Index combines a Demand Index and a Vulnerability Index in equal measure. Demand is forward looking: current young families, forecast children aged 0 to 3 in 2035, and the growth in that cohort between 2025 and 2035. Vulnerability averages five equally weighted sub-domains: socioeconomic disadvantage, family structure, parental mental health, child development and housing.

Inputs were the 2021 ABS Census, our small-area forecasts to 2035, the Australian Early Development Census, small-area labour market data, hospital access data and the client's own de-identified operational records covering facilities, utilisation, client origin and waitlists.

Four things were kept deliberately outside the need score and reported in their own right: culturally and linguistically diverse (CALD) need, First Nations need, distance to the nearest clinic, and the local clinical workforce. Folding equity and access into a single average would have hidden exactly the tensions the client needed to see.

We were explicit about what the numbers can carry. Of 185 residential areas, 21 were reported as not assessed rather than given misleading scores. Re-running the index under alternative weightings barely moved the ordering of areas, holding a rank correlation of 0.98 or better against the base case, so the ranking reflects the data rather than our weighting choices.

This enabled assessment of:

• Where families with young children are most numerous, most vulnerable, and where both are true at once
• Where high need overlaps poor access, and where high need sits comfortably within reach of an existing clinic
• Where the specialised clinical workforce actually works and lives, and how far it travels
• How CALD and First Nations families are served differently by the same footprint

• 'Greatest need' means two different places, so it needs two different answers. The growth corridor holding the largest volume of need, around 88,000 of an estimated 327,000 vulnerable young families across the metro, is not the corridor with the deepest need, which records a mean vulnerability score of 78. Reaching the most families points one way, reaching the sharpest need points the other. That matters because it stops the conversation collapsing into a single ranked list, and reframes the work as a sequence of moves rather than one decision about one site.
• Need and staffability are not in the same places, and that sets the pace. The clinical workforce is anchored at a single employment hub with around 330 relevant clinical workers, only about 9 per cent of whom commute 30 km or more, and it thins to a handful and then to none across the growth front. In the highest-need outer corridor, about 2 per cent of the metro's clinical workforce lives locally while around 7 per cent of the vulnerable young families do. This is the constraint that decides timing: it supports anchoring the replacement clinic where staffing is realistic and reaching outward as capacity allows, rather than siting at the demand frontier and hoping to recruit.
• The largest gap is the place with almost nobody on the waitlist. The corridor that leads the metro on need and access combined sits 40 to 79 km from the nearest clinic with no service and no referral pathway, and so barely appears in the waitlist data. Read naively, the waitlist would have pointed the organisation in the opposite direction. Recognising that absence of referral is not absence of need changes which evidence the board leans on when it argues for expansion.
• Not every gap needs a building. About 43 per cent of families are already reached through home visiting, phone or online rather than at a clinic, so distance is one part of access, not the whole of it. The high-need CALD communities sit within about 3 to 16 km of an existing clinic, making language-responsive and culturally safe delivery the priority there rather than a new site. And the one clinic with spare capacity, running at about 41 per cent utilisation, sits in the second-highest-need area in its region, so unlocking it is a staffing question rather than a property one. Several of the cheaper, faster moves sit ahead of any capital decision.

The pressures pointing in each direction are unlikely to ease. The outer growth fronts are forecast to keep adding young children through to 2035 while the established inner base sees its 0 to 3 cohort fall, and early childhood developmental vulnerability has risen on every domain since 2018, so the underlying need is growing rather than shifting.

Workforce is the variable to watch. The evidence supports a phased approach to the deepest-need corridor, staged from the nearest sizeable workforce anchor and built around a deliberate recruitment, training and partnership strategy rather than an assumption that clinicians can be drawn locally.

The nearest decisions are the replacement site within the recommended zone, a staffing strategy to unlock the capacity that already exists, and the sequencing of the two expansion priorities. Referral pathway data and confirmed travel times would sharpen all three.

• The most urgent question was reframed. Rather than 'where should we grow', the decision became 'where can we replace this service inside a zone we can staff, while still reaching the growth front', with the evidence to defend the trade-off.
• The southern footprint question was settled as one of positioning and capacity rather than closure or relocation, and the spare capacity in the network was correctly identified as a workforce problem rather than a siting problem.
• Two expansion priorities were named with their feasibility risk attached, so the organisation can pursue the strongest case on need while being clear that workforce, not need, is what gates it.
• The board, funders and government partners now have one comparable, independent evidence base covering every part of the metropolitan area, including an equity view of CALD and First Nations need that is read in its own right rather than averaged away.
• The organisation has carried the method forward. Within five weeks of the board briefing, it commissioned the second stage, applying the same framework across regional Western Australia, and asked for the workforce analysis to look beyond who is there today to who could be trained and retained, so the evidence can support its case for workforce development funding.

Every recommendation was framed as an evidence-based priority area rather than a site decision. Lease terms, partnerships, funding and staffing sit with the client, and the analysis was written to inform those choices, not to pre-empt them.

If you're weighing where to place a service, and the places that need you most are the places you'd struggle to staff, we can help you see both pictures at once. We work with not-for-profits, councils and service providers to build comparable, small-area evidence that holds up in front of a board, a funder or a government partner. Get in touch and we'll talk through what your decision actually turns on.

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