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Want of confidence in Minister for Health, Mr Ferguson

30 April 2019
Rosalie Woodruff MP

Dr WOODRUFF (Franklin) - Madam Speaker, it gives me no joy to provide 
support on behalf of the Greens for this no confidence motion in the 
Minister for Health, Michael Ferguson.

I sincerely accept that the best path forward is without politics and 
hyperbole, looking at evidence and listening to the people with expertise 
in order to do the best that we can with the resources that we have at our 
disposal to keep people safe and healthy. However, the evidence of the 
past five years and the letter that was provided by the Royal Hobart 
Hospital's emergency department registrars to the hospital executive and 
through them to the minister has persuaded me that this minister is not 
able to appreciate and to act on in consultation with his hard-working 
staff. He is not able or willing to listen to the people who matter the 
most and have the most expertise. He is not willing, apparently, from his 
actions to plan and act to do the best that we can as a state to avoid 
preventable deaths and to keep people safe and well. He is not willing to 
give people the best possible experience they can have when they go into 
the hospital system, which is probably where anyone would be at their the 
most vulnerable when they are feeling sick and unwell. 

It is, at the moment, one of the worst places people can find themselves 
in when they or a family member or friend, someone who loves a person, is 
sick and distressed. The conditions in the Royal Hobart Hospital and the 
Launceston General Hospital emergency departments mean that people are not 
able to be treated in a timely fashion. They are not able to be given the 
dignity that they deserve in that very vulnerable space where they are 
typically suffering.

If there was any wavering about whether we should support this no-
confidence motion, those doubts would have been fully expunged by the 
Premier. Distressingly, he went into a football-campaigning media stunt 
that was all about noise and aggressive conversations about such a serious 
issue for Tasmanians. He repeated a shopping list of things that have 
been funded under the health budget over the past five years. So what? 
Who cares? Every Government has a shopping list of things that are done. 
It is the job of governments to run things and to do stuff. It happens 
all the time. So much of what the Premier was talking about was actually 
recurrent funding anyway that had been dressed up in another form to make 
it look as though it was new money. We have the evidence in front of us. 
We know that in its very first budget, the Liberals stole $210 million 
from the health budget. They stole it from the part of the budget that 
most needed the priority area to retain that funding. We never not get it 
back.

I have been in parliament since August 2015. Every single budget since 
then that has been delivered by this Health minister, the Premier and 
through Estimates under scrutiny of this Health minister, has continued to 
serially underfund, in real terms, the annual costs of the hospital and 
failed to plan for what is known to be a massive tidal wave of chronic 
diseases and preventable diseases. That is resulting in, as the Premier 
has pointed out, the key driver for why there is now a near doubling of 
people entering the emergency department.

This is all known, basic stuff. I am an epidemiologist but pretty much 
anyone can understand this. The Government knew it in 2014 because they 
took to an election the campaign promise that by 2025 Tasmania would have 
the best health of state in Australia. As I have every pointed out 
numerous times in parliament since then, in the last 18 months it has just 
dropped off the Liberal Party's web page and has essentially disappeared 
from any rhetoric or conversation. 

It is certainly not trumpeted as a vision of this Government any longer, 
because my view is that it is really hard to do that. Everyone knew it 
was a big reach but what I managed to experience just before the minister 
disbanded that advisory committee group was that there was a group of 
expert medical professionals who worked with the Population Health Unit 
and others from the university and other parts of the Tasmanian Health 
Service who worked to develop a plan of what needed to be done in order to 
get to that visionary goal of the best health in Tasmania by 2025. They 
delivered a report. It was always going to be a big reach. Everybody 
knew that, but it had a pathway. It had clear evidence-based approaches 
for what needed to be done. The minister simply received the report and 
said thanks very much, goodbye. That was it. Nothing else came of that. 
It just went into a black hole.

Mr Ferguson - That is so untrue.

Dr WOODRUFF - What happened, minister?

Mr Ferguson - I will tell you when I speak.

Dr WOODRUFF - Fine, that is good. What happened, and we all know this to 
be true, is that the Population Health Unit has been constantly 
underfunded. I believe they are still clinging on there because you have 
to have the name because there is this sort of federal government health 
stuff that requires things like that. Other than that, I am not even sure 
they would still be there. 

What we need to do as a state, and what this minister has never been able 
to achieve, is work at the structural level. We need to work on the big 
levers that are driving people to become more chronically ill and end up 
in an ambulance, waiting for hours or days, taking up the entrance to the 
Royal Hobart Hospital emergency department, sitting there with risks to 
their health and tying up the ambulance service so that other people are 
not available, instead of getting timely care. 

We should be investigating a sugar tax, best practice in so many countries 
now in the OECD and in developing countries as well. We could have had 
the best smoking legislation in Australia. We were almost there, but Big 
Tobacco obviously had a chat to the Liberal Government. That particularly 
effective legislation was highly supported internationally, nationally and 
Tasmania-wide and would have seen us drive down over time in a known 
fashion the rate of smoking in Tasmania, particularly amongst young people 
and women. These are the groups that will be there at the emergency 
department when they are 65 or 70 with emphysema. Unless we do something, 
two out of three people who smoke cigarettes will die from a disease 
related to smoking. That is two-thirds of every Tasmanian who picks up 
smoking today. 

Surely, if you want to have that as your game they are the things that you 
look at, but this minister has not gone ahead with those very successful 
strategies. Of course other things are around like cycling and walking 
and active transport and all the sorts of things which we are going to be 
patching together with a piece of legislation and helping the local 
councils join arms to try to work on this active transport issue amongst 
other things. Those councils, the Heart Foundation, the cycling groups, 
everybody knows that we all need to get up and do more exercise and unless 
there is a government-led strategy this is not the sort of thing that will 
ever be dealt with by the market. Never. Laissez-faire Liberal economics 
has no place. It is not effective. It will not solve these problems. It 
will not help young people stop smoking, it will not help middle-aged 
women, like me, drink less alcohol. I am in a new age category of women 
who, because of working, life stress, looking after children, going into 
work and the domestic sphere at the same time, it is another major risk 
factor, the amount of alcohol that people drink.

We need support. It is not all about leaving it up to individuals. Tony 
Abbott used to say it is up to parents to decide what their children 
should put in their mouth - 'It has nothing to do with government. We 
don't want a nanny state. We wouldn't possibly want to tell people what 
to do'. Why are we happy to tell people to put on a seatbelt but we are 
not happy to decide not to put money into junk food advertising on kids' 
television, or not to put a tax on sugar, not to take out sweet drink 
vending machines from hospitals. It is nuts. This is really simple stuff.

There is an ideological problem. I think Ms Archer might have been 
pointing to the fact that I strayed rather wide but I am trying to make 
the case that this is a systemic approach -

Ms Archer - I didn't say that.

Dr WOODRUFF - Didn't you? My apologies. 

This is a systemic approach that has been operating over years. It 
started when the money came out of the budget and continued every year 
when we never funded the hospitals, even to the base level. There has 
been so much written over the years about this. I want to recognise the 
work of people like Martyn Goddard who has diligently kept track of this 
on behalf of Tasmanians. He has been doing the work because there is 
precious little you can get out of the Health department in real-time data
. That has been another problem that has dogged this Government, and 
anybody else who wants to find out information about what has happened.

My point is that when the Treasurer sat there grinning triumphantly before 
the state election last year about the fact that Tasmania was back in the 
black, we know, and we can see now, why that was. It was about priorities
. It was about the priorities of choosing to serially underfund the 
Health budget year in, year out. It was about the priorities, which were, 
'This is an individual responsibility, we'll be light on this. Let's hope 
that the private sector steps in. Let's see what we can flog off and what 
we can pull back on. Let's see where we can point the finger at the 
federal government. Let's do as little as possible, especially dealing 
with the doctors, nurses and patient groups who had to set up to 
essentially fight for the rights of people who had suffered hard 
experiences and have got no comfort or solace from the response they have 
received from the department'.

Madam Speaker, we have been robbed. We have now had years of ramping at 
the emergency department on code 4. The staff distress and the crisis in 
the Royal Hobart Hospital emergency department is no longer just a winter 
crisis. It is an all-seasons crisis. We are looking at an horrendous 
story which is unfolding for the flu season this winter. We have already 
had official warnings from the public health department encouraging people
- I cannot remember if it was the minister or a representative - to get a 
flu shot because it was going to be a terrible year. Into that space we 
have a letter from the emergency department registrars saying they are in 
terrible crisis. April is finished, tomorrow is 1 May. Where is the 
winter flu plan that was promised in April? It is not like we cannot 
predict when winter is going to happen. We know it is the same time every 
year. We knew when this was going to happen last year and the year before 
and here it is again, the promise that it will be delivered, and it has 
not happened.

It is clear that there might be a lot of 'listening' but the reality is 
that it is not in company with or truly appreciating the experiences of 
the staff.

I want to mention, without naming the doctor, a personal conversation I 
had with somebody who works in the emergency department. This person said:

All doctors and nurses understand that there is no easy answer in health. 
You wouldn't work in that system. You just wouldn't work in the hospital 
if you thought there was a magic fix. 

Everyone knows that it is never going to be easy and actually when the 
minister came in, I went to an annual conference of the Tasmanian branch 
of the Australian Nursing & Midwifery Federation and I remember talking to 
a couple of people who said:

Health is impossibly hard. It's a poison chalice but we were ready to 
work with the minister. We really were ready to work with the minister.

Let us not gild the lily here: the Labor Party and the Greens do not take 
responsibility for the way that the health budget was managed and the way 
that the Health Department was managed in that last term of government, 
but it is clear that there is a history here. There was receptivity 
amongst people who were working at the coalface when Mr Ferguson and the 
Liberals came in that there might be a prospect of having a different 
approach but they were really sadly disappointed. 

The point that the doctor made to me was that as a leader you cannot solve 
all the problems. When you are in the trenches, you cannot stop the 
bullets flying over the top of you and you cannot stop people charging but 
what you can do is be there with the people who you are leading. The 
point this person made is that it is really listening and acknowledging. 
If the minister was able to be there and accept the reality of people's 
concerns and acknowledge the working conditions were tough and able to 
recognise that what they need more than anything, as this doctor said, is 
an ability to control the conditions that they work within. We all do; 
all humans need that.

In every job and workplace, and situation in life, we find that stress 
levels of the human animal go through the roof when we do not get to 
control the environment around us. In a workplace like the emergency 
department, that is especially extreme - doctors and nurses, cleaners, 
cooking staff and all other staff - they go there and they know what it is 
going to be like but they do it willingly because they love their job. 
They have a passionate commitment to the patients but they cannot suffer 
any longer without having any control over how decisions get made at the 
basic level.

It is the minister's responsibility to really listen and understand that 
there is a bottleneck in the decision-making and the flow of information. 
The minister has to work out where it is and he has to solve it. That 
involves listening to people and finding out, on the ground, where the 
bottlenecks are and why they are happening.

They have the answers. The wonderful, extensive five-page letter to the 
hospital executive has 19 answers in it of what needs to be done. They 
are very clear; they are detailed; there is no hyperbole. They are not 
over-egging anything; they are not asking for a new hospital; they are not 
asking for all the bells and whistles. They simply have some really clear 
ideas.

The first thing they want is to more fairly distribute the burden of 
access across the entire hospital. That would immediately improve the 
patient outcomes. That involves allowing the emergency department medical 
officer in charge to escalate to Level 4, irrespective of the time of day 
or night. This is the key thing. Here are the people on the ground. 
They know exactly how many people are in what beds with what problems. 
They know what the block is upstairs but they do not have the authority to 
make that decision. It is crazy. These are basic things. There has to 
be a leader, a minister, who sits down and works out why is that not 
happening? What is the real reason behind that? How can we move forward 
and make it work so that people have control over those basic things? So 
that they can develop the clear escalation strategy that they are asked 
for as a clear trigger for escalating to a Code 4, to an emergency 
situation. 

I know that the Premier, Mr Ferguson, and the Leader of the Opposition, 
also received an email on 13 April from a woman who has been a registered 
nurse with nearly 10 years' experience at the Royal Hobart Hospital 
emergency department. She talks about the sheer stress and anxiety of not 
being able to move patients or adequately treat them due to time and space 
pressure, coupled with insipid management strategies and constant promises 
of change from our current Government which never eventuate, resulting in 
a haemorrhaging of nurses from the emergency department staff pool. She 
said if she had the authority she would invite the minister and the 
Premier to visit the department, not only for a walk through but for an 
actual shift length. 'Sure', she says, 'I have seen you walk through the 
department hurrying along past messy cubicles, smiled to by patients on 
the ramp. Most people have a base level of politeness, not because they 
think you are doing a great job, but if you came through the department 
these days you would have the pleasure of viewing our very own 
colloquially named Ferguson Wing, the front ambulance ramping corridor or 
the Hodgman Wing, the entire back corridor, both of which are lined with 
ambulance and spare hospital trolleys'. She said she felt sick and 
stressed when she left work yesterday. 'But I will return', she says, 
'for the staff, my ED family and for the patients because you cannot rest 
on the goodwill of nursing, medical, allied health and auxiliary staff to 
continue to return day after day to an abominable working environment 
without an end in sight. It is up to you, to the minister and the Premier, 
who wield the political power, to make genuine and enduring change, 
including raising nursing salaries'. That is a huge topic and we all know 
that is an essential part of the problem here, recognising the value of 
people's work by paying them a proper and real wage.

Madam Speaker, how much time do I have?

Madam SPEAKER - Six minutes.

Dr WOODRUFF - What is the vision we want to have in Tasmania? In addition 
to things like the best health by 2025, dignity for patients when they 
come into hospitals, healing spaces like they have in other states in 
hospitals - not in large cities, but in smaller hospitals where they have 
healing spaces with light, magnificent gardens. We want money directed 
into preventative health to start to chip away at this tsunami of chronic 
diseases which is going to increase on a regular basis the number of 
people needing to come to the hospital for acute care. We cannot go there, 
we simply cannot afford it. We have to take action. 

That is a vision of what a great health system could look like, but let us 
just settle for what the registrars would like. The registrars would like 
the basic model. They are happy for the home brand version. That would 
be nice. What they would like is standard, national standard care in the 
time frames that are nationally prescribed. No more, no less. They do 
not want to be better than anywhere else. They want standard patient care
. They want safe work conditions. Simple stuff. We are not talking 
about building special staff rooms. They want safe working conditions. 
They want to be in a situation where they are not so distressed that they 
are forced to write a five-page letter to the hospital executive to be 
heard.

When I presented my arguments for why we needed to deal with this urgently 
today I flagged that we had an amendment to this motion. 

Madam Speaker, I do not have time to read out the motion but the Greens 
support it. I have spoken to most of it. What seems clear to me, 
particularly from what happened on the weekend in Canberra and the 
questions we asked this morning, is that we have a desperate situation. 
We have a Health minister who is failing to keep people safe and avoid 
preventable harm and illness so I will read this amendment to the motion 
into the House.

Madam Speaker, I move -

That the motion be amended by inserting the following new paragraph after 
paragraph 13:

Notes the minister refused to send a representative to the Australian 
Capital Territory pill-testing trial, reiterating his commitment to 
uninformed ideology above evidence-based public health policies that have 
the potential to save lives.

The Labor Party put in paragraph 13 to the motion of no confidence. 
Paragraph 13 is that that they note the minister had denied women access 
to legal reproductive health services in the public health system. The 
Greens have long believed that there is only one reason behind that 
decision to deny women access to their legal right to have surgical 
termination in a public hospital. It comes from a position of ideology. 
It is fine for people to have that ideological position. That is a 
person's right, but it is not the right of a minister to let personal 
views stand in the way of a woman's right to reproductive health and her 
right to choose what happens to her body. Women must have access to their 
legal rights in Tasmania. They are legally allowed to have a surgical 
termination. It should be in a public hospital. We should not have this 
pretence any longer of women needing to wait for a private provider. 
There are many concerns about the quality of care that could be provided 
by a private provider, given the very low number of surgical terminations 
in Tasmania.

We are seeing the same ideology operating here. To get to the core of it, 
this is really about continuing a particular narrative about 'tough on 
crime'. It is about misunderstanding the real value in providing people 
with education so that they can prevent themselves from dying or from 
becoming ill. We do this in every situation all the time. We are very 
sure to make sure that people look after themselves. That is the role of 
the health minister. The role of the health minister is to do what can be 
done. 

Nobody wants to see children at Dark Mofo, or at a festival such as Party 
in the Paddock or the Falls Festival or any other festival in Tasmania, 
succumb to illness or death because they have taken a pill that has lethal 
substances in it. This is something we can do and we can do it now. The 
best thing about it is we would drive down and rate and consumption of 
those pills. 

I do not understand where the blockage is. I do not understand except 
that it has been a long-held narrative of the Liberals and is now, with 
Michael Ferguson, a trenchant position on this issue. That means that Mr 
Ferguson is incapable of doing what he needs to do as Health minister. It 
appears to be something that he has adopted himself as something he speaks 
about on a regular basis. That is another compelling reason that we have 
no confidence in the minister fulfilling his duties as the Minister for 
Health in being able to keep people safe from the harms of contaminated 
drugs.

In summary, we have been robbed by the actions of this Health minister 
from having what was promised in 2014 - to fix the problems that they had 
identified in the health system. Each of the problems they identified 
have got worse. On top of that extra things were added. Very important 
relevant visions about having the best of the best, working towards the 
best health in Tasmania in 2025 has been dumped. Other letters have been 
written in the past by other people, but the most recent letter from the 
registrars signal that despite the fact we have been here before the 
minister is not doing what is required. This is the third year where we 
have had serious conversations with health professionals about how to deal 
with this crisis coming up to winter. 

As I said at the start, it really does give me no joy to support this 
motion but somebody has to take responsibility. That is unfortunately the 
job of the minister and he is not doing his job.

The Premier, the Deputy Premier and other members will talk about the 
failure to provide practical solutions in this situation. The Greens have 
done that. We produce a fully costed alternative budget every single year
. We will be jumping through the same hoops that Mr Gutwein will be 
dealing with - the $500 million gap in the forward Estimates. We will do 
that work. We are not the Labor Party. The Labor Party chooses to do it 
for politics from time to time, depending on whether there is an election. 
We do things for principles and policies. We have a fully costed 
alternative budget from last year. We have made the hard decisions; we 
have valued the things that matter to Tasmanians the most. Everything 
matters but, at the end of the day, you have to choose where to put your 
money. You cannot please everybody all the time. We are prepared to make 
the hard decisions. We are prepared to be constructive about this. 

In the event that this no confidence motion does not succeed we will 
continue to work productively and constructively with the minister and 
anyone else to try to find practical, achievable, costeffective solutions 
to the situation of health in Tasmania.