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Want of confidence in Minister for Health, Mr Ferguson
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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.