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Emergency Department at the LGH

Dr Rosalie Woodruff MP

Dr Rosalie Woodruff MP  -  Wednesday, 13 November 2019

Tags: Health, Emergency Department, Bed Block, Launceston General Hospital

Dr WOODRUFF (Franklin) - Madam Speaker, we support the Labor Party's motion. We have long been on record for wanting more clarity on the Government's responses to the Access Solutions crisis meeting undertaken on 19 June this year in response to five years of failed administration of the public health system by the Liberal Government. As we know, this has left our public hospitals in a deplorable situation in resourcing and capacity constraints, the bed block and the impact on patients and staff as a result of that.

That crisis meeting was of all people who were responsible or have a significant role regarding the access flow issues, particularly in the Royal Hobart Hospital. The Launceston General Hospital was referred to, but it was principally about the systems affecting bed flow at the Royal Hobart Hospital and the possible solutions that could be garnered from the people in the room. I participated in that meeting in good faith on behalf of the Greens, and spent the day with many experts, as you did, Madam Speaker, and a member of the Labor Party, trying to find solutions and come up with what could be done, noting that the big elephant in the room, resourcing, was not discussed.

Fundamentally, you cannot take $210 million out of the health budget, which is what the Liberal Party did when it came into government and expect that it would not set back the health system enormously. You cannot come into government and take money out of the community health and the preventive health sectors and expect chronic diseases not to increase across the state. You cannot take money out of allied health services and reduce the opportunities for people to prevent things getting worse and progressing to more serious infections, more serious conditions that need to be operated on or need an emergency department to manage. All of those things happened. It is the response to that that we are interested in. I notice that the minister henpecked through a couple of the things that were on the table of actions from the Access Solutions meeting. I did not have time to hear them in detail. It would be more honourable and transparent of her to lay before the House a detailed response to the Access Solutions meeting. We called on her yesterday to do that in parliament today. She has not done that.

The Australasian College of Emergency Medicine's recent report about the devastating bed block and impacts on patients who have to wait more than 24 hours, made it clear that they are not satisfied with the responses that have been taken since the Access Solutions meeting. They were present. Dr Simon Judkins, Head of the Australasian College of Emergency Medicine, presented to the meeting. He provided his perspective as somebody from a large Melbourne hospital. He has expertise around Australia in what can be done and what is being done elsewhere. He made some considered and expert points about what we could be doing in Tasmania.

ACEM's view that the number of patients who are exceeding the 24-hour period in Royal Hobart Hospital and the Launceston General Hospital is extreme. It is also extreme in relation to other states. We know that at the four largest hospitals in Melbourne there were only two cases last year of people having to wait more than 24 hours in an emergency department, whereas in Tasmania 1800 people had to wait more than 24 hours. That is an abomination. Every one of those people were in an extremely stressful situation, stressful for them and stressful for the staff who have to have this massive load of people in the emergency department waiting room. The impact on the whole hospital system is enormous.

ACEM know what they are talking about. It is a fact that no other state has a hospital system which leaves patients waiting for as long as the Launceston General Hospital and the Royal Hobart Hospital. It is also a fact that following that crisis meeting, five months later, we have not anything like transparency from the government in how they have responded to the solutions and the action plan that came out of that meeting.

I appreciate the minister henpecked her way through a number of the things that she says have been done but, as is the case with Police, Fire and Emergency Management, we need more than the say-so of ministers who have been anything but transparent on the management of their portfolio. We need some documentation and some information about where things are up to.

The Labor Party and the Greens were invited to participate and we did, in good faith, participate in those meetings. We should be given the respect of an update on where the Solutions Action Plan is up to; as should every other person who was in the room. The medical professionals, health professional bodies and agencies involved, should be shown the respect of being given a response to the action plan.

Again, I ask the minister to lay before the House the action plan outcomes and implementation from the Access Solutions meeting from 19 June. Immediate actions that were to have taken, happened within two weeks, short-term actions that were to have happened by the end of July, medium-term actions before the end of October and long-term actions before the end of May next year. Where are these up to? What is not being done? What are the reasons for their not being done?

As for the amendment that the Government has provided, I am interested to hear Ms O'Byrne's comments on this. She has intimated to me that there would be the possibility of doubt from staff that the audit that is presently being undertaken is sufficient in its scope and independence. I am interested to hear more about that.

If an audit of escalation levels is being undertaken, then it clearly has to be an independent one. This Government has a very bad track record of managing these things in-house.

From their perspective, ACEM thought that 'heads should roll', that is their term, in the department. They feel that things are happening in the senior management that are a blockage. The Greens do not have a position on this, other than that it is the responsibility of the minister to work out where the blockages are in the system.

We do not go picking at individual members of the public service, bureaucrats, senior levels of management. It is not our role to point the finger at them. It is the job of the minister to identify where the blockages are and to fix them. Given that clearly it is not being done, our preference is that audits are undertaken by independent bodies. We will wait to hear Ms O'Byrne's response to this proposed amendment before we will make our minds up.

Whilst things have been appalling at the Royal Hobart Hospital, it is quite clear that what has been happening at the Launceston General Hospital are not much worse. The sheer numbers of people moving through the Royal Hobart Hospital has blown out the situation in the emergency department to an even more extreme level than is happening in Launceston.

There is no doubt that the nurses and doctors, people from the ANMF and HACSU, the LGH staff association, have all been speaking with one voice about the need to have an escalation policy at the LGH. They are concerned that this has been happening at the Royal Hobart Hospital and should be happening at the Launceston General Hospital as well.

We are concerned that although the Government keeps peddling the mistruth that they are spending more than ever on the Health budget, the fact is that they are spending less than they have in previous years consistently, and this failure to prioritise spending to at least keep pace with the increasing costs of health care year in and year out is having a terrible, corrosive effect on the system. You can keep cutting for so long, and then you get to a point where it is just not possible to provide services.

We have had this Government cut the Threatened Species Unit. In 2012 there were around 25 people in the Threatened Species Unit in the department of Parks and the minister has confirmed in the not-too-distant past that that number has been cut to one. Under this term of government the work of the Threatened Species Unit has been more than decimated form 25 down to one and the ability of that unit to be able to perform its function is impossible. It is absolutely impossible for the Threatened Species Unit to undertake all the things they are required to do under law, required under good process and required under their charter, to look after the conservation of threatened species. When you have something like that happen in the Threatened Species Unit, and then you imagine the same attitude happening in the Health department, we are talking about real patients and real staff working in areas, some of which have been slowly decreased over time, and their ability to perform for quality health care is diminished.

The evidence is the emergency department at the Royal Hobart Hospital where - and the Auditor-General made this point very clearly - that the performance of the emergency department service has been absolutely compromised and efficiencies have declined. What is much more important is that there have been real concerns about the rate of adverse events that have been occurring at the emergency department. These have increased significantly at the Royal Hobart Hospital between 2015 and 2018, and they have increased significantly at the Launceston General Hospital during the same period.

Adverse events across the four hospitals in Tasmania have gone up by 60 per cent in three years under the Liberals, and most of those events occurred at the Royal Hobart Hospital and the Launceston General Hospital. There has been a sharp increase in adverse health outcomes for people who have been admitted to the emergency department. That is why the Auditor-General recommended an urgent review into the root causes for this increase in adverse events and recommended targeted initiatives to mitigate the impacts and reduce further future incidents.

It is pretty clear that an escalation policy at the LGH is an absolute minimum requirement for the work that the Auditor-General has recommended. That is one of the many initiatives that would be required to make sure patients are attended to in a timely fashion and are correctly identified and triaged, and that there is an ability to escalate the operations of the Launceston General Hospital emergency department if required because of the burden of cases staff are facing.

We strongly support the motion and believe this is not just an operational management issue. It is fundamentally a resourcing issue and with a Government that has a Treasurer who has just agreed to cut $50 million out of the Royal Hobart Hospital, I do not have the figures for the cuts to the Launceston General Hospital, perhaps Ms O'Byrne is more aware of that, but these are real numbers and they have a real effect on the number of staff that can be employed and especially on the number of patients that can be operated on and cared for in emergency departments. This will require not just an escalation policy for the LGH but a fundamental refocusing of the Liberals onto supporting public health services and recognising the value of the people who are employed by the public purse, by taxpayers in Tasmania who want their money to go towards quality health services so that when they need them they can be sure they can get them.