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Emergency Department Report Ignored by Ferguson

Dr Rosalie Woodruff MP

Dr Rosalie Woodruff MP  -  Wednesday, 8 March 2017

Tags: Emergency Department, Health Crisis

Ms WOODRUFF (Franklin) - Madam Speaker, I rise tonight to put some more context around the public discussion of the report the Minister for Health conducted in April last year as part of the patients' access initiative Patients First, so-called. This was conducted and called Review of Access to Emergency Care at the Launceston General Hospital and the Royal Hobart Hospital. It was undertaken by three academics from the Translational Research Institute, Clinical Service Improvement and Innovation Centres from Metro South Health, Queensland Government, and they are very eminent people in their fields.

The work they undertook was with staff participation from both of those hospitals, from the Tasmanian Health Service. Informal and open forums were held at both hospitals. All staff were invited to attend and they provided teleconferencing and private interviews, as required, to get that information across.

This material was not made available, although it was submitted to the minister on 31 August 2016. The minister held that material and did not release it to the staff who participated in the review or to the public. It was only released under a right to information request from the Tasmanian Greens a week ago, six months after the review was commissioned. A review that was commissioned, I have to say, on the back of some extremely damaging media about devastating incidents that happened to patients in the emergency departments in the Launceston General Hospital and, occasionally, in the Royal Hobart Hospital.

The review found a number of structural process and cultural barriers that are really affecting health care delivery in both of those hospitals. The main safety and quality issues evident to staff were the difficulty in providing high quality care in difficult circumstances, which was precipitated by overcrowding and delays.

The reviewers also noted in their summary that very long waits for inpatient beds were evident at both sites. They also noted that data had not been made freely available to clinicians to give them guidance and safety monitoring so that they could redesign their clinical settings and practise and improve their activities. Specific comments made by staff, and I am reading comments they quote on page 17 of their review report, one physician in the emergency department at the Royal Hobart Hospital said -

The ED is too small. We have become acclimatised to a standard of access - poor - and patient privacy equals very little, that most would not accept at any public hospital interstate. Access block undoubtedly makes the department very unsafe.

That was one clinician's comment. Another clinician said -

The hospital remains reactive, rather than proactive. We focus on an after the fact escalation policy that inevitably allows preventable harm to be visited on our patients. We need a major cultural shift.

Another comment the reviewers made is that there is a lack of clear reporting lines in the organisational structure that makes clinical redesign difficult.

A second comment they make was the clinicians were frustrated as they feel they have lots of good ideas for improving flow but inadequate structure to rapidly facilitate translation of ideas into practice. They would like permission to act.

Another comment was that there was agreement with the Royal Hobart Hospital concerns about unclear clinical leadership. Further, on page 26, a failure of basic processes was noted. Comments that they include are -

It takes too long to get anything done because no-one knows who is responsible.

Another comment -

We are happy to work with any government structure, we just need to know what it is and stick to it.

And a third -

I do not know who to email about that anymore.

Madam Speaker, the review is a devastating insight into the reality of the Tasmanian health service and how it is playing out for people's lives in this state. The Clinical Staff Association has noted the silence in the past six months and in that period, in late November last year, they met with the Premier and the minister and said to them -

We have significant reservations about the present and proposed future leadership and management structures for the hospital. The most recent iteration of the THS executive structure appears dangerously optimistic. That the structure ignores the complex clinical management strategy and planning requirements.

There has been no action by this minister for six months. The Clinical Staff Association makes that quite clear. Nothing has happened since that review. It has been sat on. It was released last week after a Green's right to information. The minister came out the next day and he embarrassed himself and this Government for dressing up 27 old beds as new, but let me tell you there were not 27 new beds. There were three new beds, as far as we understand, in Launceston. The rest of them were there, they have just been permanently funded, so the minister says.

This is a devastating lack of leadership and vision as the review itself notes and the Medical Staff Association have made the point that multiple concerted efforts have been made to alert the health service to the current governance ambiguity and dysfunction. We believe the future of the THF process itself is now in the balance.

Over to the minister to respond with some vision and clarity and guidance which is what his own staff desperately call on.