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North West Maternity (Employment Entitlements) Bill 2023

Dr Rosalie Woodruff MP

Dr Rosalie Woodruff MP  -  Tuesday, 12 September 2023

Tags: North West Tasmania, Health

Dr WOODRUFF (Franklin - Leader of the Greens) - Mr Speaker, the Greens will support this bill. We have a couple of questions that we will probably raise in the Committee stage, although I will speak on some of them in my contribution.

It has been such a long and painful process for the people who live in the north west. It has been a train wreck that many Tasmanians have been watching unfold since the Liberals came into Government in 2014. In 2016, the Government took the step of moving birthing for the public and private patients into the North West Regional Hospital. At that point it was considered to be not safe. Concerns were raised that facilities at the North West Regional Hospital were not adequate.

There was an independent review in 2017 which flagged a whole raft of concerns. Still it dragged on. Under Mr Ferguson and then Ms Courtney, but particularly under minister Ferguson, there was no significant action on the concerns that mothers and families, and midwives and other staff in the north west were raising about poor service delivery at the North West Regional Hospital.

The Greens understand that the service delivery problems were nothing to do with the quality and care of the staff who were there at the time. The staff have always done an incredible job at the North West Regional Hospital under unbearable circumstances. The unbearable circumstances have been the chronic failure of successive Health ministers to take the concerns of mothers, staff and doctors seriously regarding the impoverished services available there, the lack of staff and resources to be able to provide maternity services that were safe.

The independent review in 2021 recommended that the Liberals reverse the decision they had made and move birthing services back into the North West Regional, away from North West Private Hospital. The AMA, the ANMF, mothers who had experience of birthing, as well as the report made it clear that this needed to happen as a matter of urgency. The Government's response was to push it off again until November 2024, three years after the 2021 review and seven years after the 2017 review.

Nothing would have changed if it had not been for the voices of mothers who had had hard birthing trauma experiences, mothers who talked about PTSD from the experiences they had had. These experiences directly related to under-resourcing of birth services at the private hospital. They talked about the lack of adequate pain relief. They talked about mothers who were left alone for extremely long periods without any support. About doctors not asking for consent before conducting exams. About mistakes that ended up in birth trauma and in injuries for children and babies.

While these mothers were making these statements, Mr Ferguson said that the transition should not be rushed. 'We have completely transformed the model of care for maternity services and we are constantly improving it,' he said.

This was only days before the AMA made the statement that maternity services in the north west were no longer safe and were, to quote vice president Dr Annette Barratt, 'Inefficient, ineffective and dangerous'. She belled the cat. She made it clear that staff there were utterly overwhelmed. There were not enough doctors, not enough midwives to provide the services, that women in labour were being turned away and being sent to the Launceston General Hospital, or to the Royal Hobart Hospital when the Launceston General Hospital was full.

The Deputy Premier was insisting there is 'nothing to see here' and gaslighting families and mothers from the north west, pretending that their maternity services were constantly improving and there was a transformed model of care. In fact, what had happened under the Liberals is the model of care had been transformed into something which was a dangerous and unsafe situation in which for women to give birth. The AMA talked about persistent issues with not enough staff. The AMA raised this directly with the Premier in September last year in writing and through a conversation in person with the Premier. The Premier, who had been Minister for Health, should have known how critical it was to act on those services. Dr John Saul, the president of the AMA, said:

Midwives are naturally leaving the private maternity services due to retirement or lack of certainty of employment in the future. Recruiting new ones is proving difficult for the private hospital. Additionally, several O&G doctors have or are about to leave the system. Those hardworking doctors and midwives left in the team are now being expected to carry too big a workload to be able to provide a safe service. I want to be clear we are not reflecting on individuals working in the maternity ward but on a broken system.

The system was broken in the North West Private Hospital but also has been broken and shown to be so across other hospitals in Tasmania because the Liberals have refused to undertake any nursing or midwife recruitment and retention planning at all, until being forced to do so after the last election when that process started. The Government has now been playing catch-up after nearly a decade of underinvestment and ignoring the repeated calls about the fact that our workforce was ageing and close to retirement. Such a large cohort of our nurses and midwives are close to retirement and we have people staying on in the North West Private working in unbearable situations because of their dedication to their work and the care for the women who go there.

We see a repeat of the same situation in the emergency departments in particular of the Launceston General Hospital and Royal Hobart Hospital. Both of those Eds have medical staff, nurses and midwives who are working under unbearable stress. I have recently spoken to two people who have worked at the RHH and they describe it as a war zone. These people are emergency medicine trained and they are going into a war zone every day, with extreme lack of resourcing and no spare time to do anything, so that even triaging is at its most basic level. I spoke to someone the other day who went in to do a shift and never made it through the door into the bed area of the ED because they spent their whole shift triaging patients in the admissions area. They never got out of there to do the work they were on shift to do, leaving one less person down because of the desperate lack of staff.

This is a result of the Liberals' failure to do this staffing and retention work and also the work on real wages and conditions, because without comparable wages and conditions to other states Tasmania can no longer compete in the national health workforce market because we do not have cheap housing or a cheap cost of living to offer in Tasmania anymore.

I want to acknowledge and honour the staff who work under those intolerable conditions. What must they have felt like to have had a report delivered in 2021 saying the situation was dire while at the same time their employer, the THS and the Minister for Health saying they were not going to do anything for three years at minimum; they were going to kick the can down the road. That is the same response we have had with the other report into problems at the LGH in particular.

What we have today is a bill which is finishing up the work that should have been done in this place in 2017.

Dr WOODRUFF (Franklin - Leader of the Greens) - Mr Speaker, I will conclude by speaking to some of the recommendations in the final report of the Independent Review of Quality, Safety and Management in the North West Maternity Services, which was the review that recommended that the services be transferred to the North West Regional Hospital immediately. and it took the Government two years and the outcry of mothers who had experienced poor birthing services, also the Australian Medical Association (AMA) and many others to speak out about it before it happened.

The review was a thorough one and it has a number of matters within it - recommendations that are still outstanding. I know Ms Dow spoke to some of these earlier. In particular, recommendation No 2 that:

A body of work be undertaken to address workplace cultural issues that were identified in the report with the aim of unifying the service, acknowledging that significant investment is required to build workplace culture, reflecting the shared values and build the capacity for all staff to work collaboratively across the maternity service to deliver high-quality safe patient care.

The Greens maintain that clearly has not happened across the Tasmanian Health Service. We can see that the failures of the Government in the resourcing and supporting staff to build a workplace culture which can ensure the provision of high-quality and safe patient care has occurred, not just in the North West Private Hospital and the relationship between it and the North West Regional Hospital but across all other hospitals.

This is what has happened as a result of chronic underfunding and lack of planning for nurses and midwives in particular for the last decade. We are now in a situation where we have reports coming from the emergency departments of our major hospitals that the stress on staff is so great because of the increase in load and the bed blockage. Because there has not been a commensurate increase in bed capacity and especially of staffing availability, people are working under enormous workplace stress. In that situation, what it is creating is what always happens in organisations when people are working under pressure: it creates competition between individual units and between different working worker types within an organisation.

This is no criticism or comment about people who are working in the THS. It is a function of pressure on organisations with limited resources that inevitably leads to competition rather than collaboration when people are desperately trying to get work done. So, the sort of collaboration and engagement between people who are working with different job descriptions within an emergency setting, or in any health setting, such as in the provision of maternity services, requires good communication and the constant building up of relationships between the different groups who have different tasks to perform. What happens under pressure is that there is not the time to build up the relationships. You are literally in an emergency mode all the time and focused on getting the job done as best you can. What falls away is communication. Therefore, what falls away is an understanding of where gaps might be happening and where mistakes might be made. That is what we are seeing more and more from the reports that are coming from our emergency departments and from Ambulance Tasmania paramedic staff. It is a symptom of a system under extreme pressure.

The problem with that is that it results in failures and in harm. It results in things like people dying on the ramp, and people dying when their death could have been avoided, as we have seen from a number of coronial inquests.

I would like the minister to speak specifically to recommendation 2 to tell us what is happening in the north west. I would like to think it was happening across the state, if anything is happening there. It is the lack of investment in people - in bringing them on and in keeping them in place - that has led to a situation where it is a really tough place to be working as a nurse or a midwife or medical staff or in the other roles in our hospitals at the moment.

Recommendation 13 is that:

Midwives in the north west are to be engaged and supported through secondment to work at other sites within Tasmania. This would be in addition to engaging with other professional development activities.

The purpose of that is to allow for skills transfer and to make sure that people are not siloed and isolated in their professional skill development and to give us the most highly skilled professionals working in regional areas of Tasmania. If the minister could speak to the recommendation 13 and where the Government is up to with implementing that.

Finally, recommendation 14:

Work arrangements for midwives be reviewed to encourage and support the capacity to work across the full scope of practice.

This is very important, not just for midwives, but also across many other areas of health expertise. I am thinking of nurses and the need for trained nurse practitioners in Tasmania to be able to take up some of the scopes of practice that currently must be undertaken by a general practitioner but could be taken by a nurse practitioner. The other area is with paramedics who are trained as a paramedic but who can become an intensive care paramedic and do further work to become a paramedic practitioner and ultimately lead to a pathway of increasing their scope of practice through, for example, doing a degree at the University of Tasmania and taking up some elements within a degree of emergency medicine.

This is what other states offer. They offer the opportunity for people who are skilled in an area to increase the scope of practice. That gives more opportunity for people to be able to work on a range of tasks without having to necessarily have the individual specialities on the spot all the time for the range of responsibilities that they are a currently certified with. There are many times that some of the things that general practitioners do, a nurse practitioner could do with paramedic practitioners, were we to have them in Tasmania. If we were to remove the legislative impediments the Government has in place, it would enable people to increase their scope of practice. People who are already trained in emergency medicine, who already have the skills of being able to work in an ambulance setting would be able to expand and to be working alongside other medical professionals within the emergency department setting or in other parts of rural Tasmania. They would also be able to undertake work where currently there is not an employed professional available to do that work. We have a skills shortage, in large measure because the Liberals have not invested in this area for a long time and have not planned for the retirements they were warned were coming, but there are also legislative changes that could be made that would help to reduce that by increasing professional scopes of practice.

I would appreciate it if the minister could please speak to recommendations 2, 13 and 14, with respect to where the implementation of those are up to from the Independent Review of Quality, Safety and Management in North West Maternity Services. [OK]

I have no other comment to make about the rest of the North West Maternity (Employee Entitlements) Bill other than that I am pleased it has finally come here and we are able to sort through questions of entitlement, and compensation, and conditions and so on for people who have been working in the north-west as midwives and in maternity. I thank the people who spoke out in 2021 for that initial report to be done and the investigation into the North West Maternity Services, and also those people who stood up and spoke about their experiences of birthing and how they needed it to be improved and how the Government needed to respond urgently in 2021. If it was not for them and the medical professionals in the AMA and elsewhere, we would not have had the changes that we did. We would still be in a situation where women in the north-west might be having to drive to Launceston or even Hobart to give birth. We are glad that is not the situation. However, given the pressure on the system, unless the Government changes its approach and puts more effort into recruiting and retaining medical professionals, these pressures are going to continue to rise elsewhere in the system because that is what we are seeing in our hospitals at the moment.