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Public Health Crisis

Dr Rosalie Woodruff MP

Dr Rosalie Woodruff MP  -  Thursday, 17 November 2016

Tags: Tasmanian Health Service, Health Crisis, Ambulance Ramping, Ambulances, Tobacco, Hospital Beds, WorkSafe, Bed Block

Ms WOODRUFF (Franklin - Motion) - Madam Speaker, I move -

That the House take note of the following matter: Tasmania's public health crisis.

The Greens have been watching, as has the rest of Tasmania, as the front pages of most of the state's newspapers have continuously throughout this year painted a terrible situation that has been unfolding since this Government and this minister took office and took responsibility for our state's health system. The minister made many promises and has not only failed to deliver on what he has promised, but has taken us into a far worse health situation than we were in even two years ago. It is the most appalling lack of ability, responsibility and a demonstration of where ideology is taking us in this state.

I will paint the picture of what this minister has done. Under a neoliberal market-first privatisation ideology, the minister has systematically cut the funds to the Health department. He has cut the funds to the hospital budget. The spend to this hospital budget is $18.5 million less this year than it was last year. That equates to a $50 million cut in wages, equipment and drugs. The work of people on the ground in the hospitals of Tasmania has been effectively cut by $50 million, specifically $7 million -

Mr Ferguson - When you say 'effectively' I worry about where you are going with this.

Ms WOODRUFF - The minister interjected but his department has not provided the evidence of what an $18.5 million underspend equates to.

Mr Ferguson - You are making it up.

Ms WOODRUFF - No, I am not making it up, minister. Experts in the health sector have estimated that would equate, according to the national standards for increases in wage costs and equipment, to an effective $50 million underspend this year in the hospital system, and $7 million less for emergency departments.

The management by the minister has been totally ad hoc. Every time there is a crisis he puts his hands on it and stomps it down by bringing in a short-term influx of opening a ward for a couple of months and then closing it again, or putting on some more casual staff and then taking them away again. He keeps trying to push it down, like a mushroom that pops up in one spot, and stamp it down over there. If another one rises somewhere else he tries to stamp it down. Unfortunately, it has got to a situation where we have had so many regular crises that he is no longer capable of fighting all the fires that are ablaze at the moment in the state.

The minister has used up all his capital. He does not have any other levers to pull. He has squeezed the life out of the public health system. He has blamed staff and pointed the finger at administrative inefficiencies, when in fact Tasmania's emergency departments are recognised, comparative to others in Australia, as being the most efficient. He has already the squeezed the efficiency as far as he can go. At the same time, he has created a situation by the mismanagement and the rush he has put on the THS restructuring process. That pressure has meant there is now staff at breaking point, staff in tears in the Royal Hobart Hospital emergency department, staff who are quitting, and staff who are repeatedly having to work overtime and double shifts.

This situation has arisen because the minister refuses to put on permanent nursing and doctor staff to staff the wards he opens when the mushrooms pop up over here. He opens a ward and does not put any permanent staff on them, so we have staff being taken from the casual pool which is leading to losses in staff in oncology, general surgical, orthopaedic, radiology, theatre, paediatrics, and especially in the emergency department.

It is impossible for the staff to manage in a THS restructuring process where they have not been consulted. They were given a consultation paper in October but the temporary structure is already in place. We have a structure where staff are acting in senior positions in the Royal Hobart Hospital and the Launceston General Hospital but they have not been trained. They do not have any support and are working in positions that are not legitimised or formalised. They are still being consulted by the staff and yet the system is working in this new draft structural position without a single person in the THS executive who is the voice of the hospital. There is no voice for the Royal, no LGH voice, and no north-west voice on the TSH structure anymore.

That is the situation we are in. In one weeks time, apparently, there will be a decant from the Royal Hobart Hospital. According to everything we are getting from the front page of the newspaper - because the minister is not providing us with these details - that decant will not enough beds. It does not matter how the minister likes to paint it, bed for bed is rubbish. The truth is there are already not enough beds; there is already chronic bed blockage happening in the emergency department in the hospital. The minister is using code reds as a deliberate strategy to deal with the chronic bed shortage as though it is an official technique when it is actually mismanagement, a disaster. Almost day in and day out we are getting code 3s at the Royal Hobart Hospital - serious bed block. That is because there is nowhere for patients to go upstairs now. We are going to move to decant next week in a THS system at the Royal Hobart Hospital where there are acting staff in senior positions, no voice on the THS executive, staff are working double shifts and overtime already and we are looking at having between 12-40 beds less in the new decant.

The emergency department was built 10 years ago for a 40 000 patient through-flow. Now the estimate is that we have 60 000 patients and this decant is going to go until 2019. That is at least three years where we will have less beds than we have now. We have an overflow now and we are going to have three years with less beds. As the minister knows, it has increased by 5 per cent every year, so what is the minister going to do to stop the meltdown in the Royal Hobart Hospital?

Time expired.

Ms WHITE (Lyons) - Madam Speaker, I note that no member from the government benches took the jump. I remind members of the data I shared earlier in this parliamentary session on information provided by the Australian Institute of Health and Welfare which shows Tasmanians are waiting longer in our emergency departments in our hospitals for the 2015-16 year compared to any other time in the past five years. There is no doubt the figures show our emergency departments in our public hospitals are under enormous pressure. For the month of October this year, 54 patients spent more than 24 hours waiting in the emergency department. That is a 300 per cent increase compared to October last year. It is simply unacceptable.

The figures also show that the average length of stay in the emergency department increased to the same time last year and that the time it takes for 90 per cent of admitted patients to leave the emergency department increased to 19 hours. That is a month-by-month analysis but I can provide an update to the House about figures just for today at the Royal Hobart Hospital emergency department. Currently, there are 20 admitted patients waiting for inpatient beds. Sixteen of those patients have been waiting for over 12 hours, seven of those patients have been waiting in our emergency department for over 20 hours.

These are patients who right now are sitting in the emergency department at the Royal Hobart Hospital waiting to get a bed who have been unable to be transferred into one. Why is that? Because there is simply so much pressure on our hospital, patient-flow management systems clearly are not working. The Patients First initiative obviously is failing in that these patients are being left to languish in the emergency department because they cannot access a bed in our hospital.

Right now ramping of ambulances has commenced at the Royal Hobart Hospital. So while we have over 20 admitted patients who are already waiting for an inpatient bed at the hospital, there are more turning up at the emergency department right now at the Royal Hobart Hospital. They will also need to be triaged. Potentially some of those will need to be admitted to the Royal Hobart Hospital.

While these figures are alarming for today, they in themselves are not indicative of the entire situation. If we look at just 10 days ago, we can see that a clear pattern has emerged. Ten days ago emergency department staff were dealing with a patient who had been waiting at the Royal Hobart Hospital emergency department for over 40 hours. Another had been there for over 30 hours. There were 14 admitted patients waiting for beds on 7 November. I understand that is towards the end of the day.

At the beginning of that same day on 7 November there were 21 admitted patients who had been waiting for a bed at the Royal Hobart Hospital. There is clearly a pattern here where our emergency departments are under enormous pressure. They simply cannot provide the beds that are needed to treat the patients who have been determined by triage staff to need admission to our hospitals for care.

It has got to the point where it is so serious that workers have started a campaign to highlight the bed crisis at the Royal Hobart Hospital. Members would have seen that launched recently. Members of staff at the hospital are being encouraged to [Bookmark: OLE_LINK47] 'wear red to save a bed'. This has come about because of their concern with the lack of beds currently at the hospital and the reduction in the number of beds available once the decant starts next week.

The ANMF joined with the Medical Staff Association at the Royal Hobart Hospital to launch this campaign because they are deeply concerned that there is no clear management strategy to enable safe patient care if current beds are closed during the decant. The ANMF claimed there will be 11 beds lost and further physical spaces reduced, which are currently used for flexing up when demands are so high.

The Minister for Health has claimed that there is no net reduction in funded beds. What he fails to acknowledge when he is trying to dismiss the concerns of the staff and allay the concerns of the public is that on any given day the Royal Hobart Hospital uses flex beds to accommodate the needs of the patients who are waiting to be admitted to the hospital. Once your transition, as the minister anticipates he will do from 22 November to the decant, the real risk is that without those flex beds we will have more patients waiting in the emergency department and they will be waiting longer.

If today we have over 20 admitted patients, waiting in the emergency department, some for over 20 hours already, as many as seven, what on earth is it going to look like next week once the decant starts? It is incredibly concerning.

The campaign that has been started by staff has been done in the best interests of patients. They are worried about patient safety and they feel that the strategy and approach taken by this Government is dangerous and putting patients' lives at risk. They are words from the Medical Staff Association themselves.

This is not politicisation of the issue at all by those of us on this side of the House. We are simply raising concerns of half of the staff and the membership of these unions. They are worried that they will be in a position where they are unable to provide appropriate and adequate care for the patients who present at the hospital. The minister needs to listen to their concerns.

Time expired.

Mr FERGUSON (Bass - Minister for Health) - Mr Deputy Speaker, I am pleased to speak to this matter of public importance and not just say what the Government's plan is but also debunk the false statements asserted by the Labor Party and by Ms Woodruff.

We are very committed to our One Health System reforms. I ask members to consider, with all of the pressures that we continue to experience every day, what would our health system be like without the reforms that we are implementing and without the extra funding that we are putting in place? What would it be like without those extra beds that we opened - that Labor closed? What would it be like without those extra 120 FTE nurses that are now part of our health system? Ms Rosalie Woodruff got it so wrong when she said that the THS is refusing to employ more nurses. There were 40 more nurses added to the nursing pool at the Royal.

Ms Woodruff - No, it takes three months to employ a nurse.

Mr FERGUSON - Do not change the subject; that is what you said. There are 40 more. The health system would be worse than broken today, were it not for the measures that we are implementing. The Government does not assert that the health system is fixed.

Ms White - It is worse today than it was five years ago.


Mr FERGUSON - The health system better today than it was.

Ms Woodruff - No, it's not.

Mr FERGUSON - It is better. We have already discussed the waiting list that Ms White now refuses to ever raise. She is disgusted that the Government has the waiting list at a record low.

These reforms are progressing and so they must. We are giving Tasmanians a truly statewide health service. It important that the failed structure put in place by the previous Labor-Greens government needed to be done away with Ms Woodruff said that there was no consultation on the restructure. Then in the same breath utters that there is currently a changed proposal being consulted with staff. You cannot have it both ways.

Ms Woodruff interjecting.

Mr DEPUTY SPEAKER - Order. Ms Woodruff, you have made your contribution.

Mr FERGUSON - For both previous speakers, apart from their false statements in identifying persisting challenges in our health system, it is just so typical that after nearly three years in opposition they still do not have any vision of their own. They have no plan. They have no policy that they can point to, which is absolutely a thing of shame. For an opposition that would expect people to think that they have a credible view on health, to not even be able to point to a hospitals policy is pathetic. There is never a solution. Just imagine what our health system would be struggling with today were it not for the extra resources.

Ms White - What is going to happen next week?

Mr FERGUSON - I hear Ms White say, 'What about next week?'. This is an important point. Having rescued the redevelopment from the turmoil that Ms White and the Labor Party left it in at the change of government, I now understand why Labor have refused to show support for the redevelopment. They want to be able to say it is not working. There are not enough beds. We are doing a full replacement of beds in the decant and it is safer. Ms White's party were going to send acute mental health patients into a northern suburbs nursing home - not appropriate. It is so typical. The person who said people would die of lung infections when the decant facility was being built -

Ms White - You're verballing me.

Mr FERGUSON - The Leader of the Opposition said that the Emergency Department would crumble under the weight. He scared people.

Ms White - You are verballing us.

Mr FERGUSON - It is on the parliamentary record. He said that the Emergency Department would collapse; said that it was crumbling; said people would get sick; said there was an illness cluster. WorkSafe looked into your claims and found that there wasn't a single case, let alone a cluster.

I also heard comments about ramping, overtime and double shifts - three problems in our health system that we are committed to addressing. Members should welcome that should stop misrepresenting the situation.

Ms White interjecting.

Mr FERGUSON - Listen to the negativity. Members should welcome the improvements, albeit modest. They should welcome the improvements that we have seen in these areas. It is arrogant to dismiss the improvements that are occurring.

Importantly, we are committed to fixing the health system that the Labor-Greens government left so broken. The health system is improving. The health system has a long way to go. The Labor Party, who left the health system in such a crisis, should support us in reopening beds that the Labor Party closed. They should support us in recruiting additional nursing staff who were put off by the Labor-Greens government.

We have seen some important refurbish works occurring in our centres. We have seen the redevelopment get back on track, pleasingly. The temporary inpatient facility, J Block: 54 beds brand new beds on site, brand new and to modern standard. I took a group of journalists through there on Monday.

Ms Woodruff interjecting.

Mr FERGUSON - I know you do not want to hear it. You are very uncomfortable with this. One of the journalists said to me once we are up there, 'Where are these temporary buildings?'. We were in them. They are at modern standard. While they are built for a temporary purpose they have been built to a permanent standard. They are stunning; they are clean and they are safe - debunking the scaremongering that took place where Ms White and Labor said that patients would get sick.

Members interjecting.

Mr DEPUTY SPEAKER - Order, Ms White and Ms Woodruff.

Mr FERGUSON - They're very uncomfortable. They said staff would get sick. It was dishonest. It was designed to scare. It is simply not true to in any way suggest that we have reduced expenditure in our hospitals when the budget papers make it plain that we have increased funding each and every year with increased spending in our hospitals. We had to fix the budget mess. The assertion that has been made, which is not even sourced, claiming that there is an effective $50 million cut is wrong. You are wrong.

Time expired.

Ms DAWKINS (Bass) - Mr Deputy Speaker, this matter of public importance has caused a lot of emotions in the Chamber today. The LGH has suffered from a number of significant challenges in the past 12 months, which have all been clearly documented in this place and in the media. The exodus of staff resulting from dangerous work conditions, understaffing, clogged emergency department and the constant flow of locums through the system, double shifts, ramping and bed block, all causing significant alarm.

The medical and clerical staff do their best in really difficult circumstances, having described the situation as dangerous and the solutions proffered by this minister as bandaids. When Ward 4D was opened there was a moment when people breathed a sigh of relief. The exodus of staff paused for a moment, people who remained stayed to fight on, but they want to know that ward 4D is going to remain open. They want to know that it is not a bandaid solution and that it is going to remain open.

Mr Ferguson - I am with you on that.

Ms DAWKINS - Excellent, that is very good news.

The systems have not given confidence to frontline workers. They are concerned that once the eye was taken off the ball that it would close, but now we have assurance from the minister today that the ward will remain open and will remain a full surgical ward.

Mr Ferguson - It's a medical ward, not a surgical ward. I have said it will remain open for as long as it is needed. I said so on day one.

Ms DAWKINS - I think their concern may be in the detail; for 'as long as it is needed' might be a cause for concern.

The continued use of local doctors, surgeons, psychiatrists has added to the sense of instability. It is difficult to maintain clinical practices when the key staff, those who sign off on patients' procedures, are fly-in fly-out workers with no connection to the hospital, to the staff and to the wider community.

Locums are expensive and are a real financial burden on the health system. Regional and rural hospitals all over Australia suffer from medical health professionals choosing lifestyles in big cities than those in regional and rural areas. Doctors know that the locum system is well and truly in place. They are able to work less for more cash. Who would not if that was the offer? This means that resources are not available to better implement the systems and they are left behind.

At present some departments still rely on written records and companies which provide document recovery services at considerable cost every time a record is required. The next step which I believe is being implemented at the LGH at the moment in some departments is where documents are scanned in to a computer and then reprinted for use when required. A contemporary e-health system is going to be expensive and will take time but it has to be implemented. At the moment I think it is a sign-up system but we need to see a system where if a patient presents in any circumstance their documents can be recovered immediately. The inquiry into palliative care we just have been through showed up more than ever that the most important think a person needs is the ability to be identified and have their wishes identified, especially when it comes to advance care directives.

Having seen the way the system at the LGH is now I can see that we are years away from that happening. With an ageing population it is not going to get any easier. We have to make sure that the most vulnerable people in our communities are taken care of and at this point because they are the ageing in our communities they are the least connected to the digital age and the ones who are going to need the most help to understand what they can sign up for. There is absolutely no point putting in an e-health system and saying come along and sign up if you do not know it exists or even what e-health is. There needs to be an enormous amount of health literacy that goes with what some are calling the 'disruptive age'. It will disrupt the end-of-life care and patient-centred care from many people in my electorate of Bass at the LGH until some significant investment is put into that system.

Patient outreach is also suffering from the lack of e-health records. At the moment psychiatric patients are seen as an outpatients and the staff are going through layers of written record to try to even find a patient if they have not come in for their appointment or they have not been able to contact them on the phone. These are high-risk psychiatric patients who if they are not taking their medication not only present a risk to themselves but a risk to the wider community.

It is considered a joke that the system is so broken with the incredible pressure of more and more people in my electorate of Bass feeling the weight of expectation and the strain on them. They present to the LGH to try to get some comfort from the system, to find some help and advice, and they end up in a situation where they are left with a psychiatrist who has just flown in from Brisbane, he or she is going to see them for that day, they are going to maybe take one step along the journey to good mental health, and they will be then exited through the department. The next time they come in to continue that care it will be a different psychiatrist they present to, and this happens endlessly. It is not just once or twice, this can happen 20 or 30 times to a patient. How is that giving them the sort of support that they need? We know we can offer it. We know about mental health in this community. We have studied it endlessly and we have an enormous amount of cultural practice behind it, but unless we get a system in place where those patients have some consistency, I am afraid all of that good work is going to waste.

I want to see a time where patients who present to the LGH, whether for post-operative care, psychiatric care or surgical care will be taken care of appropriately.

Time expired.

Mrs RYLAH (Braddon) - Mr Deputy Speaker, as we have just heard, the minister and the Government have been working hard since day one to overhaul our sick health system which Labor left in a shameful state after its 16 years in office. Staggering under the weight of waiting lists blown out of all proportions, our Royal Hobart Hospital was in an absolute mess, with ambulance ramping, dreadful clinical outcomes in Braddon, and a health budget in crisis after crisis.

Unlike previous governments, this Government has fully acknowledged, there are deep and systemic problems in the health system that need to be addressed in order for it to function at the level needed to deliver better results for Tasmanians. That is why this minister has been leading key work to address these issues, including the One Health System reforms, Rethink Mental Health, suicide prevention strategies, and the Healthy Tasmania Strategic Plan.

Contrast this against the actions of those opposite, when in government. We know they had a half-baked thought bubble about health reform before walking away when it became uncomfortable for them.

We are focusing on using our record budget better. That is, we are using our record budget to make record investment in health. This in stark contrast to Labor, and we all remember the 2011-12 Labor-Greens horror budget that included a $58 million cut to elective surgery over three years, the closure over 100 hospital beds, and a devastating cut to nursing staff with the loss of 287 nurses in a nine month period.

Labor and the Greens have made a lot of noise about preventative health from the other side of the Chamber. They have seen fit to criticise the Government's proactive agenda, Healthy Tasmania, even after their own abject failure to make meaningful change when they had the chance. The had the gall to criticise the decision not to pursue the proposal to raise the legal smoking age as part of Healthy Tasmania after not uttering a single word when they had the chance, during the lengthy public consultation. That is the height of duplicity and hypocrisy.

Labor and the Greens have been all over the place on preventative health. Labor's so-called preventative health policy contains a random, cherry picking of initiatives, without any vision. Astoundingly, it does not contain any actions on reducing tobacco smoking, which we know remains number one of the key preventable causes of death and disease in the community, particularly in Tasmania. It is a startling omission. Yet, they have the nerve to criticise the Government's strong range of actions on tobacco, which we have devised in consultation with stakeholders and the community.

According to their alternative budget, the Greens want to spend $100 million on a hodgepodge collection of preventative health initiatives, some of which do not even relate to preventative health and are seemingly backed by no overarching strategy. What else they will cut in the health system to -

Ms O'Connor interjecting.

Mr DEPUTY SPEAKER - Order. Interjections should cease. Mrs Rylah should be the only one speaking.

Mrs RYLAH - afford that outlandish policy? Elective surgeries, emergency department or cancer screening services?

The minister has outlined some of the key, high-level reforms under way. I want to touch on a few important initiatives relative to my electorate of Braddon. Earlier this year I was very proud to stand with Mr Ferguson to open the North West Cancer Centre. For the first time, many cancer patients in the north-west will receive radiotherapy treatment close to home, making it easier for them to maintain their normal daily life. We have delivered.

Through the One Health System reforms, the Government has now enacted an integrated a new maternity service in the north-west, and it is under way. Again, we have delivered. The service is located at the North West Private Hospital and is providing a high quality, sustainable service, and great outcomes for all women across the northwest.

We have recently seen the launch of the new hospital link bus service between Burnie and Latrobe to support patients and their families to travel to receive proper health care. It is a very good initiative. Earlier this year, the minister launched an additional 12 paramedics for the north-west, located at Latrobe. This is a terrific thing for the northwest community. A couple of months ago I launched initiatives in dental health for pregnant mothers and their babies, to deliver immediate and accessible dental care, called 'Teeth for Two'.

There is a long way to go in our work to improve Tasmania's health system, but the minister has made a bold start and has neither denied nor shied away from the challenges faced by this state. The minister and this Government will continue to deliver the leadership and vision on health Tasmanians rightly deserve.

Time expired.

Matter noted.