Health and Wellbeing
Tasmania’s health system is in crisis. Our ambulances are the slowest in the country, elective surgery waiting lists are soaring, and the proportion of patients seen on time in our emergency departments has crashed since 2014. [1] We have the highest hospital admission and prescription rates for mental ill health in the country.
Successive governments have failed to plan for the inevitable annual additional patient load, or the need for more capacity in beds and staff due to our increasing chronic disease burden and ageing population. The Liberals’ health promises have been crafted to plug gaps at election times, but done nothing systemic in between years to plan an enduring fix for the challenges. In the last seven years we have seen active health system cuts in key areas, such as elective surgeries, and the total health spend has failed to keep pace even with the annual increasing cost in health consumables let alone the increasing burden.
There has been no effective spending on preventative health, which is essential to help keep people well and out of hospitals.
The daily overwork burden faced by nurses and midwives, paramedics, clinical specialists, allied health workers, and mental health specialists has been dismissed for far too long. It also inevitably leads to poorer health outcomes for patients. It’s time we put the voice of those on the frontline at the centre of our conversation about tackling the health crisis.
Tasmania can’t ignore the reality of understaffing, insufficient beds and surgeries, the mental health impacts on staff, and the failure of governments to provide timely, accessible, affordable health services when people need them.
Urgent and substantial investment and planning is needed in preventative and community health, mental health, ambulance services, hospital staffing, and infrastructure capacity.
The Greens have listened to the concerns of health workers, patients and community. Our plan would confront the challenges they face head on.
Figure 3.5.1: Proportion of Emergency Department patients seen on time, by category[2]
Statewide Strategy for Emergency Departments
The report on overcrowding and waiting times in Tasmanian emergency departments handed down by the Australasian College of Emergency Medicine in late 2019 clearly demonstrated how patients’ lives were being put at risk by unsafe delays in access to necessary inpatient care.
ACEM also supported the findings of a 2019 report from the Tasmanian Auditor General, which found scope within the hospital system to free up existing capacity by improving processes around bed management, admission, patient management, and discharge. [3]
ACEM recommended the development of a statewide strategy for safe emergency departments that would effectively coordinate and implement improvements to process, procedures, and culture within hospitals, and that the Tasmanian Government introduce mandatory reporting of 12- and 24-hour waiting times in emergency departments.[4]
The development of this strategy must be informed by evidence and data, and include meaningful input from all health professions.
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Statewide Strategy for Emergency Departments |
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We would develop a Statewide Strategy for Emergency Departments, and introduce mandatory reporting of incidents of 12- and 24-hour waiting times in emergency departments. |
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Launceston General Hospital
The serious issues at the Launceston General Hospital are being felt throughout the communities of northern Tasmania. According to the Australasian College of Emergency Medicine, the LGH has the worst access block in Australia. Patients and healthcare staff from all professions have consistently demanded action to address access block, staffing levels, pressure on the emergency department, hospital capacity, and access to specialist.
Despite the crisis at the LGH, the government has refused to budge on addressing key concerns. For example, the Australian Nursing and Midwifery Federation have been forced to take the government to the Industrial Commission, just to try and ensure safe staffing levels for the Emergency Department.
The range of measures outlined in this policy - e.g. the Statewide Strategy for Emergency Departments; a public Urgent Care Centre for the north; recruitment of more nurses; preventative health measures - will assist with the critical situation at the LGH, however it is also crucial to invest in increased hospital capacity in the North.
Unfortunately, the Launceston General Hospital Masterplan is still yet to be released, but when it is this document will provide a clear direction for prioritising infrastructure investment.
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LGH Infrastructure Investment |
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We will commit to investing $120 million across the next four years in developing the infrastructure identified as priority in the LGH Masterplan. We will make hiring an additional 21.43 FTE nurses for the LGH Emergency Department a key priority in our recruitment and training plan for nurses. |
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More Capacity: Repatriation Hospital Refurbishment
Constructing a new campus of the Royal Hobart Hospital is a critical step in resolving some of the issues plaguing the RHH, such as bed block. Without resolving the shortfall of beds and surgeries that currently exists, and will get more severe as years go on, there is no meaningful way of approaching national standards for elective surgery waiting times. The RHH Master Plan outlines a construction of a new campus at the Repatriation Hospital site for the delivery of sub-acute and mental health services.[5]
The new campus will establish 24-hour sub-acute multidisciplinary services, and provide a range of system benefits, allowing space to be freed up at the RHH, consolidate existing external services, and allowing for further redevelopment at the Royal Hobart Hospital site to occur with less disruption.[6]
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Building a new Royal Hobart Hospital Campus |
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We will fast-track the design of the new Royal Hobart Hospital Campus on the Repatriation Hospital site and commence construction in 2022. |
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Urgent Care Centres
Stories of people waiting in emergency departments for hours and of hospital ramps full of ambulances have become the norm in the Tasmanian health system.
While expanding the capacity of hospitals is essential to deal with bed block, and increasing staffing levels for nurses and paramedics is absolutely crucial for patient safety, we also need to look at ways to take pressure off the ambulance service, to reduce presentations at emergency departments, and to deliver better outcomes to the community.
A 2017 review into Ambulance Tasmania operations conducted an analysis of 210,000 ambulance responses, and found nearly half of ambulance responses were assessed as ‘non time critical’ or ‘non-acute’ by the dispatch centre. Only two percent of patients remained in the ‘acute time critical’ category once reviewed by a paramedic. The same review also found that the use of ambulance services has grown 14 times faster than the state’s population.[7]
In a hospital setting, 88% of patients presenting at Tasmanian emergency departments are a sub-acute emergency status (Figure 3.5.2) – the highest of any state. Tasmania has the worst rate of patients being seen on time in the emergency department of any state, and is 9% below the national average.
Figure 3.5.2: Proportion of Emergency Department presentations by category[8]
Urgent Care Centres can play an important role in the health system by servicing low acuity, but urgent, illnesses and injuries[9] – or in other words, looking after patients in the space between primary care and emergency.
By providing an alternative pathway for patients assessed by Ambulance Tasmania’s secondary triage system, they can assist with reducing the number of ambulance dispatches to low acuity cases. And in cases where ambulances do attend, where appropriate they can transport patients to Urgent Care Centres instead of hospital – reducing travel time to and from hospital, avoiding extended delays at the hospital, and relieving pressure on emergency departments.
A 2019 assessment of the feasibility of Urgent Care Centres in Tasmania found that in addition to paying for themselves after ten years, they would improve the care provided to the community. Lower acuity patients who may otherwise seek care in emergency departments (and experience very lengthy wait times) will have a far more efficient and appropriate care option. Meanwhile, high acuity patients in the emergency department will benefit as clinicians are able to focus a greater proportion of attention on their care (instead of managing higher volumes of low acuity cases).[10]
This assessment projected these facilities could service 15,000 presentations per year immediately, and build up to 26,000 by 2030.[11]
Urgent Care Centres can also play an important role in linking patients with primary care providers such as GPs to ensure improved ongoing care – crucial to reducing the overall strain on the health system.
The Launceston General Hospital, Royal Hobart Hospital, and Ambulance Tasmania have been crippled by years of Liberal neglect. Urgent Care Centres would reduce the pressure on our hospital staff and paramedics, and most importantly, provide better, safer outcomes for everyone.
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Urgent Care Centres |
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We will fund the establishment and operation of two urgent care centres in the public health system – one in the north of the State, and one in the south. |
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More Nursing Staff
The Australian Nursing and Midwifery Foundation have clearly highlighted why Tasmania can’t ignore the reality of understaffing and high vacancy rates across the health system.
Funding and support for necessary staffing levels has been ignored by successive governments, and worsened by an inconsistent approach to recruitment, training, and staffing. This puts an unworkable burden on nurses and midwives, and inevitably leads to avoidable worse health outcomes for patients.
There is a substantial cohort of nurses and midwives close to retirement, and their exit from the health workforce will exacerbate these issues further in the years ahead. It’s crucial we take immediate action to replace these skilled workers. We need a strategy, and the funding to back it, that will give the best patient care and a supportive safe workplace for the nurses and midwives who provide it.
Developing a proper recruitment process and using it to hire and train the numbers of nurses and midwives Tasmania needs would be better for patients and staff. It would also bring substantial savings, by reducing the health system’s extreme over-reliance on agency staff, overtime, and double shifts.
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Addressing the Nursing Shortage |
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We will –
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Our ambulances are the slowest in the country. The median waiting times are 13.8 minutes – two minutes longer than the next worst jurisdiction.[12] In an emergency, every part of a minute counts. Figure 3.5.3 shows that Tasmania’s ambulance response times have been significantly deteriorating, particularly in recent years, and are well behind other jurisdictions.
Figure 3.5.3: State-wide Ambulance response times, all jurisdictions, 2010-2020[13]
Of 54 ambulance response locations in Tasmania, only 14 are fully staffed with salaried employees, 15 are staffed entirely by volunteers and 25 are staffed with a mix of both.[14] Figure 3.5.4 shows that Tasmania has the second lowest proportion of response locations staffed solely with salaried employees, and the third highest proportion of locations staffed solely with volunteers. Tasmania is unique in its high rate of response locations that are staffed with a mix of salaried and volunteer staff.
Figure 3.5.4: Response locations by workforce makeup, all jurisdictions[15]
The Australian Paramedics Association of Tasmania have called for 224 FTE staff (119 immediately and 105 after additional resources are procured).[16] This would be a significant increase on the current 459 FTE workforce,[17] and would likely significantly improve Tasmania’s poor response times.
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Investing in More Paramedics |
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We will invest in 224 FTE more into Ambulance Tasmania staffing, the first tranche will be 119, followed by 105 more after two years. We will also make legislative changes necessary to enable the certification of paramedic practitioners in Tasmania. |
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Tasmania’s ambulances are also badly in need of investment. In 2019-20 an additional 6 general-purpose ambulances were added to the fleet for a total of 114. Shockingly, between 2010 and 2019 the number of general-purpose ambulances in the fleet more or less remained at 108.[18] ‘Administrative and other’ vehicles have decreased from 9 to 6 in this time.[19]
The Australia Paramedics Association of Tasmania has proposed an investment of an additional 27 ambulances, 7 light fleet vehicles and 4 new stations required to meet current demand.
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Investing in Ambulances and Infrastructure |
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We will invest in 27 new ambulances, 7 new light fleet vehicles, and new stations in Rokeby, Channel, Ouse, and Legana. |
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The tragic death of an Ambulance Tasmania officer, and the resulting coronial inquest, has highlighted an extremely poor staff management culture, discrimination and unsafe work practices, and a lack of meaningful mental health support for staff regularly exposed to high levels of trauma.[20] While additional staffing and resourcing will help, meaningful and resourced mental health supports for paramedics are required.
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Paramedic Mental Health |
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We will invest in a formal trauma support program, with rostered professional debriefs for staff occurring quarterly/twice yearly. This will be accompanied by two permanent psychologist positions, permanent Regional Peer Support Officer positions, non-operational support staff, and the establishment of a stand-alone rostering unit. |
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Mental Health Support
In Tasmania 14,860 people are living with severe mental illness, 29,721 with moderate mental illness and 59,442 with mild mental illness.[21] Tasmania has the highest rate of hospital admission for mental illness, and the highest prescription rate, in Australia.[22]
Between 2013 and 2017, emergency department presentations for mental health illnesses increased by 35%. The number of young people presenting to emergency increased by a 52% between 2009 and 2017.[23]
Despite these truly concerning and distressing mental ill health increases, the services to support this wave of need has not in any way kept pace.
In April 2021,16 psychiatrists employed by the Statewide Mental Health System wrote to the Australian Medical Association Tasmania, outlining the dire state of our mental health system, including serious systemic issues leading to the loss of staff. There letter calls for an independent inquiry into the issues underpinning the failure to respond to Tasmanian’s mental health needs.
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Fixing the Mental Health System |
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We will establish an independent inquiry into issues in the Statewide Mental Health System, and provide an additional $5 million per year into staffing, recruitment and retention initiatives. |
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Community and Preventative Health
Individual health and wellness are the foundation of a healthy community. When we are physically healthier, we are also happier and our mental wellbeing is improved.[24]
For a range of factors, too many Tasmanians suffer from chronic conditions and too many end up in an over-stretched hospital system. 52% of Tasmanians have at least one chronic disease and 25% have two or more.[25] These are the highest rates of any Australian jurisdiction.
As of 2020, there were 12,086 people on our elective surgery waiting list.[26] In public emergency departments, only 66% of emergency and 58% of urgent patients were seen on time.[27]
Better funding of community health and prevention services across Tasmania will take pressure off the hospital emergency departments, and mean fewer people end up on elective surgery waiting lists.
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Community Preventative Health |
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We will allocate $3 million each year towards a grants program for community-based preventative health initiatives around the state. |
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Funding for allied health specialists has been cut by state and federal governments, and community health centres across regional Tasmania are operating with skeleton staffing, often with major gaps in specialties. We need, for example, more counselling and support, podiatry, physiotherapy, dietary advice, occupational therapy, hearing and speech therapy. We need to have these skilled professionals in communities full-time, not travelling in for one day a week or fortnight.
Community health services help people live well, and longer. They help people manage complex chronic conditions so that these don’t become acute, and they support people with wound care and rehabilitation when they are discharged from hospital. These essential services must be available in urban and regional areas.
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Community Health Centre Staffing |
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We will fund an additional 50 allied health professionals in areas of critical need in community health centres across lutruwita/Tasmania. |
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Alcohol and Drug Services
Currently there is only one drug treatment facility in the public health system – a ten bed facility in the south. As of 2017, there were 58 residential rehabilitation beds, all in privately run facilities.[28] Data suggests that 23 withdrawal beds and 125 rehabilitation beds are required to meet the needs of the most critical population alone.[29] We don’t even have half of the facilities we require to service those with the most severe need.
These services are also relied on for the court mandated diversion program, and if places aren’t available a person may not get access to sentencing options they are otherwise eligible for.[30] The lack of beds not only have significant human implications, but long-term cost implications for our health system, justice system, and society.
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Funding Alcohol and Drug Services |
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We will make governance and budget for the ADS self-contained, and establish a new state of the art Alcohol Tobacco and Other Drugs unit. We will increase beds for withdrawal management to 23, and establish three new rehabilitation facilities in the public system. These facilities will be places in the south, the north, and the north west, and will have a total of 70 new beds. |
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