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Mrs ARMITAGE (Launceston) - Madam President, local means local. I have been asked why I am here today having been discharged from hospital on Sunday after my operation but I could not in all honesty let down my community by not fighting tooth and nail for three local health networks. If that meant coming down when I was actually given a week off, it has meant coming down because to me there is nothing more important than the health of our community and representing our community.

One centralised health network is what we have now. I do not know about anyone else but I actually I do not think that it is very good. In principle, I agree with this bill and I will flag some amendments when we get into committee.

We have a rare opportunity to fundamentally reform health delivery in this State. To take advantage of this, there must be three local health networks in Tasmania. This is about quality care for our people, not cost cutting.

In 2009 the State Government reintroduced the three-area hospital service system which was supported by the then Health minister, now Premier, Lara Giddings. This immediately improved the management of the LGH and the regional hospitals in the north of the State. We must maintain this organisational model and include primary health under this umbrella. Bottlenecks in moving patients from acute care facilities to community services, convalescence and rehabilitation will continue while the State and Federal governments play the blame game.

A local hospitals network with clinician and consumer input devolves the decision-making process to the locals rather than having it prescribed by a distant bureaucracy. Local clinicians are community representatives and are best informed as to the needs of their community as well as how and where to provide it.

This does not negate the collaboration, communication and support that we currently achieve with our northern hospitals, public and private, as well as with Hobart and the occasional interstate tertiary referral. We also maintain statewide advisory committees in all the major disciplines. We do not need new or more administrative committees. This is not about being parochial; this is about local responsiveness to local need and accepting that there is an appropriate role for statewide and planned service delivery models. We are not saying, 'Let's have the model in Launceston; let's have it in the north-west'. We are saying, 'Let us have a local model in the south, a local model in the north-west and a local model in the north'. The State naturally falls into three population centres and each has significantly different challenges in healthcare delivery.

Three truly local hospital networks finely attuned to local needs will have the best chance of addressing the unique demands and difficulties of each region. Decision-making will be as close as possible to the point of delivery. The argument that three local health networks, LHNs or THOs, will be costly compared to one is superficial. When ex-Prime Minister Rudd conceived the plan, he argued strongly that local health networks will save money as they will have local people on the ground eliminating waste and ensuring efficiency. Anyone who argues that one will be more efficient than three, needs to show some evidence, not generalisations but real facts that factor in the net effect of the reduction in DHHS, so they must not be selective. Would one THO simply mask the inefficiency of the other two? Is this an argument about protecting inefficiency? If we were to allow one THO only, I believe that nothing would change. The DHHS would morph into the THO and all the problems of centralised control in Davey Street would continue.

The idea of true local THOs or LHNs is to move the bureaucracy to the site of the clinical action and make the process leaner, more responsive and more transparent. A cynic might suspect that the recent name change is designed to de-emphasise Kevin Rudd's initial idea of single funding with local control.

The reason the regions argued so strongly for three LHNs is for accountability. An enormous amount of inefficiency exists in our current health system but it is not possible to develop any relationship with the administration when it hides in a building in Hobart remote from the hospitals and health regions it claims to manage. The Government's actions suggest they are trying to centralise the control of the health networks in Hobart by stealth. Unless three LHNs are established we will be left with a status quo that has miserably failed the north and north-west regions.

I believe the name THO is misrepresenting the true case of what this legislation is aiming to do. It is clear to me that the Government is determined to have one THO rather than three LHOs or LHNs. I believe the change of name clearly shows their intent after a period of settling in that it will change to one THO .

I do have letters that I have been asked to read as well from a variety of communities, people and organisations. The first one is from Michael Bailey, the CEO of the Launceston Chamber of Commerce, where he states that the Chamber of Commerce has consistently called for three autonomous health networks managed by local boards. This position was determined after briefings from local health professionals, politicians and chamber members provided unequivocal advice that this is the best model for managing health outcomes for our State. The three local health network concept has also previously been supported by State Cabinet, the Federal Government and local health professionals.

We heard this morning from the AMA. The AMA as of last week were in favour of three health networks but of course they have advised us now that they feel that the State Government is in such a state that they do not feel that they are capable of actually managing anything and are not prepared to support this and would like us to throw this out. I believe we are a House of review and not a House of rejection so it is important that we deal with what we have before us and make the necessary amendments as best we can to get appropriate legislation.

I have a letter from the northern division of the AMA and I know that they have not met since this letter was provided to me as they met on Thursday so I will read it out because I have not had a call from them to tell me not to. This is from Dr Glenn Richardson, the northern AMA chairman. While the State AMA has got their stance this is what was given to me:

'It has come to the attention of the Northern Division of the AMA Tasmania that an amendment is to be tabled to the upper House proposing to reduce three THOs to one. This is alarming and I believe will compromise the ability of the Northern region THO to respond to the needs of the local community it serves and to respond with day-to-day decisions on the operations of the local hospital. To be able to deliver the agreed services and meet performance standards we believe the Northern THO should operate fully independently.'

I also have a letter that I have been asked to read out from Robert Dobrzynski, the General Manager of the Launceston City Council. It reads:

'Dear Rosemary,

It has come to the attention of the Launceston City Council that endeavours are being made to amend the Tasmanian Health Organisations Bill, recently passed in the Lower House, to the effect that three Tasmanian Health Organisations as contemplated by the Bill will be reduced to one Tasmanian Health Organisation.

It is difficult to convey the anguish and concern that such a move would generate in the north of Tasmania. The establishment of three Tasmanian Health Organisations within the Bill has been the result of extensive advocacy and lobbying from a broad cross section of the northern Tasmanian community. This lobbying and advocacy has reflected the extreme concern of many people expert in the administration of health networks and the provision of health services to the community, indicating that administration of health services at the closest point to the service recipient has been internationally proven to provide the most outstanding health outcomes and patient care.

The Launceston City Council has clearly established its desire for three local hospital networks for the State, with a separate single hospital network for the north of the State, provided with sufficient regional autonomy, accountable policy and delivery flexibility, together with budget capacity to provide effective health services within northern Tasmania.

Rosemary, you have been central to advocacy on this issue. I would urge that you use the facility of your good office as a member of the Legislative Council to ensure the defeat of any speculative and ill advised initiative to amend the Tasmanian Health Organisations Bill from three THOs to one THO .

The Launceston City Council stands ready to provide whatever support you may need in order to achieve these outcomes.

With grateful thanks

Robert Dobrzynski'

I also have a letter from the Australian Association of Independent Retirees - AIR - from Glenn Robinson, the President. He starts:

'The Association of Independent Retirees more commonly known as AIR has 500 members in the northern Tasmania branch and in excess of 1 000 statewide. We are the prime organization representing both partly and fully independent retirees across the nation.

Our members are both alarmed and very concerned with the current funding crisis in our Tasmanian Health Department.

One commitment made by the Minister for Health, the Hon. Michelle O'Byrne, on 13 December 2010 is very strongly supported by our members as I believe by the community at large.

I speak of the commitment by Cabinet that the local hospital networks should mirror those of Tasmania's Area Health Services. That is, three hospital networks.

The state naturally falls into three population centres and each has significantly different challenges in healthcare delivery. A truly local hospital network, finely attuned to local needs will have the best chance of solving the unique demands and difficulties of each region ...

Local clinicians and community representatives are best informed as to the needs of their community.

In conclusion, our organization very strongly supports the introduction of three local hospital networks in Tasmania.'

I have quite a few more but I do not really know whether I need to read them all. I will mention one that was sent to me. The gentleman prefers not to use his name as he is a current employee of the Department of Health and Human Services, which is quite understandable. Part of the letter says:

'I believe fervently that Tasmania needs three area health services with strong CEOs, using the expertise of people like Alistair McDonald, Bernie Einoder and the rest. It costs nothing extra. I urge you to fight strongly for three area health networks with good CEOs and local expert management before the state budget'.

I note as well that when the Southern Tasmanian Council Authority - the 12-member council of the Southern Tasmanian councils - looked at it probably mid last year, while they certainly did not say they support three, they said they do not support a single network. They were probably leaning more towards two.

The 12 southern councils of Brighton, Central Highlands, Clarence, Derwent Valley, Glamorgan-Spring Bay, Glenorchy, City of Hobart, Huon Valley, Kingborough, Sorell, Southern Midlands and Tasman have gone through this in quite some detail when you look at their submissions and the fact that they do state that they do not support one, they support two. But I think it is more that they do not support one local centralised network.

I think we must totally reject the proposal of a single THO . We support the fact that we are looking to have three THOs. It is good for the State. I am very pleased as well to hear from the member for Mersey regarding the hospital system down there. I think it is really important to say that we are certainly not being parochial here in saying that the north believes everything should be north.

We are saying that Hobart knows what Hobart needs; Launceston knows what Launceston needs; the north-west knows what the north-west needs. It is really important that we do not have marginalisation of smaller communities and repeat the current inefficiencies we see that are often established with statewide service delivery organisations. Hobart-based services often fail for 50 per cent of the population that live in the north and north-west of the State, or 58 per cent I think it might be, taking the north-west as well. We must totally reject any plan to try to centralise health services in Hobart.

I am not going to go on overly here. I believe there are some changes that need to be made when it comes into Committee. I support the bill that is before us in principle. I have a few concerns but, all in all, I am pleased to see that the Government has put forward the stance for three hospital networks. Realistically, local means local and I would ask that the members here support with the Government that we do go for three hospital networks perhaps with a few changes.

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