REPORT OF THE AUDITOR-GENERAL No. 10 of 2012-13
Mrs ARMITAGE ( Launceston ) - Mr President, this is an excellent report. It is great to see the Auditor-General looking at hospital bed management because one of the things we need to do is keep people out of hospital beds if we can. One relevant area is Hospital in the Home. This became an issue probably 18 months ago when the government had some severe cuts they needed to make in health, and Hospital in the Home was one of the areas that unfortunately was cut at the Launceston General Hospital. It is interesting to read the comments of the Auditor-General regarding Hospital in the Home. It says:
Hospital in the home (HITH) programs can provide treatments by a range of health care professionals at a patient's home. HITH programs provide a range of services, including administration of intravenous antibiotics, management of acute wounds and surgical drains.
Most jurisdictions have HITH programs under which admitted patients are provided with hospital care at home.
It shows on a graph how well it can work in keeping patients out of a hospital environment. Tasmania does not have a single statewide Hospital in the Home program. Instead each hospital decides whether to run a Hospital in the Home program in its region.
The Launceston General Hospital did have a Hospital in the Home program. Unfortunately it was one of the areas that was cut with health funding. One of the recommendations made by the Auditor-General was that:
DHHS revisits the utilisation of HITH programs at a statewide level focusing on a community based model of services delivery as a means to prevent or reduce the length of stay experienced by some patients in hospitals.
So it has been proven by the Auditor-General to be worthwhile.
It states, with regard to northern Tasmania:
In January 2012, the HITH program at LGH was suspended to achieve budget savings. The Minister defended the decision on the grounds that, in the previous year, the program was under-utilised with just 23 patients regularly using the service. Clinicians at the LGH indicated to us that the impact of the withdrawal of the HITH program would have a minimal impact on bed management because the users were mainly same-day patients.
However, the consultant's report referred to above suggested that is not the case in other jurisdictions. In particular, the report found that the HITH services were being provided in regional areas smaller than Launceston such as Mildura, Echuca and Bairnsdale in Victoria. On that basis, it appears that Northern Tasmania had been making insufficient use of HITH to free up hospital beds compared to the way it was used elsewhere.
Another area is the readmission rates within 28 days. The standard measure is the rate of unplanned readmissions compared to all discharges occurring within 28 days of separation. It also appears that Tasmania is falling down in four of the procedures listed. Of those, tonsillectomy and hysterectomy exceeded the national average by a wide margin. He recommends that -
DHHS investigates the reasons why some surgical procedures have rates of unplanned readmission above the national average.
To look at the report and read the recommendations, the fact that it has been taken on board and we can look at it and find out why people are spending extra time in the hospital when they do not need to, is well worthwhile.
The last part of the report is in regard to elderly patients, which was very interesting. It mentions patients who are waiting to return home because they do not have a nursing home to go to and they need care. It was interesting to see that the Mersey and the North West Regional Hospital had a higher wait for referral to placement, because I had always been led to believe that many people in nursing homes were sent to the north-west coast. If they could not get a nursing home bed in the north, for example, that a lot of them were offered nursing homes in the north-west and in that area.
It is interesting to read that the Auditor-General has found that the Mersey, particularly the North West Regional, has a higher wait time for elderly people who are waiting for nursing home beds or to be able to go home. They recommend that in association with the THOs, the North West investigates reasons that the North West post-placement times for elderly patients are longer than for the rest of the state and develop strategies to reduce waiting times.
The Auditor-General's report is not a north, a south, or a north-west report. It is a Tasmanian report for the whole state. It is great to see recommendations looking at working together to find out as a state why some areas are performing better than others. At the end of the day, keeping people out of hospital is our prime objective.