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Shortfall in Funding for Our State Public Hospitals

October 30, 2018

MATTER OF PUBLIC IMPORTANCE

 

Ms ARMITAGE (Launceston) (by leave) - Mr President, in accordance with the provisions of standing order 32(3)(e) I move -

 

-  That the Council does now adjourn for the purpose of discussing a matter of public importance, namely:

 

-  The apparent shortfall in funding for our state public hospitals and the ongoing difficulties within the emergency departments.

 

It is a tough world for those working in our public hospitals, particularly our emergency departments.

 

I state from the outset I am not attacking any political party, as there has always been an underinvestment in core health, irrespective of who is in government.

 

In moving this motion today I wish to bring to the attention particularly of staff in our public hospitals, whatever their roles, the extreme gratitude and respect we have for them, working under the difficult circumstances they do every day, day in, day out.

 

Our community can rest assured they will receive the best possible treatment when they attend our hospitals.

 

I have been involved with the Launceston General Hospital since the late 1970s when I worked at the hospital for its then superintendent, Tim Hogg.  On 1 September 2007, I co-organised a rally that saw over 5000 people fill Civic Square in Launceston to support our hospital. 

 

Liberal member, Sue Napier commented at that time -

 

-  The Launceston General Hospital has been struggling for some time with an unrealistic budget.

 

Labor premier Lara Giddings commented -

 

-  People should be assured the state government is well aware of the issues confronting the LGH, many of which face regional hospitals all over the country.  There are some significant pressures on services at the LGH and we are doing our very best to manage that situation.

 

The point is that it does not matter who is in power, our public hospital system will struggle, but we need sufficient resources and budget.  It will not be resolved by money alone.  The people at the coalface must feel supported and work in an environment that is safe for them and for patients.

 

I believe it was unfortunate that the three Tasmanian health organisations were not given sufficient time to work before being changed to one Tasmanian health service, which, by all accounts, did not work well, by removing local decision-making.  It has now changed again.

 

I note the public forums last week, which I was disappointed not to be able to attend.  I only heard about them a few days before and I was already committed.  I accept Mr Ferguson acknowledged problems and pressing issues in our health system.  Leader, I would be interested to hear an answer about the $1.6 billion in health-related GST receipts quoted by Martyn Goddard as not going to Health.  I also question Mr Ferguson on Mr Goddard's assertion that Tasmania gets an extra $260 million in health-related GST to fund the extra services that this state's oldest, poorest and sickest population needs, but that money has not been spent on Health.  Could that be clarified?  Has that money been diverted and, if so, to where?

 

Ongoing ambulance ramping where they can start ramping at 7 a.m. and are still ramping at 7 p.m. is becoming commonplace.  The concern is that we may get used to it, see it as the norm and become blasé about it.  It is not unusual for admitted patients to remain in an emergency department for days, and it is acknowledged that the longer a patient spends in the ED, the worse the outcome.  I have personal experience with my mother, who spent six days in the Launceston General Hospital Emergency Department before being moved to a short-stay unit and then finally a ward.  The staff were magnificent but these are emergency department staff trained for emergencies and not ward staff.  Cleaning and feeding people is not emergency nursing. 

 

I am hearing that some people do not want to be rostered on and that they burn out.  The cost of overtime and double shifts is huge.  Permanent staff are far more cost-effective.  We need safe working hours.  The loss of accreditation in both medicine and emergency at the Launceston General Hospital was a major blow to attracting medical staff as well as staff morale.  It is gruelling for the staff because the Launceston General Hospital is now on the radar of the college.

 

One of the pointers in the ED was bed block. I believe there has not been any progress on access block.  We do not just need a few beds open; we need a whole ward with permanently employed staff, not agency staff or people on double shifts.  People need certainty of employment.  Restoring accreditation needs to be the priority. 

 

It is time for a more positive spin to be attached to the Launceston General Hospital for recruitments to be successful.  While it is hoped accreditation can be regained in 2019, it has been said it will be at least a further year before we can attract junior doctors for training purposes. 

 

I ask the Leader about advanced training in cardiology.  I understand one of the two northern echo technicians is close to retirement and recruitment may be difficult.  We cannot afford this service to fall over.  Can the Leader please advise what is happening here?

 

The Launceston General Hospital and the Royal Hobart Hospital, in particular, were once sought after for intern positions but from speaking with medical students it now appears many are seeking positions on the mainland.  Students are aware of the problems in the north and south as they select intern preferences.  It is trickle-down effect from the lack of training programs and critical mass in some programs. 

 

Many graduates want to do specialty training in a hospital with a good reputation with very solid people in training programs who are there to mentor the students.  The Launceston General Hospital is fine for interns but what about residency and registrar training?

 

Even if they stay for intern training, they then may have to look elsewhere for future training depending on accreditation.  While I accept it is often difficult to recruit doctors, locum staff coming through, particularly at registrar level, do not invest in training or mentoring because they are transient staff.  We need people at the top who are ready to mentor and show pathways.  This is a critical component of training.

 

Psychiatric patients will routinely spend in excess of 12 hours in the emergency departments and they require a lot of attention.  I am told the Mental Health Act is difficult to negotiate and is adding to the problem.  On a positive note, I am pleased to see the Government setting up a Hospital in the Home service for mental patients.  While I note it is only in Hobart at this stage, I hope it will be set up in other areas in the near future if successful. 

 

At the LGH, hospital admissions are going up substantially.  Presentations are going up and the complexity and age of patients is going up.  The length of stay blows out and the longer they stay in the emergency department, the longer they stay in hospital.  The problem is widely known, just not really acknowledged.  Everyone talks but there is no solution.  There is no national emergency access target or four-hour rule. 

 

People are not admitted to our public hospitals for trivial reasons, but admissions continue to go up by about 5 per cent every year, with one in four patients staying longer than 30 days.  Exit block is hard to cure because many patients have nowhere to go and the hospital cannot push them out.  They are waiting to go somewhere, with many waiting for aged care beds.  Some subacute environments are needed.  People who come to our emergency departments and stay are sick; they need to be seen to. 

 

Some people believe our emergency departments are under stress because many people choose to go there rather than to a general practice, but we are told by those that know that is a small percentage which is dealt with very quickly.  It is concerning that of the 287 public hospitals in Australia with emergency departments, bed block at the Launceston General Hospital is the worst, with the Royal Hobart Hospital coming in slightly better at number 278.  It is generally accepted that the problem is not with the emergency departments themselves, but because they cannot move patients to the wards. 

 

Leader, it would be appreciated if you could advise how many beds there are at the North West Regional Hospital, the Royal Hobart Hospital and the Launceston General Hospital.  I can ask a question without notice if you prefer.  Added difficulties for the LGH are that many people from the north-west choose to go to Launceston rather than a hospital in their region.  This is particularly true for births and adds to the pressure.  Retrieval patients also come to Launceston because it is logistically easier to send them to Launceston. 

 

While I note the Government's statement of a $757 million health package over six years, including 298 more beds and 1332 new staff, I would like a comparison of numbers from previous years and the percentage increases per hospital.  While advertising for more nurses is pleasing, nurses point out they have trouble recruiting because of the process and time involved.  They often get a job elsewhere in the meantime because they need money to live on. 

 

I also note the arrival of a new neurologist, the Community Rapid Response Service and an advanced paramedic unit as well as the doubling of helicopters from one to two.  That is good news as well.

 

Another major concern of mine is the waiting time for specialist clinics.  I believe there is even a waiting time to get an appointment, as well as a wait time once you have an appointment.  Sometimes general practitioners believe their patients have had treatment following referral, but on occasions find out their patients are still waiting for notification of an appointment.  I have raised the waiting time for colonoscopies on a number of occasions in this House, this being part of preventive health.  It is all good to complete your faecal blood occult screening for bowel cancer, but you may then have to wait many months for an appointment following a positive result.  For example, as at 26 June 2018, the northern waiting time in days for an urgent appointment in the colorectal clinic was 63 days; semi-urgent was 480 days; and for what I assume would be a follow-up colonoscopy or similar non-urgent treatment, the waiting time was 1026 days. 

 

The biggest issue is that the focus is wrong because the problem does not lie in the emergency department.  It is also believed our acute services are diluted and we should have acute services seven days a week.

 

We need a better use of subacute facilities and we need to invest in a progressive extra number of beds every year, unless the Government comes up with some plan to alleviate these problems.

 

Unfortunately, the emergency departments at the Launceston General Hospital and the Royal Hobart Hospital are wilting under the pressure.  However we can find - or so it is reported - $140 million to remove an aesthetic blight on Macquarie Point.

 

Obviously, I am aware of the memorandum of understanding with TasWater and the $20 million investment from the Government over 10 years.  I ask the Leader:  What will the Government's additional contribution be to removing these sewage tanks?  Is this entirely state money?  Is there a federal contribution and, if so, how much?  Rather than spending $140 million to remove some sewage tanks from Macquarie Point, is there a choice to spend it on public health?

 

I also note the Government Administration A Sub-Committee into Acute Health Services in Tasmania, chaired by the member for Hobart, and I look forward to its report and recommendations with regard to health.

 

Our public hospital systems are under extreme pressure and this does not look like easing any time soon.  I ask the Health minister and his department to speak with the hospital staff and listen to their concerns and suggestions.  The people on the ground working in the hospitals are best placed to know what is going on and likely to have some idea about what to do to improve the situation.

 

I also note the paper put out previously by the Australian Nursing and Midwifery Federation, with what appeared to be some good suggestions.  Whoever is in power, we should all be working together for the good of our public hospitals and community health, and not simply disregard ideas because they come from what may be considered to be an opposing side.

 

 

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