Consideration & noting - Public Accounts Committee review on Performance of Tasmania's 4 Hospitals

Motion, Tuesday 3 May 2022

[4.47 p.m.]

Ms ARMITAGE (Launceston) - Mr President, firstly, I again thank the member for Murchison for bringing this forward. The Auditor‑General's report correctly highlights that the challenges faced by Tasmanian public hospitals are regularly publicised, including increased presentations to emergency departments, overcrowding, ambulance ramping, long patient wait times, adverse patient outcomes and the frequent presence of access block. We have seen dreadful stories in recent years of people whose inability to access care resulted in their deaths. This is a tragedy and should not occur in an advanced healthcare system such as ours.

The report also correctly indicates that the solution to fixing what is often perceived as an emergency department-only problem requires a whole of hospital and system-wide approach. Effective and efficient delivery of patient care in emergency departments depends on a variety of interrelated elements, such as prompt offloading of ambulance patients, quick and accurate triage, timely and accurate diagnosis and appropriate clinical treatment, timely discharge or admission to an inpatient bed and many others.

Combined with these findings, there has been a growth in demand over the last nine years, with patients presenting to emergency departments increasing by 15 per cent and a growing complexity of presentations. People find it very intimidating to navigate the health system and this is not helped by the horror stories we frequently see in the media. We must give Tasmanians good access to health care and ensure that the wellbeing of hospital staff, paramedics and support staff is also taken seriously.

With Tasmania's ageing population and projected growth of health concerns, many of which are unknowns thanks to the COVID‑19 pandemic, it is critical that we take steps now to ensure that our hospitals and our emergency departments are properly resourced and prepared to take on these issues. It is therefore jarring to read that the audit concluded that increasingly ED patients were not receiving timely care.

The report states:

It is my conclusion the Tasmanian hospital system is not working effectively to meet the growing demand for ED care, inpatient beds and its associated performance obligations for ED access, and patient flow within the THS service plan.

This is partly attributed to capacity constraints, particularly at the Royal Hobart Hospital which is undergoing extensive redevelopment works, but also because of longstanding cultural process weaknesses within hospitals that are impeding effective discharge planning, bed management and coordination between EDs and inpatient areas. Successive reviews by the Tasmanian and Australian governments over the last decade have highlighted dysfunctional silos, behaviours, process barriers and resistance to change from some clinicians and administrators within hospitals as major drivers of inefficiencies.

This is a damming assessment of our hospital system. Some of the recommendations from the Public Accounts Committee are that we need strong leadership, and we need to ensure that our hospital staff, clinicians, doctors and patients are listened to. Resistance to cultural change can be a result of poor leadership, or when people's ideas are not being heard. Good management of our hospital systems starts with good managers.

Our hospital system is too important to botch up. The lives of Tasmanians quite literally lie in the balance, and I am of the belief that our hospitals need to be supported and that a bottom-up approach to devising internal and external policies needs to take place. A top-down command and control model has been tried and has failed. In order to get staff and clinicians on board, they need to be listened to and taken seriously.

The system we have now is unsustainable, and people - both patients and hospital staff - get hurt in the process. To this end, I note that the committee recommends that the THS monitors the progress of cultural change through the regular use of recognised and externally assessed programs with progress outcomes reported publicly. This is a good start, and will help develop positive and trusting relationships between hospital staff and management.

For larger scale policy, results of these outcomes also need to be made public, and I hope to see some follow-through with this. Also, preventive health is a major contributor to hospital need, and demand for clinical care. I understand that the Government and the health department are aware of the importance of preventive health, and that channelling more resources into such healthcare measures is obvious. It makes sense, therefore, to do everything possible to give people access to preventive health care procedures, like endoscopies and colonoscopies, not just to ease up a hospital room, but to give Tasmanians the best chance for long-term wellbeing.

So many factors feed into the performance of Tasmanian emergency departments, and it is likely that without serious and significant change, starting from the top, it will not get any better. In conclusion, I note that under these circumstances at the frontline of healthcare delivery in our emergency departments, from clinicians to triage nurses and custodial staff, the feedback I receive from the community is overwhelmingly positive. Our hospital staff do an incredible job, especially after weathering the pandemic over the past two-and-a-half years, to deliver excellent care to vulnerable patients in need.

I thank them for their dedication and hard work, and want to construct a health system that looks after their needs, just as much as their patients. I note the recommendations of the report, and that most of them and the summary of findings have been outlined by the member for Murchison.

I do note the report and thank the member for Murchison for bringing it forward.