PARLIAMENT OF TASMANIA HOUSE OF ASSEMBLY REPORT OF DEBATES Wednesday 16 September 2020 REVISED EDITION Wednesday 16 September 2020 The Speaker, Ms Hickey, took the Chair at 10 a.m., acknowledged the Traditional People and read Prayers. QUESTIONS Launceston General Hospital - Bed-Block and Understaffing Ms WHITE to MINISTER for HEALTH, Ms COURTNEY [10.02 a.m.] Yesterday you feigned ignorance of the concerns raised by registrars in the Emergency Department about conditions at the Launceston General Hospital. You shockingly ignored revelations that patients have died as the result of overcrowding and bed block. You did not mention patients once in your media release yesterday in response to this explosive letter from staff at the LGH. While you choose to play politics, I will remind you that we are talking about people's lives. Now that you have read the letter, what is your response to the issues that have been raised? How many avoidable patient deaths have been reported at the LGH in the past 12 months? ANSWER Madam Speaker, I thank the member for her question. I will provide an update on that letter now that I have had the opportunity to read it. It is unfortunate that the Leader of the Opposition suggests that this side of the House is playing politics. The Opposition brought a letter given to a leadership person at the LGH into this House, rather than to me. To say we are the side playing politics and then to waste question time with a letter that was not provided to me speaks volumes about the Opposition Leader. Opposition members interjecting. Madam SPEAKER - Order, please. Ms COURTNEY - The LGH is an outstanding hospital and I put on the record my thanks to the extraordinary staff who work there. I know they provide high quality care because I am constantly given feedback by people in my community of the wonderful experiences they have had at that hospital and the care they have received from the hardworking staff. I can confirm that the chief executive of the LGH, the recipient of the letter, will be meeting with the registrars to listen to their concerns and consider what more can be done to assist them. As outlined yesterday I have also asked the secretary of the department to consider matters raised in the letter. I also spoke with a number of clinicians yesterday so that I can understand their concerns and map a pathway forward. As a government, we want to continue efforts to build the best system possible. We want to see staff, stakeholders and patients engaged to make the changes that we need. Wednesday 16 September 2020 1 That is why we have gone out to the community during our clinical planning for the redevelopment of the LGH to ask them what they want. We have received that feedback and it will form the basis of the LGH master planning as we go forward. I have been Health Minister now for a little over a year. During that time, I have always acknowledged the fact that there is still more that we need to do. I have always acknowledged that we have pressures at RED and that we need to continue to implement measures across all our sites to assist access. These are long-term, chronic issues that plague health systems around the world. However, each of our hospitals is unique and each has unique opportunities to fix the challenges they face. I note that the letter acknowledges some long-standing challenges including cultural impacts on bed block and the need to ensure that we are effectively using our regional and private hospitals, as well as opportunities to invest in more innovative care. We are focused on recruiting the staff we need and planning for the future while at the same time managing COVID-19. There are no more stark figures representing our commitment than the amount we have invested to put more people into the LGH. Since 2014 there has been an 85 FTE increase in doctors recruited. Forty percent of the increase in medical cover - that is, 40 FTE - has happened in the last year alone. There are over 250 FTE more nurses at the hospital with an overall boost of well over 400 more FTE than in March 2014. Let me be very clear that this Government is investing in health. We know that there is - Ms WHITE - Point of order, Madam Speaker. It goes to Standing Order 45. I ask you to draw the minister's attention to the question, which was to update the House on the number of avoidable deaths that have occurred at the LGH in last 12 months. The minister still has not mentioned patients once in her response. Madam SPEAKER - Thank you. As you know that is not a point of order but I draw the minister's attention to that part of the question. Ms COURTNEY - Thank you Madam Speaker. I am getting to the part of the member's question about my response to the letter yesterday, given that I had not had the opportunity to read it as it was not directed to me. I am responding to the member's question directly. The staff we have employed are initiatives on top of other areas that we have also invested in. We have a new patient transit lounge to help our discharge, and a state-wide operations centre, as well as our community-based initiatives such as community rapid response and mental health hospital in the home. We know that the challenges of bed block are complex and multi-faceted. A joined-up solution is required to address these challenges. Many of the initiatives have started. Much of this work has been rolled out from the Royal Hobart Hospital and these initiatives are being rolled out at other places across the state. However, we need to ensure that the initiatives being rolled out at each of our sites, such as the LGH, are specific for the needs of that community and the patients we are servicing. The initiatives also need to be specific to the challenges in that particular jurisdiction. I note that local management has recently made the patient flow team at the LGH permanent following a successful trial. This means that the LGH has a substantive, full time nursing director of patient flow who leads a team of patient flow managers and after-hours Wednesday 16 September 2020 2 nurse managers. This is happening 24 hours per day, seven days per week. I thank the amazing team that provides that support. I have had the privilege of spending many hours with them at various times of the day and night and I know they do their job with enormous dedication. I further advise that changes to medical scientists' rosters and increased staffing levels in the past 12 months has enabled improved pathology turnaround times, particularly for the ED and inpatient care areas, to assist with facilitating safe discharge. On the back of this resourcing, the LGH has introduced weekend blood services for blood specimen collection to support junior medical staff and assist in determining patient discharge. We will look at what more we can do in that area. More broadly, the Government has recruited the first new paramedics in Launceston in years, including for our rural and regional sites that support the LGH such as Beaconsfield, George Town and Deloraine. I acknowledge the dedicated staff who have done an enormous job during COVID-19, and assure the staff, patients and community that this Government remains committed to that hospital, to investing in the people, and investing in better outcomes for northern Tasmania. Launceston General Hospital - Implementation of Access Solutions Recommendations Ms WHITE to MINISTER for HEALTH, Ms COURTNEY [10.10 a.m.] Your response to a damning letter from doctors at the LGH was to refer the matter to the secretary of your department. You have effectively washed your hands of this issue, despite promising nearly a year ago to implement the outcomes of the Access Solutions meeting at the LGH. You have blamed COVID-19 for your lack of action, despite the fact that the Access Solutions meeting occurred in June last year, nearly nine months before COVID-19 began impacting our health system. The Examiner editorial today has called you out for playing politics rather than delivering the change you have promised, and I quote - Perhaps it is time for the Gutwein Government to focus on leading, stick with the facts and implement real change to improve the systems, and therefore health outcomes, at the LGH. Can you detail which recommendations from the Access Solutions meeting have actually been implemented at the Launceston General Hospital? ANSWER Madam Speaker, I thank the member for the question. As the member would be aware, the Access Solutions meeting that occurred during the middle of last year was focused at the Royal Hobart Hospital, with further work to look at initiatives that could be rolled out throughout the state-wide services, because we know the pressure in patient flow is not only a Wednesday 16 September 2020 3 challenge at the Royal Hobart. We see it at the LGH, and also see it particularly at the North West Regional Hospital. What we have done specifically at the LGH are patient flow workshops, which I was pleased to be able to attend. Local leadership worked through what the challenges were on site as well as the opportunities with these workshops, driven by the LGH's senior management group. Some of the key focuses included community-based models to support frail, elderly patients with multiple chronic conditions presenting to the LGH emergency department because they are unable to access those services in the community that are needed to keep them out of hospital.