‘On its last legs’ – why our health system is failing

'On its last legs' - why our health system is failing

It’s no secret that our Health System is at breaking point, with vigorous public discussion and commentary held over the last decade on all sides of politics. Despite the many opinions, discussions, debates and promises by our politicians, here we are in 2022 with a broken health system which continues to decay and fail to meet the needs of locals, but why?

This investigative report aims to uncover the main issues facing our health system, and how our political leaders are aiming to address them, in an effort to keep you informed and enable you to lobby your local politicians to do better.

The beginning

The major problems with our health system that we experience now, began back in 2011, under the then Labor Government. Assistant State Secretary of HACSU, Lucas Digney, said that the Labor Government at the time, led by Lara Giddings, implemented budget austerity measures that heavily impacted the functioning of the health system.

“They ran the health system on a predetermined budgetary number rather than on demand” said Mr Digney.

When asked if Labor had learned from its past mistakes, Shadow Minister for Health, Anita Dow MP, said that health is always a challenge, but it cannot be denied the system is much worse today than when the Liberals came to office.

“Tasmanians can trust Labor has its priorities right, unlike the Liberals who are prioritising a $750 million stadium over addressing the health crisis.” Said Ms Dow.

While this response provided some insight into Labor’s plans to prioritise health should they be re-elected, we are still unclear on whether Labor acknowledge their prior mistakes or have learned from them.

When I asked Jeremy Rockliff MP, Tasmanian Premier and Health Minister for a response regarding the health system being worse now under the Liberals compared to when Labor lost the 2014 election nearly a decade ago, I was provided with a list of links to previous budget-related media releases, none of which directly answered my question, instead feeding me the usual political spin along the lines of ‘look how much money we’re throwing at it.’ Colour me impressed.

Current problems

While an understanding of how the issues started with our health system is important, we also need to understand the current issues which are most heavily impacting its ability to meet the health needs of locals.

The build-up of issues has also contributed to decreasing staff morale.

“Workers are really at the end of their tether” said Mr Digney.

“And they become increasingly angry and increasingly incentivized to take action against the government because of the government’s inability to deal with those issues in any measurable way.”

While these issues are immense, it’s important to note that a great deal of money is being spent on health in an effort to make improvements, however it’s evident that this financial spend is not producing good enough results when compared to the amount spent.

“To be fair to the government, they have thrown heaps of money at it” said Mr Digney.

“But there hasn’t been any overarching strategic plan from 2014 to 2018, to say this is how we’re going to invest in various components to make improvements.”

It’s clear that strategic management is in far more demand for our health system than handouts of cash, so with all of this money being spent, what are the plans from our two major political parties to fix the major issues?

Some of the most significant issues in our health system are listed below, along with details of how each side of politics plans to solve them.

Bed block and ramping

One of the key issues in our health system is bed block. This occurs when there simply aren’t enough beds available to admit patients. This often leads to patients being kept in the emergency department while waiting for a bed to become available on a ward, therefore leading to a shortage of available beds and staff in the emergency department, which then means paramedics are needing to wait with patients in the ambulance bays. This takes ambulance vehicles and staff out of action for several hours, meaning there are less crews available to respond to 000 calls.

The government have implemented a range of strategies to help combat this problem at the LGH, such as a new 28 bed medical ward on 3D, 4 additional overnight beds in the LGH short stay surgical unit; and reopening 9 beds in negative pressure rooms in the Acute Medical Unit which were temporarily closed during construction.

“We have also implemented a new Statewide Inter-Hospital Transfer Policy enabling patients to be directly admitted to a destination ward when transferring from another THS hospital, reducing the need for these patients to go through the ED.” Said Mr Rockliff.

“To reduce demand in our hospitals we are implementing innovative approaches to offer quality care in the community.”

“Examples of these successful innovations include Community Rapid Response, Ambulance secondary triage services. PACER – police, ambulance, and clinician early response to provide urgent mental health care to people in the community and COVID@Home plus providing care for COVID-positive people in their own homes and reducing hospitalisations.”

“In the Launceston region, the Tasmanian Government is funding a pilot to enable the Launceston Urgent Care Centre (a private GP practice at Newstead) to provide an after-hours urgent care alternative to the LGH Emergency Department. The trial means that people in Launceston are able to receive urgent treatment at the Clinic outside regular GP hours, and at no charge for eligible concession cardholders.”

“We have also released our Masterplan for the Launceston General Hospital, which sets out a roadmap for the redevelopment of the LGH precinct and is supported by our commitment of $580 million over 10 years.”

Despite these measures, bed block remains an overarching issue at the LGH.

While the government have committed to the LGH upgrade, Anita Dow says not enough is being done.

“To date we have seen very little progress on these important projects with the $750m stadium in Hobart seeming to rank as a higher priority for Jeremy Rockliff” said Ms Dow.

Outpatient waiting times

Those who need to see a specialist at the LGH can expect wait times extending beyond a year in some cases. For example, a category 2 or semi-urgent referral to the outpatient cardiology clinic at the LGH can currently expect to wait an average of 1,006 days to be seen by a cardiologist. The clinical guidelines for a category 2 referral outline that an appointment within 90 days is desirable, and that the condition has potential to require more complex care if assessment is delayed; and the condition has the potential to have some impact on the patient’s quality of life if care is delayed beyond 90 days. By comparison, a category 1 referral to the outpatient cardiology clinic can expect to wait an average of 324 days, as opposed to the recommended 30-day limit in the clinical guidelines. These guidelines also state that the condition is likely to require more complex or emergent care if assessment is delayed; and that the patient’s quality of life will be significantly impacted if delayed. It is clear that these wait times can only be described as unacceptable.

One patient we interviewed, a 60-year-old Tamar Valley local named Kevin (name changed to protect his identity), was first referred to outpatient cardiology in March 2022, and is still yet to receive an appointment. Among a plethora of other health issues, his treating team currently suspect heart failure, and require a cardiologist’s assessment, and an echocardiogram to confirm or rule out the diagnosis and begin treatment. Kevin currently sees two other specialists at the LGH, and both are, like Kevin, waiting for a cardiology appointment to become available so they can move forward with their diagnosis and treatment plans.

“You have to advocate for yourself” said Kevin, stating that he is only seeing the other two specialists because he called and followed up about the status of his referrals. On one call, he was informed that his referral had been categorised as a category 2 referral, and that they were only seeing category 1 patients currently, so there would be a significant wait.

“I’ve had to see specialists privately, because of the wait times.”

“It’s cost hundreds of dollars in consult fees and transport costs”

When asked how the government plans to resolve the issue of outpatient waiting times, Jeremy Rockliff said that while there is a long way to go, they are working hard to improve the way outpatient services are delivered in Tasmania.

“That is why one of my top priorities this year is a Statewide Outpatient Plan that provides a clear, focused road map for the delivery of outpatient services over the next four years and will be co-designed with clinicians, patients, and other key stakeholders” said Mr Rockliff.

“The 2022/23 Budget committed $7.2 million over four years to transform the way outpatient services are delivered. This funding includes implementing a Statewide Outpatient Administration Hub and digital portal to improve patient communications, implement electronic referrals and ensure an efficient and effective service to improve access and reduce wait times for patients.”

In contrast, Anita Dow said that if elected, Labor would invest some of the huge spend on locums and overtime into hiring more permanent staff.

“Employing more permanent staff is a focus for Labor because we know this will help to bring the waitlist down” said Ms Dow.

A freedom of information request revealed that in the 2020-2021 fiscal year, the Tasmanian Government spent $33 million on medical locums, and $21 million on visiting medical officers, showing the extent of the issue.

Lucas Digney said HACSU were aware of the issue and actively advocating for the government to implement strategies to develop a permanent workforce, such as making subsidies and grants available to pay medical school tuition costs for students who agree to work in in-demand public health positions for a set amount of time following their graduation, similar to Australian Defence Force scholarships.

“COMPLETELY UNACCEPTABLE”

This excerpt of estimated waiting times for Urgent referrals to the outpatient specialist clinics at the Launceston General Hospital shows that some patients are waiting close to a year before being seen by specialists, despite clinical recommendations that they should be seen within 30 days.

According to the Tasmanian Health Service (THS) Category 1 (urgent) referrals should be seen within 30 days, and that the condition will l require more complex or emergent care if assessment is delayed, as well as having a significant impact on the persons quality of life.

Clinic NameIndicative Waiting Time
(Days)
Allied Health Paediatric Service367
Cardiology Clinic324
Diabetes Clinic118
Diabetes Dietitian145
Diabetes Paediatric Clinic256
Ear Nose & Throat Clinic103
Endocrine Clinic242
Gastroenterology Clinic335
General Medicine Clinic105
General Surgery Clinic115
Neurology Clinic304
Physiotherapy Lymphoedema196
Renal Clinic173
Respiratory Clinic292
Urology Clinic162
Vascular Clinic228
Wound Management Clinic559
Adapted from THS Data available at https://outpatients.tas.gov.au/clinicians/wait_times
This data was the most recently released at the time of publication, and was initially released on 26 August 2022 and is indicative only.

Elective surgery

'On its last legs' - why our health system is failing
Elective surgery waitlist data shows that 28% of patients do not receive care within recommended timeframes. (PHOTO: Stock Image).

Despite common misconception, elective surgeries are not necessarily optional, and if delayed can lead to major health problems, the worsening of conditions and to decreased quality of life for patients. Despite the obvious importance of a well-functioning elective surgical system, this is still a significant issue for Tasmanians.

The Tasmanian Government has made some strong strides in attempting to bring elective surgery waitlists under control, beginning with then-health minister Michael Ferguson implementing a strategy in 2016 that allowed for a number of patients on the elective surgery waiting list to receive their surgeries in private hospitals. While this strategy undoubtedly eased pressure on elective surgery waitlists at the time, the measure was only a temporary solution.

As it stands, as of August 2022 there are 8,935 people on the elective surgery waiting list, a reduction of 16.5% compared to August 2021. This is largely due to the implementation of the Tasmanian Governments $196.4 million Statewide Elective Surgery Four Year Plan to deliver around 30,000 extra elective surgeries and endoscopies over four years.

In addition, the number of patients treated within recommended timeframes has risen from 54% to 62%. While the government celebrate this as an achievement, it is a stark reminder that 38% of patients are waiting for treatment beyond clinically recommended timeframes, placing their health and quality of life in jeopardy.

When asked if Labor planned to also utilise private hospitals for elective surgeries if elected, Anita Dow said they are currently considering their policies for the next election.

“Other states are trialling different approaches to elective surgery including dedicated elective surgery hospitals. Short term measures can bring about reductions in wait lists, but long-term sustainable initiatives must be a priority for Government and recruiting more staff including perioperative nurses should be a very important part of this.”

Politics

While Tasmanians have many varying views on our health system, one thing we can all agree on is that politics should not get in the way of healthcare.

Our current health minister, Jeremy Rockliff, is also our premier, which has prompted Labor to label Mr Rockliff as our ‘part-time Health Minister’.

“The health portfolio is an incredibly important portfolio. It is unprecedented that there is not a full time Health Minister in Tasmania. Being the Premier of Tasmania carries significant responsibility and this responsibility should not be shared with the health portfolio. Right now, the Premier’s focus is on a $750m stadium in Hobart and not fixing Tasmania’s health crisis.”

“Each MP manages their workload in different ways. The point I have made is that there must be another MP in Premier Rockliff’s Cabinet capable of taking on the responsibility of Health Minister. Our health system needs the full attention of a full time Health Minister” said Ms Dow.

When asked for a response, Mr Rockliff said Tasmanians aren’t interested in Labor’s politics.

“As I said when I became Premier, I recognise that for Tasmanians, health is one of their most important issues and it’s for that reason I chose to retain the health portfolio as Premier. I am committed to delivering a health system Tasmanians deserve and I continue to work hard every day to deliver that.”

“Our government’s commitment to ensuring Tasmanians can get the right care in the right place at the right time is evident in our recent Budget which invests 33 per cent of the total operating expenditure allocated to health.” Said Mr Rockliff.

Lucas Digney said HACSU shared Ms Dow’s sentiment.

“Being the premier or the treasurer is one thing, but the pressure of being health minister is a totally different thing”

“Health is the single biggest portfolio by an absolute mile, it’s the most important portfolio for the community, and it’s simply not something that can be done in conjunction with being the boss.”

While our politicians talk the talk, just how well do they understand the issues of our health system?

When asked what they see as the 3 biggest issues with the health system, and how they plan to fix them, here’s what they said.

Jeremy Rockliff:

Difficulty with accessing Primary Care

All across the country, Australians are having difficulty accessing timely, affordable access to a local GP. Tasmania is no different, and we know this is a critically important part of the health System.

While primary healthcare is the responsibility of the Federal Government – and despite the best efforts of hard-working GPs – we are seeing falling bulk billing rates and increasing difficulty accessing appointments, particularly in rural and remote areas of Tasmania.

This difficulty in accessing primary care impacts all areas of our health system, including our Emergency Departments and our hospitals.

To address this, our government is increasingly stepping in to enhance primary care access for Tasmanians, and I have been engaging strongly with the Federal Government to work with us to support reform that will provide improved access to primary care.

Access to elective surgery

One of my key areas of focus is ensuring that more Tasmanians receive elective surgery procedures within clinically recommended times.

That’s why we have developed a Statewide Elective Surgery Four Year Plan with increased funding of $196.4 million to deliver around 30,000 extra elective surgeries and endoscopies.

In the 2021/22 financial year, a record number of public patients – 20,314 Tasmanians – received an elective procedure – and increase of 11 per cent of that delivered the year before and up 35 per cent on surgery in 2019-20.

For endoscopies, the waiting list also dropped by 15.9 per cent in the 2021/22 financial year and the number of people waiting longer than clinically recommended for elective surgery has reduced by more than 1050 patients or 19 per cent during the 2021-22 financial year.

We are continuing to make progress, with the latest data to the end of July 2022 showing that there are now 1648 fewer patients waiting for elective surgery than 12 months prior.

Access to health information

We know that a key way we can enhance the connectivity of care across our health system is by investing in digital health infrastructure for the future.

That’s why our government has announced that we will invest $150 million to begin implementing a 10-year Digital Health Transformation Strategy to modernise Tasmania’s public health ICT infrastructure and drive the adoption of digital health technologies to improve patient and staff experience.

This investment, anticipated to be an investment of more than $475 million over 10 years, will support greater equity in health outcomes across Tasmania’s dispersed population and will enhance patient experience with less time waiting for services, less duplication of care and advanced scheduling of appointments.

And for clinicians, this will ensure they can access the right patient information at the right time to support clinician decision making and reduce administrative burden to free up their time for clinical activities and seeing patients.

Anita Dow:

Bed Block

Promises were made to upgrade health infrastructure, including the Launceston General Hospital and stage three of the Royal Hobart Hospital and these should be prioritised by this Government, not a $750 million stadium in Hobart.

Information recently released under Right to Information revealed that $54 million was spent on locum and visiting medical officers (VMOs) in 2020/21, and $33 million was spent last financial year on nursing overtime. This is money that could be better spent on hiring more permanent staff to allow our hospitals to open more beds.

Staff shortages- retention and attraction and wellbeing.

Labor would reinvest some of the $33m spent on overtime and $54m spent on locums/VMOs in more staff and better conditions for our hardworking health care workers.

We would also put more support in place for new graduates.

This should be the priority for the Government, not a $750m stadium in Hobart. The Government isn’t getting the basics right.

Ambulance Ramping

Addressing bed block and better resourcing emergency departments would help reduce ambulance ramping. So would recruiting additional paramedics and providing more support to those we have.

Improved infrastructure is also important, including increasing the number of double branch stations across the state, and more support for our fantastic volunteer ambulance officers.

The way forward

While this report has covered some of the issues, there are a plethora of others left unmentioned, so how can we move forward to make improvements?

According to HACSU, there are plenty of ways for the everyday citizen to help improve the health system.

“They can demand better from their local member” said Mr Digney.

“Get on your local members Facebook page. Write a comment in support of a health worker, send your local member an email, or come and join a community rally at the hospital if you see them advertised.”

“There’s many things local people can do to demand better from their local representatives.”

“They can’t just in their in minds say that these people need to better, they need to get out there and tell those people, because most politicians are very good at reacting to their own constituents.”

“It’s one thing for a union official like me to be critical of the government, which I always will be, and I don’t care what colour they are, but it’s an additional punch that comes when it’s an average man or woman off the street saying these same things to their local members.”

“It makes them want to do stuff, and ultimately most politicians and motivated by garnering votes at the next election.”

“I urge the readers to put as much pressure on their local members as they can.”

“By standing up and demanding better, that’s the only way the community can affect the outcome, and the only thing that scares politicians more than camera-phones is constituents.”

Have Your Say


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