Image for Michael Ferguson: Rebuilding Tasmania’s Health System

Speech to Tasmanian Health Conference 2014 at the UTAS Medical Science Precinct today

It is my privilege to be here to speak to you today as the Tasmanian Minister for Health. In my first 100 days as Minister I have met and talked with hundreds of dedicated Tasmanian clinicians and health services staff, and hundreds of Tasmanians impacted by a system that is not operating as it should be. And two things have become crystal clear to me.

First, while Tasmanians have absolute confidence, and place enormous value and trust, in the professionalism of our State’s health professionals, they are frustrated and unhappy with a system that is not delivering better outcomes for themselves, their families, and their community. There is also no doubt that this frustration is shared by the clinical community and the limitations they face in providing necessary care to Tasmanians.

And second, while we know there is no silver bullet to fix the health system, there is a growing and urgent call, especially from key health stakeholders, for change, through sensible reform measures, to put the patient back at the centre of all of our efforts.

Let’s be honest – our health system is not in good shape.

Every health report in the past decade has been clear in that message.

The structure is inefficient, unaffordable, and not compatible with a State-wide, integrated and sustainable approach.

Waits to access almost every aspect of the health system are too long.

Too many Tasmanians are not being seen within clinically recommended timeframes – creating added pressures in other areas of the health system, including Emergency Departments and Ambulance Services.

Our health workforce is understandably fed up from the relentless demand and blockages to access with no relief in sight.

Something must change – and this Liberal Government will take the lead in implementing the reforms necessary to put our health system on a more sustainable basis

REBUILDING HEALTH

Colleagues:

This Government went to the election with a firm commitment to rebuild essential health services.

The State Government has $76 million promised for additional elective surgery, and the first tranche of this funding has been provided and the delivery of additional surgery across Tasmania commenced at the start of this month.

We will be honouring all of our commitments on health, but we also understand that health services cannot be rebuilt without a strong and stable foundation.

System reform is needed to enable meaningful and long-lasting positive changes to the health system, and deliver improved outcomes for patients.

Without effective system wide reform, the effects of any increased expenditure will be short-lived – structural and governance impediments to safe and efficient services will continue and we will continue to achieve the results that we already acknowledge are not at the level the Tasmanian community deserves.

So, while we remain committed to rebuilding health and investing in additional patient services, at the same time we will be undertaking the tough, but necessary, structural reforms needed to deliver a better health system into the future.

THE CASE FOR REFORM OF THE TASMANIAN HEALTH SYSTEM

In April of this year, the Government welcomed the substantial report by the Commission on the Delivery of Health Services in Tasmania, which included 57 recommendations for fundamental reform of the Tasmanian health system related to governance, clinical and consumer engagement, culture, and efficiency in operational management.

Shortly after this, the Integrity Commission released a damning report with key recommendations related to failures of governance and accountability in health.

These reports followed the 2004 Richardson Report, which had 34 recommendations including the need for State-wide services, health system improvement and funding to be used more efficiently – never acted on.

And the 2007 Tasmanian Health Plan, intended to be a whole of system framework for the delivery of integrated health care – which, also, was never fully implemented.

So, over a decade, we have seen four major reports and plans for reform of the Tasmanian health system, each costing millions of dollars and each taking two or more years to complete.

The case for reform has been well and truly made.

Yet for years, when confronted with another crisis in the health system, the Labor Government threw its hands in the air, pointed to rising costs, rising demand, an ageing population and increasing levels of chronic disease as the causes of health system blockage.

Yes, those are factors that make it tough for a small State to deliver efficient, safe and quality health services.

But they cannot be an excuse for the repeated failures to deliver on previous reform attempts.

In many ways, they are symptoms of the past unwillingness to address the inherent inefficiencies and faults in our state’s health system.

For make no mistake:  the missing ingredient in the reform agenda over the past decade is the political will, the leadership, and the staying power to ensure change is delivered.

The Liberal Government has the determination to lead and drive that reform, to the benefit of all Tasmanians who rely on our State’s health and hospital services.

ONE STATE, ONE HEALTH SYSTEM, BETTER OUTCOMES

Ladies and gentlemen:

Tasmania has just over 500,000 residents.

And while it’s true we have a dispersed population, we are nevertheless one small State, and our State needs one health system – not a health system for each region of the State.

The time for a meaningful and sustainable reconfiguration of health is now.

This week, Cabinet approved a number of significant reform measures that I am pleased to announce today.

Our reform agenda is titled One State, One Health System; Better Outcomes - because this best reflects our intentions.

Tasmania’s new health system will be reconfigured as a State-wide system, but most importantly, it will place the interests of patients back where they belong – at the forefront of every decision.

The four major components of the reform agenda that I will be announcing today are:

The transition from the current three Tasmanian Health Organisations to a single State-wide THO, which we will be calling the Tasmanian Health Service.

A corresponding and comprehensive review and reform of the DHHS, to enable it to better discharge its responsibilities as purchaser an system manager

Convening a new Health Council of Tasmania, providing strategic advice on the direction of Health Care in Tasmania, and composed of clinicians, consumer and community representatives, and nominees of other key stakeholders in Health in Tasmania. This will be complimented by a strengthening of the Clinical Advisory Group structure put in place by the Tasmanian Lead Clinicians Group, to enable both clinical engagement and the provision of discipline-specific clinical advice.

Developing a White Paper to set the Government’s agenda for better service planning, profiling and delivery in Tasmania. The first stage in this process will be the release of a Green Paper for public consultation by the end of 2014, with the White Paper to be released by 31 March 2015.

Before I go into further detail on each measure, I can advise that these seemingly basic structural reform measures make possible a swathe of improvements to Tasmania’s health system, such as:

1. First: Delivering significant cost efficiencies by removing duplication and leaner administrative and backroom functions, and improving procurement and purchasing practices on a state-wide basis
2. Secondly: Ensuring integrated, joined-up health services with an improved alignment with the Tasmanian Medicare Local;
3. Thirdly: Strengthening the a State-wide clinical governance framework to enshrine quality and safety as key drivers of care; and
4. Finally: Revising the way we collect, report on and learn from data and key performance indicators to drive better outcomes.

It is quite appropriate, of course, for Tasmanian patients and the Tasmanian community to ask “How will these reforms make things better for us, as users of the system?”

For consumers of our health system, the structural reform measures will deliver:

• improved, timely access at each level of health service delivery;
• significant savings to be re-directed to frontline care;
• effective clinical and community input into decision-making;
• alternatives to hospital care for those with chronic conditions to reduce demand on hospital beds;
• initiatives in the management of surgery services to reduce waiting lists and decrease cancellations, including:

-        the separation of emergency and elective surgery;
-        the introduction of a State-wide elective surgery waiting list and helpline; and
-        Publishing transparent and honest data, so patients can make informed decisions about their health care, alongside their GPs.

ONE TASMANIAN HEALTH SERVICE

The current model of three separate Tasmanian Health Organisations – one in each region – has now been in place for a little over two years.

At the time of establishment, there was considerable debate, and significant support for a single THO model and a prediction from some that maintaining three THOs would not be sustainable in the long term.

This has proved correct in time.

In addition, concerns were raised over how the existence of three separate health organisations would impact on the collaboration and cooperation which is absolutely essential for health to function in a State with the population and resources of Tasmania.

We are one state, with one health system – and our structure should reflect this.

We will move from three THOs to a single THO – to be called the Tasmanian Health Service, by 1 July 2015.

This renaming from ‘Organisation’ to ‘Service’ reflects the Government’s focus on reducing bureaucracy and delivering better health services to the Tasmanian community.

In moving to the Tasmanian Health Service, we expect to deliver significant savings over the first four years through reduced duplication and administrative costs.

Preliminary estimates suggest these savings could total up to $21 million over four years.

In addition to reduced duplication and administrative costs, a single Tasmanian Health Service will also allow us, for the first time, to make real progress in improving the fundamental planning and delivery of health services. Including:

Greater collaboration between health professionals across the State;

A truly state-wide focus on clinical governance, safety and quality- identifying and sharing best practice where it exists, and minimising needless and potentially risky variation in practice;

cost efficiencies of state-wide services, so more patient services can be delivered;

more efficient management of waiting lists, occupancy and access, and better integration of health services, and alignment with the Tasmanian Medicare Local

I want to be very clear about this: A single THO will not mean hospitals will be closed.

Hospitals are more than merely bricks and mortar constructions where services are provided.

They are central to the identity, and the feeling of security, of a community.

There is not a hospital in Tasmania of which its local community is not justifiably proud and fiercely protective.

And so I say again, this Government is not in the business of closing hospitals, and the formation of a single THO will not lead to the closure of hospitals.

Over the last two years, staff in each of the three THOs have committed wholeheartedly to the welfare and care of patients and the community in their region. This needs to be recognised and respected.

The integrity and most valuable aspects of the three THO model will be protected, including local community reference, the status of our local regional and major hospitals, and the capacity to continue to completion relevant local projects and priorities.

In order to reflect the fact that we have a distributed model of health care delivery in Tasmania, the administration and secretariat of the new single Tasmanian Health Service will be situated in Launceston.

This structure will be supported by local clinical and corporate management structures at each of the state’s large hospitals.

The single THO will also ensure local representation by drawing Governing Council members from across the State.

Existing consumer and community engagement structures within the three THOs will be retained, in order to maintain the local voice in decision making.

The formation of the Tasmanian Health Service - Tasmania’s single THO - will enable the provision of more efficient, consistent, safe and high quality care, while retaining local representation, the status of our hospitals, and the pride we rightly feel in our local community.

DHHS REVIEW

Structural reform will also be delivered within the Department of Health and Human Services.

Under the National Health Reforms, the intention was that the Department would transition from its traditional, centralised bureaucratic structure, to essentially a combination of a purchaser of health services and a slimmed down ministry/policy function.

This process stalled in its implementation, and we now find ourselves in the position that the Department continues to provide health services directly to the community, as well as a significant number of corporate support functions.

We will begin immediately a comprehensive organisational review of the DHHS so that its structure matches the job it has to do as system manager and purchaser.

This completes the stalled process of evolution towards a slimmed down purchaser model – that should have been completed as part of the health reforms two years ago.

This will reduce duplication, make the Department leaner and more efficient and deliver savings to taxpayers that will be able to be re-directed to frontline health service delivery.

In addition, it clarifies significantly some of the clouded accountabilities within the system.

The purchasing and strategic policy functions of the DHHS will be clarified.

The role of the Department as the system manager - of my behalf - will be explicitly stated so that all parties comprehend the authority and obligations of the Department in this space.

And the support services available to both THO and DHHS will be provided in more effective and efficient ways.

HEALTH COUNCIL of TASMANIA

A key finding of the Report of the Commission on Health Service Delivery in Tasmania was the lack of clinical and consumer engagement in the Tasmanian health system.

Getting this right is a key focus for the new Government.

Consistent with our election commitment to key stakeholders, we will establish a new Health Council of Tasmania to represent the perspectives of clinicians,, professional groups, consumers, the community and other key stakeholders in health in Tasmania.

The Council will be perfectly placed to provide the Minister, and other key players in the system, with the high level, strategic advice required to make the long term planning decisions health so sorely needs.

In addition to establishing the Health Council of Tasmania, I will be tasking the Department with strengthening and expanding the Clinical Advisory Group structure as devised by the Tasmanian Lead Clinicians Group. These CAGs will be vital for the facilitation of effective clinical engagement, as well as providing discipline-specific clinical advice.

• Those CAGs that are already in place will be supported to continue their work;
• A number of informal, collaborative networks that have arisen through the commitment and diligence of health professionals will be assessed for their appropriateness to be developed as CAGs; and
• Where gaps are identified, consideration will be given to the development of CAGs to address those gaps.

The Council will work closely with the existing Clinical Advisory Groups to ensure we are engaging with clinicians and consumers appropriately at every turn.

After all, it is those who are working in our health system at the coal face that are best-placed to drive positive change.

And it is at this point that I would like to make particular acknowledgement of the commitment and efforts of the members of the Tasmanian Lead Clinicians Group. These individuals have given much of their time to, among other activities:

• Developing the Clinical Planning Framework that will assist the me and the Department in determining significant future directions in health;
• Establishing the Clinical Advisory Group structure, as we have already heard; and
• Liaising effectively with clinicians, health professionals, the Department and THOs over the last two years.

The members of the TLCG have typified a professional commitment to improving the delivery of health across Tasmania, and I thank them for their efforts over the last two years, and I would encourage them to continue to contribute their professional expertise and passion, perhaps through leadership roles within the strengthened CAG structure.

WHITE PAPER

Finally, a critical element of the reform agenda is the development and articulation of a clear vision for the future direction of health in Tasmania – setting out where we are headed, the benefits, and the means to get there.

The views of the Tasmanian community will be front and centre in setting this direction, and the Government will release a Green Paper on the future direction of health in Tasmania for public consultation by the end of this year.

The Green Paper will be compiled in conjunction with the formation of the Health Council of Tasmania, to ensure we capture that body’s strategic wisdom.

Following public consultation, the Government will prepare and release a White Paper on the future direction of health in Tasmania, to guide how we develop a sustainable mix and profile of clinical programs throughout the State, in each region, and the establishment of clinical centres of excellence.

The White Paper will be completed and released by 31 March 2015, and will set the Government’s agenda for better service planning, profiling and delivery in Tasmania.

Ladies and gentlemen:

Rebuilding the health system that was left fragmented and broken by the previous Government requires an investment we committed to at the election, and will honour.

Reforming the structure – the very foundations of our health system – is an essential first step, but it won’t be quick, and it won’t be easy.

However, just because it is difficult, doesn’t mean we should not take up the challenge.

As Minister, I won’t be daunted by the job, because I know it is the right thing to do.

And I know that you, as the professionals who give so much for the people of Tasmania, recognise that change is necessary.

I have been approached time and again at my staff open forums and privately by clinicians, health workers and patients and their families urging me and the government to introduce changes for the better.

For me - and, I believe - the people of Tasmania - doing nothing is not an option.

Effectively, “doing nothing” raises the white flag and sends a message to Tasmanians they must put up with some of the worst health outcomes in Australia - that these outcomes are somehow a necessary evil of living in Tasmania.

That’s not acceptable to me.  I’m sure it’s not acceptable to anyone here.

We can keep the best of the system we have, and make sensible, evidence-based changes to redesign our health system to make it more patient-centred, stronger and sustainable.

Ladies and gentlemen: colleagues.

This Government cannot build the health system of tomorrow without your help, without you becoming a responsible partner in the reform process.

If you feel as I do, that our health system is in need of reform and can deliver better outcomes for Tasmanians, then I ask you to join with me.

Look for how your organisation, your skills, your expertise can help improve our health system.

Look for how your knowledge and know-how can help Tasmanians get the care they need sooner at less cost with better quality and better result.

Those who have heard me speak before may have heard me say that you couldn’t take this portfolio away from me.

And I believe that there is no better journey to be on right now than this one.

Because it is a journey we will all have to take together and we can really improve the quality of life for our fellow Tasmanians.

I know you share this commitment.

I know you are ready to help.

And I look forward to working with you as we deliver these significant changes for better health for all Tasmanians.

THO Reform Welcome but Launceston Wrong Location. Download Cassy’s THC speech