Madam Speaker, I rise to update the House on the progress of our reforms to rebuild Tasmania’s health system – what we’ve delivered to date, and how we will address the future challenges we face as a Government and as a community.
Upon coming to Government in 2014, we commenced a most significant overhaul of Tasmania’s health system – the One Health System.
We knew that this would be challenging, and we knew that this would mean facing some hard truths about the state of our health system, but we stayed the course and eventually achieved agreement on the model.
Establishing this support took genuine engagement and many, many conversations with the staff, the stakeholders, and most importantly, the Tasmanian community.
But we now have the plan – we have the direction, and we have the vision.
In 2014, we reviewed the Royal Hobart Hospital redevelopment and began the long process of rebuilding health services to ensure Tasmanians could access the care they needed.
We have ploughed in millions of dollars to address long waits for elective patients, achieving a reduction of 2900 days for the longest waiting patients, or 80%.
We funded the North-West Cancer Service, built helipads, set up bus services to link the Latrobe and Burnie hospitals, established the new Integrated Maternity Service in Burnie, and importantly lobbied the Australian Government hard to deliver certainty for the Mersey Community Hospital and its staff and patients.
We also established the Community Rapid Response Service in Launceston, and provided long-term funding certainty for the John L. Grove rehabilitation service in the north.
Importantly, over the past four and a half years, we have opened 120 additional beds, including the new 22 beds at the Repatriation Hospital in Hobart, and have employed an additional 100 doctors, over 500 more nurses, 70 more allied health professionals, 51 extra paramedics, and increased nurse graduates by 76%.
These investments – over 800 FTE staff and more health services for our system – do not just happen.
They are a direct result of our strong financial management, which has enabled our investment in health to increase from $5.8 billion in 2013-14 to $7.6 billion in 2018-19 – almost $2 billion more on health over the forward estimates.
And we are listening closely to what our frontline staff are telling us.
The very first Bill passed by this Parliament, this year, has delivered the next stage of our health governance reforms – strengthening local hospital leadership and bringing the health system under a single point of accountability.
These important changes in how we govern our health system, combined with the Government’s clear commitment to putting on more staff, delivering more resources, and opening more beds, will set up our system to meet tomorrow’s demand.
It is through listening to our staff and the Tasmanian community that we have strategically and methodically delivered these improvements for our health system.
In this spirit, I will be conducting another round of public forums to discuss our health system directly with Tasmanians.
These will cover the three regions of our state, starting with next Monday in Hobart at the Grand Chancellor.
I will then be in Launceston on Tuesday the 23rd of October at the Tramsheds, followed by the Burnie Civic Centre and Devonport Entertainment Centre on Wednesday the 24th of October.
I have done these forums regularly since becoming Health Minister in 2014, and I welcome the direct feedback about what Tasmanians think is working, and what they think we need to do better.
Make no mistake: every single member of this Government knows there is still much more to be done.
We know that our staff are working their guts out at the coalface.
We know that our patients deserve better.
And we take responsibility for delivering that as a Government, which is why we are working hard every day – to employ, build and serve.
It is no secret that demand for acute health services has been growing at a significant rate.
Our staff are doing a remarkable job under what at times can be significant pressure.
Hospitals all over the country are facing similar challenges in meeting demand that is outstripping the capacity.
Indicative of this growth in sheer numbers of patients that now need to be seen during a demand peak.
As the Premier noted two weeks ago, twelve years ago the Royal Hobart Hospital Emergency Department treated, on average, 108 patients per day.
In 2018, we now need a hospital that can treat up to 220 patients a day.
Between 2016 and now, annual demand on our ED Departments has risen by more than 7,000 patients.
But it is not only the number of patients that has grown.
The complexity of patients that our hospitals are seeing has increased, meaning that we have more patients coming through the front door – more patients, needing longer stays and a higher level of care.
In 2017-18, there has been 15 per cent growth in Emergency Department presentations that converted to admissions, and six per cent growth in emergency surgery.
This is a significant jump – putting pressure on patient flow and bed turnover.
At all of our four major hospitals, but at the Royal Hobart in particular, we are finding more and more that we are attempting to meet today’s demand in yesterday’s hospital buildings.
Last year due to increasing demand from an unprecedented winter flu season we flexed up, recruited more staff and invested an additional $63 million into the system.
Our strong financial position enabled us to respond.
It is for exactly this reason that this year’s budget contained not only record spending on health – an additional $465 million into health in this year’s budget – but also sensible surpluses across the forward estimates so that we can meet challenges that arise whether they be in respect of demand in our hospitals or natural disasters like floods or bushfires.
The Budget includes the roll-out of our election commitments, including the recruitment of another 478 staff over the next four years, for new and improved health services.
Madam Speaker, we have higher demand and we are investing accordingly to meet that challenge again this year.
We have continued to grow our health services – with almost 220 health staff appointed since March, including more than 130 nurses and 20 doctors.
Every year of our Government we have invested even more than originally budgeted, employing more health staff providing more health care. This year will be no different due to the demand we are experiencing.
We can afford to do this because of our sensible financial management and the strength of our finances, which mean we are able to respond whilst ensuring that the budget will remain balanced and retain the capacity to respond should other challenges emerge.
Royal Hobart Hospital Redevelopment
So Madam Speaker, it is indisputable that demand is increasing, and that we must do more to meet the health needs of Tasmanians.
And we are committed to doing just that – and a big part of this is delivering the long anticipated Royal Hobart Hospital Redevelopment next year.
That’s why we made, at the last election, the largest commitment for investment in health that this state has ever seen.
The Government has committed to fully staff and open 250 additional hospital beds at the newly refurbished Royal Hobart Hospital and the Repatriation Hospital.
This will take some time, and needs to be carefully planned as part of a considered process to ensure the bed mix is meeting our community’s needs.
The fact is there are several sections of the existing spaces at the Royal that need work.
This is why we have set aside almost $30 million to redevelop wards and units at the Royal – to ensure that they meet modern standards and deliver the best possible clinical spaces for our staff and patients.
The bed openings will be staged and managed as we complete these crucial works, with all 250 beds to be open and fully staffed by 2024.
This is an investment of almost $300 million over the next six years – a huge boost for our system’s capacity in anybody’s terms – and it is estimated the new beds will provide medical care for over 26,000 more Tasmanians each year, including elective and emergency surgery.
As I have already mentioned, the Government is absolutely committed to working closely with clinicians and stakeholders to plan the best clinical mix of beds across the site.
In April this year, we established the Clinical Planning Taskforce, to lead clinical planning for the new hospital beds and to guide the next stage of the redevelopment on the Royal precinct.
That taskforce is now working to update the overall RHH site Masterplan, which will include consideration of proposals and consultation with staff and key stakeholders on the best use of the new ten-storey K-Block tower, and the development of other parts of the hospital site.
This process will ensure that any decisions taken are properly and fully informed, with appropriate professional support and due diligence to ensure the very best interests of patients are at the forefront of any options considered.
The Secretary of the Department of Health will finish this work by February 2019, and any recommendations will then be considered by State Cabinet.
To assist the Secretary, I can today announce that a Southern Reference Group has been formed to help drive this work and ensure there is direct input from clinicians and health stakeholders.
This group is co-chaired by the Chief Medical Officer who chairs the Clinical Planning Taskforce and the Executive Director of Operations of the Royal Hobart Hospital.
The group will see Medical and Nursing Clinical Directors and professional leaders from the Royal Hobart Hospital working alongside representatives from the Australian Medical Association, the Australian Nursing and Midwifery Association, and the Health and Community Services Union.
This group will provide specific expert and local input into master planning for the Royal Hobart Hospital precinct, with the key players representing our staff at the coalface all at the table, as part of a comprehensive process of clinical stakeholder consultation.
Madam Speaker, it is important that we thoroughly consider how we continue to develop the Royal Hobart Hospital, to ensure we are planning for its future and maximising the opportunities.
However, we must also be dynamic and responsive as we implement our plans, and today I can announce that we have accepted advice from the Clinical Planning Taskforce to make some significant amendments to the configuration of K-block that will greatly improve the effectiveness and efficiency of the new facility.
Madam Speaker, we will improve the layout of level ten of the new hospital building, so that the whole floor is fitted out for general medicine and respiratory beds.
The plan was previously for their floor to be occupied by a broad number of different specialities, but the change, as specifically recommended by Royal Hobart Hospital clinicians, will deliver several key benefits:
- By grouping a greater number of general medical beds on the one floor, patients will receive more efficient and effective treatment because they are cared for on one, designated ward, not multiple wards. Our hardworking medical staff will not need to move from ward to ward to look after their patients, and the nursing staff providing care will be able to focus on a set group of patients and conditions. The outcome of this is that patients will be more likely have a reduced length of stay, meaning they can get back home sooner and recover faster in their communities.
- Patients will be able to move more rapidly from the emergency department into ward beds – helping reduce waiting times for care, relieve pressure on our ED staff, and improving patient flow throughout the whole hospital.
- Space adjacent to the Emergency Department will be freed up, providing much needed future expansion space, with the movement of current beds to the new general medicine floor. Again, this will likely mean more space for the ED to flex into in cases of demand peaks, reducing pressure on ED staff and ensuring more care is able to be provided to more Tasmanians.
Of course, RHH local management will work closely with staff as these changes take place, following completion of the redevelopment next year.
To facilitate these changes, the Acute Rehabilitation Unit will remain at the Hobart Repatriation Hospital.
In addition, neurology and stroke will remain in A-Block. We will continue to work with staff and ensure that these important services are accommodated appropriately.
Madam Speaker, these changes are strongly supported by the clinical and nursing workforce and leaders at the Royal – as well as the Australian Medical Association.
Where other changes arise out of the master‑planning process, these will be considered through Cabinet and with regard for budget planning.
Importantly, the changes I am announcing today are all accommodated within the current RHH Redevelopment construction program and budget.
There will be no impact on the timeline for practical completion, with the Redevelopment remaining on track for August 2019.
Tasmanians have been waiting a very long time for this day to come – since 2006, when a new Royal was first floated – and it is exciting that we are now on the home straight, less than 12 months out.
Once completed, there will be a service commissioning process to ensure occupation of the brand new wards and units is undertaken in the most structured and strategic way.
Again, I thank the outstanding staff at the Royal, who have been so patient and have been essentially working in a construction zone for so long.
We know how difficult this period has been, but there is light at the end of the tunnel.
Madam Speaker, boosting mental health has been a significant focus of this Government.
We have all seen the pressures that have arisen and the way that demand for mental health services has grown, especially in the South of the state.
There has been a 35 per cent increase in mental health related presentations to the RHH Emergency Department between 2013-14 and 2017-18 from 4 822 to 6 508.
The acute inpatient unit at the RHH has been experiencing increased rates of occupancy, operating at about 98.2 per cent occupancy as at 31 March 2018, and has experienced bed block on a number of occasions during 2017-18.
This is why, at the 2018 Election, the Government committed to open 10 new mental health beds at Mistral Place, as well as 15 beds at a rebuilt Peacock Centre in North Hobart which was destroyed by fire.
Today, I can announce that the Government has reworked our Plan and will now deliver an accelerated mental health beds commitment.
We will be taking immediate action to recruit and open 12 new Mental Health in the Home beds in Hobart – in response to increasing demand on the Emergency Department, and in response to increasing pressure on the acute mental health inpatient unit at the RHH.
Hospital in the Home, or “HITH”, is an innovative model utilised throughout the country, through which patients receive hospital level care whilst being accommodated in their own home.
Evidence shows that this approach provides the same quality of care as traditional, hospital-based care for medically stable patients, and has superior outcomes in some cases.
HITH staff are highly skilled and trained and are able to provide clinical interventions and services at inpatient intensity, within a community environment.
The HITH staffing model consists of staff from a range of disciplines and providing services within a multi-disciplinary model, and our Chief Psychiatrist has significant experience with helping to implement this model in other jurisdictions.
Noting current demand at the Emergency Department of the RHH, a staff member of the HITH would be expected to attend the Emergency Department each morning to identify those patients who would be more appropriately treated by the HITH team.
Madam Speaker, we are aiming to have these HITH beds open by the end of March next year, which is a shorter timeframe than pursuing the Mistral Place option, and means we are able to get on with the job of delivering much needed services sooner.
The Government will review the ongoing operation of the HITH once the construction of all new mental health facilities is completed.
So we have acknowledged that we need more mental health beds to take pressure off the Royal Hobart Hospital Emergency Department, and this is why our election policy proposed that the ten beds already accommodated the top floor of Mistral Place be mirrored on the bottom floor, following consultation with staff and services.
The Department of Health and Tasmania’s Chief Psychiatrist commenced work on how the Mistral Place commitment could be operationalised immediately after the election.
Some months ago, however, the Chief Psychiatrist noted that there were challenges with our Mistral Place plan, and unfortunately it was not looking as straightforward a project as it first appeared.
The Chief Psychiatrist has now briefed Cabinet on the outcome of this work, and I can today advise the House of our decision.
The Government will construct a brand new 12-bed dedicated mental health facility as St Johns Park in New Town, to assist with the management of demand for mental health services, to increase patient flow and deliver more access to mental health care.
This is a bigger, better facility than our initially proposed Mistral Place expansion, delivering two more beds and a better environment for clients.
We will invest an estimated $9 million of new funding over and above our election commitment funding to ensure we do this right – a total construction budget of approximately $11.5 million, which will be confirmed once planning is complete.
This new facility provides a longer term solution to increased demand for mental health care and treatment, and is in addition to meeting immediate needs through the Mental Health Hospital in the Home Program.
It also is intended that the facility will be designed so that there will be opportunities to expand capacity at the site in the future.
This is an exciting project with huge potential to develop truly joined up service models as part of the clinical planning for the facility.
Consultation on this facility will therefore commence as soon as possible, with construction to be completed in 2021.
People have been on occasion waiting many hours and sometimes days in the RHH ED for a bed to become available in the acute inpatient unit.
The Government does not accept that this is good enough, but we also do not accept that there are simple solutions that can be implemented in isolation to address these issues.
I have said on several occasions that, as a Government, we do not want to see any Tasmanians waiting too long for care.
It is the Rethink Mental Health Plan, which is universally supported and has been embraced by key mental health stakeholders, that continues to chart the path forward for Tasmania – towards an integrated mental health system that has the right supports in place at all levels of acuity.
The direction in Rethink is based on strong evidence about what a modern mental health system should look like, as well as the consistent advice of mental health stakeholders that we must focus more on the community.
It is therefore important that the House and the community is clear on exactly what improvements are coming up under the Government’s $95 million plan for mental health.
There will be 12 brand new mental health hospital in the home beds operating in southern Tasmania within the next 6 months.
Tasmania’s first ever child and adolescent mental health facilities are now less than 12 months away – due to open in Launceston in September next year, after the first stage of the 4K redevelopment is completed.
These beds will service young Tasmanians across the North and the North West, providing high levels care closer to home for these young people and their families – a huge step forward for our system.
The new adolescent unit at the Royal Hobart Hospital will follow within six months after, providing more specialist child and adolescent mental health facilities for vulnerable Tasmanians, along with the new mental health unit as part of the redevelopment, subject of course to consultation through the Clinical Planning Taskforce.
Then later, in 2020, the Peacock Centre will provide 15 more beds, before the 12-bed St John’s Park facility at New Town is completed in 2021.
All up – this means that within just three years there will be the 27 more mental health beds available in our system, plus the child and adolescent mental health facilities delivering capacity we have never had before in our State.
These important services are all about building a better mental health system with more staff, more support and more options for Tasmanians experiencing mental ill health.
The clear advice is that these new beds will take pressure off our acute mental health services and provide better care outcomes for Tasmanians, as there will be more access to mental health care at a more appropriate level.
We so are proud to be delivering these crucial improvements, and will continue to work closely with mental health staff, stakeholders and consumers to make sure that we are meeting the needs of our community.
Aeromedical Helicopter Service and Ambulance Services
The Premier confirmed two weeks ago that the core team of six new medical specialists, who will operate Tasmania’s first ever integrated medical and search and rescue helicopter service, have now completed their training in pre-hospital and retrieval care.
These consultants have been completing this intensive training alongside our dedicated flight paramedics, and will be permanently stationed out of the airport from February 2019.
We have brought forward funding to boost the service sooner, so that the team is in the best possible position to ramp up to full capability in mid-2019.
Now that these specialists have been trained, they are also able to train other members of the service, which is the first time Tasmania has ever had this level of training capacity.
The new service will dramatically improve response times, and the expert advice is that it will save up to nine lives in Tasmania every year.
All up we’ll be recruiting an expected 30 additional specialist paramedics, doctors, nurses and support staff, and with the addition of helipads at the Mersey and Royal Hobart Hospital all four of our major hospitals will be connected to an integrated aero-medical service for the first time – saving vital time which will be the difference between life and death for critically unwell or injured Tasmanians.
Further support our ambulance service will come via the secondary triage service, which will be commencing next year.
This initiative will help ensure patients who do not require emergency intervention or transport to an emergency department are connected with a more appropriate health service.
This has the benefit of ensuring more paramedic resources are available for emergency calls, meaning paramedics are more able to attend to the most urgent call outs.
It is estimated that, once fully operational, the secondary triage service will assess almost 22,000 calls per year, and has the potential to divert up to 16,000 patients to alternate service providers.
At my direction, the Secretary and Chief Executive of Ambulance Tasmania have been consulting directly with ambulance staff all over the state on the best locations for new resources under our commitment to deliver 42 new rural and regional paramedics over the next five years.
They have done a fantastic job, listening to paramedics from Sorell to St Helens, and we remain firmly committed to delivering these much needed paramedics in the near future.
I’ll have more to say soon on the first rounds of recruitment and where those placements will be, but all of these paramedics will provide vital support for their colleagues in more populated areas, as they will ensure less need for these paramedics to go out of area to collect patients.
Community Rapid Response
Finally, I am pleased to confirm that in the coming weeks we will be commencing recruitment for the $11.1 million Community Rapid Response – Hospital in the Home teams in southern and North West Tasmania.
These teams will ease pressure on hospital presentations – diverting delivering care which can be safely delivered in the community or in the home, especially for those who have chronic and complex illnesses and who are frequent hospital and Emergency Department users.
All up, it is estimated that more than 30 new allied health professionals and nurses will be recruited to operate the service, providing around 20 000 appointments and other services over the next three years.
The Government have a strong record on delivering more resources for our health system – doing whatever we possibly can to boost services and provide more access to care.
We have acknowledged that our health system is under pressure from rapidly increasing demand and we know there is more to be done, but Tasmanians can be assured we are committed to listening to health professionals, key stakeholders and the Tasmanian community as we deliver on our plan.
To build a better health system and boost the capacity of our hospitals, the facts are that we need to build the facilities and plan properly for the services that are needed.
And as I have outlined today, we are doing just this.
This Government will never stop working to deliver the health system that Tasmanians deserve.
We have the plan, we have put the funding in the Budget.
As a Government we have the will to do better, and the drive to do more.
And now it is a matter of delivering.