Transcript of media conference with AMA President Dr John Saul, Vice President Dr Annette Barratt, and AMA Tasmania Board Member Dr Michael Lumsden Steel at AMA Tasmania office, Davey St, Hobart, 26 February 2024.
Dr John Saul
We have a health system in crisis, we have problems across the board. Every domain of health is struggling in Tasmania. And we really need to get stuck into our key priorities here, especially with an election coming up.
General practice – we know about the problems we’ve got there. It’s normally a federal government responsibility. We’re seeing some good work from our state government as they step in to fill some holes, but it’s just crisis management. We’re not seeing an overall concerted effort from state and federal governments to get general practice back on track. General practice does so much heavy lifting. If we manage a chronic disease as well, in a general practice setting, we save emergency department presentations, we save hospitalisations, we get people out of hospital quicker if we can do more work in general practice. This is an area of primary care that needs massive support. And it’s been sadly lacking from our governments. That’s one of our key priorities.
Relieving pressure in our hospitals, of course, is well and truly there. Building critical infrastructure is just a massive component problem that we’ve got. We just seem to have vision without delivery when it comes to our infrastructure. My family, we don’t live long lives, we’re going to be dead before a lot of this stuff is done. When you look at what what governments are doing, it’s talking, it’s producing headlines. It’s not putting bricks and mortar together to provide us with the essential infrastructure we need.
Community support – we’ve got so many areas where we need to work here: vaping, ADHD, assessment of our child support services, there is so much we need to do in this area.
And of course, we need to ensure that we have robust complaints process going forward. And we’ve talked about that one before, that needs to be addressed in this election. So we have five key priorities.
Journalist – John Hunt
You talked about primary care and the federal government responsibility. But what could the state government do to work with the federal government? Do you want to see them putting in is more money? Or is it more moral support, what are we’re talking about?
Dr John Saul
We’re seeing this state government to date doing crisis management with areas of extreme pressure in general practice, and they’ve done some good work there. We’ve seen benefits with rural rural support packages that have been thrown at areas in crisis, whether it be East Devonport, Bridgewater, or some of our more rural areas, we’ve seen some work from this state government.
But it’s not enough and it’s not consistent. We’re going from crisis to crisis in general practice, especially in our rural areas.
Payroll taxes is another area which is a constant threat to general practice. These are ill-defined rules in payroll tax, and if they’re brought down aggressively they could cripple general practice. We fully respect the Labor Party with their position they’ve taken, they’ve taken a strong stance saying they will leave general practice alone when it comes to aggressive payroll tax claims. We hope the other major parties will come to the same party, they must come to the same party to give general practice surety going forward.
Journalist – John Hunt
You talk about the technology as well in robotic surgery, the LGH, and things like that. How far behind are we at our hospitals with the technology needed to improve patient care?
Dr Michael Lumsden Steel
What we’re seeing across the state is years of delayed investment in IT and other infrastructure processes actually really catching up with us.
Part of medicine in 2024 is innovation. We see a lot of things that used to require open surgery, having multiple days in hospital, being replaced by day case or overnight stay procedures, which is fantastic. Robotic surgery is one of these areas, it’s evolving surgery too and for certain surgical areas there’s shown to be clear patient benefits, which is reduced complications, but also early discharge.
For somewhere like Launceston, it now really needs to attract and retain a neurologist in the north of the state. Getting robotic surgery into the LGH would provide the northern half of the state with access to this type of surgery, which is available down south. Now it is available in private, not in public. But for Launceston to get that provides a great innovation to attract and retain specialists and care for the patients that are in the north of the state. And this is what we’re seeing rolled out around the country. So we’re saying for Launceston, we really need to be in that regional market.
Journalist – unidentified
Can you talk about the log jam in the emergency department? I guess it doesn’t seem like there’s just one solution, but –
Dr Michael Lumsden Steel
John has obviously already already hit the nail on the head, we need to get our GP workforce up and running again, which is going to help keep patients out. People forget that GPs can deal with a lot of acute injuries too, that don’t always need to come to an emergency department. They can talk to specialists outside the hospital.
But critically, the hospitals need more more resources, which is both beds, medical imaging and pathology investigations so we can turn patients around quicker. But also patients that no longer need to be in the acute hospital need to go somewhere. What we’re seeing now is that the hospital has got 20 to 30 to 40 patients every day, that should be somewhere else. And that could be being assisted to go home earlier, or going to a sub-acute facility. These are resources we don’t have.
We talked about community resources before too. What we’re seeing is the community resources that we need to get patients home at the moment are non-existent. We talked about looking at how we support aged care facilities, how it can keep and care for aged care residents in their facility, and how we can get them home sooner too so that they’re not in the hospital system for a day longer than they need to be. In fact, even half a day is too long sometimes because that denies someone having operation.
The only thing we can turn off to the hospital – it’s not the ambulances, it’s not the patients that present with acute illnesses, it’s elective surgery – and the flow-on effects of there being no beds and the log jam is that patients are getting their major surgery cancelled And that’s upsetting. Procedures that they’ve had to have their family fly down from the mainland, or get care in for their loved ones at home because their primary carer to have their surgery, when they rock up and they’re told sorry, on the day, ‘we just can’t do you today’. The amount of stress and angst these patients go through. It’s wearing down on the healthcare workers, and the poor patients that get cancelled once twice, three times they’ve just had enough.
Tasmanian Times
There have been the closures of a number of private facilities including St Helens maternity and facilities not built like the one that was proposed for North Hobart. What needs to be done in that space to encourage more private investment in the health sector in Tasmania?
Dr Michael Lumsden Steel
I think clearly at the moment we’re facing a bit of an economic challenge. The cost of building and infrastructure and renovations etcetera is very high. But can we see it getting any lower? The state government has been doing a lot of heavy lifting, having to get on with things for many years in the past.
We need them to collaborate with private because without these private facilities – the implosion of the Mother Baby Unit impacted significantly on parents, there was no alternative – the Royal Hobart Hospital is not able to absorb those beds. We literally do not have the capacity in public to suddenly fill voids when private facilities shut down. So we need to look at collaboration, we need to look at the funding models, and look at investor models to actually ensure that these are sustainable.
There’s been several facilities that’ve been talking about renovations in Tasmania for several years or even 10 to 15 year plans. They haven’t got on with it. And that again puts more pressure back on the public system. So that collaboration that can keep patients out of public hospitals is really important.
Dr John Saul
We know Launceston especially is vulnerable here. Having just lost the opportunity of developing a private facility of 100 beds plus co-located with the LGH in Launceston is a real tragedy. We need to get this back on track with any private provider. We just need to make sure this happens.
Journalist – unidentified
In terms of GP shortages, do you have a figure for what we’re facing at the moment in Tasmania?
Dr John Saul
We’ve got at least 60 advertisements going out there wanting GPs. But I know some surgeries that will take two or three tomorrow. So the figure is probably close to a 150 GPs shortage across the state.
Journalist – unidentified
GP shortage has been an issue for a long time now. In the foreseeable future, how – if now is described as a crisis – how much worse could it get? What would happen if we don’t fix this shortage?
Dr John Saul
We know that if we have a 20% reduction in general practice consultations for health care card holders across Australia, we’re going to see an extra $3-to-6 billion worth of presentations to emergency departments and hospitalisations. Divide that by 20 and you’ve got the situation here in Tassie.
We’re already seeing it now. I’m seeing it in general practice myself at the coalface. If we’re not managing our chronic disease, right, we’re seeing more people are turning up in A&E departments, more people are staying in hospitals, more people are getting stuck in the logjam. And as a result, the people of Tasmania just aren’t being looked after.
Journalist – John Hunt
Can I ask about the fair complaint process? We talked about this a couple of weeks ago. Are you finding that any discussions haven’t progressed to reforming that to your liking?
Dr Michael Lumsden Steel
What we’re saying here is that there needs to be a review of what the fair, what the complaints process is delivering at the moment. And it’s not just doctors, it’s all staff in hospitals. We’re seeing that it’s a complaints process where the pendulum has swung way too far. And what we’re after is a system that is actually fair in principles of natural justice.
Now, for not one second, are we saying here that any patient should be compromised, or the patient’s safety should be compromised at any stage. But we’re seeing a process net that has now swung too far. We’ve seen actually it’s impacted on healthcare delivery, because we’ve got no redundancy in our healthcare system. So if we run a process that sees healthcare workers are taken out of the healthcare system for whatever reason while an investigation or some processes run that then it ends up running its process and coming back to work, that’s got massive flow-on effects.
We’ve seen that in Tasmania, we’re seeing patients having their care delayed by several weeks and having to move around the state for care because we have had a process that’s been running. We just need to get back and review to make sure we’re doing it correctly. This is not about protecting anyone, but this is about ensuring that the system is robust, it’s transparent, and it’s appropriate.
Tasmanian Times
Annette could you please speak a little about the extent of the vaping problem in Tasmania?
Dr Annette Barratt
The vaping problem in Tasmania is becoming rapidly a crisis. More and more young people are finding that vapes are easy to obtain. Unfortunately, despite the federal government’s efforts to prevent their importation, they are still available, and younger people are getting them. We’re finding primary school aged children are vaping, let alone the high school and the teenagers and the young adolescents are all vaping.
And unfortunately, we’re also seeing from that vaping a rise in smoking. For the first time in a very long period of time, Australian youth are turning to cigarettes when they can’t get vaping. And that is a national disaster in the future.
Journalist – John Hunt
Are we back to a point in vaping where we maybe were with smoking many, many years ago? Is that the concern?
Definitely, because vaping is seen in a lot of young people as harmless. They see the word vaping and think I’m inhaling water vapour. What they don’t realise, and they don’t understand, is they’re not inhaling water vapour. They are inhaling chemical particles that have been super-heated and microscopic, straight into the depth of their lungs. And they don’t understand the damage they are doing.
We don’t fully understand the long-term harm. But from a medical point of view, we know it’s wrong. And we know it’s going to be damaging by just plain medical common sense: putting chemicals super-heated in tiny particles deep into your lungs cannot be good for you.
Journalist – unidentified
What does the government need to do in this space? What would you like to see?
Dr Annette Barratt
I’d like to see a very strong education campaign aimed at the youngest people in our population right through to the eldest, but mainly in plain English. Considering that Tasmania has a very low literacy rate, and a very low health literacy rate, the program needs to be aimed effectively and it needs to go out across social media. It needs to go in places that the young people are going to see it.
Journalist – John Hunt
What are the consequences? Do you fear there’s going to be a new generation of people getting lung cancers and that, that we’ve worked so hard to prevent from 50 years ago?
Dr Annette Barratt
Definitely. We’re heading down a pathway which we can’t afford to go down. We are already talking about the health crisis. If we now then add another generation of people getting lung cancer, lung disease, emphysema, and we don’t know the other consequences. We know there’s a potential of heart disease from any lung damage. So we’re adding to the future crisis in a health system which is already struggling.
Drs Michael Lumsden Steel, John Saul and Annette Barratt.
