Madam Speaker, I rise to update the House on the progress of our reforms to rebuild Tasmania’s health system - on our achievements to date and on the future challenges we face as a Government and as a community.
In May 2014, the Commission on Delivery of Health Services, commissioned by the former Federal and State Governments, released a report into the Tasmanian health system, stressing the need for fundamental reform.
The expert panel found deep failings across our health system, including in governance, clinical and consumer engagement, culture, and efficiency.
Consistent with that report, we embarked on a significant path of reform to deliver the best health system we possibly can to our community.
Through the most extensive public and clinical consultation on health reform ever undertaken in this state, we developed the One State, One Health System, Better Outcomes reforms and our commitment to a single, statewide health system.
Many aspects of this reform have been recommended by numerous reviews going back many years commissioned by former Ministers.
This Government is committed to delivering better outcomes, backed by record spending of $6.4 billion over the next four years.
This includes our $100 million boost to frontline services, $24 million for better patient transport, and an additional $29.5 million over four years to support the implementation of the One Health System reforms.
Madam Speaker, regional division led to very real safety and quality issues, clinical communication failures, duplication or triplication of services resulting in inefficiencies and service gaps. This constrained our ability to deliver the range and volume of services that Tasmanians need.
We have broken the back of this decades long problem through establishing the THS, and I am pleased to advise the House that in its first year of operation we have seen $4 million per annum in ongoing corporate efficiencies – that is $16 million over the Budget and Forward Estimates Period – through smarter procurement, vehicle management and a renegotiation of its energy contract.
Importantly, these are not Budget savings – this funding stays with the health system to deliver frontline care.
We have released the detailed implementation plan for the White Paper, the Rethink Mental Health Plan and the Tasmanian Suicide Prevention Strategy; and our Healthy Tasmania plan; all significant documents that indicate our strong commitment to Tasmania’s health system.
So in just over two years, the Government has put in place clear strategies for the end-to-end reform of the Tasmanian health system – and we are getting on with the job of implementing those strategies.
Better Outcomes
Madam Speaker, these are landmark reforms that span the breadth of our health system.
The Government has begun what is an extensive change process designed to address problems entrenched over decades, to improve the health services Tasmanians receive. This will not happen overnight.
The White Paper is our plan for improvements to our Health system over the long term and – having clearly outlined the destination for health in this State – our task now as a Government is to take us from where we started in March 2014, to that destination.
Last week, the CEO of the THS, Dr David Alcorn, and I, hosted staff and public forums in Burnie, Latrobe, Devonport, Launceston and Hobart.
At those forums, we outlined the challenges our health system is facing, the road ahead, and importantly the progress achieved in the first year of the Tasmanian Health Service, including:
In fact, over the term of this Government, we have recruited more than 100 full time equivalent nurses across the State, as well as ten full-time equivalent additional doctors for the RHH emergency department.
We have also seen a significant boost to Ambulance services under this Government, with approximately 20 more paramedics compared to March 2014.
This includes 12 new paramedics for the North West, as well as Extended Care Paramedics for Launceston and Hobart and a new branch station at Oatlands.
And we’re very close to finalising a new Enterprise Bargaining Agreement for our paramedics, which comes on top of the 14 per cent pay rise they were afforded after we resolved the Work Value Claim last year.
Madam Speaker, as we travelled the State, Tasmanians made it very clear they support a truly statewide health service, where access to services isn’t based on historical legacy, but on where the services are needed most.
We have established the Mersey as a Dedicated Elective Surgery Centre, with more than 350 Tasmanians receiving surgery or a procedure in its first month of operation.
This builds on impressive results in 2015‑16 where the Mersey delivered 180 more surgeries than the previous financial year, with the waiting list falling by 30 per cent.
Using the Mersey will help to reduce elective surgery cancellation rates from admissions for emergency surgery, and free up beds across our Health system for more urgent patients. It is a strong start, but there is more work to do - the THS is now working to improve anesthetist cover and reduce locums at the Mersey, and this will result in recruitment of new specialists who will work at the surgery centre.
Over the next year, we will see the progressive addition of new and enhanced services at the Mersey Community Hospital, including geriatric services, palliative care, rehabilitation, drug and alcohol, rheumatology and pain management services.
This wouldn’t be possible without our One Health System reforms which have given the Mersey Community Hospital a stronger, more secure role as an acute hospital with a broader range of better and safer services.
Across our health system, the THS is working hard to break-down decades of inequality and deliver sustainable statewide clinical services, including the range of upgrades detailed in the White Paper for all our major public hospitals.
Elective Surgery
Madam Speaker, of all of the Hodgman Liberal Government’s new investments, the most important is our $76 million boost to elective surgery.
Less than half way through the programme we are seeing not just improved statistics, but real improvements in the quality of life and wellbeing of Tasmanians who had waited many years for surgery.
This investment, and our reform program, is being delivering by a single statewide Tasmanian Health Service, addressing years of regional division and duplication.
I am pleased to inform the House that, as at the end of June this year, fewer Tasmanians were waiting for elective surgery than any other time since record collection commenced 11 years ago.
This was achieved by treating more people than ever before over the last twelve months, with almost 19,000 Tasmanians receiving surgery.
This is 3,000 more than the annual average over the preceding five years, and as a result the waiting list fell by more than 30%.
We are now treating more people during the clinically recommended timeframe. In June 2013, almost 45% of Tasmanian patients were overdue by clinical urgency – compared to 11.5 per cent nationally - according to the Commission on Delivery of Health Services in Tasmania report.
Today, it is one out of every 5 who is over boundary – not at the national level, but a significant improvement and shows how far we have come.
The results have been exceptional and are a testament to both the hardworking staff in Tasmanian surgery wards and theatres and the Government’s funding and reforms.
We must continue to focus on patient outcomes, not ideology, and work with the private and not-for-profit hospitals to deliver the best, timeliest care to Tasmanians, while maximising capability within our public system.
I am extremely proud of the progress that has been made and from the bottom of my heart would like to thank the staff at our hospitals, and in the Department and THS, for their exceptional contributions and support so far.
Patients First
Madam Speaker, earlier this year with a spike in demand at our Emergency Departments and the realisation that while our One Health system reforms would deliver better emergency care over the longer-term, we had to take more immediate action.
We initiated a whole of hospital approach to the perennial pressures on our emergency departments, with 19 initiatives developed by our health system leaders and clinical experts as part of our Patients First plan, backed in our Budget with $5.4 million of new funding.
An extended care paramedic service has commenced in the North and is to be extended into the South with additional funding provided for in the 2016-17 Budget.
Healthy Tasmania
Madam Speaker, this Government has an ambitious goal to make Tasmania the healthiest population by 2025, and we have delivered our Healthy Tasmania Five Year Strategic Plan to move closer to that goal.
The plan highlights an investment of an additional $6.4 million in preventative health, which comes on top of the more than $70 million we already spend across Government.
Under the Plan, actions to reduce smoking and obesity rates are our top priorities, with a focus on school initiatives and grassroots community engagement.
Under our Plan, Child Health and Parenting Services nurses will have a stronger prevention focus as they work with families to instil healthy habits in our children.
And today, I am pleased to announce that one of our first actions under Healthy Tasmania is to strengthen the CHAPS service by making it part of the Tasmanian Health Service - the organisation responsible for delivering better health services to Tasmanians.
The transfer will bolster CHAPS’ ability to attract and retain staff by providing for benefits like access to salary packaging, and better opportunities for professional development and peer networking.This effectively reverses a decision made during 2009-10.
I would like to thank the dedicated DHHS staff that have been working on the logistics of the transfer for the past six months allowing us to finalise and announce this important decision, and we will now formally consult with staff and unions on this proposal as we move forward with the transfer.
Roadshows and further work
Madam Speaker, as the CEO and I travelled around the State to public forums – the fourth time I have done so as Minister – it was clear Tasmanians recognise the areas of improvement in our health system that have been achieved by our health service staff.
But, more importantly, meeting with Tasmanians allowed us to hear not just about what is working, but what isn’t working in our health system.
This includes the need to reduce locum use and better use our rural and regional hospitals, and to join-up and coordinate care – through patient transport and telehealth.
Another key area of concern for this Government is outpatient waiting times and waiting lists, as well as people waiting for diagnostic procedures such as endoscopy.
When we came to Government we published the outpatient waiting list for the first time, and now provide that information monthly on our Health Stats Dashboard.
We are facing growing demand, and the outpatient waiting list has grown over the past two years, from 26,000 when we first published it to 29,000, despite increases in frontline staffing across the THS.
Waiting times for the most urgent patients, and for non-urgent patients, have remained relatively unchanged over that time, but there has been an increase in the waiting time for semi-urgent patients.
I have been advised that there were 410 000 outpatient service events in 2015-16, with some 60 000 people joining or exiting the outpatient waiting list.
There is a clear need to improve outpatient service delivery, as well as data collection and administrative processes.
The Tasmanian Health Service is working to improve the consistency and reliability of recording outpatient clinic data, and to streamline referral pathways from general practice, and as we roll out increases services under the white paper this will allow for the timelier treatment of outpatients.
In the area of endoscopy which is facing growing need, in part from the success of the National Bowel Cancer Screening Program, we are recruiting the equivalent of an additional gastroenterologist and THS is exploring all other options to improve waiting times across Tasmania.
Royal Hobart Hospital Redevelopment
Madam Speaker, one of the cornerstones of any health system is our health infrastructure.
This Government has a proud record of investing in this area, right across the State, with our three Budgets including;
Most significant of all is the Royal Hobart Hospital Redevelopment, a $689 million a state-of-the-art health facility for generations of Tasmanians to come.
When we came to Government, we took advice on the Redevelopment, with concerns raised about the costs and risks of decanting and the subsequent exposure to the Crown to risks from the changed method of construction.
The Government appointed an expert Taskforce, to review the project and provide and resolve the outstanding issues facing the construction of the RHH inpatient precinct known as K-Block.
The Taskforce took expert advice and formed the view that "if the project had gone ahead earlier, it would have exposed patients, staff and the government to significant risks”.
It was clear that the project could not have proceeded at all without significant intervention and change.This Government made the changes necessary to deliver the Redevelopment, with significant improvements:
I want to reiterate the Government’s commitment to maximise the input of Tasmanian companies and Tasmanian workers to this project.
The RHH Redevelopment will continue to ensure that the Managing Contractor continues to apply the Tasmanian Buy Local Policy to all procurements, including directly inviting at least two Tasmanian businesses to tender where local capacity exists.
Industry information sessions have been held and further sessions will be held as trade packages are progressively released for tender.
At the core of this project are the principles that the facility should be safe and fit for purpose: it aims to and will deliver a state of the art health facility which will care for generations of Tasmanians to come.
But the size and complexity of the Redevelopment cannot be under‑estimated. It is a massive undertaking.And progress is being made.
Just last week the medical specialties ward moved to new accommodation on level 7, A-Block.
The new 20-bed ward allows for more privacy because it is configured in single and two bed rooms. The four bed rooms in the former ward on 1B South, are a thing of the past.
It has been done safely.
And safety is always a key consideration. A fully modular pre-fabricated Temporary Facility, being installed and fitted out in the RHH Liverpool Street forecourt, was selected for a number of important reasons.
The significant off-site construction reduces the overall disruption to the hospital. It can also be efficiently and cost-effectively dismantled, moved, re-assembled and commissioned once K-Block is completed.
A fully relocatable design also means that the substantial investment required for a temporary solution can be utilised elsewhere, providing a long term asset or return on investment if sold.
The former Government’s decanting plan involved sending vulnerable mental health patients to facilities in the outer suburbs of Hobart.
This Government accepted the recommendation of the Taskforce to abandon this risky approach, and instead to construct a temporary facility that ensures safe onsite decanting and maintenance of operational inpatient beds within the hospital precinct during construction.
In any building project of this size - and the redevelopment is the largest Health infrastructure project ever undertaken in Tasmania – there will be issues which will arise.
The contract for the temporary inpatient facility was granted to local building firm Fairbrother who in turn subcontracted to a Victorian company Modscape to complete the work.
Two significant issues have emerged since the contracted date for Practical Completion and Guaranteed Construction Sum were finalised with the Managing Contractor and are being addressed. These are:
Delays have resulted in relation to the temporary inpatient facility which is currently forecast for completion in October 2016.
In addition, the handling of asbestos and rectification of fire separation deficiencies has impacted on the construction program to date, and is likely to further do so into the future.
This in itself further supports the need to redevelop the RHH.
As I have said previously, these issues were the direct responsibility of the builder and are in no way related to the design of the facility.
Significant rectification works are now being undertaken by the builder, at its expense and at no cost to the taxpayer or the Government, except for the obvious disappointment and the pressure it places on overall timelines for the Redevelopment.
As I have repeatedly said, although the buildings are obviously late, the building will not be accepted until it is safe and fit for purpose and the project remains on budget.
Latent conditions are physical conditions on, underlying or adjacent to the site which by their nature can’t be identified before the works commenced.
As I said, the management of latent conditions includes greater than anticipated asbestos requiring rectification and the rectification of fire separation deficiencies.
Health and safety of patients, staff and those working on site are a priority for the RHH and the Redevelopment project.
The presence of asbestos in old buildings like the RHH should come as a surprise to no one, with Worksafe Tasmania receiving some 600 notifications from asbestos removalists each year.
Its presence is another reason why the construction of K-Block and Government’s substantial investment in refurbishments is important.
The Tasmanian Government’s 2014 Rescue Taskforce commissioned a hazardous materials audit to provide up to date information on areas to be refurbished under the decanting strategy.
Undisturbed, it does not pose a problem. When it is friable it must be remediated or removed.
Further asbestos has been uncovered during construction works as decade’s old construction works were peeled back and latent conditions discovered.
Additionally, some dust and debris has been disturbed as construction works occur in the hospital resulting in the discovery of potential asbestos.
There are extensive procedures in place to minimise the risk of asbestos exposure to patients and staff. This is a highly conservative approach.
Refurbishment works routinely include the remediation of hazardous materials.Air testing is routinely conducted in construction zones and adjacent areas.
To date, all air tests have been clean.Licenced contractors have been engaged to undertake the removal of hazardous materials and this only occurs within a cordoned off in an enclosed construction zone.
To supplement prior hazardous materials audits, all work areas are inspected by an independent industry hygienist to identify where asbestos is present and verify that the areas are clean and safe for works to proceed after the asbestos has been removed.
I would like to commend the Royal Hobart Hospital Executive Team and the RHH Redevelopment Project team, for their work to ensure staff are kept informed at all times.
Madam Speaker, earlier this year allegations were made that there was an “illness cluster relating to extensive mould infestations” had been identified at the RHH Worksite.
The Government took this matter very seriously, and Worksafe were engaged as is appropriate.Worksafe concluded that there was no illness cluster at the Royal Hobart Hospital.
I am sure everyone in this chamber places a high value on the safety of construction workers and our hospital staff and patients.
Madam Speaker, the Royal Hobart Hospital Revelopment Project has provided a report to the Government, which advises that the project will be completed approximately mid-2019, unless the Managing Contractor is able to successfully program works to make up time and thereby reduce delays.
I am pleased to table that report in the House today.
As Members will read in the report, the contract includes incentives for the Managing Contractor to minimise delays.
30 days after the date for practical completion, Managing Contractor Delay Damages of $17,000.00 per day apply. After 60 days after the date for practical completion, Managing Contractor Delay Damages of $35,000.00 per day apply.
Viable options to mitigate delays will be assessed by the Managing Contractor and the RHH Redevelopment, but will be undertaken only if it delivers a facility that is safe and fit for purpose.
Madam Speaker, I am advised that given the ongoing program review and resolution of associated commercial matters, further speculation on these issues may compromise the Government’s legal rights under the contract.
I appreciate the public interest in the Redevelopment and will regularly disclose information the Parliament and the community when we are advised it is appropriate to do so and are assured it will not compromise of the Government’s legal rights.
What I can assure Tasmanians is that this Government is absolutely committed to delivering a state of the art facility for Tasmanians, and we will work through these issues prudently and responsibly.
Conclusion
Madam Speaker, in conclusion, the Government has developed clear plans to improve Tasmania’s health system and critical infrastructure, in consultation with community, and we are delivering these plans.
As we implement these plans, we will face challenges and need to undergo improvement and redesign to address the issues we face.
The Tasmanian community can be assured we will do just that, while ensuring we have concrete improvements in outcomes at every step of the journey to better health system for all Tasmanians.