22 Apr 2021
Our health system is at breaking point. Doctors in general practice, in emergency departments, on medical wards and in surgery are stressed, exhausted and losing patience.
Band-aids are put on the wounds with a little more resource here and a little more bricks and mortar there and a promise of more. Meanwhile, patients are still waiting far too long to be seen in child and adult mental health services, alcohol, and drugs services, in outpatient clinics, in elective surgery theatres and emergency departments. Their health outcomes are suffering as a result.
The time is now to stop the piecemeal approach and look to the future.
AMA Tasmania is calling on the next government to invest in the digital hospital of the future to modernise the way health is delivered in every health service and every Tasmanian’s home.
We call upon all political parties to commit to a $400 million investment into information technology solutions in software and hardware that will see specialist services delivered in a patient’s home; will see medication errors reduced due to e-prescription software that can pick up anomalies; that will see GPs able to see in real-time what is happening to their patients while in hospital through an electronic medical record and receive discharge summaries immediately; and will enable doctors to update patient records at the patient’s bedside.
The benefits are enormous in building efficiency, providing better communication, and supporting different models of care. But it requires a financial commitment equivalent to that of building a new hospital. It requires a ten-year commitment that transcends governments and is legislated such that no future government can stop the project from proceeding, just as you would not leave a hospital half-built.
AMA Tasmania recognises that $400m is a lot to ask of the state government on its own but we do not just seek a contribution from the federal government we believe this would be best delivered through the federal and state governments reaching an agreement on a single funder model for the entire health system in Tasmania. This would bring primary health delivered by General Practice under the same umbrella as services delivered in the acute system.
Tasmania can be the test case for such a model, with the aim to implement such reform across the entire nation. We can see how messy our health system is and how easy it is for people to fall between the state and federal cracks with the rollout of the COVID-19 vaccination. The left hand does not know
what the right hand is doing, and systems are disjointed and operating under different expectations leaving GPs, other health workers and patients confused.
With climate change a medical emergency, AMA Tasmania similarly wants to see more government action at all levels of government in Tasmania to reduce net carbon emissions to zero by 2040.
We are already seeing patients affected by increasing temperatures, smoke from more frequent bushfires and stress from the fear for the future. We all have a responsibility to try to stop the future rapid warming of our planet. We want to see Tasmanian government policy that recognises the science and acts to reduce the impact of climate change on Tasmanians.
While we advocate strongly for these big picture ideas to be made a reality, we are very conscious of the day to day stress our doctors encounter and the slow pace of reform to improve outcomes.
Parts of our system are in crisis, with many problems ending up in our emergency departments because people did not get timely elective surgery, see a specialist in outpatients, or get care in the community. EDs become bed blocked as inpatient units’ beds are full. Some patients with mental health conditions are being left for days on end in our EDs with nowhere to go.
In mental health and alcohol and drugs, morale among doctors is low; the culture is toxic, and doctors are leaving the system at a time when reform is promised but slow to be delivered. In forensic mental health, there is not one permanent doctor.
More inpatient mental health beds are required, and Psychiatric Emergency nurses re-introduced in emergency departments while the reforms roll out which, should see more early intervention services funded, preventing people’s mental health from deteriorating to the point of requiring acute care. More psychiatrists need to be recruited using a competitive salary package offer that is more in line with larger states offering.
Alcohol and Drug Services (ADS) are on the verge of collapse, endangering the care of the Tasmanians on the pharmacotherapy program, let alone the many more on the waiting list. ADS governance must be removed from Mental Health services and more staff employed, and more detox beds opened.
A new purpose-built specialised ADS centre must be built. Currently, patients detoxing share rooms and totally inadequate bathroom facilities, with the result that a detox bed cannot be used in a range of clinical circumstances where this is inappropriate, such as a young female sharing with an older man who has a range of serious and complex health and human problems. During the COVID-19 crisis, half of the beds (10-bed facility) had to be closed because of shared rooms and bathrooms.
While additional money for elective surgery is welcome, one-off boosts are part of the problem. It is impossible to recruit permanent staff to jobs that have time-limited funding. We need to increase the emergency surgery capacity at the RHH and LGH to enable separations of elective surgery and emergency surgery streams to allow efficient use of elective time. And a commitment to increase public hospital capacity across outpatients, inpatients, and emergency.
Likewise, we need more real-time data made available to the public on elective surgery and outpatient waiting lists. We need more collaborative care between GPs and specialists that can see more follow up care provided in the community freeing up specialists to see more of the 51,000 people languishing on the outpatient waiting list.
It is time to look at how we can reduce people requiring ED services because of alcohol-induced injury or smoking-related disease. More needs to be and can be done by the government to reduce the prevalence of drinking to excess and smoking in our community. Similarly, putting a roof over a homeless person’s head will improve their mental and physical health outcomes.
The moment has come for a new single hospital to be built in the northwest. The NW coast has struggled for the past twenty years to staff its two hospitals adequately. Both hospitals have been heavily reliant on locum doctors to ensure essential medical services could be covered. COVID-19 has exposed the fragility of the service relying on locums, impacting emergency department operating hours and uncovering the ageing infrastructure.
A facility like this would mean that political promises such as where maternity will be delivered would end. And the people of the North West could be confident that they were receiving the best of care in more modern premises, built to withstand events such as pandemics. It would also make the North West more attractive to recruit and retain specialist medical staff.
Modern infrastructure must also continue to be rolled out at the RHH and LGH. The RHH 30-year masterplan brought forward twenty years and the LGH masterplan consulted and implemented. Added to this is the need to plan and fund for equipment investment to ensure that our radiology services remain at the cutting edge of diagnosis and treatment. >>>> ENDS
Published: 22 Apr 2021