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Tasmania needs health reform that is community based, commmunity driven and preventative

Introduction by Croakey: Tasmanians go to the polls this Saturday, 1 May, with media predicting the result will go down to the wire through Tasmania’s Hare-Clark proportional electoral system.

According to the local Tasmanian Inquirer, environmental and Aboriginal groups have condemned a lack of focus on the environment during the election campaign, with former Greens Leader Bob Brown dubbing Liberal and Labor parties “Tweedlechain and Tweedlesaw”.

But Tasmania’s Booker prize-winning author Richard Flanagan is doing so with a new book on the “rotting underbelly of the salmon industry”.

There’s also deep concern that’s not on the mainstream agenda about the influence of the gambling industry after Labor was “spooked” in its previous election bid to control pokie numbers.

According to Tasmanian University PhD candidate Michael Lester, writing at The Conversation,  Liberal Premier Peter Gutwein is gambling on an early election — called a year before it was due — to cash in on his government’s popularity due to its management of the COVID pandemic.

That’s seen a big focus in the election campaign on health, writes Bruce Levett, CEO of Health Consumers Tasmania which has been engaging with Tasmanian communities at regional forums and kitchen table discussions throughout the year, to explore their concerns and priorities.

He provides details and analysis of the main promises to date in the post below.


Bruce Levett writes:

As Tasmanians goes to a State election on May 1, health is clearly the number one issue for the State with both major parties committing to ‘fix’ Tasmania’s health system.

Health Consumers Tasmania of course, welcome this focus because it is what Tasmanians want, as we have learnt via a mix of sources, including three regional public forums run late last year, and surveys and general consultations with groups, organisations and individuals.

Our submission to the Tasmanian Government’s Our Health Care Futures policy summarised that feedback but, in a nutshell, in  the lead up to Saturday’s poll, Tasmanian communities have been telling us  three things:

  1. accessing health services is getting more difficult for many people, particularly those in rural and remote areas
  2. navigating the health system is difficult as the system is complex and often siloed in its approach to health delivery
  3. people want to be treated within their communities when it is safe to do so.

As importantly, as we learnt through four surveys run in 2020, COVID-19 has taught Tasmanians that:

  1. communities come together to support each other particularly when under pressure
  2. prioritising our health, and the health of our communities has become more acceptable within the community
  3. the impact on our health and wellbeing of social and economic factors (for example, jobs, family, isolation, digital connectivity etc) has become more clear
  4. prevention (or staying well) is a worthwhile strategy which is preferable to waiting for people to become unwell before providing treatment

COVID-19 has taught us many things — not least that our personal health and the health of our communities are as important as jobs and the economy.

Tasmanian communities talk about this when they refer to ‘the new normal’ along with the emergence of digital health, a better work-life balance and the value of preventative health (in our COVID-19 management plans across the country, we are still experiencing the most intensive and comprehensive preventative health program in our lifetime).

A renewed focus on mental health has been with us for a while now, but COVID-19 expanded this thinking to a greater awareness of community wellbeing.

It is within this context of ‘the new normal’, and what communities are telling us that Health Consumers Tasmania analyse the election commitments on health for the Tasmanian election.

It is important first to understand the health profile of Tasmanians, and unfortunately, it is not good. Tasmanians typically smoke more than other Australians, are more overweight and obese on average and therefore, are more prone to suffering chronic conditions like diabetes and heart disease. Tasmanians are older, exercise less and life expectancy is lower than those in other States.

At the same time, our hospitals are under major pressure due to growing demand and a lack of ongoing investment across the industry as a whole to the point that they can no longer cope. For example, the Launceston General Hospital is experiencing some of the worst ambulance ramping across the country, our ambulance service is the slowest to respond nationally and elective surgery waiting lists have doubled over the last five years.

Hospital funding

The Liberal Party signature announcements focus on investing in the major hospitals:

  • Royal Hobart Hospital (RHH) – $110 million in new funding
  • Launceston General Hospital (LGH) – $580 million over 10 years and $120m for co-location with the private hospital
  • North West Regional Hospital (NWRH) – $20 million for additional bed capacity and $8.1 million for the North-West Cancer Centre
  • Mersey Community Hospital (MCH) – $55 million.

In addition, the Liberal Party has promised to fund a number of regional centres: Kingston Health Centre ($30 million) Midlands Multipurpose Centre at Oatlands, and the Dover Medical Centre (more GPs) along with a $8.4 million commitment for staffing at rural hospitals.

The Labor Party has committed to invest $390 million over four years to the Hobart Repatriation Hospital (part of the RHH masterplan) and $59 million to upgrade 17 rural hospitals and provide 24/7 care at 30 community health centres. Note, Labor has since all but matched the Liberals’ funding commitments for each of the major hospitals above.

The point of difference with this investment is clear. The Liberal Party has focused its spending on major hospital developments whilst the Labor Party has given greater priority to regional and community health centres.

Elective surgery

Tasmanians have previously identified elective surgery as a priority, so we welcome the attention given by both major parties on this.

There are now 12,086 people waiting for surgery with the waiting list growing by 8 per cent over the last 12 months and by 58 per cent over the last three years.

The relevant factor here is that only 56 per cent of Tasmanians receive elective surgery within the clinically recommended time, compared to 90 per cent nationally.

The Liberal Party has committed $156.4 million over 4 years and Labor $137 million to clear elective surgery waiting lists.

We do not really know whether this will be the case or not given the above dollar commitments.

Royal Hobart Hospital

Ambulance services and oral health

Performance issues with ambulance services does have an impact with communities, particularly in regional and remote communities, so again we welcome further investment in this area. We were told in one of the kitchen table discussions that we hosted that some people in regional areas won’t call an ambulance because they are worried that they will divert the service away from others who may need it more than they do.

All three parties have committed to improve ambulance services. Labor commits to upgrading 35 ambulance stations ($38 million) and employing 144 paramedics; the Greens will invest in four (4) new stations, 27 new ambulances and 224 new jobs; whilst the Liberals commit to an additional $9 million for the Ambulance Tasmania vehicle fleet, to recruit 48 new paramedics, and build two new helipads at regional health centres.

Oral health is another problem area for Tasmania with 16,279 Tasmanians on the waiting list for general oral care and another 578 adults currently waiting for dentures. The Liberals have committed 20,000 additional emergency dental, general dental care and denture appointments.

At the point of writing, the other parties had not released a position on oral health.

Community health

The Liberals have committed $52 million for a range of programs including in-home care, local community delivered palliative care and services to avoid hospital admissions when safe to do so, patient transport, GP after hours support, funding for Family Planning Tasmania, to establish a Rural Medical Workforce Centre at the Mersey Community Hospital and a further $4.3 million for community organisations like COTA, Men’s Shed Association and Volunteering Tasmania.

Labor has committed to providing additional staff (90 community nurses and 85 nurse practitioners) and to establish a National Centre for Rural Health at the Mersey.

Labor’s commitment to 30 community health centres includes 24/7 nursing and access to 30 mental health social workers, a vehicle for patient transport, and an allied health team of physiotherapists, occupational therapists, dietitians, and exercise physiologists (60 all up).

The Greens commit to fund 50 allied health professionals in community health centres.

Strengthening community health is important for Tasmanians, however attracting skilled practitioners has been a struggle for some time, more so for rural and remote areas.

This has been an ongoing point of public discussion in Tasmanian and the community remains sceptical that promises to provide a larger workforce, whilst desirable, will materialise.

The missing point here is that there is an opportunity to up-skill people within the community that allows communities to support their own by committing to train 4,000 new jobs within the community services sector. (See the election priorities statement from the Community Services Industry Plan working group, which I participated in as a TasCOSS Board member).

The Liberals have announced $3.3 million over three years to address community services industry training at an online political leaders’ forum hosted by TasCOSS.

Mental health

The North West Regional Hospital is the focus for mental health with Labor promising $67 million for a mental health facility and the Liberals $40 million for a mental health precinct, both promises attached to the hospital.

Additionally, Labor promises $40 million for mental health workers to be placed in every public school and for the Speak Up, Stay ChatTY organisation to deliver programs in schools and sporting clubs. Labor has also said it will establish a Suicide Prevention Commission but has not provided details.

The Liberals have promised $26 million in programs including a Mental Hospital in the Home pilot, Emergency Mental Health Co- Response Team, Peer Workforce Coordinators, community mental health services including regional coordinators and to target mental health literacy initiatives through local groups.

There is also a commitment to expand new services developed during COVID-19 including Tasmanian Lifeline ‘mental health phone triage service’ and the Mental Health Council of Tasmania’s ‘check-In website’.

What is most pleasing about these initiatives is that they build the capacity of communities to look after their mental wellbeing with a particular focus on youth and older Tasmanians and providing more outreach services in rural and remote areas of the State.

Preventative health

This is perhaps considered the silent killer within our system.

According to Primary Health Tasmania, nearly half (48 per cent) of all hospital admissions in Tasmania are for conditions that could be prevented, yet we only spend approximately 1.7 per cent of our health budget on prevention and public health.

This election has a much stronger focus on community-based health care and prevention than previously.

The Liberals have committed $10 million in alcohol and drug treatment services through organisations like the Alcohol, Tobacco and other Drugs Council, The Drug Education Network, Alcohol and Drug Foundation’s Goodsports program, and the Salvation Army Street Teams, all who work at a grassroots level to educate and prevent harm.

The Liberals also have committed $20 million to prioritise prevention and early intervention. This has been a major priority for Health Consumers Tasmania.

The Liberals have committed $4.5 million over two years for our organisation to trial three Tasmanian Community Health and Wellbeing Network Hubs. These networks will enable communities to have a voice in what services they need locally, to identify and deliver community-led place-based health and well-being initiatives and reconnect vulnerable or disadvantaged groups to the health system.

The Liberals have committed $10 million for the next Healthy Tasmania 5-year Strategic Plan, which includes an $8 million community grant program. The Greens have also committed a $3 million community grants program for preventative health measures.

Labor’s commitment is to provide preventative health services through the 30 community health centres and it has committed $31.8 million to create a healthy school lunch program for primary school children in government schools along with the schools mental health support services.

Health Consumers Tasmania believe that without resetting the health system to keep people well within their communities, it doesn’t matter how much you spend on the hospital and primary care, it will never be enough. We think the initiatives announced will help to build the resetting process in Tasmania.

Digital heath

Providing health services online has been a positive to emerge during COVID-19, although our research identified that these innovations further disadvantaged those without access to or knowledge on how to use technology or didn’t have a GP in the first place.

Tasmania has a digital divide that makes it harder for those with low literacy levels or financial means to participate online.

As part of the Labor commitment on elective surgery, it has referenced improved IT upgrades to enhance telehealth and online health services and $200,000 for digital literacy for older people. The Liberal Party’s digital inclusion policy includes $700,000 for supporting vulnerable Tasmanians.

We have yet to see anything relating to, for example, an e-health strategy that has objectives developed from a consumer perspective. This is considered a missed opportunity by all parties.

Housing

Health policies need to integrate housing given the impact secure and safe accommodation has on a persons’ health and well-being. According to Shelter Tasmania, there is an immediate demand for an additional 1,000 social housing dwellings per year over the next four years across Tasmania.

Both the Liberals and Labor have committed to build an additional 2,000 social and affordable homes by 2027, bringing the existing work program to 3,500 homes.

Labor has committed $39 million to build or support emergency accommodation for vulnerable Tasmanian, the Liberals $35 million, whilst the Greens have committed to an early investment in 4,000 public housing dwellings to meet current housing waiting list demands in addition to 2000 rent-to-buy affordable homes for low to middle income earners by 2030.

These targets will be difficult to achieve given Tasmania’s tight construction jobs market.

Conclusion

Tasmanians repeatedly tell us they do not want to go to hospital, they want a model of healthcare that is holistic and considers the whole-of-person and whole-of-community response.

It is a proactive model that strives to reduce the burden on hospital and ambulance services by focusing on primary and preventative health, including linking with community services.

Communities want to be empowered to take the lead on identifying solutions to their health issues and preventing them from getting sick in the first place.

The Tasmanian community is ready to think differently about what health services they actually need and how they are delivered. The position of Health Consumers Tasmania is that we need to start the process of investing as heavily in preventing ill health as we do in treating people when they are not well.

What the Tasmanian election is telling us is that we are starting to see more election commitments on health that are community based and driven. That parties have seen what the community can bring to the table during COVID-19 and can therefore see the benefits of working with and through the community, but we are starting from a very long way back.


See previous Croakey articles on Tasmanian health issues.

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