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The Health Wrap: voting for health in lutruwita/Tasmania, spotlight on bulk-billing rates, plus steps forwards – and back – for women’s health

Writing from Colorado, Adjunct Associate Professor Lesley Russell examines the health policies on offer for voters in lutruwita/Tasmania, noting a stark contrast between those being put forward by political parties and candidates, and those nominated as important by Health Consumers Tasmania.

The column also takes a deep dive into bulk-billing rates in general practice, raising questions about the costs of running practices, and looks at grief, loss and youth incarceration.

The quotable?

Those fighting for women’s reproductive health rights in the United States and around the world have been buoyed by the French Government’s pioneering push to become the first country in the world to enshrine abortion rights in its constitution.”


Lesley Russell writes:

Greetings from Colorado where the snow continues to fall – in stark contrast to the dreadful wildfires in Texas.

This week, as US citizens, we voted in the Colorado Democratic primaries and it’s fair to say that we have been anxiously following these early days of the US presidential elections.

Voting on Super Tuesday was a very low key affair. I did get a tiny sticker that said ‘I voted’, but there was not a democracy dog, or even a hot dog, in sight.

There’s lots of political news, much of which is very depressing.  Thank goodness we can clear our minds with skiing and snowshoeing!

From democratic duties to snowshoeing at Acorn Creek, Summit County. Gore Range in the distance.

#TasVotesHealth2024

As we head towards the 23 March election in lutruwita/Tasmania, here’s an update on the health issues put forward by the major political parties.

But first, here’s the Liberals’ 2030 Strong Plan for Tasmania’s Future – which, amazingly, doesn’t seem to mention health (or education) anywhere.

In the accompanying call to vote, Premier Jeremy Rockliff does mention health and the fact that his government has provided an additional 298 hospital beds and employed an extra 2,500 health professionals including 1,390 nurses.

At the Liberals’ official campaign launch last week, Rockliff sought to address what many see as one of Tasmania’s biggest problem: a health system in crisis, with GPs in short supply, hospitals under pressure, and serious problems with Emergency Department ramping.

Here is what the Liberals have said they will do to address these issues:

  • Double the size of the emergency department of Launceston General Hospital, with construction to begin in 2025
  • Provide a number of new buildings, wards and specialist service units at the North West Regional and Mersey Community hospitals at a cost of $175 million
  • $187 million in capital upgrades at the Royal Hobart Hospital
  • Recruitment of 44 doctors and 25 nurses at the Royal Hobart Hospital
  • What is described as a “ban” on ramping via a directive that would require that patients arriving at hospital by ambulance must be transferred to emergency department doctors within 30 minutes
  • The state would attract up to 40 new regional and rural GPs by paying $100,000 off their university HECS fees
  • A “GP Now Rapid Response Team” of 10 state-employed GPs to be deployed at short notice to regions where a shortage emerged, such as through a sudden practice closure.

Here are the Labor health commitments:

  • Establish a fund to upgrade regional hospital infrastructure, include 24/7 emergency care for regional and rural hospitals
  • Free university degrees for 150 health workers, to work at local hospital for three years
  • Retain private maternity services in the state’s North-West, conduct a statewide review of maternity services
  • Upgrade six regional ambulance stations
  • Amend Launceston General Hospital master plan to include new, additional childcare services
  • Guarantee no payroll tax will apply to a General Practitioner.

And here are the Greens’ health commitments:

  • Hire 87 new full-time paramedics by June 2025
  • Recruit 30 new ambulance staff per year for five years, recruit 25 clinical educators and 50 clinical coaches by 2030, 120 new nurses per year until 2030, fund 10 new positions for psychiatric emergency nurses
  • Six new ambulance stations, upgrade 13 others
  • Establish Mother and Baby Service as community day program and residential stay service
  • Establish Alcohol Tobacco and Other Drugs Unit, new public withdrawal management and rehabilitation beds
  • Expand public perinatal mental health beds to 12
  • Expand community-based preventative health grants to $5 million per year
  • 24/7 on-site radiology and pathology services at the LGH
  • Pill testing at events and festivals, permanent testing facilities
  • Free smoking cessation products in GP clinics.

These were taken from the ABC News Tracker of Liberals, Labor and Greens election pledges to Tasmanians. I was unable to find any Tasmanian election commitments from the Jacqui Lambie Network .

The health priorities from Health Consumers Tasmania – many of which acknowledge the social and economic determinant of health – are here. They make quite a contrast with those of the political parties.

Also see this statement by health groups urging greater investment in prevention, including a dedicated budget for preventive health.

https://www.ama.com.au/articles/ama-tasmanias-five-election-priorities-improve-health-care
https://www.abc.net.au/news/2024-03-06/tasmania-political-donation-laws-weakest-2024-state-election/103543048

Also see this recent Croakey article: Amid election fever, a call to stop using Tasmanian children “as political pawns”, by Adrienne Picone, CEO of Tasmanian Council of Social Service (TasCOSS), which also highlights the importance of greater investment in prevention. Bookmark this link to follow Croakey’s coverage of #TasVotesHealth2024.


Truth-telling and treaty

It was interesting to read this interview with Jeremy Rockliff when he first came to the job as premier in July 2022. Then he was described as “the nice guy of Tasmanian politics thrust suddenly into the state’s top job”, the “rainbow premier” with an ambitious, progressive reform agenda.

But, the article asked, “Can this straight-talking Liberal moderate pull it off?”

I was interested, even excited, when he promised to continue former Premier Peter Gutwein’s commitment to a truth-telling process and treaty with the state’s palawa/pakana community and pledged a ban on transgender “conversion therapy”.

An Advisory Group to guide the truth telling and treaty process was established in late 2022, and its inaugural meeting was held in February 2023, but it’s not clear what work has been done and what progress has been made.

A tuylupa tunapri palawa community delegation was formed in July 2022 in response to concerns the Government was not hearing directly from the palawa community – as opposed to organisations – in developing treaty and truth-telling.

You can read more in this article from May 2023 here.

Rockliff did support a Yes vote for The Voice.  But he has ruled out Tasmania introducing a state-based Voice to parliament akin to what South Australia is doing.

Labor has stated that it is committed to the current Indigenous treaty and truth-telling process.

The Greens have committed to:

  • Supporting a “respectful and effective” model for Indigenous treaty and truth-telling.
  • Reform legislation to protect Indigenous heritage, introduce new reserve tenure for land returns.
  • Establishment of Indigenous seats in parliament.
  • Commencing an Indigenous-led process to create memorial to warriors and victims of Frontier Wars.

What is happening with bulk-billing services and clinics?

In an intriguing coincidence we recently saw two articles, in the same week, about the rapid decline in the number of general practice clinics that bulk-bill all patients.

The Guardian led off with an analysis of data from the Healthdirect service finder GP database that was done by federal electorates.

It found that found that in the past year to February 2024:

  • 455 GP clinics switched from fully bulk-billing to a mix of b