Mr DEAN ( Windermere - Motion) - Madam President, I move -

That a select committee be appointed with the power to send for persons and papers, with leave to sit during any adjournment of the Council, and with leave to adjourn from place to place, to inquire into and report upon the State public hospital system, with particular reference to -

(1) The percentage of patients receiving elective surgery within the time recommended for such surgery.

(2) The percentage of patients who have received surgery or remain on the waiting list for surgery longer than one year after surgery has been recommended.

(3) The average waiting time for treatment or admission within the public hospital system.

(4) Any improvement or deterioration of the indicators referred to in each of the terms of reference (1), (2), and (3) since the financial year ending 30 June 2004.

(5) Whether there is any, and if so what, relationship between the improvement or deterioration of the above indicators or other performance indicators of the public hospital system and the level of funding of public patient admissions by the State.

(6) The percentage of patients receiving emergency care within time recommended for each triage category.

(7) The days of admission for patients awaiting placement and resultant bed access block implications.

(8) The actual full-time equivalent level and funding allocated to -

(a) staff delivering direct health care to patients; and

(b) administrative staff at all levels who do not deliver direct health care to patients.

(9) The desirable ratio of health-care delivery staff and administrative staff referred to in 8(a) and (b) above and the optimum number and funding of each to provide effective and efficient patient care within the public hospital system.

(10) The actual hours and cost of overtime and frequency of incident reporting since the financial year ending 30 June 2004.

(11) Identifying initiatives which have been introduced in the calendar years 2005, 2006 and 2007 for retention and recruitment of clinical employees.

(12) Identifying any administrative practices or procedures which may involve unnecessary duplication.

(13) Whether the current approvals process for small capital expenditure is the most appropriate process and whether the length of time to obtain services and/or products in the calendar years 2005, 2006 and 2007 was appropriate; and

(14) Any other matters incidental thereto.

And that Mr Harriss, Mrs Jamieson, Mr Wing and the mover be of the committee, and that the President be appointed as an ex officio member.

Madam President, just before speaking on that motion I would like to congratulate you on your appointment yesterday to President. I wish you all the very best of luck into the future, probably for the next six years or even longer. I also extend my congratulations to Mr Wing, the member for Paterson, for the wonderful job that he did whilst he was in that position. He helped me tremendously when I first started off in this House and I thank him very much for that.

I also want to congratulate the honourable members for Rosevears and Huon on their re-election to the Council.

My new look is a result of my trip to Kokoda which I will talk about a little later on because it was a very interesting walk. I still have a couple of injuries and a few other things as a result of it, but very tough indeed. Maybe I will need the public health system to give me some support over the next few weeks to recover.

Mr Aird - The public health system will be so busy with these terms of reference that they won't be able to deliver any services at all.

Mr DEAN - No, it is not quite like that.

On speaking to this motion I simply want to say that this matter has been around now for a long period of time; there has been a lot of discussion about it. When you read the press there is not a day goes by where there are not situations arising in relation to some of the practices that are occurring within the public health system. When you talk to people, the public health system, where it is going, what it is providing and, probably more importantly, what it is not providing is uppermost in their minds.

Some members would have heard on ABC Radio this morning the minister's comments in relation to this motion. It was along the lines that she would be surprised if savings of $50 million could be achieved, so she was not saying that savings could not be achieved.

She also made comment in relation to a couple of other areas that she gave some support to in an inquiry in relation to elective surgery, which she specifically identified. She also specifically identified the administrative side, so she was not opposed to some investigation.

Mr Parkinson - You're drawing a long bow there.

Mr DEAN - I am not. The transcript would be available to members if they want to get it but that was a comment made by the minister this morning on radio. Shortly thereafter Mr Jacobs from HACSU was also interviewed and he made comments along the line that he would be surprised if savings could not be identified. He also gave support to the clinical services side of it being inquired into, so there is support there from these other people and, as I said, I just reflect back to the comment made by the minister in particular.

In moving the motion I want to say that I am very much aware of the 14 points of reference, and the Treasurer has referred to those 14 points, which is somewhat unusual, I suppose.

Mr Aird - Unusual? Unprecedented.

Mr DEAN - No, it is not. There have been other select committee inquiries where a large number of reference points have been put forward, Madam President.

Mr Aird - Yes, but not like this.

Mr DEAN - It is not absolutely unusual at all.

Mr Aird - It is.

Mr DEAN - Having looked at this, I could have generalised a lot of those points and brought them in under the one heading but I thought it was better to identify each specific area to ensure, if this inquiry is supported - and it should be - that witnesses are kept right on track with the area that is being considered. That is why, from my advice, it was seen fit to identify these areas and make them very specific.

I am of the view that it should receive the support of this House. There are a lot of issues in relation to the public health system that need to be put to rest and if it is done right there would be some very solid recommendations coming from that inquiry which I think would help the public hospital system moving forward.

In regard to point of reference (9), the member for Paterson, Mr Wing, and the member for Mersey will remember well the public meeting of 24 May 2008 at the tram sheds at Launceston where a number of extremely upset patients, carers and allied health services employees vented their spleen on what is generally seen as a service neglected in this State. I will talk a little more on this later, however at this time I just want to congratulate the member for Paterson on his very capable chairing of that meeting and his very pertinent comments. I would also like to congratulate the member for Mersey on her well prepared and articulated presentation, too, at that meeting. Further, I commend Launceston physician, Mr Andrew Maclaine-Cross for his very articulate and, at times, very emotional and passionate presentation to that same meeting and I also commend Kathryn Merry on her wonderful presentation - again, delivered well.

That meeting was well attended. I am not quite sure of the actual attendance numbers but I would suggest there were close to one hundred. It was interesting, too, Madam President, that there was no member of the Government present. I understand that they were invited but they saw fit not to attend that meeting. Perhaps when I go into that in a little more detail it is probably not all that surprising that they were not there.

While not wanting to pre-empt the Government's response to this motion, from the comments that I have already heard and with the heavy lobbying that has occurred, it is obvious that they will not be supporting the motion, and that is sad because there is so much that could be brought out from this inquiry if it were supported. Nobody is looking at embarrassing anybody, nobody is looking at casting blame; what we are trying to look at are ways that we can move forward within the public health system to make it a better system. They may well also put up some other reasons as to why it should not proceed. A previous select committee, I think in relation to the mining industry, indicated that there were many select committee inquiries currently proceeding and that there were staff shortages et cetera. They may also refer to all of those positions but I do not believe that they are valid in the circumstances.

Why do we need a select committee inquiry into the public health system in Tasmania? I might suggest that you have not been in this State for the last 10 years if you were to take the position that no inquiry was called for.

We know the public health system has gone from one crisis to another for a long period and without any real or tangible changes being made. There have been some changes made, but not the changes that are necessary in my view to move the public health system forward.

There have been reviews. There have been health plans. There has been planning for the future of public hospital services in the State and there is the State Government-initiated Tasmanian Health Plan; all of that has been put into place. There has been report on top of report, but what has that really done for us?

Not a lot at this moment. If you look at any organisation, from time to time there needs to be a thorough review of organisations. As an example I refer to the Police department. In the early 1990s, or perhaps late 1980s, they threw the organisation up in the air. It settled down and then they had an inquiry into every aspect of it, including employment, the work carried out, the core responsibilities, the finances and how things could happen better.

As a result of Project BATON, as some of you would remember, significant changes were made. Many good solid recommendations came from it and the majority of those recommendations were implemented, so significant change occurred in that organisation.

Mr Finch - Who called for that?

Mr DEAN - The people at commissioner level within the organisation. It was a matter that went on for a long time. It went in phases, where they looked at certain things at certain times. But it was a well-thought-out plan and a well-delivered position at the end of the process. And I might add that with Tasmania Police there were some immense financial savings that came from that process.

The Launceston City Council is another example where a review has taken place over the past 12 months. As a result significant changes have occurred in that organisation. We have seen about a $1.4 million annual saving in that organisation as a result of that review.

It found that things were being done that no longer need to be done. They looked at the administration side of the organisation and changes that could occur there to make financial savings. Every part of that organisation was considered, with the result, as some would probably recall in this Chamber, that some retrenchments occurred. While that is not good, there are times when it needs to occur.

It was very similar to what I am calling for here. I am simply calling for a select committee to look at specific areas of the public health system with a view to identifying a number of recommendations that will support and help the public health system in the future. As a result there may well be financial savings, and I will refer to that a little later.

We have seen the blame game working with State and Federal governments blaming each other et cetera. Perhaps that will change now with the Labor Federal Government in place. Perhaps we will not get so much of that. Those sorts of things, in my view, have really been damaging and have not done anything to assist the public in understanding really what is happening out there.

Very clearly the public want to see changes being made that provide them with a reasonable and acceptable contemporary public hospital system, a system that is not typical of third world countries where it is accepted to some degree. The other day my ears pricked up when I heard the comment made by a senior person, 'It is the right of a person to be well'.

Ms Forrest - They need to take some responsibility for themselves too, though.

Mr DEAN - You are right. I did not say where it came from, so one should not jump to conclusions as to who made that comment.

Ms Forrest - I am not jumping to conclusions, I am just adding that people need to take some responsibility for their own health as well.

Mr DEAN - I can help you by saying it came from a very senior person within rehabilitation services.

Ms Forrest - Those people have already had some illness or injury and that is why they are there. Otherwise they would not need rehabilitation.

Mr DEAN - I want to go into some of the areas now. The position with elective surgery and surgery appointments and so on is one that has been irritating a lot of people for a long time. I want to refer to a case that was brought to my attention three or four weeks ago, which emphasises that we have some problems in the system. I understand it could be through lack of staff or beds or wards and all of those other things that are currently occurring.

I want to refer to this case because it really does identify what the public are going through. Other members may well have other examples, probably better examples than the one I am going to refer to. This relates to a mother and father situation. Whilst they have given their consent for me to identify them here in person I will not do that. I will simply refer to them as mum and dad at this stage or mother and father.

On the birth of their child they were advised that it needed an operation. It needed an operation fairly quickly, but it was not critical that the operation occur within the first month or so. As a result of that their child was booked in for surgery, and it was booked in for surgery on many occasions. On each occasion surgery was postponed at the very last moment. The child is now 10 months old and recently the operation was scheduled to take place in Hobart. These people live in Launceston.

They rang the hospital the night before to make sure things were on track. They were advised that the operation was definitely going to take place, everything was in order, and they were to make sure to be there at a certain time. The mother arranged to take time off work - she was working at the time and had baby sitters - and she was left to bring the child to Hobart on her own. On getting to Oatlands she was running a little late on the Tuesday morning, so she rang the hospital again just to confirm that things were okay and to let them know she would be 10 minutes late. They said that that did not matter, to continue through, that the operation was definitely taking place and that everything was in place.

Just to keep it reasonably short, they got to Hobart, they booked into their hotel and arrived at the hospital. They remained at the hospital for some time, only to be told that the operation was cancelled, without any real explanation to them as to why it had been cancelled. Suffice it to say that the mother was devastated at having gone through this again and having put everything in place. The family indicated to me that the emotional drain and strain on her was incredible, as it was on the father, the emotional angst, hurt, financial cost. Interestingly, this family said that they could afford the financial cost and it would not impact on them too greatly. They were in the highest scheduled insurance scheme and in the public system as well and they pay their subscription to that system, but they were hurt to think that once again the operation had been put off. When it will take place they do not know; they simply have to sit back and wait.

[11.30 a.m.]
I am not sure why but I guess we might only have the one surgeon able to work in that area and perhaps that could be the explanation for it. I would suspect there was a higher emergency that caused that to occur, but it is interesting that it occurred right at that very last moment without these people being aware of what was going on. That is just one of the many examples of what is occurring around our State at the present time.

Some of you would recall the comments made by Professor Rob Fassett and others in the Launceston area a year or so ago. They said that unfortunately the public health system was letting people down to the extent that some people were dying prematurely as a result of what was occurring in the organisation. I think some in this Chamber would recall very well those comments being made.

As I said, this select committee inquiry, if it is supported, will look at a number of areas and I am optimistic that coming from that, Madam President, will be a number of sound recommendations to improve the public health system and make it a better and more efficient system.

It was not my decision to bring this matter before this Chamber. Certainly, I had a part to play in it, but it was a joint decision of many people working in the industry with a connection to health services, many providing the services, as well as many people using the services or those wanting to use the services and those with a strong interest in wanting a health system in this State which is reasonable in all of the circumstances. A lot of people have come forward to discuss this matter with me, Madam President, over a fairly long period. The Launceston General Hospital support group, which consists of senior businesspeople in the Launceston area and includes a number of senior doctors and professors, also supported a select committee inquiry into the public health system in this State. In fact, they moved the motion and it was supported unanimously about six months ago. They stand by that motion in their support of this select committee inquiry today.

In the Estimates processes for the five years that I am aware of, many questions have been put to staff and the minister in relation to public health in this State. Some of those questions have been answered, but some have not, particularly those in relation to statistical data requested from time to time. I specifically recall details requested on one occasion in relation to the number of senior bureaucrats in the service and the effect on the budget. At that time, there was only a limited response received from the organisation in relation to those matters. I think there would be other examples that members could provide as well.

There are practices within the hospital system that we know are fairly archaic and that is not disputed - I will refer to a meeting that I had in a moment. These include things like accrual accounting, for instance, which is just being brought into the system as we speak, as I understand it. It has been around in other organisations for a long period to give a greater ability to trace and look at expenditure and finances in an organisation, and where it is going. Simple things like the purchasing of property or the employment of personnel, the appropriate devolution of the budget are very important issues when looking at a hospital system operating efficiently and effectively.

I do not intend to speak at length in relation to this matter. I hope there are other members with some input into it with a greater and better knowledge of the health system than I have.

On 21 February 2008, I met with a number of my constituents including leading medical practitioners, one of whom was a Federal councillor of the Australian Medical Association, the AMA. There was concern about an AMA report on public hospitals which showed that, despite Tasmania's spending being the fourth highest per capita of the States and Territories, we came last in two of the main Department of Health and Ageing indicators of hospital performance, public admissions and percentage of elective admissions. We came second last in percentage of admissions waiting longer than one year. This immediately raised in my mind a question of value for money spent in this area. There is suspicion that these figures reflect significant inefficiencies within the Department of Health and Human Services' acute health services division. Anecdotes from many different sources about bureaucratic unresponsiveness to the needs of clinicians in our hospitals were also discussed, hence this becoming one of the terms of reference.

Despite these senior people raising these concerns with the current minister, her predecessor and the previous secretary of the department commencing nearly four years ago, there have been no real changes to the experience of our hospital doctors. As a result on 4 April 2008, there was a meeting attended by a number of people at Launceston, including the member for Paterson; myself; Dr Aizen; Dr Scott Parkes, the Chairman of the Medical Staff Association, Launceston General Hospital; Mr David Roberts, secretary of DHHS; Mrs Catherine Katz, head of the acute hospital services; Mr John Kirwan, CEO, Launceston General Hospital. They were all part of this meeting that we had in Launceston when discussing the public health system.

Amongst the discussions that we had were those in relation to the points of reference that are now before members in this Chamber. I want to refer to some of them.

Point (8) gets to the heart of concerns; (8)(a) refers to staff delivering direct health care to patients. Direct health-care providers include doctors, nurses, allied health workers, pastoral carers but we must also include those providing hotel services such as kitchen staff, cleaners, patient transport officers et cetera.

Administrative staff would comprise those employed by the acute hospital services directly and those hospital employees who do not meet the criteria in (8)(a). The committee should also examine the number of research and project staff employed in the hospitals. Another productivity measure I will refer to is the number of work hours per day which is included in term of reference (10). The committee could request from the department the clinical hours per patient day and other administrative hours per patient day, so it allows us to delve into that.

Term of reference (11) will provide an opportunity to evaluate the success or otherwise of recruitment and retention programs, which is one of the areas of great concern within the public health system. We need to keep the required number of staff in the system to provide the services that are necessary. We repeatedly hear about how the shortage of staff is creating a lot of the backlog that is occurring within the system.

I now refer to the possible financial savings. There is sufficient anecdotal evidence that administrative functions such as human resources management, finance and information technology are duplicated in Hobart in each of the three major hospitals, to warrant term of reference (12). It appears there is administrative duplication of a significant degree between central DHHS and each of the three hospitals. If we assume that the budget of acute health services is $700 million annually, as referred to in documentation, and of that 70 per cent is spent on wages and salaries, we can approximate the annual wages and salaries to be in the order of about $500 million spent in that area. I estimate the review of departmental structural processes could effect modest savings with that expenditure. A very modest saving, a 10 per cent saving - if that is seen as modest - would see a return of about $50 million into the organisation, which would help a lot with the current financial difficulties and problems being experienced in the organisation. Indeed, the minister made that comment this morning on ABC Radio.

At that meeting there was a lot of discussion about the problems associated with getting equipment - capital equipment and replacement equipment - and the processes that have to be gone through to get that equipment. It was seen as archaic and time consuming, it needs a drastic overhaul.

If this inquiry is supported, and I am asking members to give it support, strong recommendations could be made in a number of areas which would see more money freed up and made directly available to health services in Tasmania.

I have a brief comment to make in relation to elective surgery. It is interesting what detail comes out when you look at it more closely. The Federal funding initiatives have put pressure on each public hospital to meet targets to reduce numbers of elective patients awaiting surgery by 30 June. At current throughput the hospitals will not meet these targets due to a lack of funded nursing positions and requirement for overtime. Staffing has decreased over time and therefore the number of theatres operating and lists have been reduced. All hospitals are running below capacity, with theatres closed, and that is a common theme that we hear almost every day.

If the targets that are set are not fully met then no Federal initiative funding will be received despite improved throughput and attempts to reach targets; that is the advice that I have received from senior people within the organisation. Many small, day cases have been cleared from the waiting lists, leaving predominantly larger cases requiring admissions, which is another challenge to the system. It just goes on and on. Other areas also pose problems in the elective surgery situation.

I am aware that the ANF currently have a number of workload grievances relating to both the Launceston General Hospital and the Royal Hobart Hospital that are being considered, and overtime is one.

It is interesting that short case elective surgery lists have decreased significantly, but those patients requiring admission for more complex surgery remain on the waiting list. Madam President, this skews the waiting times as the lists are not weighted according to the seriousness of the situation. All cases are considered the same for statistical purposes. I am saying that there should be a further analysis completed of this and this inquiry could pave the way for that to occur.

[11.45 a.m.]
I referred briefly to retention and recruitment incentives. We know that there have been some incentives provided to retain doctors within our system and that is supported and to be commended because we need to do that, but what incentives have we provided to our nurses and our sisters? What incentives have we given them to want to remain in this organisation?

I want to briefly touch on rehabilitation and allied health services, Madam President. I am not going to labour this point other than to give an explanation for including those services in this inquiry. Letters to the editors of the local newspapers have been prevalent in relation to rehabilitation and allied health services.

I previously referred to an event on Saturday 24 May 2008 that was specifically set up to address allied health services and the current problems confronting services and service providers. Despite an invitation from HACSU, the Government saw fit not to attend, and no apology was offered by the Government for not having a presence there. I suppose it is not surprising when you consider that Tasmania is by far the worst-performing State in the nation when it comes to rehabilitation and allied health services.

I refer to a couple of statements from pages 1 and 4 of the review carried out by Phillipa Milne and Kathy Eagar from the Centre for Health Service Development, University of Wollongong, 7 April 2007. This was a report done as a joint initiative of the acute health services group and a community health services group of the Tasmanian Department of Health and Human Services. I think you will understand in fact why that is included as a part of this reference when I refer to a couple of comments from that document. Other members have probably seen the document although it has not been that easily obtainable. I understand it has had to be obtained initially through FOI.

I quote from page 1:

'Summary of review findings.

The review has identified that there is a significant shortage of rehabilitation services in Tasmania. Further, as the population ages over the next decade, the need for rehabilitation will significantly increase. Key findings in relation to the need for rehabilitation include:

Relative to national standards, Tasmania is under-supplied with rehabilitation beds with the current shortfall estimated at around 50-60 beds.

Medical and allied health staffing levels fall well short of recommended standards.

With only 47-49 designated rehabilitation beds in Tasmanian public hospitals, at least 70 other beds are being used by patients formerly classified as undergoing rehabilitation. Further, it is estimated that up to 195 beds, including up to 100 acute beds, are being used by patients requiring rehabilitation or restorative care.

The lack of ambulatory rehabilitation service in the North and North West regions limits alternative options to provide rehabilitation to those who require it.

The projected 45% increase in the population aged 70+ from 2003 to 2018 has major implications for rehabilitation and other sub-acute care needs.'

There are other points that have been identified on that same page - and members can reference it if they wish - that clearly identify that there are some huge difficulties in the area of rehabilitation services.

A comment from page 4 of that report is:

'Regional Development.

The two regions for priority development are the North and the North West. The South, while under-resourced by Australian standards, is demonstrably better resourced than the other two regions.'

If you look at a graph in relation to those services - outpatient rehabilitation and allied health staff comparisons - you will note that the north-west has 0.9 staff; the north of the State has 1.7 staff engaged in that area; in Hobart there are 32.8 staff involved in that area. So I think that this inquiry, if supported again, can bring out some of these issues and make some very strong recommendations in regard to allied health services and rehabilitation services.

I will not go through the quotes, but you can - and I have heaps of them here and in my office I have quite a high stack - newspaper clippings and reports in relation to some of the current problems existing within the health services area, including a number of reports on rehabilitation services and allied health services. I do not think there is any need for me to go through them and raise any issues from them, because members would have been reading those over the last five-year period during which I have been in Parliament.

In conclusion, we need this inquiry. It has been talked about, Madam President, over a long period. When I first came into Parliament five years ago there was talk then about a need for a select committee inquiry into the public health system in this State. It is not new. This should not have caught the Government by surprise. They should have known it was coming and would be brought here for debate and a request for support.

As I said, there is no intention here to create any embarrassment to anybody or any organisation or department. It is a matter of trying to move forward, trying to get a clear position with strong recommendations where the public can have a lot of their issues aired and can have some input into what is happening within the health system. That is what this is about. I am convinced, Madam President, that if the inquiry does occur and it is supported - and I do ask that you give it support - that we can make a difference, that we can come up with some very strong recommendations to move the system forward.

I accept there has been a number of changes. I accept that there are a number of reports out there, but there has not been a select committee inquiry. And a select committee has the ability to get the evidence and the information that we need in many of these areas.

[11.53 p.m.]
Mr AIRD (Derwent - Treasurer) - Madam President, the honourable member who has moved this motion said that he has heard that the Government's position is to oppose the motion. That is one option which is available to all of us. There are other options available to this Chamber and one would be to adjourn the debate on the motion. Why would you adjourn it? Would you adjourn it because there is going to be a budget brought down tomorrow and we are going to go into a process of assessing the allocations and going through the Estimates committee process, which would further develop the arguments about what is going on in the health system generally?

The honourable member alludes to the fact that we have a health plan. We do have a health plan. We have a primary health care plan and we have an acute care plan. They are both plans which have been well discussed in the community. It is true to say that parts of the overall health plan were quite dramatically derailed by the intervention of the Federal Government in terms of the use of the Mersey, particularly in elective surgery. That is still problematic, given that the discussions are going on between the Commonwealth and State governments. I am building an argument here to say that adjournment could be an option here which keeps the issue alive for the honourable member, but allows the Government and Parliament to go through a process before you get to a conclusion to proceed with this motion. So that is a strong preference that I have at this stage. It allows for a discussion around it. I do have a bit of an advantage in terms of what is going to be in the Budget.

Mr Dean - You could give me the benefit of that advantage.

Mr AIRD - Tempted as I am to persuade honourable members, I am not going to.

Mr Harriss - You wimp.

Mr AIRD - You nearly got me.
'
Ms Forrest - Take us all with you. You must be heading in the direction of significant investment in health care to even make the comment.

Mr AIRD - Health is always the biggest ticket item of a budget. That is no secret. It is always going to be the top ticket item in terms of the allocations. The other option is to amend the motion.

Mr Dean - I am all ears and happy to listen.

Mr AIRD - There is another way of dealing with it and that would be to limit the terms of reference from (1) to (7) and just deal with the elective surgery issues. If this motion proceeds in its present form you will not be able to report back for two years. It is pretty extensive. A select committee is called a select committee for a very good reason - because it is supposed to be select. This is pervasive, this is nearly the whole system in the terms of reference.

That is another option available to us when we are dealing with this motion. The other option is to vote for the motion as it is. That is my least preferred option. To vote for the motion as it is, I think is going far too far. I have raised a number of issues that I think we need to consider in this motion. I would seriously put the proposition that we should adjourn the debate on this motion, that the debate should be adjourned until a later time when we have gone through a number of the issues which I think would provide a greater level of information and a greater understanding about what is going on in the health system.

Health is one of those areas of public interest and public concern. It is legitimate; at some stage in our lives we all need to be beneficiaries of a public health system. I am aware that there has been disquiet about various facets of health. I am confident that in the future a number of the issues that have been raised can be dealt with in a way which will satisfy both those involved with the system and those involved as recipients of the system.

We do need to provide resources for the health system; we do need to address it. The honourable member has raised the issue but I think that it is far too early to proceed with this motion. I would move that the debate be adjourned on the basis that we can come back and revisit this issue following on from the Budget and the budget processes and that all honourable members can be informed about the worthiness or otherwise of these terms of reference. Therefore, Madam President, I move -

That the debate be adjourned.

[12 noon]
Mr DEAN ( Windermere ) - Madam President, I heard what the Treasurer said and I am not opposed to the adjournment of this matter, provided an undertaking can be given that this matter can be revisited within one month when we come back in July.

Mr Aird - If that coincides with the conclusion of the budget process.

Mr DEAN - This gives us an opportunity, as you said, to look at what might be in the Budget. It may coincide with some of the terms of reference and I think that the Treasurer may be saying that there will be something in the Budget to satisfy some of those terms of reference. I am not pre-empting too much.

Mr Parkinson - It would be up to you to decide whether you wanted to try to bring it on again. It would be on the Notice Paper.

Mr DEAN - Right, yes. Also it would obviously give me the opportunity to discuss the situation with the Government in relation to some amendments. That has been suggested previously, as well. I am not really opposed to that position. If that is the situation in relation to the adjournment of this matter, I am content, Madam President, to accept that position at that time.

Thursday 28 August 2008

PUBLIC HOSPITAL SYSTEM SELECT COMMITTEE

Mr DEAN ( Windermere ) - Madam President, I do not intend to talk at any length on the amendment other than to simply say that, as you have said, the amendment really does not change the substantive motion. It has been broken down. There are some changes in it which I accept and in speaking to that amendment I would like to thank the Government for their support and their help in coming forward with the amended position that we have here before us today. It has been a joint position. I accepted the position as put by the honourable Treasurer just prior to the Budget being handed down. I took that on board, accepting that the way the Budget was structured would satisfy a number of the issues in the substantive motion.

That has been the case and accordingly the motion that is currently before members satisfies all those criteria. The amendments have been circulated to all members and there has been some feedback in relation to those amendments. But it does encapsulate what we are wanting to do and I would urge that all members in the Chamber today consider the amendment currently before this Chamber. It is certainly acceptable to me in the circumstances.

Mr PARKINSON (Hobart - Leader of Government Business in the Legislative Council) - Madam President, I will just formally place on the record that the Government accepts the amended terms of reference. I commend the honourable member for Windermere for his cooperation in working towards a set of terms of reference that we felt that we could work with as well. I also commend him for his agreement to place a government member on the committee. I see the name Ms Ritchie is there and I think that is very appropriate given the contribution that she can make to the committee. I commend the honourable member for cooperation in relation to that.

Mr DEAN ( Windermere ) - Madam President, I thank those members who have spoken and I also thank the other members because they have given me feedback throughout this process that indicates very clearly that they will be supporting this motion moving forward, Madam President. Again I just take the opportunity to thank the Government for their discussions with me in relation to this matter and their now support of this motion.

As the member for Murchison said, these issues have been going on for a long period of time and if we do not take some action to look at where we are and what is happening and what some of the issues and problems really are then we will, in three or four years' time, be in a similar position to the one we currently are in.

This committee clearly will have a lot of work. It will not be easy. There are still quite a number of terms of reference that have been broken down into certain ingredients but it will require a lot of work. There are many people out there, Madam President, who are very anxious to see it commence. I have had quite a lot of feedback from a number of the medical staff and feedback from the union and also people who have been patients in the system throughout the State in the recent times.

I think, as the member for Murchison said, statements are made that we always have this huge problem at this time of the year and nothing really seems to be done about it. That is not acceptable and we need to put in place strategies to try to get around that, to circumvent that, to get on top of those issues and problems. This week media releases state that these problems are just culminating right now. Not only are there more patients coming into the system now but also there are difficulties with staff and staff illnesses that escalate the current problems within the public health system. I think it was indicated yesterday that a lot more beds might need to be closed.

They are interesting times that we are living in. I think the member for Murchison is again right, and I said it during my speech on the substantive motion, that it is not just about money, it is about procedures, it is about the way that things are done and lots of other things that come into this.

You could have as much money as you could get your hands on and then some, but that is not going to help unless the other processes are all in place to ensure that the money is expended in the right places, that the changes are made that are necessary. Those are some of the issues that are concerning a lot of people out there.

It will be interesting to see what sort of evidence comes out through this committee, but some doctors have said that they can see very obvious changes that could be made within the system that would save DHHS a lot of money. It will be interesting to see what evidence there is to support that, because if that happens, that money can then be moved into other areas - equipment areas, more staff possibly if that is what there is a need for, more nurses perhaps and whatever else is required. People in this Chamber will recall Project Baton and the Police department a number of years ago where they had a review of their organisation, and the review of the Launceston City Council, which I am fairly familiar with. As a result an enormous number of changes were made in both those organisations as to the way they now do business.

They looked at what they were doing and what they should not be doing, they looked at their financial side, the staffing levels, they looked at absolutely everything in that organisation. This committee will not be doing that but it will be looking at some very important areas within the public health system. I will be very surprised if at the end of the day we do not have to make some changes or recommendations to the Government that, if they accept them, will make a real difference in the public health system.

The Government, as someone has just commented, will need to make a real commitment to assist in the funding of this committee to ensure that we have the financial support to move forward and do the job.

Ms Forrest - And staff.

Mr DEAN - And staff. I accept that we have a number of committees running right at this moment. I am conscious of that fact.

Ms Thorp - Resources are finite.

Mr DEAN - I agree, they are finite. Since coming into this Chamber five years ago I have not known so many committees to be up and running at the same time.

Ms Thorp - There is usually a burst around election time.

Mr Parkinson - A huge increase in productivity, though.

Mr DEAN - I am getting comments form all around.

Mr Aird - I reckon the committee budget is pretty well committed for the next 12 months.

Mr DEAN - I accept that there is only a certain amount of money. When you see the public response to what is happening out there, you realise that we have to provide the necessary financial support and staff.

I just want to identify, and some of you would have heard it, the gentleman on the radio yesterday who was brought into the Royal Hobart Hospital with a suspected heart attack. He was brought in by ambulance, he sat or lay around on a bed for three or four hours and was so frustrated that he just walked out of the hospital. He came in with a suspected heart attack and he had not seen a doctor, he says, in the whole time he was in that hospital. These are some of the issues that are coming up.

I thank the honourable members for their support. I look forward to this committee commencing as quickly as is possible. I look forward to the results of that committee and expect some very strong recommendations coming out of it that we can put to the Government for consideration at the end of the time.

Motion as amended agreed to.