The Examiner’s health reporter TAMARA McDONALD sat down with Australian Medical Association Tasmania president Dr Stuart Day to discuss the Launceston General Hospital, preventative health and the state of Tasmania’s health system. Dr Day became AMA Tasmania president in July.
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TM: Can you give me a summary of your medical career, and your trajectory to state president of the AMA?
Dr Day: I did my medical training in Tasmania, and did my anaesthetic training throughout Tasmania, and [did] some time in Adelaide. Then I worked as a staff anaesthetist at the Launceston General Hospital for the last 10 years or so.
TM: What do you think are the biggest issues for Tasmania’s health system right now?
Dr Day: Our biggest issue for the Tasmanian health system is the fact that there’s just ever-increasing demand on the public health system. That demand doesn’t meet the resources, so we cannot continue currently to do everything for everybody. The health system works very well for urgent and emergency sort of workloads, and unplanned workloads ... but for the elective workloads, that often takes a back seat, due to the pressures to do other things, the pressures of that urgent and emergency work that comes through.
TM: What are the solutions to that?
Dr Day: [There is] no easy solution. All the Western health systems are struggling with that.
Tasmania’s ahead of the pack in the sense that it’s got an older population, and a less well-off population. So its demand is usually three to five years ahead of the rest of Australia when it comes to applying public hospital systems.
TM: And how effective is a focus on preventative health in that context?
Dr Day: Preventative health has good outcomes for people because everybody prefers to be weller for longer, but it does take a long time before it starts paying off.
That doesn’t solve any problem today, or in the next five years, and there’s some debate whether it solves your problem at all, in the sense that everybody then lives older and healthier, and gets a whole lot of other health problems.
TM: What would the alternative focuses be?
Dr Day: The alternate focus is unclear. Either the community … invests more in the health system, or the community decides on what the health system’s priorities are.
TM: You’re based at the LGH. We’ve heard about instances of bed block, ramping, a “mass exodus” [of staff] from the emergency department. What do you think are the key things we need to get right at the LGH to deliver better services?
Dr Day: The LGH generally does well. It doesn’t have a huge ramping problem. It has significant pressure on its ED, just from workload. That pressure is for people that are sick, people that need to be there are there and getting them through the ED into hospital beds when they need that, and that’s a growing number of people, is what’s important.
The LGH has done better from that point of view since it opened some beds about a year ago … to ease that pressure, and it’s also opened, in the last year, a short-stay surgical unit, which has allowed more flexibility on the elective surgery side. It’s tight, on a daily basis, but it’s been able to manage the demand fairly well. Launceston is a regional centre, attracting specialists to work in a regional centre is tough, the emergency department did lose quite a lot of the doctors, and is quite reliant on locums at present. But there’s some core good people there that are trying to rebuild that department by attracting specialists back to Launceston.
TM: What do you think we’re doing effectively, or best, in the health system at the moment?
Dr Day: I think our GPs give very effective, relatively cheap care … I think the LGH does deliver if you’re sick. I think there’s very good care if you’re really unwell or got some emergency problem. We’re not quite delivering on elective surgery targets and that’s just a demand issue. We’re doing more cases every year so we’re doing well in that sense, but for every one case, we book 1.5, 1.3 cases … so that unfortunately means waits.
TM: With GPs delivering good services – with the ongoing Medicare rebate freeze, what is the AMA’s position on that?
Dr Day: The AMA’s position is that [the freeze] ultimately affects people’s access because of affordability … the AMA’s position is clearly that that freeze should be lifted … that’s in the federal government sphere, and they’ve shown no indication that they’re interesting in un-freezing it.
TM: On a state level, Tassie has the highest ED and elective surgery wait times, recent AIHW reports have shown. How can congestion be eased?
Dr Day: It’s a demand problem … our demand is higher than the national average because of the older population, and the fact that we’re less well-off. If we’re going to meet that demand to meet the Australian average ... that’s more capacity. Capacity is beds in hospitals, and doctors and nurses to staff them. Our hospitals have room in them, it’s a matter of putting beds in the room.
TM: Going into 2017, what do you think Tasmania should be focused on in terms of health?
Dr Day: The AMA thinks we should be focused on getting our smoking rate down, because we’re still relatively high compared to the Australian average … we need to be looking at our obesity epidemic, and treating that as a health condition and that’s going to need similar approaches that we’ve dealt with smoking with. A multi-faceted approach, and not blaming people, but treating it as a health issue that needs treatment, education, government legislation to restrict high-sugar, high-calorie [foods] ... promoting healthy foods. Third, it would be very nice in 2017, to bed down an effective clinical management structure for the Tasmanian Health Service, now that we’ve got most of the senior positions filled … we bed down the structure under that, hopefully that can provide some of the reforms that are needed through health care.
