It was alarming to read a letter from registrars working in the Emergency Department of the Royal Hobart Hospital addressed to the Tasmanian Health Service executive, expressing their deep and real concern for the safety of patients and staff.

Working conditions and pressures at the RHH have reached a point where ED registrars have taken this serious action to highlight the critical situation.

This is a failure of government. The Minister for Health, the Treasurer and ultimately the Premier must take urgent action.

The Department of Health's own Health System Dashboard confirms the reality. Almost all indicators deteriorated during 2018. Elective surgery waiting times are longer and the number of people waiting for surgery higher. Ambulance demand and response times are increasing. We regularly see almost all ambulances ramped at EDs around the state.

Ambulance ramping, access block and unacceptably long waiting times are having a devastating effect on patient outcomes and negatively impacting patient safety. Medical staff are unable to meet most national emergency department performance standards.

Medical staff are experiencing physical exhaustion and psychological trauma as a direct result of unrealistic and unsafe workloads.

If urgent solutions are not delivered there is a real risk emergency registrars will leave the Australian College of Emergency Medicine training programs, adding pressure on emergency medicine specialists currently working in EDs, tarnishing Tasmania's reputation thereby making it even harder to attract specialists and trainees.

The Minister must act immediately to address these challenges. We are already seeing deaths whilst patients await treatment.

Many solutions are not difficult, although of course, require money. Others require longer term planning and consideration.

Those working at the coalface must be front and centre of decision making, solution finding and advising on sustainable long term funding.

We hear ad nauseam from the Minister that we are spending record funding on health. As I have highlighted previously, under this Minister's watch, the budget for health spending has consistently been less than that spent the year before. Money is found to 'top-up' the health budget, predominantly by pushing out infrastructure spending. We are constant playing catch up and falling further behind.

Our major hospitals urgently need more qualified emergency medicine specialists, registrars and nurses, including psychiatric nurses, recruited now on a permanent basis, not locums. Better utilisation of all medical staff and expansion of suitable treatment spaces must be prioritised. We cannot wait for the RHH rebuild to be completed. Stage 1, K-Block, is being reconfigured as it's built, but even when opened won't fix all these problems.

The cost of medical litigation, funded through the Tasmanian Risk Management Fund, is set to increase as a result of recent incidents and there is not enough cash in this fund to deal with it. A system where increasing medical liability costs make it even harder to spend the amounts needed to avoid adverse outcomes, is a system in terminal decline.

Appropriate mental health care for young Tasmanians is also in crisis. We have heard for years that we will have an appropriate adolescent acute mental health unit in Tasmania. Whilst these beds are being built, we need to assist those requiring acute mental health care now through a memorandum of understanding with Victorian facilities.

It is absolutely unacceptable that a young Tasmanian, after languishing in a secure adult psychiatric unit in the RHH for at least 12 months, a highly inappropriate facility for such care, was only recently transferred to an appropriate facility in Melbourne.

Equally concerning is that on transfer there were no plans in place to provide follow-up care on return. The Community Adolescent Mental Health Service has allegedly refused to look after this young person on return. This young person's mental illness will not disappear following treatment in Melbourne. Ongoing community based care is essential. The current situation is untenable for teenagers and their families particularly in the North-West of the state.

The government and Health Minister are failing Tasmanians.

In light of the critical nature of the challenges we face, it is time to take a step back, think and plan strategically about acute health services for this state before we keep spending on facilities unlikely to meet future demand.

It may be time to reflect on the lost opportunity a green-fields site would have provided for the RHH and consider how to revisit this option.

Ruth Forrest is the Member for Murchison in the Legislative Council.