Nothing presents the opportunity for a clean reset for the way healthcare is delivered than a global pandemic.
While 2020 presented unforeseen challenges to our health system, it also accelerated responses that for too long had been tossed in the "too hard or too expensive" basket. Telehealth reforms are just one example of this.
But challenges still remain. On Friday the latest Health Dashboard data revealed further blowouts in elective surgery waiting lists.
In November last year, the government released "Our Healthcare, Our Future" - the latest in a long line of discussion papers and plans aimed at fixing the state's ailing health system.
It builds on the government's 2015 One State, One Health System, Better Outcomes reform, which focused on the role of the state's four major acute hospitals and the distribution of services within a new single Tasmanian Health Service.
As highlighted in the paper, Our Healthcare, Our Future represents the second stage of the government's plan for long-term health reform, with a consultation paper that highlights key challenges currently impacting healthcare in Tasmania in 2020 and beyond.
It also proposes three key areas for improvement: better community care, modernising Tasmania's health system, and planning for the future.
In a sit down with The Examiner in December, Health Minister Sarah Courtney said the government acknowledged it needed to work better with stakeholders to ensure more sub-acute care was delivered in the community, rather than in hospitals.
But despite presenting a colourful list of "health reform milestones" that the government says it's achieved since 2014, where has it got us?
With less than a month left before the submissions for Our Healthcare, Our Future close, we take a closer look at the challenges facing our state and the government's latest plan for reform.
What are the issues?
Already, a third of the state budget goes towards health. In 2020-21, that's $2.46 billion. Of this, 40 per cent of this goes to the state's public hospitals, 34 per cent goes to primary healthcare, 18 per cent to other (referred medical services, research), and 9 per cent to capital infrastructure.
The report notes how the availability and accessibility of primary care services, such as GP services, have a flow on impact to the demand for hospital care.
"Too often Tasmanians end up in hospital because it is the only care available, not because they need hospital level care. We need to change that, with better care options in our community. We also need better planning to ensure we are getting the very best patient outcomes for every dollar we spend."
According to the report, there has been a 10 per cent increase since 2014 from 95.9 full-time equivalent GPs per 100,000 Tasmanians, to 105.4 FTE GPs per 100,000 Tasmanians in 2020.
"However, despite these improvements, we remain below the national average and there are challenges with GP attraction and retention in regional Tasmania."
Tasmania's unique demographic and socioeconomic factors also contribute to demand on services. We remain older, poorer, less healthy, less educated and more likely to be affected by disability than other Australians.
"Our population is ageing faster than the rest of Australia, and compared to the national average, Tasmania has a higher proportion of households receiving welfare benefits, and has historically faced challenges with educational attainment, literacy and health literacy."
In Tasmania in 2017-18, not including mental health and behavioural conditions, almost half of all potentially preventable hospitalisations were related to chronic conditions, compared to 40.8 per cent for acute conditions and 9.4 per cent for vaccine-preventable conditions. With an ageing population, it's expected to get worse.
RIGHT TIME & PLACE
A 2017 survey found that up to 44 per cent of admitted patients in the Tasmanian Health Service were not receiving care in the right setting for their condition.
It's estimated that up to $100 million each year is allocated to areas of care in acute settings that "could otherwise be provided in less expensive, more appropriate sub-acute, non-acute or community based settings".
"In 2017-18 Tasmania had 15,848 potential preventable hospitalisations.This means that on average, one out of every 16 beds in our hospitals is occupied by someone with a potentially preventable admission - that is around two people on each and every ward."
Immediate actions to increase and better target government investment to the right care, place and time include:
- Consulting stakeholders on the Urgent Care Centre Feasibility Study findings. The $1250,000 report, finalised in 2019 and released late last year, found there are feasible service models of UCC, with Mowbray and Glenorchy listed as suggested locations. UCCs provide an alternative to the ED for people requiring intermediate care who would otherwise go to hospital.
- Develop and implement a service that provides GPs and other primary care health professionals with rapid access to staff specialists in the North and North-West.
- Building on Tasmania's response to COVID-19, including telehealth. Throughout COVID-19, there was a 1200 per cent increase in demand for telehealth services. Now, the government aims to implement a strategy that provides high quality patient care and integrates service delivery across acute, sub-acute, primary and community care.
Immediate actions for investment in modern ICT infrastructure include:
- A new, fully-integrated Human Resources Information System to replace payroll, rostering, workplace health and safety, conduct and leave management. A key recommendation from the independent report into the COVID-19 outbreak in the North-West last April was that the Health Department implement an electronic medical record, electronic rostering system and upgraded HR systems to enable the location of staff and contact details to be obtained instantly
- The development of a Health ICT plan 2020-2030 encompassing electronic medical records, a new patient information system, electronic tools for managing care for patients in appropriate settings, and the new Human Resource Information System.
- Partnering with Primary Health Tasmania and enhancing the interface with specialists. This will include the implementation of a single eReferral system between primary care and the THS. This is seen as a key opportunity to "develop secure exchange of health information across acute, specialist and primary care and improve healthcare for Tasmanians".
A 20 year Tasmanian health infrastructure strategy will be developed, informed by the masterplans for each major hospital, along with district hospitals, community health centres, ambulance services and mental health infrastructure.
The government aims to expand on existing strategies to help build a stronger health professional workforce. This includes a partnership with the University of Tasmania to "better support the recruitment of targeted specialists in regional areas through conjoint appointments, with a particular focus on the North-West". It will engage with UTAS to explore the alignment of future course offerings to future identified gaps in the workforce.
It also wants to strengthen the state's clinical consumer voice, with the establishment of a statewide clinical senate to provide expert advice to the Health Department and ministers on health service planning.
- Submissions close February 12, email firstname.lastname@example.org. The discussion paper can be found here.