Supplementary Questions: Hospital Services - Staffing, Funding and Postoperative Care

Mrs Armitage (Launceston) Question to the Leader of the Government in the Legislative Council, Dr Goodwin

Mr President, while I do not expect to have an answer this afternoon, as they are questions relevant to answers I received this morning, I have a couple of questions that could be on notice.

First, in the answers I received with regard to the Government's fly-drive policy of having public patients operated on, or have procedures performed, in public hospitals, the Government mentioned this morning that the THOs cannot take on additional staff, particularly surgeons, only to shed them a year later. I ask the Leader if she could, through the Minister for Health, advise where the information came from because I am of the understanding that surgeons are not in short supply, particularly at the LGH. Nursing staff may be but they could be taken on for a period of two years.

Second, in answer to part 2(b) of my question, I was advised all Tasmanian public hospitals have had and have continued to have the opportunity to utilise the $25.9 million funds. It states that the Launceston General Hospital is using the funds to purchase an additional 200 ophthalmology procedures. Can it be confirmed that their 200 ophthalmology procedures are coming out of the $25.9 million? I understood that they were already performing those procedures.

In the second question, in the answer which would come down as 2(b), whereby I asked the question regarding whether contractors would be undertaking postoperative care and rehabilitation, I was advised the provider is responsible for providing rehabilitation services to admitted patients as deemed necessary by the contractor and agreed by the THO/THS.

My question is, will contractors be able to cherrypick off the waiting list to ensure that they do not have patients that need a lot of follow-up? Second, it is noted in answer (b) that it should be noted that many elderly patients are expected to require less postoperative care. My further question is in regard to patients who have been on the waiting list for some time - it is not necessarily that they are elderly patients. As it is well known that people on a waiting list for a considerable amount of time become more urgent and require a longer recovery time and would have rehabilitation and need more after-surgery care, can the Government advise whether THO/THS will be agreeing to have those patients referred back to THS for allied and other health professionals at the cost of the state Government?

Answers from the Leader of Government, Dr Vanessa Goodwin:

1. The Department of Health and Human Services (DHHS) has had extensive conversations with the Chief Executives of each Tasmanian Health Organisation (THO). The clear advice received from each THO has been that the recruitment of surgeons for short periods, in this case no more than one year, is both unachievable and undesirable. It was based on this advice that the strategy of establishing an external panel of surgical providers was developed.

In respect to discussions with THO-North, they advised the Department that its current staffed theatre and bed capacity is effectively full. To deliver any reasonable amount of additional activity it must fund and staff additional theatre(s) and the new Short Stay Surgical Unit at a cost of $ 14.8 million.

The THO Advised that this must be ongoing funding. Given the time limited funding available under THAP this was clearly not possible, and THO-North indicated that it was unable to undertake any additional activity without using the private sector. It should be noted that it was a decision taken by THO-North to establish a contract with Calvary to undertake additional surgery.

2. Yes, the 200 ophthalmology procedures are being funded by Tasmanian Health Assistance Package (THAP). These procedures are in addition to the throughput volume that THO-North have already agreed to undertake as part of their normal activity. All THOs have access to THAP funding to do work in-house and/or to utilise any current public-private arrangements. To date, THOs have used THAP funds to provide over 500 long waiting patients with their procedures.

3. No, the selection of targeted waiting list patients will be negotiated by the DHHS & THS with the contractors based on supply, clinical, infrastructure, mutual patient selection criteria and patient consent factors. This will help ensure that the contractor does not 'cherry pick' the less complex cases. Furthermore, the contract stipulates that the number of patients who are 'ready for care' that are refused by the contractor, must be less than five per cent of the total number of referrals made by the THS. The intention of the panel arrangement is to have multiple providers in a range of locations that can provide surgery for the whole range of procedures identified on the waitlist. Any significant reduction in the over boundary waiting list is a positive outcome for Tasmanian patients.

4. (b) Yes, where appropriate, the State Government will cover the cost of patients referred back to the THOs/THS for allied and other health professional treatment. In many cases the amount of follow up health care required for these procured patients will be less than they would need if they waited a longer time for their surgery through the public system. All patients considered for treatment under THAP will have waited much longer than the clinically recommended time and need their surgery as soon as possible.

All these patients are on the THO/THS waiting list and would require this follow up care irrespective of where the surgery is performed. The THO/THS makes a saving in not providing the surgery and should explore ways of directing those savings into developing better tertiary care pathways.

(Answers supplied May 27, 2015)