As foreshadowed during last month’s sittings I had intended to make a Ministerial Statement today to update the Assembly and the ACT community on how the Government is strengthening the capacity of the ACT health system to deliver public health services to Canberrans and ensure they have access to the highest quality care to keep Canberrans as healthy and well as they can be.
But instead I will include this update in the motion put forward by the Opposition, also noting there is significant work to be done to also respond to the Opposition’s motion on the Notice Paper for Wednesday’s debate. Nonetheless Madam Speaker, I welcome the opportunity to outline what I, and the Government, are doing to improve the health and wellbeing of our community and invest in a high quality, sustainable health system.
Madam Speaker, there are a number of issues I will address today, including those raised by the Opposition. In outlining these issues and in recognising some recent challenges, the Government and myself and Minister Rattenbury as the Minister for Mental Health, with whom I work closely, remain steadfastly committed to delivering the Government’s priorities. This includes, as I outlined in my Ministerial statement to the Assembly earlier this year: improving waiting times, completing and implementing the recommendations from the system wide data review, clinical service planning to deliver truly territory wide health services and drive design of future health infrastructure, improving consultation and engagement, and a strong and continuing focus on prevention.
Since becoming the Minister for Health and Wellbeing, I have had the opportunity to understand more fully the challenges and opportunities facing the delivery of public health services, meet with a wide range of stakeholders and staff, reflect on the performance and sustainability of ACT Health, and explore a range of health system models that are in operation around Australia.
As has been well explored over a number of years, the ACT has a healthy community and a high quality health system that offers a broader range of health services than cities of a comparable size.
However, the ACT has consistently struggled to achieve a number of the national performance targets. Although we have been making faster performance gains than many other jurisdictions in recent years, we need a considerable change at the top to improve this performance. The ACT Government has consistently made significant investments in health services – and this will continue – but more investment simply isn’t enough. What we currently have is not working as well as it should. Our community deserves better.
We need to make lasting and sustainable improvements in the delivery of health services, the most complex services provided by Government. We need truly territory wide health service delivery, not health delivery based on facilities as it has been for too long in the ACT. We need to design health facilities based on truly territory wide health services planning.
We need to attract and retain the right people and offer them opportunities over the course of their careers. We need better data to inform clinical decision making, drive performance improvement and to improve transparency and accountability. We must improve the quality of health care services and we must improve our performance across a range of indicators. And we must continue to find smarter ways to invest, not only in acute care services, but also in effective prevention.
We also need our system to work smarter and live within its means. And we need simpler, clearer and more accountable governance arrangements to drive system improvement.
Madam Speaker, these are not challenges entirely unique to the ACT, and in outlining this complexity and some of the challenges, it is not to shirk responsibility, but to highlight the challenges that can only be dealt with by a high functioning organisation with strong governance in place. These are not challenges that can be overcome overnight, but nor are they insurmountable. And indeed, every day across Canberra the health of our community is cared for with skill, dedication and compassion.
Madam Speaker, last week I attended staff forums at ACT Health and at those forums I shared with staff my belief that in recent times the governance arrangements of ACT Health have let staff down.
The challenges of governance have been borne out by the recent feedback from the accreditation survey, and confirmed a range of feedback I had received and views I had formed in my first year in the role.
It is the case that the Government commenced strategic reform in ACT Health in 2015, but it is fair to say that while some achievements have been made, it has not delivered the outcomes that the government sought. That must change and the decision to separate ACT Health is the most significant change in the ACT health system in many years.
Separation of ACT Health
Madam Speaker, I want to ensure the ACT public health system is best positioned to plan for and deliver health services to our community, now and into the future. This is why the separation of ACT Health is so important.
We know that clinically and medically, Canberrans can expect to receive some of the best care in the country. However the Directorate as an organisation has expanded significantly in recent years and we have seen national reforms drive significant structural change in every jurisdiction. The ACT remains the only jurisdiction in Australia to still operate as one organisation.
With a new hospital opening soon, the time is right for the ACT to also make this change to benefit from structural, administrative and governance change to ensure that as Canberra continues to grow we can deliver quality services into the future.
While acknowledging there are a variety of approaches across Australia depending on location and size, separating ACT Health into two distinct organisations - one focused on clinical and medical service delivery; and another focused on health system management, strategic policy and planning support functions - will bring us into line with other jurisdictions and modernise ACT Health’s organisational and governance structure.
Madam Speaker, the health care environment has changed dramatically in the past 25 years and we must continue to adapt with it. While the Opposition think we’re still a small town managing a health system and serving a small town population, in reality the ACT’s population has both grown and changed profile dramatically and the ACT serves as a vital regional health hub, operating the only tertiary hospital between Sydney and Melbourne.
People are also living longer, often with more than one disease or chronic condition, and as a result require more and increasingly complex care support services. There are more New South Wales residents also accessing our services, and many of these residents attend ACT Health services not for routine health issues but for more complex health matters.
Our partnerships with non-government providers have increased, as has our funding of community based health services. And we have responded to the ever changing landscape of Commonwealth health funding reform, as the Commonwealth continually seek for us to do more with less.
Canberrans need a patient centric health system that is guided by the principles of effectiveness; accountability; transparency, professionalism and administrative excellence.
Madam Speaker, it was these combination of issues that lead me to consider whether the overarching administrative and governance frameworks for the largest ACT Directorate, a Directorate that never stops operating, with the largest workforce and budget allocation in the ACT was still the right structure.
I concluded it was not and the separation of the Health Directorate into two distinct organisations will enable one organisation to have a clear focus on effectiveness for clinical operations, enabling the Health Directorate to undertake core policy, strategy and system management functions.
Madame Speaker, I expect the transition will be a seamless one for Canberrans accessing our health services and I would like to reassure the Assembly that ACT Health employees will have the opportunity to be involved in the development of the new structure.
This is a message I gave when I joined the Interim Director-General at staff forums at ACT Health last week, one at Canberra Hospital and the other at ACT Health headquarters in Woden.
The organisational change will be designed to bring greater efficiencies for clinical and medical staff, streamline service delivery, and further reinforce the goals of the Territory-wide Health Services Framework –person centric and community-focused care, enhanced preventive health and improved hospital services.
To achieve these objectives, the interim Director General has commenced a body of work to:
Madam Speaker, we have the benefit of being the last jurisdiction in this country to undertake this change and as such we are able to draw on the best of what works and what doesn’t around Australia. But we will design a model, in consultation with staff and stakeholders, which works for our city and one that enables a clear focus on effective and efficient service delivery, builds a positive culture and drives service improvement. This is an important and exciting time for our health system.
At this time it is also prudent for ACT Health to pause to closely consider and re-evaluate some of its current strategic work. It is important that the heads of the two new organisations are involved in and can influence these considerations. Work is already underway to recruit the heads of the two new organisations.
To allow the hospital’s new chief executive to closely evaluate the organisation’s structure and decide how best to move forward, the internal organisational realignment at Canberra Hospital and Health Services, that was consulted on with staff in late 2017 and early 2018 will be slowed until post October 1, with an interim organisational structure being finalised by late May.
Having met many ACT Health staff over the past two years, it was a privilege last week to share a couple of hours with hundreds more. It was a chance to outline the issues behind the separation of ACT Health and also to talk with them about accreditation.
I was able to pass on the feedback I receive from many people in our community who express their gratitude and thanks in big and small ways to the ACT Health staff who care for them, from a one off event to what is sometimes years of treatment and support.
I was also able to share with them my view expressed earlier that the governance of ACT Health has let them down in recent times, that the reforms underway since 2015 have not fully achieved what the government intended and that while we have a number of challenges ahead I know they have enormous professional and personal commitment to delivering high quality health care for our community.
It is clear to me that ACT Health staff wish to be genuinely included in the decisions affecting their organisation; that in recent times they have not felt included nor felt they understand many of the changes that have been made, and that the organisation and its governance has become too complex. Alongside the Interim Director General, I committed that this will change.
The next few months will include building trust through genuine engagement. I have asked the Interim Director-General, who has an excellent track record on these issues, and ACT Health senior staff to ensure this occurs and is a foundation of both new organisations.
Madam Speaker, it is important to note here that the Government remains absolutely committed to the development of truly territory wide health services and to that end territory wide service planning and the development of Specialty Service Plan’s and Models of Care will continue, but I have asked ACT Health to paint a better picture to staff and our community on the health needs of our community in the next decade and, after considerable feedback from staff and stakeholders over the past month, reconsider with staff the development of Clinical Centres.
I have also led a significant improvement in the partnership with Calvary Public Hospital, investing in the hospital as well as commencing negotiation on a modern new agreement with Calvary to ensure we have an integrated and truly territory wide health system. This important work includes both Calvary Public Hospital and Clare Holland House.
Madam Speaker, as Members know the Australian Council on Healthcare Standards (ACHS) undertook an accreditation survey at ACT Health in late March. ACHS look at 209 criteria under ten national standards for this important survey. While ACT Health met 176 it did not meet 33 of the core criteria. This was clearly a concerning and disappointing result for the government, ACT Health and its staff.
Of the 33 core criteria not met 17, or half, relate to governance. Reference is made to the model of ACT Health, noting the current model creates a significant degree of confusion and fails to provide clear accountability. I have spoken to matters of governance already Madam Speaker, but I reiterate the significance of these findings and the decision by the government to address these very issues through the separation of ACT Health.
Madam Speaker, the remaining matters that are the focus of the Not Met report are the subject of significant attention at the highest levels of ACT Health. The full and final report is currently being finalised and when completed will be made available to all ACT Health staff.
An accreditation coordination team has been established in ACT Health and this team will be consulting with staff in the coming weeks. While there are a number of governance related areas requiring improvement there are also areas which are patient focused and require behavioural changes in the workplace.
These relate specifically to a number of Not Mets in National Standards 3 [preventing and controlling healthcare associated infections], 4 [medication safety], 5 [patient identification and procedure matching] and 6 [clinical handover]. In order to address these ACT Health staff must focus on compliance with the relevant standards and policies to ensure that the safest level of care is being provided to patients.
This includes, for example, ensuring that ACT Health has 100% compliance when it comes to completing electronic surgical safety checklists, or ensuring the correct labelling of specimens.
ACT Health senior leaders will work with staff to make the necessary improvements in these areas, whether it be through education programs, additional training or targeted communication.
Madam Speaker, when it comes to health infrastructure, the government remains committed to building what our growing community needs.
In the 2017-18 we made a significant down payment for better health infrastructure now and into the future, with funding for an expanded Centenary Hospital, SPIRE, a new northside hospital and community health facilities.
The Budget included $236 million over four years for planning, design and the start of construction for SPIRE.
Since then the Territory-wide Health Services Framework has also been developed. It is essential that this service planning inform infrastructure planning to ensure we get the final designs right. This point has been made crystal clear to me, especially by clinicians, and for anyone following the journey of the Royal Adelaide Hospital, this provides a very salutary lesson to all governments of the need to properly inform infrastructure planning with good clinical planning. It is essential then that we focus effort now on service planning to inform the function and design of SPIRE and future northside facilities, as well as how we best plan the utilisation of our health facilities in the intervening period.
Madam Speaker, over the past 11 months since last year’s budget, preliminary work on the design of SPIRE has begun and will continue over the coming year. As members will appreciate the final design requires detailed consideration and that is well underway. The construction of SPIRE is scheduled to begin in 2020, but preliminary planning has indicated that SPIRE is unlikely to be completed in 2022-23, but rather in the following financial year 2023-24. Current tender processes will give us greater certainty around timeframes for completion of the various stages of SPIRE.
As Minister for Health and Wellbeing I am focused on ensuring we have high quality health infrastructure across the territory to meet growing demand. One very important point in all this Madam Speaker is to understand the Government’s commitments to deliver the right care in the right place at the right time.
Around the world, while we see a growing incidence of chronic conditions and more and more people living with more than one disease or chronic condition, we are also seeing a move away from all care concentrated in acute hospital settings.
This is for a number of reasons, including that care is often best delivered in sub-acute, community based or home based organisations. Also, as health literacy and self-care improve, people feel more empowered to care for themselves in setting that best enable them to continue their daily lives.
As a visiting British expert said to me just yesterday, “people should only be in hospital for things they need to be in hospital for”. It sounds simple Members, but it is a difficult solution for a complex health system. It is one we will continue to strive for, while at the same time meeting today’s, tomorrow’s and next decades health care needs.
Madam Speaker, demand for our health services is no clearer than when you consider the pressures on the Centenary Hospital for Women and Children.
Centenary provides safe, high quality care and services for families in the ACT and the surrounding region. Every day beautiful babies are born or cared for at Centenary, and families should be able to have confidence that they will continue to get high quality care there.
I am happy to say that the majority of feedback I get about Centenary is how wonderful the staff are and how great the service was. It is also an incredibly popular facility with increasing numbers of families choosing to birth at the hospital. I am very aware of the pressure this places on staff who do such a wonderful job caring for families during one of the most significant times in their lives.
The recent anonymous letter from a staff member concerned me greatly, and while a number of the issues raised were in relation to how busy it is at Centenary Hospital, I am advised that other issues raised were simply not accurate, particularly regarding accreditation, and I know senior staff and doctors at Centenary have been eager to reassure the community that the hospital is safe and offers high quality care.
Indeed, the management team is committed to working through any issues staff may raise in a respectful and supportive way. Because we know all staff have the best interests of their patients at heart.
Centenary currently uses a number of strategies to address high demand, including:
The recruitment of midwives and medical staff is an ongoing challenge that ACT Health has addressed with strategies to attract new staff and support existing staff so they continue to work at Centenary, doing what they love.
The graduate midwifery program recruited 15 new staff in 2018, which was a 50 per cent increase from the 2017 intake. The ACT Government also made a commitment to expand services at Centenary at the last election, and the planning and feasibility work is well underway.
The planning for this $70 million expansion began this financial year to enable Centenary to deliver new and increased services for women and children requiring inpatient care as well as a number of specialist outpatient services for women and children.
In addition, the ACT Government has recently funded a $2.6 million refurbishment of the maternity ward at Calvary Public Hospital Bruce so women have a more comfortable place to birth and spend those precious first few hours and days with their baby.
Madam Speaker, both Centenary Hospital for Women and Children and Calvary Public Hospital offer different choices of birthing for pregnant women. Both offer high quality care by dedicated professionals. However what we have seen in recent years is a steady increase at Centenary and a steady decrease at Calvary. As Health Minister it is simply not tenable to have valuable health expertise not being properly utilized at Calvary Public Hospital.
This is exactly why we are investing in Calvary Public Hospital’s maternity ward and look forward to that work being completed in July. Work is also underway to improve the way maternity services are offered right across our community and I expect further advice on that from ACT Helath in the near future.
Madame Speaker, I want to address the issue of waiting times – in emergency and elective surgery. Of course ACT Health is committed to bringing down wait times. This has been a challenge for some time in the ACT.
Canberra Hospital is one of the top 10 busiest emergency departments in Australia. It’s a major tertiary centre for the ACT and surrounding NSW region, we also treat many urgent and complex cases.
The ACT Government has made investments in the ED in recent times, but as demand continues, to grow at unprecedented rates and patients present with higher acuities, or in other words, more patients are more unwell, this is not having the performance effect we might have expected.
There is more work to be done to improve flows within the emergency department at Canberra Hospital and flows and procedures through the wider hospital. This work is underway and part of a good process of continuous improvement. In part this is due not only to increased presentations, but to the significant increase in higher acuity presentations.
Work is well underway to further improve flow within the Emergency Department, but importantly also within the hospital itself, including the processes for admitting and discharging patients from wards. That work is ongoing.
In the Emergency Department, it is important the ACT is meeting our targets for seeing the most urgent cases. It is also important to be clear that sometimes it is clinically appropriate for patients to stay in the ED longer than four hours, depending on their presentation and needs.
We have made some of the highest gains in the country on our emergency department figures, for example we have improved from 51% of patients seen on time in 2012-13 to 62% of patients being seen on time in 2016-17.
The performance of both ACT hospitals is comparable to peer group hospitals in other jurisdictions. The AIHW Emergency Department Care report for 2016-17 found that the 71% of ED presentations at TCH had a length of stay of less than four hours. This compared with 68% nationally within the principal referral and women’s and children hospital peer group. At Calvary Public Hospital, 76% of presentations had a stay of four hours or less, against a national rate of 70% within the public acute group A hospital peer group.
For elective surgery, ACT Health is committed to minimising the number of people waiting beyond clinically recommended timeframes for surgery in the ACT.
There have been improvements and the ACT is heading in the right direction when it comes to our elective surgery waiting list. But again, we need to continue to improve this performance. This is why in the 2017-18 Budget Update, $6.4 million was allocated to ensure additional patients receive their elective surgery this financial year.
More surgeries will be delivered both in the public and private system by increasing the allocation of operating sessions to those specialties with high demand, such as:
We are also developing a targeted workforce strategy to attract and retain more specialist doctors to the ACT.
And when it comes to going on a wait list to see a specialist, I think it is important to acknowledge that not all people on the wait list will require surgery, because surgery is not the solution in all cases. Non-surgical treatment may include medication, physical therapy, and a range of other options, as provided by a multi-disciplinary team.
Madam Speaker, more and better data will soon start to be provided to ACT Health staff and clinicians as well as to the broader ACT community as a result of the CT Health System-wide Data Review. The Review has been completed and I look forward to speaking further to this later in the week.
As I have indicated previously, I commissioned this review and as part of it wanted to ensure clinicians, health stakeholders and the Canberra community have access to meaningful data. Following a final round of consultation with staff which begins very soon, the final report will be tabled and public consultation will commence in the second half of this year. I look forward to the ACT leading the country on the provision of data to the ACT community. We have been looking closely at what South Australia do in particular and hope to learn from their good work.
Madam Speaker, of course allegations of bullying within any workplace, and including ACT Health, worries me greatly. As Minister, I am committed to ensuring ACT Health and our public health services have a respectful, supportive and inclusive approach that values all its employees, and ensures there are avenues for staff to be able to raise issues when they arise.
As a major employer with over 7000 employees, ACT Health has a zero tolerance for inappropriate behaviour in the workplace. Let me be clear, there is no place for bullying and harassment or any other form of inappropriate behaviour in our hospitals and health facilities.
ACT Health takes allegations seriously and actively works to prevent and manage any behaviours in the workplace that are inappropriate. This includes fostering a culture of reporting (through a supporting training program and systems for reporting), making sure we have well-established supports in place to respond to staff when concerns are raised and working with our staff, managers, staff representatives, medical colleges and tertiary institutions to ensure these important issues are tackled head on.
Of course, healthy workplace cultures are everyone’s responsibility and I have asked the Interim Director General to have this at the forefront of his discussions with staff and to demonstrate, with senior staff and clinical leaders in the organisation, and lead by example. Again, I am confident that this will be a feature of the new organisation.
On the issue of prescription monitoring, I am pleased to say this will be introduced on Thursday, as stated last sitting period. The minor delay was to allow the government to ensure the legislation was up to date and effective, and to determine if a national scheme was imminent. The ACT is actually leading the country, along with Tasmania on this issue, and we are moving much faster than many jurisdictions, including NSW and the Federal Liberal Government.
If Mrs Dunne is really concerned with action on this issue, I suggest she talk to her Federal counterparts about getting a national scheme up and running as soon as possible.
On the opioid guidelines issue, it was the case that this review had languished for too long. As soon as I was made aware of this issue I asked ACT Health to bring forward the review of the ACT’s opioid maintenance treatment guidelines and ensured there was extensive consultation with stakeholders.
The review and subsequent adoption of the National Guidelines for Medication-Assisted Treatment of Opioid Dependence is one of the ways the ACT Government is strengthening alcohol and other drug policies and services.
The national guidelines will also be supported by updated Controlled Medicines Prescribing Standards for clinicians and an ACT-specific document called Opioid Maintenance Treatment in the ACT: Local Policies and Procedures.
The new Opioid Maintenance Treatment in the ACT: Local Policies and Procedures document ensures that the adoption of the national guidelines supports the continued delivery of services in the ACT and provides comprehensive ACT-specific information for clinicians and consumers. Following the completion of the review it did take some time for the final guidelines to be completed, but this time was very well spent in detailed and thorough consultation.
Madam Speaker, I am under no illusions about the issues ACT Health is facing. After just over a year in the role of Health Minister I am more determined than ever to address these issues and work with our 7000 plus workforce and dedicated stakeholders – and the broader community – to do everything I can to make our health system the best it can be. Of course, this won’t be easy. It is not something that one person alone can fix, many people have an important role to play.
As Minister I do take responsibility for the strategic direction and performance of ACT Health to deliver for our community. Indeed, there is no responsibility I take more seriously and as such I am committed to seeing this through and will not be supporting Mrs Dunne’s motion today.
I also know this is not something we can fix overnight. But this government’s number one priority will be to improve our health performance one step at a time. In the immediate term, we must meet accreditation in July, and this is something everyone is focused on. We are finalising further investment in the ACT Budget next month, we have a clear plan in place to design and consult on the best structure for the two new organisations and we will take the first steps to embed quality data within the organisation through the system-wide data review.
While it’s vital we meet these challenges, I want to make it clear that ACT Health continues to deliver quality health services to our community.
From our Canberra Region Cancer Centre, to our Walk-in Centres and hospitals, we have dedicated staff who come to work every day, 365 days a year to help people. And that will always be the case.
Madam Speaker, I welcome today’s opportunity to outline how the Government is positioning its public health system to better deliver high quality, patient-centred care to our community. I have outlined some recent challenges and the steps put in place to address these issues. I have outlined the Government’s commitment to continue to pursue our priorities and modernise our health services. I have outlined the steps being taken to address accreditation and to genuinely engage and consult with ACT Health staff. I look forward to keeping the Assembly updated on this important work.