Health Consumers Tasmania

1. Introduction

This submission from Health Consumers Tasmania (HCT) draws on the lived experiences of Tasmanian health consumers. The information provided in our response to the Terms of Reference comes from a number of sources including:

• Consultations with the HCT COVID-19 Reference Group, which includes members from the NW region;
• Consultations with patients, carers and community workers who live and work in the NW region; and
• Relevant results of four online surveys about concerns and queries regarding COVID-19 (April – July) – on average approximately 30% of the respondents were from the NW region, with specific reference to survey 4 (16-19 July 2020)1 .

The stories of patients, carers and community workers not only provide strong witness to the events and practices that occurred, but also emphasise and review the impact the outbreak had on those patients who came to the hospital system with a trust that it would treat their illness and not place them at further risk.

HCT would welcome the opportunity for patients, carers and community workers to tell their stories to the Independent Review’s Expert Working Group.

HCT has high level representation on the Reference Group for the NW COVID-19 Cohort Study of health care workers at the NWRH and NWPH and has provided valuable input to date.

We are also involved, through the HCT Chair, Professor Walker, in a Survey of GPs on the NW Coast about their experiences of COVID 19 including the impact of the closure of the NWRH and the NWPH together with an analysis of patterns of change of GP usage of MBS item numbers during COVID 19 in NW Tasmania.

2. Health Consumers Tasmania

HCT is a Company Limited by Guarantee, funded by the Tasmanian and Commonwealth governments and reporting to an independent board. We have established a community of interest of over 600 people and are formally involved in 15 partnerships or committees.

HCT has been formed to provide health consumer advocacy and to use this evidence as a basis to facilitate health systems review and enhancement to ensure the health system better meets the needs of Tasmanians.

HCT has demonstrated its value through its significant contribution to support the efforts of Government, the Department and THS in dealing with the current COVID-19 crisis. HCT’s input through, for example, membership of the Public Health Emergency Operating Committee (PHOEC) and the State Planning Network together with the provision of information to the COVID-19 State Control Centre – Public Information Unit, has enabled a more informed public decision-making process during the crisis.

1 Survey Reports can be found on the HCT website https://healthconsumerstas.org.au/

3. The NW community and local culture

NW health consumers consulted note that the local community is small, interconnected, and although recovering from the COVID-19 outbreak it is still ‘on edge’. The recent advice of a sentinel single-case at the NWRH (a patient who had undergone a medical procedure in Melbourne) has caused concern and anxiety amongst health workers and with vulnerable people again using face masks and displaying caution in public places. Great care needs to be taken by the Independent Review to ensure their work is sensitive to the welfare of patients, carers and health workers as they continue to be vulnerable.

There is recognition that the culture of the North West is one of “helping out” and “stepping up.” This played a role in the spread of the virus because staff who were unwell continued to work and to congregate. The impact the culture on the outbreak, and how this can best be managed/directed in the future delivery of health services is of concern.

4. Systemic issues

NW health consumers consulted have high praise for the staff and management of the NWRH and NWPH who were affected by the outbreak, and are pleased that the review does not seek to lay blame on any particular group, but rather to focus on the systemic issues that made the hospitals and region vulnerable to the outbreak.

They are concerned that the hospitals did not have plans in place to deal with an outbreak, there was none or little infection control training, nor adequate PPE, and they were surprised that this had not been addressed through the Australian Commission Quality and Safety in Health Care (ACQSHC) accreditation. Concern was also raised about whether the hospital was appropriately implementing its policies and protocols.

The role and accountability of the ACQSHC in assessing performance against relevant quality standards in a health care setting, namely the hospitals in question, needs to be examined further.

We recognise that recommendations from the Department’s Interim Report are progressively being implemented.

5. Consumer engagement in the pandemic response

Health consumer input into the planning and decision making of the regional and facility-based response was absent during the pandemic outbreak. Standard 2 of the ACQSHC standards mandates health consumer engagement in the governance and operations of a hospital facility.

Whilst HCT acknowledge that the outbreak required an immediate emergency planning response, it is still imperative that the consumer voice be involved in providing input into any planned interventions required.

Experiences from the COVID-19 response in the State of Queensland resulted in Health Consumers QLD formal involvement in the state-wide emergency planning response through the Queensland Reform Planning Group and the COVID System Leadership Forum, chaired by the Director General and met daily during the height of the pandemic. In the Australian Capital Territory, the Health Care Consumer Association of the ACT was involved in the COVID-19 Task Force which involved participation in 7.30am daily emergency meetings during the height of the pandemic, which then became the Clinical Health Emergency Coordination centre with responsibility allocated to the ACT Deputy Health Controller.

The role of consumer engagement in an emergency response is to ensure planning and implementation does not have adverse unintended consequences on patient’s health and wellbeing.

Furthermore, without the consumer voice involved in the planning and implementation response, decision makers are operating and making decisions without the full suite of information available and necessary for informed, effective and inclusive decision making.

HCT acknowledge that Public Health Tasmania has since incorporated consumer input into COVID-19 related planning through HCT involvement in the Public Health Emergency Organising Committee (PHOEC) and the State Planning Network.

6. Casual workforce

The number of health workers who were employed across more than one health service or site increases the risk of transmission and outbreak of COVID-19. Given the longstanding demographic, systemic, employment and economic issues in the region many health workers are unable to earn an adequate income by working for a single service. Health consumers consulted are strongly supportive of the health workers and their need to earn income however they are concerned about a health system that relies on casual workers who work across sites. This raises issues of the number of different jobs many health workers have, whether this is appropriate for the health of the community, and fair employment practice.

7. Poor communications with existing patient and community networks and individual patients

When the COVID-19 outbreak occurred the hospital had very poor communication in place with patient advocate groups, local General Practices and community health services to inform them how patients within the hospital were being treated, where they were being moved to, and the manner of their discharge and support. It was perceived that the hospital communication system “closed doors” when the outbreak occurred. We urge the Independent Review to consider what communications the hospital should have in place with these support and other important networks, both during times of emergency, and as good practice.

Health consumers consulted were also concerned by the nature of communication with the public when the outbreak and hospitals shut down first occurred, as they were informed their hospital was closed, but did not know if and where they could access health services if needed.

There were also confused messages to individual patients. For example one cancer patient was told that her family in the NW had to be tested for COVID-19 regardless of lack of symptoms otherwise if she needed to be admitted to the LGH for treatment, she would be refused admission. When checking with the Holman Clinic, this turned out not to be the case.

8. eHealth records management

There has long been a sense of exasperation with the failure of the hospital system to move to adequate electronic health management technology and interface with Practice eHealth patient records, given the amount of time and money that appears to have been spent discussing and working on this topic. The Independent Review should consider why appropriate eHealth records management is not in place as it appears to be out of step with community expectations.

This has implications on both patient safety, patient care planning, patient discharge care and additional burden placed on patients (having to repeat their story) as well as operational efficiencies including reporting performance outcomes.

The impact the lack of eHealth records had on patient safety during a pandemic is of particular concern.

9. Transfer of health services

With the decanting of health services to Launceston General Hospital, there are reports of the hospital having done a good job however many patients had trouble travelling to Launceston to access those services. Many who were transferred by ambulance, had problems getting home on discharge as there was little coordination with community transport for return journeys.

Family members reported waiting for hours in ED at LGH waiting for information about the patient who had been transported by ambulance.

Health consumers consulted noted the terminology (eg “decanting”) was not understood by the public. The Independent Report should consider use of accessible language when communicating during an emergency.

10. People with disabilities

We had reports of people with disabilities who had to stand down their support workers as those workers were still employed through the hospital system. Recently there have been a number of submissions from the NW region to the Aged Care Royal Commission detailing these experiences. Person Centred Emergency Response Plans could have prepared vulnerable people for such events, and placed power in them and their ability to manage events

11. Telehealth

Most health consumers consulted agree that one of the positives to come from COVID-19, particularly the outbreak in the NW, has been the availability of access to telehealth services with new MBS item numbers, but there are many stories about people, during and after the NW hospitals closure, missing regular GP consultations, people not presenting to ED, and people not being able/reluctant to use telehealth.

We have stories of innovations to demystify telehealth. One example is the short video produced by Connecting Care featuring a respected local GP – the impact locally was significant.2 2 www.connectingcaretas.com.au/

Findings from HCT’s Survey 4 are generally reflective of Telehealth usage in the NW region:

• Most Tasmanians have heard of telehealth (90%), yet only 68% of those surveyed knew how to use telehealth which is considered low given that nearly 25% indicated they didn’t know how to use telehealth.
  • Reasons given for not knowing about telehealth was that they were unsure whether they could “easily use the internet to find information and services you might need to help with your health”.
  • People who did not know or were not sure about telehealth were more likely to be older (over 75) or were twice as likely to have finished schooling at year 11 or below.
  • The usage of telehealth has peaked in Tasmania with less people now (43%) indicating they would use telehealth compared to 55% in April. This is because a higher proportion of people now (52%) would visit their GP in person compared to 34% in April – people are now feeling safe to visit their GP in person.
  • Anecdotally, people who identified that their physical health had deteriorated since February were more likely to use telehealth to see a GP and were less likely to visit their GP in person compared to the broader sample of those surveyed.
  • Those using telehealth were either very satisfied (40%) or satisfied (46%) which is consistent with the findings in April o It is worth noting that those not satisfied (14.0%) was higher than April (8%).

12. Broader community impact

There were a number of other areas heavily impacted by the outbreak that should be considered in the Independent Review including police and their management of family violence, and any isolation compliance checks, and primary care (GPs) and community pharmacy ability to step up and provide health services and support to the public. 20 August 2020