Sarah Lovell MLC

Dear Mr Melick

Thank you for the opportunity to provide a submission to the Independent Review of the Response to the North-West Tasmania Covid-19 Outbreak.

At the outset, we feel it is important to reiterate the comments made in Labor's submission to the draft Terms of Reference (ToRs).

While the ToRs did not change following the consultation period, we remain concerned that there are no specific protections in place for public servants to participate openly in the inquiry.

The findings and recommendations of this inquiry will be critical to ensuring that  the circumstances that occurred on the North West Coast do not happen again. That will only be possible if the people closest to the outbreak, frontline health workers, are able to speak freely about their experiences.

As argued in Labor's original submission, neither the State Service Act or the Public Interest Disclosures Act provide sufficient or explicit protection for public servants to participate in reviews of this nature.

In fact, Section 7 of the State Service Code of Conduct states: "An employee must maintain appropriate confidentiality about dealings of, and information acquired by, the employee in the course of that employee's State Service employment."

To date public servants have not had their fears allayed that they will not be targeted if they disclose information that can be traced back to them.

We remain concerned that in the absence of explicit protections, it is likely that health workers will not participate in the inquiry or, if they do, their submissions may not be as detailed and important learnings may be lost.

The scope of this inquiry also remains limited to the North West Coast.

It is important that evidence from health facilities in other parts of the State is not discounted because it could assist in informing findings and recommendations that can be applied statewide.

Preparedness

The interim report into the North West outbreak painted a clear picture of a health system that was not adequately prepared for the threat of Covid-19, despite ample warning time.

On 17 March the Director of Public Health declared a public health emergency and stated that preparations for Covid-19 began in early January.

Despite this, Labor was hearing consistent concerns during this period about inadequate supplies of personal protective equipment (PPE) and a lack of staff training in the use of PPE.

On 3 April - 18 days after the declaration of the public health emergency - the first cases of Covid-19 in staff members were detected at the NWRH.

The interim report did not go into detail about the hygiene and infection control procedures that were in place at the NWRH up to this point but it appears that at this time the hospital had not activated its pandemic plan.

Despite widespread public messaging about the importance of basic hygiene, social distancing and staying at home when sick, it appears that these requirements were not adequately implemented or enforced by management in the North West health system.

The interim report found of the 73 staff who contracted Covid-19, 77 per cent attended work during their infectious period.

Chief Medical Officer Tony Lawler recommended that processes be put in place to address presentism, noting that the underlying drivers were multifaceted.

Dr Lawler said:

" ... reasons include the desire of staff to not let colleagues down, mistaking the symptoms of COVID-19 for other conditions, or concerns over perceived resource constraints."

Despite this the interim report noted:

These facts are clearly at odds with the Minister's assurances.

More recently there has been another case of Covid-19 identified at the NWRH. Labor is aware that some staff in the adjacent NWPH were not made aware of this case until they heard it on the news that night, even though they had been working at the facility throughout the day.

This raises serious questions about the communication from the Tasmanian Health Service to other health facilities, including those sharing the same grounds, when new cases of Covid-19 are confirmed.

It is imperative that communication is improved to ensure all staff and patients are aware of the heightened level of risk and can respond appropriately. This is also critical to maintain confidence in system controls.

The Premier's Economic and Social Recovery Advisory Council (PESRAC) in its Interim Report recommended as an immediate adion, 11 the State Government should explain to the community its future COVID-19 management strategy, including how outbreaks will be handled." To date the Government has failed to indicate whether it will accept this recommendation.

Misinformation and Morale

Labor is concerned that the stigma and stress on health workers on the North West Coast was exacerbated by misinformation spread at the highest levels.

This included Chief Medical Officer Dr Brendan Murphy telling a New Zealand Parliamentary Committee that the North West outbreak was most likely caused by a group of doctors attending an illegal dinner party. A subsequent investigation by Tasmania police found no evidence that such an event took place.

The Prime Minister, Scott Morrison, claimed on a commercial radio station that a health worker who had worked across multiple sites on the North West Coast had lied to contact tracers about where they had been.

The Director of Public Health in Tasmania, Dr Mark Veitch, clearly stated that Public Health had not briefed the Prime Minister on the matter.

Given the undue stress these comments placed on health workers at an already difficult time, Labor considers it important that the inquiry attempts to answer how this misinformation was passed on to both the Chief Medical Officer and the Prime Minister.

This should not be dismissed as a trivial matter. It had a material impact on staff morale at a critical time. It also raised serious concerns about the quality and accuracy of the information channels between the State and Federal Governments.

The North West Lockdown

On the 17 April the Premier, Peter Gutwein, said during hisdaily press conference that police would be establishing road blocks and check points to enforce lock down restrictions.

Mr Gutwein said: 111£ you are out of your home, you should not be surprised if you are stopped and questioned.''

Labor is aware that television crews requested footage of the road blocks in operation. It is understood Tasmania Police set up a check point for the cameras, only to dismantle it once they had stopped filming.

This gives rise to questions about how effectively the stay at home order was enforced and whether road blocks were staged for dramatic effect rather than for public health reasons.

There is no denying the hard lock down - while necessary for public health reasons - had a dramatic impact on North West Coast businesses and the local economy.

Despite this, there has been no specific support package provided to the region in

recognition of these impacts.

Labor has called for a specific economic support package for the North West Coast aimed at supporting businesses and creating jobs.

This package should contain a mix of direct support to affected businesses and industries in the form of hardship grants and loans, as well as targeted investment in major infrastructure such as the upgrade of the Burnie Port.

Essential worker exemptions

The North West outbreak has served to highlight the region's reliance on locum doctors.

The Emergency Department of the Mersey Community Hospital remains on restricted hours due to difficulties recruiting medical professionals.

In the short to medium term, this reliance on interstate locums poses a challenge for Tasmania's Covid-19 containment strategy.

It is unknown how many medical professionals from interstate, including Victoria, have been granted exemptions from quarantine to work in the Tasmanian health system.

It is essential that robust protections are in place to mitigate the risk of locums reintroducing Covid-19 to Tasmanian hospitals.

Labor is concerned that the essential worker exemption scheme contains too many loopholes and is open to exploitation.

Given the worrying outbreaks in Melbourne hospitals and increase in cases in Sydney it is submitted that this inquiry should look into the exemption scheme and whether changes are required to mitigate the risk of Covid-19 entering the state through this channel.

Aged Care

Tasmania saw a small number of cases in the aged care sector but the risk to this older cohort is well known and the experience from across Australia shows how devastating Covid-19 can be in aged care settings.

Recent data from Victoria demonstrates there is a significant difference in the rate of infection, and sadly deaths, between privately and publicly run aged care facilities. In Victoria, state run facilities have mandated nurse-staffing ratios and the correlation between more staff and more hours for each staff and fewer cases is important to investigate.

It is well understood that many workers in aged care are required to work across multiple sites to have enough hours to earn a living wage. This presents a challenge for managing workers across different sites and limiting the risk of spreading the virus.

The Royal Commission into Aged Care continues to hear evidence about circumstances in the sector and has taken a special interest in the impact of Covid-19. The Interim report, submissions and further reports should be considered by the