Tasmanian Government Response to the Final Report of the Independent Review of the Response to the North-West Tasmania COVID-19 Outbreak

1

That the Public Health resources of the State be upgraded to, and maintained at a level, which enables expanded provision of public health services, across a range of protection and prevention issues, for the community and the health care sector, and which allows the Director of Public Health to lead the health response in future pandemics.

Support

(In progress)

2

That a comprehensive respiratory protection program is implemented to address broader staff safety considerations including ventilation, design, and other aspects involved in a ‘hierarchy of controls’ approach as well as PPE.

Support

(In progress)

3

That substantial stocks of PPE are always kept on hand and regularly rotated.

Support

(In progress)

4

That efforts to promote consistent education and practice in relation to the handling and wearing of PPE continue via mandatory training, including refresher training.

Support

(In progress)

5

That all health care staff who frequently perform or assist with aerosol-generating procedures or undertake other activities assessed as high risk for COVID-19 transmission carry out fit testing of N95 masks as a priority, and a range of solutions should be developed for those who cannot obtain a fit with the available respirators.

Support

(In progress)

6

That when an outbreak occurs within a health facility (which may need to be declared following a single case) all relevant staff and patients, irrespective of presence of symptoms, be tested in addition to those identified through usual contact tracing processes.

Support in principle

(In progress)

7

That the Department of Health (DoH) strengthen and maintain its capability for rapid contact tracing in both community and health care outbreak settings. This should also include training and maintenance of surge capacity, and establishing the capacity and protocols to immediately provide supplementary outbreak management solutions such as a ‘contact tracing Flying Squad’ to attend and work together with health facility staff to support future outbreak responses.

Support

(In progress)

8

That the circumstances and legislative framework supporting the dissemination of medical and associated information to all those involved in the contact tracing process and pandemic issues management generally be widely communicated and included in educational and training materials. This should apply not only within the health system itself, but more broadly across all Government agencies.

Support

(In progress)

9

That major decisions in DoH which affect multiple agencies and the community, and require close coordination with the emergency management structure, be communicated to those agencies before there is an announcement to the media.

Support

(In progress)

10

That DoH streamline the communication process and give greater authority to managers in an affected hospital to communicate directly and quickly with their staff about an outbreak. DoH should also seek opportunities to work in partnership with third parties like unions to improve the speed and relevance of communication, building on its work with organisations like PHTas.

Support

(In progress)

11

That there be a clear separation of Public Health advice for the general community from advice for the clinical community.

Support

(In progress)

12

That DoH investigate use of an App-based tool for providing the latest information to staff, so that staff do not have to read through large numbers of emails to find key information, but instead open the App to find the latest advice on issues such as PPE. This might also require investment in smart devices to ensure information can be ‘pushed’ to all relevant staff at the same time, irrespective of where they are located.

Support

(In progress)

13

That future communications incorporate a stronger focus on health consumers (including external health service providers), with alternative communication tools such as community mail-outs and greater use of public media.

Support

(In progress)

14

That there be an immediate, localised, appropriately-tailored and transparent strategy for communicating with North-West health consumers and community members. This should take into account the ongoing anxiety and uncertainty which arose from the outbreak, and the need to re-assure the community that lessons learnt from the outbreak will inform future responses.

Support

(In progress)

15

That the communication tools used as part of any future strategy can be amended, refined and approved rapidly so as to ensure that there is no delay in disseminating information in the event of a future outbreak, because of the rapid dissemination of information, correct or otherwise, by social media.

Support

(In progress)

16

That, as a priority, DoH make additional mechanisms available for health and wellbeing support for the North-West workforce that has been affected by the COVID outbreak. Mechanisms for monitoring effectiveness should include – but not be limited to – confidential and properly designed staff surveys.

Support

(In progress)

17

That DoH regularly monitor the effectiveness of these additional mechanisms to ensure that they are meeting the objective of improving collective and individual staff mental health and wellbeing.

Support

(In progress)

18

That when an outbreak occurs in a hospital, the officer in charge of that site be authorised and encouraged to communicate directly and frequently with their staff about the latest information and direction without the need to first clear scripts and messages through successive layers of the management hierarchy above them.

Support

(Complete)

19

That DoH define clearly in one, publicly available document the key decision-making structures and officers in an outbreak, how they interact with the broader emergency management structure, and what they are responsible for. This includes being clear about their delegated authority and lines of accountability. All staff should be provided with a clear and simple description of the role, responsibility and authority of senior officers during an outbreak, including THS site pandemic response coordinators, hospital executives and senior clinicians with respect to matters such as infection control, PPE and isolation.

Support

(In progress)

20

That the Government reviews the role of portfolio ministers during an emergency, and the extent to which they are able to direct the responses of their agencies outside the legislated emergency management structure.

Support

(In progress)

21

That DoH clarifies the ongoing need for the position of ‘State Health Commander’ during an outbreak, noting the role of Incident Controller in the ECC. The Review considers it adds an unnecessary further level in the command and control structure.

Support

(Complete)

22

That, if they are retained in the future Health emergency management structure, more resources be provided to the RHEMTs to enable senior DoH staff within those committees to work with other parts of the Emergency Management system, including ensuring Commanders are not required to wear ‘two hats’ and can concentrate solely on the emergency management task.

Support

(In progress)

23

That there be open communication across the whole-of-government Emergency Management and Health Emergency Management structures to ensure no surprises and maximise the opportunity for effective planning.

Support

(In progress)

24

That DoH look for opportunities to streamline the emergency management decision-making hierarchy while introducing more clinical expertise into the senior levels of the structure.

Support

(Complete)

25

That DoH adopt the principle of delegating decision-making authority as close as possible to the coal-face.

Support

(In progress)

26

That the Government introduces regular exercises to test the capacity of the system to respond to pandemic outbreaks, and supports this with investment in the emergency management capabilities of key DoH decision-makers.

Support

(In progress)

27

That in future, key decisions and decision-making processes made and conducted throughout any emergency be carefully documented and held in a central repository within Government to, amongst other things, assist with the important process of post-incident review.

Support

(In progress)

28

That any future pandemic outbreaks across Tasmania (and the ongoing preparations for same) incorporate structured and formal input of health consumers into the emergency decision making process in real time.

Support in principle

(In progress)

29

That DoH works with appropriate organisations such as Primary Health Tasmania, the University of Tasmania and relevant consumer groups to better understand the health, social and economic impacts of the virus on health consumers.

Support

(In progress)

30

That all THS Consumer and Community Engagement Councils (CCEC) receive training and mentoring support to strengthen their capacity to engage and inform THS management’s decision making process across hospital, rural and community services.

Support in principle

(In progress)

31

That Tasmania’s whole-of-government Information Technology structure be enhanced to enable the making, storage, transmission and accessing of electronic records.

Support

(In progress)

32

That hospitals be designed or renovated to ensure suitably sized common areas to allow appropriate social distancing amongst staff.

Support

(In progress)

33

That, in emergency situations, staff in departments whose hierarchy is external to the Hospital, e.g. Statewide services such as Pharmacy, Mental Health, and those on cost centres outside the hospital impacted, receive all their communication and directions in relation to the local response through the person with day to day responsibility for managing the hospital.

Support

(In progress)

34

That, in the case of a future outbreak, the officer with day to day responsibility for managing the hospital have direct access at all times to senior emergency management staff outside the hospital, so that critical decisions may be made in a timely way.

Support

(Complete)

35

That the limit on financial delegations for local corporate managers who must make immediate purchases to support a response be suspended for the duration of the emergency period, understanding that accountability requirements remain.

Support in principle

(In progress)

36

That DoH implements an electronic medical record, electronic rostering system and upgraded HR systems to enable the location of staff and contact details to be obtained instantly.

Support

(In progress)

37

That DoH develop contingency plans for the management of an ageing workforce as it relates to, and affects, pandemic management.

Support

(In progress)