Thursday 29 June 2006 - Estimates Committee B (Giddings


Mr FINCH - This is actually from surgical services but while I have got the CEO of the Royal here it may be in your area or Stephen Ayre's. There was an increase of 11.3 per cent, or $80 million, for surgical services which was partly due to funding for more staff but leaving regional rivalry out of this, some people in the north were concerned about recent reports that some Royal Hobart Hospital patients might - I was going to say inducted by Launceston General Hospital but probably starting their recovery might be a better way to put it - but I am just wondering if I can have a comment on that, about that circumstance.

Ms GIDDINGS - About Royal Hobart Hospital patients?

Mr FINCH - Might go to Launceston, north to the Launceston General Hospital.

Ms GIDDINGS - Generally it is the other way around because the Royal Hobart Hospital is the primary hospital in the sense that we do a lot of the complex cases and other hospitals refer patients to us, but I will ask Peter to talk about that.

Dr LESLIE - Usually it does come down because of specialised services that are really only available at the Royal. If patients have been treated and are able to go back in terms of their convalescence we will try to get them back closer to home. That applies wherever they might be. We have had pressure on our intensive care unit and when that is busy we may not be able to hold somebody in Hobart for quite the period of time. So they are some of the dynamics that do occur in terms of surgery but we would not transfer specifically for surgery, we endeavour to do that.

Ms GIDDINGS - In ICU if there are too many patients in anybody's ICU around the State we look to try to keep our patients within the State but when our ICU beds are full around the State we in fact airlift people to Melbourne to be cared for in ICU so there could be a Hobart person; if Hobart ICU is full it might be we have to transfer that patient to the LGH to be cared for if they have a bed.

Dr LESLIE - If I could just comment in terms of intensive care - it is one of the pressure areas in all major hospitals and interstate you will often find that patients need to be moved or their surgery may be moved for the availability of intensive care beds. It is always one of the pressure points that we have.

Dr FORREST - Could I make one more point and also there are some State-wide services where the medical practitioner or specialist on call could be an LGH specialist so not every service is provided in every hospital and there are some that are in the LGH and not at the Royal Hobart.

CHAIR - Do we have any other questions on medical, surgical or women's and children's service specific to Hobart? This is a first, Minister, that you are to be congratulated on, to have the CEOs here to be able to answer questions so specific is a first and you are to be congratulated on it. Are there any other questions on it?

Mrs JAMIESON - I have just one on the use of information technology in virtual medicine, HealthConnect and also video linking with the other parts of the State, King Island and Flinders Island.

Dr FORREST - HealthConnect is a different thing. It is mainly to do with community health and in the community health services. There are hospital IT systems.

Mrs JAMIESON - I am wondering though do you connect with them from hospital, as in discharge information?

Ms GIDDINGS - This is also is a federally funded program. Can I suggest you put that on notice to us?

Mrs JAMIESON - Okay. I will go back to videoing as far as assistance with say surgery or specialist information being transferred.

Dr LESLIE - Not specifically although it is used quite often for conferencing calls. In fact the advisory committees all meet by video linkage; not specifically for surgery and so forth.

Mr FINCH - We in the north are fairly jealous of our LGH and hold it in high regard as perhaps our most important institution. We want it to have the very best equipment and expertise but if you look at the way the health budget is moving each year, it is obvious that the LGH and the RHH just cannot have everything. I am wondering what process is in place for sharing resources between the north and the south and what are the criteria?

Ms GIDDINGS - Ultimately I think it is a judgment we make in the budget process as to where we put our budget dollars and we have put significant investment into the Royal Hobart Hospital because it is, as I have said, the hospital that deals with the most complex cases; it is a tertiary referral centre in the official terminology in relation to that, but in having done that we have also invested in our other hospitals as well and the Launceston General Hospital is getting new linear accelerator machines, for instance; we are looking at a new Department of Emergency Medicine, the planning process in relation to that.

There is $12 million to build the Department of Emergency Medicine, $8 million for more medical procedures and $6.9 million for new medical equipment, and likewise there is a commitment to the north-west hospitals; there is the hospital equipment fund which is statewide; so ultimately it is resourcing each of our hospitals in the regions and what this leads to is the debate that the Richardson report put down on centres of excellence and understanding that you cannot have everything in any one hospital. You are not going to have everything at the Royal either in that sense so it might be that there will be a centre of excellence at the LGH and we are hoping we can work towards that sort of model for the North West Regional Hospital but these things take time.

Mr FINCH - Minister, who does the evaluation of that criteria though? Who are the people involved?

Ms GIDDINGS - You have your structures where you all meet and discuss -

Dr FORREST - There are two points here. There is one about equipment and so on and I think there is little difference between the two hospitals in terms of oncology equipment or MRIs and that sort of thing, but what there is is a difference in terms of what specialisations are carried out where and I suppose in many cases there has been an historical difference and as the minister said, point post Richardson, there is a view that we should be getting more statewide specialisation so there are policy arrangements in place to look at particular areas and say -

Mr FINCH - Including the north-west coast?

Dr FORREST - Yes, for the whole State, to say, 'Where is this best done?' The fact is that in many cases you will want to do it in all three places for locals but there are some areas where it would just be silly to do it in all three places and we have dealt with a number of instances today where outreach services occur - the renal dialysis is from the LGH but in the north-west and we have to make those kinds of arrangements. In mental health we have sometimes the north west serviced from Hobart by a particular psychiatrist and so on so we are all the time working to provide what we think is the most appropriate level consistent with economy.

Ms GIDDINGS - And we have this clinical advisory committee as well which I understand is a statewide advisory committee and we would get advice from the clinical practitioners who are part of that committee in terms of our budget priorities as well.

Mr FINCH - Who is on that committee?

[6.00 p.m.]

Ms BENT - The clinical advisory structure has five subcommittees and they are in medical services, surgical - the split that you see here - women's and children's pathology and imaging and the chairs of those committees, although they change a little bit, often tend to be the respective professor of that relevant discipline. Then the chairs of the committee go to the Clinical Advisory Committee which meets less frequently but brings together all of those ideas. So we set up in 2000 and it has been going for a long time now, that committee structure.

Mr FINCH - So how often do they get together.

Ms BLACKWOOD - Committees would meet probably every second month, but the Clinical Advisory Committee itself, less frequently, just quarterly.

Dr LESLIE - If I could just add that we have just met last week - the surgical one - which is then video linked to the north west and to LGH and Hobart. So in fact it brings together active clinicians selected in the various hospitals and between that group then it begins to plan services, recruitment issues as to where staff might be needed and so forth. So there is a very active participation that occurs in those committee areas.

Mr FINCH - Minister, are you happy with that process and can you see that continuing?

Ms GIDDINGS - I am happy with that process and I can see it continuing.

CHAIR - Okay. We do thank you for your time. Minister, if we could do the same with perhaps Launceston General and we will keep the best until last, the North West.