Tuesday 11 June 2013

Hansard of the Legislative Council

REPORT OF THE AUDITOR-GENERAL No. 10 of 2012-13

[2.40 p.m.]

Mr FINCH (Rosevears) - Mr President, I move -

That the report of the Auditor-General No. 10 of 2012-13 Hospital Bed Management and Primary Preventive Health be considered and noted.

Mr President, I move the motion in my name in respect of the Tasmanian Audit Office report on hospital bed management and primary preventive health. I strongly commend this report. It makes 16 recommendations on the better management of hospital beds and the movement of patients through hospitals, and the health department says it will adopt all of them. So, a very worthwhile exercise by the Auditor-General.

The Auditor-General, Mike Blake's, report covers two aspects of the state health system. The first is the management and utilisation of hospital beds in the present environment of increasing demand for health services. Bed management is critical at all times of the year but particularly in winter.

The second aspect of the report concerns the need to ensure development of primary health prevention strategies. The connection between the two, Mr President, is an interesting one. Preventive health initiatives are the only way that increasing pressure on our health services can be addressed. If you stop people getting sick, they stay out of the health system and hospital beds.

As Mr Blake says in his foreword:

Effective management of public hospital beds is essential as is the need to ensure the development of primary health prevention strategies that, in both the medium and long term, lead to declining demand for hospital beds. This audit set out to establish how effectively beds are managed by our four largest public hospitals and whether or not the Department of Health and Human Services' strategies to prevent people acquiring chronic conditions through primary preventive health were effective.

Of course, crucial to better utilisation of hospital beds is patient throughput in hospitals, and crucial to that is the use of out-of-hospital alternatives. The report lists some of these alternatives as outpatient treatment clinics, hospital in the home - HITH, aged care or home care, minimising the length of stay and interhospital transfers. The last one - moving people between hospitals - has been greatly assisted by the integration of primary and secondary health care a few years ago. This has enabled patients to be moved out of an acute care hospital like the LGH, for instance, to a regional hospital more smoothly and efficiently, perhaps to convalesce closer to home and family, which is always much better for a patient's recovery.

Progress has been made, too, on finding alternatives for aged people who previously occupied beds in acute hospitals merely because there was nowhere else to accommodate them.

In looking at hospital bed management systems in Tasmania's three health regions, the audit found that separate systems existed in the three regions and varied in their capacity to assist bed managers to maximise the use of hospital beds in acute care hospitals, or to make better use of spare capacity at district hospitals. The report says there is a strong case for adoption of a single statewide bed management system. It also urged the DHHS to investigate why its average length of stay compares unfavourably with other jurisdictions. The report quotes an important statistic that highlights the importance of efficient bed management in our hospitals. It points out that a hospital bed is not just a physical resource as each bed has to be supported by adequate numbers of nurses and access to doctors and equipment. An audit in New South Wales in 2008 found that the annual cost of a hospital bed ranged from $135 000 to $375 000.

In looking at improved public health in the future, the report examined two areas of primary preventive health: vaccination and encouraging healthier lifestyle choices. It found that Tasmania has achieved high rates of vaccination and hence reduced the risk of children contracting related conditions. However, for chronic conditions, Tasmania's rates of illness were higher than the rest of Australia, although the rates have decreased over an eight-year period. Rates for smoking, alcohol misuse and overweight/obesity were higher than the rest of Australia. In the case of alcohol misuse and overweight/obesity, they were increasing in Tasmania.

The report cites a lot evidence to support the benefits of expenditure in primary preventive health. Smoking rates in Australia have dropped from 75 per cent to less than 20 per cent since the 1950s, although the rate in Tasmania was 25 per cent in 2007.

Deaths from cardiovascular disease have decreased dramatically. Every dollar invested in evidence-based prevention programs, that is, targeting smoking, physical activity and nutrition, delivers an estimated $5.60 in savings to the community within five years. From $1 to $5.60, that is a good rate of return.

Tasmania, as a participant in the commonwealth's National Partnership Agreement on Preventive Health, now extended to mid-2018, can access facilitation and a rewards payment by agreeing to strive for certain performance benchmarks.

The Australian Institute of Health and Welfare reported that for 2010-11, 6.7 per cent of all Tasmanian hospital admissions were potentially preventable.

The Auditor-General's report was certainly well received by DHHS. I quote from the secretary, Matthew Daly's, response:

The Department of Health and Human Services and the Tasmanian Health Organisations accept all of the recommendations in the report and anticipate that their implementation will contribute to the improvement of patient through-put and in preventing people acquiring chronic conditions through primary, preventive health strategies.

The presentation of this report sets a new standard. Not only is it well-written and readable, but its layout is crisp and focused. Unlike some of the reports that we have struggled through in the past, this one was indeed a pleasure. The Tasmanian Audit Office is presently working on four other performance and compliance audits: fraud control in local government; the Royal Hobart Hospital redevelopment; alcohol, tobacco and other drug services' five-year plan; and radio communication networks. If they turn out to be as well done as this one, Tasmania will have achieved some strong, new assets - assets which will lead to better government and better management of our services.

It is hard to quantify, but the Tasmanian Audit Office is making an important contribution to the wellbeing of Tasmanian society and the wellbeing of our community. Audit Office reports like this make a valuable contribution to good governance in Tasmania and we are all the richer for the contribution by the Auditor-General and his team, who make such fulsome presentations when we have the opportunity to go to their reports and I appreciate the way they present. The Auditor-General, Mike Blake, is bringing on his team to make those presentations individually and I appreciate them. I appreciate the work of the Auditor-General and his team and it is money well spent.