Tuesday 11 June 2013
Hansard of the
OF THE AUDITOR-GENERAL No. 10 of 2012-13
FINCH (Rosevears) -
Mr President, I move -
the report of the Auditor-General No. 10
of 2012-13 Hospital Bed Management and Primary Preventive Health be
considered and noted.
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.
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.
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.
Mr Blake says in his foreword:
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.
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.
has been made, too, on finding alternatives for aged people who previously
occupied beds in acute hospitals merely because there was nowhere else to
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.
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.
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.
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.
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.
Australian Institute of Health and Welfare reported that for 2010-11, 6.7 per
cent of all Tasmanian hospital admissions were potentially preventable.
Auditor-General's report was certainly well received by DHHS. I quote from the
secretary, Matthew Daly's, response:
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
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.
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.