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First published May 21

Here are a few points which I think are fair and relevant regarding the AMA release ( here ) and the Minister’s response ( here ).

I am not on the AMA executive but I am a longstanding member. I am well aware of the enormous amount of deliberation and discussion that has preceded this media release.

In my opinion the AMA is appropriately concerned about the safety and quality of public health services and the competence of the current THS executive leadership team.

This concern has nothing to do with “personality politics”, it is all about quality/safe health care provision and the necessary resources to achieve that goal.

There is no AMA agenda to remove beds from the Northern Tasmanian hospitals.

In making a decision to publicly state no confidence in the THS executive leadership team the AMA considered the facts including:

1) The RHH bed crisis has been allowed to drag on for many months with ineffective or no action. This has been despite repeated warnings from senior clinical staff at the RHH. The negative consequences for patient safety have been sufficiently emphasised.

Exit block from the RHH ED for patients requiring ward admission comes with well known mortality and morbidity risks. There is no plausible reason that can be advanced to explain the inaction and ineffective actions to date.

2) The THS executive structure is inappropriate. It is highly centralised and bureaucratic and has been unable deal with day to day problems arising in the state’s hospitals, nor has it responded with adequate urgency at crisis times, including as recently as this week.

The THS executive has failed to develop the necessary trust relationships with senior THS clinicians. It has been the experience of many of those clinicians that THS executives have simply not believed in the authenticity of those clearly expressed concerns and calls for help.

3) Just over a week ago the AMA launched an online “Save the Royal” petition allowing people to express their views about the current RHH situation. Well over 500 people, doctors, nurses, patients and general members of the public have added their signatures so far. The great majority have made insightful and valuable comments as well. It is abundantly clear that the RHH and other public hospitals are highly valued but widely perceived to be under enormous stress related to inadequate resourcing.

When considering the Minister’s explanation of increasing health dollars spent, capital expenditure must be considered separately from running costs. Capital expenditure for the RHH re-development is necessary but so is the funding for the beds and staff required to run the hospital whilst this re-development takes place. It is anticipated that the re-development will take another 3 years to complete.

Whenever a hospital faces overwhelming bed shortages, as is manifestly the case at the RHH, there will be difficulty with maintaining the elective surgery program. Many people requiring elective surgery are in considerable pain, have cancer or other medical problems which worsen or are life threatening with delayed treatment. Cancellations occur too often when the ED is filled with patients who are admitted but for whom there is no available bed.

Hospital staff, General Practitioners, Community Service providers and Ambulance Paramedical staff too often feel the frustration of being unable to provide friendly, safe, quality care in such circumstances.

That this situation has been allowed to fail patients and staff so spectacularly is outrageous. I support the sentiments expressed in the AMA press release.

*Dr Frank Nicklason is Chairman of the Medical Staff Association, Royal Hobart Hospital

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