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House of Assembly - Fifty-First Parliament, Second Session (51-2)
2008-06-17 Daily Xml
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INDUSTRIAL ACTION

Ms CHAPMAN (Bragg—Deputy Leader of the Opposition) (14:40): What action is the Minister for Health going to take to address the claims that up to 50 per cent of emergency victims are at risk of adverse outcomes in our emergency departments?

The Hon. M.J. Atkinson: You mean 'harmed'?

The SPEAKER: Order!

Ms CHAPMAN: It is actually 'adverse' in the statement. Ask him—all right? Dr Bob Dunn, a senior emergency specialist at the RAH, has stated publicly that 'up to 50 per cent of patients are at risk of adverse events because of overcrowding in our emergency departments'.

The Hon. J.D. HILL (Kaurna—Minister for Health, Minister for the Southern Suburbs, Minister Assisting the Premier in the Arts) (14:40): I thank the honourable member for her question. To start with, I know Dr Dunn; in fact, I think he is a very fine gentleman. He provided me with some emergency services on one occasion at the Royal Adelaide Hospital, and he has certainly participated in a number of arrangements that we have in place to deal with the issues facing the medical fraternity. So, I do take the things that he says very seriously.

Let me say what the government's views are about emergency services. We know that the demand for emergency services in Adelaide is increasing at about 5 per cent a year, and it has been doing that for a number of years. Over the last three years, in fact, emergency presentations in our emergency hospitals have increased by about 15 per cent. So, there is huge growth.

We need to do something about that on the supply side and the demand side. Let me go through those two aspects. In terms of the supply, we need to create more spaces for emergency work to happen, and that is why we are embarking on a $2.2 billion capital works program to upgrade dramatically the capacity in our hospitals. We are building an extension to the Flinders Medical Centre worth $153 million which will create extra capacity at Flinders. There are currently something like 50,000 to 55,000 presentations in the emergency department at Flinders every year. The capacity we are creating will allow Flinders Medical Centre to deal with 70,000 presentations a year.

At the Lyell McEwin Hospital, we are virtually doubling the size of that hospital. That is a hospital which has been under resourced for many years. We are going to create extra capacity and put extra staff in it and, of course, we are upgrading the Queen Elizabeth Hospital and going through a whole range of things there. The jewel in the crown, if you like, is the Marjorie Jackson-Nelson Hospital, which we will build in Adelaide. So, we are investing huge sums of money to create extra capacity and extra supply.

Ms Chapman interjecting:

The SPEAKER: Order!

The Hon. J.D. HILL: The second issue in relation to the supply side is that we obviously need more doctors. We know it has been difficult to recruit doctors in a range of professions into South Australia—emergency doctors are amongst them. The reason for that is that the salary and pay in other states have outstripped the amount the doctors in our state receive. We agree with that; there is no dispute about that. We want to pay our doctors more; that is why we have an offer on the table which will have emergency doctors at the senior level earn $350,000-plus a year which, on our reckoning, will make them among the highest paid in Australia.

There is some dispute about whether in parts of Queensland they might get more, so I do not want to have an argument about that. The doctors will be the highest or the second-highest paid in Australia, and we believe if we can get that package accepted that will make it much easier for us to recruit. So, we do want to take on more doctors and, to that end, in the most recent budget, we have funding to employ an extra 20 personnel in the hospital. Most of those will be doctors, but there might be some other personnel as well, namely, nurse, practitioners and the like. We will leave that up to the people who run the emergency departments to determine. So, we are doing considerable things on the supply side.

We are also doing a lot on the demand side. We want to reduce the number of people who end up in emergency departments. People end up in emergency departments for a whole range of reasons. Obviously, where there are trauma and major incidents, the emergency department is the place to go, but a lot of people end up in emergency departments because there was no alternative for them. They cannot get to see a general practitioner. People complain about having to wait in emergency departments for six, eight, 10 or 12 hours. That is terrible. They should not have to wait that time, but the reason they are waiting there for that long is that if they went to see their GP they would be waiting anywhere from two to eight days to get to see a general practitioner.

The great tragedy in Australia is not how long people wait in emergency departments: it is how long they have to wait to see a general practitioner, particularly in the areas that I represent and the areas to the north of the city, because there are too few general practitioners, particularly those who bulk bill. So, cost becomes another issue. People go to the emergency department because they cannot afford to pay the extra gap that the general practitioners periodically apply. That is why we have a lot of people going to our emergency departments. So, what are we doing about that? Well, I have to say that one of the best things the last government did—finally, belatedly—was to increase the number of training places for doctors in our universities. That will take some time to come through but, when it does come through, that will help address some of these structural issues.

The other thing we are doing, of course, is that we are in the process of implementing our GP Plus health care strategy, that is, to create capacity in local communities so that there is an option other than the emergency departments for patients to go to. I know that the GP Plus in my electorate at Aldinga, which has been in operation now for about year and a half, has had a very marked impact on the number of people who go from that community to the Noarlunga Hospital Emergency Department. I think, from memory, it is in the range of about 15 to 20 per cent reduction in those from my community in that area who go to the Noarlunga Hospital Emergency Department because we have created extra capacity. Our goal is to have a whole range of these GP Plus health care centres right across the state to take the pressure off the emergency departments. In addition to that, we are investing in—

Members interjecting:

The SPEAKER: Order!

The Hon. J.D. HILL: —nurses to support GPs. We have a budget for 50 practice nurses whom we are supplying to general practice to work with the general practices, funded by us for short periods of time (three or four months), to help the general practitioners develop ways of managing those with chronic diseases so that they are kept healthy and they are kept out of hospitals.

We have a whole range of other strategies in place to support that, including telephone support systems, which we have been trialling in the southern suburbs, to support people who might otherwise go to hospital, and they are having an impact.

In addition to that, we have the Health Direct telephone system, which is now in place across most Australia and is in place in South Australia, and the advice I have is that, in the time that has been in operation (since late last year or earlier this year) something like 10,000 people who otherwise would have gone to emergency departments have not needed to go there.

So, we are doing a range of things. Not all these things can be dealt with immediately, but we have a plan and a strategy to do all these things. However, what I can say to the house is that, while I recognise the good work that the emergency doctors do—and there is nothing I would say in criticism of them: they work hard; they are dedicated; they are servants of the public; and we want to keep working with them to resolve this matter—merely paying them more money will not fix all of those structural issues I have described. Those issues can be dealt with only over time, as we build the infrastructure in the communities through GP Plus and as we build the infrastructure in the hospitals in the expanded emergency services arrangement.

We do want to reward our doctors properly. We have a very good offer on the table, and we have said to them publicly, and I will say it again today: 'If you do not think that offer is sufficient, argue your case out in the Industrial Relations Commission and let the umpire decide. We will support whatever the umpire says through that process.'

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