Pulse Check | AMA (WA)

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Pulse Check

Wednesday February 23, 2022

Australian Medical Association (WA)

Less than a year ago, Amber-Jade Sanderson was elevated to the role of WA Minister for Environment, Climate Action and Commerce. A cabinet reshuffle just before Christmas saw her take on the mantle of Minister for Health from Roger Cook, who had managed the portfolio for the past 13 years. As if health wasn’t a difficult enough beast to break in, the responsibility for mental health was also handed to Ms Sanderson.

It’s early days for the new Minister, but with the COVID-19 variant Omicron festering fast in the community, debate erupting over border re-openings, and shouts of system unpreparedness sounding from every quarter, the newly minted Minister has had no choice but to move into the fastest gear.

All eyes are now on Ms Sanderson, as she grapples with not just the State Government’s response to and management of COVID as its impact on WA increases, but multiple legacy issues weighing down WA’s health system – public hospital capacity, workforce morale, ageing infrastructure, shortfalls in mental health services and resources, and regional workforce concerns.

Medicus put a series of questions to the new Minister in a bid to understand her plans for the difficult months ahead. While most of her responses rate high on the pulse meter, indicating a commitment to act promptly and deliver change, there are others which would certainly benefit from greater ministerial intervention. As the body most in tune with WA doctors, the AMA (WA) looks forward to a close working relationship with Minister Sanderson to help facilitate improved outcomes for doctors, patients and the overall health of our State.

Q. There has been much speculation about why you chose to accept a portfolio as challenging as health, during what many would say is one of the most challenging periods in WA’s history. Why did you agree?

AJS: It’s no secret that the Health and Mental Health portfolios are challenging, and the pandemic has only added another layer of difficulty, but I have never stepped back from a challenge and believe that no job worth doing isn’t hard. I believe very strongly in patient advocacy and got into politics because I want to serve the people of WA. The Health and Mental Health portfolios are an opportunity to make a real difference; there are not many portfolios which can have such a profound effect on people’s lives.

Q. You played a major role in delivering WA’s Voluntary Assisted Dying legislation. How did you feel on 1 July 2021 when the Voluntary Assisted Dying Act 2019 came into effect?

AJS: I felt relief. Relief for those people and their families who can now face their journey with less fear and uncertainty. I spent days hearing the accounts of terminally ill Western Australians and their families, and the need for both improved access to palliative care and broader end-of-life choices was stark. It was a privilege to play a part in bringing about such a huge and important change.

Q. You have been in Parliament for nearly nine earnt during this time? What are the three biggest lessons you learnt during this time?

AJS: One thing I have learnt is that you have to be ready for anything, and be prepared to move quickly, which I think is important as we continue to battle COVID-19. I also strongly believe in collaboration and consultation. One of the best aspects of working on the VAD legislation was the relationships I built across political parties. I value my relationships across Parliament, and across the sector.

Ultimately our job in Government is to make decisions and provide clear direction, but I will always listen to a broad range of views before coming to a position.

Q. Prior to joining WA Parliament, you were Assistant Secretary of United Voice. How did your time there help to shape your current career as a politician?

AJS: I spent about 10 years with United Voice, representing low-paid workers, mostly women, in childcare, aged care, and support services in education and health. The biggest learning from that is how government decisions can impact people’s lives in a devastating way. Job security, privatisation of jobs, and industrial relations can really impact their ability to pay bills and provide for their families.

Q. What are your top priorities in the coming six months, besides managing the inevitable spread of COVID-19 in our health system?

AJS: Hospital preparedness is my top priority. We are doing everything we can to stop COVID-19 from engulfing our State, but despite these efforts, it’s extremely likely we will see a large outbreak here.

The McGowan Government has invested heavily in resourcing our hospital system, so we can manage the unprecedented demand. Through the Mid-year Review and the Budget, we have injected a record $3.2 billion into the health system, with an additional 530 beds expected to come online over the next 12 months. I intend to oversee the delivery of these beds as a priority, and to continue to support the recruitment of staff.

Workforce recruitment across the health and mental health systems, along with patient experiences and outcomes, are also at the forefront of my mind.

Q. In the final quarter of 2021, the State Government announced $1.28 billion in funding for, among a host of initiatives, an additional 270 hospital beds and associated staff.

  • When will the additional beds and staff be fully operational?
  • How will you expand physical and workforce capacity beyond this to manage demand increase?

AJS: The additional 530 beds are progressively being opened, with all expected to come online by October 2022. These are across a number of metropolitan and regional hospitals. At the time of writing, 282 beds have already been opened.

We are doing what we can to attract health staff to WA. We are allowing international workers to come in above caps, and smoothed the way for 130 staff in January alone. We have modified quarantine arrangements for healthcare workers coming in from interstate, so they can attend work after seven days’ home quarantine. We have also invested in a significant international advertising campaign.

Q. Ambulance ramping has been a major issue for quite a few years now, with 2021 breaking several ignominious records. For example, December 2021 was the worst December on record. How do you plan to alleviate the situation?

AJS: Figures show ramping has been trending downward since August 2021, which is extremely encouraging, but there is more work to do. We have invested a record $3.2 billion in the health and mental health system, including a strong focus on easing the pressure on emergency departments.

There are some great initiatives being piloted in emergency departments, like Virtual Emergency Medicine at Fiona Stanley Hospital. I welcome innovation in this space and look forward to seeing more of it.

The Primary Health sector is also very challenged right now, and I will be advocating for more support for our GPs, particularly in rural and remote areas.

Q. The AMA (WA) held an Emergency Care Summit in October last year, bringing together doctors and health leaders, in an attempt to identify immediate solutions to the ramping crisis. Have you considered the outcomes of the summit and potential actions that could be implemented?

AJS: The Summit pre-dates my time as Health Minister, but I value the perspective of the AMA and intend to meet with the President regularly. I am focused on solutions and welcome all sensible suggestions and ideas.

Q. It has been almost five years since the Labor Government came to power in WA, and we are yet to see a large-capacity medihotel – Labor’s major election commitment in 2017. The Murdoch medihotel development is slated to open next year.

  •  Why the delay?
  • And are there other medihotels in the works?

AJS: A Medihotel was launched in August 2020 by the Royal Perth Bentley Group, and the Murdoch Health and Knowledge Precinct (MHKP) is currently under construction, which will provide an 80-bed Medihotel due to open in 2023. The concept of a Joondalup location is under consideration.

Q. There have been countless examples of senior doctors who have been forced to leave the public system after being unfairly penalised with contract non-renewal. Permanent contracts are an obvious solution. What are your thoughts on this, given WA is the only State that does not offer such contracts to doctors?

AJS: The McGowan Government has a longstanding commitment to direct and permanent employment in the public sector. More than 15,000 public sector employees have been converted to permanency since August 2018. Many of these workers were previously casual employees, or on monthly fixed-term contracts.

I understand this is an issue that has been raised in EBA negotiations between the union and the Department, and it wouldn’t be appropriate for me to comment while discussions are underway. As the Minister for Health, I believe doctors and medical practitioners are the lifeblood of our health system, and I would encourage both the Department and the Union to continue working together to resolve the issue.

Q. Health workforce shortages have dominated in recent months, and we have been promised doctors and nurses from over east and overseas. How many of these doctors have commenced employment in the past six months?

AJS: In 2021, an additional 1,259 nurses and midwives were employed in WA hospitals. So far in 2022, WA health has employed 892 nurses and midwives. Nearly 600 doctors were employed in 2021, including 261 doctors from the UK and Ireland. At the start of 2022, 408 graduate doctors were employed in WA hospitals. WA hospitals are continuing to recruit doctors and nurses from interstate and overseas.

Q. The WA Country Health Service (WACHS) is plagued by workforce shortages, a collapse in workforce morale, and concerns about the sustainability of services (including access to emergency care). How do you propose to fix these issues?

AJS: Our WACHS workforce do incredible work across some very remote regions. We have to be agile and innovative to maintain access to services, including emergency care to country WA. All regional health services struggle to attract and retain health workers, despite competitive salaries and allowances. Technology is often the foundation of many of those services.
The whole health system works cooperatively to fill gaps where needed, and immediate recruitment is a priority for WACHS.

Q. Developmental Paediatrics is experiencing huge access block currently. Waiting times have blown out to about 12 months within the private sector in Perth, or appointments are not available at all. The current shortage of paediatricians, child psychiatrists and clinical psychologists will be exacerbated when self-isolation requirements come into play. The Child and Adolescent Mental Health Services (CAMHS) excludes treatment of developmental disorders such as Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD). Will you consider setting up developmental clinics at PCH and FSH, and/or community clinics to manage the large number of children with ASD, ADHD, mental health comorbidity and learning problems, currently only able to seek care in the private sector?

AJS: I am advised that the Child and Adolescent Mental Health Service (CAMHS) does not exclude treatment of development disorders such as ASD or ADHD, but does require that there be a co-morbid diagnosis of moderate to severe mental illness, as this is the remit of CAMHS. CAMHS also has a complex ADHD service for children with mental health co-morbidity. There are also many other providers of ASD/ADHD care, but I am aware that it can be difficult for families to access, due to the high demand for private paediatricians.

During 2021, CAHS increased the number of specialty training positions for developmental paediatricians, and has increased available paediatrician appointments. The Child Development Service is exploring ways to improve the efficiency of services, improve clinical pathways, and trial waitlist strategies, including allocation of additional funding to support the expansion of developmental paediatric services to meet demand.

Q. WA is one of three states nationwide (the other two being the Northern Territory and the Australian Capital Territory) that does not provide public specialist inpatient or day program services for patients experiencing eating disorders. While the Mental Health Commission indicated that the $31.6 million State Budget commitment will be used to provide intensive day programs, among other services and support, is there a political appetite to introduce dedicated inpatient services – both in metro Perth and at regional centres?

AJS: The State Government, through the South Metropolitan Health Service, is currently working with the Federal Government to determine the best model of care and appropriate location for an eating disorder treatment centre, which is currently in the planning phase.

This year’s State Budget delivered $31.7 million to expand existing and provide new state-wide eating disorder treatment services, which will include two dedicated multi-disciplinary, area-based services located in the north and south metropolitan areas. Patient transition coordinators will also be located at each health service provider to coordinate the care of people living with eating disorders, and community treatment and support services will be expanded.

Q. The WA health system is currently overrun by ageing infrastructure. And while plans are in place to replace hospitals such as King Edward Memorial Hospital, what are your plans for the long-running issue of Graylands Hospital, and contemporary replacement services?

AJS: The State Budget in September last year allocated$1.3 billion towards improving health infrastructure, major hospital redevelopments and expansions underway across metropolitan and regional WA.

The McGowan Government has established the Graylands Reconfiguration and Forensic Taskforce (GRAFT) to review the services provided at Graylands Hospital and Selby Older Adult Mental Health Service. The Taskforce, which is led by former health minister, Jim McGinty, is reviewing the options to support the future of the Graylands site through reconfiguration and system reforms, which will guide the Government’s critical decisions about future investments in mental health infrastructure and service delivery approach.

The reconfiguration of the State’s mental health system and the Graylands Hospital site is a long-term project that will not happen overnight. It is an incredibly important piece of work that will bring significant benefits to the WA community.

Q. What are the plans for WA’s new women’s hospital and what services (if any) will be shared across the QEII Medical Centre site?

AJS: The Women and Newborn Service Relocation Project (WNSRP) is the opportunity to create contemporary, world-class facilities, enabling the delivery of high-quality services, and an enhanced experience for patients and families. I am advised that clinicians are currently involved in the project across all levels of the engagement strategy, and have played a key role in determining the decisions to date. They will continue to be consulted throughout the life of the project. Options for connecting the new hospital with Sir Charles Gairdner Hospital’s emergency department, theatre suite, pharmacy, medical imaging and intensive care unit through partial or complete relocation/co-location are being explored.

Q. What are your plans to address the shortfalls in WA’s mental health services, particularly in the area of sub-specialist service development, community psychiatric services and addiction medicine?

AJS: The 2021-22 budget delivered a record $495 million boost to mental health services. More than $1.114 billion has been allocated to the Mental Health Commission in 2021-22 to deliver mental health, alcohol and other drug services. This record investment contains an extra $311 million for community accommodation and support across WA, including $135.7 million for delivering outpatient treatment services, to help people avoid hospitalisation, and get the treatment and care they need in the community. This work is already being done. For example, the $24.5 million, 20-bed Community Care Unit in Orelia is due to open shortly, supporting adults with severe and persistent mental health issues and complex needs within a home-like environment, for up to 18 months.

We know that the focus of our mental health system needs to shift from a predominantly reactive approach, to one where there is increasing investment in prevention activities, and increased capacity for community-based services to deliver responsive, well-connected community treatment and emergency response services. Getting the right balance of inpatient and community-based accommodation and mental health support services is critical to providing a system that is both effective and efficient, and there is an increased focus on children and young people.

Implementing the recommendations of the Ministerial Taskforce into Public Mental Health Services for Infants, Children and Adolescents aged 0-18 years in WA (ICA Taskforce) is a priority for me working with the sector to modernise some outdated models of care for young people in WA.

Q. As a health leader, what is your message to those who are yet to/have chosen not to receive the vaccine?

AJS: Don’t be selfish. Just get it done. The vaccine is safe and it helps prevent serious disease. It protects health workers who look after you when you are sick, and it protects the vulnerable in our community.

Q. How have you engaged with Aboriginal communities and leaders to support confidence in COVID health services (e.g. vaccination and primary care clinics), movement within the community in the event of an outbreak, and the multiple challenges associated with this (e.g. food security, aeromedical retrieval)?

AJS: We all have a responsibility to protect and safeguard our First Nations people and communities, so they can remain safe and strong. Increasing vaccination rates amongst these vulnerable communities is of utmost importance, and is a key area of focus for the WA Vaccine Program.

While there are many reasons as to why certain groups or individuals may be hesitant to be vaccinated, all efforts are made to engage with stakeholders and communities across the State, and continue to bring more opportunities for COVID-19 vaccinations. As part of the Keeping Culture Safe and Strong: Vaccination Focus program, WA Health and WA Police teams are engaging with communities at the grass roots, talking face-to-face and one-on- one with people, and including home visits and offering vaccinations to hospital inpatients and outpatients.

An extensive number of activities are underway in the Pilbara, including mobile response vaccination teams that are continuing to offer door-to-door services in all towns across the Pilbara. Also, vaccinators are being deployed to WACHS-run remote Aboriginal communities, offering opportunistic vaccinations to community members.

Q. How would you measure your success at the end of 2022? What would you regard as your successes in three years’ time?

AJS: I’ll leave that for the commentators.