Ambulance Service: Government Performance (12.06.2013)

Written on the 17 June 2013

Ms CROZIER (Southern Metropolitan) -- I am very pleased to be able to rise to speak on Mr Jennings's motion, which he just outlined to the house. I am looking forward to responding to some of the claims that he has made in his contribution to the chamber this morning. Firstly, in his opening statement he said that by pretty much every measure this government has failed. I wish to come back to a number of those issues.


He spoke about a number of areas in relation to the Victorian ambulance service. He mentioned the code 1 response times, and I remind him that in the Victorian Auditor-General's report of October 2010, Access to Ambulance Services, the Auditor-General found that:


Ambulances are taking longer to respond to code 1 emergencies, with the worst performance since 2004-05 recorded in 2009-10. Response times have worsened more in rural regions than in the metropolitan area, and increased funding of $185.7 million over four years from 2008-09 has so far not led to demonstrable improvement.


From that alone we can see we had an Auditor-General who was extremely damning of the previous administration in relation to its management of ambulance services, and I want to go into that in more detail.


There was an amalgamation in July 2008, combining the Metropolitan Ambulance Service, Rural Ambulance Victoria and the Alexandra District Ambulance Service. I presume that was with a view to efficiency, but the facts are that what happens in rural and regional Victoria in terms of response times, the nature of the accidents and what ambulance services are faced with are very different to what happens in metropolitan Melbourne, the response times and access to major hospitals. We all know that. It is obvious that the major hospitals are in metropolitan Melbourne, and if you have a heart attack in metropolitan Melbourne and need critical and intensive care, you are going to very often have a better outcome.


I want to return to that point, because there have been dramatic improvements in that area alone. Mr Jennings highlighted his own experience, and I have to agree with him about understanding the signs and commend him for highlighting his own personal issue in what must have been a very distressing time for him.


But referring back to some other areas of Mr Jennings's contribution, he himself acknowledged and he continued for over 10 minutes on a litany of stories, and it reminded me of one horrific true story that I have just reviewed while I was sitting here listening to a number of stories brought to Mr Jennings's attention. I am sure that, if I went through 11 years worth of all the media accounts of people's tragic stories, there would be many more than this one, but I raise it, in particular, because it is the story of a woman who was impaled on a fence and had an agonising wait for an ambulance in December of 2009. The Age stated at the time:


The mother of a woman who was impaled through the groin on a fence post in a horrific accident in northern Victoria has slammed the lengthy delay in getting an ambulance to the scene. Heather Broadbent says her daughter Kim was left 'hanging' in agony for 47 minutes before paramedics arrived at the property in Yarrawonga to treat her.


Victorian Health Minister Daniel Andrews -- who is now the Leader of the Opposition: described the incident as 'unacceptable' and today apologised to Kim Broadbent for 'the trauma and stress she was put through'.


This highlights what our ambulance service has to deal with on a day-to-day basis, and as someone who has worked in hospital settings in both metropolitan Melbourne and country Victoria I understand firsthand the significant work that our paramedics and ambulance officers undertake on a daily basis. It is a 24-hour service, and it is absolutely integral to our overall health service in Victoria.


Before I move on to some other areas that Mr Jennings highlighted, I want to give an overview and put this issue into context, because it is important to understand that we are not always talking about emergency service situations in relation to Ambulance Victoria. Transporting Victorian patients is undertaken in various forms. Obviously we have road transport in the form of road ambulances, but we also have fixed-wing and helicopter ambulance services, and I am delighted that it was the current government that saw an air ambulance helicopter service introduced in western Victoria. That was one of its promises when in opposition, and it has fulfilled that obligation. The service is of great benefit to the people of western Victoria.


As someone who came from far western Victoria and has used the ambulance service herself, I know how difficult it is to provide the service. As somebody who has worked in the health industry, I can say that unfortunately it is a fact that sometimes there are waiting times associated with ambulances. There are peak periods, and we know those peak periods often happen on a Friday or Saturday evening and during wintertime when road conditions are poor. There are a whole range of factors. Mr Jennings referred to patients waiting for hours and the ramping of ambulances in 2012. I am sure that at that time there was a fair amount of industrial action going on as well, including bed closures, which possibly contributed to some of those backlogs.


Ambulance Victoria undertakes a number of services, not only the transportation of critically ill patients but also non-emergency transportation services. As well as Ambulance Victoria there is the Newborn Emergency Transport Service, or NETS, with which I am quite familiar, having worked at Royal Women's Hospital.


It often transports critically ill or very premature newborns from rural and regional Victoria to large regional centres, Melbourne or sometimes, if beds are unavailable, interstate. That is common practice among health services. It is obviously not ideal for patients to have their newborns transported interstate, but it is, at times, necessary.


Like other health professionals, ambulance officers and paramedics are very important. They are often faced with critical and confronting circumstances. They are highly skilled and highly trained, and they provide care and treatment in some of the most difficult circumstances, whether they be retrieval, recovery, treatment or transportation. They work out of mobile units that have seen significant technical advancements over the years, and that goes to acknowledging the tremendous work these professionals do in sustaining and treating people in life-threatening situations.


Unfortunately there is not always a positive outcome, but very often they make the critical difference between whether somebody lives or dies. We have very high standards of health care in this state, recognised not only nationally but also internationally, and that is something of which we are all very proud.


In his contribution Mr Jennings spoke about the elective response waiting lists having blown out. There are a number of reasons for this, and I have spoken about them in the past. He well knows that the $107 million which was ripped out of our health budget by the federal Minister for Health, Tanya Plibersek, with the support of the Prime Minister, Julia Gillard, and the federal Treasurer, Wayne Swan, halfway through a financial year, had a significant effect on waiting lists.


You cannot possibly put in funding arrangements and have things set in place -- especially for elective surgery or outpatient clinics -- that are funded and agreed to and then have that money ripped out. Of course there will be a flow-on effect if that is done. That is exactly what happened. Mr Jennings has said that it is this government's fault that the response times for elective surgery waiting lists have blown out. That is not true. Mr Jennings knows that the withdrawal halfway through a financial year of $107 million has, as I said, had a significant impact on all health services across the state.


In addition, the closure of the hospital beds through the industrial action that was taken has also had a flow-on effect. In some instances elective surgery has had to be cancelled, and that has also contributed to that backlog. There were some matters raised in Mr Jennings's contribution for which the federal Minister for Health, Tanya Plibersek, should take full responsibility.


I am pleased that the $107 million has been put back into Victorian health services, but we will still be left without $368 million over the next four financial years, with the first component becoming effective in just a couple of weeks, from 1 July. Again, the way the federal government has treated Victorian patients and Victorian health services is a damning indictment of the federal government. It shows its absolute contempt for the management of health services. Members of hospital management boards and the clinicians in those health services should be congratulated on undertaking the work they have done in those very difficult circumstances of managing in extraordinarily challenging times, with significant amounts of money being just ripped out of their operating budgets.


I remind the chamber that when the coalition came to government there were significant issues that the previous government had not addressed. As I have already said, the Auditor-General's report on the extent of the problems within Ambulance Victoria highlighted a number of areas. When Labor came to government in 1999 its election commitment was fairly strong in its wording, but again that government was all words and non-delivery. At that time it said:


Through our service improvements, aim to reduce the time it takes an ambulance to arrive at the scene of an accident from 15 minutes in 90 per cent of cases to 12 minutes in 90 per cent of cases. In addition Labor will seek to improve the service so that the response time target is 10 minutes in 90 per cent of cases within 12 months.
Mr Jennings referred to budget papers. The 2002 budget papers show a target of just 13 minutes and the 2007 budget papers show that the target had blown out again to the current 15 minutes, demonstrating that under Mr Jennings's administration Labor's policies had been completely ineffectual.


When in 2008 the then Premier made the announcement about the amalgamation of the ambulance services it was quite evident that they were underresourced and not thoroughly enough planned. The government completely failed to deliver what was promised. This government inherited that situation from the previous government, and that botched merger and mess is a significant issue that the government has had to address and is now dealing with.


In his motion Mr Jennings referred to the sacking of the board of Ambulance Victoria, which is quite extraordinary. The government has a new board in position. It had to consider the issues I have highlighted, especially the botched merger that I have referred to. The new board is made up of competent businessmen and women who are beginning to look at those issues and address what has been inherited by the coalition government.


In his contribution Mr Jennings spoke of the emergency services data. I remind the house that it is this government that has been transparent and has provided accurate data and reporting. The former government refused to show the data on waiting lists. I am sure that the Victorian public is reassured that the current process is much more transparent than the one that was undertaken by the former government. Just recently there has been a report produced on that data. It highlights the Victorian public hospital wait lists for elective surgery and outpatient clinics and the failure of the previous government to address those issues.


Mr Jennings made a number of other claims about the failures of this government. I draw the attention of the house to what the government has committed to. The government is investing more than $151 million to upgrade ambulance services in Victoria. This will include 310 new paramedics, with 100 for the metropolitan area and 210 across rural and regional Victoria. There will be 30 non-emergency patient transport officers to improve non-emergency services and reduce the number of non-emergency transports undertaken by rural paramedics.


Those non-emergency transport services are important for people in rural and regional areas who are not able to access transport to hospitals. Those paramedics will be freed up to conduct necessary emergency work. For the first time mobile intensive care ambulance (MICA) units and single responder units will be placed in 10 major rural towns throughout the state, including Warrnambool, Horsham, Mildura, Shepparton, Wangaratta, Wodonga, Sale, Bairnsdale, Wonthaggi and Swan Hill.


This rollout across those areas will improve survival rates by making paramedics and dedicated MICA units available for the first time to those major regional centres. This is a significant improvement on what has been in place in the past and will provide significant services to a wide radius around those centres.


The additional funding will also cater for building and vehicle requirements associated with service upgrades in those areas, and there has been $3.2 million dedicated to establish a motorcycle paramedic unit for the inner parts of Melbourne. As we all know, there are many more cars on the roads as a result of the growth in our population. This is an efficient way to get around the sometimes congested streets of metropolitan Melbourne and attend critically ill patients who might need first aid or paramedic services.


I also draw the house's attention to the survival rates. Everybody would agree that this is an ongoing improvement and should be received very positively.


It is a good news story, and survival rates continue to have a major impact on many people. I refer to a press release of December 2012, which stated:


New Ambulance Victoria data reveals people living in rural Victoria today have a better chance than ever of surviving a deadly cardiac arrest.


New research from Ambulance Victoria shows 42 per cent of rural cardiac arrest patients are brought back to life by paramedics and transported to a hospital, with 29.3 per cent of these patients then discharged from hospital; rural patients being discharged from hospital after cardiac arrest increased from 8.1 per cent in 2003 to 16.7 per cent in 2011; and almost 40 per cent of cardiac arrest patients receive CPR by a member of the community before paramedics arrive -- a 20 per cent increase since 2004.


The message and undertakings of the Heart Foundation should also be acknowledged.


I have known a number of men aged in their early 50s who lived in country Victoria and called ambulances after having a heart attack, and sadly they did not survive the experience, so I fully understand the importance of response times. The initiatives and new treatments, including the thrombolysis that is being administered by paramedics, is having a huge impact on survival rates. That is something all Victorians should be reassured about.


I want to go back and speak on the number of paramedics that have been put in place across the state. Mr Jennings made mention of the attrition rate. I can say that it has been relatively stable in recent years at around 4 per cent, which is lower than in most other health services. It is not surprising that there would be an attrition rate of some sort among paramedics. I highlight the increase in the number of paramedics that have been employed. Mr Jennings gave a bit of a shopping list of what was going on, so I am going to highlight what is actually on the ground.


In the Loddon Mallee region there are 32 additional paramedics; in 2013 there are 252 full-time equivalents, and in 2009-10 there were approximately 220. That is an improvement. New resources will be added to those which have already been added by the government, which include: six staff to the unit in Mildura; four paramedics to the Swan Hill single response MICA unit in the peak period, which commenced in May of this year; and one internal and two contractor crews to Bendigo, which commenced in August 2010. That was under the previous government, but it was nevertheless in the last three years. Before the next election there will be additional resources provided. In Kyneton and Romsey there will be additional shifts.


In the metropolitan east area in 2009-10 there were approximately 578 paramedics. There are now approximately 713. That is an additional 135 paramedics in the area. Additional resources have been added to this area. There has been an upgrade to 24-hour service at the Belgrave unit.


Throughout the whole area -- Mount Eliza, Endeavour Hills, Officer, Clayton, Yarra Junction, Emerald, Lyndhurst and Pearcedale -- there have been upgrades. These are significant additions to services and something those communities will be well aware of.


In the metropolitan west in 2009-10 there were approximately 849 paramedics. In 2013 there are 897 -- that is, 48 additional paramedics. Additional resources will also be going into that area.


In the Barwon-south western region in 2009-10 there were approximately 224 paramedics and now there are approximately 259, which is an additional 35. I have to say that the survival rates in the Barwon area have also been quite notable. In 2009-10 the figures state that the survival to hospital was around 30 per cent and now it is 47.9 per cent, with 21.7 per cent being discharged alive.


These are significant improvements from the previous figures, and I am sure they show a commitment by all concerned in improving survival rates.


Mr Jennings mentioned Maffra and stories from the Gippsland area. Again, there are additional paramedics in that area. In 2009-10 there were approximately 190 paramedics and in 2013 there are now 255, so to say that we have 'failed on every measure' -- which I think was the quote -- is completely a misunderstanding of what is going on, with additional paramedics and services across-the-board and improved survival rates in some areas. Those survival rates are obviously an important measure of ambulance performance, and a recent report on government services showed that the metropolitan rural survival rates from cardiac arrest are not only improving but are significantly better than national and international rates. These are significant statistics, and data that has been released shows that those survival rates and the work that is being conducted by our paramedics and health services is having a significant impact.


We are leading the way, so to say that we are failing on every measure is quite an extraordinary statement.


I know that there has been some discussion around the attrition rates. As I said before, it is around 4 per cent, and I think it should be noted that the current financial year has seen a decline in the attrition rate and 42 per cent of paramedics who have left Ambulance Victoria have now rejoined on a casual basis. The feedback is all quite positive in some areas in relation to rosters, and again Mr Jennings referred to 'onerous rosters'. There has been significant input into a new roster methodology in some metropolitan areas. They are looking at providing greater flexibility to support the demands of paramedics in both their family and professional lives, and there are considerable pressures on a paramedic.


As I said, they often have to deal with confronting and difficult situations and it can be very stressful. Having a flexible roster system goes some way to addressing those issues, and although this new roster system has only been in place for a few weeks, as I said at the outset, the early feedback is positive. As an ongoing process there will be a number of surveys given to those staff who are involved in that roster system looking for further improvements, but I think it is also encouraging that the benefits have already been realised with those paramedics that have been undertaking that flexible roster system.


I know that Mr Jennings referred to a number of stories in relation to what has been going on with our paramedics, but can I say there are also some very positive stories that come out of the care that those paramedics undertake.


In my own area of the Southern Metropolitan Region, recently a paramedic resuscitated a young athlete at Melbourne Sports and Aquatic Centre, which many members would know is a facility in Albert Park. At that time the paramedic utilised a clinical trial initiative with the Alfred hospital, ensuring that this patient received groundbreaking and world-leading care. The patient actually survived, whereas otherwise it was probably going to be a potentially fatal outcome. That is a very good news story.


Also recently a 17-year-old girl suffered a cardiac arrest at Southbank. Paramedics utilising their expert skills and equipment were able to revive the girl, and she has a very good prognosis as a result of that pre-hospital intervention. I think again this just demonstrates the clinical expertise and significant improvements of our paramedics as they continually increase their training skills and the technical and medical breakthroughs that are being undertaken.


Again, there was a 30-week gestation delivery for a mother who was having a breech birth. As a former midwife I can say that a breech birth is a very difficult birth, so when this poor mother had her baby's two feet being exposed, the Southbank paramedics that attended her were confronted with seeing two very cyanosed, or blue, legs on show. That is quite a critical situation and something that paramedics need to deal with. It is not easy and it is very difficult to do, but nevertheless they stayed with that woman. They handed her over to the mobile intensive care ambulance paramedics, who delivered the baby in very challenging circumstances, I have got to say; a breech birth is not an easy one, especially with the presentation of two feet. That is not normally the case, and again they were able to deliver the baby and get that baby to care where it recovered very well.


These are all good stories that our paramedics are doing on a daily basis. There are many more that we can highlight.


I know at times there are sad and tragic outcomes, but as someone who has worked in the health industry, I understand the challenges. I understand the difficulties of what is very often faced by ambulance officers who have to do retrieval on country roads, or in remote areas at times. They are faced with very challenging circumstances.


I think they all should be supported in whatever way they can be in relation to the ongoing professional work they undertake. I would like to place on record my support for them in relation to the work they undertake throughout the state to provide a service to all Victorians.


I have to say that the motion Mr Jennings moved in the house today does not indicate what is happening on the ground. Yes, there are tragic stories, as I have said, but this government has done much to improve our health services.


We have a growing and ageing population that is challenging for all Victorian health services, we have the additional challenge of a federal government that has ripped money out of a set budget halfway through the financial year, our health services have particular seasonal and other demands and there has been industrial action, which at the time also closed some beds, contributing to the waiting lists. These are all realities of the Victorian health service.


Overall, we have put more money into the health service. We have put $151 million into Ambulance Victoria and are looking to improve that service. I say again on behalf of the government that we will not be supporting Mr Jennings's motion in the areas he has highlighted.

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