Legislative Council Committee A, Tuesday 6 June 2023
CHAIR - We’ll go to Mike first on that.
Mr GAFFNEY - Thanks. Thank you, minister. It was good to see that 97 temporary jobs were made permanent and meet post COVID 19 demand. What has been the impact of those 97 permanent jobs on Ambulance Services, and is it sufficient, or is there still more Ambulance Service, more ambulance needed, personnel needed for FTEs.
CHAIR - Before you answer the question, I might just get youto introduce your staff around the table.
Mr ROCKLIFF - Yes. We have our Chief Executive of Ambulance Tasmania, Mr Jordan Emery at the table. We welcomed Jordan to the role of Chief Executive, that's a recent appointment, and I pay tribute to his predecessor, Joe Acker, of course, and welcome Jordan not only to the role, but also to the table.
The question of the 97 which were fixed-term contracts, if we can call it that, to paramedics, 97 hired through the COVID times have now been made permanent. The question around the demand, so the funding for the 97 positions is in this budget. It includes both paramedic and operational support roles with $56 million over four years allocated in the budget to fund these positions. So a significant investment.
Obviously AT has come in and is working closely with the Department of Health to permanently fill the positions. Ambulance Tasmania senior managers are currently meeting weekly to transition the paramedics from the positions from fixed-term to permanent employment and the transition of on-road paramedics and graduate paramedics who have recently attained their authority to practice as independent paramedic practitioners. The permanent has been progressed as a matter of priority. Of course, when it comes to future demand, as pertaining the question, we’ve released the ORH report yesterday. We’ve got a copy of that to table, if you’d like me to table that.
CHAIR - Yes, please.
Mr ROCKLIFF - We’ll now consult on that report with the Ambulance Tasmania workplace. Mr Emery would like to talk through those matters, please.
Ms LOVELL - Can I just clarify a question?
CHAIR - Yes.
Ms LOVELL - Just before we move onto that. You mentioned there were paramedics who were interns who had achieved their authority to practice? And were being made permanent? I think there were 33 of those paramedics. Have they all been made permanent?
Mr ROCKLIFF - What I mentioned - Jordan.
Mr EMERY - Through you, minister. Thanks, Ms Lovell, and thanks Mr Gaffney. In relation to those 33, that was a point in time in November when we provided that data. We have paramedics or graduates move in and out of the graduate program throughout the year as they meet key milestones and graduate from the program. All of those paramedics, or a number of those paramedics have received permanency. Some of those paramedics are on fixed-term contracts. A small number of those, I believe four of the 33, one left midway through the program, and two left at the completion of their graduate program - sorry, three left at the completion of the graduate program. The remaining 29 are going through a series of either - sorry, one has been permanently appointed and the remaining 28 are going through a process of permanent appointment at the moment.
Ms LOVELL - And so all of them will be made, or are being offered permanent -
Mr EMERY - Subject to their acceptance for the position, Ms Lovell. Yes, that's correct.
Ms LOVELL - Thank you.
Mr GAFFNEY - My questions there would also be, have you found that you’ve got enough of the ambulance, the extra staff statewide coverage, or are they focused mainly in the city areas, or is there an area in the state where you find that its very hard to attract permanent staff?
Mr EMERY - Thanks, Mr Gaffney. The 97 positions comprise of 33 on-road paramedic positions in the north and north west region. 12 intensive care paramedics in the north west region. Nine community paramedic positions, three in the north, south, and north west regions. Three in each region. 17 operation supervisors and operation support managers in the north, south and north west regions. Eight special operations, emergency operation centre positions. Seven clinical service positions. Six flight paramedic training positions and four organisational support positions.
Mr GAFFNEY - One of the things we heard through the Health Inquiry, the Rural Health Inquiry was that in some professions, it’s fairly pressured and it’s a high turnover of staff, and one of the things is not losing that experience out of the health service. So I’m just wondering, those paramedics that may not wish to continue in that role, what sort of training, or what sort of support do they get to try and channel into another area within the profession?
Mr ROCKLIFF - Mr Emery or Mr Webster might like to answer that.
Mr EMERY - Thanks. Through you, minister. Mr Gaffney, Ambulance Tasmania enjoys a relatively low attrition rate compared to other jurisdictions. In the report on government services, the national average was 4.1 per cent in 2021 22. Ambulance Tasmania was 3.1 per cent, the highest being Northern Territory at 18.7 per cent, and the lowest being Queensland at 2.1 per cent in terms of attrition rate.
Specifically to your question about whether there are development opportunities for paramedics, we have a range of specialisations within the workforce. Community paramedic is one, the intensive care paramedic program is one. Of course, there are opportunities to move into leadership of educator roles. There are opportunities within our emergency management and special operations. So there are a range of areas for paramedics to diversify their careers, and particularly take time away from frontline operations in paramedic roles.
Mr GAFFNEY - Thank you. It’s interesting you mentioned other states. Do we attract many people from other states to our service in Tasmania?
CHAIR - He’s one.
Mr GAFFNEY - Exhibit A.
Mr EMERY - Through you, minister. We do, Mr Gaffney. We enjoy a number of paramedics relocating from other jurisdictions. In fact, today I welcomed 23 new graduates to Ambulance Tasmania. Some of those are individuals who’ve come down from Queensland Ambulance Service, and others who are from other states. It is actually interesting how many Queenslanders relocate to Tasmania.
CHAIR - We’ll mark up their attrition rate.
Mr EMERY - We, on a regular basis, undertake recruitment of already qualified paramedics in other jurisdictions and regularly attract candidates from New South Wales, Queensland, South Australia, Victoria, et cetera.
Mr GAFFNEY -Well, I’ve got one more question and then I’ll open it up to - because I know there's others. What tangential support is given to voluntary first responder services and not-for-profits when they work in this space to help them assist with the demand? Because I’m aware of the first response unit at Port Sorell and the one in Longford. I was going to call them - the first response unit Port Sorell, call them the ‘frumps,’ but they wouldn’t have that back in 2006. But I thought it was quite good. What sort of support do you give those volunteer groups as they do a really important role within the service?
Mr EMERY - Through you, minister. Our volunteers are some of the most incredible people in this state, and just a few weeks back, the minister and I celebrated with some of our volunteers for National Volunteer Week. In particular, last year alone, they dedicated over 200 000 hours of service to the Tasmanian community, which is breath taking and exceptional from my perspective. We have recently rolled out a significant expansion and improvement to their training package, including ensuring that we have regular paramedic educators delivering training to volunteers on a monthly basis to support their continued professional development in their roles.
That’s from a clinical practice point of view, Mr Gaffney, but of course, on top of that, volunteers have available to them all of the wellbeing support that paramedics and other Ambulance Tasmania employees have to them through the wellbeing support unit that Ambulance Tasmania co shares with the Department of Police, Fire, and Emergency Management. That includes access to peer support officers, of which there are 26 across the state. It includes access to wellbeing support officers, and our critical incident stress management experts, and a range of psychologists that can be connected confidentially through the wellbeing unit to support their wellbeing.
Mr GAFFNEY - Okay, thank you. Thanks, Chair. I’ll leave it to other people.
Mr ROCKLIFF - I’ve got the Ambulance Tasmania final report ORH. So AT engaged ORH to conduct a 10 year review, and ORH themselves specialised in taking an evidence based approach to forecast future demand rates for emergency services, such as Ambulance Tasmania. Today, I can table the final report. The modelling in the report was based on achieving a potential target median emergency response time of 10 minutes in urban areas and 15 minutes in rural areas over the next 10 years.
Work will now occur to understand from a process improvement, resourcing, and infrastructure perspective what would be required for Ambulance Tasmania to reach this target by 2031 32, and this is a journey that will take, of course, our AT staff with us, and as such, the department will be consulting employees and volunteers on whether this target is appropriate and achievable given the details that are found in the report.
The report proposes three primary mechanisms to improve response performance through until 2031 32, including process improvements such as activation times, mobilisation times, time on scene, time at hospital, and number of calls means through secondary triage. Furthermore, the report proposes four potential new locations under the heading of location optimisation, including Legana, Cygnet, Sandy Bay, and Snug. The final proposed recommendation is to further enhance frontline resourcing including through options such as expanded community paramedic positions and increased resourcing in identified geographic locations to respond to increasing demand over the next decade. I’ll table the report now.
CHAIR - I was just looking at the recommendation in that, which you won’t have time to look at the minute. You said for the suggestions that’d be 10 minute response time in urban areas or 15 in rural. Our rural response times are better than that already, so I do wonder whether we shouldn’t be keeping the bar a bit higher. Anyway, I’m sure that’s something that will be looked at as you go through that report. According to your only report on performance information, that is. I would hope that we wouldn’t actually suggest that we can extend it. We’re actually meeting times of 11, 11.1, 10.8 in Burnie. Devonport, 11, 10.8, 10.5 over the last few years. I think putting it at 15 minutes is probably not what the community want to hear, I’m just saying.
Mr ROCKLIFF - Yes. Anything further to that?
Mr EMERY - Yes, through you, minister.
Mr ROCKLIFF - Thank you.
Mr EMERY - Ms Forrest, thanks. We operated off a baseline in which we described six different areas, three urban, of which Burnie, Devonport would be incorporated into the urban areas of the north west. The current urban median emergency response time for those three regions are 10 minutes 30 seconds in the north west, 11 minutes 22 seconds in northern region, and 14 minutes 22 seconds in southern region.
CHAIR - It’s a dual carriage highway between Burnie and Devonport.
Mr EMERY - In the rural areas, north west, 16 minutes 25. Northern is 18.38, and southern is 22.25. If I could just say that the report is very much future focused about how response performance is maintained over the next 10 years, and that’s what we’re working towards in terms of a target, should that be accepted.
CHAIR - Is it possible, then, to get response times by region or station even, down to that level of detail to better understand some of the response times in our more rural areas?
Mr EMERY - Yes. Through you, minister. We certainly can, Ms Forrest. That information is available to us. I can provide some of the median emergency response time for the major urban areas at the moment. But of course, we can further -
CHAIR - You could provide it all in the table.
Mr EMERY - Sure.
CHAIR - We’ll put that on notice, probably just putting it unlikely to have it before we finish today. We’ll do that.
Mr ROCKLIFF - Thank you. Mr Webster has an answer to the 24 hour mental health ED presentation question.
CHAIR - One from Sarah?
Ms MORGAN-WICKS - I’m just confirming some numbers in that.
CHAIR - Okay. We’ll just hold for you on that one, then.
Ms MORGAN-WICKS - Sure.
CHAIR - We’ll come back to it.
Ms MORGAN-WICKS - I will wait with bated breath.
CHAIR - Rather than having to correct it if it’s not quite right.
Ms MORGAN-WICKS - Yes.
CHAIR - I assume that the ORH report looks at which stations may need to go from volunteer only stations to paramedic stations with single branch stations to double branch stations. Is that -
Mr ROCKLIFF - And new stations.
CHAIR - Yes, and new stations. I think you listed the new stations, but those that are going from volunteer to staff now, and staff ones to single branch to double branch. Have we got any indication of where that might be?
Mr EMERY - Through you, minister. Yes, Ms Forrest. The report does provide recommendations under the heading of resourcing enhancements that the minister touched on. We obviously want to consult further with the Health and Community Services Union and indeed, Ambulance Tasmania’s workforce to understand what exactly that might look like. The report also talks about possible options in terms of community paramedics as an alternative in some locations, and so whether we accept that in the entirety or choose to increase partly the number of community paramedics and then - I don’t like to call them ordinary paramedics, but ordinary paramedics as well might be part of the decision making that comes out of the consultation and 10 year master planning process.
CHAIR - How many community paramedics do we currently have in the state?
Mr EMERY - We operate nine. Three in each region.
CHAIR - All right. I’m sorry, you said that. Yes. This may be in the information we saw earlier about vacancies. Do we know how many current vacancies there are for all categories of the paramedic community, ICU, regular paramedic or whatever we call those people, in each region?
Mr ROCKLIFF - Vacancies?
CHAIR - Vacancies, yes. Unfilled vacancies at the moment. While we’re looking for that, I might just ask how many permanent paramedics are currently employed and based at the Smithton station. There’s two, so one on, one off, effectively.
Mr ROCKLIFF - Agree.
CHAIR - Yes. So you’d be aware, minister, from my adjournment contributions, that it seems we were having major problems in Circular Head, and on repeated occasions there are four and five hour waits. Some family members are choosing to drive their loved ones through to Burnie, at risk to themselves. Being a stressed parent with a sick child in the back of the car is not ideal, particularly at night with the wildlife and all. So I’m just interested. If there’s two paramedics down there, why are we experiencing such a challenge?
Mr ROCKLIFF - Well, of course, I’ll just go over to Jordan in just a moment, but while - all callouts are triaged, and available resources allocated based on clinical urgency and in line with clinical governance rules. Of course we do our absolute best to support people in the community. We empathise of course with any patients who experience delays. Quite clearly there are clear policies and guidelines outlining the types of duties and responsibilities that can be undertaken by volunteers based on their level of training and experience and with patient safety as the absolute priority.
Our level one volunteer ambulance officers must be accompanied by a paramedic or a higher-level PAO except in approved specific circumstances and this is a matter of patient safety. Smithton Ambulance Station is staffed by paramedics 24 hours-a-day and is currently supported by a number of level one volunteers only and of course as we’ve discussed already the asset that our volunteers are of course, and our volunteers are encouraged to develop their skills and progress to a higher level with training and education opportunities of course for those that are willing. But in terms of the challenges in Smithton more recently, Mr Emery can you speak to that please?
Mr EMERY - Thank you Minister and through you, Ms Forrest we do have some challenges around Smithton in the sense that on occasion we will have an ambulance attending to another emergency with that paramedic and a volunteer and a concurrent emergency incident will come through at the same time. The number of incidents in Smithton is relatively low. In May we only had 17 despatches for the full month so it’s about, you know, one incident every two days and -
CHAIR - Must have been a bit of a flurry in the last little point there, because there’s been several in this week.
Mr EMERY - Sometimes as I said that ambulance will be on its way to North West Regional. The specific challenge that the minister spoke to is correct in the sense that we focussed our recruitment efforts for volunteers in Smithton. We have nine volunteers at Smithton. They are level one volunteers and we don’t ordinarily despatch level one volunteers because they are wonderful people but inexperienced and as a matter of patient safety we wouldn’t routinely respond them by themselves or with another level one to those incidents.
CHAIR - So what level were the volunteers on King Island?
Mr EMERY - Through you, minister, we have a mix of volunteers on King Island. So we have volunteers that are level 3 and 4 that are more experienced. We have 11 volunteers on King Island. I can get the exact breakdown of their skillset but we would ensure that one of the more experienced volunteers is rostered if there is a junior volunteer rostered as well.
CHAIR - On King Island.
Mr EMERY - Correct.
CHAIR - Yes, sure. Circular Head as the minister would know has a very high volunteering ethos. I’m sure their volunteers would be willing to undertake training to raise them up the scale. Is that an option here for trying to fill these gaps? At least they can then - the volunteers who aren’t paramedics, but they can actually be better trained to assess urgency - whereas if you’re lying on the - the person on the end of the phone who gets a call from a relative who’s clearly distressed because relatives are.
I had to call an ambulance for my husband I was quite distressed but at least I was logical enough to tell them what was going on, what his blood pressure was because I’d done all that as well, but you know, but not everyone’s got the background to know what to do and what information to give so people panic. So having a volunteer who is skilled attending that scene in the first instance may be able to better assist the despatch. Is that a consideration for Circular Head?
Mr EMERY - Yes, through you, minister, Ms Forrest it’s absolutely in our interests to work with these volunteers to upskill them and we do that with all our volunteers. Part of that upskilling process involves a number of hours and exposure to incidents so that they can build that confidence. We will work with our volunteers to upskill to those higher levels so that they can be responded with a more junior volunteer. We’re not just quite at that point with Smithton given the number of new volunteers that have come onboard. But that’ll be an active process underway.
CHAIR - So if there was volunteers there willing to do it you would deliver that training?
Mr EMERY - Correct, yes.
CHAIR - And not just Smithton. Obviously in other parts of the state too?
Mr EMERY - That’s correct. Yes.
CHAIR - All right I’ll pass that through to them because I think that’s what they’re very keen to do. Did you get the vacancy rates information?
UNIDENTIFIED SPEAKER - This is the ED wait time?
CHAIR - No, the vacancy rates for ambulance. How many unfilled positions are there around the state? I know you’ve just recruited a whole heap so maybe there’s no many.
Mr EMERY - Through you, minister, we have 15 frontline paramedic positions vacant in the north west at the moment. We have exhausted an existing merit list and we will explore a process for direct appointment subject to the approval of the head of agency and that’s pursuant to clause 14(2B) in employment direction one, so we need to go through that approvals process. We’ve contacted all of our graduates who have completed the program and who would be eligible for direct appointment under that clause. Ambulance Tasmania’s compiling that information for approval of the secretary, and we anticipate that will happen in a couple of weeks.
CHAIR - Are they the only positions that are vacant? The ones in the north west?
Mr EMERY - We have some - as we work to fill these 97 COVID positions obviously we will move people from fixed-term positions into permanent positions. That work will unfold as we go and there may be some additional vacancies if a paramedic was to move into an operations supervisor position but then again we will seek to direct appoint individuals who complete their training program.
CHAIR - Okay. Did you want to give us another response Minister?
Mr ROCKLIFF - Yes. Just around Ms Lovell’s question regarding mental health ED waits are now categorising emergency department presentations involving mental health community challenging as patients often present with physical conditions also requiring treatment prior to the mental health treatment as we all appreciate. Now, the mental health emergency department waits greater than 24 hours, there’s a total of 709 for the year to date.
Ms LOVELL - Thank you. Can I just ask a clarifying question on that in relation to how they’re categorised. If there is a patient presenting needing medical treatment as well as mental health treatment how are -
Mr ROCKLIFF - Physical condition?
CHAIR - Physical health treatment?
Ms LOVELL - Yes, how are those - are they categorised as a mental patient or are they categorised as a medical?
Mr WEBSTER - Through you, minister, so they were initially categorised in their medical category so as a physical injury and that is dealt with and then the classification is changed to mental health.
Ms LOVELL - Okay. Yes.
Mr WEBSTER - Which does mean that there are quite often occasions where it’s a number of hours before they’re re classified to mental health and that leads to that so.
Ms LOVELL - Understand, thank you.
CHAIR - Not my media release.
Mr GAFFNEY - Through you, minister just one more question regarding the ambulance. How does Ambulance Tasmania work with the education department or different organisations to get the actual career pathways and prospectus out there and in the community so younger people are actually thinking about that as a career option. I’d be interested to know what proactive stuff the ambulance does to engage younger people or even older people that may want to retrain into that. So, yes.
Mr ROCKLIFF - Thank you. Good question. Jordan?
Mr EMERY - Thank you, Mr Gaffney. Through you, minister, paramedic positions are very heavily subscribed both in Tasmania and indeed across the country there are over 1000 young people going through university programs at the moment to become paramedics and in our most recent recruitment campaign for the graduates that started just yesterday afternoon, Mr Gaffney, we had over 120 applicants. So we do get a lot of interest.
We have a joint campaign that we run year round alongside Volunteering Tasmania and other emergency service organisations including surf life saving as well to recruit new volunteers because we know young people are passionate, engaged community members who want to be a part of volunteering with Ambulance Tasmania, and we are increasingly seeing young people volunteer with Ambulance Tasmania as part of extracurricular activities associated with their university study to become paramedics.
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