The community are often the forgotten stakeholders in the debate around health service delivery. To achieve meaningful change the community across Tasmania needs to have a real understanding of why health service delivery has changed and why it is vital that it continues to change.

Tasmanians deserve to have access to quality, safe, timely and effective health care. Broad community support is essential to the success of health service delivery and health care reform. If clear explanations are not forthcoming, gaining community acceptance and understanding of how health service delivery is going to change/reform, it may not be accepted. Even the best policy can fail if broad community understanding and support are lacking. 

Health service delivery has and will continue to change. Advances in knowledge, expertise, technologies and techniques result in constant research/evidence based change.New investigative technologies and more effective treatments have been developed. Generally these have less adverse side effects which is generally a cost saving, however these investigative services and treatments are often quite expensive. 

We also have a greater understanding of illness prevention and health promotion. For example, many years ago patients were in hospital for weeks following a cholecystectomy (gall bladder removal), that resulted in a large wound in the abdomen and many weeks of recovery. Now this procedure can often be undertaken as a day procedure, with very small incisions, a rapid recovery period and significantly lower risk of complications, particularly those related to longer periods of immobility and hospitalisation, including infection, blood clots (DVT) and pneumonia. 

With these medical advances community expectations increase. We expect access to more expensive diagnostic tests and treatments. With improved techniques and treatments, recovery rates and times improve. As outcomes improve, overall life expectancy increases. However as life expectancy increases so does the incidence of many chronic diseases, Therefore the need to prevent the onset of these conditions becomes more important, as does the management of the increased burden of chronic illness. The sting in the tail of improved health care (surgery in particular) is this reality and the more the demand grows. 

Compared to other States, Tasmania has a more rapidly aging demographic, with high levels of poverty and disadvantage and thus a higher chronic disease burden. Tasmania also has poor health literacy rates (the ability to obtain, read, understand and apply health care information that enables the person to make appropriate health decisions and follow instructions for treatment) and a very dispersed population. These are challenges not insurmountable problems. 

Consideration of health care should not be confined to hospitals or any building. Focussing on the location of the bricks and mortar drags us into the past. Tasmania actually does have some advantages in the delivery of health care that we should capitalise on. 

Relatively short distance, or time to care, in many areas is an advantage. It may take one to two hours travel time to access the nearest appropriate health care and much of this travel is on relatively good roads with low traffic volumes. We often forget that many residents of large cities such as Melbourne take the same time to get to equivalent health care facilities and they have all the additional stress of heavy traffic. I prefer the Tassie conditions. This 'advantage' can be a real disadvantage for individuals in regional areas who don't have access to reliable transport they can afford or weather conditions that prevent travel by road. In these cases, access in terms of transport and accommodation support should be provided. 

In circumstances requiring urgent medical care, air transport can and should be arranged. This may require additional government investment that could prove cost effective overall. 

Tasmania also has the advantage of increasing access to high speed broadband (if only we can get NBN to all parts of the State as promised). It seems incongruous that we can accept and expect new technologies to investigate and treat a vast range of medical conditions but there seems to be a reluctance to embrace similar technologies to consult on and manage many of these conditions that do not require a physical face-to-face interaction. Home monitoring of a patient's blood pressure with online interaction and consultation with a health care professional can provide a much more accurate, and possibly safer assessment, than a blood pressure check after an hour's drive and frustrating wait in close quarters in the doctor's waiting room with a range of contagious illnesses. 

The nature of each individual’s health care need is relevant in determining whether bricks and mortar and their location is important. If the required service is a surgical remedy that is expected to be a one off procedure, followed by a period of recuperation and recovery, this service does not need to be provided in every part of the State. For example, if a person requiring a hip replacement can access this surgery and avoid the complications that occur with long waiting times, they are likely to be able to return to an active life with minimal related ongoing health care demands. If these individuals need to travel even 2-3 hours to access this surgery and support is provided to them and their primary carer at that time to achieve this, better outcomes will result. We would also have a more efficient service with many more people ultimately accessing the required treatment. 

However in the case of health conditions where there is not a one off surgical or medical treatment or remedy that would reduce or remove their need for regular medical attention, a different approach is needed. Conditions such as chronic pain, for which there is no surgical remedy, asthma and some other chronic conditions, the patient needs access to appropriate health care closer to home. Some individuals with chronic illness need access to quality care and advice without the need to travel long distances. 

Despite Tasmania's geographically dispersed population, we would benefit from 'Centres of Excellence' located in different parts of the State. This must be supported through equity of access measures for those who need to travel. 

Many Tasmanians are accustomed to travelling to access health services. Under a reformed health service delivery model, we may well require people from all areas of the State, even those in the major population centres to travel to access services and thus supporting equity of access must be integral to such reform. 

Centres of Excellence that focus on the delivery of a defined range of services are also less likely, if not entirely unlikely, to have the service delivery interrupted by emergency cases. This would significantly reduce the number of deferred or cancelled surgery lists. The only reason cases would be postponed on the scheduled day of surgery would be if the patient was not fit for surgery or the surgeon was unexpectedly unavailable and unable to be replaced. 

For Tasmanians in pain and suffering a range of health challenges, especially those that will benefit from a surgical remedy, timely access to treatment will result in the best possible health outcome, with the additional benefit of the most cost effective use of limited health funding. Let us all engage in a mature, factual and open discussion of the future of Tasmania's health services.   

  Ruth Forrest MLC  Independent Member for Murchison    

Note: this article appeared in the Mercury Newspaper on 9 March 2015 titled 'Talking Point: Health goes under the scalpel'