The 2021-22 health budget includes many initiatives seeking to address the long-standing pressures and failures in our acute health services.

These pressures existed prior to the COVID-19 pandemic which has clearly exposed many of our vulnerabilities.

Before, and as to be expected, during COVID we have continued to see waiting lists that are unacceptable, even with the latest figures showing some improvement - 11,007 people actually still waiting for surgery including 1033 people in category 1 (urgent cases where patients should be treated within 30 days), it is clear we have a lot of work to do.

The most difficult challenge is getting enough qualified health professionals in the areas we need them to make a difference without a COVID-19 outbreak.

We also need a clear, implementable plan to respond to an outbreak if, and likely when, this occurs.

Other states are finding just how challenging this is and modelling suggests even with high vaccination rates, challenges remain.

Prime Minister Scott Morrison continues to push for the country to open, adding hospital systems "need to keep up" as "We cannot hold back" and "we have to come out of the cave."

We all want things to return to "normal", myself included.

However, Mr Morrison's push to "open up" at 70 to 80 per cent vaccination is worrying on so many levels. Many health experts have expressed concern.

The likely impact of such a decision on Tasmania's health system and residents, when based on modelling from credible sources, shows this is likely to overwhelm our health services, especially access to intensive care.

It is also well and good to have a high number of ventilators for patients with COVID but ventilators can't operate without skilled and qualified health professionals.

Not all nurses and doctors can care for patients on a ventilator.

Tasmania has an older population with a higher burden of chronic disease and we should be concerned with such an approach without much higher levels of vaccination.

Where does the prime minister propose the states get the necessary health professionals to meet demand?

We certainly can't expect a significant number of health professionals to suddenly appear, although for Tasmania there may be some wanting to leave other states including Victoria and NSW.

It is unreasonable to expect us to fix our problems at the expense of other vulnerable Australians or those in other countries struggling with the Delta variant of COVID-19.

... Tasmanians deserve to know what a reopening would mean, even at an 80 per cent vaccination rate, before the premier ... signs up to and adopts the so-called 'safe plan'.

If the prime minister sees this as just a matter for the states perhaps he won't mind if we manage our state's borders in ways we see fit.

What is the right vaccination rate?

We know childhood vaccination rates of 95 per cent have shown to keep childhood preventable illnesses at bay such that we rarely see cases of diseases like measles, diphtheria, tetanus, whooping cough or a range of others.

Clearly this level of vaccination provides an effective herd immunity.

We have been fortunate in Tasmania and the government has been responsive to financially supporting businesses impacted by COVID and mainland lockdowns.

This can't go on forever I agree. We need to have a community conversation.

There are many questions that will need answering.

Noting the significant demand our health services have been under pre- and during the pandemic, can our health services meet demand if we were to open up before we get to a percentage of Tasmanians vaccinated where effective herd immunity is achieved?

How many ventilators do we have and do we have medical and nursing staff resources available for bedside ICU care to meet projected demand?

Are we willing to accept that us, or our loved ones, may not be able to access an intensive care bed when needed for other serious health matters?

Are we willing to accept the deaths of some from COVID and some from other health conditions due to access issues?

Are we willing to accept that access to elective surgery may be again severely constrained and many will have to wait much longer?

Are we willing to accept that access to timely cancer treatment may not be able to be provided?

Are we willing to support the very stressed health care professionals make decisions about who should or shouldn't access intensive care when they are at full capacity?

We need to understand what the likely impact on our health services will be with just 80 per cent of eligible Tasmanians vaccinated, before that decision is made.

It is clear that high rates of vaccination are crucial to our economic and health recovery.

Tasmania is progressing well with the vaccine rollout, but Tasmanians deserve to know what a reopening would mean, even at an 80 per cent vaccination rate, before the premier, on our behalf, signs up to and adopts the so-called 'safe plan'.

The Examniner, Sunday 5 September 2021