Legislative Council Thursday 4 June, 2020

Ms FORREST question to LEADER of the GOVERNMENT in the LEGISLATIVE COUNCIL, Mrs HISCUTT -

With regard to specialist outpatient, medical services and clinics -

(1) What is the time frame for reopening outpatient specialist clinics for -

(a) each speciality

(b) each outpatient clinic at each hospital - the Royal Hobart Hospital, Launceston General Hospital, North West Regional Hospital and Mersey Community Hospital?

(2) Is telehealth being offered as an option for some specialty clinics?

(3) If so, for what specialties and in which hospital are outpatient clinics?

ANSWER

Mr President, I thank the member for Murchison for her 10 questions.

(1) (a) The known time frames for reopening specialist clinics are -

- Hospital South - staged process commenced from early May to ensure ongoing patient and staff safety in accordance with public health directives. Ongoing social distancing will directly impact the volume of patients that can be seen face to face at any one time.
- All clinic services continue for category 1, urgent and review patients and the utilisation of telephone and telehealth review continues for appropriate patients. Broadening service to allow for bookings of new category 2 and category 3 patients will be at the direction of the Royal Hobart Hospital executive.

- Paediatric services have continued following a clinical redesign with a greater utilisation of telehealth facilities. Maternity services have continued in the south, having undergone clinical redesign to ensure social distancing can be met via phone and more limited face to face physical assessment -

Ms Forrest - Cannot stop babies from being born.

Mrs HISCUTT - To continue -

- A statewide public website and information sheets have been developed to ensure that women have access to information and support.

- Category 1, gynaecology services have continued with a reduction in category 2 and 3 services being reviewed with a staged reintroduction. Surgical termination of pregnancy services has been maintained by the Women's Health Clinic South, for southern, northern and north-west women in hospitals in the north and north west.

- The Specialist Clinic at the Launceston General Hospital continues to function at a reduced capacity. The Specialist Clinic was required to physically move from its normal space and this reduced its capacity from 20 spaces to 11. Where possible, the consultants undertook telephone consultations and only critical face-to-face consults occurred.

- A small number of medical clinics were required to completely stop and this was due in part to the cohort of consultants to be seen at high risk. The surgical outpatient's ENT clinics stopped for a period as this was deemed to be of too high a risk to continue. This has now recommenced in a limited capacity.

- The MCH clinics accommodated the COVID-19 respiratory clinic in one of the consulting suites and specialist clinic staff facilitated staffing and management of the expanded COVID-19 respiratory clinics.

- Fracture clinics have continued. The additional clinics are returning with availability of specialist staff. Telehealth and phone clinics have been offered where appropriate.

(b) The known time frames for reopening each outpatient clinic at each hospital are below -

- The Royal Hobart Hospital outpatient clinic is currently seeing category 1 emergency and review patients. Staged recommencement of Category 2 and Category 3 patients will occur over six weeks due to patient volumes.

- The urology outpatient clinic is currently seeing Category 1, urgent and review patients, including BCG therapy patients.

- The neurosurgery outpatient clinic statewide service will see a staged phase back to face-to-face reviews over four to six weeks to manage patient volumes.

- The vascular outpatient clinic statewide service will recommence bookings for Category 2 and Category 3 patients over two to four weeks.

- General surgery colorectal outpatient clinics will see staged recommencement of Category 2 and Category 3 patients over six weeks due to patient volumes.

- The wound outpatient clinic will see staged recommencement of services from two to six weeks to allow for a review and bookings of Category 2 patients.

As I go through this, honourable member, I will cover the outpatient clinics first and then the update -

- Respiratory clinic numbers are to increase from 1 June 2020 and will commence bookings for category 2 and 3 patients from 1 June 2020 onward.

- Neurology will recommence some face-to-face reviews from the end of May for category 2 and 3 patients and will review clinic numbers to ensure safe social distancing in waiting rooms.

- Endocrinology will see a staged increased over four to six weeks for recommencement of category 2 and 3 patient bookings.

- General medicine will see a staged increase over four to six weeks for recommencement of category 2 and 3 patient bookings.

- Infectious disease -

Ms Forrest - Is this from the today or the date it was written? It simply says two to four weeks, so was it from a week ago?

Mrs HISCUTT - It was sent through last week.

Ms Forrest - We are probably a week into it. A lot of people are waiting for these clinics.

Mrs HISCUTT - I think I was up to infectious diseases, which will see a staged increased over four to six weeks for recommencement for category 2 and 3 patient bookings.

- The refugee and humanitarian arrivals clinic, the RAHAC, will see a staged increase over eight weeks to manage large family groups and interpreters.

- Gastroendocrinology - staged increase over five to eight weeks for recommencement for category 2 and 3 patient bookings.

- Renal - staged increase over eight to 10 weeks reverting from telephone model back to face-to-face consultation. Large clinic patient numbers and multidisciplinary clinics will increase waiting times. Telehealth utilisation will continue where appropriate.

- Rheumatology - staged increase over four to six weeks reverting back to the face-to-face model. Ongoing telehealth utilisation will continue where appropriate.

- Inflammatory spinal/SAC - staged increase over four to six weeks reverting back to the face-to-face model. Ongoing telehealth utilisation will continue where appropriate.

- Ear, nose and throat - due to increased risk of aerosol-producing procedures, these will see a staged increase over one to two months to increase face-to-face reviews. PPE use is required for scopes and aerosol-producing procedures.

- OMFU - due to increased risk of aerosol-producing procedures, will see a staged increase over one or two months to increase face-to-face reviews. PPE use is required for scopes and aerosol-producing procedures.

- Ophthalmology - slow increase in face-to-face reviews over two months to manage large patient volumes and longer wait times for multiple specialist reviews at same appointment.

- Orthopaedics - continue Category 1 reviews and emergency appointments with staged recommencement of Category 2 and Category 3 patients over eight weeks.

- Cancer services - outpatient clinic services unchanged. Some telehealth will continue for less urgent follow ups.

- Aged care - staged increase over four to six weeks reverting back to face-to-face model. Ongoing telehealth utilisation will continue where appropriate.
- Rehabilitation - staged increase over four to six weeks reverting back to face-to-face model. Ongoing telehealth utilisation will continue where appropriate.

With regard to the Launceston General Hospital, all outpatient clinics have continued. The need for social distancing will affect the capacity of waiting areas. With regard to the clinics -

- ENT clinic - recommended in a limited capacity due to increased risks. The high-risk consultants recommended operation of the outpatient clinic in a staged fashion.

- Orthopaedics - have continued to provide services utilising telehealth and critical face-to-face consultation. Capacity to increase as surgery continues to increase.

- Women and children's services - outpatient clinics will continue to function, utilising telehealth and critical face-to-face consultation. There was a prioritisation of Category 2 and 3 paediatric and gynaecological outpatients and, currently, women and children's services is finalising the reopening of all services.

- Specialist clinics - completion of the women and children's services capital works program will continue to restrict some clinics due to noise and space considerations.

With regard to the North West Regional Hospital and the Mersey Community Hospital, both the NWRH and the MCH are running modified clinics from 11 to 29 May 2020. Full services will begin commencement in June 2020.

Telehealth is offered as an option for the following specialist clinics -

- in the south, there is rheumatology, the inflammatory spinal/spinal assessment clinic, renal, vascular, neurology and respiratory clinics. Clinics are being added as appropriate and in consultation with Telehealth Tasmania.
- for hospitals in the north and north-west, telehealth has been offered in all clinics at the LGH, the NWRH and the MCH.

2. (b) Telehealth is offered in the following hospital outpatient clinics -

- telehealth has been available in all clinics at all hospitals based on the clinical need of the patient. Face-to-face appointments are offered when clinically indicated by the treating doctor. The use of telehealth has been very positive in pre-screening new patients before the face-to-face visit. In some instances it has meant the patient does not need to attend and reduces the total number of visits, assisting with social distancing in busy clinics.

 

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