Legislative Council, Tuesday 30 May 2023

Ms FORREST (Murchison) - Mr President, how much longer will the Government be able to say with a straight face that it is making Tasmania strong, safe and secure?

Let me say at the outset that I fully concur with the Treasurer that this state is an incredible place to be. However, I do not see this Budget as a basis for building a stronger future. For anyone willing to delve a little deeper into the Budget Papers, the Government's position is anything but strong. It is increasingly apparent the emperor has no clothes.

May I make another point at the outset on a more positive note. For years the budget papers were looking a bit tired, the same old format year after year; different figures for sure, but lacking accessibility for most readers, making it difficult for a reader to judge whether the Government was doing its job properly or whether it had set itself some soft targets and ended up ticking most of those boxes - surprise, surprise.

We know from repeated fiscal sustainability reports that there were some big problems ahead but after 15 minutes in the spotlight every five years, the problems were largely forgotten. Everyone heaved a sigh of relief because no-one had a clue what to do and preferred not to talk about it. So, they went back to the budget each year and ticked a few more boxes and life went on. There was always a bit of adversarial argy-bargy but little meaningful discussion of what the budget actually meant. What meaningful targets need to be established, given the problems laid bare in the fiscal sustainability reports of the past? More importantly, how will we achieve those targets?

Treasury has done us a favour this year by completely revamping this section of the Budget Papers describing our current position and rewriting the out-of-date fiscal strategies and action plans with a longer term focus. This is a question I put to the Treasurer last year, were they still fit for purpose. Obviously, they are not - and they were not - so I commend Treasury for taking that new approach. Members may recall my past comments about the relevance of these past so-called fiscal strategies so I for one am particularly pleased to see a more open and clear outline of our challenges.

I understand this may be the secretary, Mr Ferrall's, swansong budget. It has given us a much better basis on which to assess budgets. I presume the revamp and rewrite of strategies and plans had been instigated by Treasury and not the Treasurer himself. I am assuming that because the Budget that the Treasurer handed down takes virtually no notice of the strategies and plans that have been devised and how this Budget is a step on a way to achieving those plans and those targets. I will come back to that later.

First, I want to focus on what was wrong with the old fiscal strategies. The prior fiscal strategies were just a few motherhood statements thrown together. Why bother at all, you ask, when it did not help.

The Charter of Budget Responsibility Act section 4 says you have to. Section 4 says the purpose of a fiscal strategy statement is to:

(a) establish a benchmark for evaluating the Government's fiscal performance; and

(b) increase public awareness of the fiscal policies of the Government and opposition parties. [TBC]

It was failing to achieve the purpose. The benchmarks to evaluate the Government were inadequate and largely ignored, and the increased public awareness of the Government and Opposition fiscal policy was nowhere to be seen.

The current public discussion of fiscal strategies is an embarrassment, a cocktail of greed, self interest and ignorance. Any understanding of the problems facing us is conspicuously and sadly absent.

On the matter of fiscal strategies not being fit for purpose - I am still talking about the previous ones - take the old Fiscal Strategy No. 1, which stipulated:

Annual growth in general government operating expenses was to be lower than the long term average growth in revenue. [TBC]

So, we need to raise more than we spend over the longer term. What this meant in practice was that if we started heading downhill, the strategy based on past performance would ensure that we continued to head downhill. It assumed revenue was a given and we just managed the cards that were dealt to us. However, government fiscal policy should not be a passive affair. There should be targets and actively managed policies to achieve those targets. Hence, Strategy No. 1 was a dumb and entirely unhelpful strategy.

What then are the new strategies and targets? The main ones are, and I will mention four specifically: to keep debt within certain limits; gross debt per capita; net debt relative to the size of our economy; and debt service costs as a percentage of revenue to achieve a break even fiscal balance. What that means is that the receipts each year have to cover operating expenses and new infrastructure and plant. Operating expenses include interest on borrowings and an estimate of the interest accruing on the unfunded superannuation liability.

Another is to raise more of our own-source revenue; and another, to ensure we invest more in new infrastructure and plant than the amount of wear and tear on existing infrastructure and plant. That last one about infrastructure is a part of an existing strategy.

Mr President, prudence surely suggests it is eminently sensible to ensure the value of our infrastructure does not go backwards.

I will make a few short comments on the first three strategies I have mentioned, starting with the first strategy about debt. The old strategy 2 was to keep debt servicing costs, which included unfunded superannuation liability, below 6 per cent of cash receipts. This is retained as strategy 4. Whilst we may achieve that target next year, over the forward Estimates the Budget papers show debt servicing costs as a percentage of revenue steadily increasing beyond the 6 per cent target. Worse still, there is not one hint about how the Government proposes to arrest the movement that is taking us further and further away from the target. We have a target, but we are heading in the wrong direction. There is no indication as to how we are going to get there.

Mr President, am I being unduly sceptical? What is the point of having targets if you blithely ignore them and offer no policies to help meet the target? As part of the debt strategy, strategy 4 introduces a target for gross debt per capita - which is fine; but why choose gross debt? Why not use net debt, the figure that appears at the bottom of every balance sheet in government accounts? Why only debt? There are other liabilities that need to be serviced - unfunded superannuation, for instance. So, why not use net financial liabilities, which also appear in government accounts in the line immediately below the net debt figure? And why only the general Government sector?

The Tasmanian Government has a significant number of businesses outside the general government sector. Not only the older, established ones we all know - Hydro, TasNetworks, Aurora, TasPorts, TT-Line, Tas Irrigation and so on - but also the Macquarie Point Development Corporation and all the new kids on the block, like Stadiums Tasmania and Homes Tasmania.

We should not forget the broader government sector. It is all part of the Government. The Treasurer has chosen debt rather than overall financial liabilities, and selected the general government sector rather than the overall government sector in order to support this narrative that things are not as they might appear to some.

Nowhere was this more obvious than when the Treasurer defended the level of debt in his Budget the day after the Budget was handed down, saying, as the Leader also said, 'Our net debt is quite low'.

At one of his follow up Budget events, the Treasurer was reported as saying:

Our borrowings are very, very small in comparison to other jurisdictions per capita. Just have a look across the waters at Victoria, what they are doing. I wouldn't want to be in their shoes. [TBC]

If we are going to make a comparison to argue we would not want to be like them, then we should use the same measures. Tasmania has a much higher level of unfunded superannuation liabilities than Victoria. If one is to compare states, then the measure should be based on overall net financial liabilities, which includes all liabilities that have to be paid, like unfunded superannuation and employee entitlements, not just debt.

To be clear, in 2023 24, estimated net financial liabilities for Tasmania and Victoria on a per capita basis are similar, with Victoria at $32 000 just shading Tasmania at $31 000 per capita debt - comparing apples with apples. Our liabilities are growing faster than Victoria's and, in four years time, will be the same as Victoria's per capita net debt. I consider that the Treasurer was trying to hide the truth from us and urged us to 'look over there' in a distraction that is clearly misleading.

We are in the same shoes as Victoria, if you want to compare us with Victoria. It is nonsense to pretend otherwise. If you want to make comparisons, compare apples with apples and not apples with oranges.

In reality, our position is probably worse than Victoria's, because we rely much more on the federal government to help service our liabilities. That is also laid out in all its glory in the budget papers for everyone to see.

Nevertheless, I welcome establishing a strategy about debt because it helps increase the understanding of our fiscal position. I thank Treasury for the work on that. It will help people understand that debt is not the only liability which needs to be discharged, as well as the fact that the general government sector is also part of the much broader government sector, the total state sector (TSS). That is all in the back of budget paper 1. Balance sheets are there for the general government sector, the public non-financial corporations (PNFCs) and the TSS.

It is also pleasing to see the introduction of a measure of debt to the size of the economy measured by gross state product, included with the fiscal strategies. Again, my question is, why only net debt? Why not include other financial liabilities? They have to be paid, too. They do not just disappear. To be fair, in chapter 7, the budget papers give some interstate comparisons of net debt as a percentage of the size of each state or territory, and also acknowledge the importance of including unfunded superannuation liabilities when making interstate comparisons. It also proceeds to include another graph showing net debt and unfunded superannuation relative to the size of the respective economies.

The latter graph does reveal that we have the second-highest liabilities relative to our size compared to the other states - not the territories, which it is not appropriate to compare there - and we rank second behind Victoria. That is all in there, chosen not to be reflected upon by the Treasurer. There are lots of reasons why we should not be using the two territories as yardsticks. We have the second-highest debt and unfunded superannuation liabilities of all states.

Mr President, what then was the Treasurer bragging about at the breakfast presentation last Friday? I reiterate, why only measure the general government sector, especially when we keep shuffling government activities into entities outside the general government sector? For example, one could hardly argue the work of Homes Tasmania is not a state government responsibility, and that is now off the general government balance sheet.

If we include the broader state sector, we are pretty close to Victoria, as I already pointed out; and the gap is narrowing over each year of the forward Estimates.

There are no grounds for complacency or saying that things are all tickety-boo. There are certainly no grounds to claim that we are in a much safer position than Victoria; we are not, and the figures confirm it.

I can move on now to the strategic actions covering sustainability of revenue and expenses. May I speak on behalf of everyone, I hope, and say that no-one cares if the Government makes a profit or loss. No-one cares whether there is a net operating surplus or deficit. What people care about is ensuring that the Government can pay its way, deliver services and be sustainable over the longer term.

The preoccupation with achieving a net operating surplus has been misguided. I know you get sick of me repeating myself, year on year. Trying to achieve an operating surplus - note the word 'operating' - can be misleading. One could achieve a net operating surplus but still be bleeding cash when all the other infrastructure outlays, equity contributions into government businesses and payment of unfunded superannuation are considered.

Achieving a net operating surplus was never a fiscal strategy. Yet, it is something every treasurer emphasises, every Opposition leader mentions, and every commentator zeroes in on when pontificating about a budget outcome. Discussion has dumbed down the debate and has helped suppress any understanding of our true fiscal position.

The new fiscal strategies have added to the fiscal balance as a meaningful measure of a budget outcome. It has already appeared in budget papers and annual financial statements but has been largely ignored. We need to understand what it means and use it when discussing budget sustainability. The fiscal balance measures now appear as Fiscal Strategy No 5. It refers to both the general government sector and the broader total state sector. The target is, in 10 years time, to have a rolling average break-even fiscal balance over four years. It is quite a mouthful, but that is what the target is - all there in that fiscal strategy chapter. What it means is that in six years time, we have to start producing break-even fiscal balances. A break-even fiscal balance means that there will be enough revenue to pay operating costs, to cover infrastructure outlays, to pay interest on debt and by including a notional amount of interest on unfunded superannuation, pay a bit toward paying the unfunded superannuation, but not all of it.

There will not be enough to pay extra contributions into government businesses needing an equity top-up or to pay any debt principal; but at least we will be holding our own a little more than what was promised over the next four years in this Budget. At this stage, the rolling four-year average of fiscal balances is bad, but not too bad. On page 53, Budget Paper 1, the general balance is a negative $514 million. The total state sector is negative $1 billion. By the end of the forward Estimates, the rolling four-year average fiscal balance will be a negative $590 million for the general government and a negative $1.67 billion for the total state sector. The general government sector shows some improvement over the forward Estimates, but most of that comes about due to the $300 million efficiency dividend.

Those amounts pencilled in the latter years of the forward Estimates are designed to make the sham net operating balance figure move into surplus. Members who have been here for a while would remember efficiency dividends previously. They were brought in by this Government, prior to the COVID-19 pandemic and then rightly dispensed with, but we know how it goes. How will we ever start averaging break-even fiscal balances starting two years later, particularly as this is when we are going to be hit with - this is what is coming down the line - the loss of a 'no worse off' guarantee worth $75 million per year, according to the budget papers. In addition to that, the clawback of the $305 million federal grants for the Macquarie Point and new Tasmanian stadium that came with the label in the federal budget papers as 'place-based co-investments'. This means they are funds intended to support state services, such as housing and infrastructure, and by definition, are highly unlikely to be quarantined from this Commonwealth Grants Commission Assessment; some could argue it would be inappropriate for them to be so. Also, the drying-up of funds from the 2016 17 Mersey Hospital fund, worth $100 million per year, ends.

Without any other challenges, it will be an immense challenge, even without the expected softening of spending due to cost-of-living pressures and high interest rates. We still do not know whether the Reserve Bank is going to raise the rates again. Those actions taken by the RBA are designed to achieve that risk of a shrinking GST pie size as people pull back on spending.

Ms Rattray - Just this week, the banks have already started raising interest rates outside of what the RBA is doing.

Ms Forrest - Yes. It just adds to it. When people spend less, the pie shrinks. Nowhere is any of this mentioned in the budget papers, nor the Budget Speech, where one might have expected a bit more honest commentary. Rather, the Budget Speech actually persisted with a hoary-old chestnut about returning the budget to a net-operating surplus. Had the Treasurer forgotten that his Government had just adopted another measure of budget sustainability? I assume he subscribes to what is in the budget papers - Budget Paper No. 1, which outlines it. It was, however, pleasing to hear the Treasurer say in his speech:
[TBC]
The 2023-24 Fiscal Strategy provides a framework to guide Budget sustainability over the next decade and increases transparency and accountably by developing, implementing and reporting on fiscal objectives at the General Government Sector and the Total State Sector level.

Good, but then he immediately said:
[TBC]
We will chart a pathway back to surplus over the Forward Estimates with the Budget forecasting a net operating deficit of $297.5 million in 2023 24, improving to a net operating surplus of $61.2 million in 2026 27.

Why talk about a net operating balance when you have just established another measure? The Treasurer started telling us about the revised fiscal strategy designed to give budget sustainability, but then did not bother mentioning the new chosen method to do just that and what it means for the state's financial position.

It is a stark reminder the Budget Speech is a political document written by spin doctors. He should be telling us about the fiscal balance strategy and how we are going to achieve a break-even figure in a few years' time, because that is what it says. This strategic action, and a number of others, contain the words, in the commentary in the fiscal strategy chapter:

The Government is, however, taking action to improve the fiscal balance over time as demonstrated by the fiscal measures in this budget. [TBC]

I could not find those measures that were going to be taken. Outside the efficiency dividend, which is the only thing mentioned, I can see little evidence of any real actions or descriptions of real policy or decisions to see how this will be achieved. Similar words were used in the description of most of the strategies, with nothing to demonstrate how the targets will actually be met.

The state is a service deliverer, or it should be, delivering the services Tasmanians need, as well as building infrastructure to benefit Tasmanians. Fiscal strategy 4 notes: 'related to the cost of debt (including defined benefit superannuation)' - and the almost bleedingly obvious comment from the budget papers that 'the greater the cost of debt, the less funding available to provide direct services to the Tasmanian community'.

Ms Rattray - True.

Ms FORREST - But it does not line up with what is being said by the Treasurer.

There is one other fiscal strategy that I wish to raise, strategy 6, the need to raise more of our own revenue. As we know, we are heavily reliant on the federal government to provide the vast majority of our revenues. Currently, we are languishing at 32 per cent of our own revenue. No hints were given on how to raise another 5 per cent revenue. That is $500 million in additional revenue and how we are going to raise that if we are to meet this target. What is the point of setting targets if there is no discussion of how these targets will be reached? That is why this Budget is a massive fail. Sure, there is lots of money being spent, but stand back for a moment and take in the overall picture. Just have a look at the General Government Income Statement. For the four years - the Budget year plus three years of forward Estimates, revenue grows from $8.422 billion to $8.786 billion, a minuscule 0.7 per cent increase each year - less than 1 per cent and in real terms, that is a drop.

The increase in expense in the income statement actually shows a fall over four years from $8.719 billion to $8.725 (tbc ? 12.24) billion/million; take away interest paid, which rises from $86 million to $285 million, and this means even more of a fall in the outlays that make a difference in people's lives. Adjust this for inflation and the reduction of expenses is going to be very painful. We will be living with fewer services and more debts. There is no other possible conclusion.

Nowhere is it explained how the Government proposes to meet any of its targets. This is especially true of the $1 billion stadium investment. How will this investment assist the strategic actions and targets set out in the Budget? These will be questions that will be filed out no doubt by committee B, but it certainly will be with the Treasurer as well in committee A. It is as if Treasury gave the Government a detailed account of the challenges ahead but then the Government, in a moment of madness, went off and handed the AFL a blank cheque.

Let us look at the stadium deal in a bit more detail. As I have already observed, chances are the Commonwealth Grants Commission will pay us less GST in the future as a result of the stadium grants. In effect, the grants will be short term loans and will be clawed back with less GST in the future, just as occurred with the federal funding for the Royal Hobart Hospital redevelopment. It is to deliver state services. If you read the guidelines, when it is a state government responsibility, you do not get it quarantined unless there is some special arrangement. If you start undermining that arrangement, then the other states will be unhappy and we know how that all goes.

How will the stadium help us achieve a break even fiscal balance in the next 10 years? That must be a pretty simple question. The Government now has a 10 year focus. It must be modelling how the fiscal targets will be affected by major policy decisions, such as the stadium. So how will all the debt and debt service ability targets be affected? There is a more urgent need for more own-source revenue. Strategic action 6 requires us to raise another $500 million per annum in today's dollar terms to meet the target the Government has adopted. Back to my question: how will the stadium investment assist in meeting this target?

Even if one accepts the alleged benefits that spruikers say will occur - I might add, mostly without much evidence - how many of the benefits will end up in government coffers? It is time we were told. The Government must have some idea - not that the Public Accounts Committee has been able to get much out of them in that regard.

Ms Rattray - That is unusual. I am sure you are not going to leave it at that.

Ms FORREST - We do not give up easily. We are always told that a growing economy will contribute to growing government revenues but that is not the case, as these budget papers clearly demonstrate. Revenue over the forward Estimates is estimated to grow by 0.7 per cent per annum, as I have already pointed out, yet growth in the economy, as per page 28 of Budget Paper 1, will be two to three times that.

To fall back on the old argument, 'don't worry, grow the economy and government revenues will increase and we will be able to pay for all the other things that people require', is not working as people assert it does. We have been sold a pup. Like the claim that giving tax cuts to the rich will lead to more investment, the fruits of which will trickle down for the benefit of all, the trickle down effect does not work as alleged.

The Government's new fiscal strategy 9 covering infrastructure investments states 'The rigour of cost benefit analysis needs to improve'. I think the PAC could confirm that is the case, too.

The Macquarie Point cost benefit analysis is shown to be seriously deficient. From what we have been told at the public hearing at the Public Accounts Committee, there are many gaps. So what is the point of a fiscal strategy if the Government simply goes out and ignores it and does as it wishes?

In any event, fiscal strategy 9 is supposed to monitor the allocation of resources to give maximum community benefit, according to the budget papers. To borrow the words from the Charter of Budget Responsibility Act, surely that means a cost benefit ratio of more than one, in which benefits exceed costs, not a project with a cost benefit ratio as low as 0.3, as Public Accounts Committee evidence suggests may well be the case for the stadium. That is 30 cents of benefit for every dollar spent. If costs exceed benefits, the net present value of the project must be less than zero, but fiscal strategy 9 requires projects to have a positive net present value.

Why include the strategy if you are just going to ignore it on day one? I am not saying that the strategy should not be there, but why, if you are going to put it in there, then just ignore it blithely?

It is certainly something I will be keen to hear from the Government next week, how the fiscal strategies and plans were considered when the Government decided to proceed with the Macquarie Point Stadium. We know backbenchers were not told. Was it discussed at Cabinet level? I am even starting to wonder whether the Government consulted with Treasury. Given all the work that Treasury has been doing to completely revise the strategic actions and targets, they might have had a view on the stadium's possible impact. There are many unknowns. We do not know the design, which makes cost estimates little more than guesses. We do not know the exact location on the site. We do not know what the surrounding precinct will be and what it will be used for. We do not know all the detail of the ground conditions. We are a house of review; we are not a branch of the Make A Wish Foundation.

I must admit, I could not find details of the stadium grants, including the Commonwealth payments for specific purposes, listed on table 5.4 in Budget Paper No. 1. Perhaps footnote 1 explains what happened, where it said that 'not all the recently announced federal grants have been included in our Budget'. That suggests things were pretty rushed.

We need to review development of Macquarie Point as a whole, including a possible stadium, arts and entertainment precinct, Antarctic precinct, the wharf realignment. They all interact and all the implications need to be assessed in line with the Government's fiscal strategies and targets. That is what they are there for.

We also know and cannot ignore the fact that most major projects have real cost blowouts. The Government's own record clearly shows this. The cost of the proposed Cradle Mountain cable car, which the Leader spoke about, is now triple the original proposal. The cost of the new Burnie Court House is now double the original proposal, mostly as a result of having to alter the location due to public backlash from a lack of community consultation. Does that sound familiar here?

This Government has an appalling record of the actual cost to taxpayers being double or triple the original PR announcements. We have seen this also occur with other major stadium proposals in the past, here and on the big island to the north. We could all recall the greenfields hospital proposal Hobart when it was squashed by the former Labor government, preferring instead a costly and difficult rebuild on site which, whilst reviewed by the Liberal Government when it came to power in 2014, it confirmed the decision on the basis that it was unaffordable. Tasmania just needed to spend within its means and make do with refurbishing an existing hospital, with all the well known limitations and the end result.

The cynic in me - that is the cynic that absolutely supports our own football team, which we are entitled to and which we absolutely should have - observes from the benches that it appears footballers cannot be expected to make do with a refurbished ground. Before the team is even established, they must be given a blank cheque to build a new shiny stadium. We will just make do with refurbishing the old Royal Hobart Hospital on its current site.

In addition, most people in the construction industry I speak to, particularly those who know the site and its limitations, including the size but also if you are going to include a respectful truth and reconciliation art park and not overshadow the sacred site of the Hobart Cenotaph, the ground's soil conditions et cetera, most people are quite convinced the suggested total of $715 million is farcical. This figure has been proposed in the absence of any detailed design or understanding of how such a large structure, a stadium with a fixed roof, could be built on an area of mostly contaminated landfill. The cost of such a development will take thousands of hours and input from geotechnical, civil, structural, construction, electrical, hydraulic, acoustic, mechanical, lighting et cetera engineers, architects, quantity surveyors, surveyors, electrical contractors, plumbers, landscape architects, the whole lot; civil contractors, construction companies, IT and digital experts; concrete and timber suppliers - the list goes on. That is not even counting the fitout costs for seats and other corporate and conference facilities, which are also being talked about.

To suggest the same venue could be used for A-League, NRL or rugby union games, especially if Tasmania wants to get our own licence, is also fanciful. The Football Federation of Australia - FFA - has made its position clear on this matter. They would require a separate and suitable stadium to be built for them too.

If you are unsure about this, the FFA awarded an A League licence to Western United over South Melbourne. The main reason they gave for this was that Western United are building two brand new purpose built soccer stadiums, one a 15 000-seat stadium for the men's team and one 5000-seat stadium for the women's team. Mind you, I would like to know what Sam Kerr thinks about these things. She is an excellent player and she can draw a big crowd.

Ms Howlett - She is an excellent player, world's best.

Ms FORREST - She is just a rock star.

It is clear the FFA wants its sport being played in a venue that has been built for that sport. Soccer and rugby do not want their sport being played on an AFL venue, it is too big. They were also demanding much smaller venues for women's teams. Again, this is a very new trend and surely, we need to look to the future.

The other interesting thing to note about the Western United Stadium is that it was meant to be opened at the beginning of the 2021 season and is now scheduled to open in 2026.

While waiting for their new stadium to open, Western United have chosen to play their matches at Geelong, Ballarat, AAMI Park and even multiple venues in Tasmania, over playing at the roofed Marvel Stadium, which was where it was being constructed, so it was going to be the home of Victorian soccer as well as AFL, NRL and rugby union.

We have also heard about the new Perth and Adelaide stadiums being cited as examples of how things could go in Tasmania. Interestingly, on the Austadiums website, those two stadiums, Perth and Adelaide, have attracted almost no new events since their opening and 95 per cent of their events were already being played in the state. They are not new events coming to the state on the basis of this revamped stadium.

The Adelaide Oval has only had one rugby union match since it opened in 2014 and the last rugby league was three years ago. There has only been one soccer game in three years. I will come back to some of these figures again in a moment. The Perth stadium is very similar, with only one rugby union match in three years, one rugby league match in three years and only two soccer matches in three years. Looking at the predictions of about 44 events a year at the stadium at Macquarie Point, it does look a bit shaky.

Both Perth and Adelaide's A League soccer teams choose to play on smaller non-AFL venues, as do all three A League soccer teams in Victoria, and nobody plays soccer at Marvel Stadium. The Western Force, Perth's rugby union team, also chose not to play at the billion-dollar stadium in Perth, just like both Melbourne and rugby teams who chose not to play at the roofed Marvel Stadium.

We have to ask the question: where are these other 37 non-AFL events going to come from, especially when the other codes seem to be uninterested playing at AFL roofed or unroofed stadiums?

To illustrate this point, I will make a few observations with regard to soccer, rugby league and rugby union matches and reiterate some of these points.

At Adelaide Oval, the last soccer match played there was 2017. There have been four rugby league matches in 10 years and for all four the government paid a fee to attract them. There has been one rugby union match in 10 years.

At Optus Stadium, there have been three games of rugby league in five years; for all three, the government paid a fee to attract them. Rugby union, three in five years. Soccer, six in five years, and the government paid for five to attract them to come.

Marvel Stadium is notionally built for the purpose. In soccer, the last A-League game was in 2021. Today, all three A-League teams chose to play at other venues. Marvel Stadium has movable seats that turns Marvel into a so-called soccer stadium, but due to the high cost of moving the seats, most soccer matches have been played with Marvel in AFL mode, which is the reason why all three A-League teams chose to play at other venues. You just do not get the experience; the fans do not get the experience and the players certainly do not.

Mr Valentine - Too far from the action?

Ms FORREST - Yes, you cannot see it. At Marvel, there has been one rugby union match in nine years. The last rugby league match was in 2012. There are two matches scheduled for 2023.

Mr Gaffney - I went to the Western United game at York Park and there were a few people, but no atmosphere because it was too far from the action.

Ms FORREST - Melbourne Storm played one season at Marvel in 2001 - that is a while ago. They then chose to leave and play at the much older Olympic Park, which is a much smaller venue with a rugby shape.

The Storm team cited the high cost of movable seating as their reason for leaving the modern Marvel Stadium; it was quite modern in 2001.

In NRL basketball, only three matches were ever played at Marvel, despite the venue being hyped as an NBL venue when it was talked about in the late 1990s. This was also covered in the media. There was an article that talks about angry fans who could not get a good view of the match. There is an article called 'Boomers vs Team USA - fans slammed seating at Marvel stadium' [tbc]. I will just read a little from that article, which said:
[TBC]
Fans dug deep into their pockets and splashed the cash when it was announced that Team USA would be coming Down Under to take on the Boomers in a two-game series at Marvel Stadium.

The initial announcements listed the biggest names in the NBA as taking part, before, one after another, they all started pulling out. But before that happened, fans had already outlaid their hard-earned dollars, with some parting with $500 for seats at the ground level.

This is in Marvel.

On the day of the game, images began flooding social media with questions being raised about visibility for fans.

In the article, there are a whole heap of photos from Twitter and the like.

Once they started rolling into the stadium, it only got worse, as fans fumed about not being able to see the court. Even Australia's biggest film star, Russell Crowe, tweeted his dismay over the seating fiasco, with a video of his view being completed obscured by fans in front of him.

As I said, the article shows plenty of pictures from angry fans.

Further, the ugly views led many fans to compare the disaster to the now infamous Fyre Festival, which made international headlines back in 2017. Promoted as a luxury music festival, what actually eventuated was a disaster on a grand scale and it led to jail time for the event organiser, Billy McFarland.

They are not suitable. These big grounds are not suitable for that sort of event. To say they are going to make up the number of events, even with a return on investment of less than 30 cents to the dollar, there is evidence here they will not come.

If you look at Heritage Bank Stadium, which is the Gold Coast Suns stadium, there have been no soccer matches, no rugby league matches and no rugby union matches since the re development in 2011. There were three or four smaller state cricket matches a season at the Gold Coast Suns stadium.

On the so-called deal of the century that I argue it is not, I am sure all members would have been made aware of the interview with the former premier of South Australia and now Chairman of Adelaide Crows, Mr John Olsen. Mr Olsen said in an interview on ABC Grandstand:

I think you've got the deal of the century. Now, why would I say that? Well, we redeveloped Adelaide Oval at a cost of $535 million a decade ago, which will equate to approximately the cost of the Macquarie Point Stadium. [TBC]

On the first point, the cost for a redevelopment is not the same as the cost for a new stadium; there is some difference there. That aside, the issue with the 'deal of the century' regarding the Tassie team, I would say - and I will continue to ask this question - why do we have to wait five years? We are a footy state, an Aussie Rules state. We simply should not have to wait and certainly not five years. For the benefit of members, I will provide a brief summary of the time lines for the other AFL entry teams. Just bear in mind where these teams are. This is a list of all the new AFL teams that have joined the AFL since 1987. I am also going to talk about the new NRL teams that have joined since 1997. Most of these have played their first match within one year of being founded and many within six months of being founded.

Why do we have to wait five years? This highlights how much of a ride the Tasmanian taxpayers are being taken on in being forced to pay millions for a stadium and also being made to wait another five years for a team.

• Brisbane Bears: not AFL country - it might be a bit more now but was not back in 1986; founded 1 October 1986; first competitive match 10 March 1987; first AFL match 27 March 1987. Less than one year; more like six months.

• West Coast Eagles - founded 1 October 1986; first competitive match 3 March 1987; first AFL match 29 March 1987.

• Adelaide Crows: founded 19 September 1990; first competitive match 13 February 1991; first AFL match 22 March 1991.
• Fremantle Dockers: founded 21 July 1994; first competitive match 24 February 1995; first ALP match Saturday 1 April - April Fools' Day - 1995. That is a quick turnaround.
• Power Port Adelaide: founded 21 May 1996; first competitive match 28 February 1997 -

Ms Rattray - A bit longer there.

Ms FORREST - A little bit longer, not by much.

First AFL match, 29 March 1997.

These are all within a year.

• Gold Coast Suns - again, not AFL country, not like Tassie: founded on 5 September 2009; first VFL season 2010; first AFL season 2011.

Why five years for Tasmania? If you look at the NRL:

• Gold Coast Titans: founded in 2006; first NRL season, 2007.
•
• Melbourne Storm: founded 1997; first NRL season 1998.
•
• Dolphins: founded 13 October 2021; first NRL season 2023 - nearly two years there.

If you go to the NBL and look at our own JackJumpers: founded 1 October 2020; first NBL match 3 December 2021. I know that they played some competitive trial matches before this but I am unsure of the actual dates of those.

Every way you look at this, it is a dud deal and Tasmanians are being done over. Why do we have to wait five years? In my view, any contract can be renegotiated. This Government, to their great credit, renegotiated and redrew the contract with the North West Private Hospital and the so-called evergreen contract. I commended them at the time and I continue to commend them for that. Not only did they end that so-called evergreen contract, they then renegotiated the contract and in this last six months, they renegotiated that contract again to get out of it a year earlier, so we can rightly take public maternity services back into the public system. So, it can be done; this Government has done it before. If we can do it for Health, surely, we can do it for the economic welfare of this state.

Anyway, enough of the dog of a deal the Premier signed. I will move on from that and go on to some positive news.

Sadly, the Minister for Women is not here. I want to commend her on the Tasmanian Gender Budget Snapshot - a significant improvement from the first one we received last year. An enormous amount of work has gone into it and I look forward to seeing the progress of this over the years. It is sobering reading in some areas; but, in many areas, Tasmania is doing well. I commend the Government for its work in getting women into senior positions in government businesses and in senior positions in our public service as well.

There are still some concerning factors where we are going backwards against the national comparison, including specialist homelessness services for clients and rates of family violence - both disturbing matters - but it is a very good document and I thank the Minister for Women for her work in advocating for this and getting it done. It is a positive inclusion and it will be a great resource. I will not delve much into this; we have the Minister for Women for budget Estimates so there will be more time then to delve into that.

I will speak on a few other specific matters. Most of these things I can go into more detail in budget Estimates.

I have some comments on a few particular matters of education infrastructure. I note the Leader talking about $20 million on the redevelopment of the Penguin District School. It is a new school, compared to Montello Primary School. Montello Primary School has $6 million - or $7 million but once you take out all the costs even thinking about it, we are down to $6 million or probably $5 million to do the work. Montello has been forced to suck it up and try to find a plan that will make their school assessible - just accessible - within their budget. They can do that; they can put it onto two levels with a lift - although, because a TA broke a leg onsite recently, there is a whole area cordoned off that cannot be used by anybody. So much of that school is not accessible. The principal had to move classes. Normally, they have the little kids upstairs and the older kids on the varying levels downstairs. However, because of the mobility needs of a student who was going from grade 2 to grade 3, they had to rejig all that and bring grade 3 up. Talk about disruption - all because it is not accessible.

That $6 million or $7 million is not much of a spend on the building. The money available will enable them to make the building relatively accessible. It will not enable them to put in a decent play area for young people to de-escalate, with proper play equipment and an outdoor space. This is an area of one of the highest levels of social disadvantage in my electorate. These families are not able to strongly advocate for themselves; they are too busy surviving. They cannot get out there and make a noise, there is no parent body that can stamp on the door of the minister - a minister who lives in this electorate. They cannot put shade over their outdoor learning area. They cannot even demolish the horrid old toilet block.

Mr Willie - That is Third-World, that one.

Ms FORREST - The Third-World one that I have already spoken about, the bully's haven. They had to block it off because there were people hanging around outside it and because there is no visibility of that space from anywhere in the school. They cannot even afford to demolish it. They just to leave this monolith there because they do not have money to demolish it, and they want to make the school accessible.

They cannot do so many of the basic things to make this school a nice, attractive and welcoming learning space for these families. We need another $6 million here. I went through the budget papers and looked at all the amounts that all the other schools are getting. Their redevelopments are on a flat site. This is as steep as you can get. Hence, the inaccessibility of half the school.

I call on the Government to put more money into this so they can do the job properly. It is an absolute disgrace that the families of Montello Primary School cannot get a decent outcome after all these years of waiting. It is appalling. That is the worst of them in my electorate.

At Wynyard High School, no work has been done on the classrooms for years and years. There is a very easy solution. It is a flat site and there is plenty of room over by the old tennis courts that are no longer used and the car park, to build new, decent classrooms for this school. The car park could be moved on to the old tennis courts. There is plenty of land around the back. We have a new toilet block - excellent, but these children need learning spaces. I was in there doing a session with a classroom a while back, and it was so hot and stuffy. You have adolescents going through the personal changes that adolescents do, and it is hot and stuffy, no air. I thought we were being COVID-19-aware these days? Let us build Wynyard High School some decent learning areas.

Hellyer College is the same. Hellyer College has had a bit of money spent on it from time to time, but if anyone wants to visit - particularly down in the cave that is the arts and drama department - you will see the magnificent green carpet that is still there from when I was there, taped up with duct tape, all along the corridor. It is not a bad place for a music and arts park, it is all dark and underground, but that needs work as well as lot of the old areas. The cafeteria is the same as when I was there, except for a new little breakfast bay area, where you can cook your own breakfast.

Ms Rattray - I think the member is telling my story as well when it comes to schools.

Ms FORREST - Yes. There are others but they are the ones at the top of the list for me. Montello is the absolute top of the list and not because it is not having anything done, it is because we just do not have enough money to do it properly.

The other matter on infrastructure is one that was mentioned regularly when I was out on the doors: the Cam River Bridge. It is coming along, but we hope it comes along a bit faster before the next heavy rains come but anyway. I still have questions outstanding on this. I hope the Leader will have answers this week about that process for looking at the feasibility of a second bridge.

The current arrangement is that the Murchison Highway will come out where it is now, right on the edge of the bridge. It is another accident waiting to happen, without a doubt. All the trucks that come out through there, when to fix two problems, we could close that. We could take the Murchison Highway traffic over the bridge, a bit further up where there used to be a bridge many years ago, off the end of Wragg Street basically. We could take it across so that all the traffic comes down across there; it does not have to come out onto the highway there where we already have one set of traffic lights a spitting distance up the street in Falmouth Street. You go over the bridge and then after a very short distance there is a set of traffic lights that brings you out East Cam Road, you could direct the Murchison Highway traffic there, then you have some redundancy. You reduce that risk of a crash at the opening of the bridge - there we go again - and solve two problems.

I know some work is being done by GHD. I am keen to see what brief they have been given because I am not convinced they are looking for a second bridge. Until I see that, I will remain unconvinced. Anyway, that is a matter that the minister for Infrastructure might like to talk to me about next week.

On the matter of Hhousing, we all know the enormous challenges in all our electorates with access to housing. It is almost daily - or at least two or three times a week - that this matter is raised with me. I am hearing from people who are living in social or public housing, through Housing Connect or Housing Choices, who, by my assessment, are paying at or more than 25 per cent of their income. I thought that was not supposed to happen. I am not sure what is going on but many people, not just in the public sector here but in the private sector, are finding rents are so expensive and it is so tight. We need to do better. I know Committee B will really delve into this so I do not want to go on too long about that, but it is a massive issue. We need to do much more in that space.

Ms Rattray - Much more, in a more timely manner.

Ms FORREST - Yes. Having said that, when I was out doorknocking, I went to a few new areas - one area was where I fell over and got myself a black eye, a massive shiner, which was a good talking point on the doors for the rest of the week. That was in one of these new areas and they were quite well constructed, solid buildings in Somerset, near the bridge. Those people are very aware of the bridge fiasco.

The other was in another part, on the western end of Somerset. I called in and doorknocked there. Multicap are leasing some of those for some of their clients to live in with carers. One couple was living in it. These are all public social housing and, to me, they have been built really quickly, really cheaply and they have not done things that need to be done. Every time it rains, the backyard completely floods. They cannot put their little dog outside. They cannot put it out the front because it is very open out the front. All they have on the concrete floor is a thin carpet tile with nothing under it, so it is really hard. There is a gap this big - let us say, almost 80 millimetres - under the door. I thought we were building energy efficient homes.

They had a neighbour who, for reasons I will not describe here, had his air-conditioning unit on 24 hours a day, 7 days a week. Because the unit came straight into their open garage, they put up some clear perspex on the carport to try to block that because they use that door all the time. That is where their car is; they also have their dryer out there, which was quite noisy. They were told they had to pull it down.

Sitting suspended from 1.00 p.m. to 2.30 p.m.

QUESTIONS
Budget Papers and Appropriation Bills (No. 1 and No.2) 2023 - Noting

[2.38 p.m.]
Ms FORREST (Murchison) - Mr President, just before the lunchbreak I was talking about housing and the Perspex shield for the owners in this public housing building. The point I was making is that it seems that some of these properties are being built in areas that perhaps are available, but unless you do extensive ground work or proper drainage and then ensure that the house does not cost the tenant a lot to heat and maintain, it can become a bit of a false economy. I was a bit disturbed by my visit of this couple. They showed me through their property and highlighted a number of these areas. I thought, if we are building these properties for people to live in for the longer term, you would hope that they would be a little more comfortable. However, nobody wants to complain because they are grateful to have a roof over their heads. Yes, it is a new - or newish - property, but if we want these properties to last for a long time, we want them to be efficient to live in for those tenants. The power prices are going up and they are all facing the other cost-of-living pressures. Yes, you can put a door snake across the door and all those sorts of things, but you would hope that the property is not going to flood every time.
If you get a king tide and heavy rain, there is every chance that flood water could rise up and come into that property. The last time they had a big heavy rain there, it started coming under the back door. It is because the water is not draining away. It is close to the sea and we know with the impacts of climate change, we need to be cognisant of these matters. A bit more attention needs to be paid rather than just whacking places up quickly; we need to whack them up quickly but in a way that makes them liveable for the longer term and efficient to live in.

Mr Valentine - You would think they would not allow properties to be built in a zone that could be flood-affected.

Ms FORREST - One would have thought so. I saw the photos of the water in the backyard. It is not just that one property, it goes right along the line. It is low-lying and it was swampy land before it was built on. It is very near the coast; the Bass Highway is right there and then you are in the sea.

Mr Valentine - Water cannot get away quick enough.

Ms FORREST - That is right. This is going to be an increasing problem.

I will move onto Health. It was a major issue raised with me during my election campaign. I am sure that the members for Launceston and Rumney would have heard the same issues about access to health care. By and large, the care that people receive in our public hospitals, when they get in there, is excellent and of a high standard. We still hear - and, sadly, sometimes it is through the media - of some very unfortunate experiences of people in our health system. I know these things have gone on forever and they will, and sometimes people have unexpected complications and matters like that, but sadly I am hearing a little too often that the patients themselves, or their next of kin, are not being listened to about very legitimate and real concerns they have raised about their own or their loved ones' health and wellbeing. That person has gone on to suffer a significant setback or major complication that could have been not necessarily completely averted, but could have been much less serious if they had been listened to in the first place.

I have worked in hospitals; I know how it works. When you do not have time to sit and listen to a patient or relative for what can seem like a very long time sometimes, as they repeat a story over and over, this is where things get missed. This is where people's voices are not heard and that happens when you do not have enough staff.

We understand the pressures that COVID-19 made and people being sick and not being able to get work, but we know there are enormous pressures on our healthcare professionals at the moment, nowhere more obvious than in the maternity unit in the North West Private Hospital, which I will get to in a moment. This is an area where you cannot cut back on or scrimp on if we are going to get good patient outcomes. Poor patient outcomes occur where people do not have time to spend fully assessing the patient, really listening to them or their loved ones, advocating on their behalf.

To me, most of the problems that come across my desk - and I do get a lot because people know that I will understand what they are talking about and I can engage with them more meaningfully about what has been happening for them - relate to communication, a lack of communication, miscommunication or a misunderstanding of the communication. I get it when people are really stressed, the patient or the relative does not always hear everything you tell them. You can tell them today that this is what is happening for them, this is what the condition is and this is what we need to do. The next day they will not remember any of it, or only one part of it. I get that, but that is why you need people there with time to go back over it, to explain it to them. It is a staffing issue and we have to be cognisant of that.

Ms Rattray - Would you consider that support person might be a back-end service provider who may well be impacted by the efficiency dividends?

Ms FORREST - These are not paid people; we are talking about the families. Members might recall in our rural health committee report, one of the recommendations was that when a patient is navigating their health journey, whether it be through the primary health system into hospital and out again, there are paid health supports that can advocate on their behalf. These are people who are not emotionally attached to the situation. They may have an emotional connection once they have been working with a person for a while and feeling for this poor person suffering all these health issues, but they are people with a background in health that can navigate the system for people. They can say, actually, you should be asking your doctor about seeing a physiotherapist, psychologist or whatever. Rather than the person having to try to figure it all out themselves when they are highly stressed at times, they have someone who can advocate on their behalf. The Government did not disagree with that recommendation, but it would be really good to see that implemented. It could reduce a lot of these other issues if you had those people in the system to prevent some of the complications that occur and that cost money, take time, tie up beds - all of those things. It is a preventive approach. Yes, it would cost some money, but it could actually save a whole lot more. If that was in place and they cut that out, for example, I would think that is still frontline. I do not think you would call that back-end that could be cut in an efficiency dividend, for example.

Mr President, the main concern of people was getting timely access to care - getting on a waiting list first and then being on a waiting list and then getting timely access to care. With so many people I see through my office, their overall health condition deteriorates when they keep coming back waiting for surgery or other treatment. That, again, means they will often be in hospital longer, they will often have a more complicated recovery period and not be in such good shape when they go into the procedure, let alone when they come back out.

On that point, I welcome the commitment of the 22 000 additional endoscopy procedures by 2027. This equates to 5500 a year or around 110 a week by 2027. Whilst these are important diagnostic procedures, they do not take long to do. You can roll through a good number of these in any one session and they are important early detection mechanisms. I do not deny any of that, but it is really important that when you pick up someone with something that needs further care, if we are not investing in the other part of it, then these people might end up waiting for care. You get them detected early and then they sit around waiting. You cannot just up the ante doing 22 000 more endoscopies because if you do 22 000 more endoscopies, you will get more people with bowel cancer, with some other upper GI cancer or other things that need treatment. If you cannot then promptly follow them through the system, then again, their condition will deteriorate. They may require other treatment in addition to what may be a fairly simple and much lower risk procedure in the first instance.

In some respects, it is generally easy to ramp up quick and fairly uncomplicated procedures. It is much more difficult to ramp up more complex surgeries and do another 10 000 joint replacements or other surgeries that people are waiting for. They take longer in the operating theatre and in the recovery period. These people take up a bed in a hospital, whereas endoscopy comes in, goes out and gone, provided everything goes well.

Mr President, there are many more areas of Health we could talk about but I will predominately save that for next week. I want to talk about the North West Private Hospital maternity services. I welcome the announcement that the maternity service will be returned to the public system almost a year earlier than planned. I acknowledge the significant work done by Dale Webster and Francine Douce have been really leading that work. I know it was not necessarily easy. I know you had to renegotiate contracts, oh my God, you can renegotiate contracts. You can sort out employment arrangements and they have done that. The biggest challenge now as we progress to the end of the year is to make sure we have enough midwives to fill the gaps, which means recruiting more. Currently, there are not enough. That is what is at the heart of the problems in the North West Private Hospital.

We have all heard the stories. I have had them in my office. Some women are being terribly traumatised by their birth experience and that again comes down to a shortage of staff. By not having an opportunity to stay with those women as much as you need to during their labour and birth; and then particularly not having that time to sit down with them afterwards to debrief, to talk about how their labour and birth went, to deal with problems early, to identify postnatal depression early, all of those things -

Mr Valentine - We heard some of those circumstances during our acute health inquiry in, what was it, 2018?

Ms FORREST - Yes. It got much worse with staff shortages and a higher use of agency staff.

Coming back for a moment to the history of this, it was when Mr Ferguson was the minister for health. The decision was made to close birthing services at the Mersey Hospital. Now, we could argue the rights and wrongs of that; I am not going to do that right now.

I am going to say that decision resulted in fragmentation of care, poor outcomes for mothers and babies, and poor outcomes for midwives. It completely fragmented the care so that most women could not access continuity of care. There is a bucketload of evidence that shows the positive benefits of continuity of care for mothers and babies, and that was completely decimated. There is no job satisfaction for the midwives working in a fragmented system like that, and there are poorer outcomes for mothers and babies.

I am really pleased that the Government is pulling all the public maternity services back under the THS banner. I know that they will be leasing the current facilities from the North West Private Hospital for a period to do that. I am really keen to see the master plan progress, particularly this aspect where we see a standalone public maternity unit that not only provides a state-of-the-art birthing suite and antenatal wards and postnatal care for the women and babies, but it also reinstates midwifery models of care that provide continuity. If we do not do that, we have lost a fantastic opportunity. It breaks my heart to see how that system that we had up there has been undermined and decimated and, as a result, we see poorer outcomes.

I will be working very hard to see the reinstatement of continuity of care models. I would love to see the Government work with UTAS to reinstate midwifery education in UTAS, particularly in the Burnie campus. We have this magnificent nursing lab there. That is state of the art, that is fantastic. We just need the will to get midwifery training back in the state; if we get it back in the state, we are more likely to attract and retain midwives, local and homegrown midwives.

The other point I want to talk about, again on maternity services, is the unfortunate closure on 23 June of the St Helens Private Hospital, which means the closure of the mother and baby unit there. This is a unit that north-west women, and northern women, as well as southern-based women, rely on. It has been the only operating inpatient mother and baby service in Tasmania for the past 25 years. The mother and baby unit in St Helens Private Hospital had eight inpatient beds - private, but there was access for public patients. These were serviced by two specialist nurses, 24 hours a day, consulting general practitioners, paediatricians and psychiatrists. Women and babies could be admitted to this unit for a range of reasons. These include but are not limited to: postnatal depression and anxiety; maternal exhaustion - most of us mothers here would understand that is par for the course, but it can be extreme; difficulties with breast or bottle feeding; difficulties with sleep and settling - that is, the babies to sleep because the mothers do not; poor attachment between infant and mother; and poor growth of the infant for medical reasons.

Some of the member may remember beginning as new parents and the extremely difficult times this can bring. Today's mothers are facing exceptional challenges, including high parenting expectations, isolation, high background rates of mental illness, high cost of living pressures and housing insecurity, pressure to re enter the workforce early and the loss of support networks. It is all part of the way things are now.

By the time they have the opportunity to enter the mother and baby unit, mothers are often at breaking point. There have been numerous media articles published since the announcement of the closure of the unit where women have shared their stories. Women have shared how they were desperate for help before entering the unit and how the unit saved their lives and notionally the lives of their babies at times.

It cannot be overstated how effective this specialised nursing and medical care is to changing the trajectory of a family. The eight bed unit was fully utilised and received women from all around the state. Women would have to wait weeks for a bed. For families from the north and north-west, the distance to travel was often prohibitive, especially when the mother had other children whom she would not be separated from.

To access the unit, most women required private health insurance, and we know that the rates of private health insurance in some of our more rural areas - certainly among disadvantaged women - is not very high. It was a convoluted process to access a public bed and only women diagnosed with severe mental illness through the public mental health service could do so. They had to be in a bad way to get admission and that is not in the best interests of mother or baby.

One patient described the six weeks of being repeatedly assessed by various staff through mental health services before finally accessing a bed as the darkest time in her life. This is the time you should be able to enjoy being a new parent. Approximately one-third of the beds were used by psychiatry patients, a mix of public and private, with an average length of stay of 60 days. One-third third of beds were used by paediatricians with an average length of stay of 79 days, and one-third were used by GPs with an average length of stay of five to six days.

In the most recent 12 months, there were also 100 GP admissions, between three admitting GPs. Only 1 to 2 per cent of GP admissions required re admission on referral for a paediatrician or psychiatrist.

The Government is currently proposing to fill the gap in service by making three public psychiatry beds available at the Royal Hobart Hospital in K Block, with non psychiatry patients overflowing into the acute paediatric ward and other services. The dedicated psychiatric beds are important. New mothers with severe mental illness requiring admission have a right to a safe space to bring up their baby. However, this only accounts for the existing arrangements where public patients access the St Helens Hospital.

I know when I worked as a midwife, having a psychotic mother on the ward with a newborn baby and our only option for her was to take her, without her baby, to Spencer Clinic. I was the midwife who took her over. She would have strangled me if she could have but there was nowhere else suitable. She could not get to the mother and baby unit. It is a most unwelcoming, inappropriate and completely unsuitable site for a mother in that circumstance. When a woman gets puerperal psychosis, it is a dreadful condition and it requires specialist care early and with all the right supports around it, to ensure she can stay with her baby; that the baby can be kept safe but she can be cared for in a way that does not destroy their bond. The acute paediatric ward is also an inappropriate location. The rooms are not set up for sleep and settling. There is no bed for the parent, just a narrow, uncomfortable bench seat. It is also noisy and there is the issue of infection control, particularly going into winter - as we are now - where respiratory infections will dominate the ward. These babies are too young to be vaccinated against whooping cough. All the staff will have been vaccinated. I do not have doubt about that but you cannot control another child or another baby that comes in.

I go back to my days as a student nurse - this was like 100 years ago now - in the old Burnie Hospital that has since been bulldozed and a Harvey Norman store stands there now. I looked after three babies in there. They were four, five and six months old. For 10 days in a row, every shift, I looked after them. They all had whooping cough. I went from one to the other, sucking them out with suction tubing so that they did not die, so that they did not drown in their own secretions. One to the other, day in, day out. They survived, but they were too young to be fully vaccinated. We are talking here about putting a mother with a newborn who has serious mental health concerns in a paediatric ward, where you could be exposing your newborn baby to this as well.

Most of you in this Chamber would know that if you have a new grandchild coming, you go and have your booster so that at least you are protecting that baby. My children were very clear: if we did not get our boosters, there was no visiting the grandies. Not really an option, was it? I am sure we would all willingly have the vaccination to ensure we could cuddle our grandchildren. This is the reality.

Some women have also commented in the media that after a traumatic birth, returning to the same hospital is too much of a barrier to seek help. We are talking about trauma-informed practice. That is not trauma-informed, if you have to go back in the door where the trauma happened and you are not in a good way to start with.

The other essential ingredient missing in the current proposal is the staff. The nurses currently working in the mother and baby unit are uniquely skilled. They have up to 30 years experience in parentcraft. It is vital that this group of staff be utilised in the new service and also are able to train the next generation of nurses. It is a skill set; it is not something that naturally comes to any nurse or midwife. It is essential that an interim service is set up outside the hospital. I call on the Government to arrange this with urgency and to include the current number of beds, current nursing staff and ongoing availability to GPs to admit to the unit. The majority of these women would have gone home from their birthing experience - not all, but the majority, and it is the GPs that are trying to manage this. GPs have an essential role in delivering mother and baby services, with the ability to simultaneously treat the mother and baby, offering a family-minded, holistic service, and they are possibly the most cost-efficient members of the team.

I have spoken to some GPs who are very committed to this and have a deep interest in this area. I know they have proposed a statewide, holistic, community-based mother and baby service with both inpatient and outpatient capacity. This is where we should be going. It is not just about bricks and mortar; you need to have services out in the community to intervene early, to work with the CHAPS nurses and with the mum's GP to support them. As a former midwife, I absolutely agree with them that for far too long, these specialist services have only been accessible in the south and predominately to private patients. The services through the THS Parenting Centre and Child Health and Parenting Services (CHAPS) are excellent but far too stretched and not able to soak up the loss of the mother and baby service, particularly when these women need to be admitted with their babies.

Most mainland states have a publicly accessible parenting service. A notable example is the Tresillian Family Care Centres [OK] across New South Wales, ACT and Victoria. Tresillian is non-profit, supported primarily through federal and state funding. Private health insurance is used, where available, for admissions. Every dollar invested in early parenting intervention through Tresillian delivers $2.83 in benefits. There is a good cost-benefit analysis!

The GPs I have been speaking to have proposed a similar model for Tasmania. It is a model I support. I ask the Government to think about this. Ideally, we need five inpatient beds in the south of Tasmania and five in the north and, ideally, at a purpose-built centre, not inside the facility where the women have already birthed. These beds should be primarily staffed by skilled family-care nurses, and patients should be admitted under their GP - because the GP is providing the family care - with the ability to liaise with paediatricians and psychiatrists as needed. Admissions can come from the community, or as step-down from an acute hospital if the problem presents early. You might have to limit routine admissions for a period to try to manage the demand, but that is where the importance of the outpatient services become crucial. It does not take a lot of staff to run these, but it is very important that we deliver them - and deliver them early to the families who need them. That way, we can prevent some of the absolute tragedies we see.

Mr President, I will leave it at that. I believe there is a real opportunity here for the Government to step into this space, in a preventive, proactive and helpful way that improves outcomes for mothers and babies, and families.

I will also speak briefly about the increasing use of robotics in health. I was talking about this with my son, who is on the surgical pathway, currently on a six month rotation at the Royal. We were talking about the emergence of robotics in surgery and how we are going to have to get ahead of this in our state, because there will be a lot of areas of surgery where robotics will start to become the norm. If we do not have access to robotics here, we are not going to attract the registrars; they will not come because they cannot use robotics if they are not here. We also will not get the specialists who use robotic surgery.

They are becoming an increasingly important part of our surgical landscape and if we are to attract and retain specialist surgeons, we will need to provide them. I got a message from a surgeon who is especially interested in this, particularly at the LGH. Surgery in a lot of areas - neurological, general, gynaecological and ENT surgery - will soon only be performed robotically. Robotic surgery is minimally invasive - often keyhole surgery - which produces better outcomes for patients and is available in most major centres in Australia, as well as the rest of the developed world. The surgeon I was speaking to suggested that it is quite important that the state invest in a da Vinci robot [OK]at the LGH, so the patients can enjoy better outcomes, shorter hospital stays and less pain. They will not need to travel to Melbourne for robotic surgery. Unfortunately, one of my constituents travelled to Melbourne for such robotic surgery and PTAS did not cover her - even though it is not provided here - because robotic surgery is not on the list. That is why: robotic surgery is not on the list, although it is not offered here. Shorter hospital stays mean more patients can be treated in the available beds; reduced waiting times; public patients can have access to robotic surgery, not just those who can afford private treatment; and it will help in the recruitment of new surgeons to the staff.

Mr President, I am nearly done with my contribution. I will go back to the point about the surgeon contacting me about the opportunities for robotic surgery. He said that at the LGH they had just lost a new urological surgical colleague to the UK, where he is on a robotic surgical fellowship. He says if we do not have a robot here, he will not come back to work for us afterwards. All newly qualified urological surgeons are also undertaking robotic fellowships in Australia and overseas. When they compete these fellowships, they will be looking for substantive positions, but only where a robot is available. It will be impossible to attract these people back if we do not invest to address this in the near future.

To give members an indication of what it costs, the equipment this surgeon suggests we need is the Da Vinci Xi robot with a dual console for teaching so you can get the registrars in to teach and they can have two people involved. The Australian distributor is Device Technologies and the parent company is call Intuitive. The list price is around $4 million. When you think about how much you spend in Health, that is not much.

Ms Armitage - That includes all the training.

Ms FORREST - That is right.

Ms Armitage - I've had the same surgeon.

Ms FORREST - I am sure you have. The funny thing was, I have just been talking to my son about its importance and where it is going, and then next thing I get this email the next day - spooky, that.

Briefly, in closing, on primary and preventive health, in spite of our rural health committee report and the previous preventive health inquiries we have done, we still see a continued lack of investment in primary and preventive health. It seems there is a failure to understand the role of community-based providers. We tend to be cherry-picking projects rather than question the value on what evidence there is and the benefit they have. We are not focusing long term; it is a very short-term approach. You have to invest in the long term for preventive health because it takes a while to see the benefits in health as well as the economic benefits.

While acknowledging that primary health funding is predominantly the role of federal government, the state can and should continue to lobby to ensure we get additional funding.

I will have other opportunities next week during budget Estimates to drill down into more of these things, but in noting the Budget papers, there has been a lot of rhetoric on this safe and steady as we go Budget - it is not. We need to take serious actions and have some difficult conversations. We have all let this happen. We all need to be part of the solution. As I wrote in the Mercury a couple of days ago, it is the responsibility for all us. It is no longer put your head in the sand and look away. Forward Estimates are fanciful at best. Efficiency dividends of $300 million are fanciful at best. We have a dud deal on the table where Tasmania has been completely done over with the AFL, and it should be renegotiated. There are so many problems coming done the line as far as our GST and other challenges. We need to have some decent and serious conversations about this. It is not a good Budget. It is not a pass, it is a fail for the reasons I have mentioned and will continue to mention during the next week. I hope the Government takes it seriously.

 

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