Second hospital would go some way toward mending Hobart’s struggling health system

It would spread the workload across two sites and lead to patients being seen sooner, writes Ryan Posselt

Hobart has a health system that is struggling to cope with demand, the community are waiting too long for ambulances, too long for assessment in the emergency department and too long for life saving surgery. There are two main ways patients access health care at the Royal Hobart Hospital, through the emergency department and referral to surgeons for elective surgery.

Data available on the online Healthstats dashboard reveals that in November last year, 6427 patients were admitted to the Royal Hobart Hospital. While another 6171 patients were seen, treated and discharged from the emergency department at RHH. The pressure on the ED in particular is immense and it is leading to worsening performance for people seeking treatment with only 52 per cent of all patients seen within the clinically recommended timeframe.

The pressures on the ED are multifaceted. Increasing demand for care from a growing population combines with more complex health needs to create a perfect storm of an increase in complex patients requiring longer admissions and not enough beds in the hospital to meet that demand. ED professionals know that the problem lies with patients that, after assessment in emergency, need to be admitted for an overnight stay at the hospital.

Even though 6000 patients are seen, treated and discharged from the ED, they don’t cause significant stress to the system. The major problem is when access block occurs. This is when there are not enough in-patient beds in the hospital to enable smooth transition to the wards from the ED. Patients become stuck in emergency, sometimes for days and this is what leads to ambulance ramping. Ambulances ramped in emergency contribute to Greater Hobart having the second slowest emergency response times in the country as reported by the 2022 Report on Government Services.

Meanwhile, about 3000 Tasmanians are awaiting “elective” surgery, with category 3 surgical patients waiting almost a year on average beyond the clinically recommended time frames at RHH.

An additional 54,000 patients statewide are waiting a year-and-a

half on average just to see a specialist before they are placed on the formal waiting list. This is sometimes referred to as the hidden waiting list. Talk to any surgeon or anaesthetist and they will tell you that elective surgery is frequently cancelled because there are no available beds in the hospital. This leads to people waiting longer for their surgery, meaning more time in pain or off work, or worse; getting sicker or cancers spreading.

I have recently argued that a second hospital needs to be built in Greater Hobart. I believe Glenorchy would be the ideal location for a second facility. I see a second hospital as a facility that would be able to cater for a wide range of regular presentations. It would include ED, general medicine, geriatrics, orthopaedics and general surgery departments, as well as pathology and radiology. It would enable fast ambulance turnaround times with patients coming from the northern suburbs and beyond being conveyed more quickly to the hospital enabling that ambulances to then get out to the next job half an hour faster. People from the northern suburbs would not need to travel to the city to seek healthcare meaning less stress for them and less traffic in the city.

But how do we staff a new facility in Hobart? I have seen a mass exodus of staff since I have worked in the system. Health professionals are leaving in droves because of poor working conditions and pressure from an overburdened system. Pressure that leads to important things like professional development, education, training and team building being cancelled for years on end just so staff can put out fire after fire. These conditions lead to staff feeling undervalued and overworked resulting in rapid burnout.

I believe a second hospital would alleviate those pressures by spreading the workload across two sites. This will inevitably help retain staff in their important roles where we need them so much. It would also attract interstate health professionals to Hobart to help service our growing, ageing population.

A new hospital would also provide immense benefits to the surrounding community. Rejuvenation of the urban landscape around the hospital, jobs and better public transport links. It would be a win-win for the municipality that won the hospital.

With population forecasts predicting somewhere between 60,000 and 100,000 more people calling Hobart home by 2050 and with the RHH physically constrained, we’re going to need a new hospital at some point. With a decade in planning, recruiting and building ahead of us, I ask if not now, then when?