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Tasmanians understand better than anyone else the power of a connected community and what we can achieve together when we collaborate, writes St.LukesHealth CEO Paul Lupo. 

I never cease to be amazed at the Tasmanian community’s natural ability to come together for a common goal. Our collective capacity to collaborate, with a shared sense of purpose and pride, has allowed us to do things differently to other states.

This is a reality that should be capitalised by other local organisations, to think outside the square and set even more adventurous goals, knowing we are in the right place to achieve them.

It was our confidence in the community’s ability to work and find solutions together, that allowed St.LukesHealth to set our ambitious vision to make Tasmania the healthiest island on the planet.

When it comes to our health and wellbeing, collaboration is critical. If there’s one thing we have learned in the health sector, it’s that simply throwing money at a problem doesn’t buy you a solution.

At St.LukesHealth we’ve always advocated for a holistic approach to our health system. We know from experience that exploring public and private partnerships strengthens our response to health challenges.
Working with other Tasmanian individuals, organisations and governments to find ways to make our communities healthier and happier is inherent in everything we do as a business.

This is demonstrated in our collaboration with the Department of Health and our northern health partners on the co-located hospital in Launceston. We surveyed our members to inform our advocacy efforts for the right services in the right settings.

It is demonstrated in our pilot program delivered in partnership with Keiser, designed to prevent Tasmanians from having avoidable hip or knee joint replacement surgery, taking pressure off the state’s surgery waiting lists.  
Our collaborations even extend to our member product offerings, partnering with other Tasmanian organisations, including local IGA supermarkets and Bank of us, to ease the burden of rising living costs.

We are currently bringing together a coalition to create a smoke free generation in the face of rising rates of teen smoking for the first time in 25 years.

And finally, our two major builds in the north and south of the state are bringing together Tasmanian architects, builders, manufacturers, craftsmen and designers to create beautiful, calm and welcoming health spaces the whole community can access and enjoy.

Today, we open the doors to the public on the first of our community health and wellbeing hubs, right in the heart of Hobart’s CBD.

This prime location, accessible to all, will be so much more than a transactional space – we were determined to build something exciting and inclusive that goes to the heart of Tasmanians’ health and wellbeing.

A place where we could put our vision into practice – where the community can start taking small steps to improve their health and wellbeing, in a really tangible, accessible way.

Through working with other Tasmanian organisations we have already locked in a broad variety of programs, ensuring the space is genuinely a place for everyone.

Building our Tasmanian brand instils confidence to invest, confidence in ourselves as a state, and allows us to raise our expectations for ourselves.
 
For St.LukesHealth, that confidence allowed us to set our bold vision, which has in turn enabled us to attract good professionals, hungry for challenge and opportunity, back into the state and into our business.  
But we couldn’t do all that on our own of course. Collaboration has supported us to lift the bar for ourselves.
 
Tasmania is small and special and that allows us to do things differently. Let’s capitalise on this, with the confidence to take considered risk and invest in our community’s ability to collaborate.  
 
Paul Lupo is the CEO of Tasmanian not-for-profit health insurance provider St.LukesHealth.

Every Tasmanian parent wants the very best for their children. We want them to be safe, healthy, and happy.

There is a new battle emerging in the public health arena, and the health and safety of our children is very much at stake.

Vaping is poised to condemn another generation to addiction and chronic disease – just as sure as tobacco smoking has done to generations before; evidence suggests non-smokers who start vaping are three times more likely to switch to smoking continuing the cycle of ill health and lifelong battles with addiction.

According to the 2019 National Drug Strategy Household Survey, there were 227,000 people reporting daily use of e-cigerettes aged 14 years and over, this has increased significantly since then; making the need for generational change ever more critical.

While the extent of the problem is only just emerging, we know that children are in the firing line. Research suggests vaping is growing most rapidly among young people – to the point where one school in southern Tasmania has resorted to removing toilet cubicle doors in an, albeit controversial, attempt to discourage vaping.

Quit Tasmania Director Abby Smith said ‘although we are waiting for new vaping data among Tasmanian secondary school students, which will be available later this year, we know from other Australian jurisdictions that about 1 in 3 young people aged 14-17 years have used e-cigarettes.’

St.LukesHealth has submitted to the Therapeutic Goods Administration that the time is now to be bold and place tough controls on vaping. Controls which need to be unapologetically strict, well enforced, and geared toward protecting our children from an industry that has a new ‘in’, by marketing harmful substances to young people as if they were selling lollies.

The cross-sectional Generation Vape study in 2022 (NSW) highlighted how ‘Flavourings and taste’ was rated as the most important characteristic of vapes.

We have asked the TGA to place significantly tighter controls around nicotine containing vapes additionally we are also advocating for a tighter regulation of all vaping products, nicotine containing or not. Big Tobacco should not be allowed to peddle ‘flavoured’ vapes – regardless of whether they contain nicotine or not to young Tasmanians.

We don’t believe our children should be encouraged to take up a habit that increases the risk of them fighting addiction that may just last their entire lives, while shortening them, costing taxpayers massive amounts in chronic disease care along the way.

In the instances that a medical professional feels a patient may benefit from using nicotine containing vapes to cease smoking, they can still be prescribed and sold accordingly, but the import of any vapes, or the fluid they contain, for any other reason, must be banned.

We are asking government, both state and federal, as well as the governance bodies they control, to stand up and support generational change. We must act to stop another generation or more from being unhealthy, simply because it is a victim of a fatal addiction.

We need to set health policies to support good health – not health policies that support an industry to continue making money from addiction and terrible health outcomes.

This is a no-brainer in terms of protecting our kids and giving us all a chance to make Tasmania a much healthier place in the future.

Paul Lupo is the CEO of St.LukesHealth.

In the last week we have read so much about a public health system under pressure and failing the community, the ramping of ambulances, shortage of beds and now the shortage of GPS in an increasingly unaffordable Medicare system. As a consequence, Governments, health professionals, health organisations and health funders like ourselves have to make reactive and costly decisions on how we fund a health system to meet the growing challenges of an aging population.

Rather than being reactionary, what about if policy and decision makers take forward thinking and more proactive steps to assist the community in avoiding circumstances which promote poor health outcomes, and as a consequence place less pressure on the health system going forward and providing better health outcomes for the community.

We need to set health policies to support good health – not health policies that support an industry to continue making money from addiction and terrible health outcomes.

Vaping will claim the wellbeing and lives of future generations by indulging in a habit that is being promoted by Big Tobacco.

Sometimes, we need assistance in maintaining our good intentions, and that includes from policy makers who have the capacity to make it easier for us to be healthy or, at least, help make it harder for us to be unhealthy.

At this very moment, there is a compelling case for policy makers to take action to eliminate a situation which, if left unchecked, is expected to result in chronic disease and addiction over coming decades. I am referring to vaping.

The sole aim of tobacco companies is to profit from the sale of habit-forming substances that are likely to kill people when used exactly as intended.

St.LukesHealth is determined to fight back against this mounting threat to the health and wellbeing of our young people. It would appear to be a no-brainer towards our ambitious vision to make Tasmania the healthiest island on the planet.

We have submitted to the Therapeutic Goods Administration (TGA) that the time has come to drive a stake into the ground when it comes to imposing controls on vaping. There needs to be unapologetically strict and rigidly enforced restrictions introduced, to protect Tasmanian youth from an industry which is marketing harmful substances to young people as if they were selling lollies.

We are asking the TGA to make sure tobacco companies are not allowed to peddle ‘flavoured’ vapes – regardless of whether they contain nicotine or not. We don’t believe Tasmanian youth should be encouraged to take up a habit that increases the risk of them fighting addiction that may just last their entire life, as well as end it, costing the community massive amounts in chronic disease care along the way.

Every single aspect of vape sales and distribution must be regulated so their appeal to Tasmanian youth is diminished. This includes plain packaging and the exclusion of additives to give them a ‘cooling’ sensation, deliberately intended to enhance their appeal.

Where a medical professional feels a patient may benefit from using vapes in an effort to break an existing tobacco habit, they can be prescribed and sold accordingly. However, the importation of any vapes, or the fluid they contain, for any other reason, needs to be banned.

Our objective at St.LukesHealth is to get the TGA to take immediate action aimed at achieving generational change and protecting our Tasmanian youth from falling victim to the same sort of fatal addiction as tobacco, which has killed so many people entrapped by the addictive habit.   

We have a chance right now to stop our kids being coerced into decisions that will fundamentally place their health at risk for the rest of their lives.  

- Paul Lupo
CEO St.LukesHealth

Getting Tasmanians timely access to healthcare is one of our state’s most critical issues. We all know something needs to change: with almost 8,700 Tasmanians stuck on public hospital elective surgery waiting lists, the business-as-usual approach to healthcare just isn’t working and is making the health budget unsustainable.

St.LukesHealth acknowledges and welcomes the State Government’s willingness to do things differently through its new Transforming Outpatient Services Strategy. It aims to help Tasmanians access care and services, close to home, much sooner than the grim wait times we’re living with today, while assisting the government with ballooning costs.

It takes a holistic approach to shorten wait times, improve communication, and modernise processes, as outlined by Premier and Minister for Health Jeremy Rockliff this week (A Healthier Patient Care, The Mercury Talking Point, 16^th November).

The measures in the strategy are a step in the right direction, and in terms of what the State Government is able to control, seems properly targeted at achieving better access to care.

But it’s not just the State Government that needs to be a part of this plan. The Federal Government has a fundamental role in driving down demand for public hospital services.

Cost of living pressures are undoubtedly biting Tasmanian families hard and as a result of that, people may reconsider their investment in private health insurance. Unfortunately, every Tasmanian who feels they cannot afford to maintain or buy private health insurance represents another person destined to join the public hospital waiting lists, in the event they need anything other than emergency surgery.

The Federal Government must restore the means-tested private health insurance rebate as a matter of urgency. Once set at 30 per cent, the rebate brought private health insurance within reach of more people, taking significant pressure off the public hospital system. Unfortunately, the rebate has eroded significantly to less than 25 per cent in some cases – representing a whopping $23 million each year that is no longer being paid back to Tasmanians on low to middle incomes to keep them in the private system, and out of the public hospital system.

While it isn’t well recognised, two-thirds of all elective surgical procedures performed in Tasmania are performed in private hospital systems, overwhelmingly paid for by private health insurers on behalf of members who are making a decision to put their hand in their own pocket to fund their health care. So, despite meeting just one third of the surgical demand, the public hospital system is under constant pressure with long wait times. For the State Government’s measures to have the biggest impact, the Federal Government must do its bit to reduce the likelihood that people will drop out of the private system and be left with no choice but to join the long queues in the public system.

Restoring the rebate is a policy measure that would balance the demands in the health system, support the State Government’s aims and ultimately, deliver better access to health care for all Tasmanians.
 
- Paul Lupo
CEO St.LukesHealth

Legislators should be cautious in accepting the advice of the Tasmanian Chamber of Commerce and Industry when it comes to reducing Tasmania’s smoking rates.

While TCCI boss Michael Bailey is right in saying Tasmania’s approach to cutting smoking rates needs a fresh approach, his advocacy for vaping as a magic antidote to tobacco needs careful examination.

Replacing tobacco with vaping – particularly vaping products containing nicotine – does nothing to address the harms associated with nicotine addiction. This is an addiction that impacts a significant number of Tasmanians.

Setting aside the fact that we don’t fully know the long-term health ramifications of ingesting vaping fluids, it’s a reasonably safe assumption that ingesting large quantities of anything into our lungs other than air is likely to be detrimental, as Mr Bailey acknowledged. We already have evidence that vaping can and is causing serious health impacts, including respiratory disease and increased risks of heart attacks.

Beyond the emerging health impacts, Tasmania has the opportunity to ensure real and meaningful focus in assessing the social impacts and costs of addiction – an area where the Tasmanian population is significantly over represented.

Fundamentally, nicotine is highly addictive. That’s why smokers want to quit, but can’t. Their bodies simply crave nicotine, to the point they struggle to cope without it.

Shifting the consumption of nicotine from tobacco to vaping doesn’t do anything to lessen this burden of addiction. A person with a nicotine addiction can lose a significant degree of agency in their life because they are compelled and motivated to feed and prioritise the addiction – sometimes at the cost of other fundamental needs.

That loss of agency is something we as a society should be mindful of. While trading off the ongoing health legacy attached to tobacco for the ‘oh, it might not be as bad’ mythology of vaping might seem like some sort of instant policy fix for one of the greatest health disasters, it doesn’t solve the problem that people will still be addicted and will still be prioritising that addiction when it comes to living their life, not to mention other emerging health needs we currently don’t understand.

There are no prizes for guessing who’s waiting up the supply chain for that money to land in its bank account. Big Tobacco – the very same companies who have churned out cancer-causing products every single day, knowing full well that they will kill people when used exactly as intended – has been quick to hitch its profit-driven wagon to vaping as cigarette use declines.

Mr Bailey’s vapes for cigs health policy would no doubt be music to Big Tobacco’s ears. Promoting vaping on the basis that it might be better for addicts than smoking is exactly what its bottom line is counting on.
However, contrary to the TCCI’s assertion that vaping products containing nicotine are “far less harmful than smoking”, the World Health Organisation has concluded that tobacco products and e-cigarettes both pose risks to health and “the safest approach is to use neither”.

Surely the best approach from governments would be to support Tasmanians with nicotine addiction through smoking cessation programs, rather than adding to the complexity of improving health outcomes of Tasmanians. That would be a truly fresh approach. When it comes to setting health policies, I’d argue the WHO is wiser counsel than Big Tobacco – and replacing one Big Tobacco tool with another is not a policy setting Tasmania should be contemplating.

- Paul Lupo
CEO St.LukesHealth

There is a compelling observation from a current smoker in the pages of the State Government’s Tasmanian Tobacco Action Plan 2022-2026: “If it’s not around, you’re not going to buy it and you’re not going to smoke.”

This gets to the very heart of what action is needed if the government is serious about reducing the health impacts from smoking.

Pleasingly, the report also contains an action that the government will review aged-based laws in relation to the sale of smoking products and monitor the progress of New Zealand’s ‘Smokefree Generation’ which will outlaw the sale of tobacco products to anyone born after a certain date, eventually, in theory, eliminating tobacco use.

New Zealand’s smoking rate is about 11 per cent. Tasmania’s is 17.6 per cent – the second highest in the nation. On that basis alone, let’s hope the Government’s review of New Zealand’s determined plan to rid the country of a product that has caused untold death and misery translates very quickly into some level of action the plan’s title promises.

The fact is, the measures outlined by the action plan, while commendable, don’t exactly paint a different picture of how the State Government is going to tackle an issue that costs Tasmania lives and money every single day.
Worryingly, it also contains a nod to the Federal Government’s role in tobacco control, in what could be seen as an attempt to make it clear that the State doesn’t, can’t, or won’t have all the answers.

Mass marketing campaigns, extra assistance for people giving up, better education for young people – these initiatives have been around for decades, and we still have a situation where about one in every six Tasmanians is lighting up, putting them ever closer to serious, if not fatal, health outcomes.

That’s not to say these strategies haven’t played a significant role in getting to where we are, but there’s an argument that if we are going to get serious about making Tasmanians healthier, then we need to start shifting the dial and be much bolder and braver in our commitment to change starting with smoking – and vaping for that matter – that needs to go.

As I write this, just over 100 Tasmanians have died of COVID-19. Since the pandemic began two years ago, more than 1000 Tasmanians have died from smoking, yet, for some reason, you won’t find daily tallies of smoking deaths reported in the media, even though it’s killing us almost tenfold more.

The millions we as a state have spent on COVID-19 measures; the discipline with which we as citizens have largely adopted to get vaccinated, stay socially distanced, wear masks – yet one in every six of us still legally does something that is almost more certain to harm us in the long term. In some of our more financially poorer suburbs, that smoking rate climbs to as many as one in every three people.

Six years ago, then-MLC Ivan Dean fronted Parliament and stated that the smoking buck stopped there. He outlined his plan to implement a Tasmanian smoke-free generation, banning tobacco sales to people of a certain age for the rest of their lives.

It didn’t get up. Lack of government support saw Mr Dean shelve his Bill. At the time, the Government was quoted as saying it saw “problems in terms of how realistic and workable” the proposal was. For a time, it appeared a spinoff result may have been a raising of the legal smoking age to 21 or even 25, but that was stubbed out as well.

So now New Zealand is moving on creating a generation of non-smokers by simply banning them access to tobacco. And we’ll look at how it goes. In the meantime, a few more thousand Tasmanians will take up tobacco smoking, and, in time, many of those will die from it.

The fact that it took four attempts to get Voluntary Assisted Dying legislation passed through Tasmanian Parliament, even though afterwards most people seem to think it was the right thing to do to aid people suffering with incurable conditions and wondered why it didn’t happen sooner, should be a warning to legislators.

Let’s not make the same mistake with one of the biggest health challenges of our time. It is time for action – bold steps that would have the biggest single impact on improving the overall health of Tasmanians for generations. We have to get over how ‘workable’ a ban might be and get it done. Now is the time to start saving lives.

- Paul Lupo
CEO St.LukesHealth

Paul Lupo
St.LukesHealth CEO 

The State Government’s commitment to upgrading the health department’s digital health systems in the recently delivered budget should be commended.

As a new premier and health minister, Jeremy Rockliff must have had moments leading up to budget day where he wondered whether announcing $150 million health IT upgrade would have as much wow factor in the community as, say, announcing $150 million to upgrade some hospital wards, buying some new medical equipment, or employing more doctors, nurses, paramedics or allied health professionals.

Without doubt, any of those perpetual health shopping list items are arguably more likely to generate bigger headlines in news cycles where announcements about jobs and bricks and mortar investment tend to result in more clicks.

However less exciting it may be, making sure the health department can click is vital.

It’s a simple fact that digital systems underpin pretty much everything we do, whether it’s running a business, a club, or a multi-layered health system with more than 15,000 employees, four major hospitals, an ambulance service and a public health agency.

And if the digital infrastructure that is supposed to support those things doesn’t keep pace or isn’t fit-for-purpose, it leads very quickly to inefficiencies – and that is something any organisation would rather avoid, particularly the one charged with providing acute and emergency medical care to more than half a million people.

Take a situation where a patient who lives in Northern Tasmania recently had surgery at the Royal Hobart Hospital and is at an appointment with a private specialist in Launceston for a different condition. The specialist wants to prescribe a particular type of medication, but the patient thinks they may have had a bad reaction to that type of medication while in hospital, although they’re not completely sure it’s the same one.

With a new statewide patient record viewer connecting all public and private health providers, as being promised by the State Government, the specialist only needs to click the patient’s record to check, resolving the situation in seconds. Without such a system, the specialist needs to carve out time, potentially delaying other patients, to make calls or send emails requesting the relevant medical information.

In the meantime, the patient’s treatment is delayed, maybe to the point they’ll need to wait to get another appointment, which again comes at the expense of another patient trying to see the same specialist. 

Multiply the scenario by hundreds of patients in a similar situation, and it’s easy to see how bogged down a health system can become just trying to manage relatively minor day-to-day administrative processes. The life-and-death examples of these stall points don’t bear thinking about, but it doesn’t take a medical degree to believe they must occur, particularly in acute care or paramedicine situations.

Digital infrastructure that allows better communication between hospitals, general practitioners, community health providers, allied health services and specialists is a fundamentally important step to increasing health system efficiency.

With increased efficiency comes the ability for different parts of what is a complex health system to work together better. That, in turn, increases the ability for effective collaboration, and ultimately, leads to better patient outcomes.

While a patient may not necessarily be aware of it, their health and the medical care they are provided can often be dictated by just how well the system as a whole works to support them and the people they are going to for care.

We know the public health system struggles to meet demand. We know it is still dealing with the fallout from a global pandemic, and we know as a community we are getting older and sicker. Similarly, we know that simply throwing more and more money at the health budget and hoping it has some miraculous effect on acute medical pressures and surgical waiting lists isn’t working.

Making a targeted investment in the infrastructure that essentially dictates how our health system can even start delivering care, not to mention potential game changers in wider use of telehealth to better treat our far-flung population, is a smart play, and one for which the State Government should be congratulated for.

It is now up to the Government to get this spend right. With almost half a billion allocated for a 10-year digital health strategy, these first steps are critical and will define how effective our system is for a generation. For all of our sakes, the decisions and implementation around digital health must be strategic, or the health of the entire state will continue suffer under the strain of greater demand.

With the federal election over, Tasmania will look to newly minted Prime Minister Anthony Albanese’s Labor Government to deliver on its promises and get to work on the issues the electorate wants tackled as priorities.

As The Examiner reported prior to the election, one of the biggest issues identified by its readers was health care.

On that score, it was pleasing to see the ALP and the Liberal Party both commit during the campaign to deliver funding for the Clifford Craig research and innovation centre. This supports the memorandum of understanding funding commitment from the State Government, and all but guarantees this much-needed facility can be developed and operate.

Through this funding, the Clifford Craig Foundation will be able to enshrine Northern Tasmania as a medical research hub. A state-of-the-art medical research and innovation centre will attract medical professionals keen to further research in their chosen fields, bringing exceptional medical skills into our community. This will not only benefit the patients they treat, but will help teach the next generation of doctors, specialists, and other medical professionals. Importantly, their health leadership will drive better policies and better models of care.
There is no doubt that a number of Tasmanian seats feature prominently in federal elections. Bass, Braddon and Lyons were all key marginal battlegrounds and saw plenty of pollie and media attention during the campaign.

But just because the national media packs have headed home and the election spotlight has been switched off, it is not the time for the incoming government to forget about the issues that remain important to Northern Tasmanians.

Access to health care in regional areas remains a pressing issue for both state and federal governments across the country, and the regional areas of Tasmania are no different. It is no secret that people in regional areas are not just sicker, but have lower life expectancies than people in metropolitan centres.

This is a significant challenge for Mr Albanese’s government, which will need to carefully examine all options to deliver health care to regional areas, like Northern and North-West Tasmania, to ensure equitable health outcomes.

Labor’s commitment to establish and trial 50 urgent care clinics across the country, including one in both Launceston and Burnie will no doubt be warmly welcomed by anyone who has had to wait hours to access care in overcrowded emergency departments. There is no doubt that taking pressure off our acute public hospital system is of paramount importance when it comes to removing barriers to accessing timely care, and although the details of how such clinics will operate are not yet finalised, these clinics should help to improve a critical area of care.

However, to ensure long-term improvements to health care, governments, including this new one, must be brave and set their sights on fundamental reforms to improve the entire health system, not just one part of it.

I have previously argued that serious reforms need to be made by the federal government to help the private health sector take as much pressure as it can from the public system, and ultimately, deliver better health care for all Tasmanians, regardless of whether they are among the one-in-two who have private health insurance or not. This includes allowing insurers to fund procedures beyond acute hospital settings and stopping Australians having to pay some of the highest prices in the world for medical devices. Both these measures won’t cost the federal government a cent, yet would play a vital role in keeping people in the private health system and lessening pressure on the public system, as would restoring the 30 per cent private health insurance rebate for low- and middle-income earners.

St.LukesHealth will continue to lobby for the federal government to make systemic reforms to take pressure off our public hospitals. I’m pleased we, as an organisation, were able to have some conversations with candidates during the election, and look forward to presenting our ideas to incoming ministers and shadow ministers to help improve health outcomes for all Tasmanians.

Every incoming government has an over-riding mandate regardless of their policy platform and promises; that is, to make our communities and country better places for everyone. Mr Albanese’s opportunity to do that starts now. Amidst all the competing priorities he will no doubt have to manage in the coming weeks, I sincerely hope improving regional health care is at the top of his list.

Paul Lupo, CEO St.LukesHealth

For Tasmania’s health system, the federal election is looming as another missed opportunity.

Much needed structural reforms to our health sector simply haven’t been talked about. The few announcements that do concern health are based purely on providing additional funding sugar hits to try and help a system perpetually struggling to meet demand.

It is an unfortunate fact that election campaigns tend to focus on splashes of cash and bricks and mortar. A contest of ideas and policy around long-term reform of health systems simply doesn’t get a look in.

Parties of all colours seem only look at electorates, not outcomes. We need to shift our political narrative from short-term measures tied to election cycles to measures achieving long-term, sustainable outcomes where all Tasmanians can access the health care they need, when and where they need it so they can live healthier lives.

The importance of the private health system in the overall achievement of such goals is often, unfortunately, underplayed or altogether not recognised.

But it is a hard cold fact that more Tasmanians have some level of private health insurance than those who don’t. All up, more than 275,000 Tasmanians are members of private health funds. The logical outcome of this is that two out of every three elective surgeries performed throughout the country are done in the private system.

So, despite only performing one-third of the elective surgery load, the public system continues to groan under pressure of growing public hospital elective surgery waiting lists. People stuck on these waiting lists often develop more complex medical conditions and complications simply because they cannot be seen anywhere near clinically recommended timeframes. It then falls entirely on the taxpayer to provide even more resources to deal with a person who is much sicker than what they were when first diagnosed as needing surgery. Health systems should be geared to make people better, not contribute to a decline in their health.

At a time when cost of living pressures are crunching family budgets, people who are putting their hand in their own pocket to help fund their health care and take pressure off the public health system, on top of contributing to the funding of the public system, need to have every incentive possible to keep their private insurance and not become 100 per cent reliant on the public system for their health care.

As a not for profit private health insurer, St.LukesHealth would like nothing better than to be able to help as many people as possible to reach outside the acute public hospital system to access their care more quickly and in a more affordable fashion. We firmly believe it is better for people to stay out of hospital wherever possible and deliver care with the aim of keeping them out.

Unfortunately, government policy settings enshrine hospitals and hospital admission as the only gateway to care pathways.

Under current outdated regulations, private health insurers are only able to fund procedures when they are performed in an admitted hospital setting.

Private health insurance should be able to provide cover for procedures done outside of a traditional hospital, where clinically appropriate, by non-hospital health providers which are currently undertaken in a hospital.  Services like wound care, intravenous infusions, rehabilitation and other post-operative procedures could be undertaken under the supervision of a general practitioner, or other health care providers in a community setting.
 
This would have the immediate effect of reducing inpatient demand at our public hospitals.
 
Importantly, such a reform would allow fit-for-purpose patient care to be offered at a lower cost, with increased accessibility, and a focus on early intervention that addresses health issues before they become serious.

We need to ensure that private health insurance regulation provides insurers with the flexibility required to keep pace with modern care delivery settings, the changing health needs of our community and actually make it easier for people to access the care they need when they need it outside of hospital, which would in practice keep them healthier or reduce the length of a hospital stay.

Private health insurance reform is a critical piece of the health picture. Without a robust private health system, the public hospital system will continue to buckle and lurch from crisis to crisis.

Tasmania badly needs health reforms which will drive fundamental change in our health system.

Policymakers need to start seeing the health system in its entirety and allow people to use private health insurance to stay out of hospital wherever possible, not just for the good of themselves but for the good of the entire State.
 
Paul Lupo, CEO, St.LukesHealth.

One of the biggest challenges for people in regional areas is the access to health care. It’s not so much that the services don’t exist, they’re just a long way away, or difficult to get to.

People on the North-West and West coasts of Tasmania know this better than most.

When it comes to accessing surgical procedures, more than one in three people who live in the northwest must travel to Launceston to get the service they need.

At this federal election, St.LukesHealth has lobbied politicians in an effort to help people access services closer to their home, or even in their own home. As a private health insurer – the largest on the North West Coast – we would love to be able to help more people reach outside of the acute hospital system and access the care they need in community-based settings.

But under current outdated regulations, private health insurers are only able to fund procedures when they are performed in an admitted hospital setting.

We need to be able to deliver new ways of care delivery which are not only more convenient for patients as well as more cost-effective. Private health insurance should be able to provide members with cover for procedures currently undertaken in a hospital setting outside of a traditional hospital, where clinically appropriate, by non-hospital health providers.  This would include services like wound care, intravenous infusions, rehabilitation, and other post-operative procedures that could be undertaken under the supervision of a general practitioner, or other health care providers in a community setting.

This would have the immediate effect of reducing inpatient demand at our public hospitals and focus on early intervention that addresses health issues before they become serious.

For the good of our community, where more than one in two Tasmanians are covered by health insurance,  governments need to ensure that private health insurance regulation provides insurers with the flexibility required to keep pace with modern care delivery settings, the changing health needs of our community and make it easier for people to access the care they need when they need it outside of hospital, which would in practice keep them healthier or reduce the length of a hospital stay.

Tasmania needs policies that will allow for genuine reform in the health sector.

Governments need to support a modern and dynamic health delivery approach that sees people provided with timely and appropriate care while keeping them out of hospital, not enshrining hospitals and hospital admission as the only gateway to care pathways.

Private health insurance reform is a critical piece of the health picture. Without a robust private health system, the public hospital system will continue to buckle and lurch from crisis to crisis.

Giving people more options to access the health care they need, close to where they live, will drive better health outcomes for Tasmanians, particularly in regional areas.

It is no surprise that the issue of health care has again been prominent in the first half of the federal election campaign.

What is surprising, and disappointing, is the lack of policy commitments the major parties have shown thus far to enable genuine reform in the private health sector – reforms that would lay a platform for strengthening the entire health system, increasing access to care and services and ultimately boosting health outcomes for all Tasmanians.

The private health system plays a critical role in reducing demand and pressure in the public system.
The more people who can access care and treatment in the private system, the less pressure there is on Tasmania’s public hospitals. This means the public system is there for people who need it the most.

There are more Tasmanians with private health insurance than without. More than 275,000 Tasmanians, or 52 per cent of the population, have some level of private cover.

Unfortunately, the continuing COVID-19 pandemic has placed even more pressure on the public system. Elective surgery waiting lists are ballooning against a backdrop of surgery slowdowns, staff shortages and ward closures. In just the last week we have seen an entire medical ward at the Royal Hobart Hospital closed to admissions due to COVID-19. Combine those immediate and significant impacts with longer-term trends of an aging population and an increasing prevalence of chronic disease, and the pressure only looks set to increase into the future.

Governments need to implement reforms that support a modern and dynamic health delivery approach that sees people provided with timely and appropriate care while keeping them out of hospital, not enshrining hospitals and hospital admission as the only way to deliver specialised medical care.

Under current regulations, private health insurers are only able to fund procedures when they are performed in an admitted hospital setting.

Private health insurance should be able to fund procedures outside of a traditional hospital, where clinically appropriate, by non-hospital health providers.  Services like wound care, intravenous infusions, rehabilitation and other post-operative procedures could be undertaken in a community setting and appropriately funded by Private Health Insurance. This would enable privately insured members to access modern care delivery, in their preferred setting.
 
This would have the immediate effect of reducing inpatient demand in our hospitals and help decrease instances of bed block in hospitals.
 
Importantly, such a reform would allow fit-for-purpose patient care to be offered at a lower cost to consumers, with increased access, and a focus on early intervention that addresses health issues before they require hospital inpatient treatment.
 
St.LukesHealth members have already recognised the need for these type of policies. One of the strongest messages from a recent member survey was that improving health care in northern Tasmania goes well beyond providing acute hospital care. Instead, we need a major increase in health care system capacity, both in terms of an increased number of services as well as a significant improvement in those services already available, to meet the future needs of our north and north-west communities. 
 
A collaborative, well-functioning network of health care services that people can access close to their homes, families and communities, especially in regional settings, that afford high quality health care without the need for unnecessary hospital admissions is critical to achieving this.
 
The regulations applying to private health funds need to be reformed. The limitations that restrict private insurers from funding services outside of a hospital admission are in turn limiting the ability of the private system to relieve pressure from the public system.
 
It is in everyone’s interest to have a health system that is able to respond and provide the very best in health care when it is needed. No-one should have to endure hours or even days stuck in emergency departments, nor should anyone have to wait years on public hospital elective surgery waiting lists.
 
As we get older and sicker, and the system gets more and more stretched, governments need to act to allow the private system to help provide better health outcomes for all Tasmanians.
 
Health reforms aren’t easy. They take a government with resolve and preparedness to be bold, with the vision to implement changes for long-term benefits, not short-term political wins. Decisions around health care cannot be limited in scope to election cycles or simply increasing taxpayer funding without addressing ways to make the entire system work more effectively.
 
There is an opportunity right now for the next government to make fundamental changes that can underpin an improved health future for Tasmania. It is an unfortunate fact that our public system permanently struggles to cope with demand, and the state’s overall health will not improve unless changes are made to better support the public system.
 
Paul Lupo, Chief Executive Officer, St.LukesHealth

A compelling opportunity now exists to revolutionise Tasmania’s healthcare system, but it requires the entire network – including governments – to be brave, recognise that opportunity and to work together to bring it to reality.

It was shown to be possible during COVID when the entire Tasmanian healthcare network, both private and public in league with government, demonstrated the ability to work cohesively in the face of the most serious community health crisis faced in a generation.

As challenging as COVID was, there are other challenges which pose much greater long-term difficulties for the health system.

As a population, it is well documented that we are getting older. At the same time, we are getting sicker with increasing rates of chronic disease. The result of this is our public hospital system is constantly struggling to meet the health needs of the people who rely on it.

Public hospital waiting lists are ballooning to record levels. Emergency departments are full. Hospital beds are blocked to the point where even patients who require admission have to wait because there are simply no beds.

It isn’t always well understood, but the private health system plays a critical role in reducing demand and pressure in the public system.

Put simply, the more people who can access care and treatment in the private system and not rely entirely on the taxpayer-funded resources of the public system, the less pressure there is on Tasmania’s public hospitals. This means the public system is there for people who need it the most.

For context, more Tasmanians have private health insurance than do not. Just over 275,000 have some form of private health insurance, representing 52 per cent of the population. More than 130,000 of these live in the two southern electorates of Clark and Franklin, and many of them are on low to middle incomes.

The federal government understands the benefits of keeping people in private health care where they are not reliant on taxpayer funded beds, staff and resources for their care. So much so, that a means-tested private health insurance rebate is paid to help people on lower incomes access their health care outside of the public system.

The rebate commenced at 30 per cent. It has been eroded over the years to the point where in some cases, it is less than 25 per cent. While a five per cent erosion may not seem significant, it represents $23 million disappearing from the pockets of Tasmanian policy holders on low to middle incomes every single year.

This can force people back into a public system, where governments are funding 100 per cent of their care. That erosion has contributed to public hospitals being full and elective surgery waiting lists remaining stagnant.

The simplest and most cost-effective way the federal government can ease pressure on the public system is to restore the private health insurance rebate to 30 per cent and give people every incentive to access health care in the private system.

Tasmania needs policies that will allow for genuine reform in the health sector.

Governments need to support a modern and dynamic health delivery approach that sees people provided with timely and appropriate care while keeping them out of hospital, not enshrining hospitals and hospital admission as the only gateway to care pathways.

Under current outdated regulations, private health insurers are only able to fund procedures when they are performed in an admitted hospital setting.

Private health insurance should be able to provide cover for procedures currently undertaken in a hospital setting outside of a traditional hospital, where clinically appropriate, by non-hospital health providers.  Services like wound care, intravenous infusions, rehabilitation and other post-operative procedures could be undertaken under the supervision of a general practitioner, or other health care providers in a community setting.
 
This would have the immediate effect of reducing inpatient demand at our public hospitals.
 
Importantly, such a reform would allow fit-for-purpose patient care to be offered at a lower cost, with increased accessibility, and a focus on early intervention that addresses health issues before they become serious.

We need to ensure that private health insurance regulation provides insurers with the flexibility required to keep pace with modern care delivery settings, the changing health needs of our community and actually make it easier for people to access the care they need when they need it outside of hospital, which would in practice keep them healthier or reduce the length of a hospital stay.

Private health insurance reform is a critical piece of the health picture. Without a robust private health system, the public hospital system will continue to buckle and lurch from crisis to crisis.

A world-class healthcare system that meets the challenges of a regional state such as Tasmania is absolutely possible and can be used as a beacon for challenges faced by those living in regional Australia. But we must be willing to take a holistic approach and work together toward the ultimate goal of good community health that we all share.
 
Paul Lupo 
CEO of St.LukesHealth

Paul Lupo
CEO, St.LukesHealth

The federal government must commit funding to build a world-class medical research centre in Launceston. 
 
The Clifford Craig Foundation has been leading medical research in Tasmania for three decades, and its proposed research and innovation centre would ensure Launceston remains at the forefront of medical research along with capitalising on the many benefits that would bring. It would also enable an appropriately sized and funded research department for both the North and North West.   
 
“A world-class research and innovation centre would set a platform for the attraction, recruitment and retention of top line medical professionals, researchers, technicians, academics and students to the Launceston and North West areas,” says St.LukesHealth CEO Paul Lupo. “Aside from direct patient outcome benefits in the short and long term, it would also provide an immeasurable boost to the formation of health policy, particularly within a regional context, and build on Northern Tasmania’s reputation for learning and health excellence.”
 
A dedicated research and innovation centre with the resources to increase both the quantity and quality of medical research would: 

• Put Launceston on the map with a renowned research and training precinct, making the region a top choice for clinicians in a competitive market.
• Attract further research investment and employment to rural and regional Tasmania.
• Allow clinicians to conduct truly local research, targeted to patient needs and leading to a real healthcare improvement in north and northwest Tasmania.

“The importance of having a cutting-edge research and innovation centre should not be underestimated when it comes to the recruitment of top line medical specialists. The Clifford Craig Health Research and Innovation Centre will be the critical third pillar, working in tandem with the expanded LGH masterplan and proposed Calvary co-located private hospital. The centre will ensure the best clinicians come to practice in these state-of-the-art facilities, enhancing the quality of regional healthcare as well as ensuring the best possible health policy development.” 
 

Dr Jerome Muir Wilson
Managing Director, Launceston Health Hub

A world-class research centre will also help draw more desperately-needed general practitioners to Tasmania’s north. Regional GPs are in high demand, and we’re competing with national and international markets to attract them. Leading GPs want to help not only the patient in front of them, but also the population at large through research opportunities. Clifford Craig’s proposed Health Research and Innovation Centre would be a major point of difference, setting us apart from other regional centres.

There is currently no dedicated GP research centre in Tasmania. However, most of the healthcare we receive doesn’t happen in hospital: 90% of Tasmanians will see their GP each year. We badly need Tasmanian-specific general practice research to help us better understand local health needs and improve the state’s health outcomes.

This is especially critical in terms of preventative healthcare: studies done in a Sydney institute don’t translate to a regional Tasmanian setting. We know early intervention and access are so important, but we don’t have the research capacity to know where to focus local preventative healthcare efforts. The Clifford Craig Health Research and Innovation Centre would be a gamechanger to this end, addressing health issues early and keeping more people from ever needing hospital treatment.

Tasmania already has a good track record on training GPs. We have a retention rate of around 80% for GPs who train in the state, with pass marks up around 90%, well and truly above the national 75% average. The Clifford Craig Health and Innovation Centre is the missing piece of the puzzle in attracting and retaining further GPs, providing research opportunities that would be valuable for the whole state.

As the vote-vying continues in the lead up to the federal election, Tasmanians will no doubt hear politicians declare just how important healthcare is, and how committed they are to fixing burgeoning wait times.

They should bear in mind that about 10,000 of those Tasmanians are currently stuck on stagnant public hospital elective surgery waiting lists. Many of them will be living with pain. Many will be faced with a reduced quality of life as they continue to wait.

Those patients would be right to wonder why, despite so many promises from successive governments to fix the public health system in Tasmania. Elective surgery waiting lists continue to climb, and health outcomes are poorer compared with other states. This is only set to worsen as we face an aging population with increasingly complex health needs.

This election represents a golden opportunity for all parties to make a health policy decision that would not only drive down waiting lists, but also provide more timely access to health care for every single Tasmanian.

The policy is simple: restore the means-tested private health insurance rebate.

The rebate was initially introduced to cover 30 per cent of the cost of a private health policy. It puts private health within the means of more people, thereby freeing up space for others in the public system. This rebate has not kept step with increasing health service costs, meaning it now covers less than 25 per cent of the cost of a policy for low and middle-income earners.

Restoring the rebate to 30 per cent is the most effective way the Australian Government can help provide surgery and hospital access to all Tasmanians, not just those with private health insurance.

It isn’t well recognised, but Tasmania’s public hospital system relies on a healthy and robust private health system. For every person who can access private health care, more resources are available to treat people in the public system. Conversely, every person forced to leave their private health insurer becomes another person who the public system must find the room, staff and funding to care for. Restoring the rebate can stop it.

While a five per cent erosion of a means-tested rebate may not sound large, in pure dollar terms, it represents $23 million disappearing from the pockets of Tasmanian policy holders every single year.

The next Federal Government needs to step in during its first term to ensure people’s ability to take up and maintain private health cover – and stay out of the public system – is maximised. More private demand will also incentivise more investment into new private hospitals and clinics, increasing capacity further.

This has become more critical than ever as the state continues to battle the impacts of COVID-19, which are far from over.

Just last week the Royal Hobart Hospital was forced to again reduce elective surgery to help manage COVID-19 pressures. A few weeks ago, the pandemic paused elective surgery at every public hospital in the state.

Of the more than 10,000 Tasmanians parked on public hospital surgical waiting lists in January, more than 1,000 of these were classed as category one patients. If you are unlucky enough to be a less-urgent category three patient on a list at either the Launceston General Hospital or the North-West Regional Hospital, you will wait about a year for your surgery.

Tasmanians are rightly worried about the ability of the public system to provide the healthcare they need. The ongoing struggles of the public health system, exacerbated by COVID, has seen increased investment in private health insurance: more than one in two Tasmanians now hold a policy.

Governments must start seeing the health system as a single entity – not merely as a distinct and separate private and public system. It is a point in fact that two out of every three elective surgery procedures in Australia are done in the private system. The systems are critically linked; it is critical that people have every encouragement to remain in the private health system to provide a better access balance for the community.

Cost of living pressures are making this more difficult to achieve. Tasmanians are currently feeling the sting of rapidly increasing property and rental prices, and rising fuel prices both at the bowser and on shop shelves as producers pass on added costs to consumers. This looms as a difficult decision for Tasmanians to make in balancing the need for timely access to health care with other concerns in the family budget. The Federal Government can assist Tasmanians in not having to choose one over the other.

It is time for the Australian Government to act and restore the private health insurance rebate, for the good of every Tasmanian.

Paul Lupo is the CEO of St.LukesHealth – Tasmania’s leading not-for-profit health insurer.

A compelling opportunity now exists to revolutionise Tasmania’s healthcare system, but it requires the entire network – including governments – to be brave, recognise that opportunity and to work together to bring it to reality.

This is not just ‘pie in the sky’ thinking.

It was shown to be possible during COVID when the entire Tasmanian healthcare network, both private and public in league with government, demonstrated the ability to work cohesively in the face of the most serious community health crisis faced in a generation.

Now, as we continue to deal with the virus, a vital further step towards revolutionising the healthcare system has been taken in the north of the state, with plans to develop a new co-located private hospital alongside the Launceston General Hospital – one which will provide complementary rather than competitive healthcare services.

Calvary Tasmania, which is developing the new facility, is incorporating input from key health stakeholders and northern health leaders, and collaborating with the LGH to widen the range of services they collectively provide the community. That decision represents an historic breakthrough in meaningful cooperation and is to be applauded.

Further investments for overnight and same-day facilities continue throughout Tasmania, with a new hospital project by Nexus in Hobart, a day hospital investment from Cura Day Hospitals in Launceston, and investments in gastroenterology and ophthalmic care in Devonport. These are all positive examples of private investment delivering better healthcare outcomes for Tasmanians.

The challenge now is to carry this progressive thinking forward by adopting a more collaborative approach right across Tasmania’s healthcare network.

The COVID experience and the Calvary decision demonstrate that partnership, built on a spirit of cooperation, is not just possible, it is achievable, albeit it has been elusive for too long. The cause of that dysfunction is the result of several factors – the joint involvement of federal and state governments in healthcare funding; the sheer size of the system itself and the challenges of operational management; the structural division of responsibilities which has led to silos; and an introspective culture that has largely failed to understand, let alone meet, community needs and expectations.

What is needed now is a collaborative and holistic approach to our state’s health system across both the private and public sectors, in primary and hospital care, led by government – both federal and state.
Governments can make things happen. They can be the drivers for change and better outcomes. However, they need to recognise, accept and embrace an idea, a concept, a vision – one which offers tangible benefits to the community as well as for the economy.

Just such a vision is now within reach.

St.LukesHealth believes with the will and commitment of governments, Tasmania has the opportunity to develop a world-class healthcare system, with the creation of regional medical hubs that provide the right services in the right settings. The co-location in Launceston of the proposed new Calvary hospital alongside the LGH is one such promising example of what is possible when we work together.

This will set a platform for attracting top line medical professionals, researchers, technicians, teachers and academics to Launceston, provided governments are willing to start the ball rolling by establishing some of the initial ancillary services and infrastructure needed. Once government funding starts, private investment will follow.

With this in mind, we urge the Tasmanian government, leaders of Tasmania’s healthcare networks, and members of the general public to join with St.LukesHealth in making this vision of a world-class health system an issue at the forthcoming federal election.

We need to look beyond using the historic problems of the healthcare system as a cause for complaint and outrage.  We have done that in the past, but still the problems persist. Instead, let’s raise the bar and challenge our political leaders to see beyond band-aid measures and electioneering gap-funding.  Let us demonstrate the opportunity to make a positive investment in a vision that is both achievable and worthwhile – starting with a regional healthcare hub that can become the envy of the nation and a magnet to all types of healthcare professionals from other states and overseas.

The social and economic dividends are enormous. 

It will deliver better health outcomes across Tasmania – a region whose population is generally older and less healthy than other parts of the nation.  That in itself will deliver a cost saving.

The overall economic impact will be ground-breaking, not just during the development phase, but with the subsequent migration to northern Tasmania of highly skilled healthcare professionals and with the inevitable flow of private investment.

And that should not be the end game, but merely the starting point.

This opportunity goes beyond political alliances, and as such, we should use the coming election to secure commitments from the major parties, as well as from individual candidates to take-up this vision and to bring it to fruition.  

A world-class healthcare system that meets the challenges of a regional state such as Tasmania is absolutely possible and can be used as a beacon for challenges faced by those living in regional Australia. But we must be willing to take a holistic approach and work together toward the ultimate goal of good community health that we all share.

Paul Lupo
CEO St.LukesHealth