Dr Dayna Duncan from AMA NT on challenges at RDH

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Episode Transcript

Speaker 1 (00:00):
Head across right now and speak to Dr. Dana Duncan,
the head of the, well, the vice president of the
AMA here in the Northern Territory. Good morning to you, Dr. Duncan.

Speaker 2 (00:09):
Good morning, Katie.

Speaker 1 (00:10):
We've finally got you. Sorry about our tech issues. Thank
you so much for your time this morning. Now, Dr. Duncan,
there's been a lot of discussion around health again this
week after the peak bodies representing the Northern Territory's doctors
and nurses called for that code yellow to be reinstated
at Royal Darwin Hospital. labelling the situation as a dangerous

(00:31):
state of disaster and warning that Territorians are being placed
at immediate risk of harm. From your perspective, how are
things tracking at the moment at our major hospital and
what are the staff telling you?

Speaker 2 (00:44):
Look, we're really balancing on knife's edge most days at
RDH and we've normalised a state of disaster. And it's
getting to the point that we're always very careful to
not say that it's unsafe for patients because... Our doctors
and nurses are working so hard to deliver health care,
but it's gotten to the point now that it's unsafe

(01:04):
for our staff. And we're in this downward spiral where
our staff are becoming so burnt out. They're suffering from
moral injury from not being able to deliver the health
care that they want to and that their patients deserve.
And then they're leaving. And that leaves us with the
same amount of work to be delivered by fewer staff.
And we're continuing to lose staff. We're continuing to burn

(01:26):
people out and it's absolutely not sustainable.

Speaker 1 (01:30):
Dr Duncan, we heard, I mean, to me, that is
completely concerning. The fact that staff are reaching that burnout
point where they're then wanting to leave is not a
good thing in any way, shape or form. I mean,
over the last 24 hours, well, yesterday on the show,
we heard from Fiona Renshaw, who had explained that the

(01:50):
new 32-bed ward is progressively coming online and also said
that a rapid assessment clinic's going to be phased in
in a staged approach. They are also looking at utilising
the Cruella ward at different times or in different ways
at the private hospital. Will any of that make a difference?

Speaker 2 (02:11):
There's two issues here. The first is an acute and
serious overcapacity crisis. And these pressure release valves are important
to have and important to utilise. And that includes things
like the new 32-bed ward, the Corella ward. But these
are only Band-Aids that stop the acute crisis. They don't
fix the long-term problem. And the long-term problem is a

(02:34):
matter of inputs and outputs into the hospital. And that's
more about the primary care space and the aged care
space rather than anything that goes in the hospital itself.
So we're really urging all stakeholders in health to work
with the AMA and ANMF to look at how we
can fortify our whole health system to prevent this from

(02:57):
continuing to happen in the future.

Speaker 1 (02:59):
So obviously you're talking more long-term. What is needed longer term?
Are we just talking new hospital? What do you mean?

Speaker 2 (03:08):
New hospital is one small part of the picture, but
really to prevent this overcapacity crisis from continuing to happen,
it's about preventative primary care, preventable hospitalisations, and making sure
that everyone's working to their top of scope and capacity
in community. So looking at remote clinics, making sure there's

(03:28):
enough space in the health clinics and enough housing that
we can have doctors out in community and remote area
nurses delivering as much care as possible to prevent people
from needing to come to Darwin. But also in primary care,
both in Darwin and in the community, making sure that
people are getting that preventative health care. So we want

(03:51):
people to be getting their health checks and identifying heart
failure and diabetes and COPD early and treating it before
it ends up in a hospitalization. Same for getting your vaccinations,
getting your annual health check. So that's the input that
needs to be fortified and strengthened. We need to look

(04:12):
at the discharges from hospitals. So the infrastructure project that
is most meaningful that's going on at the moment is
the new residential aged care facility in Palmerston. That's actually
going to make a meaningful difference about getting people out
of hospital.

Speaker 1 (04:28):
It's not quite there yet, though, is it, Dr Duncan?
I mean, we know where it's meant to be built.
We know that a provider's been announced, but we're still
waiting for the shovel to hit the dirt.

Speaker 2 (04:38):
Absolutely. And as you just said about the Corella Ward
and about the new 32-bed ward, these projects take time.
And so that's why we need these Band-Aid solutions in
the short term while we work on the long-term solutions.

Speaker 1 (04:52):
Look, there's no doubt that there is so much work
that needs to happen here. I mean, from everything that
you are saying as well, from a new hospital, we
know that we've obviously already got the funding when it
comes to aged care. But even with that preventative care
that you're talking about out in the remote clinics and
the need for those clinics out in remote areas as
well and making sure we've got the staff out there.

(05:13):
I mean, it's all going to cost a heck of
a lot of money and there's no doubt the Northern
Territory Government cannot go that alone.

Speaker 2 (05:20):
Yeah, absolutely. But there are also low-cost solutions that can
be implemented and we can look at things like the
funding for urgent care clinics. How can that be better
utilized at a federal level to deliver preventative care rather
than band-aid care? We can look at outpatient services that
are existing. How can we make sure they're used to

(05:43):
their maximal capacity so that people can get their elective
specialist clinics and surgeries and not end up as acute
patients in hospital instead? And there's not a simple solution.
There's not a blanket solution. It's about going to each
of these departments and areas and asking them what they
need and then delivering what they need to deliver their

(06:03):
maximal scope and capacity of care.

Speaker 1 (06:06):
So even with the urgent care clinics, what could we
be doing a little bit differently?

Speaker 2 (06:10):
I mean, the AMA position on urgent care clinics is
pretty clear. They don't fix the hospital logjam. They cost
more than primary care does. And they deliver less outcomes
than primary care does. So if we could deliver one
message to Territorians and community members, it would be go
to your GP, get your annual health check and focus

(06:32):
on preventative care so that we can reduce the number
of people ending up in hospital and facilitate them living
well in community instead.

Speaker 1 (06:40):
I guess so. Like even for myself as a parent,
I've had to take my kids to the urgent care
clinic where we suspected a broken bone and then we
had another child with a burn. And it did mean
that we weren't presenting to Royal Darwin Hospital and we
were able to get that treatment there. Surely that's a
good thing.

Speaker 2 (06:56):
The thing that's blocking up RDH and hospitals around the country,
and we have data from the Australian College of Emergency Medicine,
from a number of reports and inquiries that have been
done into the urgent care centres, that these low-level, simple
medical conditions aren't what is blocking up EDs and aren't
what's blocking up hospitals. We can deal with these things

(07:18):
quite simply and quickly and get them in and out
of the ED. The problem is the patients who need
to be admitted to hospital and are backing up to
fill the EDs and therefore taking beds that can't be
used for other things.

Speaker 1 (07:30):
Well, Dr Duncan, before I let you go this morning,
I see that you have also been honoured with a
top national training award. Congratulations.

Speaker 2 (07:38):
Thank you so much, Katie.

Speaker 1 (07:39):
I know you're not someone who wants that, you know,
who wants that highlighted, I'm sure, Dr Duncan, but good
on you. A big congratulations. I think it's really important,
of course, to recognise the wonderful work of Territorians. So
a huge congratulations to you.

Speaker 2 (07:54):
Thank you so much. And absolutely a reflection of the
opportunities that come from working in the Territory. It's the
best place in Australia to be a doctor.

Speaker 1 (08:00):
Spot on. Hey, and I think that goes without saying
across so many industries as well. People feel like they
can reach their glass ceiling, I think, in the Territory,
but there's so much you can do in the Territory
as well, right?

Speaker 2 (08:11):
Absolutely. Things that I would not have had the opportunity
to do until a much more senior stage in my
career in the city, I've been able to be involved
in medical advocacy, education at a level that people in
the city have to wait years to work alongside these
greats of healthcare advocacy and education. So I'm really appreciative
of the opportunities here in the Territory.

Speaker 1 (08:33):
Oh, good on you. Well, Dr. Dana Duncan, good to
catch up with you as always. And sorry about those
tech issues earlier. We'll catch up with you again soon.

Speaker 2 (08:40):
No worries. Thanks so much. Thank you.

Speaker 1 (08:41):
Thanks so much.