Episode Transcript
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Speaker 1 (00:00):
Now we know that a review into Saint John Ambulance
has reportedly flagged serious concerns about clinical governance within the
private service. Well, that's according to a report by the ABC,
who obtained a copy of this confidential report, which found
some processes may have led to patient debts and significant
risk to staff. The report also recommended some life saving
(00:22):
procedures be urgently suspended until more senior directors are appointed
and regular auditing is in place. Now joining me in
the studio is Saint John's Director of Ambulance Services, Andrew Thomas.
Good morning to you, Andrew, morning, Katie. Good to have
you in the studio. Now, when was the report commissions?
Speaker 2 (00:42):
So, the Northern Territory Health spoke to us in February
of this year and advised that they wanted to look
at doing a report to review our safety and our
governance structures and systems, which we like, like any organization,
wells those opportunities to look at services that we provide
(01:04):
and the structures and systems that we have behind them,
particularly when we're talking around things like patient safety. So
absolutely we welcome the opportunity for someone to come in
and review what we've done. We had in late or
in through twenty twenty three been undertaking a review process
and looking at what we did and how we did
(01:26):
our clinical governance and our orditing and reviewing. And that
was on the back of we've seen significant growth in
our workload and caseload over the last four years. In fact,
I was looking at the figures that we've got at
the moment that's going into the report on Government Services
that's showing that, you know, we've sent a twenty percent
increase in workload and patients that we've seen over the
(01:48):
past four years. So that's a lot of extra workload,
particularly for our governance team that does the orditing and
reviewing of what we do and flows into then following
up on those you know, patient concerns, any any complaints
or anything that come out of feedback. So we wanted
to look at how we can improve that system and
(02:08):
so that involved us actually you know, building up a
dedicated patient safety and quality team and we employed a
dedicated manager into that role. So we've been on a
sort of a process of improvement and unfortunately, I suppose
that's been having to be done within the constraints of
the funding bucket that we have.
Speaker 1 (02:30):
Yeah, so.
Speaker 2 (02:32):
You know, by the time we received the report, we
were able to see that, you know, in that period
of time that lapsed between February when it was commissioned
and then March when the when doctor Ellis came and
undertook the report. Yeah, or his review over here, that
a lot of this there's still lots of work to do.
We know that well.
Speaker 1 (02:51):
And look, I guess the thing is fundamentally, for a
lot of people listening this morning, what they will want
to know is that any service that they received from
Saint John that it is up to the standard that
is expected and that they that they want it to be.
I know that that, you know, fundamentally, like you've touched on,
the report was commissioned by NT Health. Now my understanding
is that it was after the Darwin and Allie Springs
(03:13):
emergency departments had raised concerns about what you know, they'd
called in quotation marks substandard care bi ambulance staff but
Andrew what like what is considered substandard care?
Speaker 2 (03:26):
Yeah, so look, you know, part of our auditing process,
and you know, I firstly want to obviously acknowledge that
you know, this report coming out in the way it's
been leaked and a lot of the you know, the
headline sort of topics that have come out of this.
You know, I can imagine that obviously it does raise
some concerns from the community, and I first we want
to reassure the community that you know, our paramedics and
(03:49):
our staff that we have, you know, highly qualified professionals.
They've gone through industry training and standard paramedics came through
a university degree. They do a twelve month minimum twelve
month internship to become qualified to use our guidelines that
are approved and endorsed. So, you know, while you know,
(04:13):
there were some concerns raised from the ED departments in
Alice Springs and Darwin around some of the care that
they had seen come through, it was a small number
of cases.
Speaker 1 (04:24):
Were there any exit like were there examples given to
you guys as to what they had deemed to be
care that wasn't up to the standard that they'd expected,
or like we're kind of given the opportunity to see that.
Speaker 2 (04:36):
Yes, So as part of the review, doctor Ellis requested
for us a number of cases that you know, he
obviously had received from from the Department Health or the
ED departments, of which nearly all of them we had
already internally reviewed, and most of them we've undertaken, you know,
(04:57):
you know, changes to our structures and systems care that
not up to the standard. It might be that it's
a variantation outside of what our current guideline is, or
you know, maybe a dosage issue in terms of some
of the medication that's been given that you know, the
paramedic at the times made a choice and in hindsight
that you know, maybe that dose might have been a
(05:18):
little high or underdosed, or it might or might not
have been the correct choice, knowing later on. And so
that's a learning opportunity. And we know that within healthcare
when we're talking around high acuity, you know, urgent responses
to patients someone else, that we want to make sure
that you know, those paramedics are making, you know, those
decisions at the time in high pressure situations, no different
(05:41):
to health services and other well and the.
Speaker 1 (05:44):
Thing is they are under some bloody stressful situations. I mean,
earlier in the week you and I had spoken about
the fact that somebody was literally on the roof of
one of your ambulance vehicles while you're trying to treat someone.
You know, we'd also spoken about the fact in Allie
Springs that there were vehicles circling around the ambulance. Some
of these situations that our paramedics are in are very
(06:06):
I would imagine, quite frightening ones. Now, I know that
that's not every single day when you're out trying to
look after somebody. And I'm certainly not trying to make
excuses for what may be deemed substandard you know, is
substandard care. But what I do know is that you
guys go out to help people in their hour of need.
I mean, what would you say to any territory in
listening this morning who might be thinking to themselves, you know,
(06:29):
this report has demonstrated that, you know then that they
may not get the service delivery that they expect from
Saint John.
Speaker 2 (06:37):
So I think first I'd like to say, as I
said before, our paramedics come to work every single day.
They're highly trained, their you know, got wealth of experience
and knowledge through the academic learning and then obviously the
on learning that they get on road up here and
the experiences that they get. And we know that across
the territory, some of the workload up here is it's
(07:00):
too come to the Northern Territory. No paramedic ever goes
into a situation to make an error or cause harm
to a patient that goes against everything that that they
want to and what they believe and what they take
as from their job. But you know, we do know
that as we said, you know, with increasing workload pressures,
with the other pressures coming on board, we the report highlights,
(07:23):
you know that some of the issues that we're facing
in terms of those workload and lack of resources and
the funding and the capacity not just in our frontline staff,
but in within the support services and the governance systems
to make sure that you know, we can continue to
make sure and monitor what we're doing. But as I said,
you know, our paramics don't go to make an error,
(07:45):
and and you know when a paramedic goes there and
makes some judgment calls and it may not be correct,
obviously it absolutely you know, apart from we know that
it has an impact on the patient and you know,
we always make sure that then that's been reported through
the hospital so they can be fixed up. But you know,
it plays heavily on those paramedics as well, and so
(08:08):
you know, we take an approach that it's a when
we're looking and reviewing these cases, how can we make
improvements to the system, How can we make improvements to
the safety structures and processes, and how can we support
those paramedics to then you know, work through that process
so that they can continually improve and that that forms what
(08:28):
is good governance.
Speaker 1 (08:29):
What have the paramedics sort of spoken to you since
you know this report has been like, how are the
staff feeling over the last twenty four.
Speaker 2 (08:38):
Hours or so? Look, I think you know some of
the staff you know that I've sort of spoken to,
a lot of them are sort of keen to know
what we're doing and what changes we're making, and a
lot of them, you know, have been able to identify
some of those areas where we're making changes. Some of
those changes are probably things that the front line staff
may not sort of really see that go on because
(09:01):
they're more sort of structural changes. And some of that
is about how we've spoken with NT Health and the
emergency departments how we can improve that reporting process both
ways so that if there are any concerns that we've
got when as a collective team and working together, that
if there are concerns that are raised around you know,
what's the treatment we've provided, How can they feed that
(09:22):
to us in a timely way that we can work
collaborative together to investigate, work through the issues, and improve
those systems and improve the care that we're providing.
Speaker 1 (09:31):
And so what are some of those changes that you've
had to implement that are going to make you know,
that are going to make a difference and really see
services improved. I guess yeah.
Speaker 2 (09:40):
Look, you know we've had a big focus on obviously
our clinical education and this is not just in the
last twelve months. You know, in the last three to
four years, we've bought in mandatory face to face training
days that link into the staff's accreditation each year for
their authority to practice at their level, So whether that
be as a patient gleef Our ICPS, which is the
(10:02):
intensive care paramedics, and they're that they're they're the highest
qualified paramedics that we have in the Northern Territory and
they're the ones that you know are going to these
high acuity cases and supporting the paramedics. So we've brought
a lot of work into them about training them in
terms of clinical leadership, it's about you know, supporting decision
making because obviously in those in those sort of high
(10:22):
acuity moments when you know cognitive overload can take over.
We want to make sure that we've built a team
based approach. So we've provided training to all of our
staff in terms of being able to all of our
paramedics and patient transport services to be able to support
those icps, particularly when they're managing someone with that may
have a difficult airway that requires a focused attention by
(10:44):
the ICP. So clinical education, we've we've worked a lot
on our medication safety and how we can actually make
sure that we're making sure that the correct dosages and
drugs are being delivered to patients, and you know that's
an ongoing process as well. You know, we've worked, as
I said, with the incident reporting and that's you know,
we've always reported in any cases or any high incident
(11:09):
rated cases through to nt Health. That forms part of
obviously our governance structure. And there's been a lot of
operational changes that we've bought in as well, so to
support the staff to make sure that we're getting them breaks,
getting them at the equipment and the support that they need.
Speaker 1 (11:24):
With the increase in demand for your services though, I
mean are we in a situation where Saint John requires
more funding.
Speaker 2 (11:32):
Basically yes, To be honest, the and I think it's
about and this is the work that we're doing with
NTE Health and looking forward into the provision of ambulances
into the future is about you know, working what is
you know, while we're running a contemporary ambulance service at
the moment, we know that health scope is changing and
(11:53):
demand is only going to increase. We know that the
hospital is hospitals across the Northern Territory and all of
the health service providers are under pressure, so we need
to find ways that we do things differently. We know
that we have around about thirty seven percent of the
patients that we respond to we don't transport through to
hospital and so there's a lot of work goes We're
(12:14):
now going into how we can support those paramedics and
the crews that are responding there to have opportunities to
where can those patients go that don't have to go
into a hospital system but still form part of the
hospital structure, so that the health structure that they're getting
care that they need, but it may not be in hospital.
So there's a lot of work that's going into that.
(12:34):
But you know, we know that our resources at the
moment as workload increases, you know, we're seeing the same
number of staff and the same number of resources in
locations and that's you know, leading it well, it's leading
into those sort of delays that we're seeing in terms
of responses. We focus on our lights and sirens responses
and it's the triarch system. But you know there's those
(12:55):
people that are unwell but don't get our lights and
sirens response. We know that those times are extending out
and that's just unfortunately where our workload exceeds our capacity
on a regular basis.
Speaker 1 (13:07):
Andrew, before I let you go onto well the work
that Saint John do, but a bit of a different path.
Fifty years as Cyclone Tracy is commemorated. We know that
that too means fifty years for Saint John, doesn't it.
Speaker 2 (13:21):
Yeah. So you know last night we were at a
unveiling of a sign out the front of the PERP Station,
which PREP Station was actually the headquarters of Saint John
in nineteen seventy four, and there was some of our
staff that were there last night. We're actually on duty
that night wow at PREP Station, and you know they
(13:42):
had the opportunity to speak, and we've unveiled a sign
out there that tells a lot of the history and
the story of what happened there that night and then
in the subsequent days, the Perrap ambulance station there became
basically the major one of the major first aid points
across Darwin. And what we saw then was, you know,
in effect, from there that was the pivotal moment I
(14:02):
suppose when you saw it where it was just volunteers
running at nighttime, to then over the next couple of
months where Saint John then took on the ambulance in
Darwin and then in their subsequent years took over the
ambulance delivery across the Northern Territory. And that's fifty years
and we hope to be continuing to do that for
well into the future.
Speaker 1 (14:21):
Well look, we are going to be doing a bit
of a Cyclone Tracy special in the lead into Christmas,
so I would love to speak if they're keen to
any of those any of those Saint John's staff that
were actually working that day when Cyclone Tracy struck. I
can't even begin to imagine the carnage that they must
have seen when they went out there and had to
go and help territorians in need. Yeah.
Speaker 2 (14:41):
They you know, as was highlighted last night, there was
you know, while we had a couple of the people
that were there, it was a team based effort and
not just those Sint John volunteers. It was their families
and their children and a lot of them didn't go
home for four or five days because they didn't have
a home, but they stayed at the station. They provided care,
they built you know, they built up sort of areas
(15:03):
to treat people, they provided food, and it was a
location and point where they could assist the health services.
So it was an amazing and very emotional last night,
and particularly as we move into through Darwin this year
and as we get close to the fiftieth anniversary, there's
a lot of stories and they do touch the heart.
Speaker 1 (15:20):
They certainly do well. Saint John Director of Ambulance Services,
Andrew Thomas. Always good to catch up with you. Thanks
for joining me in the studio. Thanks, thank you.