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Legislative Assembly for the ACT: 2013 Week 2 Hansard (13 February) . . Page.. 448..

One of the significant impacts in the last 12 months—again, I am not trying to offer excuses; I am just putting the performance in context and explaining how having only two emergency departments and no small hospitals that essentially act as nursing homes as is the case in other jurisdictions impacts on the ACT—was the closure of one of the ACT's key nursing homes—Ginninderra Gardens. That has had a significant impact on bed availability at the hospital. The facility had previously been a source of transferring subacute patients requiring nursing home placements. However, since its closure about a year ago, nursing-home-type bed days in our public hospitals have increased by 30 per cent or 1,000 bed days from the seven months prior to its closure.

That goes some of the way to explaining the increases we have seen in access block, particularly for older Canberrans, but access block in general because we have a much larger number of beds taken up with long-stay patients who are not going anywhere. They are not being discharged; they are staying, and that is impacting on how many people we can get out in time from the emergency department to empty beds in the hospital.

I would really like to shift the debate about the emergency department outside the emergency department, because the solution to improving waiting times in the emergency department does not rest only in the emergency department. We can put in more staff, and we will. We have got $12 million going this year into employing more staff. We can create greater space in the emergency department and bring on new beds in the emergency department. All of that is being done. But the single biggest contributor to improving emergency department performance is improving the performance of the rest of the hospital. I am talking about the discharges from the hospital; that the hospital acts as a seven-day-a-week service—like the emergency department is open seven days a week, 24 hours a day—and that we have those kinds of business processes working through the hospital so that beds are being opened, people are being discharged early, and that patients who are in the emergency department and may have come into the emergency department overnight are getting access to those beds in the morning.

That requires significant cultural change in the hospital from everybody—from the administrators and from doctors—but unless we are creating those bed spaces in the morning we are going to have this pressure in the ED. The position the emergency department staff get put in is that they cannot clear people out of the emergency department into the rest of the hospital, so they take up beds in the ED. Therefore, ED staff cannot bring in people that are in the waiting room because their beds are taken up by people who need to go to the hospital. And yet they are the ones that get the bad press about their performance, and it is not them. They do everything they can to get people out of the emergency department. They do not want them sitting in the emergency department; they want them in beds in the hospital.

We have to require every ward to change their practices. We have to require our VMOs and staff specialists to change their practices, and we are doing all of that work with them at the moment. We are seeing change across the hospital. I met with the ED senior staff I think in December last year to talk to them. They admitted to me, "We

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