Topics: Coronavirus update; partnership with private health sector; expanding ICU & ventilator capacity
Thank you very much to everybody for joining us today. I’m joined in particular by the Chief Nursing and Midwifery Officer, Alison McMillan, and with the Deputy Chief Medical Officer, Dr Nick Coatsworth.
Nick is a specialist in respiratory conditions and infectious diseases and is overseeing Australia’s ventilator expansion program within the hospital system and the ICU. Also joined, in particular, by Michael Roff, the CEO of the Australian Private Hospitals Association.
One of our great tasks as we, on the one hand, contain the spread of coronavirus and flatten the curve – that’s our great first task. But our second task is to boost the capacity of our hospitals to deal with this outbreak, to provide the support for our patients, to guarantee that we can fight to protect every life of every Australian.
Today is about, in particular, securing and expanding that capacity. A partnership between the Australian Government, the States and the private hospitals, that will bring over 30,000 beds within the hospital system, into an integrated partnership between the Commonwealth and the States and the private hospital sector.
It will bring over 105,000 full and part-time hospital staff, including 57,000 of our amazing nurses and midwives. It guarantees them their future and their support, both during the crisis and beyond.
But most importantly, it brings their resources to the fight against coronavirus, COVID-19, in Australia. So, to put all of this in context, as I mentioned, our task is two-fold. First, to help contain the spread of coronavirus.
And I think it’s important to begin with the latest news. As of 6:00 AM this morning and the report to the National Incident Centre, there were 4,359 cases. They are being updated during the course of the day by individual States and we’ll provide this evening an updated figure. Sadly, we now have 19 lives lost.
One of the things which we’d also mention is the number of cases in intensive care and those on ventilators. We have currently, on the latest advice available to me, 50 cases in intensive care and 20 cases on ventilators.
What those figures show, coupled with the fact that now, with well over 230,000 tests completed, we have what we would regard as a reflective picture of the numbers in Australia; that if the lives lost – and each one is an agonising loss –below 1 per cent, then that is indicative that the testing regime is capturing the significant reflective data for the country.
If those within ICUs, and in particular with ventilators, in the low numbers that we see – and all of these numbers we know will climb – but they are reflective again of the numbers. And it presents a very different picture to some other countries, where the lives lost represent not half a per cent but 10 per cent of the cases.
It means that the case numbers there are not fully reflective of the situation. So, by having what we believe is the broadest and widest testing program in the world, perhaps only Singapore and Korea, but at this stage, our numbers indicate that we are at the global forefront, we have a good picture of where we’re at.
All of this is then being backed by the social measures, and these most difficult of social measures are about saying – whilst we are making progress, and whilst we are now flattening the curve in the first early stages of progress, there’s more to do.
We were at 25 to 30 per cent growth just over a week ago, on a daily basis. Now, we have come down, in the last week, to the low teens, and the latest advice I have from the National Incident Centre this morning is that the last three days have been approximately 9 per cent, on average.
That’s an achievement to which all Australians have contributed. And I want to say, in these most difficult of times, with these most difficult of measures, that none of us had ever dreamt we would ever be involved in, you have risen to the occasion. To those Australians who are at home, to those Australians who are isolating or in quarantine, I want to say thank you.
Your actions are making a difference and saving lives. This progress is early. It’s significant. But now, with these additional rules around gatherings and movement, we are going the next step to help reduce again the level of infection and to support our containment. All of that is then backed by our attempts and our plans and the reality of improving capacity.
Today, we make a very significant stride in improving capacity. Two days ago, we announced universal telehealth for Australians. In other words, we rebuilt Medicare over the course of the last 10 days. Now, we have over a million telehealth consultations that have been completed. That’s protecting doctors and nurses, and protecting patients, and providing access where otherwise it might not exist.
The second great element in the reconstruction of the Australian medical system is reconstructing the relationship between public and private hospitals. The partnership between the Australian Government, the States and the private hospital system will deliver additional capacity for the Australian system.
It does that in return for the viability of the private hospital sector throughout the course of the COVID-19 epidemic, this pandemic that the world knows, and it does it in such a way that the hospitals will be available, and their staff will be available, to participate fully in our national response and to be able to bounce out and to support the needs of the population after we emerge from the period of coronavirus.
We will be guaranteeing the viability, along with the States, of all 657 private hospitals in Australia – and we’re doing this with a Commonwealth guarantee, then State partnerships, and then the individual private hospitals relying on the source income that they have from their ordinary operations.
Those three things together will mean that our hospitals will be able to continue. An important part of this is that, in return for our guarantee, there’s a guarantee of flexibility, capacity, participation and staff retention from the private hospitals.
The Private Hospitals Association has committed to that. Their membership has committed to that. The Day Hospitals Association has committed to that, Catholic Health Australia has committed to that and we’ve had support from our magnificent doctors and nurses with the Council of the Presidents of Medical Colleges on behalf of all, all of our doctors, supporting this and being part of the statement, and the Australian Nursing and Midwifery Federation has also signed on.
And Annie Butler will be making statements from Victoria, she recently returned from overseas, and as Secretary of the National Federation, she will be speaking from home because she’s doing the right thing and practising isolation for the time being.
In terms of the capacity, it means over 34,000 beds and chairs that will be made available to the public hospital system. A third of intensive care units are within the private hospital system and will be made available. Over 105,000 full and part-time staff, including over 57,000 full and part-time nursing staff.
The activities are broad and they will work together, the hospitals have committed to be fully flexible. They may be taking public hospital services, they will be making their ICUs available, they may see an exchange of staff or equipment in either direction.
They may be providing support services for patients who are coming from aged care homes or other areas where there may be need for isolation or quarantine. They may set up in the day hospitals flu clinics, they may set up in other day hospitals’ testing clinics.
They have committed to be flexible in a way that has been beyond conception. And what this agreement does is it dramatically expands the capacity of the Australian hospital system, at the same time as we are bringing down the numbers of what could have been the case, or as Australians know, the process of flattening the curve.
I might ask Nick Coatsworth to talk about what this means for capacity in our hospitals but also to give Australians insight into what we’re doing with expanding ventilator capacity.
Thank you, Minister. Three weeks ago, I was Director of Infectious Diseases and a full-time clinician at the Canberra Health Services. At that time, I was working alongside my colleagues in intensive care through the executives of the hospital, anaesthetists, emergency physicians to develop the plan for Canberra healthcare services.
This is to say that quietly and diligently, over the past three and four weeks, intensive care units and emergency departments around Australia have been working towards increasing their capacity, as we’ve seen such horrific images coming out of Italy and the United States.
So, this dual idea of containment and capacity has been in progress concurrently. And I’m pleased, as the Minister has indicated, that today we can share some of that data with you. In particular, I’d like to focus on intensive care units and ventilators.
At any one time, there’s approximately 2,200 ventilated intensive care beds in Australia. At the moment, we are using just over 20 of those for patients who are suffering from COVID-19. With immediate expansion, repurposing of other ventilator machines, including anaesthetic machines and use of the private sector, we can expand to 4,400. Our target capacity for ventilated intensive care beds in Australia currently stands at 7,500.
We are working round the clock to procure ventilators. I can tell you today that, locally, we will have 500 intensive care ventilators fabricated by ResMed, backed up by 5,000 non-invasive ventilators, with full delivery expected by the end of April.
This capacity increase is being matched by workforce increases that I’ll let my colleague, the Chief Nurse, Alison McMillan, discuss. I’m aware that colleagues in critical care, primary care, and throughout the hospital system are under incredible strain at the moment, looking at a wave that is crossing other healthcare systems in a way that we couldn’t imagine.
I think the Minister has actually emphasised that we are a very different context in Australia. Our death rate is lower – although, those 19 deaths are a tragedy and my heart goes out to those families.
Our hospitalisation rates are lower and our number of community cases are lower. But I would urge Australians now is not the time to take the foot off the pedal. The restrictions that the Minister and the Prime Minister have introduced on gatherings are absolutely essential to prevent the virus from making its only move, which is from one person to another.
So, I would urge all Australians, follow those instructions to a T. Look towards your State Governments for exactly what they are telling you to do. And I’ll finish my comments there and hand over to the Chief Nurse.
Minister, thank you. What does this mean for nurses and midwives in the private sector? It means job security for them. That they can contribute to the response of this now and into the future.
57,000 nurses and midwives out there who have job security. And this is critically important. Nurses and midwives are the centre often of our healthcare delivery system. In our world-class system, our nurses and midwives are the most highly trained across the world and are extremely well-respected by the community.
But this is going to mean that we’re going to have to ask them to be flexible about how they work and where they work, because the work that we’re going to need them to do might require them to work in a public hospital or in an environment that they may not have worked in before. The training will be there, and we’re partnering with obviously the States and Territories to get those arrangements underway.
So, I ask, and I know, that nurses and midwives across the country will understand that our profession is focused on patients, and on patient care, and with their help, as the Minister has described, while we’re controlling the spread, we’re going to increase the capacity by utilising this vitally important part of our health service and workforce.
Michael, if you might just say some words.
Michael Roff, the CEO of the Australian Private Hospitals Association.
Thank you, Minister. I’ll just be brief. I did want to thank the Minister, though, because he
very early on realised that with the reduction in elective surgery in private hospitals, which we know in most cases will be coming to an end on Wednesday, there was no revenue coming through the door, which means it was very difficult for us to pay our nurses, maintain buildings and maintain that capacity.
So, we’ve been working very hard on this partnership. We’ve heard the word ‘unprecedented’ a lot this year, but this is absolutely unprecedented in terms of the integration of the capacity of the private hospital system, including those 57,000 nurses and the third of all, intensive care beds into one health system to deal with this pandemic and respond to this pandemic.
And very importantly also, I think, to make sure that private hospitals are there on the other side of this. It’s not business as usual, so there’s a lot of services that are normally provided in private hospitals that won’t be provided for the next six months and public hospitals, for that matter, too.
So, there is going to be a big backlog when we’re on the other side of this pandemic, and this arrangement from the Commonwealth and the States means that private hospitals will be there to help with that backlog on the other side. The Victorian Government is very close to a deal with the private hospitals in that State.
Hopefully that will be finalised today, and I’d just like to implore all of the other State Governments to very quickly come to arrangements with the private hospitals in their own States, but we’d like to see the Victorian model followed.
And I’ll probably leave it there, Minister.
Okay, thank you. Do you want to join us and- yep, Phil?
In relation to that last point, is this going to work, the integration of the private hospitals?
Like, the current public hospital system, where across the country you have split funding between the States and the Commonwealth, or are they going to be funded differently in every State in terms of the proportion of Commonwealth-State funding and whatever the private hospitals can kick in?
And within those states, will it be done by group – you know, Ramsay Health, Healthscope or whatever – or be uniform across the State?
So, there are two parts to it, as you say, exactly, Commonwealth and State funding. And so, any one hospital will have the support from the Commonwealth, will have the agreement with the State, but the States are developing both a uniform model within Victoria and Western Australia that have made the most progress.
And in my discussions with State Health Ministers last night, all committed to agreements at the earliest possible time. I think all are aiming for the end of the week. And it is likely that most States – I can’t speak for all of them – but most, will pick up the Victorian model.
So, I’ll let Victoria speak to it, but the broad principles are that they will provide a retention payment, or a payment to be available, and an activity payment. And so, we will then provide the funds over the top.
Particularly in some cases, such as day hospitals, there will be much more required from the Commonwealth. You know, on an individual hospital basis, it will vary, but at the end of the day, what we’re doing is guaranteeing the capacity that they will provide in return for us guaranteeing the viability.
Minister Hunt, are you able to put any kind of estimate on how much this is likely to cost the Commonwealth over the next six months?
And is this an effective nationalising of the private hospital system during this health emergency?
So, two things. Firstly, it is a partnership. They are available as an extension now of the public hospital system in Australia.
So, whilst we’re not taking ownership, we have struck a partnership, where in return for the State agreements and the Commonwealth guarantee, they will be fully integrated within the public hospital system. Our expectation is that this will be an additional $1.3 billion. That’s, however, not a capped figure.
If more is required, more will be provided. If it turns out that it’s not that expensive, then those funds will be available for other activities. That takes our total additional investment to over $5.4 billion within the health sector.
Just on the nine per cent, rolling three-day infection average – if we were to get to a situation where that rate comes down to one per cent or zero per cent, would we then start talking about an exit strategy to, sort of, loosen some of these social restrictions?
Look, our goal is to bring down the numbers as far and as hard and as quickly as possible. We are seeing what I would describe as early promising signs of the curve flattening. But we’ve got a long way to go. And so, let us not get ahead of ourselves. There will be an exit, absolutely.
And that will be guided by the medical advice. And one of the amazing things is that we have brought all the medical advisers together into a single national source of medical advice – the medical expert panel of Chief Medical Officers that reports to the Chief Ministers in the National Unity Cabinet – and that’s the place where these decisions are being made.
We’re very strongly supporting that process. So, the answer is we’re actually going, as we’ve seen in the last 48 hours, harder rather than softer. The measures that had been put in place in the previous two and three and four weeks have begun to yield benefit. The measures that we’ve just put in place, we hope will deliver more benefit.
And we effectively have the majority of Australians in self-isolation other than for the essential reasons. And work is one of those. But these will, we believe, improve the situation. And the more it improves, the earlier we will be able to start to release those.
But now is not the time to contemplate that release. We have to deliver the outcomes to save lives.
Minister Hunt, in terms of those beds, you said that they’d- you’d like to have 7,000 or 7,500 of those ventilated ICU beds available. Do you see a circumstance where every single one of those beds will be needed?
And also, sorry, Mr Hunt, does that kind of expose that our health sector was under resourced before this crisis? And do we expect the modelling for the coronavirus that the Deputy Chief Medical Officer mentioned he would like to see released, will that be released and when?
Sure. A few questions. A few questions in there. The first thing is we have one of the best health systems in the world. And I would argue the best and certainly, at this point, we are, in my view, the best-prepared country in the world that has seen any significant outbreak.
What we’ve been able to do is take the existing capacity and, as Nick has said, double it almost immediately by repurposing of other intensive care beds and other units such as anaesthetic units.
And then we have been able to commission over 5,500 additional units, which should- which include many in reserve capacity, over and above what we need, and that would give us the 7,500. And I’ll let Nick talk in particular about what that means.
But our belief is that that means that we should be able to meet all possible contingencies. So, that’s planning for the worst case. What we’re seeing are signs that we will be far better off. In terms of modelling, we are working on that, and there will certainly be additional modelling provided.
But the Prime Minister, over a week ago, released the modelling in terms of the charts, and made that available to the country. And that was the range. What they are doing now is reviewing that work over the course of the coming week. But every day we’re providing all the information we have.
I won’t put a time on it, because that’s- we’re being guided by the work and the pace of the work. But we are planning for- let’s put it this way – the 7,500 is planning for the highest possible need, and to make sure that we are overprepared, not underprepared.
I think your question referenced – do we foresee that we would get to 7,500? We are just over 20 at the moment and we’ve talked about building capacity whilst containing. So, another way to describe that is acting to contain whilst planning for the worst, which the Minister has said.
So, we need a stretch target, if you like, to be sure that we would have enough ventilated intensive care beds. But the absolute priority is not to get there. None of us – and not a single health professional in the country – wants us to see us anywhere near Italy or the United States.
And just to emphasise where we are, the positive testing rate is three in every 100 in Australia. And recently, it was one in every two in the United States. So, every two tests they did, someone was positive.
That demonstrates how different the community transmission is, or the amount of undetected cases in the community. We literally have hundreds of public health workers in every single jurisdiction doing the contact tracing to make sure that when someone is found with this virus, all of their contacts are found and quarantined.
And as Brendan Murphy has said, and we have said all along right from the start, that is how you combat an epidemic, by breaking the transmission chains. So, if we can keep that community transmission under control, then we won’t need anywhere near the 7,500. That is the objective.
Minister, overnight the National Cabinet agreed that the social distancing measures in place now will be the national baseline, and the next move will be based on State and Territory Chief Health Officers. Specific further measures will be recommended and taken on that localised, State-by-State basis.
Given that, what does that mean for the overall hierarchy, in terms of if the AHPPC meets and has a consensus but states want to divert?
And to give you an early example, with the enforcement of the reasons for leaving the house, New South Wales Police have strongly indicated that they will be enforcing that to the letter of that order, which means that a person could not go out of their home to visit a partner because that is not considered one of the reasonable reasons to leave a home.
So, given that there is going to be more and more intricate, specific detail that these States are rolling out, who do people listen to? And do you think that rule in particular is fair, given the state we’re in?
Look, firstly, what we’ve actually seen is the National Cabinet coming together. They are becoming more and more unified. It’s a unique arrangement in Australian history, and it’s been done at a time when everybody has been dealing with massive pressures on their economic, social and health systems, all at the same time. And for that integration to occur, I think, has been extraordinary.
In 50 and 100 years’ time, I suspect people will look back on this National Cabinet as being one of the most amazing achievements of the Federation in Australia’s first 200 years. That’s my honest view.
Having said that, the point of this is to say – what are the standards? We’ve moved across the country to the two-person rule or the family unit rule. Then it’s being applied at the individual State level. And from- you may remember from our earliest discussions, talking about this idea of rings of containment.
And the rings of containment mean that where there are local needs, where there might be a particular hot spot, then tougher restrictions can be placed. And this was exactly what was contemplated from our earliest design, but using the common principles, and at the same time what was contemplated and decided by the National Cabinet this week.
And so I think it’s completely consistent that where individual States or Territories, either across their whole jurisdiction or in part- I know in the Adelaide Hills, they had seen an outbreak following a major social gathering; that further restrictions had been put in place in some of those areas. That’s exactly the idea of rings of containment – being able to provide tighter controls to protect the population in specific areas where we need that containment.
The advice is. Sorry, if the advice is to send kids home from school, if possible, why isn’t it the same for childcare centres?
We’re following the medical advice. And, actually, with great respect, I don’t think that’s a fair reflection of the medical advice on schools. It’s- where possible, we are encouraging children to be in a position for learning.
And of course, in relation to both schools or childcare centres, what we want to preserve, above all else, is the capacity of our critical workforce to be able to work. And the infection rates amongst children are significantly lower and the consequences among children around the world are significantly lower.
Neither is a universal protection. But that was the very, very clear medical advice of the AHPPC. They took advice from infectious diseases experts. People have provided that advice fearlessly and we followed it.
Minister Hunt, just following on from Claire’s question before, in terms of couples, say, there’s someone who lives in one house and there’s someone who lives in another, but they are in a couple, would they be- just on medical advice, would they be allowed to be seeing each other and then going back to their own homes?
Or is this the point at which we say, potentially, they have to consider either isolating from each other or moving in together?
And just following on from what was said in New South Wales this morning, there was a suggestion that there should be more testing be done in certain areas to see what the community transmission was like. It was suggested that, say, in Bondi, they should be doing more because there was a cluster of cases.
What is the advice for practitioners in those areas? How do they figure out who to test when there is a limited availability of tests?
Let me deal with the testing first. In terms of the testing, New South Wales has been doing a tremendous job on testing. They have focused on the process of contact tracing. And the rules around testing remain the same – where there’s been contact or overseas travel, and there are symptoms – that they are the priority cases.
In hot spots, then we know that they are also testing more broadly, and that’s appropriate. And so, this is one of the things that we believe has allowed the rate of infection growth to decline because they have been chasing down the contacts and the hot spots simultaneously.
Now, in terms of the rules of the National Cabinet, they were laid out with regards to households and gatherings of two, where people are not from within the same households. I won’t add anything to that. That will be a matter for individual States if they wish to go further.
Some States are releasing heat maps based on their own data. South Australia says it’s waiting on the Commonwealth to finish theirs. When do you expect those heat maps to be available and to who will they be available?
So, we’ll be providing all the information that we have. I think we’re getting- data is going in both directions and then there’s common work being done on that.
Nick, I don’t know if you want to add in terms of the final resources that are being developed…and public (inaudible) is our approach in all of those things.
Sure. So there’s a variety of jurisdictional reporting mechanisms. I’ll address specifically intensive care because we’re working in partnership with the Australia-New Zealand Intensive Care Society to develop a real-time intensive care heat map, where hospitals with intensive cares will report, biaily, on their COVID-19 patients and bed and ventilator availability.
I think there’s one here that I haven’t heard from and then we’ll have to keep going after that, I apologise.
A very quick update on health staff, the workforce that have been impacted as schools go to pupil-free days and earlier school holidays.
You mentioned the number of staff that be available from the private sector but how many are actually available? Have you started to see an impact on staffing of schools, changing the way they operate?
Look, I don’t have any figures on that. In the particular case of school holidays, I know families are very used to making preparations and arrangements. At this stage, our health workforce has been holding up and I think that’s an appropriate place for me to finish. Today is about-
What about the partner issue because no one’s answered it yet. Can you go and visit a partner who lives in another house? What is the medical advice? Either way, is that a risk of transmission or is it okay?
Okay. So, let me finish this question, respectfully Claire, that because we had one and then I’ll come back and finish on that.
So in terms of the situation with the medical staff, our GPs, our aged care workers, our hospital staff, we’ve now taken measures on all fronts to assist them and they are doing an extraordinary and heroic job.
Then in terms of the situation with regards to households, people are allowed to meet in gatherings of two. If a particular State has made a ruling about entrance into houses, I will respectfully leave that to them. The National Cabinet decision was about people being able to go out in groups of two and to keep to households in addition to that.
I’m not aware of the details that you’ve just provided so I won’t try to provide advice on that. My last comment is to Australians and to our health workers. To Australians, I want to say thank you. These early promising signs are your doing.
These actions are beyond what anybody in government would ever have wanted to have done, and beyond what any Australian family would ever have sought to face. But people are rising to the occasion and this can be, can be one of our greatest moments as a country.
If people are taking care of each other, by not going out; if that they are taking care of each other by supporting their seniors – and I do want to add that there will be an additional $59 million for 3.4 million meals to be delivered to seniors at home who may be isolated.
But if you’re volunteering to provide groceries or meals for people who are otherwise truly isolated, I want to say thank you and to those who are contemplating it, that would be a wonderful human gesture.
But this can be one of our finest moments in our most difficult times as a country and Australians are overwhelmingly doing that. But right at the forefront of all of these people are our nurses, our midwives, our doctors, our allied health workers and our medical and hospital support workers.
Today is about giving them security and integrating two national systems, our public and private hospital systems, in a once-in-a-century redesign of our hospital services. It builds on what we’ve done with a once-in-a-century redesign of our general practice services that have been delivered over the last few days.
We’re building that capacity at the same time as you are providing the containment and helping to deliver the early flattening of the curve.