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Speaker 1: A Code Yello, as we have reported earlier on the show,

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Speaker 1: has been called at Royal Darwin and Palmerston Hospitals after

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Speaker 1: capacity issues for more than a week, nurses and doctors

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Speaker 1: telling us earlier on the show that they've been pushing

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Speaker 1: for the internal emergency to be declared for eight days,

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Speaker 1: with dozens waiting in ed and no beds available.

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Speaker 2: Now.

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Speaker 1: The decision to declare the code yellow was made yesterday.

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Speaker 1: It's the first since the CLP came to power, acknowledging

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Speaker 1: that spike in demand for acute care and also meaning

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Speaker 1: that some measures are able to be implemented to try

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Speaker 1: to deal with those numbers. Now joining us on the

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Speaker 1: line is NT Health's chief executive, Chris Hosking's good morning

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Speaker 1: to you.

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Speaker 2: Chris, Good morning Katie, and good morning to your listeners.

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Speaker 1: Thank you so much for your time. Now, Chris, can

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Speaker 1: you talk us through the pressures currently being experienced at

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Speaker 1: well at both Royal Darwin and Palmerston Hospital.

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Speaker 2: Yes, certainly, ken, Katie. So Obviously Royaled Owens our largest

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Speaker 2: hospital in the territory, but it's also our only true

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Speaker 2: tertiary care facility. So if you're really unwell, Royal Darwen

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Speaker 2: is generally where you need to be and Palmerston operates

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Speaker 2: as more or less as an annex of Royal Darwen,

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Speaker 2: and we have been really busy these past couple of weeks.

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Speaker 2: We certainly, as has been reported, we've had bead pressures

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Speaker 2: over recent weeks, and yesterday they reached a point where

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Speaker 2: a number of the preconditions for what we call a

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Speaker 2: code yellow, which is an escalation protocol, were met and

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Speaker 2: I had a proposal from the management at the hospital,

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Speaker 2: and so we've signed off on that and declared a

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Speaker 2: code yellow and issued a media release. But I guess

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Speaker 2: the key thing that leads to us to clearing the

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Speaker 2: code yellow is that the patient numbers we're experiencing at

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Speaker 2: the moment are not that much different to what we've

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Speaker 2: had in the past. We are very very busy that

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Speaker 2: Roald Owen generally is busy and operates close to capacity

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Speaker 2: a lot of the time. But what we've really seen

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Speaker 2: in recent days is the acuity of the patient so

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Speaker 2: how unwell they are and how much care they need

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Speaker 2: when they come into the hospital system has been higher

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Speaker 2: than normal and that places additional pressure on the system,

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Speaker 2: and so calling the code yellow was the right thing

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Speaker 2: to do, and that's what we've done.

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Speaker 1: Chris, I know that some nurses and doctors have been

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Speaker 1: calling for this to happen for a number of days.

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Speaker 1: Why did you wait so.

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Speaker 2: Long to call this one, oh, Katie. I don't want

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Speaker 2: to speculate on what some of the public messaging has been,

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Speaker 2: but certainly very aware there would have been lots of

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Speaker 2: discussion around the capacity issues. But to be really clear

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Speaker 2: that the proposal to declare a code yellow I received

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Speaker 2: yesterday afternoon. I approved that instantly, and we issued a

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Speaker 2: media release about ten minutes later. So I think this

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Speaker 2: perception that we've sat on our hands is probably not

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Speaker 2: a fair one. There are code yellow is something that

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Speaker 2: we take very seriously, and it's part of an escalation

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Speaker 2: protocol and when a number of those preconditions have been met,

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Speaker 2: the hospital management has put the proposal to me and

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Speaker 2: said we think a code yellow is justified. And look,

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Speaker 2: I know there's been a lot of speculation over the

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Speaker 2: last little while about code yellows and why they may

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Speaker 2: or may not have been called. I've long maintained a

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Speaker 2: view that if the threshold was met for a code yellow,

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Speaker 2: we would absolutely call it, and that's what we've done yesterday,

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Speaker 2: and I think that's the right thing to do.

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Speaker 1: So there's no cover up or no sort of will

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Speaker 1: of the executive to not call a code yellow.

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Speaker 2: I can explicit rule out any suggestion of cover up

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Speaker 2: or interference, and I actually spoke about this during the

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Speaker 2: recent estimates the committee back in June Kadie, where the

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Speaker 2: suggestion was that the Code yellow was being stifled or silenced,

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Speaker 2: and I made very clear remarks on the public record

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Speaker 2: then that Royal Darwin is a very busy tertiary hospital

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Speaker 2: and we do have demand pressures. It's a very old

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Speaker 2: hospital and to be fair, the territory has probably outgrown it,

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Speaker 2: but we do our people do an amazing job and

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Speaker 2: we do the very very best with what we've got

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Speaker 2: available to us. And I've been really clear that if

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Speaker 2: a code yellow set of conditions was reached, we would

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Speaker 2: absolutely call it, and we've done that yesterday and I

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Speaker 2: stand behind that decision.

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Speaker 1: Now. We spoke to the AMA a little bit earlier

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Speaker 1: this morning. We also spoke to the Nursing Amywi Re

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Speaker 1: Federation and certainly we know, and we have spoken about

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Speaker 1: this on numerous occasions, that we have got a number

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Speaker 1: of aged care patients within Royal Darwin Hospital and I'm

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Speaker 1: assuming potentially out at the Palmeston Hospital as well, that

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Speaker 1: realistically should be in an age care facility. It's an

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Speaker 1: issue we've been dealing with for many years. I've spoken

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Speaker 1: to the former Health minister about it. I've spoken to

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Speaker 1: former staff about it over the last few years. Where

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Speaker 1: are we at in terms of, you know, getting these

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Speaker 1: additional aged care beds up and running and getting that

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Speaker 1: facility built. The last that I had heard from the

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Speaker 1: Health Minister and also from the Federal Member for Solomon

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Speaker 1: Luke Gosling, was that there were discussions happening between both

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Speaker 1: the Northern Territory Health Department and also the Federal Department

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Speaker 1: of Health.

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Speaker 2: I think it is yeah, no, very very good question, Codie.

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Speaker 2: I'm glad you raised it because it is a major

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Speaker 2: contributor to bed pressures in the public hospital system here

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Speaker 2: and every state and territory has this problem, but it's

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Speaker 2: worse here in the territory than anywhere else. And to

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Speaker 2: give you some background numbers, there are only forty seven

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Speaker 2: aged care beds available in the territory per thousand people.

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Speaker 2: Everywhere else in Australia, that's about sixty seven, so we

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Speaker 2: are much worse off than other states and territories. Aged

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Speaker 2: care is a clear responsibility of the Commonwealth, not states

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Speaker 2: and territories, and on any given day, across all of

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Speaker 2: our territory hospitals, there would be around about eighty hospital

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Speaker 2: beds being utilized by patients who are approved to hand

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Speaker 2: off into an age care facility. But unfortunately there's nowhere

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Speaker 2: for these people to go, and particularly here in the

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Speaker 2: top end, we tend to accommodate those patients at Palmerston

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Speaker 2: Hospital and to give you an example today there are

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Speaker 2: forty two long stay aged care patients in Palmerston and

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Speaker 2: that's a one undred bed hospital. If we had those

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Speaker 2: people accommodated in aged care facilities in the community where

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Speaker 2: they can better be looked after, we wouldn't be calling

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Speaker 2: co Jello today. We simply wouldn't have the same pressures

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Speaker 2: on our hospital bedstock. So I am pleased to say

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Speaker 2: that there's been some terrific advocacy from the Northern Territory

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Speaker 2: in this space over the last year or so, and

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Speaker 2: since the return of the federal government back in May.

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Speaker 2: We we've been working with the Commonwealth for some months

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Speaker 2: now and the the Commonwealth government made an election promise

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Speaker 2: of sixty million dollars towards the construction of an aged

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Speaker 2: care facility in Darwin and we're holding them to that

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Speaker 2: promise and we would like to see that facility built

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Speaker 2: on the Palmerston Hospital campus on that holds package of

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Speaker 2: land there. We have land available and the Northern Territory

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Speaker 2: government has come to the table with funding for design

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Speaker 2: works and headworks for utilities and water and power and

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Speaker 2: those sorts of things. The Commonwealth are proceeding with that.

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Speaker 2: They recently ran a grant program and they've sought proposals

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Speaker 2: from aged care providers and there is a mature industry

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Speaker 2: for those types of providers, both not for profits and

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Speaker 2: for profits. We are and we know there are viable

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Speaker 2: proponents in that grant round and whoever's the successful proponent,

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Speaker 2: we expect will receive the Commonwealth funding contribution towards the

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Speaker 2: construction cost of the facility, and that that would also

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Speaker 2: be accompanied by a long term contract to provide the

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Speaker 2: service for the aged care facility. And we're just waiting

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Speaker 2: to hear the outcome of that assessment process. Now. We

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Speaker 2: talk regularly with our Commonwealth counterparts and they're working through

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Speaker 2: their assessment of those proposals, but we would hope to

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Speaker 2: know about that in the next little while. We had

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Speaker 2: previously done the engineering and scoping works for a one

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Speaker 2: hundred and twenty bed facility. As I mentioned, there's about

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Speaker 2: ahy odd hospital beds that are being utilized for this

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Speaker 2: purpose in a given day, but we'd like a bit

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Speaker 2: of capacity there for future growth. And if we can

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Speaker 2: get that out of the ground and built on the

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Speaker 2: Palmerston Hospital complex, particularly right next door to the hospital

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Speaker 2: where we headquarter our geryontology service at clinical services for

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Speaker 2: older people, it'll be a huge win for Territorians and

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Speaker 2: I think it's something that we really need to push

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Speaker 2: through over this next term of the Territory and the

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Speaker 2: Commonwealth governments because we were getting good cooperation between the

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Speaker 2: levels of government and I think the time's right to

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Speaker 2: really see that facility built.

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Speaker 1: Yeah, it's got to happen, you know, and it has

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Speaker 1: to happen sooner rather than later. I mean in terms

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Speaker 1: of that next stage that you've just spoken about, and

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Speaker 1: by the sound of it, the tender being awarded you'd

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Speaker 1: said in the next little while. I mean, Chris, are

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Speaker 1: we talking months how long are we talking here.

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Speaker 2: Look, I would expect to know the outcome of that

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Speaker 2: in the next month or two. Obviously, to get a

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Speaker 2: facility like that built, there's a lead time. I would

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Speaker 2: imagine it's probably a couple of years before we've got

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Speaker 2: it built and operational, but the sooner the Commonwealth can

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Speaker 2: choose a successful proponent, And we have been engaging with

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Speaker 2: the proponents who are in that grant round. We've had

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Speaker 2: some of them come to Darwen and walk around on

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Speaker 2: the site and talk to our hospital people. We've talked

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Speaker 2: to their engineers and they're construction people, and a lot

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Speaker 2: of these age care providers are quite capable of managing

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Speaker 2: their own construction projects, you know, they do these things

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Speaker 2: around Australia. So I'm quietly optimistic that we're finally going

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Speaker 2: to see some extra capacity here in the territory. And

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Speaker 2: now that's taken a lot of work, but I think

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Speaker 2: we're much much closer to that than we have been

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Speaker 2: in the past, and we're sitting as patiently as we

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Speaker 2: can hoping to get a positive announcement.

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Speaker 1: Well yeah, but all the while, obviously, you know, our

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Speaker 1: hospitals are under pressure, Chris in terms of you know,

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Speaker 1: the Code yellow that's implemented right now, What does that

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Speaker 1: mean in terms of those elective surgeries? Obviously they have

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Speaker 1: been delayed. How long do you anticipate that this is

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Speaker 1: going to need to stay in place.

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Speaker 2: Look, it's hard to put a specific timeframe on it, Katie,

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Speaker 2: but based on experience, generally Code yellow circumstances manifest for days,

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Speaker 2: not weeks. So it is a temporary set of really

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Speaker 2: extreme intense work pressures, and we have a range of

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Speaker 2: things we do to try and respond to that. We

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Speaker 2: step up our daily monitoring processes. We look at our

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Speaker 2: patient flows, We look at how we can get people discharged,

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Speaker 2: particularly where we've had people from regions come into our

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Speaker 2: dh because they need to access the clinical care. If

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Speaker 2: we can get them discharged and back to the region

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Speaker 2: where they can have their follow up care closer to home,

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Speaker 2: that's a really good thing. We look to expedite those

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Speaker 2: sorts of things. And so we would generally see a

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Speaker 2: code yellow set of circumstances abait over several days, but

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Speaker 2: really we monitor that three times a day, and there's

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Speaker 2: a whole set of performance metrics that we monitor very closely.

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Speaker 2: And as we see some of those settle to more

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Speaker 2: normal levels. I would expect to receive a proposal from

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Speaker 2: the hospital management to say, hey, look that things are

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Speaker 2: trending a little more normally. Now, we're probably not in

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Speaker 2: code yellow anymore. We'd like to close that off. That

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Speaker 2: doesn't mean we relax discipline, but it does mean that

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Speaker 2: we step down one level from what is probably more

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Speaker 2: of an emergency response.

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Speaker 1: And christ to anybody listening this morning who is feeling frustrated,

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Speaker 1: you know, maybe they are trying to get in for

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Speaker 1: elective surgery. You know, maybe they have been waiting for

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Speaker 1: quite some time. To anybody that's listening this morning that

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Speaker 1: is feeling really very frustrated by this situation, what do

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Speaker 1: you say to them?

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Speaker 2: I look to the people in the community. I really

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Speaker 2: just ask that we certainly understand the frustration when you're

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Speaker 2: waiting a long time for elective surgery. Obviously, in the hospital,

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Speaker 2: we work on a triage basis, and we see the

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Speaker 2: sickest people the most urgently, and sometimes elective surgery does

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Speaker 2: not get the same level of prioritization. And to be fair,

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Speaker 2: if you're waiting on a hip replacement, it probably doesn't

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Speaker 2: feel like elective surgery. You really need that surgery, and

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Speaker 2: we have had to deprioritize some of that, but I

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Speaker 2: am pleased to say we haven't. You know, we've got

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Speaker 2: cardiothoracic surgery happening today. Now that's not elective, that's life

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Speaker 2: saving surgery. But we've got specialists visiting cardiothoracic surgeons here

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Speaker 2: today and despite all the pressures, those procedures are going ahead.

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Speaker 2: So we do prioritize the stuff that is the most

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Speaker 2: clinically significant. And I do really want to assure your

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Speaker 2: listeners that if you come to Royal Darwin you will

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Speaker 2: get seen. We do not turn people away. We take

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Speaker 2: people in and we give them the very best care

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Speaker 2: that we can, and that's how we sometimes end up

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Speaker 2: with these capacity issues. I think yesterday, I think we

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Speaker 2: had thirty six patients double bunked in the emergency department,

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Speaker 2: and that means two beds per cubicle, so seventeen cubicles

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Speaker 2: thirty thirty four beds. Today, that's settled a little bit.

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Speaker 2: We've only got twenty two patients in across eleven cubicles,

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Speaker 2: so those numbers are trending down, which is a good thing.

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Speaker 2: But as I said, the presentations themselves the people are

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Speaker 2: more unwell than what we've seen over previous weeks, and

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Speaker 2: so the code yellow was the appropriate response to that.

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Speaker 2: But I do really want to assure your listeners, if

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Speaker 2: you're sick and you need to come to hospital, you

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Speaker 2: will absolutely get the care you need. It might be

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Speaker 2: a bit of a busy, noisy environment, but that's because

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Speaker 2: our people are working really hard to get you the

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Speaker 2: clinical care. And if I could, Katie, I'd just really

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Speaker 2: like to send a shout out to our staff at

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Speaker 2: the hospital, our doctors and nurses and the people who

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Speaker 2: have been really putting in the hard yards over recent weeks.

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Speaker 2: So I think they do an amazing job and we

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Speaker 2: really appreciate the work that they're doing absolutely, and I

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Speaker 2: do want to emphasize the Territorians and doctor John's Orbis

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Speaker 2: from the AMA spoke on radio earlier today and we

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Speaker 2: asked the question about, you know, is this set of

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Speaker 2: code yellow circumstances unsafe for people coming to hospital? And

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Speaker 2: he absolutely ruled that out, and so do I. It

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Speaker 2: means we've got to work harder behind the scenes to

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Speaker 2: get the care delivered to our patients. But that's exactly

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Speaker 2: what we do. Our patients, our staff step up and

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Speaker 2: make sure that people get that care. So people can

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Speaker 2: be reassured that if you do have to come to RDH,

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Speaker 2: the front doors are open and our people will give

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Speaker 2: you the very best.

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Speaker 1: You'll get that service. Well. NT Health Chief Executive Chris

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Speaker 1: Hosking really appreciate your time this morning. Thank you so

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Speaker 1: very much for having a chat with us.

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Speaker 2: Thanks for the opportunity, Katie.

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Speaker 1: Thank you