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Speaker 1: Saint John Ambulance, as we heard a little earlier this morning,

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Speaker 1: will no longer be able to perform life saving but

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Speaker 1: high risk procedures. After a directive from nt Health, high acuity,

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Speaker 1: low occurrence procedures conducted by intensive care paramedics have been

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Speaker 1: immediately suspended due to clinical governance concerns. The suspension is

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Speaker 1: to remain in place until a Chief Medical Officer is appointed,

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Speaker 1: which the Northern Territory hasn't had for two years reportedly. Now.

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Speaker 1: We spoke to doctor John Zorbis about this a little

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Speaker 1: earlier this morning, and joining me in the studio right

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Speaker 1: now is Saint John Ambulance Director of Ambulance Services, Andrew Thomas.

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Speaker 1: Good morning to you.

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Speaker 2: Good morning, Catie. It's pleasure to be here.

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Speaker 1: Thank you so much for your time this morning. Now, Andrew,

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Speaker 1: tell me why was this directive made.

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Speaker 2: Yeah, Look, and as doctor Zorbis put before, obviously we

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Speaker 2: had nt government brought in a review as we know,

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Speaker 2: early last year, and there was some issues that the

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Speaker 2: reviewer had around some of the governance of those procedures

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Speaker 2: and we've been doing a number of a lot of

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Speaker 2: work to be able to work through those processes and

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Speaker 2: there's now been established a Road Amulance Service Clinical Governance

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Speaker 2: Committee which has senior members of in T Health and

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Speaker 2: Saint John and we're working through those recommendations INT Health

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Speaker 2: have taken from there. We've been doing a lot of

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Speaker 2: work through that. Out of that committee, the decision was

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Speaker 2: made and we were advised by the CE of Health

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Speaker 2: that we were to suspend those procedures until we could

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Speaker 2: continue to work through and improve those governant aspects that

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Speaker 2: they have identified and we're working through with n T

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Speaker 2: Health on what that is. And one of the ones

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Speaker 2: obviously they've highlighted and there's been a big push as

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Speaker 2: from the AMA and other people within health, is around

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Speaker 2: having a medical director or an ambulance service medical officer

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Speaker 2: to provide some oversight.

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Speaker 1: On that and so where is the recruitment at for

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Speaker 1: a medical services officer or the other description that you'd

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Speaker 1: just given Ash.

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Speaker 2: Yeah, So in terms of that, as I said, it

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Speaker 2: was one of the recommendations and after the report was

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Speaker 2: received by Health last year and then the Road Animal

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Speaker 2: Service Clinical Governments Committee was set up in February of

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Speaker 2: this year. We've been speaking at the first meeting in

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Speaker 2: fact was greed and between both NT Health and s

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Speaker 2: John that we would look at about having a medical officer,

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Speaker 2: and NT Health had agreed to provide us with medical officers.

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Speaker 1: Since so you're waiting for MT Health now to provide.

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Speaker 2: Since that we've been working through a process, okay, and

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Speaker 2: there are there will be two positions due to the

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Speaker 2: fact that they're still negotiating some of the contracts within

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Speaker 2: In terms of those people, I can't advise about who

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Speaker 2: those positions are, but there will be one in our

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Speaker 2: springs and there will be one in Darwin, and they

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Speaker 2: will be specifically sort of through their job description, focusing

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Speaker 2: on training, clinical review of cases, credentialing of our staff,

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Speaker 2: particularly in those high end skills, and then also look

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Speaker 2: you know, being having the ongoing review of our clinical

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Speaker 2: guidelines and and providing that clinical advice to our staff

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Speaker 2: when needed in those processes. So, you know, we hope

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Speaker 2: to very shortly that NT Health have got those contracts

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Speaker 2: sorted out with those people and then we can announce

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Speaker 2: exactly who those people are and then you know, engage

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Speaker 2: with them. At this stage, it looks as though it's

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Speaker 2: probably not going to be in place until you know,

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Speaker 2: because of their current commitments until August, which we would

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Speaker 2: rather see that sooner.

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Speaker 1: But look, I suppose I'm just trying to get to

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Speaker 1: the bottom of it from you know, a territorian perspective

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Speaker 1: or from a from a patient perspective if I was

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Speaker 1: a patient, because you want to make sure that paramedics

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Speaker 1: have got every tool in their belt to be able

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Speaker 1: to save your life if required. So I suppose what

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Speaker 1: I'm hearing following on from doctor's orbis speaking to us

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Speaker 1: earlier this morning, and what you are saying is that

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Speaker 1: now these two procedures are off the table and they're

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Speaker 1: not going to be back on the table until we

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Speaker 1: have an Ambulance Service medical officer. Is there any concern

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Speaker 1: here that lives could be lost because paramedics are not

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Speaker 1: able to use these two procedures as a result of

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Speaker 1: not having this officer in place. Yeah.

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Speaker 2: Look, I mean, you know, these skills were brought in

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Speaker 2: as part of a clinical upgrade, and in two thousand

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Speaker 2: and twenty two we underwent a upskilling of specific intensive

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Speaker 2: care paramedics, which is already our highest level of clinician

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Speaker 2: in the organization and quite an intensive training program, and

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Speaker 2: that court included the previous medical officer and int health

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Speaker 2: medical officers and specialists and retrievalists and our staff went

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Speaker 2: through a really rigorous project program on training as well

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Speaker 2: as then assessment and endorsement.

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Speaker 1: So is effectively in TE health saying that they don't

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Speaker 1: deem that as enough.

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Speaker 2: I look, as I said, we've been doing through work

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Speaker 2: and we've been asked to provide evidence to NT Health

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Speaker 2: on where we're at, what those processes, those systems, those

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Speaker 2: structures that we've put in place, and we have, through

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Speaker 2: a continuous improvement process, been working on increasing those processes,

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Speaker 2: you know, since that was implemented and even in the

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Speaker 2: last eighteen months working through improvement processes. So obviously we've

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Speaker 2: provided the information INT Health, they've made a direction that's

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Speaker 2: that's there. I suppose their prerogative, and we're working with

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Speaker 2: them and that committee to understand exactly the areas that

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Speaker 2: we need to improve on and will do had.

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Speaker 1: Something happened, had there been a bad patient outcome, had

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Speaker 1: there been I don't know in appropriate use of it.

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Speaker 2: So I think Doctor's orbis from the Amama comment before

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Speaker 2: that there were some concerns raised that triggered off the

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Speaker 2: ALIS review, so that those concerns and most of those

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Speaker 2: cases that occurred were occurred when we actually had a

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Speaker 2: medical chief medical officer, and so in terms of and

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Speaker 2: that's that nothing about the process. But I'm just saying

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Speaker 2: where we've gone along is that there was concerns raised

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Speaker 2: as identified and he mentioned all of those cases were reviewed.

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Speaker 2: If there were any changes or processes or learnings from

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Speaker 2: those reviews, obviously we've put them in place and to

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Speaker 2: always make sure and that's how we respond. And we

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Speaker 2: know that within healthcare, and we've discussed before that you know,

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Speaker 2: at times sometimes things will occur that may not be

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Speaker 2: the best delivery of care. But you know, part of

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Speaker 2: good governance is about be able to identify, review them,

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Speaker 2: and then make changes to stop them happening in the future.

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Speaker 1: And look, I guess for a lot of people listening

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Speaker 1: this morning, the thing that they're going to want to

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Speaker 1: know is that if their life is at risk, that

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Speaker 1: paramedics are able to do what is required to save them,

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Speaker 1: to get them to the emergency department.

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Speaker 2: Look, our paramedics are highly qualified, and you know, I

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Speaker 2: can't speak highly and as we had before about the

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Speaker 2: amazing work that all of our paramedics and all of

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Speaker 2: our emergency communications and our intensive care paramedics. This has

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Speaker 2: been I'll say a bit of a blow for some

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Speaker 2: of our staff and particularly those intensive care paramixs who

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Speaker 2: have gone through a lot of training, regular training outside

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Speaker 2: of their own ails to maintain and keep those high

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Speaker 2: skill levels up and what else, and so you know,

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Speaker 2: they're really feeling it and what else. But I can

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Speaker 2: reassure that the public that absolutely the quality of care

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Speaker 2: that our staff will deliver and that it is these

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Speaker 2: two procedures only that are impacted, and they are a

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Speaker 2: very very small component in a very high end of

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Speaker 2: what we do and the care that we deliver. And

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Speaker 2: so care starts right from the basic care that can

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Speaker 2: be provided before people get right through the whole continuum

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Speaker 2: for our staff to deliver that quality care and then

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Speaker 2: take the patient to hospital.

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Speaker 1: Look, if you have just joined us, I am in

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Speaker 1: this studio with Sin John Ambulance Director of Ambulance Services

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Speaker 1: Andrew Thomas. Now I do want to ask, we know

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Speaker 1: the Territories Ullance Service contract, it's been reported, is going

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Speaker 1: to be up for grabs for the first time in

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Speaker 1: over a century after Saint John was of course banned

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Speaker 1: from performing these two life saving high risk procedures. The

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Speaker 1: NT News is reporting that the Northern Territory Health Minister,

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Speaker 1: Steve Edgington said that the Saint John ambulance contract was

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Speaker 1: due to expire in early twenty twenty six, with a

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Speaker 1: procurement process for a new contract to begin shortly. Has

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Speaker 1: there been any indication that Saint John is going to

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Speaker 1: lose that contract? What is the situation from your perspective

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Speaker 1: at the moment, Andrew.

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Speaker 2: Yeah, So look, just to let you know, Katie, is

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Speaker 2: that and we've spoken before us. We know that the

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Speaker 2: ambulance contract was coming up in twenty twenty six, and

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Speaker 2: we've been doing a lot of work for a significant

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Speaker 2: period of time now working through with NT government around

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Speaker 2: the ongoing process. And we knew that there was going

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Speaker 2: to be a procurement process for the ambulance service and

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Speaker 2: we've had those discussions with our staff. So that's surprised you,

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Speaker 2: that's sort of surprise at all. And we actually look

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Speaker 2: forward to a process because we don't want to roll

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Speaker 2: over a contract that we've already identified leaves the territory

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Speaker 2: under resourced for staff and ambulances. We know that currently

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Speaker 2: we're twenty five percent underresourced in our springs and we're

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Speaker 2: about forty percent underresourced in terms of emergency ambulances in Darwin,

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Speaker 2: so we're absolutely keen to engage in a process. We

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Speaker 2: did get notified on Friday via a letter from the

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Speaker 2: Sea of Health that through that procurement process, which is

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Speaker 2: well defined by nt Health, that we will be in

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Speaker 2: sole discussions with nt Health for the emergency component of

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Speaker 2: the road ambulance contract. So that's to deliver emergency ambulances

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Speaker 2: across the Northern Terrace.

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Speaker 1: So it does look ause that's going to continue if

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Speaker 1: indeed those discussions go well, but you're the in sole

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Speaker 1: discussion with them at this point in time.

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Speaker 2: That's correct, yes, and so that's that we know and

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Speaker 2: we're also advised at that point in time, is that

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Speaker 2: the the low acuity services or the patient transport services

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Speaker 2: and so that a lot of that is related to

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Speaker 2: the movement of people from aero medical facilities, you know,

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Speaker 2: from you know, in transfers from across the territory, so

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Speaker 2: from the airport to the hospital and return or from

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Speaker 2: low from residential age care facilities to hospitals in return

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Speaker 2: those type of cases, and that we know that that

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Speaker 2: was going to come out and go to a tender

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Speaker 2: process and that will be as highlighted probably today, that

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Speaker 2: will be open for other people and that's what occurs

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Speaker 2: in every other state and territory. So those sort of

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Speaker 2: private providers are in terms of ambulance for patient transport

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Speaker 2: and as you know, we know that already across the

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Speaker 2: territory we have care flight that undertake some patient transport work.

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Speaker 2: R fts do as long as us now we've been

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Speaker 2: doing that patient transport work for a long period of

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Speaker 2: time and we will be actively involved in that process

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Speaker 2: and we believe that we will be you know, a

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Speaker 2: quality person to put in for the tender.

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Speaker 1: So just in terms of that notification from the Chief

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Speaker 1: Executive of the Health Department around Saint John being in

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Speaker 1: sole discussion for the emergency care isnt. So in terms

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Speaker 1: of that, is that going to mean then if like

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Speaker 1: let's say for example, that you no longer then have

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Speaker 1: the low acuity transfer service, would that mean job losses

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Speaker 1: for Saint John.

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Speaker 2: No, Well, we need to look at and part of

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Speaker 2: that is, as we said before, we need to look

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Speaker 2: about our resourcing. And we know that and we've already

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Speaker 2: highlighted that the resourcing that we have at the moment

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Speaker 2: doesn't cover what we have in terms of our workload.

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Speaker 2: Our capacity is regularly over the years right by the workload,

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Speaker 2: so we you know, we'll need to look at that.

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Speaker 2: As A said, in terms of the patient transport services,

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Speaker 2: we will be actively pushing that and we believe that

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Speaker 2: having a patient transport service that links into our emergency service,

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Speaker 2: you know, adds a lot of benefit in terms of

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Speaker 2: being able to provide some surge capacity and rather than

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Speaker 2: relying on independent providers. So you know, as I said,

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Speaker 2: that will form part of our case going forward. In

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Speaker 2: terms of the patient transport, we will be actively looking

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Speaker 2: and making sure that the appropriate resourcing for the delivery

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Speaker 2: of emergency animals and so that's not just numbers. That's

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Speaker 2: as highlighted before and then highlighted in the Alis review

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Speaker 2: and a number of the other reviews that have been

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Speaker 2: quoted around the services, is that resourcing is not up

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Speaker 2: to a standard where it meets in other services. So

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Speaker 2: we want to make sure that and that's across the board.

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Speaker 2: We know that we are under resourced in our triple

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Speaker 2: zero call center and our amazing e m ds there

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Speaker 2: work under incredible pressure. We've seen call volumes in the

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Speaker 2: emergency call center double in the last five years and so,

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Speaker 2: and we haven't seen that corresponding increase in staffing. We

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Speaker 2: know that clinical governance and all of the concerns that

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Speaker 2: have been raised around that in education and training, we

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Speaker 2: need more staff to be able to deliver that.

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Speaker 1: Andrew, just in terms of the emergency ambulance contract and

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Speaker 1: that notification that you are in soul discussions on that contract.

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Speaker 1: When do you reckon you'll know whether Saint John is

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Speaker 1: going to be maintaining it, keeping it or not.

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Speaker 2: Well look at it. You know, as I said, we've

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Speaker 2: got notified on Friday. We've already established the first meeting

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Speaker 2: with NT Health as part of looking at that process.

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Speaker 2: And you know, like any form of procurement process and discussions,

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Speaker 2: we'll need to work through and make sure have those

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Speaker 2: concerns met that we've raised around the recruitment. Obviously, I

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Speaker 2: know that obviously Health are keen to make sure that

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Speaker 2: they want the best service they can they can get,

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Speaker 2: but you know, obviously wanting to make sure that that

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Speaker 2: fits with in their constraints that they've got as well.

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Speaker 2: So as I said, we're starting those meetings and once

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Speaker 2: we know it will be putting you know, like notifying

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Speaker 2: people about where they give with the contract.

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Speaker 1: Well, Sir John Ambulance, Director of Ambulance Services, Andrew Thomas,

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Speaker 1: we are going to have to leave it there. Good

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Speaker 1: to catch up with you this morning. Thanks so much

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Speaker 1: for your time.

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Speaker 2: No, thanks very much, Cadie.

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Speaker 1: Thank you