Inquiry into the Victorian Government’s COVID-19 Contact Tracing System and Testing Regime

Terms of Reference

That this House requires the Legal and Social Issues Committee to inquire into, consider and monitor the capacity and fitness for purpose of the Victorian Government’s COVID‐19 contact tracing system and testing regime, and in doing so consult with businesses, including small business representatives, the community sector and Victoria’s multicultural communities, and provide a report to the House no later than 14 December 2020.

Presenter:  Dr Mukesh Haikerwal AC; General Medical Practitioner, Altona North.

Briefing submission: Mukesh Haikerwal 

Microsoft Word – 20201118 FULL Statement Upper House Vic Parliament Contact Tracing (parliament.vic.gov.au)

I would like to thank this chamber initiating this enquiry and grateful for the opportunity to speak to you today.

My name is Dr Mukesh Haikerwal and I am general medical practitioner in Altona North in Melbourne’s west. I’m just completing my 30^th year in practice in this area.

In the appendix is a background of my career and advocacy.

I’m presenting this as a front-line general practitioner who has been involved in providing care the community locally across the State nationally and internationally.

The issues relating to Covid 19 need to be put into context regarding the whole response to this pandemic within our community and our state.

In our own practice we had to prepare for the GPs role in looking after people who potentially would be infected with Covid 19, how to exclude people from the clinic with respiratory disease so that this would not spread within our own workplace whilst providing care for them from testing, diagnosing, treating, providing supportive care, escalated hospital services, post hospital care.

The system initially was cumbersome. 

After a test with a problem in our building that the doctor would then have to take the PPE of and sanitise. The room was then left closed and sprayed. It was then left closed for quite some time before we would consider it reasonable to reopen. The question of deep cleansing didn’t come in as the person did not test positive.

1. The chain of getting the results from the reference lab was a problem because unlike other labs that lab only use the fax system for getting results back to us. Further the number of tests the lab had to start to handle was significant for it.
2. Early in the piece that DHHS allowed private labs to be involved in the situation which made it much easier to get results electronically in a more timely manner.
3. Later the requirement to get permission to get the test was lifted which also enormously improve the situation.
4. We started testing people in their cars in our car park to obviate the need to clean each room. In our practice of 18 consulting rooms it would have taken just over three days to close down the whole practice whilst also being cleaned.
5. If someone had tested positive we would be shut down for 14 days.
6. By testing in the car park it meant that people were in their own environment and safe and couldn’t get contaminated from within our building and we too would be safe as we would not be been contaminated. The need to cleanse premises was diminished.
7. We stopped testing in early March as we ran out of masks ran out of gloves ran out of swabs and so we had to exclude anybody with respiratory illness from a premise ease and send to hospital.
8. To their credit the Federal Minister for Health and the Federal Department of Health set up GP respiratory clinic’s. We were fortunate to be chosen as being one such clinic within our area.
9. We proceeded to industrialise the process of testing people in a clinically led way with GPs attesting to the process the whole way through. Each patient would be triaged by a nurse and swabs performed by nurse or a doctor with the whole process was reviewed by a GP. (see evaluations and presentation in Appendix). 
10. By having a robust process such as that evaluated noted below, we gathered significant information and data about our patients on site.
11. We also had to work to the guidance of the Federal Department of Health as well as the State DHHS.
12. Guidance and direction is changed regularly. This was expected and understandable and the situation. However the problem was multiple disjointed disconnected messages from different people within the Department of Health and human services not understanding the outcome of their decisions.
13. For instance a scheme was devised to label specimens that were deemed urgent for various reasons into three categories not only were they had labelled there had to be colour-coded. That is a process we managed to use technology to overcome.
14. There was an expectation that only people with symptoms were tested in the respiratory clinic. This was illogical as contacts of people who were diagnosed positive Covid were not symptomatic necessarily. They have to be tested early to ensure that if they are positive they can be isolated and quarantined for the appropriate time.
15. We were also told that everybody need to have elective surgery would have to have a swab. However these people were not covered by the scheme. So on the one hand the Department was suggesting quite rightly that people should be tested for Covid 19 before surgery. Availability was not around for that and people were not able to be tested on our site. 
16. We started work testing in anger on 3 April and had no positive tests in 7500 tests until July 2, 2020.
17. We have now seen over 100 positive patients come through our facility over 40 of whom are patients of the practice.
18. Once the testing start showing positive results our database allowed us to identify a significant cluster in the area. In one day we had nine cases and by the end of five days this had risen to 22. A subsequent cluster was of 9. 
19. These were all notified to the DHHS in the normal way. Until more recently this was all done by phone. I used to ring the phone line after 8 o’clock at night as ringing during normal business hours was impossible waiting 40 minutes each time as a minimum. Now there is an online form for reporting these cases.
20. Once you reported case to DHHS there is no further interaction whatsoever with the referring GP or testing centre Drs (in our case) about the outcome of that case.

APPENDIX: 

Dr Mukesh Haikerwal AC  General Medical Practitioner T12, Circle Health Building, Unit 6, 230 Blackshaws Road Altona North, VIC 3025 Phone: +61 3 93933900  E: mckehaik@bigpond.net.au

Mukesh Haikerwal is a General Medical Practitioner in Altona North in the West of Melbourne, Victoria Australia. He is in a group teaching and training practice where he has worked since 1991 with his wife Karyn Alexander.

They worked with a partnership of 9 to build the “Integrated” North Altona Health Hub – Circle Health (www.circlehealth.com.au) and merged two local practices under the new Altona North Medical Group (www.anmg.com.au).  

Part of their vision is CIRQIT Health (Community Innovation Research Quality and Information Technology – www.cirqithealth.com.au ) built on the upper floor.
The General practice includes a significant role in supporting patients needing psychiatric and mental health care in the area coordinating care with members of the Mental Health professionals’ network and beyond. 

The 2020 COVID-19 Pandemic was a catalyst for change in Health and Health care delivery and as part of Mukesh’s highly public interventions including “Car-Park” testing, use of Video-consultations, deployment of lay “clinical Health Assistants” and “scribes” CIRQIT was the innovator, integrator and adoption agent for the “North Altona Respiratory Clinic”- a Federal initiative.

On 26 January 2018 he was made a Companion (AC) in the General Division of the Order of Australia for “eminent service to medical governance, administration, and technology, and to medicine, through leadership roles with a range of organisations, to education and the not-for-profit sector, and to the community of Western Melbourne.”

Of note, Mukesh has held high offices in Victoria, Nationally and internationally.

• Principal in General Medical Practice
• Board of the Actuator: Australia’s Medtech incubator programme (Chair)
• Board Cancer Victoria (deputy Chair)
• Board Beyond Blue 
• Chair Beyond Blue Drs’ Mental Health Programme
• Board Brain Injury Australia
• Board Australian GP Alliance
• Board of Melbourne Academic Centre for Health (MACH): an MRFF initiative
• Honorary Enterprise Professor, University of Melbourne 
• HealthDirect Clinical Governance Committee
• AMA Gold Medalist
• Life Fellow, Royal Australian College of General Practitioners
• 2014-2016 Ex Chair Australian Institute of Health and Welfare
• 2011-2015 Past Chair of Council, World Medical Association
• 13-14/11/2014: Convenor: first #H20Melb in Australia in November 2014.
• 2013: Rotary Melbourne Community Award
• 2003-2005 19^th President, Australian Medical Association 
• 2001-2003 AMA Victoria President
• 2007-2013 Head of Clinical Leadership, Safety & Stakeholder Management: National E-Health Transition Authority
• 2008-2009 Commissioner, National Health & Hospitals Reform Commission

Mukesh is a passionate advocate for the use of technology in the health sector and stepped down as the National Clinical Lead and Head of the Clinical Leadership & Stakeholder Management Unit at Australia’s the National e-Health Transition Authority (NEHTA) after 6 years in August 2013. His roles there were in apprising the Australian community of the benefits of the vital role of IT in health care an enabler of progressive improvements and sustainability. 

He worked for the Prime Minister of Australia on the National Health and Hospital Reform Commission formulating a future vision for Australia’s health including using eHealth as an enabler. He was previously assigned to the National Minister for Health’s eHealth Ministerial Advisory Group and had roles with the Victorian State government.

He was awarded the Order of Australia in 2011 for distinguished service to medical administration, to the promotion of public health through leadership roles with professional organisations, particularly the Australian Medical Association, to the reform of the Australian health system through the optimisation of information technology, and as a general practitioner.

He was the 19^th Federal President of the Australian Medical Association, its Federal Vice President and, prior to that AMA Victorian State President. This saw him responsible for national policy development, lobbying with federal parliamentarians, co-ordinating activity across the AMA State entities and representing the AMA and its members nationally and internationally. He is a Life fellow of the RACGP and in May 2014, he was awarded the Gold Medal.

Canute was 40 when he died in 1035. He was also known as Cnut the Great, King of England, Denmark, Norway and parts of Sweden. By the time of the Norman Conquest in 1066 his story was quickly becoming lost to time but his relationship with the tide lingers on.about:blankEmbed URLPaste a link to the content you want to display on your site.EmbedLearn more about embeds(opens in a new tab)Sorry, this content could not be embedded.Try again Convert to link

Find following data as requested from the Royal Australian College of General practitioners.:

Practices (2019)

NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Aust
2 800	1 985	1 629	751	542	170	109	161	8 147

Source: Report on Government Services 2020 https://www.pc.gov.au/research/ongoing/report-on-government-services/2020/health

GPs (includes VR, non-VR, trainees) (2019)

	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Aust
Headcount	11,482	9,227	8,116	3,881	2,763	936	586	481	37,472
FTE	9,764.9	7,612.0	6,390.3	2,839.1	2,053.9	566.4	396.2	231.1	29,853.8

Source: Department of Health General Practice Workforce providing Primary Care services in Australia – Statistics by calendar year https://hwd.health.gov.au/CalendarYear.html

Community Health Centres: about:blankEmbed URLPaste a link to the content you want to display on your site.EmbedLearn more about embeds(opens in a new tab)Sorry, this content could not be embedded.Try again Convert to link

Victorian CHSs operate under two distinct legal and governance arrangements: 56 CHSs operate as part of public health services and 32 are independent registered CHCs.

The independent registered services are companies limited by guarantee, and registered under the Health Services Act 1988.

Primary Health Networks (PHNs).about:blankEmbed URLPaste a link to the content you want to display on your site.EmbedLearn more about embeds(opens in a new tab)Sorry, this content could not be embedded.Try again Convert to linkabout:blankEmbed URLPaste a link to the content you want to display on your site.EmbedLearn more about embeds(opens in a new tab)Sorry, this content could not be embedded.Try again Convert to link

6 Primary Health Networks in Victoria:

• North Western Melbourne
• Eastern Melbourne
• South Eastern Melbourne
• Gippsland
• Murray
• Western Victoria

The Covidcare APPabout:blankEmbed URLPaste a link to the content you want to display on your site.EmbedLearn more about embeds(opens in a new tab)Sorry, this content could not be embedded.Try again Convert to linkabout:blankEmbed URLPaste a link to the content you want to display on your site.EmbedLearn more about embeds(opens in a new tab)Sorry, this content could not be embedded.Try again Convert to link

LEGISLATIVE COUNCIL LEGAL AND SOCIAL ISSUES COMMITTEE

Inquiry into the Victorian Government’s COVID-19 contact tracing system and testing regime

Transcript: Mukesh Haikerwal

Microsoft Word – FINAL-Contact Tracing 181120.docx (parliament.vic.gov.au)

Melbourne—Wednesday, 18 November 2020

(via videoconference)

MEMBERS

Ms Fiona Patten—Chair Ms Tania Maxwell

Dr Tien Kieu—Deputy Chair Mr Craig Ondarchie

Ms Jane Garrett Ms Kaushaliya Vaghela

Ms Wendy Lovell

PARTICIPATING MEMBERS

Dr Matthew Bach; Mr David Limbrick; Ms Melina Bath; Mr Edward O’Donohue;

Mr Rodney Barton; Mr Tim Quilty; Ms Georgie Crozier; Dr Samantha Ratnam;

Dr Catherine Cumming; Ms Harriet Shing; Mr Enver Erdogan; Mr Lee Tarlamis;

Mr Stuart Grimley;  Ms Sheena Watt; 

Necessary corrections to be notified to

executive officer of committee

Wednesday, 18 November 2020 Legislative Council Legal and Social Issues Committee 42

WITNESS

Dr Mukesh Haikerwal, General Practitioner.

The CHAIR: Hello, everyone. Welcome back. Today we are very pleased to be joined as part of the Inquiry into the Victorian Government’s COVID-19 Contact Tracing System and Testing Regime by Dr Mukesh Haikerwal, a GP in the west. Thank you so much for joining us today. Today with me I have Deputy Chair Tien Kieu, Ms Georgie Crozier, Dr Matthew Bach, Dr Catherine Cumming, Ms Kaushaliya Vaghela, Ms Wendy Lovell, Mr Enver Erdogan and Ms Melina Bath.

Just so you know today, Doctor, all evidence taken at this hearing is protected by law, and that is under our constitution as well as the Legislative Council’s standing orders. This means that it has parliamentary privilege.

However, if you were to repeat those comments outside you may not have the same protection. Any deliberately false evidence or misleading of the committee could be considered a contempt of Parliament.

Today we are recording and we have Hansard, who will provide you with a proof transcript. I would encourage you to have a look at that to make sure we have not misrepresented you in any way. Ultimately that transcript will be available on our website. We would really welcome you to make some opening remarks, and then we will have a broader committee discussion after that.

Dr HAIKERWAL: Thank you very much. I would like to thank you all for inviting me to attend the inquiry and to present and also for putting this inquiry onto the agenda. My name is Mukesh Haikerwal and I am a GP in Altona North. The end of the year is the end of my 30th year working as a GP in this area. I have taken the liberty of providing you with a written document with my details on the back of it, and I do not intend to read all of the pages before you. I would like to make some opening comments based on that, but really I would welcome any questions you might have of me.

I would like to start by saying that we are in a much better position now in Victoria than we have been. The height of our misery was in the middle of July, when we reached the 725 cases in a day, and we have reached 3500 health workforce participants who have been infected in this process as well. In my role as a general practitioner I have moved through various phases of this contagion, starting off with when we were not particularly aware of how significant it was going to become through to the first lockdown and then the second lockdown, and each of those parts of the journey have impacted directly in our practice, which is a large multidiscipline practice in the area, together with our respiratory clinic, which has been federally funded to provide the community with a testing service. It is not just a testing service but a service for people who have respiratory illnesses that otherwise could not be seen in the general practice to be seen and consulted with by a GP with full protective gear on so that they can then be looked after and treated without necessarily having to go to the emergency department. We also do testing and of course that is also a big part of this process.

One of the things we fundamentally brought here when we set up our clinic was the rigour of gathering the patient information and data to the extent that we deployed something called the national health identifier, which has to be very specific for the patient so we know we have got the right patient, right place, right time.

That has been instrumental in being able to see who is actually coming and where they are coming from, especially when they turn out to be positive, and that information has led us to the next stage: what happens when somebody turns up positive? We started testing on site on 3 April and we had zero cases until 2 July. On 2 July we had our first case and up until now we are at about 110 cases. There have been luckily no cases since the middle of October, I am really pleased to say. We have therefore interfaced with patients face to face prior to testing, during testing and after testing. We have written to every single one of their GPs electronically informing them of their results and about any outcomes of the consultations they will have had with us. We have had our services evaluated by the University of Melbourne—both the drive-through service, which is unique for Australia, and our respiratory clinic, which is one of over 140 across the country. We have made sure that we have given good service to the individuals by following them up, especially after they test positive, and that is how I know and feel the pain that they have gone through at each of the intervals that they have had.

We have had many constant problems throughout the process. I think we have worked through them with the department, and I think the most important thing for this committee that I can bring is what we had in what I would call our two local spikes in September to October. At that time we had on one site 22 cases that I reported in five days. I called the chief health officer after the first nine on day one and said, ‘Do you want me Wednesday, 18 November 2020 Legislative Council Legal and Social Issues Committee 43 to do something about this?’, and so we embarked on a process which I think is really useful, which is working with the local council, working with the local GPs and other providers in the area, and working with a very good branch of the health and human services department in the community testing and support scheme, which made us have a very direct impact on the local spikes. We tried to replicate these in other areas. I know that Wyndham is trying very hard in this area and I know I have reached out to other areas like Chadstone and Coolaroo when they had their outbreaks and indeed to my colleagues in Shepparton, and I think there is a lot to be learned from what has happened over here.

I am speaking to you as a frontline general practitioner. I have had a representative role for many years, and I continue to have, but really I am not speaking here with a political hat on but as a GP on the front line working with other GPs and other providers around here, all of whom are looking to improve the system and provide our support to the system to make sure the system works for us and for our patients so they get a decent set of support mechanisms when they are in this position of having contagion. We want to make sure they get their results when they need them, when they have had them, and make sure that there is a proper scheme so that in the future we learn from this and actually use all the people who are able to provide services, provide care, provide knowledge—local knowledge; intelligence, you might say—and make sure we have a system that we can be proud of.

I concluded on my little piece of paper—I am sorry, if there are any typos; I apologise. I have been putting in 16 hours a day since April around the clinics and so I have thrown this together, so if there are any mistakes, I beg your forgiveness right here, right now. We have a great system in evolution. We used to be the stand-out jurisdiction in the country doing health, and I want to make sure that we get back there. Thank you.

The CHAIR: Thank you, Mukesh. I think that is a goal that we all would like to achieve, and hopefully this inquiry assists us in making those recommendations to continue that improvement. I would also like to say I think, thanks to you, the systems are better now than they were. I think this is due to some of the things that you have highlighted this afternoon.

We had Professor Rait here on Monday, and his real concern was that lack of communication with general practitioners and with the patient’s own doctor. You were saying that when you do the testing at your clinic you ask the patient who their doctor is and you electronically send the results to them. Do you believe that that has been fixed? I mean, my understanding now is anyone who goes for a test is asked who their GP is and those results are sent through, but I am wondering if that is what you are hearing practically and on the ground.

Dr HAIKERWAL: No, I do not think it is fixed. I know there is a will to fix it. I know there is a direction to fix it. It does not mean it has been fixed. The pathology labs are very good at sending on copies to GPs if it is noted, but the systems that have underpinned some of the testing have not made that a matter of fact. I get reports from my local hospital, for instance, very well, but for patients who have been to other facilities to be tested, I do not tend to get their results in my general medical practice. I then have to go through that whole process of, ‘Where did you go? So who was testing it there? Which lab did they use at that site, not this site?

Which lab do I ring to try and get your results?’, and then I will try and get it electronically into my system. So no, I do not think it is there yet, but it certainly needs to get there.

The CHAIR: Yes. I certainly was at a testing site on the weekend, and they were asking those questions and putting it in—but not yet. That still seems to be one of our problems—well, a significant issue that could be improved. Where else do you think has been overlooked? I think certainly with Salesforce the government has been working but chasing its tail, it would appear, in this. Where else do you think that we really need to change—something that fundamentally improves our health system overall?

Dr HAIKERWAL: It is a fundamental problem with the relations between the federation. For some reason GPs are deemed to be the responsibility of the commonwealth and nothing to do with the healthcare system in Victoria or any other state. That is fundamentally wrong and flawed, because we are Victorians, we work with Victorians, we look after Victorians, we have 2 million people seeing a GP every day across the country, and we employ Victorians and we keep them healthy. So that is a fundamental problem.

I am afraid to state my age. I first started in 1991, where you are sitting now nearly, for something called the Brand report, which looked into healthcare—a report for Victoria. I was probably the only GP to turn up because nobody was bothered to go because they never report about general practice. I said to the Chair, ‘Why Wednesday, 18 November 2020 Legislative Council Legal and Social Issues Committee 44 haven’t you talked about general practice?’. They said, ‘It’s not part of our terms and it’s a commonwealth responsibility’. So it is fundamental. We have gone through many changes along the way where even the department has done some really good work about working with general practice, understanding the value that can be brought to the system with a joined-up system, making sure that people get the care where they need it and not necessarily having to be in hospital all the time. I think that this is something that is often spoken of but not operationalised, and in many of my years of advocacy this has been a key part of it, working with many good health ministers actually in the state and many good secretaries of health. I have literally walked and talked with them for years, and I do not think it gets beyond that level. That is the problem. It is in the fabric of the organisation, not necessarily in the higher echelons.

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