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THE release of the AMA Public Hospital Report Card 2011 sparked yet another round of debate about the state of public hospitals around the country. This is a good thing. It leads to action.
Our report shows that, despite increased funding from the federal government, hospitals in every state and territory are not meeting existing targets for access to emergency departments and elective surgery, let alone the more ambitious targets set by the Council of Australian Governments (COAG) for the years ahead.
Our report card was based on the most up-to-date publicly available statistics — plus feedback from doctors working at the front line of care in public hospitals — which show that hospitals do not have the capacity to meet the demands of an ageing population.
The critical response from Health Minister Nicola Roxon was largely based on information not yet in the public domain, a point she later conceded. The Minister claims the new data, to be released soon, will show improvements across the board.
I hope she is right. Our report is a yearly snapshot, at a point in time in the recent past, which shows the reforms have not yet kicked in.
Our report card does acknowledge what the government has done and is doing for public hospitals — a point the government failed to recognise.
The AMA accepts the responsibility, on behalf of patients and the community, to report on the shortfalls we find and suggest how to make things better — and here are a few suggestions.
We need more hospital beds. In 2009–10, only 378 new beds were opened. The AMA and former Prime Minister Kevin Rudd agree that around 10 times that number is needed.
Hospitals must run at 85% bed occupancy. This allows flexibility for surge capacity and will allow proper training environments for our medical students and junior doctors.
We simply cannot run hospitals like supermarkets. We can’t have “just in time” delivery in health care. It does not work. We have emergencies. We have epidemics. We have natural disasters. We must be able to treat our elective surgery patients. We must be able to teach and train. We need downtime.
We also need whole-of-hospital reform. To fix access block, we can’t just focus on the emergency department in isolation. We need to look at ward transfer policies both from emergency and into the community.
We also must be honest about hospital statistics. Hidden waiting lists — the waiting lists of people waiting to get on waiting lists — must be abolished, not made into another bureaucratic art form.
The COAG agreement will go some way towards achieving this. The states and territories, as managers of the public hospitals, have to be responsible and accountable — and honest with the numbers they are reporting.
The new Independent Hospital Pricing Authority should help to promote that transparency.
Public hospital management must also become closer to the action and be well informed by the doctors and the nurses who provide the care.
When clinicians are involved directly in management decisions that affect patients and system redesign, there is a greater chance that vital resources and every new health dollar will reach the patients who need them.
Our public hospitals are still very good by world standards. If you are going to get sick or injured, Australia is still the place to be.
But we can, and must, do better.
Dr Steve Hambleton is the president of the AMA.
Posted 14 November 2011
I, of all people, understand the problem of health professionals not doing their job in a way that truly helps, one example being my search for a diagnosis during 18 months, then having emergency middle-of-the-night surgery to save my life, because of such diagnosis not being made.
However — in March I had a minor illness while in the US, but one that did need treatment. I now understand why their system is so terribly expensive – it’s bottom heavy and soooo poorly organised. What an eye opener! Give me the Australian medical system any time.
It is absolutely UNREALISTIC to expect there be no waiting
lists…. like ‘death’ and ‘taxes’, waiting lists are a certainty of life. It is time we (medical professionals) got away from talking otherwise then the boffins would do likewise!
On another note, until management and administration take their leading from the “priorities” of the clinicians there is little hope of developing an effective hospital system!!
There is also another area in urgent need of “healing” in our public hospitals – it is the relationship between disaffected clinical staff and managers – at every level. Re-engagement of clinicians needs to be built on mutual respect, which is earned rather than conferred by role. If doctors are valued for our critical decision-making in clinical matters, we must equally be valued for our decisions on operational matters. At the same time, clinicians need to accord appropriate respect to an effective management and administrative arm within health, without which the clinical work service could not function. A critical area for re-engagement is in the area of quality and clinical governance, with staff being seen as an asset to an organisation rather than a risk. With “healing” of this relationship, there is greater hope for a more effective hospital system.