Stephen Parnis: Hospital threat

WHILE participating in the recent launch of the 2015 AMA Public Hospital Report Card, the information in the report made me feel fearful for the future of our hospitals and health system.

Let’s be blunt — the public hospital system is under threat to an extent I have never before witnessed.

I have been a part of the public hospital system since 1989. I count myself fortunate to have trained in it, progressing from medical student to consultant emergency physician. I know that we provide first-class care.

I have seen a multitude of changes in our hospitals over the years. Most changes are for the better with many patients treated faster than ever before, whether for elective surgery or emergency treatment.

Many clinical outcomes are also better, and treatments for some conditions can now be managed from home instead of an inpatient bed.

In my own area of emergency medicine, the changes have been profound. Multidisciplinary team-based care, fast-track clinics, early streaming based on triage findings, the “4-hour rule”, short-stay units, improved computer systems, and new “in-reach” services to aged care facilities are just a few of the measures adopted to improve efficiency and effectiveness, as well as to reduce demand when possible.

But with a growing and ageing population, the demands increase. Every year. Without fail.

While medical care has undergone radical change, changes to the funding systems for hospitals have been even more profound. The move from “block” funding to activity-based funding started in Victoria in the early 1990s.

Shared responsibility between the federal and state governments has been an endless source of angst, as Canberra seeks to reduce its commitments, and the states face an ever-growing proportion of their entire budget going to hospitals.

We have seen the games played with cost-shifting (in so-called “privatised” outpatient clinics and procedures) for too many years.

Hospitals have been asked to do more with less for a long time. Indeed, there were times in the past when it did drive some efficiencies. However, that is no longer the case.

Now, many “reforms” run the risk of compromising care, with attempts to downgrade or close services such as emergency departments or refuse to fund adequate staffing levels in order to reduce expenditure.

Emergency departments hate going on bypass, because it means our resources have been overwhelmed, forcing ambulances to go to other hospitals. This is usually related to capacity constraints, and it puts patients at risk because their treatment is delayed.

The federal government talks about health funding being out of control. But when federal hospital funding has risen by less than 2% per year in recent years, and health spending as a share of gross domestic product has gone from 8.5% to 9.5% in a decade, those claims ring hollow.

The real crisis is flowing from the cuts to health expenditure in the 2014 federal Budget. Tens of billions of dollars will not be forthcoming, while demand continues to rise.

Something has got to give.

The medical profession does not mind a challenge, and we will always look to do things more efficiently and effectively. But we hate injustice, and there can be no doubt that standards will fall if there is no change to the federal government’s intended cuts in the years ahead.

If I cannot justify these cuts to the next patient I care for in my emergency department, then I will actively oppose them when I speak on behalf of the AMA. To do otherwise would be utterly hypocritical.
 

Dr Stephen Parnis is vice-president of the federal AMA.