BY DR RODERICK MCRAE, CHAIR, AMA FEDERAL COUNCIL OF PUBLIC HOSPITAL DOCTORS 

By the time of this column’s publication, we may have had some further information from the Federal Minister for Health Greg Hunt, at the AMA’s National Conference, although the Budget is pretty fresh. We know public hospitals are fundamental to Australia’s overall health system, dealing with greater than six million admitted patient care episodes and around 92 per cent of emergency admissions in any one year. Nonetheless, we experience chronic under-funding partially because of near stagnant growth in financial support. This has been going on for just too long; we all feel the pressure day in, day out.  We know under-funding is building to crunch point.

AMA’s 2018 Public Hospital Report Card shows bed numbers per 1000 population are static; performance, basically, is plateauing at best; waiting lists, you know the sorry truth about that and our patients are suffering!  My December 2017 Australian Medicine column criticised the Council of Australian Government’s (COAG) savage imposed financial penalties where avoidable re-admissions or hospital-acquired complications are deemed to have occurred. The AMA’s 2016 Safe Hours Audit shows that in public hospitals, 53 per cent of doctors are at “significant risk” of fatigue with dangerous fatigue levels being reported across a raft of specialty groups.

So, the effect of underfunding is cumulatively adding up to seriously affecting our, and the system’s, ability to perform optimally for our patients, and our own health and wellbeing is at stake. That’s why the 2018 Budget decisions matter; it’s about what the future holds for public hospital medicine. Without vital new investment, required infrastructure, and human resource capacity, an appropriate standard of result cannot happen.

Reflecting on AMA’s pre-budget submission, what we have said is that the Budget must fully fund, for the medium to long term, internal capacity building and expansion of their integrated care responsibility.  Not to penalise an already underfunded sector via that sneaky COAG device that will redirect otherwise committed funds.  The AMA also says States and Territories must be fully compensated for any loss in private patient revenue and any funding decisions must not dilute support for patients electing private treatment. Mr Hunt has said he intends to look at these private patient issues so we don’t yet know where Government is headed.

Despite the known pressure on public hospitals the new 2020-25 Hospital Funding Agreement ratchets up this financial pressure on hospitals even further. Within existing levels of Federal funding, the Agreement will require public hospitals to implement new measures to cut waste, increase productivity and extend their responsibilities to engage in the care of chronically ill-patients post discharge to reduce overall admissions.

I agree integrated care is essential – but this work requires new Federal funding to pay for the hospital and primary sector resources required to deliver it. The public hospital funding in the 2018 Federal Budget was nothing more than the amount forecast over the forward estimates to maintain funding at current levels. 

There are many laudable new funding initiatives out of this Budget, to name some: a rural doctor workforce/training package, increased support for aged care in the home, and mental health/suicide prevention services, new research investment and (perhaps laughable!) the “unfreezing” of Medicare indexation. However, the Budget lacks consideration of how any savings from the Government’s yet to be finished MBS reviews will be re-invested into public health, and we still wait on needed big structural reform. There must also be funds to urgently begin development of a national medical workforce strategy.  On that, your Council of Public Hospital Doctors is working through the AMA to encourage all jurisdictions to cooperate more closely in their planning and coordinating of our future medical workforce to meet Australia’s future healthcare needs.

There’s an election coming; maybe this year; and Labor has promised an additional $2.8 billion ‘better hospitals’ fund to target reducing elective surgery waiting times and increasing emergency department bed numbers. Your CPHD will be looking to score both major parties as they release more health policy and keep a watching on eye on any moves to change public hospital private practice arrangements. We must push for the government to match Labor’s pledge and make Government fund for growth, not just, as it has been, keeping pace with activity. It’s matching funding with growth and having a workforce plan that really matters!