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Hospital statistics – who do we blame now?

As reported in this edition of Australian Medicine, the COAG Reform Council last week released its latest report on the state of the National Healthcare Agreement. Rather than being a report on the performance of State and Territory Governments in return for Commonwealth funding (its stated purpose), the report reads more like a report on the performance of hospitals and primary care providers.

17 Jun 2012

As reported in this edition of Australian Medicine, the COAG Reform Council last week released its latest report on the state of the National Healthcare Agreement.

Rather than being a report on the performance of State and Territory Governments in return for Commonwealth funding (its stated purpose), the report reads more like a report on the performance of hospitals and primary care providers.

A big problem with the report, however, is that it presents many of the important numbers but it does not reveal the stories behind those numbers – the real life reasons why some States or some hospitals may not be doing as well as others.

The National Healthcare Agreement was supposed to be the end of the blame game, with the States expected to take on full responsibility and accountability for hospital performance. 

But there is yet to be strong evidence that this is happening.  The new health landscape under the Agreement is still being bedded down. There is still a significant danger that the new arrangements could lead to less accountability if the States dodge their responsibility.

That is why we need more data, and more relevant data. We need to be able to more effectively monitor activity if we are to get a meaningful national snapshot of performance that will allow policy makers to better prepare the health system for future need.

For the AMA, key performance indicators are hospital bed numbers and fully transparent waiting lists for elective surgery.

This means exposing and reporting the ‘hidden waiting lists’. These are the patients who have been referred to a hospital specialist by their GP but have not yet been to see the specialist to be booked for surgery. This is a lot of patients. They need to be counted if we are to get a true picture of need.

We won’t see a return to efficiency until we get real action on hospital beds.

The AMA has put the estimate at more than 3700 beds nationally, a number that former PM Kevin Rudd agreed with when he was at the tiller of health reform.

The COAG Reform Council tells us there were only 872 more public hospital beds in 2010-11. This did not keep pace with population growth.

We need more beds and we need better reporting of beds.

The AMA recommends that, as well as measuring the hidden waiting lists, the COAG Reform Council should adopt the AMA’s Bedwatch proposal to conduct a national stocktake of the actual numbers of beds needed in each hospital to provide safe care.

Bedwatch would track existing beds, new beds and bed occupancy rates to ensure that bed occupancy rates in public hospitals meet the AMA’s preferred level of 85 per cent bed occupancy.

I mentioned Bedwatch to Chairman of the COAG Reform Council Paul McClintock AO when we met informally last week.  He seemed genuinely interested.

I will be watching the next COAG Reform Council report with great interest.

If we are to end the blame game we need to see the greater transparency that we were promised.

We all need to be clear which level of government is accountable so we can hold them to their promises.  We also need to measure things that are important to patients – like those hidden waiting lists.


Published: 17 Jun 2012