AMA Call for More Public Hospital Beds - Doorstop

QUESTION: How have you come up with this figure of 3,750? Did you - I mean, have you done an audit on all the hospitals and how did you sort of ...?

DR CAPOLINGUA: The figure is 3,750 beds, which merely brings us to the 85 per cent safe occupancy level. We went State-by-State to each State AMA and said to them, give us the numbers of beds that you need in your State to bring your beds - your hospitals to safe occupancy. The 85 per cent figure that we put out in our public hospital report card, and each State has come back with the required numbers of beds; reminding you that this is for 85 per cent safe occupancy only, to take that pressure off, to ease the access block. It certainly isn't the call for beds that may be required for unmet need into the future.

QUESTION: Wouldn't this just exacerbate an already stretched workforce situation?

DR CAPOLINGUA: Let me tell you that the reason why doctors and nurses have left the public sector is because of the environment that they're working in there, the pressure that is on them, the compromise that they feel when they're trying to look after patients.

If we open up the capacity, we made the hospitals safe again, at safe levels of occupancy, the access block would be relieved and the bed pressure would be eased, and doctors and nurses would feel that they could treat the patients the way they needed to, they will stay in the public hospital sector and we may get some to come back.

QUESTION: How many doctors and nurses would you have to employ to staff those extra beds?

DR CAPOLINGUA: Let me tell you, that in some of the hospitals now, there's already some capacity - closed wards, theatre time that's closed - and it really is a matter of investing in opening... reopening those beds, the new beds that we need, and expanding further.

This will take some time. We want to see it happen in the first year. We want to see the money in the first year of the Australian Health Care Agreement, the extra $3 billion that we're calling for directed towards the bed numbers. And over that time, we will attract the staff back in. We have to give this a go.

Remember that, for years, the States have been contracting back the bed numbers, putting the pressure on the hospitals, and the doctors have been leaving the public sector and going solely private.

Doctors have always had a sense of altruism and wanted to work in the public sector, they want to teach in the public sector. It's been intolerable there. Let's invest in the beds. It will treat the patients and it will bring our doctors and nurses back.

QUESTION: But isn't there an overall shortage of doctors and nurses?

DR CAPOLINGUA: We have at the moment, in particular in the public sector, a drive away from the public hospitals, more into the private sector - and we know that there are a lot of nurses out in the workforce who have come away from working in their profession because it is too hard, the pressure is too great.

We really have got to invest in attracting them back in, and this is one way of treating the patients, relieving the pressure and attracting those very valuable and important staff back into the public hospitals.

QUESTION: The $3 billion you quote, is that in - is that including the beds plus extra money or is that on top of... on top of ...

DR CAPOLINGUA: The $3 billion is what we're calling for is extra funding in the first year of the Australian Health Care Agreement. And it would take about $1.2 billion to open the 3,750 beds that we're talking about.

And we're talking about the beds in the major States here. We haven't got the exact numbers required for the ACT, Tasmania and the NT, but we know that Royal Darwin Hospital, for instance, works generally at 117 per cent occupancy. That's your patients in your corridors, in the - on the chairs and on trolleys outside, and that is unacceptable, unsafe. No wonder the staff won't - don't want to work there.

QUESTION: So the $1.2 billion is included in that $3 billion?

DR CAPOLINGUA: The $1.2 billion is included in that $3 billion and, of course, we need to make sure that the States are responsible, act responsibly in using the money to open up the beds.

QUESTION: What would happen if this isn't carried out?

DR CAPOLINGUA: We are on a downward spiral as far as the public hospitals go. We know that occupancy is not at safe levels. We know that we have got elective surgery lists that are blown out. We know, indeed, that the emergency departments are under a huge amount of pressure because of access block. And we know that we've lost very valuable doctors and nursing staff out of the public hospitals.

If we don't address the beds, we will continue down that spiral, and Australians will, indeed, suffer a public hospital system that is not as good as what we should be able to deliver.

QUESTION: Dr Capolingua, the Health Minister Tony Abbott is now saying that the people on his hospital boards should be volunteers and they won't get paid. Is that acceptable?

DR CAPOLINGUA: The AMA agrees with the principle and the philosophy of local and regional hospital boards. The issue of payment is something for the Minister to have to deal with and for him to sort out and decide.

QUESTION: Would you be happy for that money to come out of the $3 billion that you're talking about for staffing those community boards?

DR CAPOLINGUA: The staffing and the issue of reimbursement of local and regional boards is an issue that needs to go forward as far as the Minister is concerned.

The money that we're talking about is money for delivering services to patients, that's what we're focusing on here.

And let me tell you, that if you're looking at local and regional boards, the number of those across the country and the number of individuals on those, you would probably save money by removing layers of bureaucracy at State health department level and perhaps, indeed, reimburse those board members.

QUESTION: Should people who are making decisions about the life and death of patients and the running of multimillion-dollar hospitals get paid nothing?

DR CAPOLINGUA: Let me tell you that lots of boards work on altruistic mechanisms. You commit yourself as part of service to the community to sit on a board and manage, for instance, a smaller hospital or in any other areas in charity work, et cetera. So that philosophy exists in the community.

As far as going forward, the local and regional boards for the public hospital sector, as I've said, it is an issue for the Minister to decide upon.

QUESTION: If you were to release a report card on where the major parties stand on meeting some of your requests over the campaign, who is out in front and who has still got work to do?

DR CAPOLINGUA: We're actually collating our report card at the moment. I have several pages on my desk with Coalition and Labor policies and, indeed, what the AMA knows Australian public needs as far as health delivery in this country. And we are going to be analysing, as we have done, more closely along the way.

We've still got some big gaps in policy. Coalition and Labor still need to deliver us some very clear pictures about the Australian Health Care Agreements; more about the public hospitals; rural Australia, we've heard very little about Indigenous health, we haven't heard much about issues around public health campaigns. There's still a lot more before our report card can be finalised.

QUESTION: Kevin Andrews has been on radio this morning saying that an audit of overseas trained doctors has found 37 in Qld that have gaps in their employment history. Do you think that the screening process for overseas trained doctors in Qld is falling behind other states?

DR CAPOLINGUA: We have certainly become aware over the last 18 months or so that there are issues around our processing of overseas trained doctors and their entry into this country. And responsibly, because issues have been pointed out, we have needed to direct our minds at improving the processes and ensuring, indeed, that we have the highest quality doctor entering into Australia to provide service in an area which meets the skill sets; in other words, that they can deliver what that area requires.

If indeed we continue to do audits and go thoroughly through the process, and we find that we need to make changes, then that is a good thing, and let's go forward and make those changes. Remembering, however, that we have been relying very heavily on our overseas trained doctors in Australia, a lot of them have provided great service to communities for a very long time, and we need to acknowledge and respect those doctors.

QUESTION: But would Qld processes be less rigorous say than WA or SA processes?

DR CAPOLINGUA: I think you'll find that sometimes the rigorousness of the process is about who needs the doctor. This is something the AMA is always concerned about; what is the driver for a health department bringing a doctor in. They have to deliver a doctor into a hospital; they have political imperatives that drive them to bring a doctor in. And I think we need to go back to making sure that the driver is a quality and safety driver. So each State, I think, health department maybe needs to look at itself and make sure that when it brings a doctor in, it's about the quality and safety of that doctor delivering service and not the expediency of putting a doctor into - plugging up a space.

QUESTION: Wouldn't States have to recruit more specialists and doctors from overseas if they were to meet your demands to open up more public hospital beds?

DR CAPOLINGUA: We actually have some capacity there right now. I know many surgeons across the country who are constantly frustrated by their surgery lists being cancelled, by operating times being cut short because the State government won't pay overtime for the nurses so that the list can run into a long case at the end.

You show me how we can fill up all of those spaces first and treat all of those patients first. Do that first and then we'll look at whether or not we're going to need more doctors in the long-term.

QUESTION: But the surgeons have got plenty of work to do in the private sector, surely?

DR CAPOLINGUA: And indeed those very…

QUESTION: Surely not going short of work?

DR CAPOLINGUA: Those very same surgeons are working in the private sector and they've got public hospital lists, and are frustrated by the service in the public hospital. And there are many surgeons and other doctors who are solely salaried and only work in the public hospital, and they are frustrated.

So let's replenish their desire to be able to treat patients.

QUESTION: Are you concerned that there are doctors working in Qld at the moment who are not qualified; they're working, say, as surgeons but they are not qualified as surgeons?

DR CAPOLINGUA: If there was ever an instance that we had concerns about particular doctors, we would need to investigate that very clearly. And you can see by the number of investigations that have needed to occur over time, that that exactly is what the process is.

Doctors who are practising in any State of Australia have had to go through screening and careful scrutiny for entrance into Australia. And if we have found that at times there have been instances where we need to do that better, then let's keep doing that better right now.

And, you know, don't get baulked or stalked by some report about an incomplete work history. Let's look at the clinical outcomes. Let's look at safely treated patients by those doctors.

QUESTION: The figure for NSW - the number of beds you'd like to see, 1600, seems disproportionately high even accounting for the larger size of the State…

DR CAPOLINGUA: NSW, you will find, will - the AMA (NSW) will report to you that there has been a philosophy of contracting bed numbers. At Royal North Shore there's been a significant decrease in the number of beds, and AMA (NSW) will tell you that they have opened desks and closed beds. In other words, there are wards filled with offices where there used to be patients. So NSW is crying out right now to just go back, you know, go back to the number of beds it had, let alone increase the number to cope with the increasing population.

QUESTION: Would the bed number largely go to city hospitals or are they needed in the country too?

DR CAPOLINGUA: The major issue here is about the major teaching hospitals where their occupancy certainly doesn't sit at 85 per cent, it sits at 95 on average, and in some instances higher up to 100 per cent.

The country hospitals are another issue as well which needs to be dealt with in the Australian Health Care Agreements. Country hospitals have actually closed down across Australia. Their infrastructure has been unsupported. They have been allowed to run down. And indeed we need to reinvest in those.

QUESTION: You made mention of the Royal Darwin. You said it had a bed occupancy of 117 per cent. The other comparisons you made were up to 100 per cent. Does that mean that Royal Darwin is the, I guess, most under-resourced of all the nation's hospitals?

DR CAPOLINGUA: Royal Darwin tends to run at a very high occupancy rate and is under great stress. The other major hospitals across Australia may reach peaks of 120 and 121 per cent, depending on the season and the time. So they can literally all get up to that degree of unsafe occupancy. Royal Darwin we know has a chronic ongoing issue and we need to address the NT overall.

QUESTION: So is that the worst of the public hospitals in Australia?

DR CAPOLINGUA: All of the public hospitals will reach very high occupancy rates that are unsafe, even as high as 121 per cent. Royal Darwin is an example that I brought up because we don't have the actual bed numbers required there, but it is an important issue that even in those states, ACT, Tasmania, and NT, beds are required as well.

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