Dr Capolingua Launches the AMA Public Hospitals Report Card

CAPOLINGUA: The Australian public hospital system is in crisis and the report produces the stats and the figures to back up what we've been saying and to back up the stories that the patients have been coming out with across the country.

QUESTION: Are there any - what are the particular areas that need addressing based on the finding of this report?

CAPOLINGUA: The first principle and the most alarming to look at is the fact that public hospital capacity has decreased by 60 per cent in the last 20 years - 60 per cent in the face of an increasing population, increasing demand and increase in ageing population, particularly those over the age of 65. So no wonder they are struggling and they can't meet the benchmarks that we try and set for them in patient care.

QUESTION: But as the report itself points out a lot of that …

CAPOLINGUA: Sorry we will have to do one question at a time because it was three then.

QUESTION: More people are turning up to emergency departments with things that could be handled by their GP?

CAPOLINGUA: The story that - and this is a story that I absolutely despise hearing, the reason for the problem is that we shouldn't have patients in emergency department and we shouldn't have patients in hospital. Emergency departments and hospitals are there to look after patients, that's why hospitals were created in the first place.

And if you talk to the emergency department doctors, the patients that are there need to be there. The percentage that could have been treated in general practice or primary care is very small, very small indeed.

So let's not find an excuse for that, let's find a way to treat those patients. And similarly, reducing beds in the face of increasing need is a denial of the fact that the Australian public need a public hospital system to care for them.

QUESTION: Could you define capacity, when you're talking about 95 per cent full at teaching hospitals. Does that mean beds, staff?

CAPOLINGUA: When we're talking about capacity, we're talking about bed occupancy. And indeed, a safe occupancy rate is about 85 per cent. We find that most of the teaching hospitals are running way above that, above even 95 per cent with spikes over the 95 per cent.

And the public hospitals in general often running above 85 per cent. We call this the 'danger zone' because if you have an occupancy that is that high you cannot accommodate the need for admissions coming through your emergency department.

QUESTION: Where is New South Wales falling down, for those of us particularly interested in what's happening here, you've chosen Royal North Shore, why have you done that?

CAPOLINGUA: Royal North Shore of course is in the hearts and minds of the people of New South Wales and the stories have been heard across Australia as well. So we've chosen that because Royal North Shore, like the other hospitals in Australia needs our support.

This state, like the other states, is suffering from the same crisis, the ability to look after patients in emergency department and attend to them in the appropriate times, 30 minutes for urgent cases, is failing, in fact only 64 per cent of Australians get seen in that appropriate time.

The medical elective surgery waiting lists have blown out across the country so that 24 per cent of patients are still not being treated in the recommended clinical time. Which means that they have ongoing pain, suffering or disability because they haven't had their elective surgery.

The beds in this hospital have been reduced over time. So there is a huge amount of stress and pressure on the doctors and the nurses, the staff who are trying to hold the system together, trying to take care of people in a situation where they actually feel compromised, and that's not good enough.

QUESTION: How does that compare to the other states and territories, how did New South Wales compare?

CAPOLINGUA: The report card has got all the stats in it and you'll find that New South Wales does not fare all that well at all. It ranks in amongst the other states and you'll see that some states do more poorly in some areas and do better in others.

The issues across the country are very similar. And it is about the management and administration of the public hospitals at a state level.

QUESTION: … some states that were particular bad or would you say overall that every state had issues?

CAPOLINGUA: Every state has issues and certainly when you look at the report card you could be quite alarmed in some areas, in some states. Victoria, which has a system of running the hospitals under local and regional boards seems to run more efficiently, certainly 30 per cent more efficiently than New South Wales.

However, Victoria has its own problems with a desperate need for funding and as we know we have a nurse's crisis there.

QUESTION: What are the areas that New South Wales rank lower thank other states?

CAPOLINGUA: If you look in detail at the public hospital report card you'll see that New South Wales ranks in areas of concern as far as the ability to see patients in the emergency department, as far as the elective surgery waiting list goes.

And it would be - we haven't got the defined data on the bed numbers, but certainly from what I hear in this state, bed numbers have gone down again, in light of an increasing population and need.

QUESTION: Do you recommend the government - the commonwealth and state governments fund public hospitals?

CAPOLINGUA: The AMA is still committed to a blending of funding from the commonwealth and the states. Health is a responsibility of governments; state and federal and neither should abrogate that responsibility.

So we're determined to make them accountable in both regions. Certainly as far as the federal government goes, we are calling for an increase in funding; an extra three billion dollars in the Australia Heath Care Agreement in top-up funding and then the indexation to be increased from what has been five per cent to eight - to nine per cent because that reflects the true cost of needing to meet the increasing demands of people.

As far as the states go, they need to meet that funding and now we have to get the states to focus more on treating patients, not trying to find excuses for not treating patients, for not having patients in bed, or not having patients in emergency departments, to remove them from increasing, you know, the bureaucracies in administration, those layers actually do not provide service delivery.

And make sure that they pay attention to their staff, the doctors and nurses. Recruit them, retain them, make sure we provide training for the new doctors into the future.

QUESTION: This is a report card, so if you were going to rank them between A and E what would our hospitals get?

CAPOLINGUA: You didn't mention F. If we - it must be the new school based system. If you look at this report card then I think one has to say that there is shame - there is shame across the state governments for the management of the public hospitals.

And indeed, you could say that the doctors and nurses are certainly not failing and if you talk to patients, they'll tell you that they're doing their very best in the circumstances. But the system is certainly failing the doctors and nurses and failing the patients.

QUESTION: Are hospital boards part of the solution?

CAPOLINGUA: Hospital boards certainly bring the accountability and responsibility back to a group of people who are connected to the community. So a local or regional board, made up of community people, business people and clinicians, is a very accountable model and it also has some independence.

Currently, in every other state apart from Victoria, where the health departments run the hospitals, there are employees, public servants who manage the hospitals as such. And certainly when you're employed by someone, and it's your employee you're dealing with, it's quite a different scenario to having an independent board come to you and say, 'This hospital needs this, we have to address this issue. The community has these requirements.' And the staff also respond to that local input.

QUESTION: How much of a problem is economic mismanagement? Is it the fact that funds aren't properly distributed or is it the fact that there's just not enough funds?

CAPOLINGUA: There's a combination of both. We certainly are calling for an increase in funds. But in many states, and I know that New South Wales is a good example of this, there seems to be a philosophy of closing beds to open desks. In other words increasing the bureaucracy, closing wards, and putting offices in. And that means that the money is going to the wrong place.

QUESTION: A Labor government if elected, would move to take over state hospitals, would that help solve some of these issues?

CAPOLINGUA: The AMA does not believe that federal control of the state hospitals is a solution and certainly would not serve Australians any better. You will make it more remote, less in touch with the community.

Each state has got different demographics, different populations and different needs. And we need that local responsiveness and a more local accountability. Imagine trying to shift blame to someone in Canberra, it's hard enough trying to shift it to someone in Sydney.

QUESTION: Are there any hospitals in New South Wales operating on a pass mark?

CAPOLINGUA: The hospital report card looks at a state by state analysis. And we haven't got the data in this report looking at hospital by hospital.

QUESTION: Can you rank individual hospitals at all, is it better to be sick at St Vincent's than Royal North Shore then?

CAPOLINGUA: There is one message here that I have to reiterate and that indeed, even though we want the hospitals to be better, the level of care is still good because of the commitment of the nursing staff and the doctors in those hospitals.

We don't want them put at more risk, we don't want to see any patients potentially damaged, or feeling an experience which has made them feel compromised in their health care. So this is saying that we can do a lot better, particularly in a country like this where we've got the money, we've got the time to invest now in our hospitals into the future.

So do not feel frightened about going to your public hospital, but certainly let's keep the voices loud and clear about making them better.

QUESTION: Have these results surprised you, I mean given the recent media coverage, particularly surrounding Royal North Shore, is this something that was expected?

CAPOLINGUA: I must admit that seeing the stats in black and white or in colour as they are in this report card, certainly drills home that all of the stories that we hear about the people who experience the bad experience in the hospitals. The cutting back in beds, the cutting back in capacity across the country by 60 per cent, is something that is really quite an overwhelming statistic.

QUESTION: This apparently marks quite a low ebb then in the hospital systems in Australia. Historically, could you sort of think of another time when things were this bad?

CAPOLINGUA: I think things are this bad right now indeed because of the increasing population, the increasing demand, the increasing chronic disease and the increasing in ageing population. And also, you know the population is educated, they understand, the know when perhaps things aren't going as well as they should be.

And indeed, we have medical treatments available now that improve the morbidity and mortality of the Australian people and we should be able to deliver those services to our people.

QUESTION: What's the consequences of this report, when you look at patient care in New South Wales specifically, what does this mean?

CAPOLINGUA: We know that the doctors are worried about clinical compromise and clinical compromise is what jeopardises patient care. They want to be able to make decisions for their patients that they know are the best ones.

From the very beginning, if you have no capacity to admit a patient to a bed, you know you've got a problem. If you know that the theatres are closed and the patient waiting for elective surgery continues to have suffering and disability, then you've got a problem.

When you know that the emergency department is overloaded because there are no beds to admit people to, then you know that you're stretched as a doctor trying to cover those patient needs.

And in fact there's a very recent study showing that coronary risk and morbidity and mortalities increase in emergency departments when they're under great strain. So that people going in with heart conditions are more at risk when the emergency department's overloaded. So yes, we are worried about patient safety. Bed occupancy over 85 per cent is a danger zone as well.

QUESTION: Can you tell us, what's the distance between the best performing hospital in the state and the worst performing state, is that a large gap?

CAPOLINGUA: Again you will have a look at the report card and because there are variations and variabilities in each of the parameters that we measure, it's hard to put one right up there and say, this is - this is better than any of the others.

I have mentioned and will reiterate that the Victorian model of the local and regional boards runs more efficiently. However, Victoria itself is not satisfied. The Victorian AMA's certainly not satisfied with their public hospital sector and the cry for more money there to be able to continue that efficiency, they've reached max capacity as far as efficiency goes. That investment is required in Victoria.

QUESTION: So how much more needs to go in, are you willing to put a dollar figure on it?

CAPOLINGUA: We are calling for an extra three billion dollars in top-up funding in the Australian Health Care Agreement going forward. So that's in the first year. And then from then on every year, instead of an indexation of five per cent, we're looking for eight to nine per cent so that the increments will help to meet the demand.

QUESTION: Where does New South Wales sit amongst the other states, is it last, is it in the middle?

CAPOLINGUA: The report card shows varying aspects of the hospitals' efficiency and effectiveness and those aspects are being the emergency waits, the wait lists, the bed capacity, so over 85 per cent and you will see that New South Wales is variable on those, like the other states are. So we've got a problem across the board.

Certainly, Victoria seems to be working more efficiently than New South Wales, 30 per cent more efficiently than New South Wales. So New South Wales cannot be proud by any means of what it's doing in its public hospitals. It's got a lot of work to do.

QUESTION: What about some of the other states, can we ask about say about the ACT, Northern Territory, Western Australia how did they fare, what are their issues?

CAPOLINGUA: All of the states actually have very similar or the same issues. The emergency departments overloaded, ambulance ramping outside an overloaded emergency department, access block; in other words not enough beds for patients to be admitted.

Elective surgery waiting lists, drawn out because of cancellation of operating theatres, you know low activity days. There is actually capacity, some capacity in the hospitals already, if we reinvest in staffing and opening beds. So the problems are across the country. Each state has to accept responsibility for those.

QUESTION: Do you think the government's just hoping that more and more people will sign up to private health insurance and they won't have to take so much responsibility for it?

CAPOLINGUA: The private health insurance membership across the country is actually very important. We need to make sure that coalition and Labor commit to continuing the private health insurance rebate and investing in private health insurance.

If Australians left private health insurance and swamped the public sector, as has happened in the past, it would be an even greater disaster than what we have now.

QUESTION: At this point in the election campaign would the AMA be prepared to say which policy, coalition or Labor, would be better for public hospitals?

CAPOLINGUA: We had a debate between the prime minister and Kevin Rudd on Sunday night and I think you'll all recall very clearly that health barely got a mention. And yet we know that health is something that really has an impact on all Australians, each one of us in all sorts of ways.

So my question to the prime minister and to Kevin Rudd is, where are the policies on health. We need to know what they want to put on the table clearly to address all of these issues into the future. Are they frightened to put policies up. Are they frightened their policies won't stand up to scrutiny. So far I haven't seen anything that satisfies what the AMA is asking for.

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