Dr Hambleton, Public Hospital Report Card, Sydney
Transcript: AMA President Dr Steve Hambleton, AMA Vice President Professor Geoffrey Dobb, AMA QLD President Dr Alex Markwell, AMA NSW President Dr Brian Owler, AMA VIC President DR Stephen Parnis, AMA WA President Dr Richard Choong and AMA SA President Dr Peter Sharley
Subject: Public Hospital Report Card 2013
STEVE HAMBLETON: Ladies and gentlemen, we would like to welcome you here this morning. We're here to talk about something that's very important to every man, to every woman, to every child in this country, and to everybody that has taken a sick relative to an emergency department in the middle of the night, to everybody who has tried to attend a public hospital to get their elective surgery done. We're here to present the AMA Public Hospital Report Card to talk about the state of what's happening in our public hospitals around the country.
It's a unique report card. It's the only times series that look at the performance over time of our public hospitals to give us an idea of are we improving, are we staying the same, what's happening in our public hospital sector. Sadly, we are not seeing the improvements that we need. We are not seeing any increase in the number of beds. We are not seeing access to emergency departments the way we want. We're not seeing emergency - the elective surgery targets coming down as much as we want to.
When we measure against key capacity and performance indicators, the public hospital system is simply not meeting the clinical demands put upon it. And, of course, what's happening is we are seeing the governments blame each other. Now is not the time to blame one another. Now is the time to engage with the clinicians and actually do something about it. Today I am very fortunate to have with me my fellow presidents from around the country, my vice president, Geoffrey Dobb, who is an emergency medicine physician.
I have got Dr Alex Markwell for Queensland who is an emergency medicine physician. I have got Dr Steven Parnis from Victoria. I have got Dr Brian Owler from New South Wales, Dr Richard Choong from WA and Dr Peter Sharley from South Australia. Each of these people works in the system and can tell you exactly what's happening, the impact on patients in the system. And I will get each of them to tell you a little bit about their state.
We are seeing some improvements in some areas, but it's few and far between. What we need to make sure is that governments work together, they don't withdraw funding - they certainly don't withdraw funding retrospectively from health - to make sure we can get funding to the bed, to the doctor, to the nurse, to make sure we can deliver care in our public hospital sector.
So our report card highlights those issues and said now is the time to engage with clinicians. One of the big concerns we've got is that if we haven't got sufficient capacity in our hospitals, we won't have the capacity to teach and train the next generation of junior doctors. We know that last year we were talking about the number of doctors coming out of universities. They are in the system now. They deserve to be trained with the same quality that we were trained.
So we need to focus on solving the problem, not blaming each other. Thank you, ladies and gentlemen. We have got a number of statistics here which we might be able to present. The number of public hospital beds per capita, for example, has not changed, 2.6 beds per thousand population. And despite the increased investment, something like 10 per cent increase investment in funds, we have not seen an increase in the number of hospital beds.
If you look at the number of hospital beds per person over 65 - now, they're the ones that use the beds - that number continues to fall. So we need to focus on this area and make sure we get some outcomes. I'm happy to have questions, but I will pass to each of my state presidents in a moment to give you some individual stories about what's happening in their state.
QUESTION: On a national basis, are there any stats that are of particular concern?
STEVE HAMBLETON: Well, I guess, broadly they're all of concern. State governments have all agreed on the access targets for emergency and access targets for elective surgery. We're simply not meeting them. Category 3 patients, on average we are seeing only 66 per cent of those people being seen within the clinically appropriate time, and the target is 80 per cent. Now, the fact is when you're sitting in emergency with your mum, you want to make sure that we've got the capacity to see her, get her seen on time, have that chest pain sorted out, have that gall bladder operation or that gall bladder issue sorted.
QUESTION: Is that no doubt causing worse health outcomes in some circumstances than you would otherwise hope for?
STEVE HAMBLETON: Well, it certainly is. We have very strong data right here from Australia looking at what happens when you delay people getting out of emergency. If there's insufficient beds in the system, and we can't get people out of emergency, it does cause harm, and we do see unnecessary deaths that we do want to protect against.
QUESTION: Do you have data on how often that happens?
STEVE HAMBLETON: We certainly do, and there's data available to say that if we get this right, if we get people out of emergency, we can look after them properly. We can get the sick people into the hospital, into the system, when they need it. We can get emergency surgery done when we need it. That's why we need to drive capacity.
QUESTION: If there has already been an increase of 10 per cent from the Federal Government in funding, then what's the problem? Is it the administration? Where is that money going to?
STEVE HAMBLETON: Well, this is a good question, and we need to have clear answers for. We had seen an increase in funding. In the last 12 months, however, we have seen decreases in funding. We have seen adjusting of the funding rules to mean that they're withdrawing funding that was there in the past. We have also seen state governments cut budgets, and all of these are having serious impacts on our ability to actually get the job done and see our patients at the front line.
QUESTION: What sort of budget cuts have we seen around the country?
STEVE HAMBLETON: Well, we know there's pressure on each of the state governments. We know that - and I will probably get my state colleagues to actually talk about that in more detail. But we have seen a lot of state governments withdrawing funds, decreasing jobs, and it is really putting pressure on our ability to see patients appropriately at the front line. We have also seen the Federal Government do the same thing.
Now is not the time for any government to withdraw funds from the public hospital sector. Now, I might pass over to, perhaps, Queensland first. Alex Markwell.
ALEX MARKWELL: Thank you. This report card really highlights the issues that we see across the country, but particularly in Queensland. We're still struggling to meet our targets with patients in emergency departments waiting longer than they should be to be seen, and we're not yet reaching the targets that have been put in place with the national emergency access target. The other thing that is of concern is our access to elective surgery.
And although the figures presented today suggest that we are starting to improve, we still have a hidden waiting list that isn't discussed. We still have patients who wait many, many years. The majority of our elective surgery patients will wait well over the time that is clinically recommended before they are actually put on a surgical waitlist. So we have a hidden waiting list.
We also have a range of short-term decisions that will impact on the long-term outcome of our patients, and these include things such as cuts to nursing staff, doctors. We have got a loss of training capacity and a whole range of preventative health programs that have been cut which will ultimately affect the health of Queenslanders in the future.
QUESTION: Is it too early to see the impact of those cuts at the moment?
ALEX MARKWELL: We are starting to see positions such as nursing positions - nurses that would go out to residential aged care facilities and assist with catheter changes, for example, nurses that will look after children with cystic fibrosis up in Townsville who have been - have lost their positions. So that means that these children will actually have to fly to Brisbane more often. We are starting to see the impact of these cuts already.
BRIAN OWLER: Brian Owler, local state president, AMA New South Wales. Good morning, everyone, and thank you for coming along. I think it's actually timely to remember why we embarked on health reform in the first place. We embarked on health reform because of people out there in the community that don't have timely and equitable access to healthcare. It's people waiting on trolleys in the emergency department.
It's someone's grandmother with a fractured hip waiting on a trolley in an emergency department for 24 hours because there is no bed or theatre for her to have proper care. It's the breadwinner for a young family who can't work because they have agonising pain from a protruded disc. And it's someone's child who, for instance, has a need of a tonsillectomy and has obstructive sleep apnoea but can't get a tonsillectomy in a timely manner.
Those are the sorts of problems why health reform in our public hospital system is important. With regards to funding, it is - what we have seen with funding is that the blame game has been on peptides. What we have seen is governments put the finger at each other. And I think we're here to say that all governments, no matter their persuasion, are put on notice that the AMA is there to make sure that we look at the figures and we're the ones that are pointing to the figures and actually telling the public where the money is coming from and where the cuts are coming from to their healthcare.
Capacity in our public hospital system is very important for us to be able to reach the targets, both in elective surgery, but also for our emergency departments. It's not just about getting patients out of the emergency department more quickly. It's actually about getting them into a proper bed to get the most appropriate care. And we have seen that doing that, actually dealing with access block in our emergency department, improves patient care and patient outcomes.
And we have seen the data from WA which says when you achieve these targets, when you improve access block in the emergency department, you actually deliver better patient outcomes. But what we need to do that is both physical and workforce capacity in our public hospitals. So it means actually having more beds in our public hospitals for patients to go to, and it means making sure that we get training and teaching right for the future so that we can train the medical graduates coming through to be the GPs and specialists that provide care for our patients in the future.
Reform was not just about emergency departments and elective surgery. They're the headlines. Reform was always about whole of hospital reform. And what we've seen is reform to the governance, reform to the way that our hospital system is budgeted and administrated, but what we haven't seen is the reform filter through to the departments and the individual level. And that's really the next phase: it's making sure that the whole of the hospital health reform is instituted and that patients get better care.
As far as New South Wales is concerned, elective surgery targets are close to being met, but what we've seen is the median waiting time going up. So we've seen the targets being - or the waiting times being pushed out towards the maximum capacity within each of the three categories. And sooner or later, that is going to cause a problem, because the waiting times are going to be at the very edge. And this comes back, of course, to capacity.
In terms of our emergency departments, the figures have been disappointing. What we've seen is our emergency access target remaining static despite hundreds of millions of dollars being put in for capital and infrastructure. So what we need to see is that reform now filter through to the rest of the hospital system. That's where the change is going to occur, and this is not the time for governments to withdraw funding. This is the time when we should renew our efforts on public hospital reform to make we get better outcomes for the patients. Thank you.
QUESTION: How would you say the New South Wales Government has performed on the issue of funding?
BRIAN OWLER: Well, what we've seen in New South Wales is the labour expenses cap being instituted, and that has been $775 that has come out of state budgets over the next four years. We have also got $2.2 billion worth of efficiency savings. There's no what is the next generation of clinicians likely to miss out on that this current generation of clinicians has?
STEVE HAMBLETON: Well, it's a very, very important point that we cannot afford to lose one more senior doctor out of the health system, and we hear that there's senior doctors being offered redundancies in our health system in various states. We've got a surge of young people coming through - men and women who have trained in medicine - who - we need to give them an opportunity to be taught and trained.
If our elective surgery numbers go down, their exposure to patients goes down. If the emergency departments are clogged up with people that can't into hospital, they're not getting the clinical exposure. So it has a multiplier effect. If we can fix the problem, get people out of emergency, we can train the next generation; we have more doctors to see the population of our country. Thank you very much, ladies and gentlemen. Each of the state presidents is available if you want to talk to them individually about their state, and I appreciate you coming here this morning. Thank you very much.
15 February 2013
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