Transcript - AMA Vice President on public hospital crisis

Outlet: ABC Radio National,
Friday 15 October 2021
Subject:   Public Hospitals in Cycle of Crisis
Host: Sally Sara

SALLY SARA:    The Victorian Government is forging ahead with plans to ease COVID restrictions next week. That's despite case numbers hitting a new national high yesterday. The Premier Daniel Andrews says yesterday's shock case number of 2297 won't affect the state's reopening map. It comes as newer analysis released by the Australian Medical Association paints a really dire picture of the ability of the hospital system to cope when restrictions are eased. Dr Chris Moy is a GP and the Vice President of the AMA. Dr Moy, welcome back to RN Breakfast.

SALLY SARA:    The Victorian Government is forging ahead with plans to ease COVID restrictions next week. That's despite case numbers hitting a new national high yesterday. The Premier Daniel Andrews says yesterday's shock case number of 2297 won't affect the state's reopening map. It comes as newer analysis released by the Australian Medical Association paints a really dire picture of the ability of the hospital system to cope when restrictions are eased. Dr Chris Moy is a GP and the Vice President of the AMA. Dr Moy, welcome back to RN Breakfast.

CHRIS MOY:    Good morning.

SALLY SARA:    This research that's been put together by the AMA, what are the numbers that worry you the most? The, kind of, picture it paints about the stresses on the health system?

CHRIS MOY:    So, essentially, this report called the Public Hospital Cycle of Crisis uses, in fact, the Government data. So it lays really bare in really hard numbers what I see every day as a GP not being able to get care for my patients, but also what the patients see, which is essentially being ramped up in front of an emergency department, having taken too long to be seen in an emergency department, taking too long to be taken up to a ward because there's no bed, and also having to wait for surgery, for elective surgery. And basically, it says that the whole system is choked up. And that was even without COVID and walking into now. Now, what it really shows is that there's a really frightening picture of where the projections are going now and what is going to happen from here. But also, then, that COVID now is on top of this. It's the poison cherry on top which is really going to collapse the whole thing because it's unsustainable in terms of the number of beds and number of doctors and nurses that are there. Now, just to give you some couple of figures. The sort of figures that are out there is that, essentially, the emergency department presentations - and admissions - are going to essentially double in the next about nine years or so. And so what's going to happen then is they're going to be the majority of people ending up in beds in hospital.

    Now, you might think that seems okay. No, no. The hospitals don't look just after COVID and don't look after just things from emergency. They look after other care, like surgery- other surgery, elective surgery, cancer care, care for other people and what happens then is that those coming from emergency departments are going to take over the majority. I think the one that really is scary then is that, because of that, care is going to be displaced. You're not going to be to get that elective surgery or the other surgery treatment you need, or it's going to be delayed. And the figures for what we call unmet demand, (that means that the care that somebody needs but isn't getting at the moment) it's running at about four per cent, which is not great. So that means four per cent of people can't get the care they need. That's about 300,000 admissions a year. That's going to increase to something like about 14 per cent by 2030. So that means that about 1.4 million people, admissions, are not going to happen - unable to happen - even though they're needed. On the government figures - patients can't get the care they need.
    Now, to give you an idea, that's actually more than the entire amount of annual elective surgery that happens in the year. So I think that gives you a stark reminder that, essentially, you've got about a one in six, one in seven chance of not getting the care you need from the public hospital system. And the question is: Is that reasonable for a first world country which prides itself on the health system, which has done such a great job during COVID?

SALLY SARA:    What about in the here and now, Chris, with the COVID restrictions being lifted in New South Wales, they're about to lift in Victoria, what's the immediate picture about whether the health system will be able to cope when there is an expected increase in cases?

CHRIS MOY:    So, look, at the moment, as I said, these are the figures now. So that's where we are now and projected without COVID. The scary bit is that COVID's going to add another layer to this. And now, there are different ranges based on part from figures, for example, from the Doherty ranging right up to- ranging right up to the figures that are occurring in the UK itself.
    So, in terms of the UK, the UK's real life numbers are different. So we've given numbers, for example, the emergency department presentations may increase from somewhere between about point six to four per cent extra - so about a 124,000 extra admissions year from emergency departments. And in terms of intensive care, this could increase from somewhere between about seven per cent to up to 47 per cent on the worst case scenarios, in terms of patient days per year, in terms of care. So there’s an incredible extra layer of extra care that's going to be required, which is, again, going to displace more of the care that's required by people for other things.

SALLY SARA:    Victoria is looking at its roadmap for opening up. Do you think the hospital system will be able to cope? 

CHRIS MOY:    Well, we're hearing on the ground, fortunately, there's a little bit of stabilisation in the last few days, but that's in the context of good vaccination rates and the lockdown. So the AMA’s position - and it sits with the New South Wales situation as well - is we have to ask them to really watch the situation with the hospital's at the moment. And as you're taking off the levers, you have to see what happens. And if it starts to really go up there, that's the thing you need to do. You need to look at the constraints. We've just told you that how tight it is now, to push it up, to open up any further, and to put pressure on the hospital system will not only mean inability to cope with COVID, but the inability to cope with other things as well. So it is extremely on edge at the moment. And what we'd say is, we take, for example, in Victoria, we'd say to the Premier, go back - what he said was that you need, in terms of relaxing things, don't just go by the vaccination rate. Look at what your health system is doing at the moment and how it's actually coping.

SALLY SARA:    Let's look briefly now at the issue of vaccination. While the overall numbers are looking really promising now, what kind of concerns do you have about some of the local government areas, and especially the regional areas, that are not keeping up at the moment?

CHRIS MOY:    Look, the concern is always the fact that it's the unvaccinated that are going to suffer. And there's significant regional variations in terms of geography, but there's also variation in terms of different cultural groups, and even within local health districts, there's differences. And so the issue then is that we need to consider, in those health districts, the impact on those groups, and also whether the particular health system, particularly, for example, in the country or rural areas, whether that health system can cope with an increase in the number of cases. And particularly in rural areas, they have much, much more limited capacity to scale up, especially, for example, if the health system itself gets affected, and, for example, the doctors and nurses get infected and the health system is knocked out. So this is really important, not just to be looking at the overall number, but also looking at where the weakest spot is because that's where the biggest problems are going to occur.

SALLY SARA:    Chris Moy, we've had the Royal Australian College of General Practitioners talking about some GPs having to actually throw out hundreds of expired vaccine doses. Is that your experience with your members as well? What are you hearing? 

CHRIS MOY:    Look, unfortunately, there has been to some degree, and that's got to do particularly with the AstraZeneca. vaccine, but also a little bit of Pfizer which we've heard from Queensland. So there is some concern about that. And it's a sad bit that that's occurred. I think there's been a completely disproportionate fear of AstraZeneca, which may actually turn out to be as good if not a slightly better vaccine than some of the others in the longer term. So because they hit the re-use by dates, there is the potential loss of vaccine due to the use by dates and that's a really terrible thing given the fact that we really still don't have quite enough people vaccinated at the moment. 

SALLY SARA:    When do you think is going to be crunch time, nationally, with these existing problems with pressure on the health system and opening up, perhaps pouring many more cases into the system?

CHRIS MOY:    Well, I think the report that we've put out says that we're already at crisis without COVID essentially, and that it will really go into crunch time in the next little bit. And it's not just the short term, it's actually into the longer term as well because COVID is with us and there will still be a- some proportion of individuals who are going to need COVID care. And that's being seen in the UK, because clearly vaccinations have an effect on the number of people getting really sick and dying and so that's the great advertisement, but it's going to have some people going to get sick and it's just an extra layer on the health system, which is already unsustainable now but in projections even without COVID, unsustainable in the future.

SALLY SARA:    Chris Moy, thanks for joining us again on Breakfast, we really appreciate it.

CHRIS MOY:    It's a pleasure.

SALLY SARA:    That's Dr Chris Moy, a GP and also the Vice President of the Australian Medical Association.