Transcript: Dr Hambleton, Doorstop, AMA Public Hospital Report Card 2011

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AMA Public Hospital Report Card 2011

STEVE HAMBLETON:  Yeah look thank you very much everyone for coming here this morning. We'd like to present to you the AMA public hospital report card. This is a report card that the AMA does every year to try and give us some idea of how our hospitals are performing.

Now with COAG and the federal government and the state governments arguing over the last couple of years about hospital funding, it's very important that we actually see that that funding actually gets delivered to the bedsides of the patients who need the care in our country.

And we know certainly that the financing deal has put the states fairly and squarely back in the driver's seat for healthcare, so it's their responsibility to make sure the funding gets to the patient where care can get done. And sadly our report card again has shown that there's been a deterioration in the amount of care being able to be delivered to our patients in this country.

There's three things we look at. We look at the number of beds, we look at the amount of waiting in emergency and category three, which is a good indication of pressure on the emergency departments, and we look at elective surgery median waiting times.

In each of these three parameters we're disappointed.

Yes, there's been extra beds. There's 378 extra beds around the country. But we're looking for something like 3800 extra beds. And certainly in the waiting times in emergency departments we're seeing a deterioration in that category three which means there's more pressure on those emergency departments.

And the timing we want to see in those category three is over 70 per cent according to COAG. So sadly, we're not making those times. For elective surgery, the median waiting time is 35 days. Thirty-five days is actually growing. It was 27 days not that long ago. So we do need to see state governments step up to the mark. And we want the accountability to say that the money has got to the front line, it is delivered, and it delivers services.

QUESTION:  So even though the funding drama's been sorted out, the situations getting worse and worse every year.

STEVE HAMBLETON: Well it's gradually getting worse and we do need to turn that around. There's significant new funds coming in to the health system, which is going to happen over the next couple of years, and we need to make sure that money makes it to the bedside.

So far we're actually slipping back, we're not going forward. We're not. We'd like to see new beds.

Queensland Hospitals

QUESTION:  How will Queensland hospitals fare compared to other states?

STEVE HAMBLETON: Well Queensland's interesting. The median waiting time for surgery in Queensland is quite good. It is growing. It's below the national average. One of the major concerns we have in Queensland is the hidden waiting list. Are we looking at real figures? We want to know how much time it takes between the time a doctor GP sees a patient, and that patient gets surgery.

We know the time between the specialist seeing the patient and the surgery being done beats the national average, but really what the patients want to know, what the GPs want to know is that hidden waiting list: we'd like to see that measured as well.

Hidden Waiting Lists

QUESTION:  Could you explain the hidden waiting list, what is that?

STEVE HAMBLETON: Well I'm a GP. My surgery is not far from here. When I refer a patient even to this hospital I get a letter back saying thank you for your letter. We'll let you know when the patient gets a booking.

You know, it can be six months before that patient actually gets a listing with a specialist. And that's when the waiting list that we're measuring is starting. After the doc… the patient's seen the specialist, not from the time when I've made the referral. That's a great disappointment.

Public Hospitals

QUESTION:  Are people dying because of the situation at public hospitals?

STEVE HAMBLETON: Well look, public hospitals are the engine room of our health system. If they don't operate we can't look after our patients properly. But - and certainly if people wait too long, their condition deteriorates, and certainly we can see people dying, waiting to get seen in our hospitals.

QUESTION:  The AMA's always had an argument about the need for extra beds, but over the course of the last decades or so we've seen a great improvement for each bed. That's what the government always says that they're getting more out of each bed.

How do you counter that argument?

STEVE HAMBLETON: Well actually the figures are very good, but they have levelled off. So the length of stay has actually come down which means we're being more efficient with our hospital services and so the number of people who get turned around very quickly is increasing.

Both of those graphs are in this report. And they're flattening out.

So we've got the efficiencies in that area about treating patients better. The real measure we need to look at is the number of beds for those patients over 65, but that's a good measure of our capacity to treat people who've got the chronic disease, who need our hospitals.

And certainly our figures for that are really going backwards very quickly. And I think there's 2.6 beds per thousand of the population, but we look over at the population over 65, it's significantly decreased.

Local Hospital Boards

QUESTION:  Will boards, local hospital boards make a difference to these sorts of figures?

STEVE HAMBLETON: Well look, what we've said to the federal government is we need to make sure that management is closer to the action, we need to make sure that management connects with the doctors on the front line.

And actually I've got a doctor who works in this hospital next to me, Dr Michael Bonning, who's the lead of the junior doctors round this country. And certainly he's in a position to give us some first hand reports. But we've got to make sure that when we do system redesign you engage doctors who work in the system, so management local to the hospital is going to be much more likely to be able to do that.

Doctor challenges

QUESTION:  So what are the challenges that doctors are facing?

MICHAEL BONNING: Certainly local clinician management is an issue at lots of hospitals. I work here and I just finished work this morning and what we find is that when decisions that affect patients at a management level are made by clinicians, we often get more resources going to those people that are on the front line.

So the nurses, the midwives, the doctors, all the allied health professionals who allow us to actually take care of patients, and that's what's important.

QUESTION:  How hard are you all working?

MICHAEL BONNING:        Look, I've spent a lot of time at this hospital and so do a lot of my colleagues. The way in which most of us are working is - I suppose it's reasonable but it's a lot of strain on a lot of people to get the work done and specifically to take care of patients in the way that we want to. So taking care of them in a prompt manner, in a timely fashion, and in a way that means that they've got dignity, that they've, you know, that they're being taken care of in a way that their families and they would expect.

QUESTION:  We just heard that it's not all bad though, that you're treating patients quicker and more efficiently.

MICHAEL BONNING: Certainly in my unit, the department of obstetrics, our average length of stay is going down and that people are being seen promptly. We've looked at lots of new innovations in the way in which you get people through our department and also making sure that they're taken care of in a way that means that especially when they're delivering that means that they're actually delivering well, delivering better, and that we're utilising the resources that we have better.

So that means after hours as well as in hours.

QUESTION:  And last month the ED here was overcrowded, I think it was around 13 per cent of the time. What kind of impact does that have on the staff?

MICHAEL BONNING: So the emergency department's just one part of the way this hospital works and when an emergency department is overcrowded, it's often a symptom of what's going on in the rest of the hospital.

This emergency department or any other is often limited by the way in which it can get patients up to wards, and do so in a responsible manner. If you're sending patients to wards too quickly, then you often end up with patients who are unstable, up on wards where there are h… where there are less doctors, where there are less nurses, and people aren't actually able to be looked after.

So lots of the time I would prefer to see a patient kept in the emergency department if they need to be.

And the way in which we should be looking at the whole system is to look at emergency length of stay and overcrowding and support that with more beds and more staff upstairs and in emergency departments to actually treat them appropriately - and then get them to wards.

Just saying that overcrowding is the only issue is - doesn't look at the whole problem and doesn't I suppose align with the fact that that can actually be helped and assisted by not just… we don't, when we talk about beds we don't just mean a bed in a ward. We mean a bed with staff, and with an appropriate staffing, at all hours, to make sure that patients are taken care of well.

QUESTION:  Michael, the problem in the past has always been the bed block. And a lot of it was because of aged care positions not being available so that we can transfer them out of the hospital, is that improving?

MICHAEL BONNING: Sure. It gets a bad profile probably whichever way I look, but that's all right. Aged care is certainly one of the things that we think needs to be improved to make sure that patients can actually get out of here. I know from my own experience that we do often have to use bed days in inappropriate fashions to make sure, to keep patients here where they can be looked after because they can't get into a nursing home - or into an aged care facility.

And that's not utilising an acute hospital bed in the way it should be utilised. It's for sick patients, not for patients who are just waiting to move into aged care, and transition into a place where they can live and I suppose enjoy themselves in their, often in their later days.

So…

QUESTION:  It's expensive too - a bed here, never a bed there.

MICHAEL BONNING: Much more expensive to keep a patient here and requires a lot more staffing, so tying up staff who are required by their duty of care to make sure that they're observing this patient, to make sure that they're doing things like ward rounds when in actual fact that patient is probably very stable, and could very easily make the transition if there was beds available out in the community.

Public Health

QUESTION:   Public health users are probably going to watch these stories tonight and panic. Can you offer them any assurances?

MICHAEL BONNING: This is the greatest place I've ever worked. It's a place where we can deliver some of the best care I've ever seen in the world, and I've had the privilege to work overseas, and certainly it's, places like this are run off not just bricks and mortar and beds, they're run because people love working there; and they are able to deliver excellent care - often in spite of some of the limitations that are placed on them.

People work hard. And they work hard because they care about the patients that are there. So it's a - I think Queensland's public hospitals are certainly… you know, the doctors and nursing staff and allied health staff are ready, willing and able to take care of everyone out there.

And no one should be worried about going to their local hospital.

Hospital bed occupancy rate

QUESTION:  Dr Hambleton, one of your prescriptions is for an 85 per cent occupancy rate of hospital beds. Surely that means that you have beds just sitting there idle, 15 per cent of beds sitting there doing nothing. That's certainly what health ministers have said of your idea in the past.

STEVE HAMBLETON: Well I'd certainly first of all reiterate the comments from my colleague Dr Bonning about the safety and the quality of the staff and the patients, the care that's occurring in Queensland hospitals. When you get into Queensland hospitals you're looked after very well. And we're talking about waiting times. We're talking about getting you in.

Now as - going back to bed occupancy, 85 per cent bed occupancy allows the hospital some flexibility. It allows surge capacity. You simply cannot run hospitals like a supermarket. You can't have just in time delivery. We actually have emergencies, we actually have flu epidemics. We need to be able to treat our elective surgery patients, we need to be able to teach and train, we need to be able to make sure that the doctors of tomorrow are as well trained as the doctors of yesterday.

So we do need downtime. We do need to use that for teaching and training, and that's a key thing for public hospitals. So to say that we should run them at 90 per cent plus occupancy doesn't work. And it certainly doesn't work with surge capacity, it doesn't work with teaching and training, it doesn't actually work with efficiency.

QUESTION:  But given that the health budget is now the most dominant part of the state budget, and those health costs are rising at an unsustainable rate, you're offering a solution that will cost more money.

STEVE HAMBLETON: Well certainly it will cost more money. We've actually got a first-world health system. We need to maintain that first-world health system.

The number of beds per thousand population is actually falling, so if we maintained that number of beds per thousand of population we'll have that capacity. It's really not a matter of government saying well what are we going to spend our money on - it's a matter of the people of Australia understanding the importance of health care, and the importance of having health systems that are healthy.

Healthy health systems equals healthy patients equals good outcomes.

QUESTION:  Given that these figures are now up to a year and a half old, do you think the trend has c… is there any anecdotal evidence or preliminary statistical evidence that these trends have continued?

STEVE HAMBLETON:Well look, the MyHospital…

STEVE HAMBLETON:       Oh look it's - the timing is appalling. I mean it just says something about the level of respect that the system has for the visiting medical officers and as I say they're often the engine room of teaching. We do rely on our permanent staff and we've got to make sure we support them but they need to work in partnership with the visiting medical officers.

 

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3 November 2011

 

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