TRANSCRIPT: Launch of AMA Public Hospital Report Card 2009

Wednesday 14 October 2009

E &0E

Speakers: AMA President, Dr Andrew Pesce; AMA Chairman of Council, Dr Roderick McRae; AMA Executive Councillor and AMA NT President, Dr Paul Bauert; AMA NSW President, Dr Brian Morton; AMA Executive Councillor and former AMA SA President, Dr Peter Ford; AMA Vice President and former AMA QLD President, Dr Steve Hambleton.

DR PESCE:    
Well, thanks for coming. Well, here we go again. This is the first time I'm delivering this report card as the AMA President. But every year the AMA President gets here, delivers the Public Hospital Report Card, and every year the message is the same: things are getting worse.

The governments aren't up to the task of improving the ability of our public hospitals to meet the demands. And our report card shows that once again things are slowly getting worse. Every year governments meet, they have their agreements, but every year things get worse.

Our report card shows objectively that slowly things are deteriorating. Access in emergency departments is worse. Waiting times for elective surgery are worse. On all measures, public hospitals are gradually getting worse.

And significantly, this report card covers the first six months of the Rudd Government's injection of funds into the public hospital system.

And the AMA asks, what's been the result? Where has that money gone? Why are things still getting worse?

We need to have accountability. The current funding for the public hospital system is dysfunctional to the point that extra funds don't deliver results.

A single funder for the public hospital system doesn't automatically solve problems, but it provides transparency and accountability and makes people accountable and responsible for the outcomes in our public hospitals.

So we need to reinforce the message. The AMA holds public hospitals to account and challenges them to provide access in emergency departments so that no more than 10 per cent of patients wait more than eight hours until they're admitted to hospitals.

This can only be delivered if we have an acceptance of an 85 per cent occupancy rate in our public hospital system, so that we've got some reserve to treat peaks in demand which are currently blocking up our emergency departments.

It really worries me that I have talked to heads of departments of health and they challenge the 85 per cent occupancy target, where by any yard stick that's the measure that everyone accepts is a suitable target to help us meet the needs of our communities.

So we have to get on there. Governments have to take responsibility. We have to get them to agree to these targets, and we have to see what their plans are in an open and transparent method to achieve these targets.

I'm happy to take questions.

QUESTION:    
What's the occupancy sitting around at the moment, if you want 85 per cent?

DR PESCE:
Well, it depends on state by state, but basically overall it's about 95. In some hospitals it's greater than 100 per cent. It's ridiculous.

QUESTION:    
Is anyone at 85?

DR PESCE:    
There is no state with 85 per cent occupancy.

QUESTION:    
No hospital?

DR PESCE:    
There are some hospitals in rural areas, because of less throughput, but overall we need to talk about the system capacity in general.

QUESTION:    
Is the AMA saying now that increased funding is no longer going to make a difference?

DR PESCE:    
No, that's not correct. What we need is increased funding, but we need accountability for where that funding goes. We need to have governments accountable to say these are the number of beds that we have got, we aim to increase them by this number, and that's where the funding is going.

QUESTION:    
Well, what responsibility do you take? I mean you represent 28,000 doctors across the country.

DR PESCE:    
Well, we're here to make sure that governments listen to us. And I'm afraid the governments don't listen to us enough.
And it's not just the AMA. I work in the public hospital system. There's lots of non-AMA doctors who have got strong messages for government. They've been excluded from planning. They've been excluded from decision-making.

QUESTION:    
Have you, has the AMA been excluded from planning and decision-making?
DR PESCE:    

The AMA isn't formally consulted, but we give our feedback all the time. So I don't think we're excluded. I think we're the only plausible voice for governments to listen to in the public domain. But every government needs to consult the hospitals and doctors working at the coalface as to what they should be doing.

QUESTION:    
What's the AMA's position now on a federal takeover of either public hospitals or community services?

DR PESCE:    
The Federal Government doesn't have a great track record in providing services, but we see great advantage in a single funder purchasing those services from the usual providers. And in the context of the health system in this country, that would be the state governments.

How that decision-making is made at a local level is very, very important. So if we have a single funder funding the services, and state governments providing hospital services, all doctors that I have spoken to are very, very concerned that no matter what happens we need to have local input into decision-making as to how those resources are allocated to allow hospitals to deliver the services.

So we need a rational funding model, we need a rational service provision model, but we need local consultation to make sure that the service provision reflects local needs.

QUESTION:    
Which state is doing best and the worst?

DR PESCE:    
There are different parameters. Most states are pretty much on par. If you look at the numbers, there are a few percentage points in one area or in another. One thing that I'm really, really worried about is the statistics don't always say everything.

And the doctors that I work with every day tell me that patients don't even get on waiting lists for elective surgery now until they've passed a certain bar of getting referred to the hospital outpatient clinic. And often that's where the wait is.

So we've got the irony of waiting lists for waiting lists, and it's really difficult to sort of compare states and jurisdictions on the basis of those statistics because they, quite frankly, are a little bit of a movable feast.

QUESTION:    
Is that something new that you've seen in this year's report?

DR PESCE:                                                                                                                                                                                It's something which is becoming more and more talked about by my colleagues as governments, I suppose, acknowledge the importance of these comparisons. And they do what they do best in meeting them, and that's often get the target right but not by providing the service that's meant to be provided.

QUESTION:    
So they're finding trickier ways to hide the real waiting lists? Is that a fair summary?

DR PESCE:    
Yeah. Yeah. Recognising the political importance of achieving waiting list targets, there are ways to restrict access of patients to get onto the waiting list in the first place. And doctors are talking to me about this all the time.

QUESTION:    
So is it that rate of hospitals operating at too full a capacity, is that what you say is the chief problem that is leading to these issues?

DR PESCE:    
It's a very fundamental problem. It's a problem in terms of access for services, but also putting the staff who work in the hospitals under enormous pressure when they are trying to provide safe care for patients.
When you're operating at 85 per cent capacity, you've got a bit more time to think about things. You've got time to schedule investigations. You've got time to perform the procedures that are necessary instead of always just running around trying to keep up.
Now, hospitals which are at 100 or 105 per cent capacity, there is really no fat in the system. The staff are operating with very little margin of error, and it's no wonder that from time to time systems fail and adverse outcomes occur.

QUESTION:    
But is it hard to argue that hospitals should treat less patients and that that would lead to an improvement in their services?

DR PESCE:    
No, we're not saying that they should treat less patients. They need to treat the patients that need to be treated. We need to think of more intelligent ways to treat them.
Part of our proposal to achieve the 85 per cent occupancy is to do a stocktake of the sub-acute beds. You've got to remember, a lot of the beds in our public hospitals - which are the appropriate places for the acute treatment - are being used to keep people under treatment because there's no other avenue for their sub-acute care as they recover from surgery or wait to get into aged care facilities.
And so if we were able to commit funds to sub-acute beds, we could then free up the existing resources within the public hospital system to focus on the acute patient care that they are designed to provide.

QUESTION:    
Are there any measures in this year's report card that indicate any improvement at all from last year's?

DR PESCE:    
There are a couple of percentage points improvements in some of the elective waiting list surgery times. But as I said, I'm a little bit sceptical as to the veracity of that because of the waiting lists for the waiting lists.

QUESTION:    
What are the hospitals that are running over 100 per cent capacity?

DR PESCE:    
Some of the major metropolitan hospitals routinely will run at over 100 per cent capacity. I'm not going to name them. They know who they are, the state departments of health know who they are, and it's not a good thing.

QUESTION:    
You mentioned that Rudd's increased funding hasn't helped the problem, but you've just mentioned in one of your suggested solutions that funding to a particular ward may assist. So what are your other suggestions?

DR PESCE:    
Well, I think we need to have the governments come together and agree how they're going to verify that the funding that they've been allocated has been reflected in increased capacity.
At the moment it's not clear, and at the moment we don't have an agreement on that. So what we need to say is - to our state departments of health - when you get extra funding from the Commonwealth Government, we want you to set the targets that we can verify. Have you met them or have you not met them? And that's what we need.

QUESTION:    
Some hospitals would probably argue that with swine flu it's put extra pressure on the health system this year. Is that fair?

DR PESCE:    
Yeah, look, there was a time where a lot of elective surgery was cancelled to allow capacity for hospitals to deal with the swine flu epidemic. I extend my admiration to the hospital staff who were able to sort of handle this very unusual and acute episode of care, and I think patients got really, really good care.
It, however, was reflected in a temporary down-scaling of our ability to deliver the more elective surgery, and that's obviously put us a little bit behind, and we need to catch up on that.
So swine flu had an impact. And it's one of those things that, you know, that's why we need 85 per cent capacity, because every now and then you will have swine flu or something else that you have to immediately respond to. And if the only response is by downgrading everything else you should be doing, well other people suffer.

QUESTION:    
There's a broader issue too. Like, we've got an ageing population. You said we need to have more, there's got to be more beds in say aged care instead of those people clogging up the hospitals. Is that basically…

DR PESCE:    
Yeah, there are many - it's not just aged care. There's rehabilitation care for people who are recovering from their illnesses that takes some time. We can't put them back home, but they don't really need to be in a hospital.
So intelligent investment in sub-acute care can free up the acute services that could help us look after the patients and get us meeting these targets of access for elective surgery and for acute care for the really sick patients.

QUESTION:    
Is this the worst report card the AMA has ever given to the public hospitals?

DR PESCE:    
It's incrementally a little bit worse. So we don't have to dramatise it and say that it's suddenly got a lot worse. But what we're seeing is, over time…

QUESTION:    
But it's getting worse if it's increasing…

DR PESCE:    
It is the worst, and over time things have gotten worse. Over time, the systems in place are gradually failing, and each year it's worse. And here we are again; we're just saying the same thing.

Now, Kevin Rudd correctly identified worries about the performance of public hospitals before his election. The AMA has supported the proposals to address these problems, and has continued to support Mr Rudd's proposal to go forward, consult within the hospital sector, and come to an agreement how it's going to be turned around.

Our report card and our response to the Hospitals and Health Reform Commission report give quite clear benchmarks that we would advise the government to aim for, and we would like to see them commit to an agreement from all of the states to pursue those goals.

QUESTION:    
Dr Pesce, are you going so far as to say hundreds of millions of dollars has been squandered? I mean we had this big health care agreement in January 2008. You had that blitz on elective surgery. What's happened? Are you saying that that's gone to waste, hundreds of millions of dollars?

DR PESCE:    
What I'm saying is that the extra resourcing hasn't reflected itself in an improvement in outcomes, and we have to ask why. And it just shows that throwing dollars at a problem doesn't always solve the problem. You need to have the structures in place to make sure that the extra resources are reflected in improved outcomes.

We don't see it just in health; we see it in other areas as well, like Indigenous health. It's not a new phenomenon. What we need to do is not just have governments throw dollars at problems, but put in place systems of transparency, accountability and planning to make sure that the goals that we're aiming for are achieved.

QUESTION:    
You've mentioned Rudd a lot today, but what about how the states manage it, and in particular NSW, which has had a pretty terrible run in the last 12 months?

DR PESCE:    
Yeah, look, each state has its own problems. My doctors from each state talk to me. There's problems in every state. There's no one who's happy with their public hospital system. I'm the federal President of the AMA, so I will tend to focus on federal issues. My state colleagues can talk about each state.

QUESTION:    
Doctor, could you introduce us to your colleagues, and maybe they can have something to say to flesh out the report as well.

DR PESCE:    
Sure, no problem. From the hospital system we have Dr Rod McRae, who is an anaesthetist from Victoria.

QUESTION:    
Okay, well we're hearing that this report is showing that elective waiting lists are continually manipulated. What's your experience?

DR MCRAE:    
Well, that is an accurate summary of what my experience is. All of the workers within the public hospital are working within the constraints afforded them. There's very good care provided within the public for those people fortunate enough to gain access to it.

Everybody has their own health status. One of the key things is - and the point related to the 85 per cent occupancy - that's really like 10 in the morning. So that if somebody presents with their unexpected emergency, they can be accommodated well with the adequate provision of health care facilities.

And so later in the afternoon, people who have the intention of elective surgery can have that occur. But if you have the public hospital sector absolutely 100 per cent occupied, there is no space. So if you have your emergency, then you have to reside in the emergency department. And that's not the adequate provision of the health care that the doctors of Australia wish to provide to the patients of Australia.

QUESTION:    
What are some of the incidents that you've had to deal with over the past year that have shocked you and are evidence that the system is in decline?

DR MCRAE:    
Well, there's just the general difficulty of hearing my colleagues expressing their anguish at meeting somebody who requires elective surgical care to prevent a subsequent emergency health care episode occur, that they're not able to get that person to receive their elective care in a timely manner to avoid a subsequent emergency.

And I hear it time and time again. So the other thing to bear in mind is the population of Australia is increasing. And yet the expectation is that all health care providers, particularly the medical practitioners of Australia, will provide more with either a true less infrastructure support or expecting to squeeze more out of what's there.

QUESTION:    
Are you having to squeeze more out?
DR MCRAE:    
Every medical practitioner is experiencing that.

QUESTION:    
Is it still satisfying being a doctor?

DR MCRAE:                                                                                                                                                                               It's tremendously satisfying being a doctor because those people that you have the opportunity to treat, you help, you assist them. That's why people enjoy medicine and actually put up with a lot of the otherwise very uncomfortable experiences. Once a person achieves access into the public health care system, they receive outstanding care. It couldn't be anywhere better in the world.

Our lament is that there isn't the resource or infrastructure available to provide in a timely fashion what everybody here would regard as what they would want for themselves, for all the people of Australia. We're just calling for more infrastructure to enable us to provide the very high level of care that could be provided.

QUESTION:    
Do you feel let down by the Rudd Government? Do you hold hope that they might be able to turn things around?

DR MCRAE:    
No. My interest is purely to practise medicine to the best of my ability. I think that's a political argument. We continue as an organisation to point out avenues where useful contributions could be made to a complex system.

QUESTION:    
Are you saying that people who have been bumped from elective surgery are presenting as emergencies later on?

DR MCRAE:    
That's the nature of any sort of illness or health care problem…

QUESTION:    
Can you give us an example of what type of illness?

DR MCRAE:    
It would just be a hypothetical, but if anybody here has a hernia down in the groin, you can say well, we can do an operation to help with that. But then if they can't get an elective support or management of their problem, then subsequently they may have a complication related to it. I mean that's just as a very crude example. But that's the sort of thing we're dealing with. It's probably time to have a chat about NSW.

DR PESCE:    
Could I introduce Dr Brian Morton, who is the AMA President of NSW.

QUESTION:    
Dr Morton, could you explain to us, there's a graph in the booklet here that shows quite a steep decline for 2007, 2008 and we suspect onwards. What happened there?

DR MORTON:    
NSW has failed the benchmarks in care, either in the emergency department access time. So the 30 minutes for an urgent patient to be seen, that's dropped by five per cent. For waiting times for elective surgery, it's also dropped.
The waiting time for elective surgery has increased by five days across the state. And we have people who are waiting for significant operations inconvenienced, in pain and waiting for that answer, is that breast lump cancer or not?

QUESTION:    
So if we've received increased funding, what do you think has actually occurred to produce these worse results?

DR MORTON:    
Recent reports from the NSW Auditor-General showed that NSW Health and the NSW Government dropped its own funding on receipt of funds from the Federal Government. The funds required for NSW should have increased by eight per cent to match inflation in health, and that has meant that health in NSW has not even kept standing in the same place.

QUESTION:    
Can we get a figure in real terms what that drop is?

DR MORTON:    
Four hundred and forty three million was given by the Rudd Government to NSW to ease the burden. The State Government reduced it by seven million. The State Government should have increased their funding by $1 billion to keep pace with inflation.

QUESTION:    
So the states have been stepping back while the Rudd Government is stepping forward. Is that right?

DR MORTON:    
There are lots of changes in the state budgets that need to be carefully looked at. It's not good enough for the states to operate by decreasing their fundings when they get a Federal Government handout.

QUESTION:    
Some doctors have, or some surgeons rather, have said that they won't even bother with elective surgery because the waiting lists are just so bad they can't even get their patients in. Is that what you've...?

DR MORTON:    
I think the elective is a misnomer. It usually sounds like it's a nose job or something simple like that. Elective surgery in public hospitals is categorised 30, 90, 365 day urgency. The Government is not providing sufficient funds and beds for those patients to access that degree of urgency.

They are not getting into hospital within their 30 days. They're not getting into hospital in 90 days to have the breast lump checked, the hernia repaired, their gall bladder removed. It's not about Botox or nose jobs.

QUESTION:    
Some people may have heard that, just the reference to hospitals operating at 100 per cent, they might think that's a good thing. Why is it not?

DR MORTON:    
We need to look at how hospitals can respond to emergencies, as discussed earlier with swine flu. We need our hospitals to operate at 85 per cent so that there is margin for emergencies, for epidemics, as has happened with the swine flu.

But we also need to be aware that hospitals that run above 85 per cent don't have the staffing to manage that increased level of extra pressure. And we need to make sure that our hospital staff, nurses, allied health doctors, are all operating at peak efficiency, at high quality.

QUESTION:    
Are any of Sydney's major medical hospitals ...  operating at 100 per cent a lot of the time?

DR MORTON:    
We understand from reports that come back from our surgeons and doctors in hospital that they're operating regularly at 95 per cent. Probably around the time of the swine flu it was around the 100 per cent mark. It goes up and down from week to week.

QUESTION:    
Is that all Sydney, all major metropolitan hospitals? Can we take for granted that not one of them is operating at a safe level in Sydney?

DR MORTON:    
The benchmark is 85 per cent. That's an international benchmark level for hospital occupancy. All our hospitals in NSW in the metropolitan area are operating above 85 per cent.

DR PESCE:    
We've talked a lot about the major hospitals in the major states. I'd like to introduce Dr Paul Bauert from the Northern Territory, who - there's always a bit of a different perspective from the smaller states and territories.

DR BAUERT:    
Well, there is a difference.

QUESTION:    
Can you spell your name and everything for us?

DR BAUERT:
I'm Paul Bauert, B-A-U-E-R-T, and I'm the Northern Territory AMA President as well as being on executive council for the Federal AMA. And I'm a paediatrician working at the Royal Darwin Hospital.

QUESTION:    
Have you seen things get gradually worse in Darwin?

DR BAUERT:
Yes, Darwin is peculiar in that we are twice as busy as any other public hospitals in other jurisdictions, and yet we don't have the staff that really reflects that degree of busyness. Secondly, 70 per cent of our inpatients are Indigenous people, often with significant co-morbidity, serious illness.

So on top of that, our figures, we're talking about 85 per cent occupancy. If we could get that. that would just be fantastic because we would have much better outcomes. But we're constantly working at 100, 105, sometimes in some wards it's up to 120 per cent occupancy, so people are in corridors.

Now, this is happening too frequently. And we know that whenever we get hospitals as busy as that it results in poor outcomes. It results in longer lengths of stay, more serious illness and even death - and this has been shown on evidence based studies around the country - so that our hospitals are becoming more dangerous.

What we really want to see is where these extra funds that we've been talking about are actually going and having an impact. And there's just not enough transparency.

And the further you get away from the bigger centres, the more it becomes obvious that the transparency between the Federal and the Territory Governments is just not there. So part of what we'd really like to see is much more transparency, much more accountability, and this will be reflected in better outcomes for our patients.

QUESTION:    
You've mentioned impact of the funds, but all of the figures relate to 07/08, so over a year ago. The Government would doubtless say you've only given them three or four months for their funding to have an effect. I mean they would surely come back and say well yes, look at the next set of figures; that's when you'll see a difference.

DR BAUERT:
I did a ward round yesterday in the paediatric department of the Royal Darwin Hospital, and I can tell you things aren't getting any better. They're no better yesterday than they were a year ago. And when I do a ward round tomorrow, when I get back from here, they won't be any better again.

So it's on the ground, it's where the patients are, that we're not seeing any benefit from those funds. We just need to see more transparency and see those funds get to the actual bedside.

QUESTION:    
Does a hospital like Darwin need to have a different funding model to incorporate more funds from Indigenous health?

DR BAUERT:
Yeah, I believe so. And there is already a loading, and the rest of Australia contributes very well to our disadvantage and our distance problems, and we're very grateful for that. But the problem is getting those funds to actually produce better outcomes.

There's too much administration, there's too much bureaucracy and there's too much blaming one another for the poor outcomes. We need, as we've mentioned, a single funder, transparency for those funds to get to the people that they're supposed to be meant for.

QUESTION:    
And you've mentioned patients in corridors. Can you just give us some more examples of what happens in a hospital that's operating above capacity?

DR BAUERT:    
Well, it's been shown in studies, both in Canberra and Perth, that if you do have access block - that is, people waiting to get into a hospital bed - you can end up with adverse outcomes, and in particular you can end up with death.

And patients are dying unnecessarily while they're waiting to get into beds. Being kept and managed on a bed in a corridor without the facilities that would be associated with a normal hospital bed, acute hospital bed, is dangerous.

QUESTION:    
Could you give us some examples? You're saying patients are dying unnecessarily. What have you seen in recent times?

DR BAUERT:
Well, look, I won't speak about specific issues. I mean this whole concept was argued by the bureaucracy in the territory about three or four years ago, saying that there had been no adverse outcomes. They were shown to be wrong and that's all history.

QUESTION:    
But it's still happening?

DR BAUERT:
It's still happening, and it will continue to happen while you have 100 per cent occupancy. Thank you.

DR PESCE:    
We also have Dr Peter Ford from South Australia, Past President of South Australia AMA, and he can talk about the South Australian perspective.

QUESTION:
Again, if you could just say and spell your name for me.

DR FORD:    
Yes, Peter Ford. I'm the immediate past President of the AMA in South Australia. F-O-R-D is the spelling.

QUESTION:    
And do you work in a hospital or...

DR FORD:    
No. I'm a general practitioner in an outer suburb of Adelaide.

QUESTION:    
As a feeder to the public hospital system, what are you seeing in terms of your patients and their ongoing care?

DR FORD:    
Well, we see the waiting time of people in pain. We have old people taking narcotics because they're waiting for joint replacements. They wait for two years at our local hospital to get an outpatient appointment.

They wait a further one to two years to have their procedure, whether that's a knee replacement, arthroscopy or whatever. Of course, there are waiting times for other services, medical services, paediatric services and so on. So the situation in South Australia is, quite frankly, unacceptable.

Again, we've seen $13.6 million delivered to South Australia for the emergency, for the urgent attention to the long term waiting list, that was provided by the Rudd government. But at the end of the day, while certainly there was some effect in that area, we still see these long waiting lists, congestion in emergency departments and so on.

QUESTION:    
You would see the management of a patient's problems actually multiply, the complexity of the problem multiplies while these people are waiting and on medication?

DR FORD:    
That's right. Narcotics are dangerous drugs. They have many side effects, and particularly in older people. We're seeing a considerable expansion of the use of narcotics in the community and we see the downside of that. So that predisposes people to confusion, to falls and many consequences of inappropriate care.

QUESTION:    
Are people dying waiting for a knee replacement?

DR FORD:    
There are, there would be people who would die before their knee replacement occurs.

QUESTION:    
Do you believe that there's an ongoing greater cost to the public health system caused by this wait? If these issues were treated earlier, the cost would be less?

DR FORD:    
Ultimately, that's the result. You know, if staff, nurses and doctors are operating under duress in emergency situations, we see people being managed in corridors. We won't talk about the lack of privacy that occurs in that situation.

But in some hospitals we see very innovative systems employed by staff to describe the location of patients. For example, in one hospital they use the location of the barouche they designated as CW. That means corridor against the wall versus corridor not against the wall.
There is a gold standard waiting area in one hospital. Those patients have access to an overhead television in the emergency department, and so on. So these are perhaps somewhat comical issues, but on the other hand, the people who are working there, and the patients who are experiencing that care, are really in a situation that's entirely unacceptable.

DR PESCE:    
Queensland? Steve Hambleton, the AMA vice President.

QUESTION:    
If you can spell your name too.

DR HAMBLETON:        
Steve Hambleton, H-A-M-B-L-E-T-O-N.

QUESTION:    
What's the state of things in Queensland?

DR HAMBLETON:    
Well, I'm a general practitioner in Queensland and my patients are waiting to get into hospitals as well. Queensland has made waiting lists for waiting lists an art form for years, and the other states are now copying.

We've got to end the blame game, get on with fixing the hospital system, and stop blaming each other, get the bed occupancies down. We suffer from the same problems in Queensland, overloaded hospitals.

QUESTION:    
If people just keep turning up in ambulances needing care, I mean how do you argue that less people should be admitted to hospitals?

DR HAMBLETON:    
Well, it's poor planning over a long period of time. We need to invest in extra beds. We've heard the President suggest we need step-down beds. There are people in hospital who shouldn't be there. We need to talk to the doctors in hospitals who understand how we can better manage. There's a disconnect between the clinicians working in hospitals and those making the decisions, and that's a big problem.

QUESTION:    
And what about this hidden waiting list thing? How cranky should taxpayers be that the Government are fiddling, I guess, to try and make us think that we've got a better health system than we do?

DR HAMBLETON:
Well, you just can't believe the figures, and you can't compare state to state because you don't get on the waiting list until you've actually seen the specialists and outpatients. The Forster Inquiry in Queensland four years ago discovered this, and it's simply not acceptable.

The patients can't have confidence in the figures they're seeing. That's why the AMA report card is the one they should look at, so we can get a real view of what's happening in our hospital system.

QUESTION:    
Sorry, we just heard examples there from the Northern Territory. Is it as bad as that in NSW where patients are in corridors and, you know, dying because of that access block to emergency departments?

DR MORTON:    
There will be issues where patients are left in hospital corridors awaiting assessment. Patients, no, look, I don't want to go there. I don't believe they…

QUESTION:    
That's all right if they're not. I'm just asking if it is that bad…

DR MORTON:    
Well, they probably will but...

QUESTION:    
...we could get there if we don't address the situation now. But at this stage we're doing better than Northern Territory? Is that true?

DR MORTON:    
I think everyone has to understand that all states failed benchmarks. We may be doing better than a state that failed worse than NSW did, but we are not achieving quality care, safe levels of hospital occupancy in NSW.

QUESTION:    
So, in terms of NSW health, it's definitely a big fail on this report card?

DR MORTON:    
I think the overall has to be said that NSW fails yet again to meet the benchmarks of quality care.

DR PESCE:    
I'd also like to clarify somethin thing about 85 per cent occupancy. Occupancy isn't just a bed; it's just not an empty bed if it's not occupied. We're talking about the staffing and diagnostic facilities and all the infrastructure required on a pro rata basis to deliver care.
So 85 per cent occupancy, we're not just fixating on the physical bed. We're talking about staffing, planning of services, assuming 85 per cent average occupancy. Probably every bed will probably be used every day. It's just as patients go in and out of the system. So 85 per cent occupancy is not just the number of beds. It's the level of services and infrastructure available in the hospitals to provide safe care.

QUESTION:    
So you're not saying that 15 per cent should be empty?

DR PESCE:    

No, no, we're not saying that at all.

ENDS