SEPP Organization Blog

Hospital Crisis - Australian ABC 13 November 2009 15:30 http://www.abc.net.au/unleashed/stories/s2738218.htm
Brian Morton Australia Broadcasting Company Correspondent

The public debate about waiting lists for elective surgery has become a discussion about numbers - rather than a discussion about people.

The way we discuss hospital waiting lists has sterilised the debate and anaesthetised us to the human reality of what those lists represent.

Elective surgery is not about just botox, nose jobs or breast implants. It’s about amputations, angioplasty and skin grafts. It’s about hip replacements, mastectomies, cataract surgery and gall bladder removals.

Patients waiting for these operations are described as being in Category 1, 2 or 3. We measure their waiting times in weeks. Put in these numeric terms, a Category 3 patient waiting over 52 weeks for surgery, sounds harmless enough. But waiting to have a gall bladder removed, for example, is a painful business. It’s not only painful for the patient, it causes stress and anxiety for the patient’s family, and may keep the patient out of the workforce for an extended period of time.

This is the human cost of public hospital waiting lists, and why waiting lists matter. It’s why we should be concerned about the failure of our hospitals to manage the growth in demand for surgery.

In common usage, ‘elective’ implies that someone has a choice. But in a medical sense, elective surgery is defined as surgery that, in the opinion of a specialist, is necessary and admission for which can be delayed for at least 24 hours. Too many patients are waiting too long to have these operations.

Consider the record of New South Wales hospitals in dealing with cases of semi-urgent (Category 2) surgery. This represents over one third people on hospital waiting lists.

The Australian Medical Association’s Public Hospital Report Card 2009, released last week, reported that 75 per cent of patients are being treated within the recommended timeframe. Or put another way, one in four patients are not being treated within the recommended three months.

The official waiting list figures are also misleading, as they do not recognise the time people spend waiting to get into outpatient clinics in the first place. In this sense, there is another hidden waiting list - just to get onto the official waiting list.

Despite promises from both Australian Federal and State Governments, the waiting list problem is not going away.

At the beginning of 2008 the Federal Minister for Health announced a ‘blitz’ on public hospital waiting lists, involving a funding injection of $150 million to conduct 25,000 procedures nationally.

Nevertheless, waiting lists have remained long and waiting times have not significantly improved. The AMA has argued that at least 90 per cent of patients should be seen within the recommended time frames for surgery. Even this target means that we still have patients waiting for an entire year for the surgery they need.

Achieving it will require a concerted effort from State and Federal Government to tackle underlying structural problems in the hospital system - not just one-off ‘blitzes’.

The Public Hospital Report Card 2009 found that bed occupancy rates in Sydney, for example, hover around 90 per cent, and often get up to dangerous levels of 95 per cent or higher. Having access to more beds is important - but these beds must also be adequately staffed.

Last year the AMA conducted a national survey of junior doctors in public hospitals. Fifty four per cent of the doctors surveyed found their workload to be excessive, and 41 per cent believed this workload compromised patient safety.

There is only so far we can stretch the rubber band. Investment is desperately needed in staff recruitment, retention and training. The bad news is that demand for surgery in public hospitals is going to keep growing. Our ageing population will result in more hospital admissions, and a more complex case mix for hospital professionals to deal with.

That means the improvements that have been made in hospital productivity over the past decade, with patients spending less time in hospital before being discharged, will be harder to maintain.

No one denies that reforming the health system is complex, but changes need to be made now - not delayed by the endless cycle of policy reviews and inquiries. The human costs of public hospital waiting lists cannot be ignored any longer.

COMMENTS From Australia on this Australian Hospital System problem:

·         Barnaby Rudge :

14 Nov 2009 9:21:18pmThe hospital system is itself paralysed by being run by labor goverments overseen by a labor government. Rudd is a pathological Field Marshall doling out money that he gets from mining, but cluless in the machinations of managing Australia with his neolabor socialism.

Maybe he is hoping that there are some more doctors on the passenger manifesto of the asylum cruisers.

Socialism is not in the least what it pretends to be. It is not the pioneer of a better and finer world, but the spoiler of what thousands of years of civilization have created. It does not build, it destroys. For destruction is the essence of it. It produces nothing, it only consumes what the social order based on private ownership in the means of production has created.

MISES, LUDWIG VON, on Socialism

Robert Heilbroner opined after the fall of the Soviet Union, that “It turns out, of course, that Mises was right” about the impossibility of socialism. “Capitalism has been as unmistakable a success as socialism has been a failure. Here is the part that’s hard to swallow. It has been the Friedmans, Hayeks, and von Miseses who have maintained that capitalism would flourish and that socialism would develop incurable ailments.

Australia faces a bleak future in this modern competitive world with our current leadership.

·         maxwell :

14 Nov 2009 10:24:07amThis equation is true - less doctors = less surgery performed. Less general practitioners = less patient consults, less patients diagnosed, less patients having surgery performed. So if there is a current hospital bed and patients requiring surgery problem it is because there are high doctor per patient ratio’s and poorer government funding. Sorry for saying this cliche but “it’s not rocket science”! It is, however, economics and the government knows this. It is also true of any profession - when you constantly criticise a worker and cap or reduce their income you will have problems attracting more workers to that field. It is a truth that doctors are media bashed on a regular basis and that medicare has been reduced and that it hasn’t grown in line with the economy over the past 20 years. So YES doctors and not just GP’s have been undervalued, devalued and placed under constant scrutiny and criticism to the extent that THIS NECESSARY PROFESSION IS NOW LESS ATTRACTIVE TO THOSE WHO WOULD HAVE ACTUALLY PERFORMED VERY WELL IN THE ROLE. The governments are to blame and society also for allowing the governments to let the health system and it’s doctors become so devalued, downgraded and under facilitated. PROBLEM - YES IT’S A HUGE PROBLEM! It will not be fixed by decreasing salaries, decreasing medicare or decreasing hospital funding.

·         wizard :

14 Nov 2009 10:13:32amThe only thing more corrupt than the political system, which elects KRudd on the promise to reform the medical system and then does zip, is the medical system, which happily takes money from medicare and then fails to deliver proper services. Specialists are at the top of the food chain, and patients come a very poor last in the food chain. 

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