Australia’s Public Hospitals Seem to be Descending into Chaos!

It has been a bad news day for Australian Public Hospitals this Sunday (23/09/2007).

First we had:

http://www.theage.com.au/news/national/chaos-rules-hospitals/2007/09/22/1189881836970.html

Chaos rules hospitals: doctor

Jason Dowling
September 23, 2007

THE shamefully chaotic state of Melbourne's hospital emergency departments is jeopardising patient safety, compromising doctors' mental health and leaving health-care agencies exposed to negligence law suits, a whistleblower alleges.

Even the death of a patient in an overcrowded, under-staffed emergency department was not enough to prompt a phone call from senior management, despite a registrar's pleas for help.

In an explosive and astonishing attack on the state of emergency care in Victoria, Dr Andrew Buck, of the Monash Medical Centre, claims staff are "taking short cuts and compromising patient safety to meet unrealistic, arbitrary benchmarks" linked to a funding carrot.

In a letter to the state's top health officials — leaked to The Sunday Age — Dr Buck, a senior emergency registrar at Southern Health, says despite Monash Medical Centre buckling under record numbers of patients during the recent flu and gastro outbreaks, no extra staff were put on to help manage the crisis.

…. (see URL above for the whole article).

Then we had:

http://www.news.com.au/story/0,23599,22466363-2,00.html

Hospital keeping patients in old storage rooms

By Andrew Chesterton

September 23, 2007 12:00am

ONE of Sydney's busiest hospitals is so under-resourced that patients are being squeezed into storage rooms for treatment.

Nurses at the Royal North Shore Hospital at St Leonard's report critical understaffing and that 100 positions for registered nurses and midwives are vacant.

The hospital has launched "treatment rooms'' to relieve the burden on emergency beds.

But the new rooms are little more than a hospital bed stuffed into an old storage room.

Frustrated nurses are threatening industrial action. They could call an emergency union meeting as early as this week, claiming they are being pushed too hard to pick up the slack. "It's a shambles," said one highly placed nurse, who did not wish to be identified.

"There is barely enough room to walk around the beds, let alone treat people properly."

The nurse said her colleagues were working up to 19 hours overtime every week to fill the gaps left by the vacant positions.

"We are worked off our feet," she said.

"We have to do so much overtime to meet targets."

The nurse said her colleagues were seriously considering industrial action to improve their working conditions.

Ambulance officers, speaking through the Health Services Union, confirmed that patients were being treated in inadequate rooms with little room to move.

…. (see URL above for the whole article).

And last we had:

http://www.news.com.au/heraldsun/story/0,21985,22465163-2862,00.html

Doctors call on Brumby to fix hospital

Article from: Sunday Herald Sun

Chris Tinkler

September 23, 2007 12:00am

A KEY Melbourne hospital has been labelled "the killing fields" at a high-level meeting of doctors.

The damning indictment on the health system is revealed in a letter from a leading doctor to Premier John Brumby, obtained by the Sunday Herald Sun.

In the letter Dr Peter Lazzari reveals how Maroondah Hospital has become known as "the killing fields", as it is forced to rely on under-trained doctors to manage life-and-death cases.

Dr Lazzari, chairman of the medical staff at Angliss Hospital, wrote to the Premier demanding action.

In the letter, he says: "All the chairs of medical staff of Victoria's major public hospitals at the August meeting at AMA House were appalled to hear the Maroondah representative speak gravely of his hospital's reputation among doctors on rotation as the "killing fields".

Opposition health spokesman Helen Shardey said: "If we have doctors making these sorts of claims, the Government can no longer turn a blind eye."

…. (see URL above for the whole article).

As someone who worked in public hospitals for almost 15 years as everything from a raw intern to a Intensive Care Specialist and Director of Emergency Medicine (at Royal North Shore Hospital (RNSH) even) I simply don’t recognise what is being described.

On occasions one could be very, very busy and on occasions space was tight but what is talked of here makes one think the plot is very much lost and that without drastic action many people will come to serious harm.

A characteristic of all three articles is not senior staff saying we are really struggling and urgently need help – but rather saying “oh look it a bit tight but basically all is OK”. This state of denial and cowering to the Health Department and Ministers seems now to be the routine. I can’t remember the last time an Area CEO or equivalent went public to say we need more and better resources and we need it now! Certainly wasn’t in the recent past!

Are things as bad as painted? Well if my friends who still work at RNSH are to be believed they are – and this makes me very sad indeed.

I blame six key things for the present situation:

1. The forced application on public health services of so called “efficiency dividends”. This is managerial “crap-speak” from the top of the Health Department saying we want you to do more work than last year (in terms of patients treated etc) but we are going to reduce your budget to do this by 1.5% every year. (Clearly there comes a point where the wheels come off – and this fiction of sustainability has been now in place for almost 20 years! No wonder morale is -1000%)

2. The lack of recognition of the need to have the health system behave as an integrated whole where all care is delivered in the appropriate setting at the appropriate setting at the appropriate cost. (i.e. acute expensive high intensity beds are not occupied by patients who need an aged care bed and GP is affordably available to patients are not forced into hospital emergency departments and so on)

3. The failure of Health Sector management to recognise that with an aging population and more complex technology there would be an inevitable rise in the demand for hospital beds and that the trends of the 80’s in closing acute hospital beds was not sustainable.

4. The lack of strategic investment in Health Information Technology throughout the entire public hospital sector which has left these complex organisations unable to manage themselves anywhere near as well as is actually possible – both clinically and administratively.

5. Despite the rhetoric the inability of the overall health system to raise its proportional investment in the preventive areas of health – leading to later higher expenses and resource consumption.

6. Real mismanagement of the Health Sector Workforce issues with unwise cutbacks in training of doctors and nurses coupled with a lack of preparedness to make clinical roles much more flexible and capability based (driven largely by the medical lobby which wants to preserve an unsustainable sinecure in my view).

In a sentence I really think political leadership and senior health sector management has got the hospitals into a huge mess – and really should take a good hard look at themselves – and not be blaming those who are toiling away in the trenches. I fear, however, not much will change until the public starts to throw out governments who underperform in this area!

If these six key areas were addressed – things could be much, much better all over and my former colleagues would not be retiring at a very rapid rate – simply to preserve their sanity.

David.